Background. In the last few years topical corticosteroids have been frequently reported as causing allergic contact dermatitis. More than 50 types of corticosteroides can cause this problem. Budesonide is a synthetic steroid, obtained in 1979. In Italy it has been on the market as Bidien® cream, ointment and lotion since 1989. Cases of allergic contact dermatitis have been observed since 1980, while in Italy the first case was described in 1991. Case report. A 26-year-old housewife who had no history for allergic reactions or atopy, was treated with Bidien® ointment for a week, because she presented an erythemato-papular dermatitis on her right hand. The eruption resolved in a few days. After fifteen days the skin lesions reappeared. Therefore the patient applied again Bidien® ointment, but the lesions had progressively and visibly worsened. The patient was treated with oral corticosteroids and the lesions improved in a week. Subsequently patch test with the GIRDCA standard series and Bidien® ointment were performed. They showed a positive reaction (++) only for the topical steroid. We further patch tested the patient with the pure ingredients of Bidien® ointment and with other commercial topical steroids. The test resulted positive (++) only for budesonide. Discussion. Clinical diagnosis of allergic contact dermatitis due to corticosteroids is not always very easy. If a dermatitis does not improve after topical corticosteroids treatment, a steroid contact hypersensitivity should be suspected. Patch test should confirm the clinical finding, but there are still much discussions about the patch testing conditions for corticosteroids. Standard patch test with corticosteroids does not exist and false positive and negative reactions are possible. In the present case clinical diagnosis has been confirmed by the positivity of patch test with the commercial product and with budesonide 0.025% petrolatum. Cross reactions are often observed in patients affected with allergic contact dermatitis to budesonide. In our patient there were not cross reactions or concomitant sensibilization with other topical corticosteroids.

Dermatite allergica da contatto da budesonide

STINCO, Giuseppe;
1993-01-01

Abstract

Background. In the last few years topical corticosteroids have been frequently reported as causing allergic contact dermatitis. More than 50 types of corticosteroides can cause this problem. Budesonide is a synthetic steroid, obtained in 1979. In Italy it has been on the market as Bidien® cream, ointment and lotion since 1989. Cases of allergic contact dermatitis have been observed since 1980, while in Italy the first case was described in 1991. Case report. A 26-year-old housewife who had no history for allergic reactions or atopy, was treated with Bidien® ointment for a week, because she presented an erythemato-papular dermatitis on her right hand. The eruption resolved in a few days. After fifteen days the skin lesions reappeared. Therefore the patient applied again Bidien® ointment, but the lesions had progressively and visibly worsened. The patient was treated with oral corticosteroids and the lesions improved in a week. Subsequently patch test with the GIRDCA standard series and Bidien® ointment were performed. They showed a positive reaction (++) only for the topical steroid. We further patch tested the patient with the pure ingredients of Bidien® ointment and with other commercial topical steroids. The test resulted positive (++) only for budesonide. Discussion. Clinical diagnosis of allergic contact dermatitis due to corticosteroids is not always very easy. If a dermatitis does not improve after topical corticosteroids treatment, a steroid contact hypersensitivity should be suspected. Patch test should confirm the clinical finding, but there are still much discussions about the patch testing conditions for corticosteroids. Standard patch test with corticosteroids does not exist and false positive and negative reactions are possible. In the present case clinical diagnosis has been confirmed by the positivity of patch test with the commercial product and with budesonide 0.025% petrolatum. Cross reactions are often observed in patients affected with allergic contact dermatitis to budesonide. In our patient there were not cross reactions or concomitant sensibilization with other topical corticosteroids.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11390/670211
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