STEROIDS, CORTICOSTEROIDS: Allergen or Not An Allergen?

Allergen (or, several are)

In what is a particularly cruel irony, many of the steroids used to calm extreme itching and inflammation may cause them. Corticosteroids were the American Contact Dermatitis Society‘s “allergen of the year” in 2005. Specifically on the published allergen lists are: Budesonide, Clobetasol-17-propionate, Hydrocortisone-17-butyrate, Desoximethasone, Triancinolone, and Tixocortol-21-pivalate.

Steroids can be extremely important and necessary to quickly calm the inflammation of severe reactions. However, steroids are not meant for long-term use. Continued use can cause several problems, including:

  • A decrease in efficacy over time (which can unfortunately cause some people to use them even more, out of desperation for the same clarity they once achieved);
  • Thinning of the skin (leading to heightened sensitivity to ever more ingredients);
  • Steroidal acne;
  • Rebound phenomenon — when finally taken off of steroids after consistent use, patients may experience a flare-up that can be even more severe than their worst episode prior to steroids (some severe cases require hospitalization); and
  • Long-term steroid use has a high incidence of debilitating and sometimes fatal conditions like Cushing’s disease.

Far less dangerous and more effective in the long run: limit your steroid use to severe emergencies, and only use a steroid with your doctors prescription and specific instructions. Instead, ask your dermatologist for a patch test to help you practice more accurate prevention. Even chronic contact dermatitis, atopic dermatitis and other inflammatory conditions can be managed very well by consistent and accurate prevention and barrier care alone…enough so that you may only need a topical steroid once or twice a year.

For more…

Main References: 

Regularly published reports on the most common allergens by the North American Contact Dermatitis Group and European Surveillance System on Contact Allergies (based on over 28,000 patch test results, combined), plus other studies. Remember, we are all individuals — just because an ingredient is not on the most common allergen lists does not mean you cannot be sensitive to it, or that it will not become an allergen. These references, being based on so many patch test results, are a good basis but it is always best to get a patch test yourself.

1. Wetter, DA et al. Results of patch testing to personal care product allergens in a standard series and a supplemental cosmetic series: An analysis of 945 patients from the Mayo Clinic Contact Dermatitis Group, 2000-2007. J Am Acad Dermatol. 2010 Nov;63(5):789-98.

2. Verallo-Rowell VM. The validated hypoallergenic cosmetics rating system: its 30-year evolution and effect on the prevalence of cosmetic reactions. Dermatitis 2011 Apr; 22(2):80-97

3. Ruby Pawankar et al. World Health Organization. White Book on Allergy 2011-2012 Executive Summary.

4. Misery L et al. Sensitive skin in the American population: prevalence, clinical data, and role of the dermatologist. Int J Dermatol. 2011 Aug;50(8):961-7.

5. Warshaw EM1, Maibach HI, Taylor JS, Sasseville D, DeKoven JG, Zirwas MJ, Fransway AF, Mathias CG, Zug KA, DeLeo VA, Fowler JF Jr, Marks JG, Pratt MD, Storrs FJ, Belsito DV. North American contact dermatitis group patch test results: 2011-2012.Dermatitis. 2015 Jan-Feb;26(1):49-59.

6. Warshaw, E et al. Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004. J AmAcadDermatol 2009;60:23-38. 

7. Foliaki S et al. Antibiotic use in infancy and symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old: International Study of Asthma and Allergies in Childhood Phase III. J Allergy Clin Immunol. 2009 Nov;124(5):982-9.

8. Kei EF et al. Role of the gut microbiota in defining human health. Expert Rev Anti Infect Ther. 2010 Apr; 8(4): 435–454.

9. Thavagnanam S et al. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy. 2008;38(4):629–633.

Want more great information on contact dermatitis? Check out the American Contact Dermatitis SocietyDermnet New Zealand, and your country’s contact dermatitis association.

DrVR LVB 8rDF Bertotto8106e 5May2014 20191023 e1704713881138

Laura is our “dew”-good CEO at VMV Hypoallergenics and eldest daughter of VMV’s founding dermatologist-dermatopathologist. She has two children, Madison and Gavin, and works at VMV with her sister CC and husband Juan Pablo (Madison and Gavin frequently volunteer their “usage testing” services). In addition to saving the world’s skin, Laura is passionate about health, inclusion, cultural theory, human rights, happiness, and spreading (like a VMV cream!) goodness!



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