Epidermal DR+T6- dendritic cells in inflammatory skin diseases

T lymphocyte and dendritic cell subpopulations were counted in three biopsies each of endogenous eczema and pityriasis rosea and two of lichen planus and compared with previous findings in psoriatic lesions. In common with psoriasis, proportionately more CD4 T cells than CD8 T cells were DR+ in both epidermis and dermis of all lesions. In addition, total numbers of epidermal dendritic cells were significantly increased in endogenous eczema and pityriasis rosea, and variably in lichen planus lesions. Interestingly, a DR+T6- subpopulation of dendritic cells was present in varying proportions in all three skin lesion types. Electron microscopy of DR+T6- dendritic cells from psoriatic lesions, using an immunogold staining technique, showed the cells to be of the Langerhans' cell lineage. DR+T6- dendritic cells are a subpopulation of Langerhans' cells which are not specific to psoriasis, but present in the lesions of other benign, inflammatory skin conditions in which CD4 T cells are preferentially activated.     

Quantitative analysis of contact sites between mast cells and sensory nerves in cutaneous psoriasis and lichen planus based on a histochemical double staining technique

Summary The aim of the present study was to test further our previous hypothesis that the inflammatory reaction in psoriasis is neurogenic. For this purpose, contact sites between mast cells and sensory nerves were morphometrically analysed in the basement membrane zone, papillary dermis and three dermal zones of lesional/non-lesional psoriatic and lichen planus skin as well as in healthy control skin. The analyses were made on sections stained with a histochemical double stain developed for this study. With the double stain, active mast cell tryptase was stained blue enzyme histochemically, and the sensory nerves black using specific monoclonal anti-neurofilament antibodies with immunogold. In psoriatic lesions, both mast cells and mast cell — nerve contacts were markedly more frequent in the basement membrane zone and in the papillary dermis when compared with the corresponding areas in the other groups. Mast cell numbers were increased in both lesional and symptom-free skin in lichen planus, but no increase was found in the mast cell — nerve contacts. Increased contacts between mast cells and sensory nerves indicate that the elements exist for neurogenic inflammation in psoriatic lesions. These increased contacts are not due to the extensive inflammatory reaction only, because they were not observed in lichen planus lesions.     

蕈样肉芽肿与扁平苔藓、银屑病浸润细胞的免疫组化比较

目的 探讨免疫表型对蕈样肉芽肿与扁平苔藓、银屑病鉴别诊断的意义.方法 应用ABC免疫组化技术检测15例蕈样肉芽肿,17例银屑病和17例扁平苔藓,6例正常人皮肤的CD1a、CD4、CD8、ICAM-1、LFA-1、HLA-DR(树枝状细胞)、CD30和CD7的表达情况.结果 蕈样肉芽肿表皮CD1a,CD30,ICAM-1(单一核细胞P<0.001,树枝状细胞P<0.01)的阳性细胞密度明显高于扁平苔藓、银屑病、正常人皮肤.蕈样肉芽肿表皮CD4,CD8,HLA-DR的阳性细胞密度明显高于扁平苔藓.蕈样肉芽肿真皮中CD1a阳性细胞的线性密度(P<0.01),真皮内ICAM-1和LFA-1阳性细胞百分比亦较扁平苔藓增多(P<0.05).蕈样肉芽肿表皮CD7阳性细胞与扁平苔藓、银屑病比较差异无统计学意义.银屑病和扁平苔鲜真皮内CD7阳性细胞百分比高于蕈样肉芽肿和正常人皮肤.结论 蕈样肉芽肿和扁平苔藓、银屑病皮损CD1a、CD4、CD8、ICAM-1、LFA-1、HLA-DR、CD30和CD7免疫表型有差异,其结果可为探讨发病机制提供线索.     

High-frequency ultrasound as a useful device in the preliminary differentiation of lichen sclerosus et atrophicus from morphea

High-frequency ultrasound diagnostic equipment (HFUS) using probes with frequencies above 15-MHz has been utilized conventionally in preoperative assessments and postoperative follow-up of skin tumors. The advent of probes with even higher frequencies (up to 30-MHz) has widened the clinical applications of HFUS to inflammatory dermatoses which are histologically confined to the epidermis and upper dermis, such as psoriasis and atopic dermatitis. Ultrasound imaging has the advantage of being a noninvasive and relatively inexpensive technology that is quick and easy to perform. In addition, information obtained from HFUS is unique and useful for clinical diagnosis and evaluation for various skin disorders. We believe that HFUS has the potential to become a powerful tool for either clinical or investigative dermatology. Herein, we present a case of lichen sclerosus et atrophicus (LSA) to which we applied HFUS before skin biopsy and obtained substantial information for the differential diagnosis from morphea, and we reemphasize the usefulness of HFUS in studying the inflammatory skin disorders.     

Cellular localization of fractalkine at sites of inflammation: antigen-presenting cells in psoriasis express high levels of fractalkine.

BACKGROUND: Chemokines play a key role in cell trafficking at sites of inflammation. The fractalkine CX3C chemokine is unique in several aspects. Fractalkine is expressed on activated endothelial cells and exists in two forms, either membrane anchored or in a soluble form. The soluble form is a potent chemotactic agent for T cells/monocytes and the anchored form functions as an adhesion molecule. In view of these specific functions fractalkine is capable of controlling the key regulatory mechanisms of cell trafficking at sites of inflammation. OBJECTIVES: Little is known about the significance of this important molecule in inflammatory diseases. We undertook this study to elucidate the role of fractalkine in inflammatory diseases of the skin. METHODS: We used a polyclonal antifractalkine antibody (immunoperoxidase and immunofluorescence stainings) in cryosections obtained from tissues of normal skin and that of selected cutaneous inflammatory diseases (psoriasis, lichen planus, eczema). RESULTS: Increased expression of fractalkine was observed in the dermal blood vessels of lichen planus, eczema and psoriasis tissues. The most striking finding was that the dermal dendrocytes in the papillary dermis of psoriasis tissues expressed high levels of fractalkine. Compared with 186.64 +/- 51.69 fractalkine positive dermal dendrocytes per mm2 of the upper dermis of psoriatic tissue, the number of positive cells in lichen planus, eczema, and normal skin were 17.29 +/- 12.50, 12.50 +/- 6.75 and 5.93 +/- 3.53, respectively. We also performed double label immunofluorescence staining with nerve growth factor receptor (NGF-R) antibody and fractalkine antibody. NGF-R-positive terminal cutaneous nerves were in close contact with the fractalkine-positive dermal dendrocytes in psoriatic lesions. CONCLUSIONS: The results of this study confirm that fractalkine is upregulated at sites of inflammation. Thus, it is likely that this molecule plays a key part in cell trafficking. An increased expression of fractalkine at the dermal papillae provides a plausible explanation for the migration and accumulation of T cells at these sites in psoriasis. Earlier studies have reported an increased number of dermal dendrocytes in psoriatic tissue; however, the functional role of these cells in the pathogenesis of psoriasis is largely unknown. Expression of fractalkine on the surface of dermal dendrocytes suggests an active role for these cells in localization and activation of lesional T cells.     

Mycophenolate in dermatology

Originally used to treat psoriasis nearly three decades ago, mycophenolic acid, reformulated as mycophenolate mofetil (MMF), has been rediscovered by the world of dermatology. As a relatively well-tolerated immunosuppressive used in organ transplant recipients, MMF has recently been reported to show promise for several dermatologic conditions, including psoriasis, pemphigus vulgaris, pyoderma gangrenosum, bullous lichen planus, and even connective tissue diseases such as lupus erythematosus and dermatomyositis. Although not intended to be exhaustive, this review discusses MMF with regard to its basic pharmacology, its side effects, and its reported efficacy in a variety of dermatologic indications. Relevant literature was retrieved by a Medline search combining the terms "mycophenolate" or "mycophenolic acid" and "skin" or "skin disease" or a number of specific conditions ("psoriasis", "dermatitis", "eczema", "pemphigoid", "pemphigus", "vasculitis", "pyoderma gangrenosum", "Crohn's disease", "graft-versus-host disease", "lichen planus"). As MMF has only been recently re-introduced for dermatologic application, the nature of much of the literature is admittedly that of case reports or case series. Nevertheless, the results are sufficiently promising to warrant further larger, control studies.     

Localization of haptoglobin in normal human skin and some skin diseases

BACKGROUND: Haptoglobin (Hp) is an acute-phase reactant, known to be produced mainly in the liver. Haptoglobin can also be detected in the cytoplasm of normal epidermal Langerhans cells (LCs), and can prevent their functional maturation. The synthesis of Hp in skin cells has not been well studied. METHODS: We examined Hp expression at mRNA and protein levels by in situ hybridization and immunohistochemistry, respectively, in normal human skin and in the skin of patients with psoriasis, lichen planus, erythroderma, seborrheic keratosis, verruca vulgaris, basal cell carcinoma, systemic lupus erythematosus, pemphigus and bullous pemphigoid. RESULTS: (1) Haptoglobin mRNA was expressed in the epidermal keratinocytes (KCs), the epithelial cells of hair follicles, sebaceous glands and eccrine glands in normal skin and all dermatoses investigated. (2) Whereas compared with normal skin, the Hp mRNA in KCs of patients with psoriasis, lichen planus, erythroderma, seborrhoea keratosis and verruca vulgaris was significantly intensified, it was weaker in patients with systemic lupus erythematosus, pemphigus and bullous pemphigoid. (3) Haptoglobin protein only stained positively in some KCs of patients with psoriasis, lichen planus and erythroderma. (4) Although some but not all epidermal LCs were positively stained with anti-Hp antibody in normal skin and in skin samples from all patients, the ratios of Hp-positive LCs/total LCs were significantly higher in those diseases with intensified Hp mRNA in KCs. CONCLUSIONS: Skin is another extrahepatic organ where Hp can be synthesized by KCs. The expression of Hp mRNA in KCs and the Hp protein in both LCs and KCs appears to be correlated with the amount of inflammation, which might indicate that skin itself is involved in down-regulating the local inflammatory reaction by KC-synthesized Hp.     

Association of ras p21 with differentiation of epidermal keratinocytes in proliferating skin diseases.

We examined the localization of DNA replicating cells and ras oncogene product p21 positive cells in proliferating skin diseases, such as psoriasis vulgaris, lichen planus, verruca vulgaris, verruca plana juvenilis and seborrheic keratosis. ras p21-positive cells were found rather in the differentiated layers than in the proliferating layers of the epidermis. We indicate that the expression of ras p21 can be associated with the differentiation of epidermal keratinocytes not only in tumor tissues but also in inflammatory skin disease.     

Type 1 IFN-induced protein MxA and plasmacytoid dendritic cells in lesions of morphea

Morphea is an autoimmune sclerotic skin disease of unknown pathogenesis. As type 1 interferons (IFN) have been implicated in the pathogenesis of systemic sclerosis, we proposed that type 1 IFN promote localized inflammation and fibrosis in morphea. To investigate the expression of the type 1 IFN-inducible protein myxovirus A (MxA) and the presence of plasmacytoid dendritic cells (pDC) in lesions of morphea, lesional skin of 10 patients with morphea was examined by immunohistochemistry for the presence of the type 1 IFN-inducible protein, myxovirus A (MxA), and the pDC markers, CD123 and BDCA-2, and was compared with lesional skin of cutaneous lupus erythematosus, lichen planus and keloid. Lesional and non-lesional morphea skin was compared. MxA was expressed in the epidermis as well as the reticular dermis and subcutis in morphea. pDCs were abundant around vessels and between fibrous bundles. Non-lesional biopsies demonstrated little or no expression of MxA and pDC markers. Keloid showed minimal expression of MxA and pDC markers. We demonstrate the expression of type 1 IFN-related protein MxA and plasmacytoid DCs in lesional but not in non-lesional biopsies of morphea. These findings suggest a potential role for type 1 interferons in the pathogenesis of morphea.     

Plaque psoriasis vs. atopic dermatitis and lichen planus: a comparison for lesional T-cell subsets, epidermal proliferation and differentiation

BACKGROUND: T-cell infiltration in plaque psoriasis has recently been an important subject of investigation. Interestingly, comparative analyses of the disease-specific composition of the lesional T-cell infiltrate in plaque psoriasis and other inflammatory dermatoses have only sparsely been performed. OBJECTIVES: To compare plaque psoriasis vs. atopic dermatitis and lichen ruber planus with respect to T-cell subsets, epidermal proliferation and keratinization. PATIENTS AND METHODS: Biopsies were taken from untreated lesional skin of patients, six with psoriasis, six with atopic dermatitis and six with lichen planus. T-cell subsets (CD4+, CD8+, CD45RO+, CD45RA+, CD2+, CD25+), an epidermal proliferation (Ki-67) and a keratinization marker (K10) were stained immunohistochemically and quantified using image analysis. RESULTS: The high number of CD8+ T cells (52 +/- 13 cells mm(-1)) found in the psoriatic epidermis was not found in the epidermis of atopic dermatitis (9 +/- 4), nor in the epidermis of lichen planus (34 +/- 10). The other T-cell subsets in the epidermis and dermis showed no statistically significant differences between psoriasis and atopic dermatitis. In contrast to the limited presence of CD4+, CD8+ and CD2+ in the psoriatic dermis (110 +/- 19, 27 +/- 9, 127 +/- 41, cells mm(-1), respectively), more impressive numbers of these cells were observed in the dermis of lichen planus (300 +/- 53, 144 +/- 38, 272 +/- 48, respectively). CD45RO+ memory effector T-cell counts were significantly higher in the epidermis of lichen planus (39 +/- 10) than in psoriasis (19 +/- 5). Psoriatic epidermis proved to have major keratinocyte hyperproliferation (247 +/- 26 cells mm(-1) lamina basalis), as compared with atopic dermatitis (134 +/- 15) and lichen planus (128 +/- 20). Furthermore, a marked decreased expression of keratin 10 was observed in psoriasis (41% of epidermal area) contrary to atopic dermatitis (70%). CONCLUSIONS: Psoriatic epidermis exhibits a pronounced CD8+ epidermotropism with accompanying epidermal hyperproliferation and abnormal keratinization, which changes are only minimally expressed in atopic dermatitis and lichen planus. In plaque psoriasis, substantially fewer activated CD4+ and CD8+ T cells in the dermis and less CD45RO+ T cells in the epidermis are present in comparison with lichen ruber planus.     

Lichen planus remission is associated with a decrease of human herpes virus type 7 protein expression in plasmacytoid dendritic cells

The cause of lichen planus is still unknown. Previously we showed human herpes virus 7 (HHV-7) DNA and proteins in lesional lichen planus skin, and significantly less in non-lesional lichen planus, psoriasis or healthy skin. Remarkably, lesional lichen planus skin was infiltrated with plasmacytoid dendritic cells. If HHV-7 is associated with lichen planus, then HHV-7 replication would reduce upon lichen planus remission. HHV-7 DNA detection was performed by nested PCR and HHV-7 protein by immunohistochemistry on lesional skin biopsies from lichen planus patients before treatment and after remission. Biopsies were obtained from lichen planus lesions before treatment (n = 18 patients) and after remission (n = 13). Before treatment 61% biopsies contained HHV-7 DNA versus 8% after remission (P = 0.01). HHV-7-protein positive cell numbers diminished significantly after remission in both dermis and epidermis. Expression of HHV-7 was mainly detected in BDCA-2 positive plasmacytoid dendritic cells rather than CD-3 positive lymphocytes. HHV-7 replicates in plasmacytoid dendritic cells in lesional lichen planus skin and diminishes after remission. This study further supports our hypothesis that HHV-7 is associated with lichen planus pathogenesis.     

光动力治疗炎症性及感染性皮肤病的进展

光动力治疗在皮肤科领域应用广泛,如治疗鳞状细胞癌、基底细胞癌、Paget病、Bowen病、光线性角化病、痤疮、鲜红斑痣及尖锐湿疣等取得了满意疗效.目前关于光动力治疗适应证的研究已扩展到银屑病、口腔扁平苔藓及部分局部感染性皮肤病中,取得了一定的疗效,尤其是对面部扁平疣及皮肤利什曼病等几种炎症/感染性皮肤病,更显示出高效率、低复发及美容效果好等优点,值得进一步研究.     

The diagnostic significance of immunoglobulin and fibrin deposition in lichen planus

Direct immunofluorescent (IF) staining was performed on biopsy specimens from fifty-three patients with active lichen planus. In fifteen of these cases uninvolved skin sites were also examined. Globular or cytoid body-like deposits of immunoglobulins, mainly IgM, were detected in forty-six of the active lesions, and in half the uninvolved skin biopsies. The deposition of fibrin in the papillary dermis and around follicular structures was seen only in the active lichen planus papules. The significance of these findings was assessed by comparison with the IF results obtained in 252 biopsies from various cutaneous disorders, stained by the same technique during the period of this study. Although the presence of immunoglobulin cytoid bodies and fibrin was found to be highly characteristic of lichen planus, these findings were not specifically diagnostic. Morphologically identical deposits were seen not infrequently in lupus erythematosus and in eczema. Active lesions of dermatitis herpetiformis, erythema multiforme and other rare dermatoses also showed these cytoid body-like immunoglobulin deposits.     

Proliferative activity of CD8(+) T cells as an important clue to analyze T cell-mediated inflammatory dermatoses

Abstract To elucidate the pathogenesis of T cell-mediated inflammatory skin diseases, we examined the exact sites where CD8(+) T cells proliferate, correlating them with the localization of antigen-presenting dendritic cells. We performed CD8/Ki-67 double immunohistochemical staining and single staining for CD1a, CD68, and factor XIIIa on sections of paraffin-embedded tissue samples of inflammatory dermatoses in which T lymphocytes are thought to play a crucial role. The dermatoses were lichen planus (12 samples), acute graft-versus host disease (GVHD) (12 samples), chronic GVHD (10 samples), spongiotic dermatitis (8 samples) and psoriasis (7 samples). Labelling for Ki-67 among CD8(+) T cells was predominantly observed in the subepidermal lymphoid infiltrate, and was scanty in the epidermis. This suggested that proliferation of CD8(+) T cells occurred preferentially in the dermis. The labelling index for Ki-67 among dermal and epidermal CD8(+) cells was quite different among the different diseases studied (P < 0.05). They were rich in the subepidermal portion of the dermis of spongiotic dermatitis, acute GVHD and chronic GVHD, but rare in the dermis of psoriasis and lichen planus. A moderate infiltrate was also observed in lesional epidermis of spongiotic dermatitis, acute GVHD and chronic GVHD, whereas they was almost none in the epidermis of psoriasis and lichen planus. CD1a(+) dermal dendritic cells were densely distributed within the lymphoid infiltrate in the affected dermis of spongiotic dermatitis, psoriasis and lichen planus, whereas they were minimal in GVHD. These dermal dendritic cells are candidates as stimulators on T cells in the dermis. In conclusion, the proliferative status of T cells could be an important clue in the elucidation of the pathophysiology of T cell-mediated inflammatory dermatoses. Received: 13 December 2000 / Revised: 24 April 2001 / Accepted: 11 July 2001     

血管内皮生长因子在扁平苔藓及银屑病皮损中的表达

目的探讨扁平苔藓及银屑病患者皮损表皮血管内皮生长因子(VEGF)表达情况。方法用抗VEGF及CD34抗体行免疫组化染色,对扁平苔藓及银屑病皮损标本进行观察,计数表皮下方真皮的毛细血管密度。结果正常人表皮VEGF基本阴性,扁平苔藓及银屑病患者非病变部VEGF阴性,移行部表皮上层VEGF染色逐渐由弱到强,由间断到连续;病变部表皮VEGF阳性,以表皮上层细胞质的细颗粒状染色为主。CD34染色各部分真皮上层毛细血管密度为;扁平苔藓的非病变部(45.61±15.70)个/mm²、移行部(68.63±15.36)个/mm²、病变部(92.07±16.84)个/mm²;银屑病的非病变部(43.73±14.55)个/mm²、移行部(72.12±18.81)个/mm²、病变部(100.29±21.93)个/mm²,各病种三个部位之间比较差异均有统计学意义。结论扁平苔藓及银屑病皮损表皮分泌VEGF,并与真皮毛细血管增生扩张密切相关。     

Circumcision and genital dermatoses

CONTEXT: It is well recognized that the presence of a foreskin predisposes to penile carcinoma and sexually transmitted infections. We have investigated the relationship between the presence or absence of the foreskin and penile dermatoses. OBJECTIVE: To determine whether there is an association between circumcision and penile dermatoses. DESIGN: A retrospective case control study of patients attending the department of dermatology with genital skin conditions. SUBJECTS: The study population consisted of 357 male patients referred for diagnosis and management of genital skin disease. The control population consisted of 305 male patients without genital skin disease attending the general dermatology clinics over a 4-month period. MAIN OUTCOME MEASURES: The relationship between circumcision and the presence or absence of skin disease involving the penis was investigated. The rate of circumcision in the general male dermatology population was determined. RESULTS: The most common diagnoses were psoriasis (n = 94), penile infections (n = 58), lichen sclerosus (n = 52), lichen planus (n = 39), seborrheic dermatitis (n = 29), and Zoon balanitis (n = 27). Less common diagnoses included squamous cell carcinoma (n = 4), bowenoid papulosis (n = 3), and Bowen disease (n = 3). The age-adjusted odds ratio for all penile skin diseases associated with presence of the foreskin was 3.24 (95% confidence interval, 2.26-4.64). All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosus was diagnosed in only 1 circumcised patient. Most patients with psoriasis, lichen planus, and seborrheic eczema (72%, 69%, and 72%, respectively) were uncircumcised at presentation. The majority of men with penile infections (84%) were uncircumcised. CONCLUSIONS: Most cases of inflammatory dermatoses were diagnosed in uncircumcised men, suggesting that circumcision protects against inflammatory dermatoses. The presence of the foreskin may promote inflammation by a k?ebnerization phenomenon, or the presence of infectious agents, as yet unidentified, may induce inflammation. The data suggest that circumcision prevents or protects against common infective penile dermatoses.     

细胞分化标志分子在扁平苔藓皮损中异常表达的研究

通过研究扁平苔藓皮损中角质形成细胞分化标志的表达情况，分析扁平苔藓的病理机制。本实验应用免疫组化方法以银屑病和正常皮肤为对照，检测扁平苔藓中TGk、Filaggrin、K17和K16的原位表达。结果显示TGk和Filaggrin在扁平苔藓皮损表皮中表达增强，K17和K16在扁平苔藓皮损表皮中出现阳性染色，银屑病皮损中上述标志分子有类似表达，而正常皮肤中则无此现象。提示扁平苔藓皮损中角质形成细胞存在着过度增生和异常分化，上述增生分化标志可能是其病理改变的分子基础。     

临床诊断湿疹患者400例的病理诊断分析

【摘要】 目的 根据临床诊断为湿疹的患者的病理诊断,分析误诊情况。探讨临床容易误诊为湿疹的皮肤病及容易导致误诊的相关因素。 方法 回顾性分析我院皮肤科门诊2006年8月到2013年4月间临床以湿疹为诊断并做组织病理检查的所有病例,收集临床数据,重新阅片确定病理诊断,对获得的资料进行分析。 结果 400例临床诊断为湿疹的患者中,110例病理诊断为非湿疹皮炎,占27.5%。误诊病种包括银屑病16例,大疱性类天疱疮13例,扁平苔藓11例,皮肤淀粉样变9例,蕈样肉芽肿8例,恶性肿瘤14例等,其他39例。60 ~ 79岁年龄段及生殖器部位误诊率最高,分别为33.9%和46.2%。 结论 湿疹临床上容易误诊,易误诊疾病包括银屑病、大疱性类天疱疮、扁平苔藓、皮肤淀粉样变、蕈样肉芽肿以及皮肤恶性肿瘤等。老年人及生殖器部位误诊率最高,对于此类患者应积极采取皮肤病理检查。     

Detection of transferrin and C3d receptors in the skin of patients with various dermatoses

The localization of transferrin and C3d receptors in various skin lesions and normal appearing skin have been studied on sections with the PAP technique. The transferrin receptor was recognized in the lower epidermis from psoriatic plaques. Here it was more evident than in other inflammatory or hyperproliferative disorders where it was mainly detected on the basal cells. In healthy skin or lesions of lichen planus, scleroderma and ichthyosis the transferrin receptor was not detected in the epidermis. The C3d receptor was in normal skin found on the basement membrane and on elastic fibres in the papillary dermis. The basement membrane was strongly marked in pemphigoid but was not seen in lichen planus and Ehlers-Danlos syndrome. In patients with urticaria factitia, contact dematitis, psoriasis and Darier's disease the suprabasal cells also expressed C3d whereas in other dermatoses the epidermis was negative. Colloid bodies in lichen planus and GVH reactions expressed both the transferrin receptor and C3d.     

Successful treatment of chronic skin diseases with clobetasol propionate and a hydrocolloid occlusive dressing.

The lesions of 141 patients with chronic skin diseases unresponsive to therapy were treated once a week with clobetasol propionate lotion left under the completely occlusive patch Duoderm. In 131 patients the lesions resolved completely, while partial remission was observed in the remaining 10. The mean interval to complete remission was: for chronic plaque psoriasis, 12 days; psoriasis on palms and soles, 2.5 weeks; palmoplantar pustulosis, 2.2 weeks; skin lesions of Reiter's syndrome, 3 weeks; chronic lichenified eczema, 2.0 weeks; neurodermatitis, 3.1 weeks; breast eczema, 9 days; discoid lupus erythematosus, 3.7 weeks; lichen planus, 2.8 weeks; sarcoidosis, 4 weeks; and lichen sclerosus et atrophicus, 2 weeks. Other conditions benefitting from the treatment were pompholyx, necrobiosis lipoidica, granuloma annulare and pretibial myxedema. The amount of topical corticosteroids needed was reduced to at most 1/20 and to as little as 1/100, compared with common topical steroid preparations.