To the Editor.—Hyperpigmentation, Inflammation and Double-Blind Format.—
Hyperpigmentation developed without preceding inflammation, usually after two weeks of topical lomustine therapy for psoriasis. Clinical clearing, however, usually accompanied the appearance of hyperpigmentation or followed it by at most one week. Hyperpigmentation without preceding inflammation has been reported with other nitrosoureas1,2 and with nitrogen mustards.3 Postinflammatory hyperpigmentation did develop, especially in intertriginous areas, but this was a much later development. Inflammation did not develop in every patient, and in those that did develop intense inflammation, it was usually limited to intertriginous areas. Thus, our study, like any double-blind study that involves an active agent, was double-blind up to the point when a unilateral effect occurred.
Percent Body Surface Treated.—
As can be seen from the table in our article, the total applied dose is more important than the percent of body surface treated. Of the three
Peck GL, Guss SB, Key DJ. Comment on Topical Lomustine Therapy for Psoriasis-Reply. Arch Dermatol. 1973;108(2):273-274. doi:10.1001/archderm.1973.01620230065026