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Skin atrophogenic potential of methylprednisolone aceponate (MPA)
Author(s) -
Ortonne J.P.
Publication year - 1994
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/j.1468-3083.1994.tb01058.x
Subject(s) - medicine , dermatology , telangiectasia , placebo , double blind , corticosteroid , atrophy , clobetasol propionate , surgery , pathology , alternative medicine
The most prominent and most discussed local side effect of topical corticosteroids is the thinning of the skin. Therefore, the atrophogenic potential is an important indication of the quality of a new corticosteroid. Several studies have been conducted to investigate this parameter. In rats, the effect of breaking strength of the skin, the most appropriate model for evaluating atrophogenicity in animals, showed that MPA and prednicarbate (PC) reduced the breaking strengh only slightly compared to clobetasol propionate (CBP). These results indicate that MPA could be classified as a corticosteroid with low local atrophogenic potential. This was confirmed in humans by a placebo controlled double‐blind study comparing intra/interindividuals MPA (cream, ointment and fatty ointment) and bethamethasone‐17‐valerate (BMV), CBP and PC (cream only) under occlusive dressing over 6 weeks. Three different parameters were assessed (dermal atrophy (clinical picture), surfometric measurement of the dermatoglyphic pattern, visual evaluation of telangiectasia). In all three formulations, MPA is of lower atrophogenic potential than CBP. While there is no statistical difference between BMV and MPA, the atrophogenic potential of MPA is low. In order to reflect more the clinical use of topical corticosteroids, MPA preparations (cream 0.1% and fatty ointment) has been evaluated in comparison to BMV in an 8‐week non‐occluded application test. MPA was applied once a day (5 days a week) and BMV twice in 20 healthy subjects according to a double‐blind randomized design. Assessment of atrophogenic potential was performed weekly using clinical scores (atrophy and telangiectasia) as main criteria and skin thickness measurements (ultrasound imaging) as a second criterion. BMV cream gives higher numbers of telangiectasia than MPA preparations and vehicles. From the skin thickness measurements, MPA treatments once a day has a lower thinning potential than BMV twice a day. These findings were confirmed by clinical trials. In 1145 patients suffering from various types of eczema who used MPA in cream and ointment, mild atrophy of the skin was observed in only one patient. Moreover, clinical signs of atrophy were present in only two out of a group of 673 patients (590 adult and 83 children) treated with MPA fatty ointment. In a group of 66 patients who used this same MPA fatty ointment during 3–4 months, no signs of skin atrophy were observed. Considering animal and human studies, MPA can be classified as a corticoid with low atrophogenic potential.