hydrocortisone-valerate and Psoriasis

It would be desirable to develop an alternative system to clinical studies to evaluate the potency of generic topical corticosteroids and of new formulations of existing innovator corticosteroids. The vasoconstrictor assay is a reliable method for testing potency; however, its results do not always agree with clinical studies. Psoriasis offers an ideal clinical model to evaluate corticoid potency because the ability to perform within-patient comparisons of the treatment of bilateral lesions permits meaningful comparisons with a relatively small sample size. The results of bilateral comparisons in psoriasis agreed with those of the vasoconstrictor assay in 20 of 23 comparisons of active agents and in numerous comparisons of active corticosteroids with a placebo. Eczematous dermatoses do not lend themselves well to bilateral paired comparison studies and therefore require parallel treatment studies with relatively large sample sizes to produce statistically significant comparisons.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone Valerate; Double-Blind Method; Follow-Up Studies; Humans; Hydrocortisone; Placebos; Psoriasis; Skin; Skin Diseases, Eczematous; Therapeutic Equivalency; Vasoconstrictor Agents

A double-blind parallel group study was undertaken to assess the effect of adding a topically applied corticosteroid cream to a modified Goeckerman regimen to treat patients with psoriasis. Nineteen patients with psoriasis were treated with either this regimen and hydrocortisone valerate cream or the regimen and vehicle cream. Patients were given daily treatments until their skin cleared or until twenty-eight treatments were received. They were then followed up until rebound or relapse occurred or 6 months had passed. The addition of hydrocortisone valerate cream to the modified Goeckerman regimen led to relapse after 5.9 weeks in comparison with 17.9 weeks for the control group.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Clinical Trials as Topic; Coal Tar; Female; Humans; Hydrocortisone; Male; Middle Aged; Ointments; Psoriasis; Time Factors; Ultraviolet Therapy

Evaluations of the comparative efficacy and safety of hydrocortisone valerate 0.2% ointment were made in six double-blind, multicenter trials involving a total of 485 patients, 209 with atopic dermatitis and 276 with plaque psoriasis. The vasoconstrictor activity of hydrocortisone valerate 0.2% ointment was also assessed in normal subjects. Hydrocortisone valerate 0.2% ointment displayed therapeutic effects within three days. In terms of global evaluations of efficacy, hydrocortisone valerate was more effective than vehicle and was comparable to other intermediate or moderate potency corticosteroid ointments. The vasoconstrictor activity of hydrocortisone valerate 0.2% ointment was greater than that of other moderate potency ointments.

Topics: Adrenal Cortex Hormones; Adult; Clinical Trials as Topic; Dermatitis, Atopic; Double-Blind Method; Drug Evaluation; Female; Humans; Hydrocortisone; Male; Middle Aged; Ointments; Psoriasis; Vasoconstriction

Therapy with systemic corticosteroids, despite attendant serious risks, is mandatory in diseases such as pemphigus, acute disseminated lupus erythematosus and some cases of exfoliative dermatitis that are ordinarily fatal, for in such cases life may be prolonged and the patients made comfortable. If no contraindications exist, therapy with corticosteroids is desirable, for diseases of short duration-contact dermatitis, serum sickness reactions and drug eruptions of all kinds-provided the causative factors have been removed and the reactions are causing severe distress.On the basis of encouraging reports in the literature corticosteroid therapy may be instituted with justification for a group of unrelated, intractable and discomforting diseases such as maddening pruritus ani, sclerema neonatorum, dermatomyositis, certain cases of sarcoidosis, berylliosis, Behcet's syndrome, universal calcinosis, Reiter's disease and ulcers of sickle-cell anemia. One must always bear in mind the well-defined contraindications to corticosteroid therapy and the hazards of its use, particularly if therapy is to be prolonged. Results from topical hydrocortisone therapy are particularly pleasing in chronic eczematous otitis externa and especially when it is combined with an antibiotic drug. Results are excellent also in nuchal eczema, dermatitis of the eyelids and in pruritus ani. More often than not, hydrocortisone ointment and lotions benefit more than do other standard remedies such diseases as atopic eczema, contact dermatitis, lichen simplex-chronicus and eczematized phases of conditions such as psoriasis and superficial mycotic infections. Preparations containing a combination of hydrocortisone and an antibiotic are more useful than hydrocortisone alone. When used with discrimination, with full attention to the selection of cases and proper concentration in the correct vehicle, hydrocortisone preparations in combination with antibiotics are excellent antieczematous agents.

Topics: Adrenal Cortex; Adrenal Cortex Hormones; Anti-Bacterial Agents; Behcet Syndrome; Dermatitis; Dermatitis, Atopic; Dermatologic Agents; Dermatology; Drug Eruptions; Eczema; Glucocorticoids; Humans; Hydrocortisone; Neurodermatitis; Pruritus Ani; Psoriasis; Skin Diseases