Adrenal Function After Application of Topical Steroids Under Occlusive Plastic Film

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Abstract
BECAUSE OF the very large increase in the use of topical steroids under plastic films1 in such conditions as psoriasis and atopic dermatitis, we thought that it would be worthwhile to study the adrenal function of patients who are undergoing such therapy. Except for tests which are concerned with adrenal reserve, determination of 17-ketosteroids and 17-hydroxysteroids in the urine is probably the most sensitive indicator available at the present time for evaluation of adrenal suppression due to administration of some of the more recently developed anti-inflammatory steroid compounds. These apparently are excreted in a form which is not detected by current methods used for measuring 17-ketosteroids or 17-hydroxysteroids in the urine,2 so that the values obtained represent only endogenous production. This approach was not feasible with topically applied hydrocortisone and prednisone, the urinary end-products of which are similar to those resulting from endogenous adrenal secretion. Goldman and Cohen