A young woman being treated for linear scleroderma became allergic to fluocinonide (Lidex) cream while using it with occlusion. She was able to continue treatment with fluocinonide ointment without an adverse reaction.
Patch testing with the ingredients of the cream demonstrated sensitization to an impurity in commercial stearyl alcohol and irritation from propylene glycol. The woman had no adverse reactions to fluocinonide ointment because this preparation contains no stearyl alcohol and very little propylene glycol.
This case reemphasizes the important role of vehicles in contact allergy and indicates that allergic sensitization may be induced despite the presence of a potent topical steroid.
Shore RN, Shelley WB. Contact Dermatitis From Stearyl Alcohol and Propylene Glycol in Fluocinonide Cream. Arch Dermatol. 1974;109(3):397-399. doi:10.1001/archderm.1974.01630030055015