SUMMARY:With the use of the photoacoustic spectrometry system, in which a mixture of lipid-and water-soluble dyes is applied to the skin and then irradiated with light from a xenon lamp (425 nm and 550 nm), we measured photoacoustic signals of both dyes within the stratum corneum and their disappearance rate through the stratum corneum. The signal intensity was higher and dyes penetrated faster in clinically normal skin of patients with atopic dermatitis (AD) compared with healthy subjects, indicating an impairment of the in vivo cutaneous permeability barrier function against both lipophilic and hydrophilic chemicals. Furthermore, penetration rates of the hydrophilic dyes tended to increase in proportion to the severity of AD and significantly correlated with serum IgE levels in the severe AD group. Thus, abnormal barrier functions of clinically normal skin in AD may predispose inflammatory processes evoked by irritants and allergens, especially their water-soluble elements. (Lab Invest 2002, 82:1451-1461.

Percutaneous peptide immunization (PPI) is a simple and noninvasive immunization approach to induce potent CTL responses by peptide delivery via skin with the stratum corneum removed. After such a barrier disruption in human skin, epidermal Langerhans cells, although functionally matured through the up-regulation of HLA expression and costimulatory molecules, were found to emigrate with a reduced number of dendrites. CD8+ populations binding to MHC-peptide tetramers/pentamers and producing IFN-; appeared in the blood after PPI with HLA class I-restricted antigenic peptides. PPI with melanoma-associated peptides reduced the lesion size and suppressed further development of tumors in four of seven patients with advanced melanoma. These beneficial effects were accompanied by the generation of circulating CTLs with in vitro cytolytic activity and extensive infiltration of tetramer/pentamer-binding cells into regressing lesions. PPI elicited neither local nor systemic toxicity or autoimmunity, except for vitiligo, in patients with melanoma. Therefore, PPI represents a novel therapeutic intervention for cancer in the clinical setting.

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Our results suggest that monomyeloid precursors harboring HHV-6 are navigated by HMGB-1 released from damaged skin and probably cause HHV-6 transmission to skin-infiltrating CD4(+) T cells, which is an indispensable event for HHV-6 replication. These findings implicate the skin as a cryptic and primary site for initiating HHV-6 reactivation.

A study of therapeutic drug monitoring indicated that cyclosporin administered before meals produces higher blood concentrations than an equivalent dose administered after meals. Our objective was to compare the efficacy of cyclosporin administered before and after meals, respectively, in psoriasis vulgaris patients. We performed an open trial study. Patients were randomly assigned to receive cyclosporin before (group B, n = 20) or after meals (group A, n = 17), and were followed up in 10 dermatology clinics. The difference between groups was evaluated in severity. The percent reduction in psoriasis area and severity index score from baseline was 29.8% in group A and 75.4% in group B (A vs B, P = 0.00005). Two patients in each group withdrew due to abnormality of laboratory data. Short-term, low-dose treatment with cyclosporin before rather than after meals is suggested as a new effective treatment regimen for psoriasis, with the added advantage of lowering costs.