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The intrinsic potencies of two novel topical thiol ester corticosteroids, RS-85095 and RS-21314, were compared with the high potency corticosteroids clobetasol 17-propionate and fluocinonide, using human vasoconstriction assays. In these assays, four or five concentrations (0.03 to 3 mg/L) of the corticosteroids in 95% ethanol (alcohol, USP) were applied to predetermined sites on the forearm of volunteers and were occluded following evaporation of the alcohol. The responses were scored in terms of the presence or absence of vasoconstriction and the degree of vasoconstrictive intensity. No statistically significant difference was found in the intrinsic potencies of RS-85095, RS-21314, and clobetasol 17-propionate, and all three corticosteroids were significantly more potent than fluocinonide.

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No abstract

Corticosteroids are presently the most widely used and effective agents in topical therapy of cutaneous disease. The use of plastic film dressings increases the effectiveness of treatment, but also increases absorption and the possibility of systemic corticosteroid effects, and raises the question of possible adverse effects on pituitary-adrenal function. A summary of previously published studies on this question is presented, and criteria for distinguishing transient adrenal suppression from true adrenal insufficiency are outlined. Proved cases of adrenal insuffiCiency caused by topical corticosteroids have not been reported, but the number of properly studied cases is too small for firm conclusions. The question of "dosage" of topically applied corticosteroids has heretofore received scant attention. A dosage schedule,which is effective treatment for many steroid responsive lesions and is below the range which produces significant systemic effects, is presented. The results of pitUitary-adrenal function tests in specific cases treated with known amounts of topical corticosteroids are presented. Because of the importance and widespread use of topical corticosteroids, it is urged that further study of these questions be pursued.