SummaryThirty-nine patients (15 outpatients and 24 inpatients) with a variety of skin diseases affecting variable areas of the body surface were treated with clobetasol propionate ointment (Dermovate). Before and after treatment the adrenal response to an intramuscular injection of tetracosactrin was tested and additional 9 am plasma cortisol levels were measured at intervals during treatment. A satisfactory initial therapeutic response was achieved in almost all cases during the trial period.When more than 50 g of ointment a week was used a significant number of patients developed adrenal suppression. When less than 50 g per week was used any suppression tended to be transient, and cortisol levels recovered as treatment progressed. Introduction It is well recognised that when corticosteroids are applied to the skin there may be sufficient percutaneous absorption to affect hypothalamic-pituitary-adrenal (HPA) function. This effect seems to parallel topical anti-inflammatory activity and is more likely to occur when large quantities of cream or ointment are applied to extensive areas of diseased skin.

Summary1. A simple cannula and a cannula guide for making injections into the cerebral ventricles of conscious rats are described. 2. Intraventricular injections of 5-hydroxytryptamine (5-HT) or of noradrenaline (NA) were without effect on the nociceptive threshold of rats.3. Intraventricular injection of 5-HT potentiated the antinociceptive effect of morphine. Reserpine pretreatment antagonized the antinociceptive effect of morphine; this effect was reversed by intraventricular injection of 5-HT. 4. Intraventricular injection of NA attenuated the antinociceptive action of morphine but was without effect on the inhibition by reserpine of the antinociceptive effect of morphine. 5. Subcutaneous injection or slow intravenous infusion of either 5-HT or NA (up to 300 ug/rat) were without significant effect on the antinociceptive effects of morphine. 6. Intraperitoneal administration of dopa increased the nociceptive threshold above normal, but reduced the antinociceptive effect of morphine. Intraventricular injection of either dopa or dopamine had no antinociceptive effect but inhibited that of morphine. 7. It is suggested that the antinociceptive effect of morphine may depend on the balance between the concentrations of 5-HT and NA in the brain.

No abstract

SUMMARY A new topically active corticosteroid, clobetasol propionate, has been investigated in the laboratory and in dermatological clinics to determine the best formulation for clinical use. Clinical trials involving 1150 patients were undertaken. In patients with bilateral psoriasis or eczema, clobetasol propionate, at a strength of 0.05%, was compared with betamethasone 17‐valerate ointment and cream, fluclorolone acewnidc ointment and cream and fluocinonide (FAPG). The new steroid was shown to be effective therapeutically, especially in psoriasis. Each comparison in the trial was analysed independently and the following statistically significant differences were demonstrated.

Clobetasone butyrate ointment has been shown to be more effective in treating psoriasis and eczema than flurandrenolone ointment yet to cause less epidermal thinning in a human experimental model. This is an indication that the clinical activity of topical glucocorticoids may not necessarily be inseparable from their propensity to cause atrophy of the skin.