Topical drugs can be absorbed percutaneously in sufficient amounts to cause untoward systemic effects. Generally speaking, infants and young children appears to be more vulnerable than adults. It has been shown that the prolonged and extensive use of topical corticosteroids can induce iatrogenic hypercorticism and that they may also impair the patients ability to cope with stress. Furthermore, the relatively limited use, areawise and timewise, of agents such as phenol, resorcinol, salicylic acid, hexachlorophene, boric acid, mercurials, and podophyllin may suffice to elicit dire systemic reactions.

A paired comparison of the efficacy of a topically applied fluoridated corticosteroid, 0.2% fluocinolone acetonide in a cream base (Synalar-HP®, Syntex) and the base alone was carried out in 28 patients with alopecia areata and alopecia totalis. A satisfactory to excellent therapeutic response was obtained in 17/28 patients (61%), with the corticosteroid cream treatment. The patient’s age and the duration of the alopecia appeared to be important factors in the outcome. Although relapses were encountered in 11/17 patients (63%) during the course of treatment or within 3 months after treatment was discontinued, 12/17 (71%) of those who responded did retain sufficient regrowth for the result to be considered satisfactory. The only troublesome complication was the development of a localized acneform eruption in 5/28 patients (18%) between the ages of 15 and 25 years. None of the patients developed clinical evidence of systemic absorption.

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