Percutaneous Absorption of Hydrocortisone During and After the Acute Phase of Dermatitis in Children

Abstract

Percutaneous absorption of hydrocortisone was measured by a fourhour absorption test in !6 children duting and after the acute phase of dermatitis. In the acute phase, after the application of 1% hydrocortisone cream the increment in plasma cortisol ranged from 47 to 961 nmol per liter (median 248 nmol/L), After the acute phase the increment was significantly (P < 0,0!) lower: range 18 to 241 nmol per liter (median 95 nmol/L), In addition to local effect, topical hydrocortisone therapy of childhood dermatitis is accompanied by a systetnic effect that may be pronounced in the acute phase of disease. Convalescence is connected with a diminished systemic efFect due to the restoration of the skin barrier to hydrocortisone.Percutaneous absorption of drugs is influenced by the physical and chemical characteristics of the drugs, the vehicle, and the barrier properties of the skin. Clinically important is the question of how the skin barrier to glucocorticoids is influenced by dermatitis. Feinblatt et al (1) suggested that the percutaneous absorption of labeled hydrocortisone, measured by excretion in urine, was higher in children with atopic dermatitis than in those with normal skin, Bronaugh et al (2) showed that absorption of hydrocortisone through eczematous monkey skin in vitro is double that through normal skin, A study using direct measurement of plasma cortisol revealed that absorption was higher in children with severe skin disorder than in those with mild or moderate skin disease (3).The present study evaluated the effect of dermatitis on the percutaneous absorption of hydrocorti-

Evaluation of the atrophogenic potential of hydrocortisone 1% cream and pimecrolimus 1% cream in uninvolved forehead skin of patients with atopic dermatitis using optical coherence tomography

“…In AD, there already is a defective epidermal barrier (36)(37)(38), and penetration of topical corticosteroids is 2-to-10-times greater than that through healthy skin (39).…”

Corticosteroid use during pregnancy and risk of orofacial clefts

“…In a study involving young adults with atopic dermatitis, percutaneous application of 1.0% hydrocortisone cream yielded median serum cortisol levels of 125 nmol/L during the acute phase of the condition and 16 nmol/L during remission. 31 Furthermore, it has been shown that even for a lowpotency corticosteroid such as hydrocortisone, 15.0% of the dose crosses the placenta unmetabolized. 32 These studies suggest fetal serum cortisol levels in the range of 2.4-18.75 nmol/L after the application of 1.0% hydrocortisone cream to the mother's skin.…”

“…We had access to data for the period covering Jan. 1, 1996, to Mar. 31,2009. The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) was used to code diagnostic information.…”

Low Basal Serum Cortisol in Patients with Severe Atopic Dermatitis: Potent Topical Corticosteroids Wrongfully Accused

“…In children with AD, percutaneous absorption of hydrocortisone was proven to be significantly lower in the convalescent phase of the disease compared with the acute phase, probably owing to the restoration of the skin barrier. 4 Several years after the introduction of hydrocortisone, new synthetic corticosteroids were developed. Synthetic corticosteroids can modulate endogenous cortisol secretion by influencing hypothalamic and pituitary effects on adrenal gland activities through the hypothalamic-pituitary-adrenal (HPA) axis.…”