ENDOTHELIAL CELL ADHESION MOLECULES IN PSORIASIS

Skin biopsies from patients with psoriasis and normal controls were examined for the expression of cell adhesion molecules including intercellular adhesion molecule-1 (ICAM-1) endothelial leukocyte adhesion molecule-1 (ELAM-1), HECA-452 and 4D10, using an immunoperoxidase techique. This study demonstrates that psoriatic skin exhibits a wide variety of markers of endothelial cell activation which are either induced or increased expression (ICAM-1, ELAM-1 & 4D10). Moreover, ICAM-1 & HECA-452 are also on leukocytes. These antigens may facilitate the adhesion of inflammatory cells to endothelium and antigen-presenting cells in psoriatic skin. Thus, they may play a role in faciliating the infiltration of leukocytes into psoriatic skin.     

HYPEREOSINOPHILIC SYNDROME PRESENTING WITH ERYTHRODERMA

A patient with idiopathic hypereosinophilic syndrome presenting with erythroderma is reported. The literature on this syndrome is reviewed and no previous report of presentation with erythroderma has been found.     

CYCLOSPORIN TREATMENT OF ATOPIC DERMATITIS: FIVE CASE STUDIES AND LITERATURE REVIEW

This study reports on five adult patients with severe atopic dermatitis who were treated in our department with a three month course of cyclosporin * * The drug is registered as “CYCLOSPORIN” in Australia.
All patients demonstrated significant clinical improvement with minimal side effects. We conclude that provided safety guidelines are observed, cyclosporin can be used with good effect in those patients where conventional treatment is unsatisfactory. This paper also reviews the use of cyclosporin in atopic dermatitis and includes a brief discussion of how it may alter pathophysiologic mechanisms.     

SURVEY OF AUSTRALIAN ISOTRETINOIN PRESCRIBING

In Australia, dermatologists have been designated as the sole prescribers of isotretinoin and thus we are in a unique position to audit national usage of the drug. Questionnaires were sent by the Australasian College of Dermatologists to all 204 practising Fellows in Australia. The aim was to study the number and type of patients treated with isotretinoin, the manner in which the drug is prescribed, adverse reactions and the number of pregnancies occurring during and after treatment. Judging from the 85% of questionnaires which were returned, isotretinoin is an effective and well-tolerated drug for the treatment of severe nodulocystic acne. In the five years that isotretinoin has been used in Australia, 11 pregnancies while taking the drug were reported. These pregnancies occurred despite exhaustive counselling by dermatologists and the patients being fully aware of the risks to the fetus and the need for adequate contraceptive measures. With one exception, all agreed to have a therapeutic abortion. There were two reports of congenital abnormalities after cessation of treatment, neither of which were thought to be related to isotretinoin. In several regions where a dermatologist is not available, a specialist physician may prescribe isotretinoin according to State Health regulations.