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

Abstract

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.

• Authors: Margret J Einarsdottir, Maria Bankvall, Jairo Robledo-Sierra, Per-Olof Rödström, Ragnhildur Bergthorsdottir, Penelope Trimpou, Bengt Hasséus, Oskar Ragnarsson
• Journal: Oral diseases (Oral Dis) (Apr 27 2023) ISSN: 1601-0825 [Electronic] Denmark
• PMID: 37103329 (Publication Type: Journal Article)
• Copyright: © 2023 The Authors. Oral Diseases published by Wiley Periodicals LLC.