Assessment of HPA-Axis Suppression with Fluticasone Cream 0.05% in Patients with Extensive Psoriasis or Eczema

Abstract

This study evaluated the effects of fluticasone cream 0.05% on the hypothalamopituitary-adrenal (HPA) axis in patients with extensive psoriasis or eczema. Six inpatients in a hospital setting, three with extensive eczema and three with extensive psoriasis of at least 30% body surface involvement, were enrolled in this study. In an open-label design, all patients received fluticasone cream 0.05%, 15g applied twice daily without occlusion for 7 consecutive days. The primary outcome measures were HPA-axis suppression (determined by morning plasma cortisol and 24-hour urinary free cortisol concentrations), selected blood chemistries, urinalysis and haematology profile. During the treatment phase, four of the six patients studied experienced insignificant changes in morning plasma cortisol concentrations. In one patient, a decrease in plasma cortisol concentrations 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, which may have been attributed to consumption of alcohol by this patient. Fluticasone cream 0.05% was well tolerated in patients with extensive eczema or psoriasis and had a low potential for suppressing endogenous cortisol secretion, even when applied to extensive areas of diseased skin for 7 days.