No abstract

SUMMARY. —Beclomethasone dipropionate is a new topical steroid with marked vasoconstrictor and anti‐inflammatory activity. At a concentration of 0·025% in a simple, oil‐in‐water emulsion “cream” base beclomethasone dipropionate is significantly more effective clinically than is fluocinolone acetonide 0·025%) in an apparently similar base. The effectiveness of beclomethasone dipropionate 0·025% in an ointment base is significantly increased by dissolving the steroid in propylene glycol before incorporating it into the ointment. Beclomethasone dipropionate 0·025% in a propylene glycol/ointment base is clinically indistinguishable from fluocinolone acetonide 0·025% ointment. Further investigation of the influence of cream and ointment bases on the clinical effectiveness of topical steroids might prove interesting.

Twenty-nine atopic children aged 3-12 years were given elimination diets for 3 weeks, individual groups of foods being then reintroduced over 6 weeks. Most children improved whilst dieting and relapsed on return to normal food intake. In all but 4 cases some food group which caused exacerbation of symptoms was identified, fruits and colourings proving more of a problem than milk and eggs. Taking into account these suspected food allergens, tailored diets were designed for each child. Using these diets the group participated in a double-blind crossover trial of oral sodium cromoglycate (SCG) versus placebo. Twenty-two patients completed the trial. The results indicated that tailored diets were of value in the management of eczema but SCG did not produce a significant additional effect. At follow-up 1 year later most children were adhering to their diet; thirteen were better and only three worse. Children who had initially continued using SCG had stopped it; no accompanying change in their eczema was noticed. A considerable reduction in the use of topical steroids was observed, in marked contrast to previous requirements. Sequential measurements of total serum IgE (PRIST) showed variable changes apparently unrelated to recent SCG therapy. There was little agreement between skin prick tests and specific IgE (RAST) to corresponding foods. Correlation between RAST and food challenge was poor for positive results (r = 0.39) but good for negative results (r = 0.99).

No abstract

A double-blind, group comparison trial of a topical cream containing 4% sodium cromoglycate (SCG) was undertaken in forty-six patients with chronic atopic eczema. A statistically significant improvement was seen after 9 weeks in the actively treated patients compared with the placebo group. However, in general, no benefit was observed in severe eczema, perhaps due in some part to the seemingly late onset of action of SCG. Measurement of total serum IgE before and after the trial showed an increase in levels which was apparently unrelated to treatment with SCG or placebo or to a change in severity of the eczema. The amount of SCG in the urine was small and very variable, indicating low percutaneous absorption. The calculated bioavailability ranged from 0.01% to 2.75% of the applied dose. These results together with follow-up studies suggest that topical SCG as a long-term measure may be useful in the management of mild or moderately severe eczema, reducing the frequency of acute exacerbations.