DIAMO-DIPHENYL SULPHOXIDE IN DERMATITIS HERPETIFORMIS
1
1181 LIVER IN NORMAL PREGNANCY, PRE-ECLAMPSIA, AND ECLAMPSIA G. BRAS. Department of Pathology, University College of the West Indies, Mona, St. Andrew, Jamaica. SiR,-Dr. Antia and his colleagues (Oct. 11) state that exudation in the space of Disse does not seem to be an artefact or agonal change. Their fig. 2 is given apparently to substantiate this. I believe that this photograph was taken from a post- mortem specimen of the liver, and I note that under Materials and Methods the authors mention that in two cases tissues were obtained immediately after death. Among many hundreds of biopsies I have never en- countered the picture given in fig. 2 except in postmortem material; so I believe that it is important that this should be explicitly stated when it is the case. Otherwise, the photograph in combination with the text may mislead some readers. DIAMO-DIPHENYL SULPHOXIDE IN DERMATITIS HERPETIFORMIS J. O’D. ALEXANDER. Department of Dermatology, Glasgow Royal Infirmary. SIR,-Diamino-diphenyl sulphoxide (D.D.s.o.) has recently been introduced as an alternative to dapsone (diamino-diphenyl sulphone) in the treatment of leprosy. It is said to be almost as effective as dapsone in that disease and to cause less side-effects-notably, less adverse effects on the blood. Since dapsone is now recognised as probably the best available treatment for dermatitis herpetiformis it seemed that a trial with D.D.S.b. in this very troublesome condition was warranted. 12 patients were treated. All but 2 of these had been suc- cessfully controlled with dapsone for periods varying from two to four and a half years. The other two were a child in whom control was only achieved by a combination of liq. arsenicalis and local hydrocortisone and a patient who had not had any treatment. 1 patient failed to report back. The results of treatment in 11 cases are shown in the accompanying table. Control of the condition (i.e., disappearance of lesions and relief of itch) was achieved in 5 cases. The controlling dose varied from 50 mg. to 200 mg. daily. In the remaining 6 cases the beneficial effects were slight or nil. D.D.S.O. was consider- ably slower in controlling the disease than dapsone. The important feature of this small trial is the toxicity of the drug. Only 2 out of the 11 patients showed no evidence of upset. Urinary symptoms and signs of varying severity were present in the other 9. The symptoms appeared to be pro- portional to the dosage. In case 2, for example, the dosage was altered after four days to 100 mg. on alternate days and the symptoms were aggravated shortly after each dose of 100 mg. Case 5, on the other hand, developed symptoms only after fourteen days and they continued in spite of a lowered dose. Because of the frequency and severity of urinary symptoms, investigations into the cause have necessarily been scanty; but in several patients the urine was bacteriologically examined before and after treatment and the development of a Escherichia coli infection (such as has been reported with dapsone) 1 cannot be blamed. Crystalluria was not found. Davey et al.,2 in treating leprosy’ in 24 patients over a period of fifteen months, gave 100 mg. of D.D.S.O. daily, and 18 patients received the drug for a year or longer. The drug was apparently well tolerated by both children and adults. There was a slight fall in haemoglobin in 13 patients, with spontaneous recovery, and also a slight temporary leucopenia. No other toxic signs were observed. The general health of leprosy patients is not nearly so good as that of patients with dermatitis herpetiformis and toxic symptoms would therefore be more likely. It is surprising that these urinary symptoms have not previously been reported. This trial indicates that D.D.s.o. is not a suitable drug for the treatment of dermatitis herpetiformis and suggests that it should be used in leprosy only with great care. A supply of tablets was kindly provided by I.C.I. Pharma- ceuticals Ltd. 1. Combes, F. C., Reisch, M. Brit. J. Derm. 1957, 69, 25. 2. Davey, T. F., Kissaun, A. M., Moneta, G. Leprosy Rev. April, 1957. AN INJECTION UNIT INSTEAD OF THE HYPODERMIC SYRINGE SIR,-It is true that those solutions for injection which are nowadays put up in ampoules of standard dosage could equally well be packed in the Ampin’ device described by Mr. Flood (Nov. 22, p. 1114). The device is not so useful for those injections which are administered in varying dosage or which need to be given slowly over a long period-for example, insulin. Patients undergoing stabilisation may require frequent change of dose or strength. Again, the anxsthetists require a more flexible form of dosage than can be provided by the ampin system. To meet all the dosages and strengths required in hospital practice the variety of ampins would have to be very large. It therefore seems unlikely that ampins will entirely replace the use of syringes in hospitals, though they have many advantages for users in general practice. It is worth noting, however, that the cost of using ampins is considerably higher than that of using syringes and needles. Mr. Flood suggests that the costings I published in 1956 are low and offers an explanation which unfortunately does not fit the facts. In 1956 the service had already been in operation for 21/2 years, so that an initial supply of new syringes could not be an important factor. *Before treatment. F =frequency of micturition. D=dysuria. H=h2ematuria.
Transcript of DIAMO-DIPHENYL SULPHOXIDE IN DERMATITIS HERPETIFORMIS
1181
LIVER IN NORMAL PREGNANCY,PRE-ECLAMPSIA, AND ECLAMPSIA
G. BRAS.Department of Pathology,
University College of the West Indies,Mona, St. Andrew, Jamaica.
SiR,-Dr. Antia and his colleagues (Oct. 11) state thatexudation in the space of Disse does not seem to be anartefact or agonal change. Their fig. 2 is given apparentlyto substantiate this.
I believe that this photograph was taken from a post-mortem specimen of the liver, and I note that underMaterials and Methods the authors mention that in twocases tissues were obtained immediately after death.
Among many hundreds of biopsies I have never en-countered the picture given in fig. 2 except in postmortemmaterial; so I believe that it is important that this shouldbe explicitly stated when it is the case. Otherwise, thephotograph in combination with the text may misleadsome readers.
DIAMO-DIPHENYL SULPHOXIDE INDERMATITIS HERPETIFORMIS J. O’D. ALEXANDER.Department of Dermatology,
Glasgow Royal Infirmary.SIR,-Diamino-diphenyl sulphoxide (D.D.s.o.) has
recently been introduced as an alternative to dapsone(diamino-diphenyl sulphone) in the treatment of leprosy.It is said to be almost as effective as dapsone in thatdisease and to cause less side-effects-notably, less adverseeffects on the blood. Since dapsone is now recognised asprobably the best available treatment for dermatitis
herpetiformis it seemed that a trial with D.D.S.b. in thisvery troublesome condition was warranted.
12 patients were treated. All but 2 of these had been suc-
cessfully controlled with dapsone for periods varying from twoto four and a half years. The other two were a child in whomcontrol was only achieved by a combination of liq. arsenicalisand local hydrocortisone and a patient who had not hadany treatment. 1 patient failed to report back. The resultsof treatment in 11 cases are shown in the accompanyingtable.Control of the condition (i.e., disappearance of lesions and
relief of itch) was achieved in 5 cases. The controlling dosevaried from 50 mg. to 200 mg. daily. In the remaining 6 casesthe beneficial effects were slight or nil. D.D.S.O. was consider-
ably slower in controlling the disease than dapsone.The important feature of this small trial is the toxicity of the
drug. Only 2 out of the 11 patients showed no evidence ofupset. Urinary symptoms and signs of varying severity werepresent in the other 9. The symptoms appeared to be pro-portional to the dosage. In case 2, for example, the dosage wasaltered after four days to 100 mg. on alternate days and thesymptoms were aggravated shortly after each dose of 100 mg.Case 5, on the other hand, developed symptoms only afterfourteen days and they continued in spite of a lowered dose.Because of the frequency and severity of urinary symptoms,
investigations into the cause have necessarily been scanty; butin several patients the urine was bacteriologically examinedbefore and after treatment and the development of a Escherichiacoli infection (such as has been reported with dapsone) 1cannot be blamed. Crystalluria was not found.Davey et al.,2 in treating leprosy’ in 24 patients over
a period of fifteen months, gave 100 mg. of D.D.S.O. daily, and18 patients received the drug for a year or longer. The drugwas apparently well tolerated by both children and adults.There was a slight fall in haemoglobin in 13 patients, withspontaneous recovery, and also a slight temporary leucopenia.No other toxic signs were observed. The general health ofleprosy patients is not nearly so good as that of patients withdermatitis herpetiformis and toxic symptoms would thereforebe more likely. It is surprising that these urinary symptomshave not previously been reported.
This trial indicates that D.D.s.o. is not a suitable drugfor the treatment of dermatitis herpetiformis and
suggests that it should be used in leprosy only with greatcare.
A supply of tablets was kindly provided by I.C.I. Pharma-ceuticals Ltd.
1. Combes, F. C., Reisch, M. Brit. J. Derm. 1957, 69, 25.2. Davey, T. F., Kissaun, A. M., Moneta, G. Leprosy Rev. April, 1957.
AN INJECTION UNIT INSTEAD OF THEHYPODERMIC SYRINGE
SIR,-It is true that those solutions for injection whichare nowadays put up in ampoules of standard dosagecould equally well be packed in the Ampin’ devicedescribed by Mr. Flood (Nov. 22, p. 1114). The deviceis not so useful for those injections which are administeredin varying dosage or which need to be given slowly overa long period-for example, insulin. Patients undergoingstabilisation may require frequent change of dose or
strength. Again, the anxsthetists require a more flexibleform of dosage than can be provided by the ampinsystem.To meet all the dosages and strengths required in
hospital practice the variety of ampins would have to bevery large. It therefore seems unlikely that ampins willentirely replace the use of syringes in hospitals, thoughthey have many advantages for users in general practice.
It is worth noting, however, that the cost of usingampins is considerably higher than that of using syringesand needles.
Mr. Flood suggests that the costings I published in 1956 arelow and offers an explanation which unfortunately does notfit the facts.
In 1956 the service had already been in operation for 21/2years, so that an initial supply of new syringes could not bean important factor.
*Before treatment. F =frequency of micturition. D=dysuria. H=h2ematuria.
