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

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.