Percutaneous absorption of hydrocortisone was studied in 18 children (aged from 6 weeks to 14 1/2 years) with atopic or seborrhoeic dermatitis, by measuring their serum cortisol before and after application of 1% hydrocortisone cream. Endogenous secretion of cortisol was suppressed with dexamethasone. A 24 h absorption test was performed on nine children. In six, percutaneous absorption was detected. The highest serum cortisol level was reached within the first 6 h. A 4 h absorption test was developed on the basis of the 24 h test. This short absorption test was performed on nine children, and in eight of them absorption of hydrocortisone was detected. The rise of serum cortisol ranged from 98 to 2669 nmol/l. The 2 h ACTH test was performed to evaluate the effect of previous treatment with topical glucocorticoids. Suppressed adrenocortical function was found in five of 13 children, and was associated significantly with high post-application serum cortisol levels. This occurred more often in infants with a severe skin disorder than in older children or in those with mild or moderate skin disease.

To determine whether inhalant allergens could induce eczematous lesions we studied 17 patients with atopic eczema (with or without allergic rhinitis), 13 patients with allergic rhinitis without atopic eczema and 10 healthy control subjects. The allergens, birch pollen (Betula verrucosa) and house dust mite (Dermatophagoides pteronyssinus), were applied in aluminium chambers for 48 h on clinically normal skin. In 17 patients with atopic eczema, six epicutaneous test reactions of the delayed type to birch pollen and three to house dust mite were seen at 48 or 72 h. In 13 patients with allergic rhinitis without eczema there was one delayed reaction to birch pollen and none to house dust mite. No delayed type test reactions to either allergen were seen in the controls. Biopsies of the positive test sites revealed an eczematous reaction with epidermal spongiosis and microvesiculation. Immunostaining of cryostat sections showed dermal cell infiltrates consisting of mainly T lymphocytes (ratio of T4:T8, 2-6:I) and to a lesser degree Langerhans and indeterminate T6+ cells. 50-90% of the cells were Ia+. The numbers of basophils and mast cells did not exceed 10-15%.

Hietanen J, Salo OP, Kanerva L, Juvakoski T: Study of the oral mucosa in 200 consecutive patients with psoriasis. Scand J Dent Res 1984; 92: 50-4.Abstract -The oral cavities of 200 consecutive psoriasis patients, most of them with widespread disease on the skin, were examined (man/woman ratio 1.63:1, mean age ofthe patients 43.7 yr). The average duration ofthe disease at time of examination was 15.8 yr. When questioned, 16% of the patients reported changes in the joints, which, according to them, had been verified by radiography. 72.5% of the patients reported on nail involvement at some time during their disease. Fissured tongue was present in 9.5% ofthe patients, and geographic tongue and smooth tongue each in 1 % ofthe patients. Angular cheilitis was found in 3.5% ofthe patients. In 20 out of 200 cases, the oral mucosa showed changes and biopsy was taken. Four out of 20 patients showed histoiogic features typical of psoriasis, including accumulations of leukocytes in the upper layers of the epithelium, all with widespread psoriasis skin involvement. Areas of oral mucosa were most often deep red in color, the buccal mucosa and tongue being the two most common sites. Two out of these lour patients had a fissured tongue and one had a geographic tongue.

Percutaneous absorption of hydrocortisone was measured by a fourhour absorption test in !6 children duting and after the acute phase of dermatitis. In the acute phase, after the application of 1% hydrocortisone cream the increment in plasma cortisol ranged from 47 to 961 nmol per liter (median 248 nmol/L), After the acute phase the increment was significantly (P < 0,0!) lower: range 18 to 241 nmol per liter (median 95 nmol/L), In addition to local effect, topical hydrocortisone therapy of childhood dermatitis is accompanied by a systetnic effect that may be pronounced in the acute phase of disease. Convalescence is connected with a diminished systemic efFect due to the restoration of the skin barrier to hydrocortisone.Percutaneous absorption of drugs is influenced by the physical and chemical characteristics of the drugs, the vehicle, and the barrier properties of the skin. Clinically important is the question of how the skin barrier to glucocorticoids is influenced by dermatitis. Feinblatt et al (1) suggested that the percutaneous absorption of labeled hydrocortisone, measured by excretion in urine, was higher in children with atopic dermatitis than in those with normal skin, Bronaugh et al (2) showed that absorption of hydrocortisone through eczematous monkey skin in vitro is double that through normal skin, A study using direct measurement of plasma cortisol revealed that absorption was higher in children with severe skin disorder than in those with mild or moderate skin disease (3).The present study evaluated the effect of dermatitis on the percutaneous absorption of hydrocorti-

Skin lesions were produced by application of 50% potassium iodide to twelve patients with dermatitis herpetiformis (DH). Perivascular cellular infiltrates were found to be characteristic of developing lesions. The cells were mainly round cells; alpha-naphthyl acetate esterase staining revealed that in 24-h lesions the mean percentage of T-lymphocytes was 43%, that of mononuclear phagocytes 6% and that of non-T/non-M cells (mainly B-lymphocytes) 44%. The percentage of the latter was highest (mean 81%) in 6-h specimens, suggesting that these cells are participating in the early stages of lesion formation. The infiltrating cells in dermal papillae and within subepidermal vesicles were predominantly polymorphonuclear leukocytes (mean 86%) with some mononuclear phagocytes and non-T/non-M cells. Immunofluorescence examination confirmed that fibrin deposition is characteristic of the initial lesions of DH and showed that the same is true of fibronectin. Seven out of eight patients had fibronectin deposits in dermal papillae. IgA was found in all and C3 in most of the specimens and, with the exception of papillary vesicles and blister cavities, the intensity of IgA and C3 fluorescence showed no marked alterations during the development of lesions.