Twenty patients with lesions of vitiligo were treated either with % betamethasone valerate (BV) or with % clobetasol propionate (CP) creams and similar control areas with placebo preparations. After 3 months of treatment three of the ten patients treated with BV showed a significant amount of repigmentation only in the steroid-treated areas. Only one of the ten patients treated with CP showed partial repigmentation. Using both light and electron microscopy, histological studies of biopsies taken from control- and steroid-treated areas showed a marked repopulation with functional melanocytes in the repigmenting vitiliginous skin. The melanocytes in these steroid-treated repigmented areas were more dendritic and dopa-positive and, unlike melanocytes in the pigmented margins of untreated areas of vitiligo, contained many melanosomes of normal size, shape and melanization. It appears that both topical corticosteroids are of use for the treatment of selected patients with vitiligo and can induce repigmentation of the skin.
Charman and other researchers in the department of dermatology at Queens Medical Centre asked 200 patients or parents of patients with atopic eczema to fill out a questionnaire about their attitudes toward corticosteroid creams. They found almost three-quarters of the responders worried about using corticosteroid creams on their own or their child's skin . The most common concerns were the risk of skin thinning, which was feared by almost 35% of those surveyed. Twenty-four percent feared long-term effects in general, and almost 10% were afraid of possible effects on a child's growth and development.
Prescriptions written for topical steroids should include explicit instructions about where and how often to apply the preparation, and the body areas where use must be avoided. Pharmacists should ensure these directions are included on the dispensing label. Prescribers should bear in mind that patients may keep unused or leftover corticosteroid skin preparations for some time after they are prescribed and thus forget the original indication or instructions for use. The prescribing of unnecessarily large quantities should be avoided. Patients should be warned not to share their topical steroid preparation with other people as this may result in unsafe application to unsuitable areas such as the face, as well as the potentially inappropriate treatment of undiagnosed skin conditions.