Insulin-Like Growth Factor Axis, Bone and Collagen Turnover in Children with Atopic Dermatitis Treated with Topical Glucocorticosteroids

Abstract

Topical glucocorticosteroids are widely used in the treatment of children with atopic dermatitis. Due to percutaneous absorption, these agents may become systemically available and cause inhibition of growth in children. However, the mechanisms responsible for the growth-suppressive effective are not fully understood. To evaluate whether treatment with topical budesonide has any adverse effects on growth-hormone-dependent serum levels of insulin-like growth factor I (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3), and on the serum markers of bone and collagen turnover osteocalcin, the carboxy-terminal propeptide of type I collagen (PICP), the carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) and the amino-terminal propeptide of type III procollagen (PIIINP). 13 children (mean age 9.5 years) with atopic dermatitis were studied in an open longitudinal trial with run-in and budesonide treatment periods of 2 weeks' duration. During the run-in, only emollient was used. During the treatment period, budesonide cream 0.025% followed by emollient were applied twice daily all over the body except on the face. At day 14 of each period, blood samples were taken and eczema was scored according to a severity index based on extent and activity of the disease. Compared to the run-in, budesonide treatment was associated with a statistically significant reduction in mean severity index (p = 0.002). No statistically significant effects on serum levels of IGF-I, IGFBP-3, osteocalcin or ICTP were observed. The serum concentrations of PICP and PIIINP were reduced with (mean +/- 1 SD) 43 +/- 64 milligrams (95% confidence interval 3.5-80 milligrams, p = 0.03, t = 2.4, d.f. = 12) and 1.2 +/- 1.5 milligrams (95% confidence interval 0.3-2.1 milligrams, p = 0.01, t = 3.0, d.f. = 12), respectively. Type I and III collagen turnover may be suppressed during short-term treatment with topical budesonide in children with atopic eczema. clinical implications need further study.