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Common Allergens Found in Topical Cortisone – Could They Make Your Eczema Worse?

Lately, in many of the online eczema communities, I’ve seen a lot of talk about the overuse of and addiction to topical steroids or cortisone used to treat eczema. This condition is called Red Skin Syndrome and sufferers have uncontrollable spreading eczema. I featured a guest post from one mom whose child is in the process of steroid withdrawal and it sounds just horrific. But just what causes the skin to react in such a way for some people when they use cortisone for a long period of time?

I recently came across some information about a “steroid allergy” that intrigued me. Could those with Red Skin Syndrome actually be having an allergic reaction to the steroid or more specifically, to a specific ingredient in the steroid? And what about others, without Red Skin Syndrome, that use cortisone with little change in their eczema? Or those that must use ever-increasing strengths of cortisone to experience any relief from their eczema? We know allergies, eczema, and asthma are all related – after all, they compose the atopic triad.  So, is there such a thing as a steroid allergy and could it further aggravate someone’s eczema?

In the article, “Propylene Glycol: An Often Unrecognized Cause of Allergic Contact Dermatitis in Patients Using Topical Corticosteroids,” written by Mohammed Al Jasser, MD, Nino Mebuke, Gillian de Gannes, MD, FRCPC, it clearly states that patients may in deed have an allergic reaction to a topical cortisone medication, but it may not be the actual cortisone triggering the allergy, but instead propylene glycol, an ingredient found in many, but not all topical cortisone medications. According to the article, propylene glycol can cause a cutaneous reaction. What is a cutaneous reaction?

Cutaneous reactions are split into four categories, as explained by the authors:

  • Irritant contact dermatitis (frequent exposures of an irritant on the skin, not a true allergy)
  • Allergic contact dermatitis (when an allergic reaction occurs up to a few hours after the allergen made contact with the skin)
  • Non-immunologic contact urticaria (localized redness and swelling)
  • Subjective or sensory irritation (stinging or irritation of the face, eyes, nose, or throat)

The North American Contact Dermatitis Group claims allergic contact dermatitis reactions to propylene glycol to be low at around 3.5% of patients. But any of the above reactions would certainly be terrible for anyone, especially someone already dealing with eczema. What if the cortisone they were prescribed actually further irritated their skin? After all, propylene glycol is the most common allergen found in cortiosteroids and is found in 65% of the topical steroid medications on the market, while being more common in branded ointment and gels. And cortisone was responsible for 18.3% of positive patch test results to propylene glycol allergies.

(Side note: A quick Google search also listed sorbitan sesquioleate as the next most common allergen in cortiosteroids. This study shows 10.7% of dermatitis patients tested had a positive patch test result to this chemical.)

How do you know if you have a true allergy to propylene glycol?

According to the articles authors, “ACD (Allergic Contact Dermatitis) to topical CS (Cortiosteroids) should be suspected if the dermatitis worsens or does not improve during treatment.” I find this interesting as when the dermatologists were prescribing cortisone for my son’s eczema and it didn’t help, they just wanted to prescribe stronger steroids. No one ever mentioned that my son could have become sensitized to propylene glycol or that he might have developed an allergy to it. I’m not sure that a lot of dermatologists are aware of or open to speaking about propylene glycol as a known irritant and allergen. It sounds like anyone, whose eczema does not improve with the use of steroids, but especially if it worsens with steroid use, could have developed an allergy to propylene glycol.

If you think you have an allergy or have reacted in any way to propylene glycol, you can request a skin patch test for this chemical. However, since allergy testing isn’t always conclusive, perhaps it would be better to try cortisone without propylene glycol or to move away from cortisone all together. If you are interested in trying a propylene glycol-free cortisone, please refer to the table at the bottom of the article. Or try a generic cream version, which seems to be the least likely to contain this chemical, but it’s still not guaranteed to be PG free.

Even if you don’t use cortisone you still need to be wary of propylene glycol, as it’s in many other products. When reading labels beware of its other names: 1,2-Dihydroxypropane; 2-Hydroxypropanol; Methylethy Glycol; 1,2-Propanediol; Propane-1,2-Diol. Here is a list of other products where it may be hiding.

  • antibacterials
  • antifungals
  • benzoyl peroxide
  • emollients
  • food (for coloring, thickening, and flavoring)
  • household cleansers
  • solvent (in lacquers and varnishes, even nail polish)
  • antifreeze
  • lubricants
  • cutting-fluids
  • inks

Back to the original question, could those suffering from Red Skin Syndrome, a topical steroid addiction, be reacting to not just the steroid, but to the propylene glycol, sorbitan sesquioleate, or another chemical they contain? It’s certainly possible, but no studies have been done to prove this. One thing we all know about allergies is that anyone can become allergic to anything. And with eczema, no two cases are the same. One person’s miracle could be another person’s danger.

Have you experienced Red Skin Syndrome? What are your thoughts and theories around what causes it? Do you have an allergy to propylene glycol or sorbitan sesquioleate? Do you notice that cortisone doesn’t improve your eczema or possibly worsens it?

14 Comments Post a comment
  1. jake #

    over the years, i’ve been prescribed a few different brands of triamcinalone cream because some pharmaceutical companies use lanolin as an inactive ingredient, and i’m allergic to wool. i would never find this out until i brought the creams homes and read the packaging and medication guide. i had been using one brand of triancimalone with lanolin for over a year but hadn’t realized it until i switched from tubes to the big jar and noticed it on the label.

    Like

    November 25, 2013
    • Hi Jake – Very interesting. And did you react to the one that had lanolin and you didn’t realize?

      Like

      November 26, 2013
  2. gigi #

    PG is used in the ink to print on capsules of the meds i was taking, in the cetaphil my dermatologist had me using in both cleanser and moisturizer, and the list goes on.

    hi, im fighting my own battle right now and am looking into whether it could be propylene glycol allergy. Im currently on antihistamines and just found this out. its in vapor from e cig’s, makeup, flavored coffee etc. read your labels, and ask if there is no label.

    Like

    October 31, 2013
    • Wow, on labels? Unbelievable! I find this out on the same night I hear that recycled fiber toilet paper usually contains bPA!! Is there nothing natural and pure anymore?

      Like

      November 1, 2013
  3. shanna tyler #

    I wanted to give my account of red skin syndrome and how i managed to suppress the steroid addiction/withdrawal symptoms and I hope this will help many of you that are suffering from this dreadful horrible condition as it really surprisely worked for me. My journey of using steroid creams began in 2011. I had a flare up after reacting to chlorine while swimming and was prescribed betnovate C containing betamethasone 0.1% by the doctor. This worked a charm and my skin was clear in 3 days, but due to my bad judgement i continued to use it whenever I had a minor flare up. The flare ups became frequent each time so therefore I requested a repeat prescription from my doctor. I continued using it for a year, i then started to notice that my skin was thinning badly and the veins underneath my skin had become very visible. In my disappointment I immediately stopped the treatment, a few days later I started to feel weak and fatigued (possibly due to not tapering) however my face became very warm and itchy so suddenly and the itchiness just became worse and worse and would not stop and the heat became unbearable so I decided to Google and book an appointment with my dermatologist. After goggling I became aware of this weird disease that seemed so spooky and painful it was unbelievable that doctors are prescribing this drug continuously. The pain and discomfort were so unbearable that I had to take some time of work as I could not concentrate properly. After reading all the reviews, comments and having trued different things (ice, benadryl, apple cider vinegar,oilutum, diprobase etc) to ease the discomfort nothing was working and the warm weather made the condition worse. So I decided I would go back and start using it until I could find a cure that worked.

    I then spoke to a dermatologist who was very alarmed to hear that my doctor had continued to prescribe me this strong potent cream and she immediately told me to start tapering it off instead of abruptly stopping to avoid messing up my adrenal gland. However while I was still going through the steriod withdrawal my skin became a hot mess it seemed like my skin was trying to get rid of my old skin, the heat and itchiness reminded me of when I had a skin peel years ago (the feeling was similar) so I deduced that possibly the skin on the surface was so damaged by the cream that my body might have been trying to get rid of this skin. Therefore I had to put my theory to the test,firstly i decided to taper off the cream for 5 months for the good of my health, this also allowed me to wait for the cooler/colder weather to set in, Within this time I did major research about the syndrome and it was saddening to know that I would have to go through the long anguish at some point in my life as there was no plausible cure this was unbearable and unthinkable for me.

    5 months came and I could stop and it was early October 2012 and the cold had set in, I then ordered a jar of skin barrier repair cream to help boast the lipids in my skin after the peek which I gad read was helpful to people with harsh eczema. I should also say that after reading about how some eczema suffers have reduced their symptoms by eating non gluten products I decided to change my diet as well and I no longer eat any bad gluten products, I now only eat whole grain organic foods no more bad foods for me.

    At the same time I also ordered a bottle of TCA 15% facial peel from a reputable clinic in the UK (I don’t want to mention the clinic cos I don’t want to sound like am selling someones product on this blog) I recommend that you guys find a good skin beauty clinic online that sells skin peels responsibly or go have it done professionally. As I had done peels before at home I decided to do it at home where I could monitor my own progress, 2 days after receiving my TCA peel iI finally did the at home peel, it was painful for the 3 – 4 minutes but after neutralizing I was fine (I had done skin peels a few times several years ago). It took 8 days for the old burnt skin to completely peel off and new skin to come out. FYI with skin peels you have to allow the skin to peel naturally otherwise you scar and cause more irritation. (PLEASE READ MORE ABOUT PEELS BEFORE ATTEMPTING TO USE AND IF ITS YOUR FIRST TIME TRY A LESSER PERCENTAGE LIKE 8 – 10% TCA PEEL PREFERABLY, DO A LITTLE RESEARCH TO GET THE FACTS ON HOW TO GET THE BEST RESULTS FOR YOUR SKIN TYPE). You can try any medium peel depending on your skin type but for me TCA is the best and its versatile – (glycolic, lactic acid peel are less effective as they remove skin microscopically but TCA removes old skin off literally).

    So after the revealing of the new skin I slathered the barrier cream and sunscreen and stayed away from sun or uv rays to not cause any damage to the new skin. I was very anxious, just waiting for the pain, heat and itching to start again but a day passed 2 days then 3 days then before i knew it was a week and now its been a month and half and have not had any symptoms. I only used the barrier cream for 3 days then stopped (forgot) so this is not really necessary but just in case you want to make sure you get the same results as me buy a good barrier cream that has lipids (again I dont want to sell anyone’s product so I recommend you do intense research online there are quite a few good barrier creams to chose from).

    So i hope this will help someone out there who is suffering with this syndrome as it really worked for me. Words of wisdom – please be cautious with the skin peel this is an acid that is really dangerous and requires a lot of care – if doing at home skin peel buy one with full instructions from a reputable dealer who will take responsibility if you have any problems or questions. Please if you used steroid creams or steroid products over the recommended time (1 week)you need to safely taper it off as an abrupt stop can be fatal (read about tapering online and speak to your doctor/gp to get help with tapering). Hope for the best for everyone with this syndrome and lets kee spreading the word and making people aware of these dangerous products, my condition affected my face and neck only, peels can not be carried out on children – over 18years only
    Reply to this

    Like

    December 17, 2012
    • Thank you so much for your comment. I cannot imagine what it must have been like to come through the withdrawal. What a HUGE accomplishment! Good for you for staying strong and for determining how to help cure your body from within. Jennifer

      Like

      December 19, 2012
  4. I have a friend dealing with Red Skin syndrome and I am humbled by the pain and impact that disease has on a family. This was a very, very valuable post. Keep up the great work. You are truly helping so many.

    Like

    November 30, 2012
    • Thank you so much! It’s wonderful to hear from you.

      Like

      December 3, 2012
  5. Great post. I used steroids for 15 years and became addicted. I went through terrible withdawal, but now, at 12 months off steroids i am healing. My blog is topicalsteroidwithdrawal.blogspot.co.uk. I post progress photos regularly.

    You make some good points about possible steroid allergy. We are all a pretty allergic bunch, to be sure, and react to most things we put on our skin. For me, i think the main cause of rss is the effect of steroids on the blood vessels. Steroids are designed to constrict the blood vessels, so when they are applied, the skin is less red. When steroids are stopped, the blood vessels dilate, because they are not being suppressed any more. This makes the skin go very red and burning. Tests on blood of people with rss show that they have elevated levels of nitric oxide, which is a vasodilator. We only heal when the nitric oxide levels go down.

    Thanks for your post and pubicizing this distressing skin condition.

    Like

    November 27, 2012
    • Louise – Thank you for the information on RSS. I confess I don’t know that much about it, but it certainly fascinates me and I feel it’s a very under diagnosed condition.

      Like

      November 28, 2012
  6. I don’t have a propylene glycol allergy (that I know of) but I follow a blogger (http://theallergista.com/) who does and it’s crazy how many products and foods it’s in. I haven’t experienced Red Skin Syndrome but I’ve been reading a lot about it lately, since I first read about it on your blog and just general withdrawal from topical steroids.

    I think it does make sense that doctors should consider an allergy to an inactive ingredient in the product if the patient doesn’t respond positively, rather than increasing to a stronger steroid. I’ve had severe allergic reactions to a preservative in an IV medication (and it almost killed me). It took a while for the doctors to consider it may be the preservative and ended up having to get the same medication specially compounded.

    I do use topical steroids (clobetasol mostly) but hate the feeling of having to rely on them :(

    Like

    November 27, 2012
    • Hi Amanda – Thanks for introducing me to The Allergista. That’s a new blog for me – great site. Scary that you had such a severe reaction to a preservative! I’m glad they figured it out and now you’re aware.

      Like

      November 28, 2012
  7. This is a really interesting article and I had not considered the possibility of an allergic reaction to the inactive ingredients in corticosteroids. I agree that some people may be sensitive or allergic to the inactive ingredients which could lead to contact dermatitis. However, I have Red Skin Syndrome and I feel that it is caused by the steroids themselves, not the inactive ingredients.

    Contact dermatitis should clear up shortly after discontinuing use of the product, but those of us with RSS find it takes a long time before our skin clears and is healthy again – a year minimum for many people. An argument could be made that since PG is a common ingredient to find in personal care products, we could be exposed to it in other products even after stopping topical steroids. However, since most people with RSS find their options are very limited for personal care products, I don’t believe this is the case. Because we have such sensitive skin, most of us are limited to very basic moisturizers like Vaseline, olive oil, palm oil, etc. Even products we used in the past or those specifically labeled for “sensitive skin” cause irritation, so I think that automatically cuts down our exposure to it.

    There are also people with RSS who have not been using topical steroids; they have either used oral steroids or injections. Admittedly, I am not a doctor but I did a quick Google search and it doesn’t look like PG is used in those versions.

    I appreciate your post on this topic because it was not something I had considered before. I’ve never really looked at the “inactive” ingredients in medicines (assumed medicine for people who have sensitive skin wouldn’t contain known irritants…I should never assume!) but it makes sense that people have reactions to it and never know. I can believe that dermatologists would overlook that possibility since (in my experience anyway) they are so convinced they know the solution to a rash (cortisone) and when that doesn’t work, the solution is just…more cortisone. In reality, there could be a whole host of possible causes – whether it’s Red Skin Syndrome, propylene glycol sensitivity, food allergens, nickel allergy, staph or yeast growth, SLS sensitivity, or something else. I don’t understand how doctors can take a one-size-fits-all approach to eczema when there are so many probable causes.

    It just goes to show you have to be your own advocate and do your own research!

    Like

    November 27, 2012
    • Yes, you are definitely right that we have to be our own health advocates. And eczema is definitely not a one-size-fits-all skin condition. I do wonder if you can be sensitive to the inactive ingredients, just like you can be to certain foods. Gluten for example – you can have a sensitivity that causes eczema to flare, but not a full on allergy. So, eating gluten over time can cause a skin reaction, but not necessarily using it just one time. This could happen with some of these inactive ingredients in our medications. Who knows for sure. Just interesting to think about.

      Like

      November 28, 2012

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