Plasma cortisol levels were studied on some skin patients comparing with normal controls. Blood specimens were taken by venopuncture and plasma cortisol levels were measured by modified method of Murphy et al., and results obtained were as follows:
1) Plasma cortisol levels in healthy controls were varing by the time of a day or by individuals but in the morning they showed relatively constant and high levels of 8.0-10.5 mcg/dl (mean 9.5 mcg/dl), some skin patients receiving no systemic corticosteroid therapy also showed the similar plasma cortisol levels.
2) Plasma cortisol levels of the skin patients receiving systemic corticosteroids were also measured in the morning time and they showed extreamely low values of 0-2.0 mcg/dl.
3) With some skin patients who were received systemic corticosteroid therapy, plasma cortisol levels were followed up for several months after discontinuring of the drug, and gradual recovery of plasma cortisol levels were observed.
4) Reactive increase of plasma cortisol levels to ACTH in the patients received systemic corticosteroid therapy was also studied in detail.
5) From these results, it was supposed that the control of chronic skin patients receiving systemic corticosteroid will be able to be improved by frequent measurement of plasma cortisol levels and its reaction to ACTH.

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The contents of long-term corticosteroid therapy particularly in systemic lupus erythematosus for its revaluation have been investigated. We have recogized the facts that positive fullness of corticosteroid therapy in the first suppressible stage, synthetic conclusion regarding loss in quantity have been important and we should take full cognizance of outbreak of infectious diseases.

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Fundamental and clinical studies were made of adverse reactions to corticoids with the following results.
1. Histopathologic and electron microscopic examinations of livers from rats receiving injections in large doses of dexamethasone sodium phosphate revealed a high degree of glycogen deposition in hepatic cells. This finding is considered to provide histologic evidence of a glyconeogenetic action possessed by these compounds which manifests clinically as unwanted side effects that might possibly lead to the development of diabetes mellitus.
2. Steroid myopathy, as major side effect of corticoid therapy, by no means is of rare occurrence in dermatology. In some instances the condition was associated with myatrophic changes, both myogenic and neurogenic, as evidenced by histopathological as well as EMG studies.
3. According to an experimental study in rabbits, there is an intimate relationship between the degree of morphologic changes and myopathic changes in EMGs in steroid myopathy, a finding indicating the possible diagnostic usefulness of EMG in the detection of initial changes in affected muscles. Furthermore, corticoids used systemically gave rise to degenerative changes, though of a slight degree, in peripheral nerves as well as to the retention of sodium ions in nerve fibers.
4. Even in such dermatologic conditions as representing relative indications for systemic corticoid therapy, e.g. eczema-dermatitis group, palmoplantar pustulosis and psoriasis, there are instances in which the use of corticoids in relatively small doses accompanied by an overt decrease at the adrenocortical reserve.
5. The application of steroid ointments under occlusive dressing in a dose of 15 to 30g/day in patients with fairly extensive skin lesions, e. g. psoriasis, with presumed impairment of the barrier zone was attended occasionally by side effects similar to those seen with systemic corticoid therapy.

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Corticoids are assumed to exert little or no teratogenic effect on humans. On the other hand, the same agents have been found to cause congenital defects in experimental animals. Therefore, careful administration of the agents during pregnancy or to women possible to be pregnancy seems to be desirable. Judging from animal experiments, it is advisable to administer carefuly to the following situations.
1. On 5∼9 weeks gestation.
2. Patients having relatives with clefe lip and or palate.
3. Long time administration.
4. Corticoids with small difference between teratogenic dose and clinical dose.
5. Simultaneous administration of other drugs.
6. Malnutrition.

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The present study included 22 various dermatologic diseases, predominantly bullous dermatoses, erythrodermas and alopecias. We discussed the following problems: 1) the indications; 2) the 3-day-continuous intramuscular injection as a test for the adrenocortical function; 3) the combined treatment with ACTH-Z and corticosteroid and 4) the side effects.

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Derivatives of cortisones causes cleft palate of the oral cavity with low incidence which is, by no means, negligible. Therefore, patients with systemic lupus erythematosus of moderate severity are adviced not undertake pregnancy. However, if strongly desired, delivery may be performed during periods of remission when corticosteroids are not administered. Administration of corticosteroid, in small dose, for long period may induce stresses dusing delivery, which in turn may possibly cause acute adrenal insufficiency. The latter can be prevented by taking twice as much as the maintenance dose of predonisolone (30mg), which is followed by a gradual decrease in dose until a week after delivery.

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Representative 4 cases of mental disturbances occurring in corticoid treatment has been indicated. In these cases, clinical symptoms are various and non-specific. The classification of these cases presents particular difficulty. Confussion, delirium, incoherent, apathy, amnastic, syndrom, anxiety, insomnia, restless, overactive and talkactive state, depressive state, catatonic stupor, manic state, euphoria, distrust, delussion of persecution, auditory illusion, paranoid state, depersonalisation etc. are observed. There is no corretion between the severity, duration and occurance of the mental disturbances and total or avarage daily dose and the kind of corticoid. Our cases into 3 types, acute transient type, acute prolonged type and chronic type are clasiffied in these coures. In general, mental disturbanes in our cases were reversible by the interruption of corticoid treatment. But, in some cases the symptoms were prolonged. In chronic case, longrange, 5 to 10 years, were administreted with corticoid. Then, in some chronic cases, adrenocortical hypofunction are suggested. It is of some interest that the mental disturbances caused by corticoid are based on the premorbid personality or the endogenous familiar tendency.

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A number of clinical and experimental studies have been made on the so-called chloracne, but there have been no reliable method of treatment. Two cases of chloracne were treated with the combination of skin abrasion and expression of comedones with acomedo extractor with considerable benefit. The lesions most indicated are acne-like lesions with pigmentation on the face, especially the ones overlying the bones. General anesthesia is the rule, Skin abrasion is done first, followed by expression of horny substances within the hair follicles with a comedo extractor taking enough time. After this, the wound surface is disinfected and antibiotic-containing corticosteroid ointment is applied. The first case which received this combined therapy 3 years ago showed satisfactory results both in pigmentation and acne and the other case is also having a satisfacotory course after 1 month of treatment.

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To examine the safety of the materials of cosmetic bases, 14 kinds of the vehicles were made of several materials, and then the patch test study was carried out. The results obtained were as follows. The materials having safety in a usual concentration, were beea wax derivative, white petrolatum, mineral oil, stealic acid, cetanol, isopropyl myristate, propylen glycol, paraffin wax, anhydrous lanolin, hydrogenated castor oil derivative-60M, polyoxyethylene stearate-10M., polyoxyethylene glycol monostearate, glycerol monostearate, sodium cetyl sulfate, polyoxyethylene laurate and sorbitan sesquioleate. The material having insufficient safety was sodium lauryl sulfate. Preservatives such as butyl and methyl p-hydroxybenzoate were probably safe at the concentration of 0.05%, but care must be taken about at 0.1% when they were contained in the permeable vehicles.

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The commercial product soaps were studied in vitro to determine if the soap solutions were capable of affecting epidermal protein. Sodium N-acyl-L-glutamate (AGS) soap, sodium fatty acid soap (A) and lauryl sulfate soap (B) were selected in the present study. The epidermal protein was prepared from the rat at the various months of age. The human stratum corneum was taken from casts removed in an orthopedic clinic. The pathological scale was collected from patient with psoriasis. The sulfhydryl content in the protein solution incubated with soap solution, was determined by the method of amperometric titration. The sulfhydryl concentration in the rat pidermis was definitely altered after incubation in the certain desired concentration of soap solution. However, AGS solution showed the lowest grade of denaturation for the epidermal protein. The sulfhydryl value in the psoriatic scale incubating with soap solution increased above two fold, whereas the AGS solution caused only the thirty percent of increase in sulfhydryl vale. It was found that the AGS soap solution has the mild effect for the normal and pathological protein in the epidermis.

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A patient with generalized pustular psoriasis (Zumbusch type) was treated with nonspecific hyposensitization therapy, mainly “Neurotropin Special” for 10 Months. This patient was obtained comparatively long term remission. Namely, this patient showed improvement of 5 points; cutaneous manifestation, pain of joints, fever, laboratory data and cold urticaria.

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A case of a 60 year-old housewife with sporotrichosis was reported. She has been treated with topical hot pack to the lesion of the right cheek for six months. The lesion enlarged gradually in size. Then amphotericin B solution was injected to the lesion twice a week for a month, and the lesion healed, leaving scar. In this case, topical injections of amphotericin B to the lesion have several kinds of merits, such as technical easiness, small dosis of the drug, and effectiveness without recurrence and side effects.

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