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In a randomized double blind study, we investigated the systemic effects of 3 different ointments containing corticoids. Every 7 patients out of a total of 21 patients suffering from various skin diseases were daily treated with 40 g of one of the 3 corticoid preparations over 8 days (group A: 0.05% clobetasol-17-propionate; group B: 0.25% fluocortolone trimethyl acetate; group C: 0.25% fluocortolone trimethyl acetate + 0.25% fluocortolone capronate). The plasma cortisol levels were determined by radioimmune assay. In group B and C, we did not observe any effect on the pituitary-adrenal axis, whereas in group A the plasma cortisol levels were extremely low already after 1 day of corticoid application. This adrenal suppression did not return to normal within 4 days after discontinuation of the corticoid. Our results suggest that highly potent topical corticoids are capable of adrenal suppression even without occlusive dressing and even in healthy persons.

The new corticosteroid diflucortolone valerate was clinically investigated in an international, multi-centre trial by a total of 162 dermatologists in 22 countries in more than 6,285 patients with inflammatory and allergic skin diseases. Depending on the condition of the skin, diflucortolone valerate was applied as a cream, ointment or fatty ointment at a concentration of 0.1%. Most of the patients treated with the cream displayed weeping skin conditions. The ointment was used mainly in patients with neither weeping nor very dry skin conditions, while the fatty ointment was employed mainly in very dry processes. After the exclusion of invalid record forms, 5,578 cases remained for computer evaluation. The results confirm that the success rate in local corticoid therapy can be improved by adapting the base to the respective skin condition. The forms investigated were found to be highly effective preparations with excellent skin tolerance. They can be placed on a par with today's leading topical corticoid preparations.

A 45-year-old patient developed squamous cell carcinoma 4 years after renal transplantation and immunosuppressive therapy with azathioprine and fluocortolone. During the following 3 years, the patient developed on sun-exposed skin several premalignant hyperkeratoses, Bowen's carcinoma, basal cell carcinoma, as well as squamous cell carcinoma and carcinoma of the eccrine sweat glands, both showing the clinical picture of keratoacanthoma.