Effect on plasma cortisol level and urinary cortisol excretion, in healthy volunteers, after application of three different topical steroid ointments under occlusion

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Abstract
The systemic effect of the topical glucocorticoid ointments budesonide 0.025% (Preferid), hydrocortisone-17-butyrate 0.1% (Locoid) and betamethasone-17,21-dipropionate 0.5% (Diproderm) was studied in 9 healthy volunteers. Five g ointment was applied on about 13% of the total body surface, using occlusive technique for three consecutive nights. The cortisol values in plasma and urine were measured before, during, and 3 days after applications. Although budesonide and betamethasone-17,21-dipropionate are equipotent drugs from a therapeutic point of view, the halogenated betamethasone-17,21-dipropionate caused significantly greater decrease in both plasma- and urinary cortisol levels. Between the two non-halogenated glucocorticosteroids, budesonide and hydrocortisone-17-butyrate, no significant difference was found despite the large difference in anti-inflammatory effects. The results indicate that it is possible to improve the ratio between the local therapeutic effect and the systemic activity of a glucocorticosteroid. Budesonide represents such an improvement.

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