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Joel Schlessinger, MD; Bruce Miller, MD; Richard D. Gilbert, PhD; R. Todd Plott, MD;

Arch Dermatol. 2006;142:1568-1572.

Objective  To assess the potential of a superhigh-potency 0.1% fluocinonide cream to suppress the hypothalamic-pituitary-adrenal (HPA) axis in pediatric patients with atopic dermatitis.

Design  A multicenter, multiple-dose, open-label safety study in 4 age cohorts with 0.1% fluocinonide cream applied once or twice daily for 2 weeks.

Setting  Clinical outpatient setting.

Patients  Patients with moderate to severe atopic dermatitis with 20% or more of the body surface area involved were included in the study. Each cohort began only after evaluation of the preceding cohort: ages 12 to younger than 18 years (cohort 1); 6 to younger than 12 years (cohort 2); 2 to younger than 6 years (cohort 3); and 3 months to younger than 2 years (cohort 4).

Main Outcome Measures  Assessment of HPA axis suppression, local and systemic adverse events, and change in disease status from baseline.

Results  Suppression of the HPA axis was not observed in any patient treated once daily for the 2 youngest cohorts. Suppression was observed in 1 (7%) of 15 and 2 (12%) of 16 patients in the fluocinonide twice-daily group in cohorts 1 and 2, respectively. In all 4 cohorts, more than 90% of patients in the fluocinonide once-daily and twice-daily groups showed improvement in their disease status.

Conclusions  Once-daily treatment with 0.1% fluocinonide cream for 2 weeks does not result in HPA axis suppression under the conditions of this study. Once-daily applications provided similar or better efficacy as twice-daily applications with a lower risk of HPA axis suppression. The frequency of HPA axis suppression is no greater in younger children than in older children.

Trial Registration  isrctn.org Identifier: ISRCTN71227633

Author Affiliations: Skin Specialists PC, Advanced Skin Research Center, Omaha, Neb (Dr Schlessinger); Oregon Medical Research Center Inc, Portland (Dr Miller); TKL Research Inc, Paramus, NJ (Dr Gilbert); and Medicis Pharmaceutical Corp, Scottsdale, Ariz (Dr Plott).

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