Deflazacort—a safer systemic steroid for the treatment of chronic dermatoses

Systemic steroids are widely and effectively used for the management of many chronic skin disorders. However, prolonged administration of glucocorticoids is associated with unwanted effects, including impairment of glucose tolerance, weight gain and acceleration of bone loss. Clinical and animal studies have shown that deflazacort, an oxazoline derivative of prednisolone, may have less deleterious effects on bone and glucose metabolism at doses with equivalent immunosuppressive and anti‐inflammatory activity (Cannigia et al. , 1977; Gennari et al. , 1980; Hahn, Baran & Halstead, 1979). We have studied 15 patients established on long‐term treatment with oral prednisolone (> 3 months) for a variety of dermatological conditions and in whom deflazacort was substituted in an equivalent dose (5 mg prednisolone =6 mg deflazacort). Patients were investigated before, and 3 months after, substitution. The dose required of deflazacort did not change, nor did the clinical condition deteriorate, suggesting the adequacy of the substitution to control the dermatological disorder. Fasting urine calcium/creatinine, an index of net calcium release from bone, decreased, and this decrease was most marked in adult patients in whom calcium excretion was increased before starting deflazacort (P < 0.005 at I month; P < 0.05 at 3 months). This was associated with a decrease in hydroxyproline excretion but no change in serum alkaline phosphatase, suggesting that the decrease in skeletal losses was due to a decrease in bone resorption. Patients who had marked weight gain on prednisolone had significant weight loss (mean 5 48 kg) within 3 months of changing to deflazacort. There were no significant changes in glucose metabolism and blood pressure. We conclude that deflazacort is well tolerated, maintains adequate control of steroid‐requiring dermatoses, and may have less adverse effects than prednisolone.