Hypothalamic-pituitary-adrenal function and glucocorticoid sensitivity in atopic dermatitis

Area of Science:

• Pediatric Dermatology
• Endocrinology
• Immunology

Background:

• Topical glucocorticoids (GCs) are standard treatment for atopic dermatitis (AD).
• Some children with AD exhibit resistance to topical GCs, necessitating investigation into the underlying mechanisms.
• Understanding the extent of GC resistance (generalized vs. localized) is crucial for effective AD management.

Purpose of the Study:

• To assess hypothalamic-pituitary-adrenal (HPA) axis function in children with moderate to severe AD.
• To determine if GC resistance is generalized or specific to diseased skin.
• To correlate topical GC use with HPA axis function and clinical response in pediatric AD.

Main Methods:

• A low-dose ACTH stimulation test (LDST) was performed on 35 children with AD and 14 healthy controls.
• Patients were grouped based on the potency and route of GC administration.
• Plasma cortisol and ACTH levels were measured to assess HPA axis function.

Main Results:

• HPA axis suppression was infrequent with mild/moderate topical GCs but common with potent GCs or combination therapy.
• Four out of four patients using potent topical GCs and three out of seven using combination therapy failed the LDST.
• Treatment score, reflecting GC potency, area, and duration, correlated with cortisol response (r²=24%).

Conclusions:

• Long-term use of mild or moderate topical GCs rarely causes HPA suppression in pediatric AD.
• Potent topical GCs or combination therapy significantly increases the risk of HPA suppression.
• In severe AD with HPA suppression but lack of clinical response, localized skin resistance to GCs is suggested over generalized resistance.