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Topical corticosteroid-induced adrenocortical insufficiency: clinical implications
Cheryl Levin1, Howard I Maibach
1Department of Dermatology, University of California at San Francisco Medical Center, 90 Medical Center Way, San Francisco, CA 94143, USA.
American Journal of Clinical Dermatology
|April 30, 2002
Summary
Topical corticosteroids can cause adrenal insufficiency, especially with overuse or in certain patients. While laboratory evidence is strong, clinical cases are rare and usually reversible, suggesting caution but not routine supplementation.
Area of Science:
- Dermatology
- Endocrinology
- Pharmacology
Background:
- Topical corticosteroids are widely used for skin conditions.
- Overuse can lead to systemic adrenal insufficiency.
- Understanding risks is crucial for patient safety.
Purpose of the Study:
- To evaluate the health risks of topical corticosteroids in causing adrenal insufficiency.
- To identify risk factors and diagnostic methods for adrenal suppression.
Main Methods:
- Systematic review of laboratory and clinical findings.
- Analysis of literature on topical corticosteroid use and adrenal function.
Main Results:
- Strong laboratory evidence of adrenal hypofunction exists.
- Risk factors include high potency, prolonged use, and application to thin skin.
- Infants and those with damaged skin barriers are also at risk.
Conclusions:
- Topical corticosteroids require cautious use due to potential systemic adrenal suppressive effects.
- Clinical adrenal insufficiency is rare and typically reversible.
- Routine adrenal supplementation during stress is generally not necessary.