Amcinonide

Background: Contact allergy (CA) to topical corticosteroids (CS) is relatively rare; however, current data from Germany are not available. Furthermore, valid risk assessment needs to take into account of the actual exposure to CS in the population.Patients and Methods: The reaction profile of 9 CS included in a “CS test battery” of the German Contact Dermatitis Research Group (DKG) in patients seen in German clinics belonging to the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org) between 01/1995 and 12/2004 was analyzed. Applying the “Clinical Epidemiology/Drug Utilization Research” approach, annual incidences of CA to CS in Germany were extrapolated. These estimates were used as numerator for a relative incidence (RI) estimate which used exposure in terms of “defined daily doses” (DDD) to the respective CS as denominator, the latter information collected by the AOK Research Institute (WIdO).Results: On average, 7.4% of all patients were patch tested with the CS series, mostly yielding < 1% positive reactions. Exceptions included hydrocortisone 17‐butyrate (1.5%), amcinonide (1.6%) and budesonide (2.6%). With a RI of 10.7, 23.6 and 4.9 per 100 000 DDD, respectively, the three CS mentioned classify as moderate topical drug allergens. Clobetasol 17‐propionate and triamcinolone acetonide both yielded a RI of 1.4/100 000 DDD, indicating low sensitization risk. For hydrocortisone, betamethasone, prednisolone and dexamethasone (RI < 1/100 000 DDD) the risk of sensitization appears minute.Conclusions: The results support and extend previous evidence on the CA risk of CS, adding to a therapeutic index and risk assessment.

Estimation of the population‐based relative incidence (RI) of contact sensitization to a set of topical drug allergens (cases/100 000 defined daily doses (DDDs) per year) (1995–2004) and comparison of the RI for drugs with a similar therapeutic scope.

Clinical data regarding the frequency of contact sensitization to important topical drug allergens in Germany were obtained from the Information Network of Departments of Dermatology (IVDK). This was extrapolated to the general population level using the ‘clinical epidemiology and drug utilization research’ (CE‐DUR) approach. As denominator of exposure, national prescription data (DDDs of topical drug specialties) provided by the WIdO Research Institute (Bonn) were aggregated per substance.

The probable RIs of contact sensitization to topical ‘skin’ corticosteroids ranged from 0.3 (dexamethasone phosphate disodium salt) to 23.3 (amcinonide) cases/100 000 DDDs per year. Concerning topical aminoglycoside antibiotics, the RI of framycetin sulphate was about threefold higher than that of gentamicin sulphate. Regarding topical ophthalmic use, the RI of kanamycin sulphate was higher compared to gentamicin sulphate. Active principles marketed over‐the‐counter (OTC) had, in general, lower RIs, with the exception of bufexamac, benzocaine, clioquinol and phenylephrine.

The population‐based risk assessment—quantitatively considering exposure in the RI estimation—revealed a ranking of contact sensitization risk to topical drugs which partly differed from the respective frequencies in the clinical patch test population. Some drugs available OTC carry non‐negligible risk, too. The current findings should contribute to differential therapeutic considerations regarding topical drug use. Copyright © 2008 John Wiley & Sons, Ltd.