title: Salivary cortisol response to stress in young children with atopic dermatitis.
abstract: Poor responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis under stress may be one explanation for stress-induced exacerbation of atopic dermatitis (AD) symptoms. In previous studies, children and adults with AD showed attenuated salivary cortisol responses to psychosocial stress, suggesting hyporesponsiveness of the HPA axis, but few studies have been conducted in young children, who are vulnerable to systemic side effects of topical corticosteroid (TCS) therapy. We evaluated whether salivary cortisol responses to the stress of venipuncture in young children with AD were related to the severity of AD or performance of TCS therapy. We studied 38 young children with AD (median age 16.5 mos, range 3-66 mos) being treated at our outpatient unit. Patients were divided into three groups according to the scoring of atopic dermatitis index: mild (n = 12), moderate (n = 14), and severe (n = 12). To evaluate the responsiveness of the HPA axis to stress, salivary cortisol was determined before and after venipuncture. Salivary cortisol responsiveness to stress correlated negatively with severity of AD (p = 0.048) but not with previous use of TCS (p = 0.43) in young children with AD. Our findings suggest that the disease activity of AD, rather than TCS use, is responsible for HPA axis dysfunction in children with AD.
authors.affiliation: Division of Allergy, National Research Institute for Child Health and Development, Tokyo, Japan. rkojima@nch.go.jp
authors.forename: Reiji
authors.initials: R
authors.lastname: Kojima
authors.forename: Akio
authors.initials: A
authors.lastname: Matsuda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nomura
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsubara
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Nonoyama
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Ohya
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Saito
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsumoto
mesh_terms: D000287:Administration, Topical; D000553:Ambulatory Care; D002675:Child, Preschool; D015331:Cohort Studies; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000378:metabolism; D007223:Infant; D008297:Male; D018962:Phlebotomy / Q000009:adverse effects; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012463:Saliva / Q000737:chemistry*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013315:Stress, Psychological; D016896:Treatment Outcome
chemical_list: D006854:Hydrocortisone