Effect of Topical Corticosteroids on Adrenal Function in Children with Atopic Dermatitis
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Atopic dermatitis (AD) is one of the most common and troublesome chronic diseases in childhood. Adrenal suppression is a potential complication of topical corticosteroids in AD. The purpose of this study was to investigate the response to low-dose (500 ng/1.73 m2) adrenoconicoid hormone (ACTH) test in AD patients in comparison to normal controls. Twenty-five prepubertal children were compared to eight healthy control subjects (mean age 7.56± 2.5 years and 7.25±2.49 years, respectively: male to female ratio 1.1:1 and 1:1. respectively). All patients were subjected to thorough medical history and clinical examination, as well as random blood glucose. total and differential blood count and plasma cortisol (mg/di) was measured by radioimmunoassay. The basal (0). peak (30). 60 minutes and increment (peak minus basal) in plasma cortisol concentrations in children with mild AD; used mild potent corticosteroid, were not significantly different from controls indicating no mat adrenal sensitivity to low-dose Aril I. In moderate AD patients; used moderately potent corticosteroid. the peak and increment in plasma cortisol levels were lower than controls but within normal values (p < 0.01 and p < 0.05 respectively). Severe AD patients: used potent corticosteroid, showed lower peak (p < 0.001) and subnormal increment (p < 0.001), while the basal and 60 minutes plasma cortisol levels were within normal. There was a significant positive correlation between the peak and, the basal (p < 0.01): in (p < 0.0 I) and 60 in (p < 0.05) where as it was inversely correlated with the eosinophilic count (p < 0.05) in all AD patients. The increment did not correlate with basal and stimulated levels of plasma cortisol in the group of severe AD. These findings indicate that patients with severe AD may have normal base line cortisol levels but poorly responded to low-dose ACTH, which may be due to stress or suppression of adrenal gland by the use of potent topical corticosteroids medication. Mild to moderately potent topical corticosteroids did not suppress the adrenal function in children with AD.