Clinical use of topical cortisteroids

The action of topical corticosteroids is anti-inflammatory and antimitotic. By the use of laboratory and clinical trials they can be divided into four grades of potency. Weak steroids may be made more potent by better penetration which can be achieved by plastic occlusion or by alteration of the vehicle in which they are suspended. Local side-effects of topical corticosteroids are described and attention is drawn to the face as a particularly vulnerable area. Use of large amounts of the most potent steroids has produced Cushingoid states normally associated only with systemic steroids, and this is more likely if the patient has liver damage. Practical advice on the choice of steroid for particular disorders is given and the importance of intermittent treatment both for safety and effectiveness is stressed.