We read with interest the recent article by Schlessinger et al1 that assessed the potential of the topical corticosteroid fluocinonide to suppress the hypothalamic-pituitary-adrenal(HPA) axis. In this study, fluocinonide cream was applied for 2 weeks to 126 patients aged 3 months to 18 years with atopic dermatitis. The authors defined HPA axis suppression as serum cortisol levels of 18 μg/dL or lower (to convert serum cortisol to nanomoles per liter, multiply by 27.588) 30 minutes after intravenous (IV) cosyntropin stimulation. Using this cut-off cortisol level, they found that 3 patients (2%) showed evidence of HPA axis suppression. However, the authors did not specify the corticotropin dose that they used. They merely mentioned that they used cosyntropin as directed in the package insert. Because the manufacturer suggests collecting blood samples before and 30 minutes after IV injection of 250 μg of corticotropin (or 125 μg in children 2 years or younger),2 we assume that the authors used this conventional dose of corticotropin.
Ishay A, Ziv M, Kerner M, Luboshitzky R. Suppression of the HPA Axis in Pediatric Patients With Atopic Dermatitis. Arch Dermatol. 2007;143(11):1447-1462. doi:10.1001/archderm.143.11.1449-b