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TO ASSESS THE SAFETY OF DIFFERENT CLASSES OF SYSTEMIC CORTICOSTEROIDS IN A SHORT NON-TAPERED THERAPY FOR ACUTE DERMATOLOGICAL CONDITIONS: A PROSPECTIVE COHORT STUDY

Background 
A short non-tapered course of corticosteroids (CS) is desirable, especially for acute steroid responsive dermatological disorders. Oral corticosteroids in short course may seem to be free from significant side effects; however, may be associated with increased risk of hyperglycemia, elevated blood pressure, mood and sleep disturbance and severe conditions like sepsis and venous thromboembolism etc . Thus this study was done to assess the safety of short course corticosteroids in terms of HPA axis suppression/ recovery as well as other systemic side effects.
Methods
This was a single-center, open-label, prospective cohort study in which consecutive subjects suffering from acute dermatitis , belonging to the age group of 18 years to 40 years were recruited. The three equal study Groups-A, -B and -C received Hydrocortisone, Prednisolone and Betamethasone, respectively in single morning doses of 0.5 mg/kg body weight equivalent of Prednisolone over 5 days. Routine investigation and Morning basal serum cortisol concentration (to assess HPA axis activity) were measured before, during and two weeks after the study to assess the safety of CSs. 
Results 
In our study, all the three CSs were found to have excellent clinical effect and safety. In all the study groups, morning cortisol levels falls below the base line values on first visit, then start to rise on second follow up, however never achieve the baseline values again during the study period. 
Conclusion
A five day single-morning-non-tapered dose 0.5 mg/kg body weight of prednisolone equivalent of hydrocortisone, prednisolone and betamethasone are safe.
Summary:
• Short course intensive corticosteroid therapy however safe, but has been known to affect HPA axis reversibly.
• No study is available to address comparative effect of different classes of corticosteroid on HPA axis, particularly in short course of therapy. 
• This study has analyzed the effect of effect hydrocortisone, prednisolone and betamethasone, one each from short-, intermediate- and long-acting corticosteroid class, respectively. A short course of corticosteroids is desired in contrast to conventional tapering doses, especially for acute, brief steroid responsive dermatological disorders.