D2.48 - When Treatment Becomes the Cause: Allergic Contact Dermatitis to Topical Corticosteroids

Topical corticosteroids are widely used in the management of contact dermatitis because of their ability to inhibit immune-mediated hypersensitivity reactions. However, paradoxically, these agents may induce true delayed-type allergic hypersensitivity reactions. 

Objectives: To describe the sociodemographic and occupational characteristics of patients with cutaneous allergy to topical corticosteroids.

This was a retrospective descriptive study including all patients diagnosed with cutaneous allergy to topical corticosteroids based on patch testing using the European Standard Series. Patients were recruited at the Dermato-Allergology Unit of the Department of Occupational Medicine and Occupational Diseases at Farhat Hached University Hospital in Sousse over a 10-year period, from January 1, 2010, to December 31, 2020.

A total of 26 cases of sensitization to topical corticosteroids were identified, representing 1.46% of all patch tests performed during the study period. Patients’ ages ranged from 6 to 65 years, with a mean age of 41.19 ± 13.71 years. A male predominance was observed (17 men vs. 9 women). Most patients (n = 16) were professionally active, with a mean occupational seniority of 13.5 ± 9.68 years. Pruritus was the predominant functional symptom, reported in nearly all patients (96%). Skin lesions were mainly located on the hands (63%). The most frequently observed clinical presentations were erythematous–vesicular and erythematous–squamous lesions, accounting for 51.9% and 33.3% of cases, respectively. The mean duration of lesion progression ranged from 1 to 28 years. Sensitization to budesonide was identified in 11 cases, whereas the remaining 15 patients were sensitized to tixocortol pivalate. Positive patch test reactions were considered clinically relevant in 13 cases. Co-sensitization to other allergens was observed in 19 patients, while only 7 cases were exclusively sensitized to topical corticosteroids.

Topical corticosteroids are often regarded as “miracle drugs” because of their potent anti-inflammatory effects. However, beyond their well-known adverse effects such as skin atrophy and striae, they are also capable of inducing allergic contact dermatitis. Although relatively uncommon, corticosteroid allergy should not be overlooked.