Corticosteroids contact dermatitis

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Erythema, inflammation, pain, and itching caused by contact dermatitis can be effectively treated with topically applied corticosteroids. With such a wide range of products and potencies available, an appropriate steroid selection is based on severity and location of the lesions. Table 62-6 shows a list of topical steroids and their potencies. Higher-potency preparations are used in areas where penetration is poor, such as on the elbows and knees. Lower-potency products should be reserved for areas of higher penetration, such as on the face, axillae, and groin. Low-potency steroids are also recommended for the treatment of infants and children.32,33... 

Pruritus Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses Contact dermatitis, atopic dermatitis, nummular eczema, stasis eczema, asteatotic eczema, lichen planus, lichen simplex chronicus, insect and arthropod bite reactions, first- and second-degree localized burns, and sunburns. 

After treatment, use topical corticosteroids to decrease contact dermatitis, antihistamines for pruritus pruritus may continue for 4-6 wk... 

Schmutz JL. Unusual clinical presentation in a case of contact dermatitis due to corticosteroids diagnosed by ROAT. Contact Dermatitis 2001 44(2) 105-6. 

Marcos C, Allegue F, Luna I, Gonzalez R. An unusual case of allergic contact dermatitis from corticosteroids. Contact Dermatitis 1999 41(4) 237-8. 

Lauerma AI. Occupational contact sensitization to corticosteroids. Contact Dermatitis 1998 39(6) 328-9. 

Dooms-Goossens A. Allergy to inhaled corticosteroids a review. Am J Contact Dermatitis 1995 6 1-3. 

Isaksson M, Bruze M, Hornblad Y, Svenonius E, Wihl JA. Contact allergy to corticosteroids in asthma/rhinitis patients. Contact Dermatitis 1999 40(6) 327-8. 

Bennett ML, Fountain JM, McCarty MA, Sherertz EF. Contact allergy to corticosteroids in patients using inhaled or intranasal corticosteroids for allergic rhinitis or asthma. Am J Contact Dermat 2001 12(4) 193-6. 

Whitmore SE. Delayed systemic allergic reactions to corticosteroids. Contact Dermatitis 1995 32(4) 193-8. 

Corticosteroids have a range of activity. They have potent antiinflammatory and immunosuppressive activity. Many synthetic drugs are available as corticosteroids. In appropriate doses, these are used as replacement therapy in adrenal insufficiency. The topical application of corticosteroids is safer when compared with systemic use. Corticosteroids should be used in smaller doses for the shortest duration of time. A high dose may be used for life-threatening syndromes or diseases. A tapering pattern of withdrawal should be followed to avoid complications of sudden withdrawal. Systemic therapy is indicated in a variety of conditions. These are administered by intraarticular injections with aseptic conditions for rheumatoid arthritis and osteoarthritis. In skin diseases, such as eczema, contact dermatitis, and psoriasis, corticosteroids are used topically. In some cases, steroids are combined with antimicrobial substances such as neomycin. 

Allergic contact dermatitis may occur in the presence of treatment with topical corticosteroids. 

Irritant or allergic contact dermatitis is eczematous and is often caused by antimicrobials, local anaesthetics, topical antihistamines, and increasingly commonly by topical corticosteroids. It is often due to the vehicle in which the active drug is applied, particularly a cream. 

Dooms-Goossens A, Andersen KE, Brandao FM, Bruynzeel D, Burrows D, Camarasa J, Ducombs G, Frosch P, Hannuksela M, Lachapelle JM, Lahti A, Menne T, Wahlberg JE, Wilkinson JD. Corticosteroid contact allergy an EECDRG multicentre study. Contact Dermatitis 1996 35(l) 40-4. 

Erythema is inevitable after a phenol peel (Figure 37.18). ft can sometimes be less severe and of a shorter duration if a corticosteroid is injected intravenously at the beginning of the peel. Its intensity varies from patient to patient, from light and imperceptible to severe and deep. Resorcinol is a potentially allergenic phenol derivative persistent, pruritic erythema after a resorcinol peel might be a sign of contact dermatitis. 

Topical testosterone patches may cause contact dermatitis, which responds well to topical corticosteroids. 

Several cases of allergic hypersensitivity reactions including anaphylactic reactions, urticaria, and contact dermatitis to various corticosteroid preparations have been reported (Alani and Alani 1972 Gutzwiller 1974 Kounis 1976 Tegner 1976 and references cited therein), but the immunochemical mechanisms involved have apparently not been studied as yet. 

Alani MD, Alani SD (1972) Allergic contact dermatitis to corticosteroids. Ann Allergy 30 181-185... 

Alani SD, Alani MD (1976 b) Allergic contact dermatitis and conjunctivitis to corticosteroids. Contact Dermatitis 2 301-304... 

Comaish S (1969) A case of hypersensitivity to corticosteroid. Br J Dermatol 81 919-925 Conant M, Maibach HI (1974) Allergic contact dermatitis due to neutral red. Arch Dermatol 109 735... 

Coskey RJ (1971) Contact dermatitis due to nystatin (letter). Arch Dermatol 103 228 Coskey RJ (1978 a) Contact dermatitis due to multiple corticosteroid creams. Arch Dermatol 114 115-117... 

Maibach HI, Conant M (1977) Contact urticaria to a corticosteroid cream polysorbate 60. Contact Dermatitis 3 350-351... 

Tegner E (1976) Contact allergy to corticosteroids. Int J Dermatol 15 530-523 Thompson G, Maibach HI, Epstein J (1977) Allergic contact dermatitis from sunscreen preparations complicating photodermatitis. Arch Dermatol 113 1252-1253 Thormann J, Kaaber K (1978) Contact sensitivity to phenylbutazone ointment (butazolidine). Contact Dermatitis 4 235-236 Thormann J, Wildenhoff KE (1980) Contact allergy to idoxuridine. Contact Dermatitis 6 170-191... 

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