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Adrenocortical function in patients with severe atopic dermatitis.

K Matsuda1, T Katsunuma, Y Iikura

  • 1Department of Allergy, National Children's Hospital, Tokyo, Japan.

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|August 3, 2000
PubMed
Summary

Adrenocortical suppression in severe atopic dermatitis (AD) patients may stem from topical corticosteroid absorption and other disease-related factors. Further research is needed to fully understand the causes of this complication.

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Area of Science:

  • Endocrinology
  • Dermatology

Background:

  • Topical corticosteroids are commonly used for atopic dermatitis (AD).
  • Adrenocortical suppression is a known potential complication of topical corticosteroid therapy.

Purpose of the Study:

  • To investigate if adrenocortical suppression in severe AD patients is solely due to topical steroid application.
  • To differentiate the impact of topical corticosteroids from disease-specific factors on adrenal function.

Main Methods:

  • 45 hospitalized severe AD patients were divided into two groups: those who had not used topical corticosteroids for three months (n=17) and those who used them daily (n=28).
  • Adrenocortical function was assessed using rapid ACTH tests upon admission and before discharge (average 23 days later).
  • Both groups received topical corticosteroids during hospitalization.

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Main Results:

  • Patients with severe AD exhibited significantly lower basal serum cortisol and ACTH-stimulated responses compared to controls.
  • No significant differences in initial adrenal function were observed between the two pre-treatment groups.
  • Following treatment, Group 1 (no prior topical steroids) showed significant improvement in morning basal serum cortisol, unlike Group 2 (daily topical steroid users).

Conclusions:

  • Adrenocortical suppression in severe AD patients is likely multifactorial.
  • Percutaneous absorption of topical corticosteroids contributes to adrenal suppression.
  • Disease-related factors inherent to atopic dermatitis also play a role in adrenocortical dysfunction.