Davallow Ghajar Ladan, Wood Heickman Lauren K, Conaway Mark, Rogol Alan D
1 University of Virginia, Charlottesville, VA, USA.
Clin Pediatr (Phila). 2019 Apr;58(4):406-412. doi: 10.1177/0009922818825154. Epub 2019 Jan 29.
Our objective was to assess the risk of adrenal insufficiency (AI) with short-term use of low- to moderate-potency topical corticosteroids (TCS) for treatment of atopic dermatitis. Our systematic literature search revealed 9 studies (n = 371) that evaluated AI using adrenocorticotropic hormone stimulation testing, with measures of serum cortisol levels at baseline and following at least 2 weeks of TCS application. Biochemical AI was defined by a stimulated cortisol level of ≤18.0 µg/dL (~500 nmol/L). The overall proportion of AI with low-to-moderate TCS use was 2.7% (95% confidence interval = 1.47% to 4.89%). None of the children showed any clinical evidence of AI or adrenal crisis. Short-term use of low- to moderate-potency TCS for the treatment of atopic dermatitis is associated with a low risk of adrenal suppression. General practitioners do not need to test these patients for adrenal suppression in the absence of concerning signs and symptoms of AI.
我们的目标是评估短期使用低至中效外用糖皮质激素（TCS）治疗特应性皮炎时发生肾上腺功能不全（AI）的风险。我们的系统文献检索发现了9项研究（n = 371），这些研究使用促肾上腺皮质激素刺激试验评估AI，并在基线时以及应用TCS至少2周后测量血清皮质醇水平。生化性AI的定义为刺激后皮质醇水平≤18.0 µg/dL（~500 nmol/L）。使用低至中效TCS时AI的总体比例为2.7%（95%置信区间 = 1.47%至4.89%）。没有儿童表现出任何AI或肾上腺危象的临床证据。短期使用低至中效TCS治疗特应性皮炎与肾上腺抑制风险较低相关。在没有AI相关体征和症状的情况下，全科医生无需对这些患者进行肾上腺抑制检测。
