A recent report by Brodkin, on the transmission of varicella to two individuals who were exposed to herpes zoster while receiving corticosteroids, was the subject of an editorial in the Nov 9 issue of The Journal (186:592). The editorial reiterated the view that infection is a major hazard in corticosteroid therapy, and suggested the use of reverse isolation or severe limitation of external contacts for all patients receiving corticosteroids. We believe this attitude is far more cautious than is justified by the evidence, and we wish to present another point of view.
Theorectically, steroids may promote infection by increasing local vascular tone, preventing the exudation of inflammatory cells, and perhaps also by reticuloendothelial blockade. Soon after adrenocorticotropic hormone and cortisone became available, they were found to influence adversely the course of experimental infections. However, in most studies, comparatively enormous quantities of these compounds were administered. Adrenal corticosteroids actually have