COMPARISON OF SKIN ATROPHY AND VASOCONSTRICTION DUE TO MOMETASONE FUROATE, METHYLPREDNISOLONE AND HYDROCORTISONE

Background/aims Topical glucocorticoids with improved benefit/risk rat io are of great interest in dermatology, but there are very few trials directly comparing the efficacy and side-effects of these new prepara tions. In our study the vasoconstrictor effect and side-effects of two of these new glucocorticoids were evaluated and blanching effect was determined by two-dimensional laser scanning. Methods In a randomised, double blind intra-individual comparative trial, 10 subjects were tre ated with various glucocorticoids or drug-free vehicle. The test drugs were mometasone furoate (MF), methylprednisolone aceponate (MP) and h ydrocortisone (OH-C). The preparations were tested for a period of 3 w eeks with occlusion on the flexor side of the forearm. Skin thickness and vasoconstriction were determined using 20 MHz ultrasound scanning, laser Doppler scanning (LDS) and chromometry. Results No adverse effe cts were observed during the observation period. Only partial vasocons triction occurred in most cases during the observation period. MP and MF produced maximal blanching between days 3 and 5 of treatment, while with OH-C clinically visible blanching did not occur. Ultrasound eval uation of skin thickness showed similar behaviour for all three steroi ds tested: there were no signs of skin atrophy in any of the cases. LD S evidenced hypoperfusion of a test area on the perfusion image in onl y a few patients and there were no significant differences between the steroids tested. On evaluation of vasoconstriction caused by the ster oids tested using chromometry there was a significant difference betwe en MF and OH-C on the La*b* scale (P < 0.005). Only at day 3 was a bl anching effect caused by MP and MF demonstrable (a-value, P < 0.05). C onclusion In summary, the synthetic steroids MF and MP presented side- effects similar to those of OH-C but much greater vasoconstrictor effe ct; after an application period of over 5 days under occlusion a blanc hing effect in our model was not demonstrable by means of chromometry. Two-dimensional laser scanning offers no advantage in the evaluation of the blanching effect in comparison to one-dimensional laser fluxmet ry (LDF). (C) 1998 Elsevier Science B.V.