How Do Systemic Steroids Suppress Contact Allergies?

Craig A. Elmets, MD

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In This Article

Abstract and Introduction

Abstract

Systemic steroids increase TGF-β, thereby inducing a chain of actions that eventually improve contact allergies.

Introduction

Systemic corticosteroids are among the most widely used medications in dermatology. Although many effects of these potent immunosuppressive agents are known, understanding of the mechanism by which they benefit allergic contact dermatitis is incomplete. To characterize the effects of oral glucocorticosteroids on the cutaneous immune response, investigators examined biopsied specimens from 24 participants from an earlier study of anti-inflammatory compounds in nickel-allergic patients who were randomized to 10 mg prednisone daily or placebo. After the 10-day study period, all were patch-tested to nickel sulfate.

The prednisone recipients had significantly reduced patch-test reactions. Specimens from the prednisone recipients showed fewer CD4+ and CD8+ T-cells, neutrophils, macrophages, and non-Langerhans cell dendritic cells but many more CD25+FOXP3+ regulatory T cells and epidermal Langerhans cells, as well as a dramatic increase in transforming growth factor-β (TGF-β) mRNA. In vitro studies showed that the prednisone treatment resulted in Langerhans cells that were much better than untreated Langerhans cells at stimulating the proliferation of regulatory T cells. Regulatory T cells required both interleukin-10 and TGF-β to mediate their suppressive effects.

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