An overview of the efficacy of topical corticosteroids in experimental human nickel contact dermatitis

Abstract

We review controlled trials of corticosteroid effect in experimentally elicited acute nickel contact dermatitis in man, in the hope of clarifying optimal efficacy for clinical use. To maximize discrimination and objectivity, we focus on data with 1 well-characterized allergen, nickel, in studies utilizing bioengineering documentation. Higher potency corticosteroids are effective (unlike in experimental irritant contact dermatitis), but optimum schedules still require definition.Key words: allergic contact dermatitis; corticosteroids; man; colorimetry; echography; laser Doppler flowmetry; transepidermal water loss; bioengineering methods; nickel. C Munksgaard, 2000. Accepted for publication 24 May 2000Allergic contact dermatitis (ACD) is an inflammatory disease for which topical corticosteroid therapy is widely utilized. Corticosteroids inhibit antigen-specific activation and proliferation of lymphocytes although their exact mechanism of action remains unclear (1, 2). We review studies that utilized bioengineering techniques to evaluate the efficacy of topical corticosteroid in human experimental nickel contact dermatitis, in the hope that these highly controlled experiments might provide insight into optimum therapy.Application of allergen in sensitized patients elicits a standardized allergic contact dermatitis. Bioengineering instrumentation, such as laser Doppler flowmetry (LDF), colorimetry and echography, is useful in quantifying the skin's allergic response. LDF evaluates the intensity of the inflammatory reaction (3). Colorimetry assesses the blanching effect of corticosteroids (4). Echography evaluates edema and inflammation (5). OverviewDe Lacharriere et al. studied the effects of clobetasol propionate 0.05%, hydrocortisone 1% and an emulsion control on experimentally elicited nickel ACD in 10 nickel-allergic patients (6). ACD was elicited by 2-day (D) patch test application of 5% NiSO 4 to the upper back. 1D following removal of nickel patches, the corticosteroids were occlusively applied for 6 h, evaluation of their efficacy occurring upon corticosteroid patch removal and again 18 h later. The corticosteroids produced a significant decrease in LDF (as well as an increase in transcutaneous pressure of oxygen) when compared to involved skin. As this was an abstract only, we do not know if they could distinguish between the compounds; this abstract also did not include the mass per unit area of corticosteroid applied.Queille-Roussel et al. (7) investigated the efficacy of clobetasol propionate 0.05% cream, hydrocortisone 1% cream and a cream vehicle on ACD,elicited by a 2-D patch application of 5% NiSO 4 on the lower back of 12 nickel-sensitive volunteers. Open application of 26 mg/cm 2 of corticosteroids 2¿ daily for 4D (D 3-6) and 1¿ on the morning of D7 followed nickel patch removal. The effect of corticosteroids was evaluated on the evening of D7. Clobetasol propionate 0.05% cream significantly decreased LDF, colorimetry and visual score values, when compared with untreated skin

Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications

“…When triggers cannot be identified/avoided or there is residual dermatitis after triggers have been removed, TCS [25,26] or TCIs [27,28,29] may reduce inflammation; however, chronic use of TCS should be avoided, especially on the face and diaper area. Long term and frequent (greater than once daily) application of TCS (especially higher potency preparations) is contraindicated, due to an increased risk of skin barrier compromise and systemic exposure.…”

Signal transducer and activator of transcription 1 decoy oligodeoxynucleotide suppression of contact hypersensitivity

“…Topical corticosteroids, which are widely used in the therapy of ACD, exert their anti-inflammatory effects mainly through inhibition of the transcription factors activator protein 1 (AP-1) and nuclear factor kB (NF-kB). 9 However, long-term treatment with these drugs might lead to skin atrophy, 10 and it was such drawbacks that spurred the search for alternative treatment modalities.…”

Single doses of local betamethasone do not suppress allergic patch test reactions to nickel sulfate

“…Contrasting to studies on corticosteroid pretreatment prior to patch testing, there are several studies of repetitive topical application of corticosteroids on already‐formed nickel patch test reactions. These studies show that at least potent corticosteroids suppress the reactions when used repeatedly (10–12). The reason why we saw no effect in this study may be that we used single doses of corticosteroids.…”