Substitution of a fluorine atom at the ninth carbon position1 enhances materially the electrolytic as well as the antiphlogistic activity of hydrocortisone.2 The former property renders fludrocortisone (9α-fluorohydrocortisone) unsuitable for systemic therapy,3 the latter promising for topical use.
Studies of Sulzberger4 and co-workers and of Robinson,5 using the paired comparison method, seem to indicate that fludrocortisone is in many instances superior to hydrocortisone in the topical therapy of various dermatoses, mainly eczema. The majority of Robinson's5 patients were treated with fludrocortisone alone without adequate controls. Both of these methods are open to criticism and do not prove beyond doubt the effectiveness of fluorinated hydrocortisone.
Eczema is a capricious disease. Its course depends on a great number of factors besides the topical use of an effective agent. Change of environment such as hospitalization, intercurrent diseases, psychological factors,