Topical clobetasol treatment for oral lichen planus can cause adrenal insufficiency.

Autor: Einarsdottir MJ; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden., Bankvall M; Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden., Robledo-Sierra J; Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Faculty of Dentistry, CES University, Medellin, Colombia., Rödström PO; Clinic for Oral Medicine, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden., Bergthorsdottir R; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden., Trimpou P; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden., Hasséus B; Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Clinic for Oral Medicine, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden., Ragnarsson O; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Jazyk: angličtina
Zdroj: Oral diseases [Oral Dis] 2024 Apr; Vol. 30 (3), pp. 1304-1312. Date of Electronic Publication: 2023 Apr 27.
DOI: 10.1111/odi.14588
Abstrakt: Objective: Glucocorticoids suppress the hypothalamic-pituitary-adrenal axis, which may lead to glucocorticoid-induced adrenal insufficiency. The study aimed to investigate the prevalence of this state in patients with oral lichen planus treated with topical clobetasol propionate.
Methods: In this cross-sectional study, 30 patients with oral lichen planus receiving long-term (>6 weeks) clobetasol propionate gel 0.025% were invited to participate. Adrenal function was assessed by measuring morning plasma cortisol after a 48-h withdrawal of clobetasol treatment. In patients with plasma cortisol <280 nmol/L, a cosyntropin stimulation test was performed.
Results: Twenty-seven patients were included. Twenty-one (78%) patients presented with plasma cortisol ≥280 nmol/L (range 280-570 nmol/L), and six (22%) <280 nmol/L (range 13-260 nmol/L). Five of these six patients underwent cosyntropin stimulation that revealed severe adrenal insufficiency in two patients (cortisol peak 150 nmol/L and 210 nmol/L) and mild adrenal insufficiency in three patients (cortisol peak 350-388 nmol/L).
Conclusion: In this study, approximately 20% of patients receiving intermittent topical glucocorticoid treatment for oral lichen planus had glucocorticoid-induced adrenal insufficiency. It is essential for clinicians to be aware of this risk and to inform patients about the potential need for glucocorticoid stress doses during intercurrent illness.
(© 2023 The Authors. Oral Diseases published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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