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Sixty patients with persistent palmoplantar pustulosis (PPP) were treated with clomocycline (Megaclor) in a double-blind, cross-over trial in an attempt to establish whether the condition responds to tetracycline. Each patient received 3 months each of clomocycline and placebo in random order. Forty patients completed the trial. Twenty-two failed to respond to either treatment, fifteen improved on clomocycline, two improved on placebo and one placebo and one improbed on both treatments. These results are highly significant (P = 0-003) and suggest that clomocycline may suppress pustulation in some patients. The twenty-two 'non-responders' were compared with the eighteen 'responders' for sex, age, length of history and associated psoriasis but no significant differences were found. Difficulties in assessment and the possiblity of improvement deing due to spontaneous remission are discussed. Further follow-up of both groups suggested that clomocycline used over long periods favourably influenced the course of the disease in the 'responder' group.

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