PLASMA CORTISOL LEVELS AFTER TOPICAL USE OF FLUOCINOLONE ACETONIDE.

EVIDENCE of suppression of the adrenal cortical hormones by topical steroids used under polythene occlusive dressings in the treatment of psoriasis has recently been reported by Scoggins (1962), Gill and Baxter (1964) and Kirketerp (1964). Scoggins and Kirketerp used fluocinolone acetonide 0-025% and Gill and Baxter 0-01%. Scoggins, Gill and Baxter only studied subjects who had had " total body occlusion " using 45 g. or more of the cream. Scoggins applied this quantity of cream twice daily and Gill and Baxter only once a day followed by a 12-hour period of occlusion. Kirketerp occluded 17-78 % of the skin and applied 10 g. of the cream daily to each 17% of body surface occluded. Even using as little as 10 g. of cream, Kirketerp found a decrease in the urinary excretion of the 17-ketogenic steroids. In practice it has been found that the clinical results of treatment with weaker concentrations of fluocinolone acetonide than those of the standard (0025 and 001 %) commercial preparations are satisfactory. Further, occlusion of the entire skin surface is not as frequently employed as occlusion of smaller areas. This form of therapy is now employed extensively as outpatient treatment, and in some instances for a considerable length of time. We have studied the effect of the use of a weak preparation of fluocinolone acetonide in such cases in order to determine whether suppression of the plasma 11-hydroxycorticosteroids (plasma eortisol) occurs. Investigations by Christy et al. (1956) suggested that small doses of oral steroids administered for a long time (i.e. 6-12 months) may be more likely to suppress adrenal cortical function in conditions of stress than larger doses of oral steroids for a short time (i.e. approximately 1-4 weeks). Thus protracted occlusive therapy with topical steroids, might prove a hazard to the patient.