An open-label adrenal suppression study of 0.1% fluocinonide cream in pediatric patients with atopic dermatitis.
OBJECTIVE
To assess the potential of a superhigh-potency 0.1% fluocinonide cream to suppress the hypothalamic-pituitary-adrenal (HPA) axis in pediatric patients with atopic dermatitis.


METHODS
A multicenter, multiple-dose, open-label safety study in 4 age cohorts with 0.1% fluocinonide cream applied once or twice daily for 2 weeks.


METHODS
Clinical outpatient setting.


METHODS
Patients with moderate to severe atopic dermatitis with 20% or more of the body surface area involved were included in the study. Each cohort began only after evaluation of the preceding cohort: ages 12 to younger than 18 years (cohort 1); 6 to younger than 12 years (cohort 2); 2 to younger than 6 years (cohort 3); and 3 months to younger than 2 years (cohort 4).


METHODS
Assessment of HPA axis suppression, local and systemic adverse events, and change in disease status from baseline.


RESULTS
Suppression of the HPA axis was not observed in any patient treated once daily for the 2 youngest cohorts. Suppression was observed in 1 (7%) of 15 and 2 (12%) of 16 patients in the fluocinonide twice-daily group in cohorts 1 and 2, respectively. In all 4 cohorts, more than 90% of patients in the fluocinonide once-daily and twice-daily groups showed improvement in their disease status.


CONCLUSIONS
Once-daily treatment with 0.1% fluocinonide cream for 2 weeks does not result in HPA axis suppression under the conditions of this study. Once-daily applications provided similar or better efficacy as twice-daily applications with a lower risk of HPA axis suppression. The frequency of HPA axis suppression is no greater in younger children than in older children.


BACKGROUND
isrctn.org Identifier: ISRCTN71227633.
Schlessinger
Joel
J
Advanced Skin Research Center, Omaha, Neb., USA.
Miller
Bruce
B
Gilbert
Richard D
RD
Plott
R Todd
RT
D000293:Adolescent; D018926:Anti-Allergic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005447:Fluocinonide / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D007223:Infant; D008297:Male; D009824:Ointments; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018926:Anti-Allergic Agents; D009824:Ointments; D005447:Fluocinonide; D006854:Hydrocortisone