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Corticosteroids have been used as drug treatment for some time. Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a complicated 36-step process that started with deoxycholic acid, which was extracted from ox bile . [43] The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception . [44] In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone. [45] The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field. [46] The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.

Keratosis Pilaris DO’s
1. Do take measures to prevent excessive skin dryness , especially in colder winter months.
2. Do use mild soaps like Dove soap-less cleanser or Cetaphil cleanser.
3. Do lubricate skin with special lotions containing lactic acid like Amlactin or Lac Hydrin Lotion.
4. Do talk with your physician about using tretinoin (Retin A), alpha hydroxy acid lotions (glycolic acid), urea cream (Urix 40), and salicylic acid ( Salex).
5. Do gently massage the lotions into the affected area twice a day.
6. Do use a mild loofah or Buf Puf to gently scrub the area weekly

The App is based on the AAD psoriasis clinical guidelines. Adherence to the guidelines recommendations will not ensure successful treatment in every situation. Furthermore, these guidelines should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the disease. This guideline reflects the best available data at the time the guideline was prepared. The results of future studies may require revisions to the recommendations in this guideline to reflect new data.

Medium potency topical steroids

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