418 Risk of adrenal insufficiency in pre-pubertal girls treated with ultra-potent steroids for lichen sclerosus

• Published in: Archives of disease in childhood Vol. 108; no. Suppl 2; pp. A222 - A223
• Main Authors: Lee, Hannah, Corbett, Harriet, Blair, Joanne, Webster, Sara, Williams, Cara
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023
• Subjects: Cortisol; Females; Girls; Hormones; Hydrocortisone; Inflammation; Lichens; Menopause; Patients; Propionic acid; Puberty; Sclerosis; Skin; Steroid hormones; Steroids
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.353

ObjectivesLichen sclerosis et atrophicus (LS) is an inflammatory skin condition which mainly affects the genitals. In females the condition is seen most commonly in girls before puberty and women after menopause. The aetiology is unknown, but an autoimmune association is likely. LS is usually treated by application of very potent topical steroids (clobetasol propionate). However, there are concerns about systemic absorption of potent steroids through pre-pubertal genital skin. There is a lack of research about the risks of adrenal insufficiency following use of topical steroids in this patient group.The aims of this study:To understand the risk of adrenal insufficiency when using a very potent topical corticosteroid on pre-pubertal genital skin when treating LS.To determine the feasibility of testing early morning cortisol in order to monitor cortisol levels during treatment of LS in pre-pubertal girls with a very potent topical corticosteroid.MethodsTo treat LS, girls apply clobetasol propionate topically to the affected area for 12 weeks. For the first 4 weeks this is applied once a day, then reduced to alternate days from weeks 4–8, finally reduced to twice weekly from weeks 8–12.Early morning serum cortisol levels were requested at 4, 8 and 12 weeks. A cortisol level of below 100 nmol/L raised the suspicion of adrenal insufficiency. A short synacthen test (SST) was undertaken, and oral hydrocortisone was used as treatment if confirmed.ResultsBetween Nov 2019 and May 2022, 21 pre-pubertal girls received topical steroids for LS, 18 had serum cortisol measured at least once during treatment.4/18 (22%) of girls in this study had low serum cortisol (<100nmol/L) and underwent SST.3/4 (75%) of girls with low serum cortisol had a normal SST.1 girl was diagnosed with adrenal insufficiency following SST and commenced oral hydrocortisone as treatment.ConclusionThis small-scale study highlights a need to measure cortisol levels in this patient group due to the risk of adrenal insufficiency. However, families found it difficult to attend hospital for the tests and the children were reluctant to undergo repeated venepuncture. Recent studies indicate that salivary samples are an accurate way to measure cortisol and this method will be used in forthcoming studies.