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Corticoids given therapeutically may interrupt the loop on feedback mechanism by which plasma cortisol levels are controlled. This was demonstrated when corticoids were applied to the skin in the treatment of dermatoses and when taken by mouth the patients with polyarthritis. In rats, Endomethasone root fillings has similar effect. Corticoids applied to the gingiva or instilled into periodontal pockets did not lower group mean plasma cortisol levels but individual patients did show suppression of cortisol secretion. It is concluded that all corticoids, no matter how applied, will have this effect, although present analytical methods may be too insensitive to detect the smaller changes.

A new topical corticosteroid: fluocortin-butylester, was employed in 11 eczematous children (atopic and seborrhoeic dermatitis), with a good clinical result. These topical applications involve no significant risk of interference with the pituitary-adrenal function.

50 patients with weeping dermatoses were treated with the investigational preparation SH K 183 MB - Nerisona Cream. Very good or good results were achieved in 90% of the cases. No systemic or topical side effects were observed. The cream was assessed as being very good in respect of its cosmetic properties.

Record on a case of collagen disease with pure red cell anemia and perimembraneous glomerulonephritis. The direct antiglobulin tests with anti-IgG and anti-kappaserum were positive as were the tests on antinuclear serum-antibodies. During therapy with fluocortolon and azathioprin the anemia remitted completely even when therapy was stopped. The antiglobulin tests became negative, the glomerulitis remained active, there was no deterioration of renal function.

Butyl 6alpha-fluoro-11beta-hydroxy-3,20-dioxo-16alpha-methyl-1,4-pregnadien-21-oate (fluocortin butylester, Vaspit) is a recently developed corticosteroid, its distinguishing properties being that it is non-embryotoxic and has practially no systemic effects. In the course of 6 multicentre studies fluocortin butylester was tested in the forms of cream, ointment and fatty ointment in a comparison with corresponding formulations containing fluocortolone (Ultralan) caproate or pivalate, or hydrocortisone acetate. The total study population comprised 1705 patients with various dermal disorders. The results of these double-blind contralateral studies permit the conclusion that the efficacy of the Vaspit preparations ranges between those of fluocortolone and hydrocortisone acetate. Considering the risks involved with local corticosteroid therapy in children the development of a local corticosteroid with the properties of fluocortin butylester must be acknowledged as an advance.

Diflucortolone valerate 0.1% in the form of a cream - Nerisona Cream - was investigated in various dermatological diseases. Very good results were achieved in 68.7% of the total of 64 treated cases, good results in 18.8%, moderate results in 9.4% and poor results in 3.1% of the cases. The patients assessed the cosmetic properties of Nerisona Cream as excellent. No side effects were observed.

The antiinflammatory efficacy of butyl 6alpha-fluoro-11beta-hydroxy-16alpha-methyl-3,20-dioxo-1,4-pregnadien-21-oate (fluocortin butylester, Vaspit) as a 0,75% ointment was tested in comparison with 1% hydrocortisone acetate ointment in the model of the pyrexal erythema. Fluocortin butylester appeared to be significantly superior to hydrocortisone acetate.

We compared the effects of increasing doses of beclomethasone dipropionate (BDP) and fluocortin butylester (FCB) on several indices of pituitary-adrenal function in healthy adult subjects. Significant depression of urinary free cortisol excretion and the response to metyrapone was seen only at the highest dose (1600 mg/day) of BDP. This depression was not reflected by frequent measurement of the serum cortisol concentration. FCB used well in excess of its presumed therapeutic dose range showed no evidence of any effect on pituitary-adrenal function. These results confirm that at high doses BDP causes pituitary adrenal suppression. Differences from studies showing reduced adrenal function in children on BDP doses of 400 to 800 mg/day probably reflect differences in the dose per kilogram of body weight. Since the use of FCB was not accompanied by any adverse side effects or evidence of reduced pituitary-adrenal function, it may be a variable alternative for asthmatics who require high doses of inhaled glucocorticoid.

Although the etiology and pathogenesis of Wegener's granulomatosis is still obscure, the pathological process is assumed to belong to the group of immunologic diseases. Destructive lesions commonly appear in the midface, particularly in the nose, and are seen microscopically as necrotizing vasculitis. We report a 19 year old woman with undetected disease who was finally diagnosed by repeated biopsies through collaboration between an otolaryngologist and a pathologist. This emphasizes the importance of an early diagnosis for therapeutic reasons since cooperation with an internist prevented the patient from developing gross mid-facial lesions. Treatment involved corticosteroids, immune suppression, and temporary low-dose heparin. During a seven-year period of follow-up, limited tissue changes occurred. Wegener's granulomatosis without treatment will proceed to death, while early recognition and proper treatment can induce long-lasting remissions. Thus, it becomes necessary for head and neck clinicians to become familiar with symptoms of the initial stage of the disease since they must help to secure a proper diagnosis (particularly through biopsies when indicated).

Diflucortolone valerate was administered to 35 psoriatic patients of both sexes in 0.3% concentration as a W/O emulsion in comparison with various commercially available preparations to study its action in the psoriasis plaque test according to Scholtz and Dumas. The study showed the test substance to be equipotent with the halcinonide, clobetasol-17-propionate and desoximetasone preparations and significantly superior to those containing betamethasone-17,21-dipropionate, betamethasone-17-valerate and fluocinonide.

The object of the present study was to investigate the clinical efficacy of Nerisona fatty ointment in very skin conditions. A total of 37 patients, most of them with chronic dermatoses, was treated. Either very good or good results were achieved in 100% of the cases. The side effects observed were very slight.

A case of vitamin C allergy of the delayed type is reported. Eczematous skin lesions appeared during normal uptake of the vitamin C contained in food. After a vitamin C-free diet, the skin lesions disappeared. Patch tests and an oral exposure with vitamin C gave positive reactions. This observation of vitamin C allergy is compared with previous published cases.

We report on 161 patients suffering from inflammatory dermatoses on hands, forearms, and lower legs who had been initially treated with 0.1% difluocortolone valerate. During the maintenance therapy carried out over a period of 3 to 4 weeks, we tested the efficacy of Kamillosan cream vs. 0.25% hydrocortisone, 0.75% fluocortin butyl ester, and 5% bufexamac in a bilateral comparative study. For the indications tested Kamillosan cream showed more or less equieffective therapeutic results as compared to 0.25% hydrocortisone. It is superior, however, to the non-steroidal anti-inflammatory agent 5% bufexamac as well as to 0.75% fluocortin butyl ester, a further glucocorticoid. With regard to neurodermitis, Kamillosan cream not only shows the same therapeutic effect as 0.25% hydrocortisone but is even of marked superiority towards other reference products.

A 0.1% diflucortolone valerate ointment was investigated in a randomised double-blind contralateral comparison against a 0.2% flumethasone ointment in 52 selected patients with neither weeping nor very dry dermatoses. The results are presented and commented on according to indications.

The clinical efficacy of diflucortolone valerate as a fatty ointment was investigated in 65 patients with very dry dermatoses. The results were very positive, being excellent in atopic eczema, neurodermatitis and atopic cheilitis. No side effects were observed.

Bi-Nerisone cream and a control preparation, also in the form of a cream, have been clinically tested on 343 patients by means of a double blind study. Equilvalent results were obtained without registering any significant statistical differences, a finding, however, proving to be of great importance as Bi-Nerisone only contains two active substances (Diflucortolone valerat + Chlorquinaldol), whereas the control preparation contains a total of four (Betamethasone valerate + Gentamycin + Tolnaftate + Clioquinol).

A 34 years old white male patient suffering from a seropositive "probable" rheumatoid arthritis developed a severe hypocomplementemic mesangiocapillary glomerulnophritis. Rheumatoid factor-Latextest and Waaler-Rose-Titers and IgM have been found highly elevated in the serum. The third component of complement (C3) was markedly depressed, while the fourth component (C4) was within the normal range. The rapid progression of both diseases forced us to start an immunosuppressive drug therapy using azathioprine and steroids, 18 months after the beginning of the treatment the patient is well, has only slight proteinuria, normal levels of complement and no joint pain. The possible connections between rheumatoid arthritis and mesangiocapillary glomerulonephritis in this case as well as the therapeutic approaches are discussed.

The investigational preparation Nerisona Cream (diflucortolone valerate 0.1%, investigational no. SH K 183 MB) was used in 47 patients with various inflammatory or pruriginous dermatoses. Either very good or good results were achieved in 89.3% of the cases. Nearly all the patients thought highly of the cosmetic properties of the preparation. No side effects were observed.

Programmed ventricular stimulation was performed in a patient with sarcoidosis who exhibited an episode of sustained ventricular tachycardia. Sustained rapid ventricular tachyarrhythmias requiring cardioversion for termination were induced by double right ventricular apical extrastimuli during control, and treatment with disopyramide, quinidine, and fluocortolone. In contrast, only four repetitive ventricular complexes were induced during combined therapy with quinidine, mexiletine and amiodarone. While receiving the latter regimen, the patient has been asymptomatic during 28 months of follow-up.

We report the results of a controlled double blind assay of treatment in 51 dermatologic cases, with a new steroid cream (diflucortolone) and an already known one (flumetasone). The diflucortolone valerate was significantly better than the flumetasone pivalate in the treatment of 16 cases of psoriasis, 33 eczemas and two cases of lichên planus.

Primary pulmonary hypertension is an irreversible and fatal disorder. Every effort should therefore be made to discover all the other treatable diseases which may be associated with pulmonary hypertension. The association of systemic lupus erythematosus and pulmonary hypertension was rarely reported in the past. We add another case in which pulmonary hypertension was the presenting symptom of systemic lupus erythematosus (SLE). In contrast to the previously reported cases, our patient responded well to corticosteroids. It is assumed that this favorable response was due to the relatively early stage of the disease, when the histopathologic pulmonary changes were still in the reversible inflammatory stage.

The blocking effects of inhaled beclomethasone dipropionate (BDP) and fluocortin butyl ester (FCB) on the immediate and late asthmatic reactions induced by inhaled allergen were studied in two trials. In the first, a double-blind cross-over trial compared BDP (800 micrograms daily as powder) with FCB 8 mg daily (1:20 by wt.-Formulation 1). The second trial was identical in design and compared FCB 8 mg daily (1:20) with FCB 8 mg daily as Formulation 2 (1:40). Known BDP, 400 micrograms daily by pressurized aerosol was studied at the end of the second trial. Allergen provocation was performed before and after 7 days treatment with each drug, with a 2-week interval between each drug. Overall, a blocking index for the immediate reaction of greater than 50% was obtained in ten of twenty patients (50%) using BDP, and five of twenty-one (25%) using FCB (P less than 0.01). The late reaction was blocked in nine of eleven (82%) instances on BDP, and four of fourteen (33%) on FCB. Contrary to earlier reports, inhaled corticosteroid agents used for several days prior to bronchial challenge, were found to block both the immediate as well as the late reaction in many individuals.

The effect of fluocortin butylester (FCB) in the topical treatment of perennial rhinitis was investigated in a double-blind study using a cross-over technique. The daily dose was 4 mg. Of the 30 patients who completed the trial, 26 had either allergy or nasal eosinophilia. 20 of the 30 patients preferred FCB to placebo. Moreover, there was a positive, but not statistically significant, therapeutic effect according to the patient score cards (0.1 less than p less than 0.2). In other words, the results are positive, but not definite. It is concluded that possibly the dose ought to be increased to obtain a more reliable effect.

A 36-year-old man suffered from diarrhoea for some weeks and was treated with Salazosulphapyridie and Fluocortulon when he developed a transient myopia combined with an angle closure glaucoma. The refraction of his mild hyperopic eyes (+0,5 dpt) changed to -5,5 dpt and the intraocular pressure increased to 40 mm Hg in the right and 42 mm Hg in the left eye. Accommodation and pupillary reflexes were normal. Ultrasonic examination showed an increased axial diameter and a forward shifting of the lens. The resulting flattening of the anterior chamber induced the angle closure glaucoma. All symptoms disappeared within a week after the administration of Fluocortulon had been discontinued.

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.

Morphological demonstration of the typical Sézary cell in peripheral blood confirmed the diagnosis of Sézary syndrome in a 64-year-old patient with generalized erythrodermia and typical histopathological skin changes. Enzymes and immunocytological membrane characteristics of Sézary cells changed in the course of the disease after cytostatic therapy. Polychemotherapy clinically led to transitory complete regression of skin changes. Reviewing the few published investigations it is found that the morphologically sufficiently defined Sézary cells are apparently not uniform cytochemically and immunocytologically in different patients.

Six groups of children suffering from widespread atopic dermatitis were treated once daily with six topical steroids of different potency. Systemic effects were measured by the morning estimation of plasma cortisol. A clear relationship was demonstrated between clinical efficacy of the steroid treatment and degree of reduced adrenal function. This study demonstrated that a rapid and marked therapeutic effect can be obtained with potent topical steroids applied once daily without occlusion, but in children is accompanied by a fall in plasma cortisol.

6alpha,9-Difluor-11beta-hydroxy-16alpha-methyl-21-valeryloxy-1,4-pregnadiene-3,20-dione (diflucortolone valerate, Nerisona) 0.1% as a cream, ointment and fatty ointment was investigated in a double-blind contralateral design in 925 patients in comparison to fluocortolone (Ultralan), fluocortolone caproate and fluocortolone pivalate in three concurrently performed studies. The results of the contralateral study show Nerisona cream and ointment to be more effective (P less than 0.01) than Ultralan. The fatty ointment was also superior, but the difference was statistically significant (P less than 0.05) only in the indication psoriasis. No differences could be established in the less sensitive absolute assessment. The therapeutic success rate of 76-92% according to strict criteria-only complete healing and distinct improvement were counted as a success-clearly demonstrates the efficacy of the preparations. The local side effects recorded-mainly irritation and burning- were of a mild nature.

A report was given on a new inhalable corticoid - Fluocortin butylester (FCB) - administered to patients with bronchial asthma. Forty eight cases with extrinsic asthma induced by allergen challenge participated in this study. A good protective effect was seen in 10 patients inhaling 8 mg daily. This dosis produced a remarkable effect of Raw and FRC. No side effects were observed in a study carried over 3 years. Furthermore, there was detected a normal adrenal function during the duration of FCB therapy.

Fasciitis with eosinophilia (also Shulman's disease or eosinophilic fasciitis) is characterized by an inflammatory thickening of the fascia, eosinophilia and hypergammaglobulinemia. It has clinical and histopathological similarities with scleroderma, though evidence for systemic involvement is rarely found. In this report, we describe the clinical and laboratory features of two patients with this disease and their response to treatment and we discuss its relationship to scleroderma and the pseudosclerodermatous syndromes and its prognosis.

In the present paper, the clinical trial of a new difluorinated corticosteroid suitable for topical use is reported. Because of its proven efficacy in very different dermatoses, it is useful as a new reliable product for external use having a broad spectrum of indications. Altogether, 50 patients were treated for a number of dermatoses (various forms of eczema, neurodermitis constitutionalis among other rare skin diseases). Complications, especially skin lesions due to corticosteroids, were not observed. The availability of the test preparation in three different forms has the advantage that it is not only suitable for the primary dermatosis, but it can also be adapted to the various degrees of acuteness.