title: Role of the ACTH test and estimation of a safe dose for high potency steroids in vitiligo: A prospective randomized study.
abstract: BACKGROUND
  Topical corticosteroids are used as first line of therapy for vitiligo, although side effects such as adrenal insufficiency are possible.
  
  
  OBJECTIVE
  To establish the role of ACTH test before, during, and after treatment with high potency topical steroids; to determine if adrenal insufficiency occurs secondary to the use of high potency topical steroids in patients with vitiligo and intact cutaneous barrier; and also to determine response to treatment and side effects.
  
  
  METHODS
  Forty-four adults with non-segmental vitiligo affecting 20% or less of the body surface area were included and randomized to receive topical clobetasol propionate 0.05% cream (group 1) or placebo (group 2) for 12 weeks, with a maximum dose of 50 g per week. The placebo group was crossed over after week 6 and started on clobetasol until completion of the study. Serum cortisol levels with the 1 μg ACTH test were determined at baseline and on weeks 6 and 12.
  
  
  RESULTS
  No adrenal insufficiency was detected nor statistical significance was achieved when comparing cortisol levels between and within the groups at baseline and weeks 6 and 12. Group 1 had a better response to therapy but with more side effects.
  
  
  CONCLUSIONS
  Doses of 50 g or less per week of clobetasol during a period of 12 weeks are safe on adult vitiligo patients, although local side effects are possible. Repigmentation rates were incomplete with single steroid therapy, making combined therapy a better option.
authors.affiliation: Department of Dermatology, Dr. José E. González University Hospital, Monterrey, Nuevo León, México.
authors.forename: Alberto
authors.initials: A
authors.lastname: de la Fuente-García
authors.affiliation: Department of Dermatology, Dr. José E. González University Hospital, Monterrey, Nuevo León, México.
authors.forename: Minerva
authors.initials: M
authors.lastname: Gómez-Flores
authors.affiliation: Department of Endocrinology, Dr. José E. González University Hospital, Monterrey, Nuevo León, México.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mancillas-Adame
authors.affiliation: Department of Dermatology, Dr. José E. González University Hospital, Monterrey, Nuevo León, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ocampo-Candiani
authors.affiliation: Department of Dermatology, Dr. José E. González University Hospital, Monterrey, Nuevo León, México.
authors.forename: Oliverio
authors.initials: O
authors.lastname: Welsh-Lozano
authors.affiliation: Department of Endocrinology, Dr. José E. González University Hospital, Monterrey, Nuevo León, México.
authors.forename: Jesús Zacarías Villarreal
authors.initials: JZ
authors.lastname: Pérez
authors.affiliation: Department of Endocrinology, Dr. José E. González University Hospital, Monterrey, Nuevo León, México.
authors.forename: José Gerardo
authors.initials: JG
authors.lastname: González-González
authors.affiliation: Department of Endocrinology, Dr. José E. González University Hospital, Monterrey, Nuevo León, México.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lavalle-González
keywords: Adrenal insufficiency; cortisol; topical steroids; vitiligo