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Systemic absorption of topical corticosteroids has
produced reversible hypothalamicpituitary- adrenal (HPA) axis suppression,
manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some
Conditions which augment systemic absorption include the
application of the more potent steroids, use over large surface areas,
prolonged use, and the addition of occlusive dressings. Therefore, patients receiving
a large dose of a potent topical steroid applied to a large surface area and
under an occlusive dressing should be evaluated periodically for evidence of
HPA axis suppression by using the urinary free Cortisol and ACTH stimulation
tests. If HPA axis suppression is noted, an attempt should be made to withdraw
the drug, to reduce the frequency of application, or to substitute a less
Recovery of HPA axis function is generally prompt and
complete upon discontinuation of the drug. Infrequently, signs and symptoms of
steroid withdrawal may occur, requiring supplemental systemic corticosteroids.
Children may absorb proportionally larger amounts of
topical corticosteroids and thus be more susceptible to systemic toxicity. (See
If irritation develops, topical corticosteroids should be
discontinued and appropriate therapy instituted.
In the presence of dermatological infections, the use of
an appropriate antifungal or antibacterial agent should be instituted. If a
favorable response does not occur promptly the corticosteroid should be discontinued
until the infection has been adequately controlled.
The following tests may be helpful in evaluating the HPA
Urinary free Cortisol test
ACTH stimulation test
Carcinogenesis, Mutagenesis, And Impairment Of Fertility
Long-term animal studies have not been performed to
evaluate the carcinogenic potential or the effect on fertility of topical
corticosteroids. Studies to determine mutagenicity with prednisolone and
hydro-cortisone have revealed negative results.
Pregnancy Category C
Corticosteroids are generally teratogenic in laboratory
animals when administered systemically at relatively low dosage levels. The
more potent corticosteroids have been shown to be teratogenic after dermal application
in laboratory animals. There are no adequate and well-controlled studies in
pregnant women on teratogenic effects from topically applied corticosteroids.
Therefore, topical corticosteroids should be used during pregnancy only if the potential
benefit justifies the potential risk to the fetus. Drugs of this class should
not be used extensively on pregnant patients, in large amounts, or for
prolonged periods of time.
It is not known whether topical administration of
corticosteroids could result in sufficient systemic absorption to produce
detectable amounts in breast milk. Systemically administered corticosteroids
are secreted into breast milk in quantities not likely to have a deleterious
effect on the infant. Nevertheless, caution should be exercised when topical
corticosteroids are administered to a nursing woman.
Pediatric patients may demonstrate greater
susceptibility to topical corticosteroid induced HPA axis suppression and
Cushing's syndrome than mature patients because of a larger skin surface area
to body weight ratio.
Hypothalamic-pituitary-adrenal (HPA) axis suppression,
Cushing's syndrome, and intra-cranial hypertension have been reported in
children receiving topical corticosteroids. Manifestations of adrenal
suppression in children include linear growth retardation, delayed weight gain,
low plasma Cortisol levels, and absence of response to ACTH stimulation.
Manifestations of intracranial hypertension include bulging fontanelles,
headaches, and bilateral papilledema.
Administration of topical corticosteroids to children
should be limited to the least amount compatible with an effective therapeutic
regimen. Chronic corticosteroid therapy may interfere with the growth and development