The use of topical corticosteroids for skin conditions may suppress adrenal gland function. According to an article in Family Practice News (January 1, 2004:69), the U.S. Food and Drug Administration recommended that a black box warning be placed on certain topical steroid medications.
A black box warning is the strongest safety warning required by the FDA and is reserved for medications that carry a risk of serious adverse effects. The warning typically appears within a black border on the drug label and in prescribing information. When clinical evidence suggests that a medication poses a significant risk, the FDA can require manufacturers to include this warning.
Use of topical steroids may lead to asymptomatic secondary adrenal suppression, particularly when used to treat atopic dermatitis in children. This suppression often goes unnoticed until the child experiences physiological stress—such as trauma or infection—which may precipitate acute adrenal insufficiency. Symptoms of acute adrenal insufficiency can include low blood pressure, weakness, fatigue, nausea, and vomiting, and are often mistaken for other conditions.
Topical steroids are frequently prescribed for infants and young children with atopic dermatitis, sometimes in children under six months of age. This makes awareness of potential systemic effects especially important, even when medications are applied to the skin rather than taken orally.
