Effects of topical corticosteroid versus tacrolimus on insulin sensitivity and bone homeostasis in adults with atopic dermatitis—A randomized controlled study

Abstract

AbstractIntroductionTopical corticosteroids (TCS), used to treat atopic dermatitis (AD), have been associated with type 2 diabetes and osteoporosis in epidemiological studies, possibly explained by systemic absorption.ObjectivesWe examined whether intensive daily whole‐body TCS treatment over 2 weeks followed by twice weekly application for 4 weeks could elicit insulin resistance and increase bone resorption in adults with AD.MethodsA randomized parallel‐group double‐blind double‐dummy non‐corticosteroid‐based active comparator study design was completed in Copenhagen, Denmark. Thirty‐six non‐obese, non‐diabetic adults with moderate‐to‐severe AD were randomized to whole‐body treatment with betamethasone 17‐valerate 0.1% plus a vehicle once daily or tacrolimus 0.1% twice daily after washout. Insulin sensitivity assessed by the hyperinsulinemic‐euglycemic clamp combined with tracer infusions and biomarkers of bone formation (P1NP) and resorption (CTX) were evaluated at baseline, after 2 weeks of daily treatment and after further 4 weeks of twice‐weekly maintenance treatment.ResultsAD severity improved with both treatments and systemic inflammation was reduced. After 2 weeks, we observed similar increase in peripheral insulin sensitivity with use of betamethasone (n = 18) and tacrolimus (n = 18). Bone resorption biomarker, CTX, was unchanged, while bone formation marker, P1NP, decreased after betamethasone treatment after both 2 and 6 weeks but remained unchanged in the tacrolimus arm.ConclusionsWhole‐body treatment with TCS leads to systemic exposure but appears not to compromise glucose metabolism during short‐term use, which may be a result of reduced systemic inflammatory activity. The negative impact on bone formation could be regarded an adverse effect of TCS.