Patch Testing for Corticosteroid Allergy in the United States

Abstract

A COMPELLING CASE has been made for patch testing patients for corticosteroid allergy. In a study of 2073 patients screened for contact dermatitis, 2.9% to 4.8% were found to be allergic to one or more corticosteroids.¹ Burden and Beck found 5.1% of their patch test patients in Manchester, England, were corticosteroid-sensitive.² The work presented in this issue of the Archives³ argues convincingly for patch testing with budesonide and tixocortol to identify most of these individuals. Unfortunately, neither agent is currently available on a routine basis for patch testing in the United States. What then can a conscientious and well-read dermatologist do to ensure an accurate diagnosis for a patient's care? Actually, several issues are involved in answering this question: what steroid would be an appropriate screening test (other than budesonide and tixocortol); what vehicle and concentration would be appropriate; and what is the role of intradermal testing?