Determination of HPA axis suppression in patients on systemic steroids in dermatology

Abstract

Steroids are mainstay of treatment in most of the non-infectious dermatological conditions. The study was conducted to determine how various doses and duration of systemic steroid therapy affects HPA axis. To determine HPA axis status in patients on systemic steroids in dermatology. To study how various doses and duration of steroid treatment affects HPA axis. This longitudinal study was conducted on 77 patients who were on systemic steroids for dermatological conditions. Patients were categorized into 6 groups depending on the dosage and duration of steroid treatment. Serum 8 a.m. Cortisol and ACTH levels were tested. About 54 patients were on long term steroids and 23 were on short term steroids. 44 patients (81.5%) on long term steroids had suppressed levels of cortisol and 39 patients (72.2%) had suppressed levels of ACTH. Suppression was maximum in patients on high dose and taken for long duration (p<0.001). There was significant lowering in mean 8AM cortisol and ACTH levels after short term steroid therapy; however, no suppression was seen. Duration of steroid therapy and suppression of 8AM cortisol and ACTH values were associated significantly. Patients on short term steroids showed no suppression of both serum 8 a.m. cortisol and ACTH levels but there was statistically significant lowering of levels. The study found that longer the duration and higher the dose of steroid therapy, the greater is the suppression of both serum 8 a.m. cortisol and ACTH levels.