Objective. To investigate the expression patterns of interferon-y (IFNy) and tumor necrosis factor a (TNFa), both of which are potent inducers of class I1 major histocompatibility complex (MHC) and intercellular adhesion molecule 1 (ICAM-I) expression, and their codistribution with HLA-DR and ICAM-1 in skin lesions, cultured fibroblasts, and peripheral blood mononuclear cells (PBMC) of systemic sclerosis (SSc) patients in different stages of disease.Methods. Investigations were carried out using immunohistochemistry studies, reverse transcriptasepolymerase chain reaction, dot-blot hybridization, and cytometric analysis. Serum levels of TNFa were determined by enzyme-linked immunosorbent assay.Results. In the early inflammatory stage of SSc, class I1 MHC and ICAM-1 expression could be detected on most endothelial cells and on fibroblasts located especially in perivascular areas surrounded by infiltrating lymphocytes, which belong to the T helper 1 phenotype expressing IFNy and TNFa. In this early disease stage, an enhanced expression of TNFa on cultured dermal fibroblasts and PBMC, as well as elevated serum titers of soluble TNFa, could be found. Matthias S. Gruschwitz, MD, Gisela Vieth: University of Erlangen-Nurnberg, Erlangen, Germany.Address reprint requests to Matthias S. Gruschwitz, MD, Department of Dermatology, University of Erlangen-Nurnberg, 91052 Exlangen, Germany.Submitted for publication December 19, 1995; accepted in revised form September 3, 1996. important in the putative autoimmune response and in the perpetuation of fibrotic processes in SSc.