Adrenocortical function in patients with severe atopic dermatitis.
BACKGROUND
Adrenocortical suppression is a potential complication of the use of topical corticosteroids in patients with atopic dermatitis (AD).


OBJECTIVE
To determine whether or not the adrenocortical suppression observed in patients with severe AD is a sole result of the application of topical steroids.


METHODS
A total of 45 patients with severe AD that required hospitalization for treatment were enrolled. These patients were divided into two groups according to the treatment received before hospitalization: group 1 had not used topical corticosteroids for at least three months (n = 17), while group 2 had used topical corticosteroids daily (n = 28). Otherwise, these two groups were matched to clinical characteristics. A rapid ACTH test was performed upon hospital admission. Topical corticosteroids were then applied to both groups. The second ACTH test was performed just before discharge, an average of 23 days after the first test.


RESULTS
The basal serum cortisol levels as well as the response to ACTH stimulation in the first examination were significantly lower in the AD patients than in the controls (P < .001), although there were no significant differences in the results between groups 1 and 2. The followup study of adrenocortical function at hospital discharge showed that morning basal serum cortisol levels were significantly increased in group 1 (P < .01), despite their topical corticosteroid treatment, while no significant increase or decrease was seen in group 2.


CONCLUSIONS
Our findings suggest that the adrenocortical suppression seen in patients with AD may be caused by the percutaneous absorption of topical corticosteroids as well as by other factors related to the disease.
Department of Allergy, National Children's Hospital, Tokyo, Japan.
K
K
Matsuda
T
T
Katsunuma
Y
Y
Iikura
H
H
Kato
H
H
Saito
A
A
Akasawa
D000287:Administration, Topical; D000293:Adolescent; D000302:Adrenal Cortex / Q000502:physiology*; D000305:Adrenal Cortex Hormones / Q000493:pharmacokinetics; D000893:Anti-Inflammatory Agents / Q000493:pharmacokinetics; D001249:Asthma / Q000503:physiopathology / Q000652:urine; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000503:physiopathology* / Q000652:urine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008297:Male; D012720:Severity of Illness Index; D012869:Skin Absorption / Q000187:drug effects
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone