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Adrenocortical suppression by topical application of glucocorticosteroids in infants with seborrheic dermatitis
Insights
Topical glucocorticosteroids for infant seborrheic dermatitis significantly reduced plasma cortisol levels. Cortisol levels remained low during treatment and showed slow recovery after cessation, indicating potential pituitary/adrenocortical inhibition.
Area of Science:
- Pediatric Dermatology
- Endocrinology
Background:
- Seborrheic dermatitis is a common inflammatory skin condition in infants.
- Topical glucocorticosteroids are frequently used to manage infant seborrheic dermatitis.
- Concerns exist regarding the systemic absorption and potential endocrine effects of topical corticosteroids in infants.
Purpose of the Study:
- To investigate the effect of topical flumethasone pivalate on plasma cortisol levels in infants with seborrheic dermatitis.
- To assess the duration of pituitary/adrenocortical suppression following topical corticosteroid treatment.
Main Methods:
- Fifteen infants diagnosed with seborrheic dermatitis were enrolled.
- Treatment involved topical application of flumethasone pivalate 0.02% for 10 days.
- Plasma cortisol levels were measured before treatment, during treatment, and 2 days post-treatment.
Main Results:
- A significant decrease in mean plasma cortisol levels was observed within 2 days of treatment initiation (8.8 to 2.5 micrograms%).
- This reduction in cortisol levels persisted throughout the 10-day treatment period.
- Two days after treatment cessation, cortisol levels increased but remained suppressed in some infants, particularly those with more extensive skin involvement.
Conclusions:
- Topical flumethasone pivalate treatment in infants can lead to significant pituitary/adrenocortical inhibition.
- The potential for endocrine suppression necessitates careful consideration, especially for extensive applications in infants.
- Monitoring plasma cortisol levels may be warranted in infants treated with extensive topical glucocorticosteroids.
Abstract:
Fifteen infants with seborrheic dermatitis were treated with topical glucocorticosteroids (flumethasone pivalate 0.02%). Early morning plasma cortisol levels were determined prior to treatment, during the 10-day treatment period, and 2 days after its termination. The mean plasma cortisol level prior to treatment was 8.8 +/- 3.4 micrograms%; after 2 days of application there was a significant decrease of the mean to 2.5 +/- 1.3 micrograms% that persisted throughout the treatment period. Two days after termination of treatment, the mean plasma cortisol level rose to 7.1 +/- 3.7 micrograms% but in five infants was still less than 5 micrograms% and in two less than 2 micrograms%, the latter two having shown the greatest involvement of the skin. The possibility of pituitary/adrenocortical inhibition similar to that observed with the systemic administration of glucocorticosteroids and the potential associated risks should be considered when treating cases that would require extensive application of flumethasone pivalate in infants.