Steroid-responsive Dermatoses Research Articles

A survey of United States dermatologists' knowledge, attitudes, and practices with intramuscular triamcinolone.

Since the 1970s, intramuscular triamcinolone (IMT) has been available as an option for systemic corticosteroid use in dermatology. Although shown to be safe and effective in early studies, this method of systemic corticosteroid delivery fell out of favor in the 1980s in many United States residency programs. To identify factors associated with US dermatologists' preferences for and use of IMT we surveyed a random sample of US board-certified dermatologists to assess knowledge, attitudes, and practices regarding IMT in dermatologists' daily clinical practice. A total of 844 out of 2000 dermatologists completed the survey (42.2%). Only 55.0% reported feeling comfortable using IMT for steroid-responsive dermatoses, while 90.4% felt comfortable using oral corticosteroids for steroid-responsive dermatoses. Most participants (59.2%) did not prefer IMT over oral corticosteroids when both were indicated. One third (33.3%) of the participants reported that none of the faculty during their residency advocated using IMT. Receiving education on IMT indications (OR = 1.96 [95% CI: 1.46-2.63]) and encouragement to use IMT (OR = 4.29 [95% CI: 3.01-6.11]) during residency were positively associated with use of IMT at least once a month in current practice. Current knowledge, attitudes, and practices surrounding IMT vary amongst practicing dermatologists. Modifiable factors such as training could improve comfort with use of this short-term systemic steroid treatment modality.

Clobetasol propionate 0.025% cream in the management of steroid responsive dermatoses: an expert opinion

<p class="abstract">Topical corticosteroids play a key role in managing steroid responsive dermatoses (SRD). Current topical corticosteroid therapies are associated with various disadvantages. The current consensus article aims at providing a collation of evidence-based literature and clinical insights of the experts, regarding the efficacy, safety and usage of clobetasol propionate (CP) 0.025% cream in the management of SRD like plaque psoriasis. Clinical evidences suggest that the novel formulation of CP 0.025% cream has comparable efficacy and a better safety profile vs CP 0.05% cream in the management of plaque psoriasis. According to the doctors' experience, CP 0.025% can be used as first-line treatment for the management of SRD. In children 12-18-year-olds, CP 0.025% may be used cautiously, considering risk-benefit ratio. CP 0.025% may also be used as a maintenance therapy, after disease is brought under control with systemic therapy. Using moisturisers, salicylic acid, calcipotriol or tacrolimus as concomitant therapy with CP 0.025% cream may be beneficial in the management of SRD. In various comorbidities like diabetes and hypertension, CP 0.025% cream may be a better alternative verses CP 0.05% cream. Clinical evidences and experts suggest that for management of SRD, clobetasol propionate 0.025% cream can be recommended as a formulation with comparable efficacy and better safety profile versus CP 0.05% cream.</p>

JAAD Game Changers: A prospective observational study evaluating hypothalamic-pituitary-adrenal axis alteration and efficacy of intramuscular triamcinolone acetonide for steroid-responsive dermatologic disease

Capsule Summary:•Scant information on the administration, effectiveness, and safety of intramuscular triamcinolone acetonide (IM TAC), an important therapeutic alternative when topical corticosteroid treatment is impractical or ineffective, is available.•Thirty or 60 mg of IM TAC dosed 6 weeks apart on 2 occasions resulted in significant improvements in patient- and physician-reported clinical measures compared to baseline without causing iatrogenic Cushing syndrome or secondary adrenal insufficiency.•This series offers preliminary evidence of the efficacy and safety of IM TAC for a number of steroid-responsive dermatoses and provides a guide to dosing, frequency, and administration for dermatologist considering the use of IM TAC.How did this article change the practice of dermatology?A 30- or 60-mg intramuscular injection of triamcinolone does decrease total cortisol levels and results in significant improvement in patient- and physician-reported clinical measures compared with baseline.1 However, it does not appear to have significant clinical sequelae such as iatrogenic Cushing syndrome or secondary adrenal insufficiency in patients.

Development and Validation of RP-HPLC Method for Desoximetasone in Bulk and Cream Formulation

Desoximetasone chemically is 9-fluoro-IIβ21-dihydroxy-I6a-methylpregna-I.4-diene-3.The precise mechanism of the anti-inflammatory activity of topical steroids in the treatment of steroid-responsive dermatoses, in general, is uncertain. So, in present investigation chromatographic methods were developing use RP-HPLC for estimation of Desoximetasone in bulk and in cream formulation and method validation according to ICH guidelines. The main objective of this study was to develop a simple and reproducible method for desoximetasone by Reverse Phase High Performance Liquid Chromatography (RP-HPLC). In this work the desoximetasone separation was carried out by using C18 cosmosile column (250mmx4.6mm particle size 5µm). By using 0.1% orthrophosphoric acid pH adjusted up to 3 at uv detection of 240nm.The mobile phase was used at various ratio for gradient elution the ratio of mobile phase was 20:80 v/v. Methanol and water used for mobile phase and flow rate was being set at 1mL/min. The linearity of proposed method was found in range of r =0.9989. Statistically validation parameters such as linearity, accuracy, precision, LOD and LOQ were checked.
 Keywords: Desoximetasone, RP-HPLC, Method validation.

New opportunities in the therapy of steroid-specific dermatosis - combination of topical glucocorticosteroid with urinium

External therapy with topical steroids is used for a long time. To date topical glucocorticosteroids (TGCS) are in the leading position in dermatology among all medicines for external therapy. TGCS as a powerful tool of pathogenic action can rapidly reduce or decrease inflammatory changes in the skin and eliminate subjective symptoms of dermatoses (itching, burning). their positive effect lead to the rehabilitation of working ability and daily living activity, positively affect the psychoemotional state and significantly improve the patient’s quality of life. Urea in dermatology has been used for a very long time, as it softens the skin, reduces its dryness and eliminates peeling. In recent decades interest in this compound has intensified after a formation of an idea about natural moisturizing factor (NMF) - a complex of substances (which includes urea) being a part of the intercellular matrix of the epidermis and capable of retaining the water in the epithelial layer of the skin necessary for its normal functioning. The article presents modern literature data on the reasoning of the inclusion of a combination of topical glucocorticosteroids with urea in a complex therapy of steroid-responsive dermatoses.

Clinical experience of using 0.1% mometasone furoate cream for external treatment of steroid-responsive dermatoses

An up-to-date synthetic non-fluorated topical glucocorticosteroid, Histan-N (0.1% mometasone furoate cream), has an evident antiinflammatory, anti-allergic, immune-suppressive and antiproliferative action. Goal. To assess the efficacy, safety and tolerability of Histan-N for the treatment of patients with steroid-responsive dermatoses. Materials and methods. As many as 80 patients with eczema, psoriasis, atopic dermatitis, dermatitis and allergic dermatitis as well as lichen acuminatus underwent treatment. All of the patients received general pathogenetic therapy and external treatment with Histan-N. The treatment efficacy was assessed based on the trends of such dermatological indices as PASI, SCORAD and EASI as well as visual analog scale. Results. Dermatological indices reduced by 70%—90% as compared to the baseline against the background of treatment. Conclusion. The clinical results obtained for Histan-N demonstrate a substantial clinical effect of the drug, absence of adverse effects and high safety of the drug.

A prospective observational study evaluating hypothalamic-pituitary-adrenal axis alteration and efficacy of intramuscular triamcinolone acetonide for steroid-responsive dermatologic disease

The lack of recommendations regarding dosing and administration, an undetermined risk of hypothalamic-pituitary-adrenal axis alteration, and the unknown effectiveness of intramuscular (IM) corticosteroid injection to treat dermatologic disease may be deterrents to use. We sought to evaluate presence and duration of iatrogenic Cushing syndrome and secondary adrenal insufficiency in patients receiving IM triamcinolone acetonide (TAC), and to assess physician- and patient-reported outcomes. We conducted a prospective observational study of 14 patients given the diagnosis of steroid-responsive dermatologic disease who received either 1 or 2 doses 6 weeks apart of IM TAC. Baseline and follow-up cortisol, adrenocorticotropic hormone, Physician and Subject Global Assessments of Disease Activity Scale score, and the visual analog scale score of pruritus were evaluated at 6-week intervals. Although mean total cortisol was significantly decreased at 6 and 12 weeks compared with baseline, IM TAC did not result in iatrogenic Cushing syndrome or secondary adrenal insufficiency in any patient. Mean Physician and Subject Global Assessments of Disease Activity Scale scores were significantly improved at 6 and 12 weeks compared with baseline. Mean visual analog scale pruritus scores were significantly improved at 6 weeks compared with baseline. The study was limited by the cohort size and a lack of a comparator group. IM TAC appears safe when administered as 2 injections at 6-week intervals. Significant improvement was noted across a number of steroid-responsive dermatoses. These results may provide a guide to dosing, frequency, and administration for dermatologists considering the use of IM TAC in the appropriate clinical contexts.

Clinical utility of clocortolone pivalate for the treatment of corticosteroid-responsive skin disorders: a systematic review

Clocortolone pivalate 0.1% cream is a class IV mid-strength topical glucocorticoid. After topical application the glucocorticoid achieves higher concentration in inflamed skin compared with normal skin. Furthermore, pharmacologic studies have shown that there is little systemic absorption of clocortolone pivalate and hence no adrenal suppression. Systematic review was performed to evaluate the efficacy and safety of the glucocorticoid. PubMed, the Cochrane Library, and individual websites of the top 20 dermatology journals were searched using a defined strategy. Following the selection criteria, eight clinical trials were selected, of which five were randomized controlled trials. The trials mainly included patients with atopic dermatitis and eczemas. Quality appraisal of randomized controlled trials was done using the Delphi list, which showed that the trials had weaknesses in several items. The results of the systematic review tend to show that clocortolone pivalate cream is generally effective with early onset of action and has a good safety profile in the treatment of these conditions. Further studies comparing this glucocorticoid with other glucocorticoids and treatments in steroid-responsive dermatoses are desirable.

A study to evaluate the efficacy and safety of hydrocortisone aceponate 0.127% lipophilic cream in steroid responsive dermatoses in Indian patients

Topical corticosteroids (CSs) are the mainstay of therapy in various steroid responsive dermatoses. Newer CSs are more efficacious and safer than the older ones. There is no published data on the efficacy and safety of a new steroid hydrocortisone aceponate in the Indian population. To evaluate the efficacy and safety of hydrocortisone aceponate (0.127%) lipophilic cream in the treatment of steroid responsive dermatoses in Indian patients. Four hundred and fifteen patients with clinically diagnosed steroid responsive dermatoses enrolled in this study. They were advised to apply hydrocortisone aceponate (0.127%) lipophilic cream as a thin film to all the affected areas twice daily. Cleansing was done prior to the application with either soap-free cleanser or soap (that would not affect the study result). Use of oral antihistamines and/or antibiotics was permissible. However, other oral/topical steroid use was not permitted during the study. Patients were evaluated at day 0 and at day 21. Data were recorded regarding clinical improvement and side-effects, if any. They were then analyzed to determine the efficacy and safety of the cream. Physician's global evaluation of therapy showed that lesions were cleared in 82 (22.10%), excellent result in 200 (53.91%), good result in 72 (19.41%), fair response in 15 (4.04%) and no change in 2 (0.54%) patients. There was no history of exacerbation in any patient. The study showed that hydrocortisone aceponate (0.127%) lipophilic cream is an effective therapeutic agent with a very good safety profile in various steroid responsive dermatoses in the Indian patient population.

Compatibility of Tacrolimus Ointment with Corticosteroid Ointments of Varying Potencies

Tacrolimus is often coadministered with various topical corticosteroids in the treatment of steroid-responsive dermatoses; however, the stability of these products in combination has not been examined extensively. To assess the in vitro compatibility of three tacrolimus-corticosteroid ointment combinations compared with unmixed controls. Tacrolimus-clobetasol propionate, tacrolimus-desoximetasone, and tacrolimus-hydrocortisone-17-valerate ointment combinations were prepared, stored with unmixed ointments at three temperature/humidity conditions, and evaluated for stability at days 0, 1, 2, 7, 14, and 28 via reverse-phase high-performance liquid chromatography. There was no significant difference in the rate of drug degradation in mixed and unmixed ointments over time or across temperatures for tacrolimus (time p = .94; temperature p = .44), clobetasol (time p = .98, temperature p = .30), desoximetasone (time p = .98; temperature p = .94), or hydrocortisone-17-valerate (time p = .87, temperature p = .36). This study did not examine the compatibility of tacrolimus with nonointment formulations. Tacrolimus-clobetasol propionate (superpotent), tacrolimus-desoximetasone (high potent), and tacrolimus-hydrocortisone-17-valerate (midpotent) ointment combinations are chemically compatible for at least 4 weeks.

Desonide: a review of formulations, efficacy and safety

Background: Desonide is a low-potency topical corticosteroid that has been used for decades in the treatment of steroid-responsive dermatoses. The favorable safety profile of this topical agent makes it ideal for patients of all ages. Objective: This article provides a review of desonide's history, pharmacodynamic properties, vehicle technology, efficacy and safety. Methods: Randomized controlled trials, as well as open-label and non-comparative studies, case series and reports, experimental models, and data from the Galderma pharmacovigiliance program were reviewed in order to address the clinical efficacy and safety of desonide. Results/conclusion: Clinical efficacy and safety have been proven in multiple clinical trials. In addition to cream, lotion and ointment formulations, the recently developed hydrogel and foam preparations have increased desonide's versatility and patient tolerability.

Clobetasol propionate emulsion formulation foam 0.05%: Review of phase II open-label and phase III randomized controlled trials in steroid-responsive dermatoses in adults and adolescents

Clobetasol propionate 0.05% emulsion foam was recently developed for use on multiple body sites. We sought to evaluate safety and efficacy of clobetasol emulsion foam 0.05% to treat steroid-responsive dermatoses in multiple age groups. A phase II open-label study evaluated the effect of clobetasol foam on the hypothalamic-pituitary-adrenal axis in 52 participants aged 6 years or older with mild-to-severe atopic dermatitis (AD). Cosyntropin stimulation test was used to determine the effect of clobetasol foam on hypothalamic-pituitary-adrenal axis, with a normal response considered to be a postinjection serum cortisol level greater than 18 mug/dL. Another phase II open-label pharmacokinetic safety study was conducted in 32 participants aged 12 years or older with mild-to-moderate plaque-type psoriasis. Pharmacokinetic parameters evaluated included maximal plasma concentration of clobetasol propionate, time to achieve maximum concentration, and area under the curve. Two phase III, randomized controlled studies assessed treatment success in participants aged 12 years or older with moderate-to-severe AD (N = 377) or mild-to-moderate plaque-type psoriasis (N = 497). In all studies, participants received study drug for 2 weeks. In the AD study, treatment success was determined using a composite end point requiring an Investigator's Static Global Assessment (ISGA) score of 0 or 1, erythema score of 0 or 1, induration/papulation score of 0 or 1, and improvement in the ISGA score of at least two grades from baseline. Likewise, the study in plaque-type psoriasis used a composite end point requiring an ISGA score of 0 or 1, erythema score of 0 or 1, scaling score of 0 or 1, plaque thickness score of 0, and improvement in the ISGA score of at least two grades from baseline. Significantly more participants achieved treatment success on clobetasol foam than vehicle foam (P < .0001 and P = .0005 for each study). Reversible hypothalamic-pituitary-adrenal axis suppression was observed in 27% of participants aged 18 years or older and 47% in participants aged between 6 and younger than 12 years, but 0% in participants aged between 12 and younger than 18 years. The studies evaluated short-term use only. Clobetasol emulsion formulation foam is safe and effective for treatment of moderate-to-severe AD and mild-to-moderate plaque-type psoriasis in patients aged 12 years or older.

Relative efficacy and interchangeability ofvarious clobetasol propionate vehicles in the management of steroid-responsive dermatoses

Topical corticosteroids have long been the cornerstone in thetreatment of steroid-responsive dermatoses. Despite the effectiveness of these formulations, there is a misperception that drugs delivered via ointments are more potent than those delivered via other vehicles. Potency, however, is a complex function of the physical and chemical properties of both the active ingredient and its vehicle. Studies have determined that newer vehicles (eg, lotions), particularly those in the super-high-potency class, not only heighten the ability of the active ingredient to penetrate skin but also are preferred by patients over ointments and creams. This review of the literature investigates the effectiveness andtolerability of a high-potency corticosteroid lotion compared with cream or emollient cream formulations in treating moderate to severe plaque-type psoriasis and atopic dermatitis. A literature search was conducted of US and international published clinical trials (1975 to November 2004) comparing all potencies of topical corticosteroid cream and lotion formulations using MEDLINE and the Web sites of individual dermatologic journals. No specific study designs were excluded from this search. Search terms included corticosteroid-responsive dermatoses, creams versus lotions, topical corticosteroid clinical trials, plaque-type psoriasis, atopic dermatitis, clobetasol propionate, drug bioavailability, Class I topical agents, and vasoconstriction. The primary diagnoses were moderate to severe plaque-type psoriasis and atopic dermatitis. Two unpublished clinical investigations comparing clobetasol propionate lotion 0.05% with clobetasol propionate cream 0.05% and emollient cream 0.05% in a total of 421 patients were also included. In the 20 published and 2 unpublished trials identified and reviewed, the response rates were comparable between the lotion and cream formulations. In addition, in a psoriasis study, clobetasol lotion received significantly better cosmetic-acceptability ratings compared with clobetasol cream (P < 0.05). In the studies reviewed, the effectiveness and tolerability of clobetasollotion were comparable to those of clobetasol cream and emollient cream in studies in adults with moderate to severe psoriasis or atopic dermatitis

The use of foam vehicle topical corticosteroid formulations in combination with other topical agents: a clinical perspective based on available studies and observational use

Topical corticosteroid foam formulations available in the US include betamethasone valerate 0.12% foam (BMV foam) and clobetasol propionate 0.05% foam (CP foam). Both are approved for use in adult patients with steroid-responsive dermatoses affecting the scalp, with CP foam also approved for treatment of psoriasis affecting both scalp and non-scalp sites. Both BMV foam and CP foam have been shown to be effective for several dermatoses affecting off-scalp locations. As topical corticosteroids are commonly used in combination with other agents, such as topical calcineurin inhibitors, calcipotriene and tazarotene, the interaction and impact of the foam vehicle when used in combination with other topical agents has been evaluated. Available studies suggest compatibility with several other vehicles and therapeutic agents from both cutaneous pharmacokinetic and clinical perspectives. This poster reviews pharmocokinetic studies evaluating drug penetration and compatibility of topical corticosteroids formulated in a specific foam vehicle with other topical agents likely to be used in combination in the clinical setting. Clinical experience with combination treatments will also be included. Where available, pharmacokinetic information related to agents other than topical corticosteroids formulated in the same foam vehicle will also be discussed.

Inhibitory Activity of CX-659S, a Novel Diaminouracil Derivative, against the Rebound Phenomenon following Withdrawal of Corticosteroid Therapy for Chronic Contact Hypersensitivity Responses

Background: CX-659S, a newly discovered anti-inflammatory compound, exerts inhibitory effects on chronic contact hypersensitivity responses (CHRs) induced by repeated application with picryl chloride (PC), which is known to mimic many, if not all, events occurring within lesional skin of patients with atopic dermatitis (AD). CX-659S suppresses the expression of mRNA for interleukin (IL)-4 and IL-10 but not that for IFN-γ, and inhibits serum IgE production in a chronic CHR model. Although topical corticosteroids have been widely utilized in steroid-responsive dermatoses such as AD, their chronic use may be associated with significant side effects. In addition, a rebound phenomenonoften occurs after discontinuation of prolonged use of topical corticosteroids, with enhanced production of IgE and Th2 cell cytokines. The purpose of this study was to assess whether CX- 659S inhibits the rebound phenomenon after discontinuation of chronic treatment with prednisolone in a chronic CHR model in mice. Methods: The efficacy of CX-659S as a sequential therapeutic agent after discontinuation of chronic treatment with prednisolone was tested on PC-treated ears of BALB/c mice with chronic CHR. Effects were quantified by measurements of ear thickness, serum IgE and cytokine mRNA expression. Results: The rebound phenomenon was confirmed after discontinuation of chronic treatment with prednisolone in chronic CHR in mice, i.e. by evidence of flare thickening of the ear, enhanced expression of mRNA for IL-4 and IL-10 and increased serum IgE. Sequentially applied CX-659S suppressed these rebound phenomena with a good cosmetic result. Conclusions: CX-659S is the first promising compound with inhibitory activity on the rebound phenomenon following withdrawal of corticosteroid therapy without immunosuppression.

Comparative efficacy of once-daily flurandrenolide tape versus twice-daily diflorasone diacetate ointment in the treatment of psoriasis

Background: Flurandrenolide tape has recently been listed as a group I topical cortico-steroid. There are no studies that compare this product to group I ointments in the treatment of steroid-responsive dermatoses. Objective: Our purpose was to determine the relative efficacy of flurandrenolide (4 mg/cm 2 ) tape versus 0.05% diflorasone diacetate ointment in plaque psoriasis. Methods: Thirty patients participated in an investigator-blinded, randomized, bilateral paired-comparison study of flurandrenolide tape applied to lesions of one side of the body once daily for up to 16 hours versus diflorasone diacetate ointment applied contralaterally twice daily. Lesions were assessed at baseline, then reevaluated at 2 and 4 weeks. Results: Flurandrenolide tape–treated plaques showed consistently greater clearing in terms of erythema, scaling, induration, and treatment success for all plaques, as well as the subset of knee and elbow plaques, when compared with the lesions receiving diflorasone diacetate ointment. Conclusion: The efficacy of flurandrenolide tape in the treatment of psoriatic plaques surpasses that of diflorasone diacetate ointment. (J Am Acad Dermatol 1998;38:186-90.)

Long‐term treatment with 6α‐methylprednisolone aceponate

AbstractAim 6α‐Methylprednisolone aceponate (MPA) is a new steroid double ester for topical use, the potent action and lack of untoward side‐effects of which became evident in two different studies.Background Recent studies have proved the concept that MPA is both potent and extremely well tolerated when used for a relatively short time.Methods Two multicentre studies on patients with steroid responsive dermatoses using either MPA fatty ointment (n = 66) or MPA in a vehicle individually adapted to the patients' skin condition (n = 256) were conducted over a maximum of 4 and 6 months, respectively. Plasma Cortisol levels were determined in study I (n = 45) to reveal potential systemic effects.Results Complete healing and marked improvement were achieved in 86 % of 322 patients. There were no systemic side effects and no significant alteration in plasma Cortisol levels during and after treatment. Minor temporary local side effects were observed in 7%.Conclusion MPA (Advantan) is a potent antiinflammatory topical steroid virtually devoid of systemic adverse effects and with a low incidence of local side‐effects.

SAFETY AND EFFICACY OF MOMETASONE FUROATE CREAM IN THE TREATMENT OF STEROID RESPONSIVE DERMATOSES

The safety and efficacy of once daily application of mometasone furoate cream 0.1% was determined by comparison with twice daily applications of betamethasone dipropionate cream 0.05% in a single blind, dual centre, randomized study in patients with a variety of steroid-responsive inflammatory dermatoses, the most common of which was psoriasis. Morning plasma cortisol levels revealed little adrenal suppression in either of the two study groups and there was no significant difference between the two groups. Routine laboratory investigations showed no trends in values outside the normal ranges that were of clinical significance. Less skin atrophy was seen in the group treated with mometasone furoate. In comparison to the betamethasone dipropionate treated group, those treated with mometasone furoate exhibited only slight evidence of skin atrophy, and this was not observed before four to twelve weeks of treatment. Eighteen percent of patients using mometasone reported adverse reactions but all were of limited duration and did not persist despite continued application of the drug. Nine percent of patients using betamethasone dipropionate reported adverse effects. Both drugs were found to be highly effective with no significant difference between the two groups at the termination of the treatment period. Of importance is the fact that whilst mometasone furoate is found to be a highly effective treatment for a variety of steroid-responsive dermatoses, this drug has only a limited potential for production of local and systemic side effects. Thus, a high margin of safety can be expected for patients using this drug.

Once-Daily 0.1% Mometasone Furoate Cream versus Twice-Daily 0.1% Betamethasone Valerate Cream in the Treatment of a Variety of Dermatoses

A randomized, investigator-blind, parallel-group trial was conducted to compare the safety and efficacy of 0.1% mometasone furoate cream applied once daily with that of 0.1% betamethasone valerate cream applied twice daily in patients (n = 69) with allergic contact dermatitis, atopic dermatitis and other steroid-responsive dermatoses. After 3 day's treatment improvement in conditions averaged 38.2% and 39.3%, respectively, in the mometasone and betamethasone treatment groups, and after 21 days average improvements were 93.6% and 96.5%, respectively. The physicians' global evaluation of overall change in disease status and the patients' evaluation of treatment also indicated that the two treatment regimens produced comparable, rapid and progressive improvements in the patients' conditions, and no local side-effects were reported. It is concluded that mometasone furoate was as effective as betamethasone valerate in the treatment of a variety of steroid-responsive dermatoses, although mometasone furoate was applied only half as frequently.

A comparative study of betamethasone dipropionate with salicylic acid and betamethasone valerate for the treatment of steroid-responsive dermatoses of the scalp

Betamethasone dipropionate (0.05%) with salicylic acid (2%) lotion and betamethasone valerate (0.1%) lotion were compared in a double-blind randomized study in 56 patients with steroid-responsive dermatoses of the scalp (39 had psoriasis and 17 had eczema). Scaling and pruritis were the most common presenting features. Forty-seven patients completed the 3-week course of treatment. Both lotions resolved scaling, although the betamethasone dipropionate with salicylic acid was significantly better than the betamethasone valerate for scaling in psoriasis patients (p = 0.009). Virtually all patients had pruritus at baseline, and both treatments had a rapid onset of action, with a trend towards a higher proportion of complete symptom resolution in the betamethasone dipropionate patients after 2 weeks of treatment. Excoriation and inflammation were alleviated by both applications, especially for the psoriasis patients. This trend was reflected in the investigators' evaluation in the ‘much improved’ category, whe...