Patch Test Reactions to Corticosteroids: Retrospective Analysis from the North American Contact Dermatitis Group 2007-2014

Melanie D. Pratt, Asfandyar Mufti, Jennifer Lipson, Erin M. Warshaw, Howard I. Maibach, James S. Taylor, Denis Sasseville, Joel G. Dekoven, Matthew J. Zirwas, Anthony F. Fransway, C. G.Toby Mathias, Kathryn A. Zug, Vincent A. DeLeo, Joseph F. Fowler, James G. Marks, Frances J. Storrs, Donald V. Belsito

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Introduction: Corticosteroids may cause delayed hypersensitivity. On the basis of structure, the following 4 groups of corticosteroids are recognized: A, B, C, and D (subdivided into D1 and D2). More recently, a newer classification system subdivides corticosteroids into groups 1, 2, and 3. Cross-reactions are unpredictable. The objective of this study was to describe positive patch test and co-reaction patterns to corticosteroids. Methods and Results: A retrospective analysis of 17,978 patients patch tested by the North American Contact Dermatitis Group between 2007 and 2014 was performed. Corticosteroids tested during this period included the following: tixocortol-21-pivalate 1.0% petroleum (pet), budesonide 0.1% pet, triamcinolone acetonide 1.0% pet, desoximetasone 1.0% pet, clobetasol-17-propionate 1.0% pet, and hydrocortisone-17-butyrate (HC-17-B) 1.0% (pet and alcohol). Overall, 4.12% (n = 741) of patients had 1 or more positive reactions to corticosteroids. Tixocortol-21-pivalate positivity was the most common (2.26%), followed by budesonide (0.87%), HC-17-B (0.43%), clobetasol-17-proprionate (0.32%), and desoximetasone (0.16%). Reaction strength was strong (++ or +++) in almost twice as many tixocortol and budesonide reactions (>64%) as compared with the other 3 corticosteroids (<34.5%). Of the patients with positive corticosteroid reactions (n = 741), most (70.7%) had sensitivity to only 1 corticosteroid. Co-reactivity was highest between desoximetasone and budesonide. Conclusions: Sensitivity to corticosteroids is important. Consistent with other studies, the highest frequency of corticosteroid positivity was seen in group A (tixocortol-21-pivalate), followed by group B (budesonide) and D2 (HC-17-B). Co-reactivity varied; more studies are needed to fully understand structural cross-reactivity.

Original languageEnglish (US)
Pages (from-to)58-63
Number of pages6
Issue number1
StatePublished - Jan 1 2017

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Dermatology


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