tixocortol-pivalate and hydrocortisone-acetate

Tixocortol pivalate is an established marker to topical corticosteroid allergy. The prevalence of tixocortol pivalate hypersensitivity is well established in Europe, where exposure to this corticosteroid as a therapeutic agent varies. In the United States, tixocortol pivalate is not commercially available and the prevalence of hypersensitivity to it is unknown.. We investigated the prevalence of tixocortol pivalate hypersensitivity in our patch-tested population. We further characterized these patients by clinical background, other contact allergens, and the reactivity to other corticosteroids.. Tixocortol pivalate has been incorporated in our standard 1-52 patch test series since November 1992. We reviewed the histories and patch test results in all patients tested with the standard 1-52 series from November 1992 to December 1996.. Of 1536 patch-tested patients, 45 had hypersensitivity to tixocortol pivalate. Dermatitis involving the face was the most common (14 patients). Of the 45 patients, 40 had another allergen identified on patch testing. Eighteen patients underwent further patch testing to an extended corticosteroid panel, and 14 had sensitivity to another steroid agent.. The 2.9% prevalence of tixocortol pivalate hypersensitivity in our patch test population is within the range reported in Europe. Patients with tixocortol pivalate hypersensitivity tend to have other contact allergens on patch testing. Predisposing factors to tixocortol pivalate hypersensitivity include facial dermatitis and sensitivity to other contact allergens.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Allergens; Anti-Allergic Agents; Anti-Bacterial Agents; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Europe; Facial Dermatoses; Female; Humans; Hydrocortisone; Male; Middle Aged; Minnesota; Neomycin; Patch Tests; Prevalence; Risk Factors; Triamcinolone

Topics: Administration, Topical; Anti-Inflammatory Agents; Dermatitis, Contact; Humans; Hydrocortisone; Injections, Intradermal; Patch Tests; Prospective Studies

Affinity for the dexamethasone binding sites of tixocortol pivalate, (the ester of the 21 thiol derivatives of cortisol), a steroid with local anti-inflammatory activity similar to cortisol acetate and with no systemic activity, was investigated in comparison with other steroids: tixocortol (the thiol derivative yielded by esterase hydrolysis), cortisol acetate and cortisol. The rank order of relative affinity for dexamethasone receptor of mouse thymocytes (37 degrees C) was: dexamethasone (1), cortisol (0.20), tixocortol pivalate (0.16), tixocortol (0.065), cortisol acetate (0.05). The corresponding 21 oxygenated ester (cortisol pivalate) was found less potent (0.080). Using rat renomedullary interstitial cells in culture, tixocortol pivalate showed also a higher receptor affinity than tixocortol. Cortisol acetate was as potent as tixocortol pivalate. The biological activity of tixocortol pivalate measured by the inhibition of PGE2 secretion on the same model, was similar to cortisol acetate and cortisol (10(-6) M, 24 h incubation, 38-55% inhibition). Tixocortol was less active (26%). These results with tixocortol pivalate are in good agreement with previously reported in vivo studies and show a good correlation between its binding ability and biological effect.

Topics: Animals; Binding, Competitive; Cells, Cultured; Dinoprostone; Hydrocortisone; Kidney Medulla; Mice; Prostaglandins E; Rats; Receptors, Glucocorticoid; Receptors, Steroid; Thymus Gland; Time Factors