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Systemic use of corticosteroids in dermatology.

The use of corticosteroids systemically in dermatology has benefited patients with pemphigus and systemic lupus erythematosus in that they now have a better chance to carry on a productive life. These hormones, used cautiously, can alleviate some of the tremendous suffering during the explosive exacerbations and acute crises of atopic and neurodermatitis. Corticosteroids are useful in the widespread and acute contact dermatitis and drug eruptions; they are contraindicated in the treatment of ordinary psoriasis. Every attempt should be made by history-taking, clinical examination and necessary laboratory studies to reach an accurate diagnosis before corticosteroids are used. If use of them is indicated, then total patient care is required to avoid complications, and a very careful follow-up is mandatory.

Adrenal Cortex Hormones↗

[Cyclosporin A in the therapy of inflammatory dermatoses].

The experience reported in the literature with cyclosporin A (CyA) in the treatment of various inflammatory and autoimmune dermatological diseases is reviewed and compared with the authors' own experience of treating 36 patients presenting with psoriatic arthritis [8], generalized pustular psoriasis [2], palmoplantar pustular psoriasis [12], Behçet's disease [2], disseminated circumscribed scleroderma [2], acrodermatitis continua suppurativa [2], pemphigus vulgaris [1], lupus erythematosus [3], pyoderma gangrenosum [1], severe atopic eczema [2], and actinic reticuloid [1]. On the basis of the authors' own experience and the reported results, treatment with CyA appears to be primarily indicated in pyoderma gangrenosum, circumscribed scleroderma, psoriatic arthritis and acrodermatitis continua suppurativa. In diseases such as actinic reticuloid, Behçet's disease, localized and generalized pustular psoriasis, treatment with CyA leads to good results with an acceptable risk-benefit ratio. In our view, it is doubtful whether treatment with CyA alone is indicated in alopecia areata, lichen ruber, dermatomyositis, atopic eczema, systemic scleroderma, bullous diseases, and lupus erythematosus, and in the last two it should be given only in combination with systemic steroids. Literature reports provide no support for the use of CyA in ichthyosis vulgaris, pityriasis rubra pilaris, and cutaneous T-cell lymphomas. The risk-benefit ratio of CyA treatment should be carefully considered, especially in diseases that are not life-threatening.

Behcet Syndrome↗

Indirect immunofluorescence (IFA) on kinetoplasts of Trypanosoma theileri for serological diagnosis of systemic lupus erythematosus (LES) in the dog.

An indirect immunofluorescence technique was developed to detect antibodies to ds-DNA in a dog affected by Systemic Lupus Erythematosus (LES). The assay was based upon the use of the antigen substrate Trypanosoma theileri, isolated from samples of bovine blood and maintained in culture tubes. Slides were prepared by the drop method and maintained at -20 degrees C until used. This T. theileri immunofluorescence test, evaluated with positive and discriminant results in a previous study on human sera affected by LES, was used for the first time in the diagnosis of canine LES. The results indicate that T. theileri IFA is specific and reliable.

Animals↗

Photopheresis for T cell mediated diseases.

Photopheresis is a relatively safe and technically simple modality for immunomodulation. The extracorporeal activation of a drug with UVA constitutes a novel form of drug delivery. The usefulness of this system in erythrodermic CTCL is well established. Immunomodulating therapy can thus be conducted outside the host, where controlled conditions permit cellular manipulations not possible in the intact patient. This system is an excellent paradigm for future immunomodulating therapies in diseases such as pemphigus vulgaris and lupus erythematosus.

Humans↗

Cutaneous immunofluorescence.

This article provides an update on skin immunofluorescence as a useful laboratory procedure in the evaluation of diseases that have cutaneous manifestations. It also provides insight into some of the problems with submitting and processing specimens as well as the difficulties and variables encountered when interpreting positive results.

Fluorescent Antibody Technique↗