A new synthetic corticosteroid was found to be effective without causing sodium retention, even when given to patients with advanced renal disease and hypertension. A dose of 2 mg was equal in potency to 5 mg of prednisone and 4 mg of methylprednisolone. Fifty patients were given paramethasone orally as a single daily dose, usually immediately before breakfast. Forty-five or 90% were able to control their illness by this method. The effect of steroids on the renal lesion was analyzed and, except for benefit in acute toxic lupus nephropathy, the results were disappointing. Long-term antimalarial therapy frequently produced mottled bluish-black hyperpigmentation on the shins which may be confused with ecchymoses associated with steroid therapy. One patient developed muscle weakness due to vacuolar degeneration which clinically resembled steroid-induced myopathy.