Corticosteroid classes: a quick reference guide including patch test substances and cross-reactivity.

I n the 2004 Burden of Skin Disease study conducted by the American Academy of Dermatology Association and the Society for Investigative Dermatology, approximately 90.6 million Americans were reported to be affected by psoriasis, atopic dermatitis, and allergic contact dermatitis. Importantly, the leading therapeutic modality for these dermatitides isunquestionably topical corticosteroids. Although allergic contact dermatitis to topically applied corticosteroids was first reported in 1959, corticosteroid allergy has only been a widely recognized entity for the past 17 years. In their patch test results for 2001 and 2002, the North American Contact Dermatitis Group reported a 3% incidence rate in positive reactions to tixocortol-21-pivalate (up from 2.7% the year before), a 1.1% incidence rate for budesonide, and a 0.5% incidence rate for hydrocortisone-17-butyrate. In fact, this family of allergens has become so prevalent that the North American Contact Dermatitis Group added triamcinolone acetonide and clobetasol-17-propionate to the 2003 standard series. With broad and vast utilization, it stands to reason that corticosteroids became recognized as the American Contact Dermatitis Society’s 2005 allergen of the year. The anti-inflammatory nature of corticosteroids makes the diagnosis of