The potency of clobetasol propionate: serum levels of clobetasol propionate and adrenal function during therapy with 0.05% clobetasol propionate in patients with severe atopic dermatitis.
BACKGROUND
Percutaneous absorption of topically applied 0.05% clobetasol propionate (CLO) can be assessed indirectly by measuring cortisol levels. A direct way is to measure systemic levels of topically applied CLO.


METHODS
Serum concentrations of CLO were measured by liquid chromatography-tandem mass spectrometry (LC/MS/MS), and were related to serum cortisol levels in 25 patients with an exacerbation of atopic dermatitis (AD) before and after the first day of treatment with 0.05% CLO in hospital. The body surface area (BSA) affected by AD was measured.


RESULTS
Before the start of 0.05% CLO treatment, normal cortisol levels were measured (0.47 ± 0.18 μmol/l) and CLO concentrations could not be detected. After the first day of treatment, cortisol levels decreased to 0.04 ± 0.05 μmol/l. Serum concentrations of CLO could be detected in all patients (0.112-4.504 ng/ml). Levels did not differ between patients who had received two applications versus one application of 0.05% CLO. There was no correlation between the affected BSA and serum concentrations of CLO.


CONCLUSIONS
Serum levels of CLO can be measured by LC/MS/MS. When prescribing 0.05% CLO, one must bear in mind that, even after an application of 20-30 g, CLO is systemically available and potent enough to induce adrenal gland suppression.
Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands. s.g.a.vanvelsen@umcutrecht.nl
Sara G A
SG
van Velsen
Marlise P
MP
De Roos
Inge M
IM
Haeck
Rolf W
RW
Sparidans
Carla A F M
CA
Bruijnzeel-Koomen
D000293:Adolescent; D000311:Adrenal Glands / Q000187:drug effects / Q000503:physiopathology; D000309:Adrenal Insufficiency / Q000139:chemically induced; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use; D002990:Clobetasol / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D002990:Clobetasol; D006854:Hydrocortisone