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SATURDAYOctober 16SESSION 19:05– 9:20Click here to return to Dermatology Update 2004 Schedule and Abstracts |
John Berth-Jones Topical corticoids have now been in use for treating skin disease for over half a century. During the decades since hydrocortisone was introduced numerous analogs have been developed from this molecule. Modifications to both the ring structure and the side chains have increased specificity of action, increased penetration, increased potency and allowed rapid metabolism to minimise side effects. One of the most recently developed corticoids for topical application is fluticasone propionate, which has a fluoride carbothiate and a propionate ester at C17 and a methyl group at C16. A large volume of clinical trials have resulted in topical corticoids becoming the mainstay of treatment for most eczematous dermatoses. However some questions remain unanswered. Dermatologists use a range of strategies including various forms of intermittent treatment which they believe help to get the best results, but until recently such strategies have been largely based on intuition rather than sound evidence. A study was therefore undertaken to explore the efficacy and safety of twice weekly fluticasone propionate (FP), cream and ointment for reducing the risk of relapse of atopic dermatitis (AD). This was a randomised, double-blind, parallel-group study of 20 week's duration involving 376 adolescents and adults. After stabilisation with regular FP 0.05% cream or FP 0.005% ointment for 4 weeks, those controlled then continued into a 16-week maintenance phase on daily emollient and twice weekly application of either FP or placebo. Median time to relapse was 6 weeks for emollient alone vs. >16 weeks for FP. There were no differences between groups in adverse events. Twice weekly application of fluticasone propionate is therefore useful to maintain remission in atopic dermatitis.Click here to return to Dermatology Update 2004 Schedule and Abstracts |