The effect of percutaneously absorbed steroids on hypothalamic-pituitary adrenal function after intensive use in in-patients*

Abstract

Hypothalamic-pituitary-adrenal (HPA) axis function has been monitored in adults and children who required intensive treatment of their skin disease with topical corticosteroid preparations while in hospital. Evidence of mild suppression of the HPA axis was seen in adults when the more potent topical steroids were used, but recovery of function was rapid when the intensive treatment ceased. In children suppression was still present in twelve of sixteen cases on the 2nd day after treatment with 0-1% betamethasone 17-valerate ointment had stopped, yet in nine cases treated in a comparable manner with 1% hydrocortisone acetate ointment, there was no evidence of impaired HPA axis function.

Adverse effects of topical glucocorticosteroids

“…86 In addition, retarded growth in children exposed to long-term potent and superpotent topical formulations is possible. 87 Topical corticosteroids can also precipitate or exacerbate hyperglycemia. 88 For prevention, the use of less than 50 g per week of potent corticosteroids has been suggested.…”

Adrenal Insufficiency as a Result of Long-Term Misuse of Topical Corticosteroids

“…These patients are more susceptible to serious side effects because of the greater ratio between body surface area and body weight, as well as the immaturity of their skin barrier which facilitates percutaneous absorption [12]. Munro [13] detected suppression of the HPA axis in children as well as in adults after treatment with potent topical steroids. Two adults achieved recovery of their function 2 days after cessation of treatment.…”

Treatment of Eczema with an Indigenous Drug Manjishtha (Rubia Cordifolia Linn.) - A Preliminary Study

“…However, with large quantities of these potent preparations transient adrenal suppression is likely to occur, especially early in the treatment.Also, evidence of mild suppression of the HPA axis -'hypothalamis pituitary adrenal axis' is reported in adults when the more potent topical steroids were used, with rapid recovery of the function when intensive treatment ceased [3].…”