Pitfalls and opportunities in the treatment of atopic dermatitis

Abstract

In the first part of this thesis we investigated the systemic effects of topically applied corticosteroids on the adrenal gland and on bone mineral density (BMD). A single application of 20-30g of 0.1% betamethasone valerate ointment or 0.05% clobetasol propionate ointment resulted in a decrease of serum cortisol levels within 24 hours in 89.5% of adult patients with an exacerbation of AD. At the end of the hospital admission, recovery occurred in all patients when 0.005% fluticasone propionate ointment was used prior to discharge, in 60% when 0.1% betamethasone valerate ointment was used, but recovery was not observed when 0.05% clobetasol propionate ointment was used (10-30 g/day). After discharge, serum cortisol levels had normalized in all patients. A method is described to measure systemic levels of clobetasol propionate by liquid chromatography-tandem mass spectrometry (LC/MS/MS) during use of 0.05% clobetasol propionate ointment. Using this method, a single application of 20-30g 0.05% clobetasol propionate ointment in adult patients with an exacerbation of AD resulted in a rapid decrease of serum cortisol levels paralleled by serum levels of clobetasol propionate. A two-year follow-up study on BMD was done in adult patients with moderate to severe AD. The observed percentage of osteopenia (37.3%) and osteoporosis (4.0%) in our study was significantly higher compared to the general population, but remained constant during follow-up. We found no significant difference in the change of BMD between patients who had used