Hydrocortisone pivalate

A 58-year-old woman, who had been involved in the manufacturing of glucocorticoid creams and ointments for over 10 years, developed occupational contact sensitization to topical glucocorticoids (472). Patch tests were positive to hydrocortisone, hydrocortisone butyrate, and tixocortol pivalate. Intradermal tests were positive to hydrocortisone succinate, methylpredniso-lone, and prednisolone. An oral challenge with betamethasone 0.75 mg, 2.5 mg, and 8 mg on three consecutive days resulted in no adverse reactions. 

Tixocortol pivalate is a marker for glucocorticoid contact allergy, as a positive patch test suggests established contact allergy to hydrocortisone, prednisolone, and their derivatives (95). A literature search via Medline from 1966 to May 2000 revealed only one patient hypersensitive to tixocortol pivalate and budesonide in a pilot study in 34 patients (10 with asthma, 13 with rhinitis, 11 with both) (96). From case reports, the prevalence of glucocorticoid-induced contact allergy has been estimated at 2.9-5%. 

Hydrocortisone Acetate Fluocortolone Pivalate Norethisterone Acetate... 

Hydrocortisone Acetate 58 Fluocortolone Pivalate Nandrolone Decanoate... 

A woman had received intralesional paramethasone and other topical glucocorticoids several times for alopecia between the ages of 7 and 18 years (381). When she was 30 she was again treated with intralesional paramethasone for a relapse of alopecia. She developed pruritus after the first intralesional injection and erythema, edema, and vesicles 6-8 hours later. A biopsy showed spongiform lymphocytic folliculitis with spongiosis and exocytosis in the sweat gland ducts and in the pilosebaceous unit. She was treated with triamcinolone cream and her skin lesions resolved. Patch tests were positive for paramethasone, with cross-reactivity to tixocortol pivalate, hydrocortisone, and hydrocortisone butyrate. 

Branching of the esterifying acid, such as in flumethasone pivalate (trimethyl acetate) may, because of steric hindrance, slow down the rate of hydrolysis, thereby increasing effectiveness. Fluocinolone acetonide (Table 14-1) incorporates all these desirable features. Its topical potency is exemplified by its 0.01% concentration in commercial products (compared with hydrocortisone, 1%). 

Type IV reactions to CSs are mainly diagnosed by patch testing. Tixocortol pivalate, budesonide, and hydrocortisone 17-buyrate are the principal drugs employed for testing. An evaluation of the... 

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