The Impact of Corticosteroid Allergy

The key to treatment of corticosteroid allergy, especially delayed-type reactions to topical corticosteroids, is in recognizing it as a possible diagnosis. Corticosteroids are among the most important anti-inflammatory agents in a physician’s therapeutic armamentarium; these medications are the cornerstone of treatment for most dermatoses and may be overlooked as the culprit in cases of refractory dermatitis. Clues to possible corticosteroid allergy include persistence or worsening of dermatitis with the use of an appropriate agent or a change in the clinical pattern of disease. Patients may neglect to mention use of over-the-counter topical corticosteroid use; the possibility of corticosteroid contact allergy is more likely in those with chronic dermatoses such as atopic or stasis dermatitis. Once suspected, corticosteroid allergy can be confirmed by a repeat open application test (ROAT) with the suspect medicament agent in addition to standard patch testing. Patch testing techniques that may improve diagnostic accuracy include testing to agents from all classes, performing a late (7–10-day) reading, and considering “rim reactions” as likely relevant. Once the patient’s allergy is known, the clinician can choose a safe alternative. To minimize the risk of inducing corticosteroid allergy, physicians should consider prescribing agents that are less allergenic, e.g., those in classes C or D1, especially for patients with chronic skin disease.

Duke Scholars

Author Christopher Robert Stamey Dermatology