When dealing with patients with severe
atopic dermatitis (AD), inpatient treatment is useful for alleviating skin symptoms in short periods of time. We previously found that many severe AD patients had low serum
cortisol levels at admission. The present study was undertaken to evaluate the efficacy of inpatient treatment in 29 adults with AD through comparisons of serum
cortisol, plasma
adrenocorticotropic hormone (
ACTH), serum
thymus and activation-regulated chemokine (TARC), and serum
lactate dehydrogenase (LDH) levels at admission with those at the time of discharge. Serum
cortisol and plasma
ACTH levels were significantly higher at discharge. On the other hand, serum TARC and serum LDH were significantly lower at discharge. We examined whether the suppression of hypothalamic-pituitary-adrenocortical function that was seen at admission was attributable to disturbed circadian rhythms due to
sleep disorders by analyzing hypothalamic-pituitary-adrenocortical function in relation to the presence/absence of
sleep disorders, serum
cortisol levels and daily urinary free
cortisol. Of the 17 patients with low serum
cortisol levels upon admission, 15 (88.2%) had
sleep disorders upon admission. However, the daily urinary free
cortisol increased significantly from 8.0 ± 5.5 μg/day (at admission) to 18.5 ± 17.2 μg/day (at discharge). These results suggested that the suppression of endocrine function seen at admission was not attributable to disturbed circadian rhythms due to
sleep disorders but represented true suppression of the endocrine system. These results indicated that inpatient care was useful for treating patients with severe AD, enabling efficient improvement of the skin condition and recovery from suppressed endocrine function.