Study of the Effects of Hydrocortisone and Hydrocortisone 17-Butyrate Ointments on Plasma ACTH Levels and Synacthen Responses in Children with Eczema

Abstract

This study compares the effects on the hypothalamo-pituitary adrenal (HPA) axis of two dosage schedules of hydrocortisone 17-butyrate and hydrocortisone ointments in 20 children suffering from eczema. Children with moderately extensive eczema received either 30 g of 0.1% hydrocortisone 17-butyrate or 30 g of 1% hydrocortisone ointment weekly for 4 weeks without occlusion. Children with extensive eczema received either 60 g of hydrocortisone 17-butyrate or 60 g of hydrocortisone weekly for 4 weeks. All four groups showed some clinical improvement. Although many of the children appeared to have some impairment of adrenal function prior to entering the trial, no further significant depression of the HPA axis as reflected by the plasma ACTH levels and a 30-min Synacthen test was observed during the trial. On the basis of 4 weeks’ treatment, hydrocortisone 17-butyrate did not have a significantly different effect on the HPA axis in children from that of hydrocortisone.

IL-4 and interferon-gamma production in children with atopic disease

“…All the highly atopic children and the four mildly atopic children with active dermatitis received topical hydrocortisone 1% cream and/or betamethasone valerate 0 02% cream without occlusive dressings. Systemic effects such as suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome have been described in children with the use of high potency steroids [11][12][13][14][15], but are not generally seen with hydrocortisone and betamethasone valerate [16][17][18]. The effects of absorbed topical steroids on cytokine production are not well documented.…”

Paradoxical normalization of blood pressure in a child with atopic dermatitis treated with cyclosporin

“…However, he was not cushingoid and had been applying a topical corticosteroid with negligible mineralocorticoid effect. When used for up to 4 weeks in children with extensive eczema, hydrocortisone 17‐butyrate did not cause a significant depression in the hypothalmopituitary adrenal axis as reflected by the plasma adrenocorticotrophic hormone levels and a 30‐min Synacthen test 6 …”

Halogenation and topical steroids

“…The use of occlusive dressings to alter the clinical activity of topically active steroids is an old concept and Munro (1976) showed that 60 g of hydrocortisone 17-butyrate 01% applied daily under occlusion caused a similar degree of HPA axis suppression to 30 g of betamethasone 01% applied daily. Marten et al (1980) could, however, detect no significant difference between the suppression produced by hydrocortisone 1% or hydrocortisone 17-butyrate 01% when applied without occlusion in amounts of3Og or 60 g to children suffering from eczema.…”