Relapse-associated autoantibodies to BP180 in a patient with anti-p200 pemphigoid.

Anti-p200 pemphigoid and bullous pemphigoid (BP) are autoimmune subepidermal blistering diseases characterized by autoantibodies to a 200-kDa dermal antigen (p200) and two hemidesmosomal proteins (BP180 and BP230), respectively. We report a 70-year-old man with haemorrhagic blisters, widespread crusted erosions, and the immunopathological characteristics of anti-p200 pemphigoid. Treatment with doxycycline, topical corticosteroids and immunoadsorption led to rapid clinical remission. However, 19 weeks later, a relapse occurred with generalized itchy urticarial erythema and tense blisters. At this time, both strong dermal and epidermal IgG staining was detected by indirect immunofluorescence microscopy on salt-split skin, and autoantibodies against both p200 and the 16th noncollagenous (NC16A) domain of BP180 were found. Interestingly, the relapse was associated not only with the detection of autoantibodies to a second autoantigen (BP180), but also with an altered clinical phenotype. This case was a unique occasion to directly monitor the emergence of intermolecular epitope spreading during the course of an autoimmune bullous disorder.

Treatment of trigger finger by steroid injection.

A retrospective study of 235 patients with 338 primary trigger fingers determined the efficacy and safety of steroid injection. Initial treatment consisted of one to three injections of corticosteroid mixed with local anesthetic. Those fingers that failed injection therapy had conventional release of the first annular pulley. Seventy-seven percent of all fingers showed resolution or improvement; 49% after a single injection, 23% after two injections, and 5% after three injections.

Evaluation of topical anti-inflammatory steroid formulations in an Arthus model of inflammation.

Formulations of a number of steroids were evaluated after topical application in a reversed passive Arthus test (RPA) in rabbits. Four 21-chlorosteroids in the same cream base were investigated. The preparations of SQ 18,566 (halcinonide) and SQ 20,811 showed anti-edema activity, but those of SQ 15,361 and SQ 20,589 were less active. Ointment formulations of halcinonide also reduced edema in the RPA. These results, coupled with previously reported clinical data, suggest that the RPA might be utilized to distinguish good from poor formulations of anti-inflammatory steroids prior to screening tests or clinical trials in humans.

Double-blind comparison of halcinonide and betamethasone valerate. Use with occlusive dressings in psoriasis treatment.

In a double-blind, paired-comparison study of the effectiveness of corticosteroid creams used under occlusion for the treatment of moderate to severe psoriasis, a new drug, halcinonide cream, was superior to betamethasone valerate cream, a steroid widely and effectively used for the treatment of psoriasis. This superiority was demonstrated in patients after both one and two weeks of treatment.

double-blind"double-bind.

In a double-blind trial over a 2-week period in 34 patients with psoriases vulgaris, clobetasol propionate cream was shown to be more effective than betamethasone valerate cream. In a further 16 patients whose psoriasis had not responded to betamethasone valerate ointment, treatment with clobetasol propionate ointment was substituted. Fourteen of the 16 patients experienced a rapid improvement of their lesions.