Topical fluticasone in atopic dermatitis

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Fluticasone propionate (FP) is a synthetic corticosteroid with potent anti-inflammatory properties, best known to most pediatricians for use as an inhaled preparation in asthma. More recently, topical FP preparations have been formulated for use in atopic dermatitis.

The use of potent corticosteroids on the skin of small infants is always concerning, both for direct cutaneous effect but also because of systemic absorption. The high skin surface to body volume ratio of small infants makes them, in theory, much more susceptible to such systemic effects.

Hebert et al report the systematic assessment of hypothalamic pituitary adrenal axis function in 44 children receiving FP for extensive, severe atopic dermatitis; the mean body surface area treated in these children was 65%. There was no significant difference in baseline or cosyntropin-stimulated cortisol in these children from baseline to the end of treatment (which was at least four weeks). This data should be reassuring to practitioners considering topical FP in infants with extensive atopic dermatitis.