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Background: Percutaneous absorption of topically applied 0.05% clobetasol propionate (CLO) can be assessed indirectly by measuring cortisol levels. A direct way is to measure systemic levels of topically applied CLO., Methods: Serum concentrations of CLO were measured by liquid chromatography-tandem mass spectrometry (LC/MS/MS), and were related to serum cortisol levels in 25 patients with an exacerbation of atopic dermatitis (AD) before and after the first day of treatment with 0.05% CLO in hospital. The body surface area (BSA) affected by AD was measured., Results: Before the start of 0.05% CLO treatment, normal cortisol levels were measured (0.47 ± 0.18 μmol/l) and CLO concentrations could not be detected. After the first day of treatment, cortisol levels decreased to 0.04 ± 0.05 μmol/l. Serum concentrations of CLO could be detected in all patients (0.112-4.504 ng/ml). Levels did not differ between patients who had received two applications versus one application of 0.05% CLO. There was no correlation between the affected BSA and serum concentrations of CLO., Conclusion: Serum levels of CLO can be measured by LC/MS/MS. When prescribing 0.05% CLO, one must bear in mind that, even after an application of 20-30 g, CLO is systemically available and potent enough to induce adrenal gland suppression.

Background: Patients with severe atopic dermatitis (AD) often require treatment with oral immunosuppressive drugs. Everolimus is a rapamycin-derived macrolide with immunosuppressive and antiproliferative effects. Everolimus demonstrated efficacy not only in the prophylaxis of organ rejection in kidney transplant patients, but also in decreasing disease activity in psoriasis patients., Objective: To evaluate whether everolimus is an effective treatment in patients with severe AD., Methods: Two patients with severe AD were treated with everolimus in combination with low-dose cyclosporin A (CsA) or prednisone. During treatment, a disease activity and safety laboratory examination was performed., Results: Everolimus either in combination with prednisone or with CsA did not result in improvement of disease activity in two patients with severe AD., Conclusion: Everolimus does not seem to be an effective treatment in these two AD patients, either in combination with prednisone or with CsA.