ASSESSMENT OF HPA-AXIS SUPPRESSION WITH FLUTICASONE CREAM 0.05-PERCENT IN PATIENTS WITH EXTENSIVE PSORIASIS OR ECZEMA

Objective: This study evaluated the effects of fluticasone cream 0.05% on the hypothalamopituitary-adrenal (HPA) axis in patients with exten sive psoriasis or eczema. Patients: Six inpatients in a hospital setti ng, three with extensive eczema and three with extensive psoriasis of at least 30% body surface involvement, were enrolled in this study. Me thods: In an open-label design, all patients received fluticasone crea m 0.05%, 15 g applied twice daily without occlusion for 7 consecutive days. The primary outcome measures were HPA-axis suppression (determin ed by morning plasma cortisol and 24-hour urinary free cortisol concen trations), selected blood chemistries, urinalysis and haematology prof ile. Results: During the treatment phase, four of the six patients stu died experienced insignificant changes in morning plasma cortisol conc entrations. In one patient, a decrease in plasma cortisol concentratio ns occurred following several days of treatment; these concentrations recovered after 6 to 7 days of treatment. In the remaining patient, a marked decrease in morning plasma cortisol concentrations occurred, wh ich may have been attributed to consumption of alcohol by this patient . Conclusion: Fluticasone cream 0.05% was well tolerated in patients w ith extensive eczema or psoriasis and had a low potential for suppress ing endogenous cortisol secretion, even when applied to extensive area s of diseased skin for 7 days.