Allergic Contact Dermatitis to Clobetasol used for Stasis Dermatitis

Case Report

Austin J Clin Case Rep. 2014;1(1): 1002.

Allergic Contact Dermatitis to Clobetasol used for Stasis Dermatitis

Daniel Butler BS1, Maryam Afshar2, Antoanella Calame2 and Sharon E Jacob2*

1Department of Dermatology University of Arizona, USA

2Department of Dermatology, University of California, USA

*Corresponding author: Sharon E Jacob, Department of Dermatology, University of California, San Diego and Rady Children’s Hospital 8010 Frost Street, Suite 602, San Diego, CA 92123, USA

Received: March 18, 2014; Accepted: April 10, 2014; Published: April 15, 2014


Allergic contact dermatitis has been identified as a potential exacerbating factor for psoriasis vulgaris often times in association with topical therapies [1- 5]. This case demonstrates that patients with new onset or recurrent flares of pustular psoriasis should be considered for patch testing, which should include all topical agents, including corticosteroids.

Keywords: Psoriasis; Corticosteroids; Contact dermatitis; Pustular; Clobetasol

Case Report

An 88-year old female with chronic venous insufficiency of the lower extremities had been treated for stasis dermatitis for several years with clobetasol propionate and compression. The patient presented to clinic with worsening dermatitis, which progressed to include her thighs, despite regular clobetasol application. To investigate potential causes of the worsening dermatitis, the patient was patch tested. A positive patch test reaction was noted toclobetasol proprionate and notable negative patch tests to rubber chemicals disperse dyes and a swatch of her compression hose. Given this information, the patient was switched to desoximethasone 0.25% ointment once daily, an alternative class of corticosteroid and tacrolimus ointment 0.1% once daily, and continued on compression.

The patient’s stasis dermatitis became well controlled on this regimen for the next 18 months. She then presented with acute onset, bilateral, erythematous and mildly scaly papules and plaques, with scattered pustules, covering approximately twenty-five percent of her body surface area. The lesions predominated on her thighs and lower extremities with scattered lesions on the trunk and buttocks. She reported that a week prior to the eruption, a friend gave her clobetasol spray, which she was using twice daily because of the ease of application. A diagnosis of pustule ear allergic contact dermatitis (ACD) versus pustular psoriasis was entertained and punch biopsies were obtained.

Histopathology revealed mild epidermal acanthosis with slight spongiosis and a slightly proliferative epidermis. Focal decrease in the granular cell layer with overlying parakeratosis and neutrophils were present. A sparse infiltrate composed of lymphocytes, histiocytes, and neutrophils, along with a few dilated blood vessels, was present in the upper dermis. No eosinophils were present. These histologic findings were most compatible with pustular psoriasis (Figure 1).

Citation: Butler D, Afshar M, Calame A, Jacob SE. Allergic Contact Dermatitis to Clobetasol used for Stasis Dermatitis. Austin J Clin Case Rep. 2014;1(1): 1002. ISSN 2381-912X