Topical clobetasol treatment for oral lichen planus can cause adrenal insufficiency

Abstract

AbstractObjectiveGlucocorticoids 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.MethodsIn 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.ResultsTwenty‐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).ConclusionIn 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.