Prolonged treatment with topical glucocorticoids results in an inhibition of the allergen-induced weal-and-flare response and a reduction in skin mast cell numbers and histamine content.

The inhibitory effects of topical glucocorticosteroid treatment on the immediate dermal allergic reaction were studied in 10 patients in a double, randomized, placebo-controlled fashion. The aim was to study whether a prolongation of the treatment time would enhance the inhibitory effect beyond the 30-40% reduction previously reported after 1 week of treatment, and whether any changes in skin reactivity were accompanied by changes in the level of mast cells or histamine at the challenge site. Allergen and histamine skin-prick tests were performed on both forearms before the start of the study and after 2 and 4 weeks of treatment with placebo cream on one forearm and with 0.05% clobetasol-17-propionate cream on the other. Punch biopsies from the skin treated actively and with placebo were taken after 4 weeks in eight of the patients. The specimens were used for the light-microscopic evaluation of mast cell density and for the measurement of histamine and protein content. After 4 weeks of treatment we found a reduction in the allergen-induced weal (72%; P less than 0.001) and flare (62%; P less than 0.05) response. There was also a minor reduction in the histamine-induced weal (38%; P less than 0.05) but not the flare response, suggesting that the glucocorticoid treatment induced a reduced mediator release at allergen challenge. This could be partially explained by the finding of a reduction in the number of detectable skin mast cells (85%; from 0.78 to 0.11 mast cells per unit area) and in the histamine content of the skin as related to the tissue wet weight (36%; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)