Different Skin Thinning Potential of Equipotent Medium-Strength Glucocorticoids

Abstract

In this study, we investigated the effect of prednicarbate, mometasone furoate and betamethasone 17-valerate on total skin thickness over a treatment period of 6 weeks. The study was conducted as a double-blind, placebo-controlled randomized clinical trial with a confirmatory approach. The influence of these drugs on healthy human skin under non-occlusive conditions was assessed by measuring total skin thickness and epidermal thickness using 20 and 50 MHz sonography, respectively. Epidermal surface structure was evaluated using profilometry. Visual assessment addressed signs of atrophy and formation of telangiectasia. The reduction of total skin thickness induced by prednicarbate was clearly less than that caused by betamethasone 17-valerate and mometasone furoate. Prednicarbate led to a higher degree of skin thinning than vehicle. For technical reasons, epidermal thickness could not be reliably evaluated with 50 MHz sonography. Profilometry did not demonstrate any differences between treatments. Visible signs of atrophy or telangiectasia were detected in two subjects each upon betamethasone 17-valerate and mometasone furoate, but not upon prednicarbate or its vehicle. Prednicarbate is a topical glucocorticoid with an improved benefit/risk ratio, as it causes less skin atrophy than the equipotent betamethasone 17-valerate.

Comparative safety and efficacy of topical mometasone furoate with other topical corticosteroids

“…Further clinical trials of up to 6 weeks in healthy adult volunteers15, 16, 17 and patients with psoriasis18 have found the atrophogenic potential of mometasone furoate 0.1% ointment or cream to be low. However, in two studies, mometasone furoate 0.1% ointment used for 6 weeks with occlusion in healthy adult volunteers was associated with a significantly greater incidence and severity of skin atrophy and telangiectasia than methylprednisolone aceponate 0.1% ointment9 and prednicarbate 0.1% ointment,1 but it was not as pronounced as it was for betamethasone valerate 0.1% ointment 1…”

“…Since the introduction of hydrocortisone in 1952, topical corticosteroids have become the cornerstone of treatment for many inflammatory skin conditions due to their ability to reduce inflammation 1. Initial success with hydrocortisone spurred the development of new topical corticosteroids by modifying both the ring structure and side chains of the hydrocortisone molecule, leading to compounds with variable anti‐inflammatory potency and side‐effect profiles 2, 3.…”

Evaluation of the atrophogenic potential of hydrocortisone 1% cream and pimecrolimus 1% cream in uninvolved forehead skin of patients with atopic dermatitis using optical coherence tomography

“…For several years, high-frequency ultrasound imaging is established in measuring total skin thickness and corticosteroidinduced atrophy (8,19). In contrast, optical coherence tomography (OCT) as a non-invasive high-resolution method enables the evaluation of epidermal thickness and was shown to be useful for the early detection and monitoring of side effects such as thinning of the epidermis (20)(21)(22)(23)(24).…”

Test systems for the determination of glucocorticoid receptor ligand induced skin atrophy

“…15 Optimization of the benefit/risk ratio is a main challenge for the development of novel compounds targeting the GC receptor (GR). 16,17 An always better understanding of the molecular mechanisms of GR-mediated effects and side effects triggered the discovery of novel GR-ligands with a putative superior profile. A particular attractive class of compounds are selective glucocorticid receptor agonists (SEGRAs) which are currently entering clinical development.…”