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Morning plasma cortisol levels in infants treated with topical fluorinated glucocorticosteroids
Insights
Topical fluorinated glucocorticosteroids can significantly lower plasma cortisol in infants, though levels normalize later. This highlights the potential for percutaneous absorption even with typical use.
Area of Science:
- Pediatric Endocrinology
- Dermatology
- Pharmacology
Background:
- Topical glucocorticosteroids are widely used for infant skin conditions.
- Concerns exist regarding potential systemic absorption and endocrine effects in infants.
- Plasma cortisol levels are a key indicator of the hypothalamic-pituitary-adrenal (HPA) axis function.
Purpose of the Study:
- To investigate the impact of topical fluorinated glucocorticosteroids on plasma cortisol levels in infants.
- To assess the potential for HPA axis suppression following standard topical corticosteroid therapy.
Main Methods:
- Plasma cortisol levels were measured in 17 infants (mean age 12.1 months) at 8 AM.
- Measurements were taken before and on days 3, 7, and 14 after applying a topical fluorinated glucocorticosteroid.
- Statistical analysis was performed to evaluate changes in cortisol levels.
Main Results:
- A statistically significant depression in plasma cortisol was observed in 11 out of 17 infants at days 3, 7, and 14.
- Despite transient suppression, all infants' plasma cortisol levels returned to normal.
- No significant overall depression of plasma cortisol was found for the entire group of 17 infants.
Conclusions:
- Topical fluorinated glucocorticosteroids can cause transient HPA axis suppression in infants.
- Healthcare providers should be aware of the possibility of percutaneous absorption and potential systemic effects.
- Monitoring or caution may be warranted even with standard office-based topical corticosteroid use in pediatric patients.
Abstract:
The plasma cortisol levels of 17 infants of mean age 12.1 months taken at 8 AM were measured before and after application of a topical fluorinated glucocorticosteroid. There was a statistically significant depression of plasma cortisol value in 11 infants at days 3, 7, and 14 after therapy. All of the plasma cortisol levels returned to normal. For the entire group of 17 infants, however, there was no significant depression of plasma cortisol levels. Even in the usual office use of topical glucocorticosteroids, one must be aware of the possiblity of percutaneous absorption.