Topical corticosteroid-induced adrenocortical insufficiency: Clinical implications

Topical corticosteroids are often prescribed for the treatment of dermatological disorders. However, systemic adrenal insufficiency may result from their overuse. Current literature detailing both laboratory and clinical findings was analyzed, in the hopes of evaluating the health-risk potential of topical corticosteroids in producing adrenal insufficiency. Risk factors identified in this report included use of high potency corticosteroids, occlusive or prolonged treatment application, and use in thin-skinned areas. Other patients at risk for development of adrenal suppression include infants and those with damaged skin barriers. Several diagnostic tests may be utilized to measure adrenal function, though each has its limitations. The most common tests include measurement of plasma total cortisol, 24-hour steroid, adrenocorticotrophin hormone stimulation and insulin tolerance. The report finds strong laboratory evidence of adrenal hypofunction. Additionally, clinical reversible adrenal insufficiency has been observed on rare occasions. Therefore, topical corticosteroids should be used with an increased awareness of the potential for systemic adrenal suppressive effects. However, since nonreversible clinical secondary adrenocortical-insufficiency disease has not been clearly documented with even class 1 topical corticosteroids, native adrenal supplementation in periods of stress appears unnecessary; rare exceptions cannot be excluded.