Journal
CLINICAL PEDIATRICS
Volume 58, Issue 4, Pages 406-412Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/0009922818825154
Keywords
adrenal insufficiency; topical corticosteroids; hypothalamic-pituitary-adrenal axis; ACTH; cosyntropin; cortisol; atopic dermatitis
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Our objective was to assess the risk of adrenal insufficiency (AI) with short-term use of low- to moderate-potency topical corticosteroids (TCS) for treatment of atopic dermatitis. Our systematic literature search revealed 9 studies (n = 371) that evaluated AI using adrenocorticotropic hormone stimulation testing, with measures of serum cortisol levels at baseline and following at least 2 weeks of TCS application. Biochemical AI was defined by a stimulated cortisol level of <= 18.0 mu g/dL (similar to 500 nmol/L). The overall proportion of AI with low-to-moderate TCS use was 2.7% (95% confidence interval = 1.47% to 4.89%). None of the children showed any clinical evidence of AI or adrenal crisis. Short-term use of low- to moderate-potency TCS for the treatment of atopic dermatitis is associated with a low risk of adrenal suppression. General practitioners do not need to test these patients for adrenal suppression in the absence of concerning signs and symptoms of AI.
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