Perspectives in corticosteroid research.

In dermatotherapy, potent drugs are needed which can be used as alternatives to corticosteroids, but which are without unwanted local and systemic effects. Three theoretical possibilities for the development of such advanced drugs have been presented. Firstly, dissociation of wanted and unwanted effects by selection of a certain corticosteroid structure is proposed. However, this is impossible, because corticosteroid receptors are ubiquitous and all display the same specificity. Secondly, manipulation of the pathways of the inflammatory response may be more feasible. Because of increasing knowledge of the mechanism of inflammation and the pathogenesis of cutaneous inflammatory diseases, it is predictable that effective nonsteroidal anti-inflammatory drugs for topical use will be developed some time in the future. Lastly, the effects and side effects can now be limited to the site of application, thus avoiding systemic risks, by optimising corticosteroid activity with respect to receptor binding and pharmacokinetic properties. However, it is realistic to assume that, even in the future, corticosteroids will always possess both desirable and undesirable properties.