T-cell receptor repertoire and cytokine pattern in granuloma annulare: defining a particular type of cutaneous granulomatous inflammation.

Granuloma annulare is a common granulomatous infiltration of the skin of unknown etiopathogenesis. We analyzed granuloma annulare biopsies in 11 patients and could find in all patients significant numbers of CD4-T cells. These cells showed a broad usage of the different T cell receptor Vbeta families and a rather unbiased repertoire when the complementary determining region 3 spectra were analyzed by the Immunoscope technique. Comparison with the peripheral blood mononuclear cell repertoire, however, identified in all patients few skin-specific expansions, which were for one patient also present in two distinct skin sites. Extensive sequence analysis of the complementary determining region 3 region confirmed the presence of a limited number of skin-specific expansions together with various nonspecific T cell infiltrations. Analysis of the intralesional cytokine expression revealed abundant production of interleukin-2, which was not dominant in granulomas from leprosy patients and was not reflected by the cytokine profile in peripheral blood mononuclear cells. These results demonstrate the capacity of the granulomatous response to recruit T cells in high numbers with only few clones expanding specifically. The high local production of interleukin-2 might thereby play an important role in the nonspecific attraction of T cells to the granulomatous site.

Topical steroids under wet-wrap dressings in atopic dermatitis--a vehicle-controlled trial.

BACKGROUND: The wet-wrap dressing technique has proved to be beneficial in cases of exacerbated atopic dermatitis (AD) skin lesions. OBJECTIVE: The effect of wet-wrap dressings was investigated in a controlled trial comparing a steroid (mometasone furoate 0.1%)-containing and a steroid-free (vehicle) preparation in an in-patient comparison study. METHODS: 20 children aged 2-17 years with exacerbated AD were treated twice daily with wet-wrap dressings over a 5-day period. RESULTS: AD in treated areas significantly improved in both study arms; however, the effect was significantly better in the mometasone-treated group (p < 0.01). Transepidermal water loss improved in both arms without any significant differences. Staphylococcus aureus colonization decreased during the first 3 days of active treatment independently of the therapeutic modalities chosen. At day 5, colony counts further dropped on the steroid-treated lesions. CONCLUSION: Application of the wet-wrap dressing technique for exacerbated AD lesions is effective, combination with a topical steroid being superior to a steroid-free application without bearing the risk of a bacterial superinfection.

Topical tacrolimus (FK506) and mometasone furoate in treatment of dyshidrotic palmar eczema: a randomized, observer-blinded trial.

BACKGROUND: Dyshidrotic palmoplantar eczema is a frequent disease often running a chronic relapsing course. Topical glucocorticosteroids form the mainstay of therapy, and alternatives are urgently warranted. OBJECTIVE: This study was performed to compare the efficacy of tacrolimus (FK506) 0.1% ointment and mometasone furoate 0.1% ointment in the treatment of dyshidrotic palmoplantar eczema. METHODS: Sixteen patients were included in the study after a randomized, observer-blind, intrapersonal comparison protocol. After a 2-week washout period, the active treatment phase amounted to 4 weeks with twice-daily topical application of test substances and additional use of emollients at will. Thereafter, patients were monitored at weekly intervals up to 8 weeks. RESULTS: The dyshidrotic area and severity index showed a more than 50% reduction of baseline values after 2 weeks of active treatment both for FK506 (P =.003) and mometasone furoate (P =.022) in palmar areas. After active treatment, a nonsignificant increase in the dyshidrotic area and severity index was seen with FK506 treated areas. Fourteen of 16 patients had recurring symptoms requiring further therapy within 3 weeks after the active treatment phase. CONCLUSION: Treatment with FK506 offers the possibility for rotational therapy with mometasone furoate in long-standing cases of chronic dyshidrotic palmar eczema.