Prescription topical corticosteroids used to treat swelling, redness, and itching caused by severe allergies or skin problems such as eczema and psoriasis, have been linked to adrenal suppression called hypothalamic-pituitary-adrenal (HPA) axis suppression that can lead to potentially fatal conditions such as Cushing’s syndrome.
The largest incidence of adrenal suppression was seen with betamethasone propionate, which was approved in 2001 and is available in a cream, ointment or lotion. In one study, 58 percent of 60 patients with atopic dermatitis aged 1 to 12 who were treated with Diprolene AF Cream (0.05%), which contains the active ingredient betamethasone. The rate was 53 percent in patients treated with Diprosone Ointment (0.05%).
Clobex lotion, which contains the drug ingredient clobetasol propionate, was approved in 2003. In a small study of adults with atopic dermatitis who used the drug for two weeks, 56 percent developed adrenal suppression.
In most cases, the adrenal suppression went away after treatment with the corticosteroids were discontinued. But in some cases, the problem arose after treatment was discontinued.
Pandel, which contains the ingredient hydrocortisone probutate, just updated its safety label to include new warnings that warn of the risk of HPA axis suppression and other unwanted systemic glucocorticoid effects “may occur during or after withdrawal of treatment. Factors that predispose to HPA axis suppression include the use of high-potency corticosteroids, large treatment surface areas, prolonged use, use of occlusive dressings, altered skin barrier, liver failure and young age.”
Anyone who has used prescription topical corticosteroids and experienced side effects should file a report with the FDA MedWatch Adverse Event Reporting Program at www.FDA.gov/MedWatch/Report.htm.