Influence of topical corticosteroids on hormones in urine and plasma

In the present study the effects on endogenous hormones of application of topical corticosteroids are investigated. Radioimmunological assays of the hormones cortisol, adrenocorticotrophic hormone (ACTH) and alpha-melanocyte stimulating hormone (alpha-MSH) before, during and after a large-area treatment with topical corticosteroids (30 g/d 0.025% fluocinolone acetonide ointment for 9 days) are performed in eight patients suffering from extensive inflammatory dermatoses (7 cases of eczema, 1 case of psoriasis). Cortisol was measured in plasma daily under treatment. In addition, gas chromatographic and mass spectrometric determinations of urocorticoids and uroandrogens are carried out in 24-h urine. A distinct, treatment-induced suppression of the endogenous steroid production was significant (-42.7%, p less than or equal to 0.05) within the first four days and diminished (-24.4%, p less than or equal to 0.10) after nine days' steroid therapy. The suppression of the plasma ACTH was also significant (-23.1%, p less than or equal to 0.05). The alpha-MSH level did not show any alterations. The measured urocorticoids showed an average fall of -38.9% (p less than or equal to 0.05). It is noteworthy that despite continued steroid treatment the marked initial suppression of the endogenous steroid production diminishes. It is possible that a therapy-induced "normalization" of the epidermis brings about a diminished steroid influx and thus a lower systemic load. Under the therapy conditions chosen here, the androgen metabolites in the urine did not show any significant fluctuations.