Comparative evaluation of skin atrophy in man induced by topical corticoids

Abstract

In this in-patient study, mild skin atropy was observed clinically in 6 out of a total of 22 patients after fluocinolone acetonide and in 1 patient after flumethasone pivalate ointment applications (P < 0.05). Investigations were discontinued prematurely on days 14 and 17 in 2 patients because they developed early atrophy due to fluocinolone acetonide applications. Histological findings indicating either moderate or marked skin atrophy were evident in 15 patients after flucinolone acetonide as against 1 patient after flumethasone pivalate ointment applications (P < 0.001). In comparison with the controls the mean decrease in epidermal thickness was more marked after fluocinolone acetonide applications, namely 30.5% vs. 21.3% after flumethasone pivalate applications. The ultrastructural tissue changes were less marked at the sites to which flumethasone pivalate was applied. In comparison with controls, the percentages of mean decrease in diameters of collagen fibrils measured in 6 volunteer patients ranged from 5.1-27.6% after fluocinolone acetonide and from 0% to 12.3% following flumethasone pivalate ointment applications. This difference was statistically significant (range P < 0.01 to < 0.001). This experimental study has demonstrated that flumethasone pivalate displays only a mild atrophogenic effect and it is clinically and histologically significantly less atrophogenic than fluocinolone acetonide. Flumethasone pivalate can therefore be reckoned as a suitable topical corticosteroid especially for the long-term treatment of corticoid-responsive dermatoses.