bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between Deposition of Immuno‐Components and Infiltration Pattern of Polymorphonuclear Leukocytes in the Lesions of Chronic Urticaria
Authors: Sugita Yasushi , Morita Eishin , Kawamoto Hiroaki , Horiuchi Kenji , Yamada Satoru , Koro Osamu , Yamamoto Shoso
Published: April 2015

Urticaria is often associated with perivascular infiltration of leukocytes into the lesions. Although mast cell‐derived chemical mediators are considered to play crucial roles in the infiltration of leukocytes as well as in the dermal edema, other mechanisms for the leukocyte infiltration have not been well defined. This study revealed that approximately 25% of the cases of chronic idiopathic urticaria in whom wheals had continued for more than 12h had deposition of immuno‐components in the lesions, although histological examination of the lesions did not show leukocytoclastic vasculitis. In these lesions with deposition of immuno‐components, both neutrophils and eosinophils had infiltrated at a constant ratio (approximately 2:1), whereas, in the lesions without deposition, a variable population of leukocytes was seen. This result suggests that activation of complements occurs in the lesions of a considerable percentage of patients with chronic idiopathic urticaria and that the complement fragments influence the infiltration patterns of polymorphonuclear leukocytes.
Post‐Scabetic Nodules: A Lymphohistiocytic Reaction Rich in Indeterminate Cells
Authors: Hashimoto Ken , Fujiwara Keiko , Punwaney Juanita , DiGregorio Fiorino , Bostrom Paul , El‐Hoshy Khaled , Aronson Peter J. , Schoenfeld Robert J.
Published: April 2015

We studied six infants and two adult cases of nodular scabies with immunostains and electron microscopy. All eight cases have had either direct (KOH) or family histories of scabies and were treated with lindane 1% cream or permethrin 5% cream. Family members responded very well, but our patients developed multiple papulo‐nodular lesions which were initially very pruritic and, in some cases, persisted from several months to over one year. H & E stain of biopsied tissue sections revealed a heavy perivascular and periappendageal lymphohistiocytic cell infiltration. Immunophenotype of these cells was compatible with Langerhans cells, i.e. CD1A (+), S‐100 (+) and HLA‐DR (+). Electron microscopy showed that these histiocytic cells satisfied all the ultrastructural criteria of Langerhans cells except for the absence of Birbeck's granules. Lag, a monoclonal antibody for Birbeck's granules, was negative. “Persistent nodules in scabies” or “nodular scabies” seems to represent a prolonged response of indeterminate cells‐lymphocytes to mite antigens.
Eosinophilic Pustular Folliculitis: Report of Seven Cases in Thailand
Authors: Rattana‐Apiromyakij Niramol , Kullavanijaya Preya
Published: April 2015

Seven cases of eosinophilic pustular folliculitis (EPF) were diagnosed at the Institute of Dermatology within the seven years from 1989–1996. There were 4 males and 3 females, age 24–44 years, with durations of the disease before diagnosis ranging from 3 months to 5 years. The face was the most commonly involved area. Lesions also occured simultaneously on other sites including the chest, trunk, scalp, and palmoplantar areas. Diagnosis was made from clinical features, hematologic examinations, and histopathologic pictures. Topical piroxicam gel, 0.5%, and oral indomethacin gave good results; some lesions subsided within a few days, and the remissions lasted for four months to five years.
Localized Multiple Glomus Tumors of the Face and Oral Mucosa
Authors: Yu Hee‐Joon , Kwon Sang‐Jin , Bahn Jae‐Yong , Park Jong‐Min , Park Yong Wook
Published: April 2015

We describe a 54‐year‐old patient with an unusual localization of localized multiple glomus tumors. She had several nodules on the left mandibular area, lower lip, and anterior part of the buccal mucosa. A biopsy taken from the left mandibular area showed cystically dilated vessels lined by endothelial cells and a few outer layers of glomus cells in the dermis to subcutis. Localized multiple glomus tumors are rare, and both their facial and oral mucocal localization are extremely rare.
Solid Facial Edema in a Patient with Rosacea
Authors: Uhara Hisashi , Kawachi Shigeo , Saida Toshiaki
Published: April 2015

We report a 53‐year old man with symmetrical nonpitting edema, conjunctivitis, and acneiform eruptions on the face. Histopathological examination showed perifollicular lymphohistiocytic infiltration and telangiectasias in the upper dermis. Loosely aggregated non‐caseating granulomas were scattered through the dermis; some of them were seen in the perifollicular regions. The patient was treated with fleroxacin (100 mg/day, orally) for two weeks with a marked reduction of both solid facial edema and periorbital edema.
A Retrospective Survey of Mucocutaneous Manifestations of HIV Infection in Malaysia: Analysis of 182 Cases
Authors: Jing Wang
Published: April 2015

A retrospective analysis of 182 HIV positive Malaysians was done in two centers, the University Hospital Kuala Lumpur (UHKL) and the General Hospital Kuala Lumpur (GHKL) from March 1997 to February 1998. Demographic and clinical data were analyzed. The analysis showed that 130 out of 182 patients had mucocutaneous disorders (71.4%). In the study there were 125 males (96.2%) and 5 females (3.8%). The majority of the patients were in the age group from 20 to 50 years. The patients who presented with mucocutaneous disease also had low CD4+ T lymphocyte counts, and most of them had AIDS defining illnesses. The number of cases with generalized hyperpigmentation was very high (35.7%), followed by papular eruptions (29.1%) and xerosis (27.5%). Seborrheic dermatitis was seen in 19.2% of the cases and psoriasis in 7.7%. The most common infections were oral candida 35.7%, tinea corporis and onychomycosis 9.9%, and herpes infection 4.3%. However, mucocutaneous manifestations of Kaposi's sarcoma were rare. The results suggested that mucocutaneous findings are useful clinical predictors of HIV infection or a sign of the presence of advanced HIV infection.
Herpes Zoster Infection Complicated by Motor Paralysis
Authors: Akiyama Naoko
Published: April 2015

We reviewed a total of 1,432 patients diagnosed with cutaneus herpes zoster at Hyogo College of Medicine Hospital between 1989 and 1997 for epidemiologic assessment and outcome in patients with zoster paralysis referred for rehabilitation. Of the 1,432 herpes zoster patients (624 males and 808 females, mean age 54.3 years), 12 were referred to our department of rehabilitation medicine for muscle weakness: one had myelitis, and eleven others had lower motor neuron damage. Except for one 43‐year‐old man with myelodysplastic syndrome, all the lower motor neuron deficit patients were over 60 years of age. Involved myotomes were more widespread than involved dermatomes in eight patients. Electromyography in four patients demonstrated denervation of involved muscles. Five patients experienced complete or near complete recovery from their muscle weakness. The muscle weakness related to herpes zoster was occasionally diagnosed by electromyography as motor neuron damage. Manifestations of motor neuron complications were not noticed but might in fact be more common than was the clinical muscle weakness.
Palmoplantar Pustulosis with Pustulotic Arthroosteitis Involving Temporal Osteomyelitis and Meningitis
Authors: Seno Akemi , Arata Jiro , Matsuura Yoshiko , Suemitsu Ichizou
Published: April 2015

A 46‐year‐old man who had been suffering from palmoplantar pustulosis (PPP) for 3 years had anterior chest pain and left temporal pain from six months after the onset of his disease. A bone scan revealed abnormal uptake at the sternoclavicular joint and left temporal region. The head CT and MRI gave the diagnosis of temporal osteomyelitis with meningitis and myositis. His headache continued even after tonsillectomy and was effectively treated with cyclosporine A (3 mg/kg/day). Oral cyclosporine A was beneficial for the osteomyelitis and skin lesions. Sterile lytic bone lesions occurring most often at the sternocostoclavicular joint have been associated with PPP. However, there have been no reports of a PPP patient with temporal osteomyelytic involvement.
Inhibitory Effects of Alpinia speciosa K. SCHUM on the Porphyrin Photooxidative Reaction
Authors: Liao Ming‐Ching , Arakaki Hajime , Li Yaping , Takamiyagi Atsushi , Tawata Shinkichi , Aniya Yoko , Sakurai Hiromu , Nonaka Shigeo
Published: April 2015

It is thought that the β‐carotene defense mechanism against photosensitivity involves the inhibition of singlet oxygen formation, a kind of active oxygen. When we screened chemical substances obtained from plants indigenous to Okinawa, known to have residents with the longest life span in Japan, we found that Alpinia speciosa K. SCHUM (Japanese name: gettou), which is used as a food preservative, has an activity similar to that of β‐carotene. We measured the amount of lipid peroxide (LPO) formed from a hematoporphyrin‐containing rat liver microsomal suspension irradiated with visible light. The inhibitory effect of Alpinia speciosa on LPO formation was confirmed when the addition of increasing concentrations of Alpinia speciosa extract led to a decrease in the amount of LPO formed. Moreover, the reaction mechanism that affects the amount of singlet oxygen formed was measured, and the effect of the extract was determined by the ESR trapping technique. It was found that the extract effectively inhibited the formation of singlet oxygen. The extract of Alpinia speciosa contains dihydro‐5,6‐dehydrokawain. It was confirmed that dihydro‐5,6‐dehydrokawain, which is a water‐soluble compound, has singlet oxygen quenching activity. We synthesized five derivatives of kawain and found that dimethyl [6‐(2‐phenylethyl)‐2‐oxo‐2H‐pyran‐4‐yl] phosphorothionate has the strongest singlet oxygen quenching activity. The use of the compound from Alpinia speciosa that exhibits singlet oxygen quenching activity as an inhibitory agent of the phototoxic reaction in porphyria is expected.
Spitz Nevus on the Palmar Surface
Authors: Banba Keisuke , Fujioka Akira , Takasu Hiroshi , Ishibashi Akira , Ohta Midori
Published: April 2015

Relatively little is known about the incidence of Spitz nevus on palmar surfaces. This report places a case study in the context of the Japanese literature regarding the occurrence of Spitz nevus on palmar surfaces. Although the proportion of palms and soles in relation to the body surface is about 5%, the incidence of the Spitz nevus was 2%. The mean age at onset was 17.8 years, and all 4 cases were women. The clinical features were a black macule or flatly elevated small modules. The size of the lesions was relatively small, extending from 3.5 mm to 8.0 mm. Although the backs of the hands and insteps have almost the same area as the palms and soles, the incidence of onset in these regions was 6.3% (13 cases). We thus concluded that Spitz nevus tends to be rare on palms and soles.
Multiple Fibroepithelial Basal Cell Carcinoma of Pinkus Associated with Seborrheic Keratosis in a Nevoid Distribution
Authors: Rodriguez Rene Alejandro , Neto Cyro Festa
Published: April 2015

We describe a patient with multiple fibroepithelial basal‐cell carcinoma (FEBCC) associated with seborrheic keratosis distributed in a neviform fashion on the left side of the body and clinically resembling skin tags.
A Rare Association of Systemic Sclerosis with Psoriasis Vulgaris
Authors: Yamamoto Toshiyuki , Katayama Ichiro , Nishioka Kiyoshi
Published: April 2015

Three patients with systemic sclerosis (SSc) and psoriasis vulgaris were evaluated. The onset of psoriasis preceded by 3–7 years the onset of SSc in all cases. All the patients presented diffuse scleroderma, accompanied by lung and esophageal involvement in two cases. Sjögren's syndrome occurred in one case. Myalgia developed with the onset of SSc in two patients. The PASI score was not high (mean; 5.2), implying that the degree of psoriasis was not severe in these cases. However, this might have been due to the systemic prednisolone administered for myalgia.
Photosensitivity in HIV‐Infected Individuals
Authors: Vin‐Christian Kirsten , Epstein John H. , Maurer Toby A. , McCalmont Timothy H. , Berger Timothy G.
Published: April 2015

Objective

To characterize photosensitivity in HIV‐infected individuals using minimal erythema dosage (MED) UVA (ultraviolet A light) and UVB (ultraviolet B light) photoprovocation light testing.

Design

Prospective, controlled analytical study

Setting

University of California, San Francisco, between March 1995 and January 1997.

Patients

13 HIV‐seropositive patients with clinical and pathological features consistent with photodermatitis, 13 HIV‐seropositive patients with biopsy‐proven eosinophilic foliculitis (EF), and 10 HIV‐seropositive patients with CD4 (T helper cell) count below 200 cells/uL and no history of photosensitivity or EF.

Intervention

Each patient underwent MED testing for UVB. All 13 patients with suspected photodermatitis underwent full photochallenge testing with UVA and UVB for up to 10 consecutive week days.

Results

Mean MED to UVB in patients with clinical photosensitivity and EF was lower (p=0.004 and p=0.022 respectively) than that of patients without a clinical history of photodermatitis. There were no significant differences in mean CD4 count or Fitzpatrick skin type. Positive photochallenge tests (papular changes at site of provocative light testing) to UVB (9 of 13 patients) were much more common than reactions to UVA (3 of 13 patients) in the photodermatitis group. All patients with clinically active photodermatitis developed papular changes at the site of UVB photochallenge testing, but only 1 of 5 patients with photodermatitis in remission developed papular changes with UVB photochallenge testing. Seven of the 13 patients with photodermatitis had Native American ancestry. Photosensitive patients were commonly taking trimethoprim‐sulfamethoxazole (TMP‐SMX), but no more commonly than EF or control patients.

Conclusions

Photosensitivity in HIV‐infected individuals appears to be a manifestation of advanced disease. Most patients are sensitive to UVB. The most severely affected individuals are both UVB and UVA sensitive, and may show reactions to visible light. A significant Native American ancestry may be a risk factor for development of photodermatitis in patients with advanced HIV disease. Finally, patients with eosinophilic folliculitis may be subclinically photosensitive.
Expression of 27 KD, 65 KD and 72/73 KD Heat Shock Protein in Atopic Dermatitis: Comparison with Those in Normal Skin and Contact Dermatitis
Authors: Ghoreishi Mehran , Yokozeki Hiroo , Hua Wu Ming , Nishioka Kiyoshi
Published: April 2015

The expression of Heat Shock Protein (HPS) 72/73, HSP65 and HSP27 in skin lesions of atopic dermatitis (n=21) was studied and compared with that in contact dermatitis (n=18) and normal skin (n=9). Keratinocytes in the whole epidermis expressed both HSP65 and HSP72/73 with a membranous, cytoplasmic or nuclear/perinuclear staining pattern much more intensely in atopic dermatitis than in contact dermatitis and normal subjects. In approximately half of the subjects with atopic dermatitis, infiltrating cells in the dermis expressed HSP65 and HSP72/73; this was not observed in contact dermatitis. HSP27 was expressed in the upper epidermis with a cytoplasmic or nuclear/perinuclear staining pattern in all groups. HSP27 was not expressed by infiltrating cells. A clinical evaluation of atopic dermatitis showed that more severe types of atopic dermatitis expressed more intense expression of HSP65 and HSP72/73, but not HSP27, in their skin lesions. These findings suggested that HSP65 and HSP72/73 may play roles in the pathogenesis of atopic dermatitis.
A Case of Classic Kaposi's Sarcoma in a Japanese Man: Detection of Human Herpes Virus 8 (HHV‐8) Infection by Means of Polymerase Chain Reaction and Immunofluorescence Assay
Authors: Yamada Yozo , Funasaka Yoko , Nishioka Eri , Okuno Toshiomi , Ichihashi Masamitsu
Published: April 2015

The recently discovered human herpes virus 8 (HHV‐8) has been implicated in the pathogenesis of Kaposi's sarcoma (KS). Because classic KS in Japan is rare and the detection of HHV‐8 DNA by polymerase chain reaction (PCR) has heen successful only in limited cases, the frequency and role of HHV‐8 infection in KS in Japan remain unclear. Herein we report a case of classic KS in a Japanese man whose HHV‐8 infection was confirmed by the detection of lesional viral DNA and serum antibodies against lytic antigen.
Postoperative Hyponatremia in a Patient with ACTH‐Producing Merkel Cell Carcinoma
Authors: Anzai Saburo , Sato Toshihiro , Takayasu Susumu , Asada Yuji , Terashi Hiroto , Takasaki Syuji
Published: April 2015

Merkel cell carcinoma is characterized by specific neuroendocrine features and the expression of several neuropeptides. We report a case of Merkel cell carcinoma with post‐surgical hyponatremia in an 85‐year‐old Japanese woman. A tumor on the left cheek histopathologically showed the characteristics of Merkel cell carcinoma together with Bowen's disease. Although an increased level of ACTH was found both in the tumor and in the peripheral blood, the postoperative hyponatremia in our patient seems more likely to have been caused by the stress of the operation and indapamide, considering that the ACTH level in the tumor was much lower than those in other ectopic ACTH‐producing tumors in previous reports.
Successful Mapping of Lymphorrhea Using Patent Blue Dye after Lymph Node Dissection for Malignant Melanoma
Authors: Setoyama Mitsuru , Shimada Hidehiko , Kanzaki Tamotsu
Published: April 2015

Patent blue is a dye that has been used for intraoperative lymphatic mapping. We used this mapping method on a patient with lymphorrhea after groin dissection. We easily detected the lymphatic channel causing lymphorrhea and successfully ligated it. This technique may have great merit for treating of lymphorrhea.
Late Onset Hyalinosis Cutis et Mucosae
Authors: Hashimoto Ken , Su W.P. Daniel , Wang Paul W‐S , Eto Hikaru
Published: April 2015

Two cases of non‐familial, late onset (50 and 62‐years‐old) hyalinosis cutis et mucosae were studied and compared with classical early onset cases. Late onset cases showed essentially the same histological and ultrastructural features described for early onset cases. The late onset variety should be distinguished from other diseases; they resemble systemic amyloidosis and sometimes the adult form of colloid milium.
Salivary Gland MALT Lymphoma Associated with Helicobacter pylori Infection in a Patient with Sjögren's Syndrome
Authors: Nishimura Masae , Miyajima Susumu , Okada Natsuko
Published: April 2015

We report a case of salivary gland MALT lymphoma in Sjögren's syndrome associated with localized H. pylori infection. A 76–year‐old woman had a history of bilateral cheek masses for two years. Histologically, the parotid glands were invaded by numerous centrocyte‐like cells to form lymphoepithelial lesions. The tumor cells showed immunohistological differentiation into B cells. Southern blotting demonstrated immunoglobulin gene rearrangement. These results indicated that the tumors were MALT lymphoma. H. pylori, as assessed by the urease test (CLO test; BML Ltd., Tokyo, Japan), was positive in the tumor specimen. After wide local excision of the tumors followed by radio therapy and oral administration of antibiotics and proton pump inhibitor, no evidence of recurrence was found during the 24–months of follow up. H. pylori infection in the salivary gland is rare, although the source of infection and transmission of H. pylori organisms has been thought to be the oral cavity. We discussed the association between H. pylori infection and salivary gland MALT lymphoma. The microorganism may play a role as an additional antigenic stimulus for the development of salivary gland MALT lymphoma as well as for the development of gastric MALT lymphoma. This means that H. pylori can play a role in lymphoma progression as booster of B cell lymphoproliferation.
A Case of Acrodermatitis Enteropathica
Authors: Öztürkcan Serap , İçağasioğlu Dilara , Akyol Melih , Cevit Ömer
Published: April 2015

Acrodermatitis enteropathica is a rare hereditary disorder affecting zinc metabolism that is characterized by dermatitis, alopecia, gastrointestinal disturbances, eye infections, and growth failure. We report a 17‐month‐old girl with acrodermatitis enteropathica. Physical examination showed a cutaneous eruption consisting of vesiculobullous and psoriasiform skin lesions symmetrically distributed in the perioral, acral, and perineal areas. Her plasma zinc level was decreased (75 μg/dl), but within the normal range (60.00–135.00 μg/dl). The patient was given zinc sulfate 50 mg/day. At the end of two months, she had significantly improved.
Do Training‐Dependent Differences in Perspiration Exist between Healthy and Atopic Subjects?
Authors: Stern Ursula M. , Hornstein Otto P. , Salzer Bernd
Published: April 2015

Sweating (perspiratio sensibilis) serves predominantly for thermoregulation and is triggered, among other stimuli, by physical stress. Although consensus on sex‐dependent differences in sweating has not been reached so far and recent studies revealing abnormal diminution of the sweating capacity in atopic subjects are mainly based on heat exposure experiments, the influence of endurance training on perspiration in atopics has not yet been evaluated. Using a special sweat collector device reliable even during intensive body movement, we compared the sweat production of age‐matched male and female healthy controls (14 m, 10 f) to that of in‐patients with atopic eczema (AE: 14 m, 10 f) during and 5 min after physical exercise (30 min) with a bicycle ergometer under standardized experimental conditions. The individual stress limit was determined by a previous endurance test including repeated lactate blood level measurements and continuous heart rate control. Informed consent was obtained from every participant in the study. One half of both the patients and the controls underwent three week endurance training, and the preceding sweat measurements were repeated in all patients and controls after the training period under identical conditions. On average, the healthy males perspired nearly twice as much as the corresponding females (p<0.0016). Highly significant mean differences of maximum sweat secretion rates were also found between the atopics and the controls. Healthy individuals of both sexes perspired nearly three times as much as did the patients with AE (males: p<0.0004; females: p<0.00009). Among the atopics there were remarkable, yet statistically insignificant, sexual differences in sweat production. After three weeks, sweating rates were similar to the initial ones in the training group as well as in the non‐trained control group. Gender differences in perspiration do not only exist betweeen healthy males and females but also in patients with atopic skin disorder, yet the latter ones at significantly lower levels as compared to healthy control subjects. No influence of a three‐week‐exercise phase on sweat secretion in atopics and controls could be proven. For designing further studies on intra‐ or intersexual differences of drug‐independent perspiration, standardized physical stress can be recommended as an experimental prerequisite for sweat measurements.
Topical δ‐Aminolevulinic Acid‐Based Photodynamic Therapy for Japanese Actinic Keratoses
Authors: Itoh Yoshiyasu , Ninomiya Yoshiharu , Henta Tetsuro , Tajima Shingo , Ishibashi Akira
Published: April 2015

Based on the opinion that 5‐aminolevulinic acid‐based photodynamic therapy (ALA‐PDT) may be disadvantageous to Oriental patients with dark skin, including Japanese, because the competing chromophore melanin inhibits the photochemical reaction, we assessed the therapeutic effects when Japanese AK were treated with ALA‐PDT. Fifty‐three lesions in ten patients were followed up for over one year. The cure rates of AK on the face including the neck and on extremities were 81.8% and 55.6%, respectively. The results were approximately the same cure rates as those reported for AK in Caucasian patients. However, a larger number of treatment sessions were required. In the red light range, incoherent light including 630 nm and 670 nm is superior to 630 nm laser light.
Skin Ulcer at the Blunt Apex of a Giant Warthin's Tumor
Authors: Abraham Zeev , Rozenbaum Michael , Keren Ruth
Published: April 2015

An unusual finding of Warthin's tumor or papillary cystadenoma lymphomatosum with ulceration of the overlying skin is described in a patient who refused surgical removal of this growth. The present article is the second case published in the English language dermatological literature on this fascinating tumor. To our knowledge, the clinical presentation and course of the disorder in this individual are unique.
Small Congenital Nevi Associated with Melanoma: Case Reports and Considerations
Authors: Betti Roberto , Inselvini Elena , Vergani Raffaella , Crosti Carlo
Published: April 2015

Melanocytic nevi, both congenital and acquired, are considered to be precursors of melanomas. Data about the malignant potential of these nevi are conflicting, particularly with reference to the nevus of the smallest size. Patients with preexisting melanocytic nevi (both congenital and acquired) have risks of developing melanoma that differ from those of subjects without them. The purpose of this study was to verify the presence of melanoma in preexisting nevi both congenital (congenital nevus associated melanoma) (CNAM) and acquired (ANAM). In particular, we investigated melanomas associated with small congenital nevi (SCN). A cohort of 190 patients with primary melanomas was studied. Congenital nevi were called “small” (SCN) when their diameters were less than 1.5 cm. Epiluminescence microscopy (ELM) was performed to further improve the clinical diagnosis and to observe the more subtle changes in the preexisting nevi. Forty of the 190 cases of melanoma were associated with preexisting nevi; of these, 15 had congenital features with a CNAM largest diameter of 1.5 cm. These 15 cases were melanomas of the superficial type with a mean tumor thickness lower than that of ANAM (0.33 vs 1.50). There were no differences between the locations of CNAM and other melanomas. Male patients were significantly more affected. ELM microscopy permitted us to detect the early malignant changes in nevi and thus to improve our diagnosis. A high percentage of small congenital nevi were found to be associated with melanomas. They may be considered as melanomas precursors. Because of their large number and frequency, prophylactic removal of all SCN is not feasible. However, they should be removed as soon as possible when clinical or ELM changes are observed.
Two Cases of Confluent and Reticulate Papillomatosis: Successful Treatments of One Case with Cefdinir and Another with Minocycline
Authors: Yamamoto Asayo , Okubo Yukari , Oshima Haruko , Oh‐i Tsunao , Koga Michiyuki
Published: April 2015

The present report presents two cases of confluent and reticulate papillomatosis. Case 1 was a 24‐year‐old man who had suffered from skin eruptions for six months, and Case 2 was a 19‐year‐old woman who had had this disease for three days. In both patients, reticular dark brown papules, accompanied by mild keratosis and infiltration, spread from the trunk to the neck and upper arm. Direct light microscopy did not detect the presence of any fungi, and histopathological examinations confirmed hyperkeratosis, acanthosis, papillomatosis, and mild small‐round‐cell infiltration. Thus, these patients were diagnosed as confluent and reticulate papillomatosis. Neither one had diabetes or thyroid dysfunction. In Case 1, cefdinir was effective, and in Case 2, minocycline hydrochloride and ketoconazole were effective. To the best of our knowledge, this was the first documented case of confluent and reticulate papillomatosis responding to cefdinir.
A Case of Intramuscular Hemangioma of the Back
Authors: Kim You Chan , Park Hyang Joon , Cinn Yong Woo
Published: April 2015

Intramuscular hemangioma is an uncommon tumor that usually involves an extremity. They rarely occur after the age of 30. We report a case of an intramuscular hemangioma occurring on the back of a 39‐year‐old man. Histopathologically, the tumor consisted mainly of large vessels between the muscle fibers. Phleboliths were observed in some of the vessel walls.
Hair‐Discoloration of Japanese Elite Swimmers
Authors: Nanko Hiroko , Mutoh Yoshiteru , Atsumi Reiko , Kobayashi Youko , Ikeda Michiko , Yoshikawa Nobuko , Fukuda Satoru , Kawa Youko , Mizoguchi Masako
Published: April 2015

To understand hair‐discoloration in relation to swimming, we examined sixty‐seven elite swimmers of the Japan National Swimming Team and fifty‐four, age‐matched subjects as controls. The incidence of hair discoloration (61%) in the swimmers' group was significantly higher than that in controls (0%) (p<0.0001). Interestingly, surface damage of the nail plates coexisted in the swimmers with the scalp‐hair discoloration. The hairs picked from the eight swimmers and two age‐matched individuals as controls were examined by electron microscope (EM) and EM X‐ray microanalyzer. The swimmers' discolored, golden hair revealed complete disappearance of hair cuticle both by scanning EM (SEM) and transmission EM (TEM). The quantity of melanosomes in the cortex decreased, and their diameter was smaller than that of controls. In addition, irregularly shaped melanosomes with variable electron density and less electron‐dense melanosomes with white haloes were frequently observed in the swimmers' golden hair. The X‐ray elemental spectrograph by SEM revealed that the content of sulfur in all the swimmers' discoloured hair was lower than that in the normal controls and that the content of chlorine in the male swimmers' discoloured hair was higher than that in the female swimmers and the normal controls. The X‐ray elemental microanalysis by TEM focused on melanosomes in the cortex of the cross section and detected elemental chlorine in all swimmers' golden hairs. It did not detect any element in the control hairs. The 14C‐tyrosine uptake test of hairbulbs found no significant difference between the swimmers and the normal controls. These findings suggest that hair discoloration was mainly due to cuticle damage by friction with water. Hypochlorous acid in the swimming pool water can penetrate to the hair cortex through the cuticle. It can oxidize and degenerate melanosomes there.
Effects of Adjuvant Interferon‐alpha Low‐dose Therapy in Melanoma Patients on Serum Inhibin B
Authors: Karamfilov Theodor , Wollina Uwe , Hipler Uta‐Christina , Graefe Tim , Schreiber Gerhard
Published: April 2015

Because the primary aim of adjuvant therapy for melanoma is not curative, all the possible aspects of quality of life have to be considered. One aspect of increasing importance is fertility. The effect of adjuvant interferon α‐therapy for malignant melanoma on male fertility has not been systematically investigated. In the present study, twelve male patients with primary cutaneous melanoma (pT3, 4; N0; M0) who were taking adjuvant low‐dose interferon α2b (3 times 3 mio U/week) for one year were included. Inhibin B—an established marker of male fertility—was measured with an immunosorbent assay before and after one year of interferon α‐therapy to investigate whether this treatment has any influence on fertility. The results were compared with those from normal controls (n=40). The mean serum inhibin B concentration in melanoma patients before interferon therapy was 225.4 ± 112.5 pg/mL; after treatment the level was 229.6 ± 82.0 pg/mL. This difference was not statistically significant (p>0.05). The serum inhibin B concentration in controls was 201.5 ± 17.1 pg/mL, which was not statistically different from either untreated or interferon‐treated melanoma patients (p>0.05). We conclude that low‐dose interferon α does not have a significant (negative) effect on inhibin B or male fertility.
A Case of Primary Cutaneous Actinomycosis
Authors: Wee Seong Ho , Chang Sung Nam , Shim Jeong Yun , Chun Soo‐ll , Park Wook‐Hwa
Published: April 2015

Primary cutaneous actinomycosis is very uncommon because of the exclusively endogenous habitat of the organism. We report a case of primary cutaneous actinomycosis characterized by histopathological “sulfur granules”. The patient had a well‐defined subcutaneous nodule on the left thigh without any other lesion and was treated with surgical excision and subsequent oral ampicillin for six weeks. There has been no recurrence during a 1‐year period of follow‐up.
A Case of Black Dot Ringworm with a Review of Japanese Cases
Authors: Ooka Shiho , Kashima Masato , Kubota Yasuo , Noguchi Atsushi , Kawai Shinichi. , Nakamura Yuka , Kano Rui , Watanabe Shinichi , Hasegawa Atsuhiko , Mizoguchi Masako
Published: April 2015

Black dot ringworm (BDR), caused by Trichophyton violaceum var. glabrum (T. glabrum), was observed in a 28‐year‐old Japanese female who had been treated with prednisolone (22.5 mg/day) for systemic lupus erythematosus. It was successfully treated with oral terbinafine (125 mg/day) for 12 weeks. The causative fungus was identified by molecular analysis as well as morphological and biochemical examination. The chitin synthase 1 (CHS1) gene cleavage pattern of the clinical isolate with restricted enzyme HinfI was identical to that of T. violaceum. We reviewed previous reports of BDR to determine the historical trend of this infection in Japan. Since 1974, 93 Japanese cases have been reported. The age distribution was bi‐modal: the higher peak consisted of children (aged 0–15 years), and the lower peak was composed of the elderly (aged 60–75 years). In the elderly group, females were predominant (M: F=1: 22, p<0.001). T. violaceum, including T. glabrum, was identified as the most common causative fungus of BDR (75.3%). Sixty percent of cases showed slight erythema. In 8 families, 16 cases were found to be intrafamilial infections. A history of previous steroid treatment was described in about 40%.
Mal de Meleda: A Review of Turkish Reports
Authors: Ayman Taliha , Yerebakan Özlem , Yilmaz Ertan
Published: April 2015

Keratoderma Palmoplantare Transgrediens or mal de Meleda (MDM) is a very rare, inherited disorder. Its name derives from the island of Meleda. Although, MDM has been reported from many different countries, only two Turkish patients with MDM have been reported in the international literature. Our six cases of MDM are reported, and retrospective analysis of published Turkish patients with MDM is included. We review the clinical characteristics, associated findings, consanguinity, and family history of the cases. In total, 26 Turkish cases of MDM including ours have been documented. Ten cases showed various nail abnormalities, the most common associated feature. We add 24 new cases from Turkey to the list in the literture. Our findings suggest that the MDM gene may also have originated elsewhere than in Mljet.
A Case of Vesiculo‐Bullous Darier's Disease Associated with Bipolar Psychiatric Disorder
Authors: Mei Sandra , Amato Lauretta , Gallerani Isabella , Perrella Esterina , Caproni Marzia , Palleschi Giovanni Maria , Fabbri Paolo
Published: April 2015

We describe the case of a 71‐year‐old men suffering from Darier's disease since his youth and presenting with intensely itching, vesicular and pustular lesions, localized on his arms, legs and on the ulnar side of his right hand. The patient also had a 30 year‐history of bipolar psychiaric disorders. The histopathological examination of lesional skin showed suprabasal acantholytic clefting, hyperparakeratosis, and dyskeratosis. Histopathological and immunopathological (direct and indirect immunofluorescence) results, were consistent with vesiculo‐bullous Darier's disease. Corticosteroid therapy with methylprednisolone at low dosage (0.2 mg/kg/day) was started with a quick resolution of the vesicular lesions on his arms and legs.
Novel Approaches to Chemoprevention of Skin Cancer
Authors: Bickers David R. , Athar Mohammad
Published: April 2015

Protection against sun‐induced damage leading to photocarcinogenesis in skin is a highly desirable goal. Among various strategies, chemopreventive approaches utilizing non‐toxic agents to prevent the occurrence of precancerous lesions or their surrogate markers are potentially attractive. Epidemiological and experimental studies provide evidence that some naturally occurring chemical agents in the human diet can diminish cancer risk. Aside from water, tea is the most common beverage consumed worldwide. Black tea accounts for nearly 80% of total tea production. Black tea and green tea are derived from the same plant, Camelia sinensis. Green tea contains monomeric polyphenols known as flavanols and black tea contains dimeric flavanols and polymeric polyphenols known as theaflavins (TFs) and thearubigins (TRs). Over the past fifteen years our laboratory has been exploring the feasibility of using tea and its constituents as an approach to skin cancer prevention. We demonstrated that green tea, black tea and constituent polyphenols protect against chemical‐ and ultraviolet B (UVB)‐induced carcinogenesis and reduce the growth of established tumors in skin. We have also shown the efficacy of green and black tea extracts against UVB and psoralen + ultraviolet A (PUVA)‐induced early damage in skin. Although PUVA is highly effective in treating certain skin diseases, careful follow‐up studies of cohorts of patients have shown that similar to UVB, PUVA treatment increases the risk for cutaneous squamous cell carcinoma and melanoma. We have found that oral administration of a standardized green tea extract (SGTE) prior to and during treatment of SKH‐1 mice diminished PUVA‐induced skin hyperplasia and hyperkeratosis. SGTE‐treatment also inhibited PUVA‐induced accumulation of c‐fos and p53 proteins and epithelial hyperproliferation. Both topical application and oral administration of SGTE after PUVA‐treatment reduced skin inflammation and cell hyperproliferation. Topical application of SGTE to human skin prior to PUVA‐treatment inhibited the delayed skin inflammatory response. Similarly, oral and topical administration of standardized black tea extract (SBTE) and its two major polyphenolic sub‐fractions protect against UVB‐induced erythema in SKH‐1 mice. Furthermore, topical application of tea extracts to human volunteers protects against UVB‐induced erythema. In summary, these studies indicate that tea extracts are effective in reducing UVB‐ and PUVA‐mediated DNA damage, expression of early response genes and early inflammatory changes in skin. These studies verify a conceptual rationale for employing naturally occurring dietary constituents as an approach to cancer chemoprevention.
Lasers in Dermatology—A Critical Update
Authors: Anderson Richard Rox
Published: April 2015

Lasers are accepted for treating nevus of Ota, other pigmented lesions, hair removal, vascular lesions, leg veins, tattoos, and for skin resurfacing. These are photothermal treatments, in which certain skin “targets” are heated, followed by selective wound healing. Small pigmented targets such as the dermal melanocytes in nevus of Ota, are best treated with short (<1 μs) laser pulses. Large targets, such as hair follicles, have long thermal relaxation times and are best treated with longer pulses. In general, the ideal pulse duration is about equal to the thermal relaxation time for pigmented targets. However, sometimes the actual target is not pigmented and is at some distance from a pigmented structure. For example the follicular stem cells, which are not pigmented, line the outer root sheath far away from the pigmented hair shaft. These cells appear to be an important target for permanent hair destruction. Pulses longer than the thermal relaxation time of the hair shaft allow heat conduction and better damage of follicular stem cells. Epidermal cooling works far better with pulses longer than about 10 ms, delivered through a cold medium (e.g., cold sapphire in contact with the skin). Thus, the combination of cooling and long near‐infrared laser pulses allows safe and effective pigmented hair removal in all skin types. In contrast, epidermal protection from short pulses is best with dynamic pre‐cooling (e.g., cryogen spray), for example during portwine stain treatment. A major challenge for the future of photothermal laser treatments is to develop ways of treating non‐pigmented skin “targets”. New uses for lasers are emerging. Diagnostic laser imaging and spectroscopy will soon emerge in dermatology. A near‐infrared laser confocal microscope provides histology‐like images of human skin. Imaging is painless and takes only a few minutes. Lesions including melanoma, basal cell and squamous cell carcinoma, microvascular and inflammatory lesions, dermatophytes, verrucae, etc, have distinct appearances. However, sensitivity and specificity of laser‐based diagnostic imaging has not yet been compared with histopathology. Laser phototherapy is also emerging in dermatology. The 308 nm excimer laser has recently been shown to clear psoriasis faster than conventional phototherapy. Scalp psoriasis may soon be treated by fiber‐optic delivery of this UV laser. The variety and utility of lasers in dermatology will probably continue to grow.
Erythema Induratum Associated with Tuberculous Lymphadenitis: Analysis of a Case Using Polymerase Chain Reactions with Different Primer Pairs to Differentiate Bacille Calmette‐Guérin (BCG) from Virulent Strains ofMycobacterium tuberculosisComplex
Authors: Wang Tsun‐Cheng , Tzen Chin‐Yuan , Su Hsin‐Yi
Published: April 2015

We retrospectively analyzed a bacille Calmette‐Guérin (BCG) vaccinated female patient who developed erythema induratum in association with tuberculous lymphadenitis. The polymerase chain reaction (PCR) with two pairs of primers was performed. Only one pair was able to detect the myocobacterial DNA from the paraffin‐embedded specimen of the erythema induratum (EI) lesion. However, both pairs showed positive results with the tuberculous lymphadenitis specimen. Sequence analysis of the PCR products excluded the possibility of BCG as the potential pathogen. Both lesions responded favorably to antituberculous therapy. Our study attests to the tuberculous nature of EI and demonstrates that BCG vaccinationper sedoes not induce the lesion or interfere with the PCR result. Finally, using at least two pairs of primers targeting different genomic segments and possessing species‐identification capability may raise the detection rates and solve some controversies about the nature of tuberculids.
Pedunculated Atypical Cellular Blue Nevus
Authors: Ryou Ji‐Ho , Lim Tuk‐Woo , Lee Mu‐Hyoung , Haw Choong‐Rim
Published: April 2015

Atypical variants of cellular blue nevus are considered to have features intermediate between typical cellular blue nevus and rare malignant blue nevus; they usually show bizarre pleomorphic cells which have prominent nucleoli. We describe a 37‐year‐old‐Korean woman who had had an asymptomatic pedunculated single mass on her right thigh for 17 years. A skin biopsy showed a tumor consisting of intensely pigmented dendritic cells and less or nonpigmented epitheloid cells in the dermis with striking atypia. There has been no evidence of recurrence for 3 years after surgery. The diagnosis of atypical cellular blue nevus was made on the basis of clinical features and skin biopsy findings.
Squamous Cell Carcinoma Arising in Chronic Perianal Pyoderma
Authors: Ishizawa Toshiyuki , Koseki Shin , Mitsuhashi Yoshihiko , Kondo Shigeo
Published: April 2015

We report a rare case of squamous cell carcinoma developing from fistules of chronic perianal pyoderma in a 49‐year‐old Japanese man. He first noticed an abscess and nodule on his buttocks and perianal area 21 year previously (at the age of 28); the fistules formed later. These fistules were surgically removed, and an artificial anus was constructed 14 years ago (at the age of 35) in our hospital, when a histopathological examination revealed no malignant changes. However, he was recently admitted to our hospital with arterial bleeding from the ulcer of the buttock. On admission, the histological diagnosis of the ulcer was well differentiated squamous cell carcinoma. Wide local excision of the ulcer and scar tissue, including the sacrum, was performed. The defect was covered with a left latissimus dorsi flap and skin graft. He received radiation therapy after the operation. However, he died of cachexia and pneumonia. This case indicated that the CPP would better have been treated with wide excision before the development of SCC. Therefore, we recommend careful follow‐up of patients affected by CPP and repeated biopsies of the lesion, particularly when the condition is severe, longstanding, and extensive. We discussed the term “CPP” and reviewed 22 cases of SCC arising in CPP reported in the Japanese literature.
Reticulate Acropigmentation of Kitamura: First Case Reports from Nepal
Authors: Joshi Arun , Sah Shatrughan P.
Published: April 2015

Two young Nepalese females, aged 34 and 17 years, presented with multiple small brown macules in a reticulate pattern on the distal extensor aspects of their limbs. The first patient's daughter also had similar lesions. The second patient had similar lesions on her eyelids and palmar pits as well. The clinical diagnosis of reticulate acropigmentation of Kitamura (RAK) was made in both the patients and was confirmed histopathologically. These are the first case reports of this condition from Nepal.
Non‐ulcerative Basal Cell Carcinoma
Authors: Takahashi Hiroyuki
Published: April 2015

We report two cases of basal cell carcinoma (BCC) arising on the genitalia. The first case was a 49‐year‐old male who became aware of a dull erythematous plaque with a keratotic surface on his scrotal skin, and the second case was a 44‐year‐old female suffering from a keratotic plaque on her right vulvar region. Neither lesion was ulcerative. Both were resected under local anesthesia following a clinical diagnosis of angiokeratoma for the former and seborrheic keratosis or BCC for the latter lesion. Histopathological study revealed that both lesions were BCC. Many questions regarding the pathogenesis of BCC still remain to be clarified. Because most of the reported cases have been ulcerative lesions and the genital region is an uncommon site for BCCs, caution should be taken in cases in whom a clinically non‐ulcerative tumor suspected to be angiokeratoma or seborrheic keratosis arises in this region.
Endothelial Function in Hypertension: Victim or Culprit?
Authors: Bleakley Caroline , Hamilton Paul Kevin , Pumb Richard , Harbinson Mark , McVeigh Gary Eugene
Published: April 2015

Far from simply lining the inner surface of blood vessels, the cellular monolayer that comprises the endothelium is a highly active organ that regulates vascular tone. In health, the endothelium maintains the balance between opposing dilator and constrictor influences, while in disease, it is the common ground on which cardiovascular risk factors act to initiate the atherosclerotic process. As such, it is the site at which cardiovascular disease begins and consequently acts as a barometer of an individual's likely future cardiovascular health. The vascular endothelium is a very active organ responsible for the regulation of vascular tone through the effects of locally synthesized mediators, predominantly nitric oxide (NO), endothelial NO synthase (eNOS), and superoxide. NO is abundantly evident in normally functioning vasculature where it acts as a vasodilator, inhibits inflammation, and has an antiaggregant effect on platelets. Its depletion is both a sign and cause of endothelial dysfunction resulting from reduced activity of eNOS and amplified production of nicotinamide adenine dinucleotide oxidase, which, in turn, results in raised levels of reactive oxygen species. This cascade is the basis for reduced vascular compliance through an imbalanced regulation of tone with a predominance of vasoconstrictive elements. Further, structural changes in the microvasculature are a critical early step in the loss of normal function. This microvascular dysfunction is known to be highly predictive of future macrovascular events and is consequently a very attractive target for intervention in the hypertensive population in order to prevent cardiovascular events.