Cook L J, Freinkel R K, Zugerman C, Levin D L, Radtke R
J Am Acad Dermatol. 1982 Jun;6(6):1054-60. doi: 10.1016/s0190-9622(82)70090-8.
Systemic absorption of topically applied glucocorticoids in quantities sufficient to replace endogenous production is not uncommon. However, iatrogenic Cushing's syndrome resulting from the use of topical corticosteroids is very rare. Thus the possibility that systemic absorption may cause hyperglucocorticism has been deemphasized and examined only sporadically. We have studied changes in carbohydrate metabolism induced by topical glucocorticoids in a psoriatic patient who had developed Cushing's syndrome from topical desoximetasone (Topicort). The results indicated that (1) fasting hyperglycemia and increased insulin-glucose ratios could be induced within 24 hours of administration of topical glucocorticoids, (2) insulin resistance accompanied abnormal carbohydrate tolerance, and (3) fluctuations in circulating leukocytes paralleled the changes in carbohydrate metabolism. The findings suggest that metabolic indexes of glucocorticoid action action may provide useful parameters for assessing systemic absorption of topical glucocorticoids. glucose relationship as one such index to assess the risk of treatment of extensive chronic skin disease with potent topical glucocorticoids.
局部应用糖皮质激素的全身吸收量足以替代内源性分泌，这种情况并不罕见。然而，因使用局部皮质类固醇导致医源性库欣综合征的情况非常罕见。因此，全身吸收可能导致糖皮质激素过多症的可能性一直未得到重视，只是偶尔进行过研究。我们研究了一名因局部使用去氧米松（特皮康）而患上库欣综合征的银屑病患者，局部糖皮质激素对其碳水化合物代谢的影响。结果表明：（1）局部应用糖皮质激素24小时内可诱发空腹血糖升高和胰岛素-葡萄糖比值增加；（2）胰岛素抵抗伴有异常的糖耐量；（3）循环白细胞的波动与碳水化合物代谢的变化平行。这些发现表明，糖皮质激素作用的代谢指标可能为评估局部糖皮质激素的全身吸收提供有用的参数。将葡萄糖关系作为评估强效局部糖皮质激素治疗广泛慢性皮肤病风险的一个指标。
