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To the Editor.—
Shore and Shelley in the Archives (109:397, 1974) describe "contact dermatitis from stearyl alcohol and propylene glycol in fluocinonide cream" in a patient who developed intolerance to fluocinonide cream and showed positive patch tests to the propylene glycol and stearyl alcohol constituents of the fluocinonide cream. On the basis of positive patch tests to propylene glycol, and to commercial stearyl alcohol, they concluded that the patient showed irritation from propylene glycol, and had developed contact-type allergy to a contaminant in the stearyl alcohol.I would like to suggest that their data are compatible with the conclusion that both the propylene glycol and the stearyl alcohol patch tests represented irritant responses rather than that the positive stearyl alcohol tests constituted an allergic response. Distinguishing irritant tests from allergic patch tests on purely morphologic grounds is difficult and the literature is full of studies where experienced investigators have mistaken
Epstein E. Patch Test Reactions. Arch Dermatol. 1974;110(2):299–300. doi:10.1001/archderm.1974.01630080087042