Potent steroids

As Daktacort cream contains hydrocortisone, a mild steroid, its use is rarely associated with side-effects unlike the potent and very potent steroids. The product is generally applied once or twice daily for 1 week. It should be discarded once the expiry date has elapsed. Daktacort is only available as cream or ointment. 

Examples of group I, i.e. weak or low efficacy topical steroids, are hydrocortisone acetate in various concentrations, methylprednisolone 1.0% and prednisolone 0.5%. Group II, the moderately potent steroids, includes alclometasone dipropionate 0.05%, hydrocortisone butyrate 0.1%, triamcinolone acetonide 0.025% and fluocinolone ace-tonide 0.01%. Group III, the potent steroids, contains among others betamethasone valerate 0.1%, betamethasone dipropionate 0.05%, budesonide 0.025%, desoximetasone 0.05%, fluticasone propionate 0.05%, amcinonide 0.1%, fluocinonide 0.05% and mometasone furoate 0.1%. Group IV comprises the very potent agents such as clobetasol propionate 0.05% and halobetasol propionate 0.05%. 

This compound, a potent steroid with both glucocorticoid and mineralocorticoid activity, is the most widely used mineralocorticoid. Oral doses of 0.1 mg two to seven times weekly have potent salt-retaining activity and are used in the treatment of adrenocortical insufficiency associated with mineralocorticoid deficiency. These dosages are too small to have important anti-inflammatory or antigrowth effects. 

In 1953, Fried and Sabo announced the synthesis of the highly potent steroid analogue fludrocortisone (9-fluoro-hydrocortisone), formally accenting the beginning of the analogue era [10-13]. 

Uses. Adrenal steroids should be considered a symptomatic and sometimes curative, but not preventive, treatment. Ideally a potent steroid (see below) should be given only as a short course and reduced as soon as the response allows. Corticosteroids are most useful for eczematous disorders (atopic, discoid, contact) and other inflammatory conditions save those due to infection. Dilute corticosteroids are useful in psoriasis (see p. 309). 

Aconitum spp. contain potent steroid alkaloids including aconitine, mesaconitine, and jesaconitine, the three major toxins. The main alkaloid of these plants is aconitine, a highly toxic alkaloid. 

Note that a draft EU document III/5581/992 Validation Master Plan Design Qualification, Installation and Operational Qualification, Non-Sterile Process Validation, Cleaning Validation states that for certain allergenic ingredients, penicillins, cephalosporins, or potent steroids and cytotoxics, the limit should be below the limit of detection by the best available analytical method. ... 

THERAPEUTIC USES Many inflammatory skin diseases respond to topical or intralesional administration of glucocorticoids. Absorption varies among body areas the steroid is selected on the basis of its potency, the site of involvement, and the severity of the skin disease. Often, a more potent steroid is used initially, followed by a less potent agent. Twice-daily apphcation is sufficient, and more frequent apphcation does not improve response. In general, only nonfluorinated glucocorticoids should be used on the face or in occluded areas such as the axiUae or groin. 

Psoriasis is one of the few inflammatory dermatoses that has not responded to routine topical steroid therapy, but these more potent steroids appear to work if a special occlusive dressing is used. In this technique, a thin layer of cream or ointment containing flurandrenolide is applied to the individual patch of psoriasis. The area is then covered with plastic food wrap or a similar pliable plastic film. 

Adrenal glands are small monnds of tissue located at the top of each kidney. The outer layer of the gland, the adrenal cortex, produces a number of potent steroid hormones, the adrenocorticoids. They are classified into two groups according to function Mineralocor-ticoids regulate the concentration of ions (mainly Na ) in body fluids, and glucocorticoids enhance carbohydrate metabolism. 

Sorensen, P.W., Hara, T.J. Stacey, N.E. 1987. Extreme olfactory sensitivity of mature and gonadally-regressed goldfish to a potent steroidal pheromone, 17a, 20P-dihydroxy-4-pregnen-3-one.J. Comp. Physiol. [A] 160, 305-313. 

Miscellaneous - As a consequence of the wide-spread search for anti-inflammatory agents several novel structures with a variety of activity-profiles have been discovered. A pyrazolo(3. 4-c) pyridine derivative (Su 15336) (XXI), possessing the partial structure of a family of very potent steroids, has been reported to be one of the most active nonsteroidal agents. 5-n-Butyl-l-cyclohexyl-2, 4, 6-trioxoperhydro-pyrimidine (XXII) (TBA 300) is a moderately active compound comparable to phenylbutazone. 

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