Topical Fluticasone Propionate

Fluticasone propionate is a fluoromethyl androstane 17beta-carbiothioate that is classified for dermatological use as a moderate potency corticosteroid. It is available in 0.05% cream and 0.005% ointment formulations for the treatment of patients with inflammatory dermatoses responsive to corticosteroids. Although it demonstrates greater activity than other corticosteroids of similar potency in vasoconstrictor assays in humans, fluticasone propionate demonstrates low potential to cause significant systemic effects such as suppression of the hypothalamopituitary-adrenal (HPA) axis. This is because it has a high affinity for the glucocorticoid receptor and high lipophilicity, and the small amount of drug that is absorbed is rapidly metabolised to the inactive carboxylic acid derivative in the liver (i.e. it has low systemic bioavailability). In clinical trials, the efficacy of fluticasone propionate cream at 4 weeks did not differ significantly from that of hydrocortisone butyrate 0.1% cream in patients with moderate to severe atopic dermatitis and betamethasone valerate 0.1% cream in patients with moderate to severe psoriasis. Likewise, after 4 weeks, the ointment form of fluticasone propionate had similar efficacy to betamethasone dipropionate 0.05% in patients with psoriasis or atopic dermatitis, although the latter agent may have a faster onset of activity in patients with atopic dermatitis. Fluticasone propionate ointment was generally more effective than hydrocortisone butyrate ointment in patients with psoriasis. A sustained response was usually observed after about 1 week's application of fluticasone propionate, and although once and twice daily administration had similar efficacy, a twice daily regimen may have a slightly faster onset of effect. In trials which included both adults and children, the only adverse events reported were local cutaneous reactions (most frequently, pruritus). Thus, fluticasone propionate, with its low potential for systemic toxicity and possible advantage of once daily administration, is a useful addition to the topical corticosteroids available for the treatment of psoriasis and atopic dermatitis.     

Long-term management of atopic dermatitis in infants with topical pimecrolimus,a nonsteroid anti-inflammatory drug

BACKGROUND: Pimecrolimus cream 1% (Elidel, SDZ ASM 981), a nonsteroid selective inhibitor of inflammatory cytokines, is effective in the treatment of atopic dermatitis (AD). In this study we compared early intervention with pimecrolimus cream with treatment with a vehicle control. OBJECTIVE: The purpose of this investigation was to assess whether early treatment in infants of AD signs/symptoms with pimecrolimus could influence long-term outcome by preventing disease flares. METHODS: In this 1-year, double-blind controlled study, 251 infants aged 3 to 23 months with AD were randomized 4:1 to a pimecrolimus-based regimen (n = 204) or a conventional treatment regimen (n = 47). Both groups used emollients for dry skin. Early AD signs and symptoms were treated either with pimecrolimus cream to prevent flares or, in the control group, with vehicle. Vehicle was used to maintain blinding conditions. In the event of flares, moderately potent corticosteroid was permitted in both groups. The primary efficacy end point was the incidence of flares at 6 months. RESULTS: Pimecrolimus significantly reduced the incidence of flares compared with control treatment (P <.001), with 67.6% versus 30.4% of patients completing 6 months with no flare and 56.9% versus 28.3% completing 12 months with no flare. Overall corticosteroid use was substantially lower in the pimecrolimus group: 63.7% versus 34.8% of patients did not use corticosteroids at all during the study. Pimecrolimus was also more effective than control treatment in the long-term control of pruritus and the signs of AD. There were no clinically significant differences in incidence of adverse events between the 2 treatment groups. CONCLUSIONS: Treatment with pimecrolimus of early signs and symptoms significantly modified the disease course in infants by reducing the incidence of flares and improving overall control of AD. Pimecrolimus was safe and well tolerated.     

The effect of topical steroid application on natural killer cell activity

Peripheral blood natural killer (NK) cell activity of a group of 10 healthy non-atopic volunteers was reduced following the topical application of 15 g of 0.1 % betamethasone valerate ointment to the skin nightly for 1 week. In contrast, no such effect was observed when the inactive base of the steroid ointment was used. NK cell activity dropped significantly by day 7 ( P < 0.05) and then recovered, although NK cell activity at day 22 was still lower than that observed at the start of the experiment. These findings suggest that topically applied steroid is absorbed in sufficient amounts to cause a systemic effect on NK cell function. This may have implications in a number of dermatological disorders, including atopic dermatitis, where topical steroids form the mainstay of treatment.     

Vulvar lichen sclerosus: effect of maintenance treatment with a moisturizer on the course of the disease

OBJECTIVES: Vulvar lichen sclerosus (LS) is an inflammatory disease of unknown etiology that may result in significant discomfort and psychological distress in postmenopausal women. One of the most troublesome features of LS is its chronically relapsing nature. The aim of this study was to investigate the effect of maintenance therapy with a moisturizer in preventing the risk of relapse and progression of vulvar LS in postmenopausal women. DESIGN: Between January 1995 and January 2006, 34 postmenopausal women with vulvar LS were included in a prospective open trial. The participants were treated with a topical corticosteroid cream (0.1% betamethasone valerate) once daily for 1 month and then with maintenance therapy with a moisturizing cream alone once daily. Follow-up visits were scheduled after 1 month and then twice per year (median follow-up, 58 mo). RESULTS: Overall the symptoms of all women improved after therapy with a topical steroid. Twenty-four women (71%) became symptom free, and 10 (29%) experienced partial response. Eighteen of the 24 women (75%) who became symptom free and 6 of the 10 women (60%) who exhibited a partial response reported no worsening of their symptoms while on therapy with a cold cream alone. Total resolution of the clinical signs occurred in 6 of the 19 women with mild vulvar architectural changes. Partial resolution of clinical signs was observed in 22 women (64%). No change was noticed in six (18%) women. None of the participants experienced worsening of vulvar scarring. None of the participants developed vulvar intraepithelial neoplasia or squamous cell carcinoma during the follow-up period. There were no side effects. CONCLUSION: Long-term maintenance therapy of vulvar LS with a moisturizing cream can maintain the symptom relief induced by topical corticosteroids in women with vulvar LS while being safe and inexpensive. This treatment may also be associated with a reduction in topical corticosteroid use because more than half of the women could eliminate corticosteroids altogether.     

Efficacy and tolerance of tacrolimus and pimecrolimus for atopic dermatitis: a meta-analysis

Tacrolimus ointment and pimecrolimus cream have proved to be suitable for the treatment of atopic dermatitis. We conducted a meta-analysis of the efficacy, adverse events/withdrawal of tacrolimus versus pimecrolimus in the treatment of atopic dermatitis. According to our meta-analysis, 0.1% tacrolimus was more effective than 1% pimecrolimus in the treatment of adult patients and moderate to very severe pediatric patients, and more 0.1% mild pediatric patients treatal with pimecrolimus withdrew from the trials because of a lack of efficacy or the occurrence of adverse events, compared with mild pediatric patients treated with 0.03% tacrolimus. The combined analyses of tacrolimus with pimecrolimus showed that tacrolimus was more effective than pimecrolimus (week 3: RR=0.67, 95% CI=0.56-0.80; week 6/end of study: RR=0.65, 95% CI=0.57-0.75), and fewer tacrolimus-treated patients withdrew because of a lack of efficacy (RR=0.32, 95CI%=0.19-0.53) or the occurrence of adverse events (RR=0.43, 95% CI=0.24-0.75), compared with pimecrolimus-treated patients. In conclusion, tacrolimus has higher efficacy and better tolerance than pimecrolimus in the treatment of atopic dermatitis.     

Topical pimecrolimus in the treatment of human allergic contact dermatitis.

BACKGROUND: Contact dermatitis is a common clinical problem, with prevalent sensitizers being cosmetics, metals, medicines, and plants. Plants of the Toxicodendron species cause allergic contact dermatitis (ACD) in 50% to 70% of the population. Pimecrolimus is an ascomycin macrolactam developed for the treatment of inflammatory skin diseases and approved by the US Food and Drug Administration for atopic dermatitis. There are studies supporting the effectiveness of macrolactams when administered before antigen challenge, but there are no studies describing the effectiveness of these drugs in the treatment of established human ACD. OBJECTIVE: To investigate the effect of topical pimecrolimus in the treatment of Toxicodendron-induced ACD once rash is evident. METHODS: Poison ivy tincture was applied to the bilateral anterior forearms of 12 subjects with Finn Chambers (Allerderm Diagnostic Products, Petaluma, CA). After dermatitis was evident, volunteers treated each arm twice daily with either 1% topical pimecrolimus cream or placebo in a blinded fashion. Outcomes measured were a dermatitis grading score and time to rash and itch resolution. RESULTS: The median +/- SEM time for rash resolution was 16.55 +/- 1.59 days in the treatment group and 16.27 +/- 1.82 days in the placebo group (P = 0.601). The median time for itch resolution was 4.73 +/- 1.56 days in the treatment group and 4.91 +/- 1.59 days in the placebo group (P = 0.167). The average dermatitis score was 2.26 +/- 0.17 in the treatment group and 2.32 +/- 0.15 in the placebo group (P = 0.62). CONCLUSIONS: The application of topical pimecrolimus is ineffective in the treatment of ongoing Toxicodendron-induced ACD.     

Psoriasis vulgaris: once-versus twice-daily application of calcipotriol cream

The cause of psoriasis is still unknown. It occurs with equal frequency in both sexes. In many patients topical application alone will suffice to keep psoriasis under control. Vitamin D3 affects keratinocyte differentiation in psoiasis. Thirteen patients with mild to moderate psoriasis vulgaris were enrolled in this trial (eight men and five women), aged between 14 and 40 years. Each patient was instructed to apply calcipotriol cream once daily on the right side and twice daily on the left side for 6 weeks. The treatment assessment was based on psoriasis area severity index (PASI) at 0, 2, 4 and 6 weeks. Serum calcium was assessed prior to and at the end of treatment. Calcipotriol cream was clearly effective in psoriasis and in both sides an almost similar effect was seen. The reduction in PASI was remarkable in both sides and the change was from 7.9 (pretreatment) to 2.4 (once daily) and 2.1 (twice daily). Out of the treated patients, seven (53.8%) had complete to marked clearance of both sides. Two patients (once daily) versus three patients (twice) had moderate improvement. Mild improvement was observed in three with twice-daily and in two with once-daily application. Post-treatment serum calcium was normal in all cases. In conclusion, there was no significant difference between once- and twice-daily application of calcipotriol cream, and single night application of topical calcipotriol could be more practical and reliable, and less expensive.     

Treatment of atopic dermatitis with alpha 1-proteinase inhibitor.

Alpha 1-proteinase inhibitor (alpha 1-PI), a serine protease inhibitor, was tested for its efficacy for the treatment of recalcitrant atopic dermatitis. Atopic dermatitis affects both children and adults and has no established etiology. We hypothesized that during inflammation there is an excess of serine proteases and a deficiency of their naturally occurring inhibitors at the local site of tissue injury, even though there is a normal serum level of serine protease inhibitors. This pilot study consisted of a nonblinded trial using alpha 1-PI at a concentration of 20 mg/mL in an aqueous solution in an alternate day schedule in conjunction with a 1% cream of alpha 1-PI (Stage I) and a 5% cream of alpha 1-PI for maintenance therapy (Stage II). Before enrollment in this trial all six patients failed to respond to high potency topical steroids. Safety was gauged by careful clinical monitoring of subjective complaints, objective findings of erythema, edema, and serial measurements of blood chemistries and complete blood counts. Wound healing was documented by serial photography. Written informed consent was obtained from each patient. All six patients showed significant clinical improvement within 6 to 21 days of initiation of alternate day therapy. Alpha 1-PI stopped pain, pruritus, and promoted tissue healing without scarring in all six patients. No adverse side effects of therapy were documented by clinical history, physical examination, or by blood studies after 120 days of therapy. Atopic dermatitis may be one example where inflammation is due to an imbalance of serine proteases and their naturally occurring inhibitors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of facial seborrheic dermatitis with pimecrolimus cream 1%: an open-label clinical study in Korean patients

Pimecrolimus cream 1% has shown to be effective in patients with a variety of inflammatory cutaneous disorders. And it might be a useful modality in the treatment of seborrheic dermatitis. This prospective study was aimed at assessing the efficacy and tolerability of pimecrolimus cream 1% in the treatment of facial seborrheic dermatitis. Twenty patients were instructed to apply pimecrolimus cream 1% for 4 consecutive weeks. Assessment of the disease severity was performed at baseline and at week 1, 2, and 4. Clinical assessments of erythema, scaling, and pruritus were measured using a 4-point scale (0-3). Global assessments of the disease severity by patients and investigators were performed at each visit. Mean clinical scores of erythema, scaling, and pruritus significantly improved by 87.4%, 91.9%, and 91.5% respectively at week 4 (p<0.001). Improvements in the global assessment of disease severity determined by patients and investigators also showed excellent results. No specific adverse events other than transient burning and tingling sensations were noted. The relapse of facial seborrheic dermatitis was mostly observed between 3 to 8 weeks after the discontinuation of pimecrolimus. We suggest that the topical application of pimecrolimus cream 1% can be an effective and safe alternative for treatment of facial seborrheic dermatitis.     

Pimecrolimus leads to an apoptosis-induced depletion of T cells but not Langerhans cells in patients with atopic dermatitis

BACKGROUND: Apart from the long-used corticosteroids, topical calcineurin inhibitors (tacrolimus, pimecrolimus) represent novel therapeutic options for the treatment of atopic dermatitis. OBJECTIVE: This study was designed to investigate the pathophysiological target cells and mode of action of pimecrolimus in atopic skin. METHODS: Twenty-two patients were randomly assigned to treatment with pimecrolimus cream 1%, matching vehicle cream, or beta-methasone-17-valerate (BMV) cream 0.1% in a randomized, double-blind, vehicle-controlled, parallel group clinical trial. Treatment was given twice daily for 3 weeks. Cryostat sections of skin biopsies were taken before as well as at selected time points after initiation of therapy. For certain experiments, healthy volunteers were topically treated with the creams described twice a day on 5 consecutive days. Epidermal sheets were prepared from suction blisters. For in vitro experiments, untreated, healthy human skin was obtained from patients undergoing plastic surgery. The effect of pimecrolimus and BMV on Langerhans cells (LCs), inflammatory dendritic epidermal cells, and T cells was investigated by using immunofluorescence and flow-cytometry techniques. RESULTS: While topical BMV treatment depleted LCs in healthy and atopic skin, pimecrolimus did not affect their number. Correlating with the disappearance of inflammatory cells, we observed a depletion of inflammatory dendritic epidermal cells and T cells on pimecrolimus and BMV treatment. Furthermore, we show that pimecrolimus depletes T cells by the induction of apoptosis. CONCLUSION: In summary, our data show that pimecrolimus reduces pathological T cells in atopic dermatitis skin via apoptosis, whereas LCs remain unaffected.     

Effect of Topical Application of Black Seed Oil on Imiquimod‐Induced Psoriasis‐like Lesions in the Thin Skin of Adult Male Albino Rats

Psoriasis is a chronic inflammatory skin disease that affects about 1%–3% of the world's population. Black seed oil, i.e., the oil extracted from black seeds (Nigella sativa seeds), possesses a broad spectrum of pharmacological actions including anti‐inflammatory, immunostimulatory, and antioxidant properties. This study aimed to investigate the effect of black seed oil on imiquimod (IMQ) induced psoriasis‐like skin lesions. To this end, 30 male albino rats were divided into three groups: group I, control group; group II, psoriasis‐induced group receiving daily topical applications of IMQ cream (5%) on the shaved back skin for 10 consecutive days; and group III, black seed oil group receiving a daily topical dose of black seed oil 5 mg/kg body weight for 10 days after induction of psoriasis. Animals of all groups were sacrificed and specimens obtained from the skin of the central part of the back were processed for histological and immunohistochemical staining with proliferating cell nuclear antigen (PCNA). IMQ application led to epidermal inflammation, hyperplasia and alterations in the normal appearance of keratinocytes with degenerative changes observed at both light and electron microscopic levels. Collagenous fibers were abundant in the dermis and PCNA‐positive cells were detected in all layers of the epidermis. However, topical use of black seed oil strongly inhibited IMQ‐induced psoriasis‐like inflammation and alleviated all epidermal and dermal changes observed after IMQ application, allowing us to conclude that black seed oil can be used as an adjuvant topical therapy for treating psoriasis. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 301:166–174, 2018. © 2017 Wiley Periodicals, Inc.     

Prednicarbate

Prednicarbate is a synthetic nonhalogenated moderate to high potency corticosteroid. It is rapidly metabolised during skin permeation to prednisolone. Prednicarbate is indicated for relief of inflammation and pruritus associated with corticosteroid-responsive dermatological disorders such as dermatitis (eczema) [including atopic dermatitis] and psoriasis and can be used in children and elderly patients. Large clinical trials conducted in patients with various dermatoses confirm the efficacy of the drug. Smaller trials, conducted in patients with dermatitis, show prednicarbate generally to have similar activity to comparator corticosteroids. Data concerning use of prednicarbate in psoriasis are more limited, although again the drug demonstrated similar efficacy to the corticosteroids with which it was compared. The tolerability of prednicarbate was generally good, although methods of recording adverse events were not clearly reported in many trials. The atrophogenic potential of prednicarbate appears to be low when no occlusion is used. However, atrophogenic effects increase with occlusion. Therefore, prednicarbate is a useful option for the treatment of corticosteroid-responsive dermatoses and appears to have low atrophogenic potential when used without occlusion.     

An assessment of the genetic toxicology of novel boron‐containing therapeutic agents

Boron‐containing compounds are being studied as potential therapeutic agents. As part of the safety assessment of these therapeutic agents, a battery of genetic toxicology studies was conducted. The battery included a bacterial reverse mutation (Ames) assay, an in vitro chromosome aberration assay in peripheral human lymphocytes, and an in vivo rat micronucleus study. The following compounds represent some of the boron‐containing compounds that have been advanced to human clinical trials in various therapeutic areas. The borinic picolinate, AN0128, is an antibacterial compound with anti‐inflammatory activity that has been studied in clinical trials for acne and the treatment of mild to moderate atopic dermatitis. AN2690 (tavaborole) is a benzoxaborole in Phase 3 clinical trials for the topical treatment of onychomycosis, a fungal infection of the toenails and fingernails. Another benzoxaborole derivative, AN2728, a phosphodiesterase‐4 (PDE4) inhibitor, is in Phase 2 clinical trials for the treatment of atopic dermatitis. AN2898, also a PDE4 inhibitor, has been studied in clinical trials for atopic dermatitis and psoriasis. AN3365 is a leucyl‐tRNA synthetase inhibitor that has been in clinical development for the treatment of various Gram‐negative bacterial infections. These five representative compounds were negative in the three genotoxicity assays. Furthermore, AN2690 has been studied in mouse and rat 2‐year bioassays and was not found to have any carcinogenic potential. These results demonstrate that it is possible to design boron‐based therapeutic agents with no genetic toxicology liabilities. Environ. Mol. Mutagen. 54:338–346, 2013. © 2013 Wiley Periodicals, Inc.     

Betamethasone valerate in the treatment of summer hay fever

Betamethasone valerate nasal aerosol in a daily dose of 400 μg was compared with a placebo in a double-blind trial involving 103 patients with summer hay fever. The patients ‘and physicians’ preference for the active compound was statistically significant (P<0.001), with 88% of the patients receiving betamethasone valerate obtaining substantial relief of symptoms. The analysis of patients' daily symptom scores showed that nasal symptoms were significantly reduced by the active aerosol (P<0.001). A day-by-day comparison of nasal symptom scores with pollen counts indicated a decreasing allergic response as the season progressed; possible reasons for this are discussed. No clinically significant side effects were observed. Short tetracosactrin tests from ten randomly chosen patients on betamethasone valerate showed no abnormality and nasal swabs for Candida culture from a further thirty-two patients were negative. It is concluded that intranasal betamethasone valerate is an effective and safe form of therapy for seasonal rhinitis.     

伊曲康唑联合阿莫罗芬乳膏治疗马拉色菌相关性皮肤病的疗效观察

目的 观察口服伊曲康唑胶囊联合外用阿莫罗芬乳膏治疗几种常见马拉色菌相关性皮肤病的临床疗效。方法 选择2017年2月~9月我科门诊收治的经临床确诊的花斑糠疹、马拉色菌毛囊炎、脂溢性皮炎患者270例,随机分为治疗组136例和对照组134例。对照组患者口服伊曲康唑胶囊治疗,治疗组在此基础上对患者皮损处外用阿莫罗芬乳膏,比较两组临床疗效及不良反应情况。结果 治疗组花斑糠疹、马拉色菌毛囊炎、脂溢性皮炎的治疗总有效率分别为92.86%、83.34%、83.34%,高于对照组的71.43%、52.94%、43.34%,差异有统计学意义（P＜0.05）;对照组5例患者口服伊曲康唑出现轻度胃肠道不适症状,治疗组2例患者皮疹部位轻度灼热,均不影响继续治疗,疗程结束停药后均消失。两组不良反应发生情况比较,差异无统计学意义（P＞0.05）。结论 口服伊曲康唑胶囊联合阿莫罗芬乳膏外用治疗马拉色菌相关性疾病疗效确切,安全性高。     

Intranasal betamethasone valerate in the treatment of seasonal rhinitis

Betamethasone valerate aerosol given in doses of 100 μg into each nostril twice daily was compared with a placebo in a double-blind, cross-over trial involving thirty patients with seasonal rhinitis. Patients recorded symptoms of eye irritation and watering, sneezing, rhinorrhoea, and nasal blockage, on a diary card. Analysis of the symptom scores showed that nasal symptoms were significantly better on betamethasone valerate than on placebo (P<0.01) and that nasal blockage in particular was improved (P<0.001). The patients’preference was significantly in favour of the active compound (P < 0.02) and no side-effects were noted. It is concluded that betamethasone valerate offers a safe and effective form of treatment for seasonal rhinitis.     

Intravenous immune globulin (i.v.IG) therapy in steroid-resistant atopic dermatitis

Many trials have been done on steroid-resistant atopic dermatitis. Recently, intravenous immune globulin (i.v.IG) was reported to be effective in the treatment of steroid-dependent atopic dermatitis. The aim of this study was to clarify whether i.v.IG therapy is effective in steroid-resistant atopic dermatitis. Forty-one steroid-resistant atopic dermatitis patients were tested in this study. Patients who weighed less than 30 kg were administered 500 mg/kg of i.v.IG. Patients who weighed 30 kg or more were administered 15 g of i.v.IG. Patient evaluations and laboratory tests with peripheral bloods such as eosinophil percentages and serum IgE levels were performed at days 0, 1, 7, and 21. In the present study, patients who responded to i.v.IG therapy were classified as Group A. Twelve patients who showed transient effects with lower clinical significance were classified as Group B (29.3%). Remaining 12 patients (29.3%) in Group C showed no improvement at all. Serum IgE levels and blood eosinophil percentages were markedly decreased in Group A. I.v.IG therapy may be recommended in the treatment of atopic dermatitis with extremely high serum IgE levels.     

A 12-month double-blind assessment of betamethasone valerate aerosol in the management of asthma

A double-blind trial of the topically active corticosteroid, betamethasone valerate in aerosol form, in the control of chronic asthma is reported. The results show that this is an extremely effective therapeutic agent in non-steroid dependent but nonetheless moderately severe asthmatics. Patients were well controlled on 800 μg of betamethasone valerate daily and control was maintained over a 12-month period. This form of treatment has few undesirable side effects but there is probably an increased incidence of oropharyngeal and laryngeal candidiasis. In particular, adrenocortical suppression was not noted.     

Treatment of atopic dermatitis and psoriasis vulgaris with bupropion-SR: a pilot study

OBJECTIVE: To determine whether the antidepressant bupropion may be useful in treating atopic dermatitis and psoriasis in nondepressed patients. METHOD: Ten nondepressed subjects with atopic dermatitis and 10 with psoriasis completed a single-track, open-label treatment protocol with bupropion-SR in doses of 150 mg/day and 300 mg/day, administered sequentially for 3 weeks each, followed by a 3-week wash-out. Treatment response was assessed at the end of each 3-week period. RESULTS: Six of the 10 subjects with atopic dermatitis showed a reduction in affected body surface area by the end of 6 weeks of bupropion treatment, with affected area increasing toward the prestudy baseline in all responders following bupropion discontinuation-a highly significant treatment effect (p =.0003). Of the 10 subjects having psoriasis, improvement over baseline after 6 weeks of treatment was seen in eight subjects, with coverage increasing toward the prestudy baseline in the responders following bupropion discontinuation (p =.001). Average reduction in affected area in the responders at week 6 of treatment was approximately 50% in both groups. CONCLUSIONS: The generally good tolerability and relative safety of bupropion-SR makes a trial of this agent worthwhile in patients with atopic dermatitis or psoriasis who have failed treatment with more conventional medications. Normalization by bupropion of potentially causative neuroendocrine, immunologic, or catecholaminergic abnormalities in both of these dermatologic disorders is a possible mechanism of action for the observed salutary effects of this drug on our subjects' skin disease.