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. |
