Percutaneous adrenal suppression with topically applied corticosteroids

Synthetic fluorinated derivatives of cortisone, when topically applied, are absorbed readily and may suppress adrenal function. In the case presented here, large quantities of topically applied triamcinolone acetonide were used in the treatment of atopic dermatitis. This caused a noticeable decrease in the plasma cortisol level. That this was the result of adrenal suppression rather than insufficiency was indicated by a satisfactory response of the plasma cortisol levels to a cosyntropin injection test. In patients with a history of recent and extensive use of topically applied corticosteroids, appropriate diagnostic and therapeutic measures are indicated to avoid postoperative adrenal insufficiency.