Reactions to the local use of thephorin.

The early reports on the use of Thephorin,* a hydrogenated phenyl-pyridindene derivative, seemed to indicate that it was an ideal antipruritic, i.e., it effectively and consistently relieved the sensation of itching while producing relatively few or no untoward side effects. Lehmann et al. (1) reported that it is very potent in antagonizing important physiologic effects of histamine on smooth muscle, on arterial pressure, and on capillary permeability. Lehmann (2) proved—and Strauss (3) in reviewing antihistamine therapy, stated—that Thephorin is a more potent local anesthetic than procaine, which suggests the possibility that its local action may be more that of a local anesthetic than that of an antihistaminic. In August, 1947, Kesten and Sheard (4) reported that Thephorin by mouth was effective in thirty-three of forty-one patients (80%) with dermatoses characterized by wheal formation and was a worthy adjuvant in allaying itching in twenty-two of thirty-nine patients (56%) with intensely pruritic dermatoses. They also found that the subcutaneous injection of Thephorin prevented itching in experimentally produced wheals. One year later, Woolridge and Joseph (5) reported on the treatment of atopic dermatitis (disseminated neurodermatitis) with Thephorin orally and locally. Seventeen of twenty-three patients (74%) showed more than 50 per cent clearing in from one to seven weeks. It was the opinion of these authors that the oral administration could be omitted without materially affecting the results. These reports mentioned side effects of irritability and sleeplessness as reactions to the oral use of the drug, which promptly subsided when Thephorin by mouth was discontinued. Woolridge and Joseph cited a patient whose eruption became worse under therapy, but who gave a negative response to patch test with Thephorin. Shelmire (6) was the first to report sensitization dermatitis from the use of Thephorin. He reported on a series of 305 patients with pruritic dermatoses treated with five per cent Thephorin ointment. Of these a very high proportion, namely 233 patients (76.4%) showed benefit from the application of the salve; while a contact-type sensitization developed in only one patient. He states, however, that the skin sensitization index is higher than these figures would indicate. In an additional 150 patients treated with the salve, but who were not included in his first report because of an insufficient observation period, five additional eases of contact dermatitis due to Thephorin were encountered. Thus, Shelmire observed six instances of contact-type sensitization amoung 455 patients, an incidence of 1.31 per cent. He considered this low, because the