Low basal serum cortisol in patients with severe atopic dermatitis: potent topical corticosteroids wrongfully accused
Low basal serum cortisol in patients with severe atopic dermatitis: potent topical corticosteroids wrongfully accused
复制标题
DOI：
10.1111/j.1365-2133.2007.07753.x
复制
发表时间：
2007-05-01
影响因子：
10.3
通讯作者：
de Bruin-Weller, M. S.
中科院分区：
文献类型：
--
作者：
Haeck, I. M.;Timmer-de Mik, L.;de Bruin-Weller, M. S.
背景 外用皮质类固醇广泛用于治疗炎症性皮肤病，包括特应性皮炎 (AD)。一些研究描述了下丘脑-垂体-肾上腺功能的暂时可逆抑制。然而，缺乏肾上腺功能永久性紊乱的可靠证据。 目的 将中度至重度 AD 患者的基础皮质醇水平与先前使用的外用皮质类固醇和疾病活动性联系起来，并研究住院期间外用皮质类固醇治疗对基础血清皮质醇水平的影响。 方法 对两组 AD 患者进行评估：25 名需要住院的严重 AD 住院患者（第 1 组）和 28 名中重度 AD 门诊患者（第 2 组）。在第一组中，在入院时和出院时两次测量早晨基础血清皮质醇水平；在第2组中，早晨测量一次基础血清皮质醇水平。记录皮质醇测量前 3 个月内局部皮质类固醇的使用情况，并使用六区六征特应性皮炎 (SASSAD) 评分和血清胸腺和活化调节趋化因子 (TARC) 水平监测疾病活动性。 结果入院时，第 1 组 80% 的患者基础皮质醇水平显着降低 (P < 0.001)。在第 2 组中，除三名患者外，所有患者的基础皮质醇水平均正常。比较两组，入院时第 1 组的皮质醇水平显着低于第 2 组（P < 0.001）。入院时第 1 组的疾病活动度显着高于第 2 组（P < 0.001）。在皮质醇测量前的 3 个月内，外用皮质类固醇的使用没有差异。第 1 组出院时，基础皮质醇水平显着升高 (P < 0.0001)，而疾病活动性显着降低 (P < 0.001)，这通过血清 TARC 水平和 SASSAD 评分的下降反映出来。 结论 严重 AD 患者基础皮质醇值低的原因是疾病活动，而不是外用皮质类固醇的使用。
Background Topical corticosteroids are used extensively to treat inflammatory skin disorders including atopic dermatitis (AD). Several studies have described temporary reversible suppression of hypothalamic-pituitary-adrenal function. However, sound evidence of permanent disturbance of adrenal gland function is lacking.Objectives To relate basal cortisol levels to prior use of topical corticosteroids and disease activity in patients with moderate to severe AD and to investigate the effect on basal serum cortisol levels of topical corticosteroid treatment during hospitalization.Methods Two groups of patients with AD were evaluated: 25 inpatients with severe AD who required hospitalization (group 1) and 28 outpatients with moderate to severe AD (group 2). In group 1, morning basal serum cortisol levels were measured twice, at admission and at discharge; in group 2, morning basal serum cortisol levels were measured once. Use of topical corticosteroids in the 3 months prior to the cortisol measurement was recorded and disease activity was monitored using the Six Area, Six Sign Atopic Dermatitis (SASSAD) score and serum thymus and activation-regulated chemokine (TARC) levels.Results On admission, basal cortisol levels in group 1 were significantly (P < 0.001) decreased in 80% of the patients. In group 2, the basal cortisol levels were normal in all but three patients. Comparing the two groups, group 1 on admission had a significantly lower cortisol level than that of group 2 (P < 0.001). Disease activity in group 1 on admission was significantly higher than that of group 2 (P < 0.001). There was no difference in use of topical corticosteroids in the 3 months before cortisol measurement. At discharge in group 1 there was a significant increase (P < 0.0001) of basal cortisol levels and a significant (P < 0.001) decrease in disease activity reflected by the decrease in serum TARC levels and SASSAD score.Conclusions Disease activity, rather than the use of topical corticosteroids, is responsible for the low basal cortisol values in patients with severe AD.