PRELIMINARY AND SHORT REPORT THE EFFECT OF GAMMA GLOBULIN IN PUSTULAR ACNE* LOREN W.SHAFFER,M.D., BENJAMIN SdHWIMMER, M.D. AND RENATO J.STANICCO,M.D. One of us (LWS) bad occasion to treat a young Clinical Response: Patient 1: New lesions ceased white man with gamma globulin for prophylaxisappearing immediately after the first injection. after exposure to infectious hepatitis. He wasBy the third week most of the cystic and pustular given two injections, 10 cc. each, of human Polio-lesions had dried up, and no new ones had ap- myelitis Immune Globulin, one week apart. Itpeared. Comedones were not decreased in number. was observed that shortly after the second injec-The patient maintained his improvement through tion, his severe pustular and indurated acnethe fifth week when the cystic and pustular lesions improved considerably. This observation led tobegan to recur. the present study, of which this is a preliminary Patient 2: New lesions continued to develop report. throughout the period of treatment and the one This study of the therapeutic effect of gammamonth follow up. globulin in pustular acne is coupled with a study Patient 3: There was no observable effect of of the serum protein and C-reactive protein levelstreatment. before and after treatment. Patient 4: The first improvement was seen in Method: Four patients in their late teens, other-the second week and by the third, all cystic and wise healthy, but with severe pustular and cysticpustular lesions were dry. The improvement acne that had been resistant to conventionallasted for two weeks after which the lesions methods of treatment were selected for the study.began to return. All therapy for acne was discontinued. On two Discussion: The expected rise in gamma glo- successive weeks 10 cc. of Poliomyelitis Immunebulin that accompanies chronic infections was Globulin containing 165 15 mg per cc of thenot seen in any of the four cases. (The normal globulin fraction of pooled normal human plasma,values for gamma globulin by the Ammonium were injected intramuscularly. At the time of theSulfate precipitation method employed are 1 to first injection and one week after the second,1.4 Gm%). One patient ( 3) showed a moderate fasting blood specimens were drawn for C-reactivedeficiency. The C-reactive protein was positive or protein, serum albumin, serum globulin, andshowed a trace in three of the four patients. gamma globulin determinations. The patientsFurther investigation will be necessary to deter- were observed at two week intervals for observa-mine whether a significant number of patients tion of the clinical response. with severe pustular acne show a systemic re- sponse as indicated by elevation of the serum Results: gamma globulin and appearance of the C-reactive protein.Previous experience indicates that other PolioGm %Gm,,Gm% Serum Serum indicationsof systemic response, temperature, ImmuneSerumSerumGamma C-reartive GlobulinAlbu-Glob-Glob- Protein sedimentation rate, and leukocyte count, are nor- Injected mm olin ulin malin patients with pustular acne. The mechanism of the clinical improvement Patient 11 10 cc 5.32.51.4 Negativein the two patients that improved is unknown. 2 10cc — — — — — It is unlikely that passive transfer of antistaphy- 3 4.92.2 1.41 Trace lococcol immune antibodies is a factor because of Patient21 10cc 4.7 2.4 1.23 ——— Negative— the well known failure to develop circulating 2 10cc— antibody titer or clinical immunity to this or- 3 5.12.2 1.23 Trace ganism. Further work will be done to determine Patient 31 10cc 5.2 1.8 .81 Faint dosage schedules to obtain and maintain improve- Trace — — — — ment, and to determine whether the gamma 2 10cc— globulin directly and/or indirectly aids in local 3 5.21.8 .81Faint skin resistance. Trace Conclusions: No valid conclusions can be drawn Patient 41 10cc4.9 2.8 1.53 2+ 2 10cc — -— — — State University and Detroit Receiving Hospital 3 — and the Social Hygiene Clinic, Detroit Depart- 5.1 2.6 1.35 Negative ment of Health, 660 Clinton Street, Detroit 26, Michigan. * Fromthe Department of Dermatology, Wayne Received for publication December 3, 1957. 97 98 THE JOURNAL OF INVESTIGATIVE DERMATOLOGY from the small number of patients studied. How- tuberculosis. Riv. ist. Sieroterap. ital., 30: ever, the results were interesting enough to war- 287—296,1954. 2. BJAGINI, H. AND P0LL&ccl, M.: Serum elec- rant further study. trophoretic aspects in some children's dis- We wish to acknowledge the helpful sugges- eases. Atti acad. fisiocrit. Siena, Sea. med.— tions of Samuel Albert, M.D., Ph.D. of the Detroit fis.(13),2; 19—22, 1955. Institute of Cancer Research. The gamma globu- 3. SHETLAR, M. H., BULLOCK,JANE A.,SHETLAR, un used in this study wassuppliedby the Michi- CLARAL. AND PAYNE, RIcHARD W.: Compari- gan Department of Health Laboratories. son of Serum C-reactive Protein, Glycopro- tein and Seromucoid in Cancer, Arthritis, REFERENCES Tuberculosis and Pregnancy. Proceedings of 1. MULARGIA, A. AND VANNINI, P.: Gamma globu- the Society for Experimental Biology and un eleetrophoretic patterns in patients with Medicine, 88: 107—109, 1955..