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Human epidermal cell suspensions were prepared from patients sensitized to trichophytin. The cells were 75% to 95% viable, and contained 2% to 6% Langerhans cells as judged by immunofluorescence staining with an anti-DR antiserum. T lymphocytes from the same patients were co-cultured with trichophytin, with or without epidermal cells or macrophages. Proliferative T-cell response to trichophytin was obtained in cultures containing epidermal cells or macrophages. Pretreatment of the epidermal cells with anti-DR antiserum abolished the response, but normal rabbit serum did not, indicating that HLA-DR positive Langerhans cells are able to induce the cellular immune response to trichophytin. These data indicate that Langerhans cells play an important role in dermatophytosis.

Onychomycosis is difficult to cure as this requires eradication of the primary infection and protection of new areas of growth from reinfection. A new topical treatment (K101) has been developed. The aim of this study was to assess the efficacy, safety and tolerability of K101 treatment of distal subungual onychomycosis. This was a 24-week (plus 2-week washout), multicentre, randomised, double-blind, placebo-controlled study in 493 patients with distal subungual onychomycosis (K101, n = 346; placebo, n = 147), stratified according to degree of nail involvement. More patients with ≤50% nail involvement achieved the primary endpoint (mycological cure after 26 weeks) in the K101 group (27.2%) than placebo (10.4%; P = 0.0012). Proportions for patients with 51-75% involvement were 19.1% for K101 and 7.0% for placebo (not significant). More patients applying K101 than placebo judged that their condition had improved from week 2 (P = 0.0148) to week 24 (P = 0.0004). No safety issues were identified. K101 provides early visible improvements in nail appearance and a clinically meaningful antifungal activity.

Pemphigus vulgaris is extremely rare in childhood. Only 35 cases of juvenile pemphigus vulgaris have been reported in the literature up until to now. During the pre-steroid era, the outcome of the disease was usually regarded as fatal. Today, the prognosis has improved because of the possibility of early diagnosis by immunofluorescent techniques, determination of antibodies against epidermal intercellular substance and early therapy with systemic steroids. A case of juvenile pemphigus vulgaris with a favourable outcome in a 13-year old girl is described.

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