Adrenocorticotropic hormone test and estimation of a safe dose for high potency steroids in vitiligo.

Sir,

A recent report on “adrenocorticotropic hormone (ACTH) test and estimation of a safe dose for high potency steroids in vitiligo”[1] is very interesting.[1] de la Fuente-García et al. concluded “doses of 50 g or less/week of clobetasol during a period of 12 weeks are safe on adult vitiligo patients.”[1] There are some considerations of using the ACTH test. Since this test is considered potentially dangerous, it should be carefully conducted. Hence it may not be practical in general dermatology practice. The control of diurnal variation is unpredictable.[2] In the present study, the control of time of blood collection did not seem appropriate. In addition, focusing on the measurement of cortisol by electrochemiluminescence technique, the ELECYS is mainly used for salivary samples and not blood samples.[3] There do not seem to be any publications to confirm the accuracy and reliability for testing blood samples.