bluuebunny/crossref_metadata_2025 huggingface dataset:
Generalized Lichen Nitidus Appearing Subsequent to Lichen Planus
Authors: Kawakami Tamihiro , Soma Yoshinao
Published: April 2015

A 27‐year‐old man was seen with multiple, small, shiny papules on his shoulders, upper arms, and trunk, and hyperpigmented violaceous plaques on his feet. The former was diagnosed as generalized lichen nitidus and the latter, as lichen planus. It is not likely that the coexistence of the two diseases in this patient is a fortuitous one, since generalized lichen nitidus is a very rare condition. The association of lichen nitidus and lichen planus suggests that lichen nitidus is closely related to lichen planus and that the two diseases may be different manifestations of essentially the same pathogenetic process.
Correlation of Lesional Skin Corneometry Values with Serum E‐Selectin Levels and Disease Severity in Patients Affected by Plaque‐type Psoriasis: Recovery after Effective Therapy
Authors: Carducci Massimo , Mussi Anna , Bonifati Claudio , Tomaselli Roberta , Onorati Maria Teresa , Trento Elisabetta , Ameglio Franco
Published: April 2015

Ten subjects with plaque‐type psoriasis (5 females, 5 males, median age 47, range 20–71 years, median psoriasis area and severity index [PASI] score=15.5, range 8.1–23.0) were observed before (week 0) and at the second and sixth week after starting treatment (PASI=10.5, range 7.8–14.6; PASI=8.5, range 1.6–11.6, respectively).

At each of these times, the patients were evaluated for both lesional and unlesional skin corneometry and serum E‐selectin values, previously shown to be increased in psoriatic subjects.

At time 0, both the corneometry and the E‐selectin values were significantly correlated with the PASI, infiltration and desquamation scores. As expected, the corneometry was statistically higher in the unlesional than in the lesional areas (p<0.001).

After therapy, the lesion improvement was related both to the PASI scores and E‐selectin level decreases (from median levels of 15.5 to 8.5 and from 18 to 13.2 ng/ml, respectively, p<0.05) as well as to the corneometric level increases (from a median value of 34.5 to 42, p<0.05). Considering the data obtained at all of these times, significant correlations were found between the PASI scores, lesional skin corneometry and serum E‐selectin levels.

In conclusion, lesional corneometry seems to represent an objective alternative method for reliably monitoring psoriatic patients.
Human Type VI Collagen: Purification from Human Subcutaneous Fat Tissue and an Immunohistochemical Study of Morphea and Systemic Sclerosis
Authors: Takasaki Shuji , Fujiwara Sakuhei , Shinkai Hiroshi , Ooshima Akira
Published: April 2015

Collagen was isolated from human placenta by pepsin digestion and salt precipitation. This collagen was similar in its electrophoretic mobility and immunological reactivity with monoclonal antibody to form B of type VI collagen in the literature (Trueb B, Schreier T, Bruckner P and Winterhalter K. 1987. Eur. J. Biochem. 166: 699–703). We prepared polyclonal rabbit antiserum against α2 chain of type VI collagen and performed an immunohistochemical study using this polyclonal antibody. It reacted in fat tissue and around vessels and peripheral nerves in normal human skin. To confirm the presence of type VI collagen in fat tissue, we isolated collagen from human subcutaneous tissue. This collagen showed a similar pattern in polyacrylamide gel electrophoresis with that from human placenta and cross‐reacted with monoclonal or polyclonal antibody against type VI collagen. By immunohistochemical staining, abundant type VI collagen was observed in the septum of subcutaneous fat tissue in morphea or systemic sclerosis. In the mild hyalinizing areas or after treatment with 6M urea or hyaluronidase in highly hyalinized areas, the staining of type VI collagen increased. These data suggest that the amount of type VI collagen in subcutaneous tissue is involved in the early phases of these fibrosing disorders and that type VI collagen accumulates even more in hyalinizing tissue in late phases of these diseases.
“Malignant Spitz Nevus” in a 2‐Year‐Old Japanese Child
Authors: Nitta Yukiko , Ohkochi Yasuyuki , Hara Kazuo
Published: April 2015

Smith et al. (1989) have reported a variant of Spitz's nevus with histological atypical features. Despite local lymph node metastases, further metastases were not observed. They proposed the name “malignant Spitz nevus” for this variant.

A 2‐year‐old Japanese girl had a large nodule (27 × 17 mm) surrounded by an indurated erythema over the Achilles tendon. Histologically, it proved to be a melanocytic lesion resembling spindle cell and epithelioid cell nevus (Spitz's nevus) with unusual features; the tumor extended deep into the subcutis, and the mitotic figures deep into the tumor, together with prominent lymphatic vessel invasion by melanocytes. Thus the tumor was aptly termed “malignant Spitz nevus”. Flow cytometric analysis of the DNA content revealed a diploid pattern. The child is well 5 years after a wide resection of the tumor. The diploid pattern of the DNA content as well as the good prognosis could support the idea that “malignant Spitz nevus” fits within the spectrum of Spitz's nevus.
Successful Treatment of Severe Arthralgia Associated with Palmoplantar Pustulosis with Low‐Dose Oral Cyclosporine A
Authors: Yamamoto Toshiyuki , Kimura Kyouko , Katayama Ichiro , Nishioka Kiyoshi
Published: April 2015

Two patients with severe arthralgia associated with palmoplantar pustulosis (PPP) were treated with oral cyclosporine A (CsA). Clinical efficacy was assessed on a 0–4 point scale for erythema, desquamation, infiltration, and pustulation, and on a 0–3 point pain scale. Skin lesions and arthralgia improved within twelve weeks with low dose CsA ranging from 2.1 to 2.2 mg/kg/day. High levels of plasma interleukin‐6 (IL‐6) were reduced to the normal range.
Androgen Status in Adolescent Women with Acne Vulgaris
Authors: Aizawa Hiroshi , Nakada Yoshiko , Niimura Michihito
Published: April 2015

Androgens are essential for the development of acne. The object of this study was to elucidate the androgen status of women with adolescent (Tanner's stage IV–V) acne alone and compare them to age‐matched normal controls. We measured serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), and dehydroepiandrosterone sulfate (DHEA‐S) in 15 women with adolescent acne and 13 age‐matched healthy controls. No significant differences were found between the mean levels of T, FT or DHT levels in patients and controls. However, the mean levels of DHEA‐S in the patient population (1886 ± 829 ng/ml) were significantly (p<0.05) higher than normal controls (1287 ± 620 ng/ml). There was also no correlation between androgen levels and acne severity. Thus it is unlikely that serum androgens play a principal role in women with adolescent acne.
Differential Cell‐ and Immuno‐Biological Properties of Murine B16‐F1 and F10 Melanomas: Oncogene c‐fos Expression, Sensitivity to LAK Cells and/or IL‐2, and Components of Gangliosides
Authors: Nakayama Juichiro , Urabe Kazunori , Tsuchida Tetsuya , Urabe Atsumichi , Terao Hiroshi , Taniguchi Shun'ichiro , Hori Yoshiaki
Published: April 2015

Differential cell‐ and immuno‐biological properties of two murine melanoma B16 variants, B16‐F1 and F10, were investigated. Studies focused on the expression of proto‐oncogene c‐fos, sensitivities to LAK cells and/or IL‐2, and modulation of the expression of ganglioside components after treatment with IL‐2. Proto‐oncogene c‐fos was found to be highly expressed in F10 lines by an in situ hybridization technique and also in F10 lung metastatic nests by immunofluorescent staining with anti‐c‐fos antibody. F1 melanomas were more sensitive to local injection of IL‐2. F10 melanomas hardly responded to IL‐2 treatment, but successive injections of a combination of LAK cells and IL‐2 did cause prolongation of survival rates, even of F10 melanoma‐burdened mice. A major component of gangliosides of both F1 and F10 melanomas was GM3. Production of GM3 in F10 melanomas treated with IL‐2 for 4 days increased, and, if the treatment was continued for 7 days, minor components of gangliosides, such as GM2, GM1, and GD1a, appeared only in F1 melanomas, while the increase of production of GM3 disappeared in both melanomas. These experimental results may provide clues for additional mechanisms which allow these two murine melanoma variants to show different implantation and metastasis rates.
Serial Cultivation of Human Nail Matrix Cells under Serum‐free Conditions
Authors: Nagae Hiroaki , Nakanishi Hideki , Urano Yoshio , Arase Seiji
Published: April 2015

We have established serial cultures of human nail matrix cells (NMCs) under serum‐free conditions. We cultured NMCs using two different methods depending upon the volume of nail matrix obtained. When a sufficient amount of nail matrix was obtained, they were minced and treated with 0.25% trypsin and 0.03% EDTA. The NMCs were transferred directly as a dispersed cell culture into KGM medium. Because a sufficient amount of matrix was rarely obtained, we developed a method by which NMCs were cultured primarily as implanted small matrices in Eagle's MEM (high Ca# medium) supplemented with 15% fetal bovine serum for the first 4 to 5 days; during this time, the NMCs expanded from the matrices and formed colonies around them. NMCs then were cultured with KGM. In both methods, KGM medium supported the growth of NMCs without a biological feeder layer. These cells could be cultivated serially for at least seven passages. Half of the cells were positively stained with a monoclonal antibody against hair (hard) keratin which is expressed in nail matrix in vivo, indicating that the cells originated from the nail matrix. These methods will now permit investigations of nail matrix cells that previously were unfeasible because of the relative lack of cells and difficulties with propagation.
Successful Treatment of Dark‐colored Epidermal Nevus with Ruby Laser
Authors: Baba Takako , Narumi Hiromi , Hanada Katsumi , Hashimoto Isao
Published: April 2015

The pulsed ruby laser has a selective thermolytic effect. Recently, it has been available for the treatment of superficial pigmented disorders. We studied 5 cases of epidermal nevus treated with the pulsed ruby laser. In comparison with the usual methods including electrocautery, cryotherapy and skin abrasion, ruby laser therapy is an excellent tool due to technological ease and rapid improvement. Depigmentation after treatment in 2 cases was the only side effect of this therapy. Bose cases had a dark pigmentation of the skin. Despite of the risk of discoloration, the ruby laser is one of the most effective tools for therapy of pigmented epidermal nevus.
Immunofluorescence Study of Pemphigus from North India
Authors: Kumar Surendra , Thappa Devinder Mohan , Sehgal Shobha
Published: April 2015

Both serum studies by indirect immunofluorescence (IIF) tests and skin biopsy examination by direct immunofluorescence (DIF) were performed on 22 cases of pemphigus with clinically active lesions. Twenty cases had pemphigus vulgaris and two, pemphigus foliaceus. The majority of cases (70%) were between 21 and 60 years old; the mean age was 39.5 ± 12.7 years. There was no sex predilection. DIF showed the positive fluorescence of intercellular cement substance (ICS) of the epidermis in all 22 cases (100%). IgG was positive in 77.27%, followed sequentially by C3C (50%), IgA (45.45%), and IgM (36.36%). Six cases (27.27%) also showed granular immunoglobulin and/or complement deposits at the dermoepidermal junction. IIF detected serum antiepithelial antibodies in 18 cases (81.81%) using human esophagus as substrate. Most of these cases (88.88%) showed IgG type of antibodies; the other 11.11% exhibited IgA and IgM in low concentrations. 1+ titer positivity was observed in 15 cases. This study demonstrates the value of DIF for a definitive diagnosis of pemphigus. However, it is also important to appreciate that immunofluorescence is not a substitute for histopathology, but rather complementary to it.
Odontotrichodysplasia: A Case Report with a Review of Conditions Combining Ectodermal Dysplasia (Subgroup 1–2) with Skin Manifestations
Authors: Yadav Tribhuvan P. , Mishra Smita , Gupta Vijay K. , Gautam Ram K. , Kar Hemanta K. , Bhardwaj Minakshi
Published: April 2015

We report a 5‐year‐old girl with partial anodontia, hypotrichosis, hyperpigmentation of the skin, absence of pilosebaceous structures, and long thin fingers. There has as yet been, to the best of our knowledge, no report of such a combination of features. A review of conditions combining ectodermal dysplasia (subgroup 1–2) with skin manifestations is presented.
The Safety and Efficacy of Low‐dose Tissue Plasminogen Activator in the Treatment of Systemic Sclerosis
Authors: Wilson Diane , Edworthy Steven M. , Hart David A. , Fritzler Marvin J.
Published: April 2015

The safety and efficacy of low‐dose (10 mg) recombinant human tissue plasminogen activator (rhtPA: Activase®: Genentech) was studied in 14 systemic sclerosis (SSc) patients. The patients were enrolled in a double blind, placebo‐controlled crossover trial. Patients Who met the inclusion criteria were enrolled in the study, given placebo or rhtPA and then crossed over at 3 months. Assessment criteria included the Rodnan skin score; a daily patient diary to record side‐effects, frequency, and severity of Raynaud's episodes and activity; and pulmonary function tests. Ten mg of rhtPA (Genentech) was administered over a 4 hour period using a myocardial infarction protocol. None of the patients experienced side‐effects from the treatment protocol. No differences in the frequency or severity of Raynaud's episodes were noted during the two arms of the study. However, when the mean change of the Rodnan skin score in the placebo arm was compared to the rhtPA arm of the protocol, a significant difference was observed (0.8 vs. —5.4, p<0.001). Three patients had moderate improvement and seven showed mild improvement. Mild deterioration or no change in study parameters was noted in 4 patients. This study has demonstrated that the administration of low‐dose rhtPA is safe and is accompanied by modest improvement in symptoms of a subset of scleroderma patients.
Basal Cell Carcinomas of the Auricular Region: A Study of 23 Cases
Authors: Betti Roberto , Inselvini Elena , Gualandri Lorenzo , Crosti Carlo
Published: April 2015

Basal cell carcinomas (BCCs) of the auricular region are not frequently reported, especially in the Japanese literature. Predisposing conditions such as sun exposure or frostbite are possibly involved in their development.

In this study, we report our cases of auricular BCCs, discussing the obtained results, the possible significance of predisposing conditions, and the correlation with the histologic subtypes involved.

Among 1094 patients with BCCs, auricular tumors were observed in 23 patients (2.1%), 4 women and 19 men. All of them were present on the external sun‐exposed auricular side. Histologic patterns were nodular and micronodular (13 cases) and infiltrative (10 cases). No differences were observed between sexes. The relative degree of elastosis was higher in men than in women. Frosbite was recorded in 4 cases.

The ear is an anatomical region that is heavily exposed to sun‐light and equally prone to frosbite. Our data showed that all the lesions were located on the auricular region more or less exposed to sunlight. There was a recorded previous history of predisposing factors in most cases, and the high degree of elastosis suggests the involvement of these predisposing factors. Moreover, the high prevalence of infiltrative subtypes observed in our survey suggests a possible correlation between some histologic subtypes, sun‐exposure, and frostbite. The differences between the relatively high number of auricular BCCs reported in the literature in contrast with the Japanese observations suggest the involvement of social or local conditions.
Piroxicam Induced Stevens‐Johnson Syndrome
Authors: Katoh Norito , Kagawa Keizo , Yasuno Hirokazu
Published: April 2015

Stevens‐Johnson syndrome in a 63‐year‐old Japanese woman is described. Oral provocation test revealed the causative agent to be piroxicam.
Psychosomatic Treatment of a Case of Chronic Urticaria
Authors: Hashiro Makoto
Published: April 2015

A 35‐year‐old Japanese woman presented with urticaria in January of 1992. As her symptoms gradually became worse, she came to our hospital in March of that year. I treated her with various combinations of antihistaminics and antiallergics. However, her symptoms did not respond and continued to deteriorate. Although her blood was analyzed in an attempt to identify antigenic or physical factors, no positive data were obtained. Because three kinds of psychological tests showed that the patient was highly anxious and depressive, I additionally treated her with psychotropics and psychotherapy in May of 1994. After a month, the symptoms began to disappear. She has since been free from the symptoms while taking medicine only twice a week. Our group recently presented the efficacy of psychotropics in patients with chronic urticaria.

This case suggests that highly anxious or depressive cases with chronic urticaria should be treated not only dermatologically, but also psychologically.
Disseminated Epidermolytic Acanthoma with Disseminated Superficial Porokeratosis and Verruca Vulgaris in an Immunosuppressed Patient
Authors: Chun Soo Il , Lee Jong Seo , Kim Nam Soo , Park Kyung Deuk
Published: April 2015

A 40‐year‐old man who had received long term immunosuppressive treatment for 14 years following kidney transplantation developed multiple skin lesions on both antecubital fossae, scalp, and both lower extremities. Histopathologic findings from three skin regions revealed characteristic features of epidermolytic hyperkeratosis, verruca vulgaris, and disseminated superficial porokeratosis, respectively.

Although immunocompromised individuals may demonstrate verruca vulgaris or porokeratosis, disseminated epidermolytic acanthoma (DEA) has not been reported to be associated with immunosuppressed status. We suggest that immunosuppression may play a role in the pathogenesis of DEA, as shown in our case.
The Origin of Pilonidal Sinus: A Case Report
Authors: Yabe Tetsuji , Furukawa Masayoshi
Published: April 2015

The etiology of pilonidal sinus remains controversial. Some think it is congenital, and others think it is acquired. It is difficult to distinguish acquired pilonidal sinus from congenital, because infection almost always complicates both. We report here one case of acquired pilonidal sinus unaccompanied by infection. Histological examination showed that no epidermis or hair pollicle was present in the inner wall of the sinus. This case shows that acquired pilonidal sinus is due to invasion of external hairs and that this condition needs to be distinguished from congenital pilonidal sinus.
A New Intralesional Therapy of Cutaneous Leishmaniasis with Hypertonic Sodium Chloride Solution
Authors: Sharquie Khalifa E.
Published: April 2015

One hundred and fifty‐eight lesions of acute cutaneous leishmaniasis in 70 patients were treated with hypertonic sodium chloride solution “HSCS” (88 lesions) or sodium stibogluconate (50 lesions); 20 lesions were left untreated as controls. The injections were given at 7–10 day intervals, and patients were followed‐up for 42 days.

“HSCS” was shown to be a very effective local therapy (96.05% cure rate) and was as effective as local sodium stibogluconate (96.42% cure rate). With both types of therapy, most lesions needed only one injection. Mild improvement was noticed 7–10 days after the first injection, and the cure was complete within 2–6 weeks (mean 4 weeks) of follow‐up. None of the control lesions showed a cure within the six weeks follow‐up. The mechanisms of action of both “HSCS” and sodium stibogluconate probably involve interference with the osmotic pressure of the cell cytoplasm of the parasites and lesional tissues. Scarring was either absent or minimal following healing of the treated lesions with both types of treatment. Post‐inflammatory hyperpigmentation was observed in all patients.

We strongly recommend intralesional “HSCS” as a cheap, safe, and effective local method for treating cutaneous leishmaniasis.
Localized Cutaneous Amyloidosis Simulating Lichen Simplex Chronicus
Authors: Muramatsu Tsutomu , Honoki Kumiko , Shirai Toshihiko
Published: April 2015

We report a case of localized cutaneous amyloidosis in a 42‐year‐old Japanese woman. Skin lesions were confined to the nuchal area, and the clinical appearance resembled that of lichen simplex chronicus. Our experience with this case indicates that, in cases presenting with persistent skin lesions simulating lichen simplex chronicus, amyloid should be specifically looked for in biopsy material.
Lichen Sclerosus et Atrophicus in a Band‐like Arrangement
Authors: Izumi Tatsuya , Tajima Shingo
Published: April 2015

We report a case of lichen sclerosus et atrophicus (LSA) in a band‐like arrangement. The patient had a white atrophic plaque on the left breast which showed the typical histological features of LSA. One month later, the patient had developed multiple, brown‐colored plaques from the right breast to the right upper arm following the distribution of the peripheral nerve. These plaques showed the mild histological changes indicative of LSA. This band‐like arrangement of LSA appears to be unique.
A Case of CREST Syndrome Associated with Sick Sinus Syndrome
Authors: Inazumi Toyoko , Tajima Shingo , Ando Takashi , Shimada Megumi
Published: April 2015

Cardiac manifestations of the CREST syndrome or limited systemic sclerosis (ISSc) are very rare. We report a case of CREST syndrome associated with sick sinus syndrome. Histopathology of cardiac muscle revealed fibrotic changes, suggesting that such changes may be pathogenetically related to CREST syndrome.
Vasculitis
Authors: Smith J. Graham
Published: April 2015

Many cutaneous and systemic disorders are associated with inflammation and necrosis of blood vessels. Several classifications of vasculitis have been used. Internists tend to utilize the classification of Fauci with modifications such as those by Cupps. Gibson and Ryan, who are dermatopathologists, have classified vasculitis based on vessel size, leukocyte type, and presence of granulomas. A more recent classification has been developed by Jennette, a pathologist, and colleagues.

The etiology of vasculitis is varied; it includes bacteria, viruses, chemicals, autoimmune disease, malignancy and abnormal exogenous and endogenous proteins. Leukocytoclastic vasculitis can be experimentally reproduced by the Arthus phenomenon. IgM and C3 are found in cutaneous blood vessels and associated with circulating immune complexes. CH50, C3 and C4 may be reduced in serum.

Increased incidence of nasal carriage of staphylococci is associated with higher relapse rates in Wegener's granulomatosis and toxic shock syndrome toxin from staphylococci is associated with the Kawasaki syndrome. Additionally, at least four systemic vasculitic drug reactions can be confirmed with patch testing.

Antineutrophil cytoplasmic antibodies (ANCA) are found in association with certain systemic vasculitides. These may be tested with indirect immunofluorescence and enzyme linked immunosorbent assays (ELISA) with radioimmunoassays. Originally cytoplasmic ANCA (cANCA) was identified with proteinase 3 as the antigen and perinuclear ANCA (pANCA) was related to myeloperoxidase. While cANCA is very specific for proteinase 3, pANCA is associated with a number of antigens other than myeloperoxidase. pANCA is found with alcohol fixed but not formalin‐fixed neutrophils. cANCA is particularly sensitive and specific for Wegener's granulomatosis and predicts prognosis and response to therapy. pANCA is not so specific and is associated with a number of other vasculitic syndromes.

Cutaneous vasculitis is managed primarily with colchicine, dapsone and prednisone, with recent studies indicating that there may be a synergistic effect of pentoxifylline with dapsone. Systemic vasculitis involves treatment with various agents. Recently it has been observed that co‐trimoxazole (trimethoprim/sulfamethoxazole) is useful in many cases of Wegener's granulomatosis along with other more toxic chemotherapeutic agents.
Studies of Patients with Anti‐Epiligrin Cicatricial Pemphigoid
Authors: Yancey Kim B. , Kirtschig Gudula , Yee Carole , Lazarova Zelmira
Published: April 2015

We have recently identified patients with a form of cicatricial pemphigoid who have IgG anti‐basement membrane autoantibodies directed against epiligrin, a laminin isoform closely related if not identical to laminin 5. These patients' autoantibodies bind the lower lamina lucida of human epidermal basement membrane and immunoprecipitate this laminin isoform from extracts and media of biosynthetically radiolabeled human keratinocytes. Immunoblot studies show that these patients' autoantibodies specifically bind the α subunit of this laminin (i.e., laminin subunit α3). We have found no evidence of these autoantibodies in normal volunteers or patients with other bullous skin diseases (including those with other forms of CP). These studies have identified a group of patients with an acquired, autoimmune, subepidermal bullous disorder who have disease‐specific autoantibodies directed against the α subunit of epiligrin/laminin 5. These findings correlate with prior reports showing that a monoclonal antibody directed against this laminin subunit induces detachment of keratinocytes from extracellular matrix in vitro as well as epidermis from human skin in situ. Together, these findings suggest that this laminin mediates attachment of basal keratinocytes to epidermal basement membrane and that autoantibodies directed against it may be pathogenic. Moreover, recent studies showing that subunits of this laminin isoform are mutated in some patients with Herlitz's junctional epidermolysis bullosa indicate that acquired or inherited abnormalities in this adhesion ligand are associated with skin diseases characterized by separation of epidermis from epidermal BM.
UVB‐Dependent Modulation of Epidermal Cytokine Network: Roles in UVB‐Induced Depletion of Langerhans Cells and Dendritic Epidermal T Cells
Authors: Takashima Akira
Published: April 2015

The epidermis of mice consists of three cellular components, i.e., keratinocytes, Langerhans cells (LC), and dendritic epidermal T cells (DETC). Each epidermal subpopulation produces a different set of cytokines, thereby forming a unique cytokine milieu. These cytokines, in turn, support the survival and growth of LC and DETC and regulate their immunological functions. LC and DETC play important, but distinct, effector roles in protective immunity against antigens that are generated in or penetrate into the epidermis. Acute or chronic exposure of mice to ultraviolet B (UVB) radiation is known to impair this cutaneous immunity, as evidenced by the failure to induce T cell‐mediated immune reactions, by the generation of antigen‐specific immunological unresponsiveness, and by the development of skin cancers. Importantly, these changes are associated with reduced densities of LC and DETC in UVB‐exposed skin, suggesting that the deficiency in these epidermal leukocytes may account for some of the deleterious influences of UVB radiation on skin. Here I will review the recent advance in our understanding of the mechanisms by which UVB radiation may deplete LC and DETC from epidermis. More specifically, I will discuss the following possibilities: a) UVB‐mediated suppression of the production of relevant growth factors for LC and DETC, b) UVB‐induced abrogation of surface expression of growth factor receptors, and c) UVB‐triggered apoptotic cell death in epidermal leukocytes.
Expression of Lewis Y (Ley) Antigen in Human Anagen Hair Follicles
Authors: Tamada Yasuhiko , Takama Hiromichi , Ikeya Toshihiko , Yokochi Takashi , Mori Hijiri , Matsumoto Yoshinari
Published: April 2015

Lewis Y (Ley) antigen, a difucosylated tetrasaccharide found on type 2 blood group oligosaccharides of glycolipids and glycoproteins, is thought to be a phenotypic marker predictive of cell differentiation. The distribution of this antigen in human anagen hair follicles was examined by immunohistochemical staining using a monoclonal antibody (AH‐6) to Ley. In the bulbar and suprabulbar portion of anagen hair follicles, Ley antigen was detected in the three layers of the inner root sheath. Subsequently, the positive staining became translocated to the innermost layer of the outer root sheath in the middle part of the hair follicles. In the upper portion of the hair follicles, Ley antigen was found in the outer cells of the outer root sheath. These findings suggested that the expression of Ley antigen in the anagen hair follicles was correlated with the processes of keratinization or terminal differentiation.
Apoptosis Identified by DNA Fragmentation in Epidermal Neoplasms
Authors: Mori Osamu , Hachisuka Hiroshi , Kiyokawa Chie , Sasai Yoichiro
Published: April 2015

In the previous study, we demonstrated apoptotic cells in basal cell carcinomas by means of terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick end labeling (TUNEL). Positive staining cells were present at the peripheries and centers of the nests. The number of positive cells increased in cases showing deep infiltration.

We also stained other epidermal neoplasms using this modified TUNEL method. In squamous cell carcinomas, many positive cells were observed in poorly differentiated types, but only a few cells were stained in well‐differentiated types. TUNEL positive cells were rare in Bowen's disease. No positive cells were seen in seborrheic keratosis or verruca vulgaris. Our studies showed that apoptotic cells were more common in rapid growth neoplasms than in slow growth neoplasms.
In vitro and In vivo Antibiotic Susceptibility of Lyme Disease Borrelia Isolated from the Ixodid Tick in Japan
Authors: Fujita Hiroshi , Yamada Kazuto , Kurita Toru , Masuzawa Toshiyuki , Yanagihara Yasutake
Published: April 2015

Antimicrobial susceptibility of the Lyme disease Borrelia, strain HP1 vi, isolated from the tick Ixodes persulcatus in Hokkaido, Japan, was determined in vitro and in vivo. A broth dilution technique was used to determine the minimum inhibitory concentrations (MICs) and minimum borreliacidal concentrations (MBCs) of five antimicrobial agents. Strain HP1 vi was most susceptible to minocycline (MBC, 0.2 μg/ml). The other antimicrobial agents tested, aspoxicillin, cefmetazole sodium, imipenem cilastatin sodium, and panipenem betamipron, had higher MBCs of 12.5 μg/ml, 25 μg/ml, >25 μg/ml, and >25 μg/ml, respectively. In vivo antibiotic susceptibility study using a ddY mouse model demonstrated that minocycline and amoxicillin were effective; minocycline had a lower 50% effective dose (ED50) value (6.25 mg/kg) than amoxicillin (30 mg/kg).
Mild Insulin Resistance during Oral Glucose Tolerance Test (OGTT) in Women with Acne
Authors: Aizawa Hiroshi , Niimura Michihito
Published: April 2015

The purpose of this study was to evaluate serum levels of basal insulin and glucose‐stimulated insulin, and to evaluate their correlations with androgen levels in women with acne. Serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA‐S), sex hormone binding globulin (SHBG), insulin‐like growth factor‐1 (IGF‐1), and immunoreactive insulin (IRI) were measured and compared in thirty women with moderate or severe acne and thirteen healthy controls. Serum FT, DHT and DHEA‐S levels in the acne group were significantly higher than those in the control group. In the acne group, there were no significant correlations between insulin or IGF‐1 levels and T, FT, DHT and SHBG, despite the positive correlation between insulin and IGF‐1. In order to determine the effects of insulin secretion as a dynamic response to an oral glucose tolerance test (OGTT) on serum androgen levels in acne patients, we examined the responses of serum insulin and androgen levels to a 75 g, 2 hour OGTT in the acne group and in the control group. Basal insulin levels were not significantly higher than those in the control group, but the summed insulin levels during the OGTT in the acne group were significantly higher than those in the control group. Serum T and FT levels in the acne group decreased during the OGTT, but these changes were not so significant when compared to normal controls. In conclusion, we tried to demonstrate mild insulin resistance during the OGTT in acne patients. However, postmeal transient hyperinsulinemia does not seem to play an important role in determining hyperandrogenemia in acne patients.
A Case of Cutaneous Malignant Fibrous Histiocytoma
Authors: Ichikawa Eiko , Asano Satoe , Okabe Seigo , Itami Makiko , Ohara Kuniaki
Published: April 2015

A 54‐year‐old Japanese man with cutaneous malignant fibrous histiocytoma on the back is reported. He not only had a past history of thyroid cancer 1 year prior to the onset of the skin tumor, but also had simultaneous bladder cancer. Despite the early, wide resection, the prognosis was rapid and progressive. Histologically, the primary lesion of the skin tumor was difficult to differentiate from dermatofibrosarcoma protuberans; however, the recurrent and the metastatic lesions changed in appearance.
Kaposi's Sarcoma Associated with Lung Cancer and Immunosuppression
Authors: Kato Naoko , Harada Masao , Yamashiro Katsushige
Published: April 2015

We report a 65‐year‐old Japanese woman with Kaposi's sarcoma (KS). The eruption first occurred on the legs while she was admitted for treatment of poorly differentiated lung cancer. Approximately eight months after the evolution, cutaneous tumors rapidly spread to the forearms, trunk, and pharynx. At that time, the patient had received systemic corticosteroid (10–40 mg/day of prednisolone) for about three months to reduce pulmonary inflammation. The laboratory data showed anemia, lymphopenia, hypogammaglobulinemia, and a decreased T cell count, although the serological test for HIV infection was negative.

The patient was treated with radiation (X‐ray for KS of pharynx and electron beam for KS of lower legs) and local intralesional injection of vinblastine. Although both therapies were very effective and well tolerated, she died of bacterial pneumonia and sepsis. Autopsy revealed KS tumors, unknown before death, in both lungs, the esophagus, and the stomach. The left lung cancer had disseminated and metastasized to the right lung, pleura, mediastinum, and abdominal cavity.

It is suspected that chronic respiratory distress and systemic use of corticosteroids might have induced the rapid extension of KS.
Pruritic Papular Eruptions and Candidiasis Due to HIV Infection
Authors: Uchigasaki Shuhko , Baba Shunichi , Kakinuma Hiroshi , Suzuki Hiroyuki , Sawada Shigemasa , Kasori Junichirou , Okamoto Takeharu
Published: April 2015

We present two patients with refractory papular eruptions and severe candidiasis. Both of them are positive for treponema pallidum and have suffered from pruritic papular eruptions (PPE) that had resisted therapy for years. Also, candidiasis appeared in the mouth, at intertriginous sites, and on the feet The clinical features suggested immunodeficiency, and HIV tests were positive.

Histologically, the specimen from the PPE lesion showed perivascular and perifollicular mixed cell infiltration. The fungus was identified by both Parker‐KOH‐mount examination and mycologic culture as Candida albicans. The pruritic papules were healed almost completely with oral antihistamine and topical corticosteroid treatment, and the candidiasis mostly disappeared after treatment with topical antifungal agents alone. We learned from these two cases that refractory PPE and severe candidiasis indicate a need for HIV testing.
A Case of Connective Tissue Nevus Associated with Seborrheic Keratosis‐like Eruption, Atrophic Scar, Alopecia, and Microtia
Authors: Isoda Midori , Okuda Yuka
Published: April 2015

We report a 44‐year‐old Japanese man who had connective tissue nevus, seborrheic keratosis‐like eruptions, atrophic scars on his hands and feet, alopecia, and microtia. These concurrent abnormalities are distinct from previously described multiple malformation syndromes.
DNA‐Damaging Agents Induce the 72‐kD Heat Shock Protein in SV40 Transformed Normal Human Fibroblasts
Authors: Muramatsu Tsutomu , Ohno Haruhiko , Shirai Toshihiko , Takahashi Akihisa , Ohnishi Takeo
Published: April 2015

In order to elucidate the involvement of DNA damage in the induction of heat shock proteins (stress proteins), we examined the induction of 72‐kD heat shock protein (HSP72) in an SV40‐transformed human fibroblast cell line (WI38VA13) which was exposed to various DNA‐damaging agents, including 1‐(4‐amino‐2‐methyl‐5‐pyrimidinyl)methyl‐3‐(2‐chloroethyl)‐3‐nitrosourea hydrochloride, bleomycin hydrochloride, cis‐diaminedichloroplatinum (II), mitomycin C, methylmethane sulfonate, N‐methyl‐N'‐nitro‐N‐nitrosoguanidine, and 4‐nitroquinoline‐N‐oxide. Induction of HSP72 was detected by the indirect immunofluorescence method using a monoclonal antibody. All the DNA‐damaging agents used in this study induced HSP72 on human fibroblasts. This result indicates that DNA damage is one trigger for the induction of HSP72.
Serum Sex Hormone Levels in Adult Patients with Atopic Dermatitis
Authors: Ebata Toshiya , Itamura Ronko , Aizawa Hiroshi , Niimura Michihito
Published: April 2015

Serum levels of sex hormones were measured in adult patients with atopic dermatitis (AD) and compared with those in sex‐ and age‐matched healthy controls. In 40 male patients with AD, serum levels of testosterone (T) (447 ± 96 vs 593 ± 149 ng/dl, P<0.001), free testosterone (FT) (14.6 ± 3.2 vs 20.0 ± 5.1 pg/ml, P<0.001) and estradiol (E2) (27.2 ± 7.2 vs 33.2 ± 7.9 pg/ml, P<0.05) were significantly lower and serum levels of luteinizing hormone (LH) (4.57 ± 1.6 vs 3.11 ± 1.2 mIU/ml, P<0.001) were significantly higher than those in healthy controls. There were no significant differences in serum levels of dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA‐S), dehydroepiandrosterone (DHEA), or follicle stimulating hormone (FSH) between the two groups. In 25 female patients with atopic dermatitis, T, FT, DHT and DHEA‐S levels did not differ from controls. In conclusion, serum T levels were lower in male patients with AD. However, similar changes were not seen in female patients.
Multiple Dermatofibromas Accompanied by Eruptive Benign Keratoses in a Patient with Systemic Lupus Erythematosus
Authors: Kuniyuki Shuichi , Shindow Kiyo
Published: April 2015

We describe a 39‐year‐old woman with systemic lupus erythematosus who developed 20 dermatofibromas accompanied by more than 30 eruptive benign keratoses while she was receiving systemic corticosteroid therapy. We are not aware of a previous case of multiple dermatofibromas accompanying multiple eruptive keratoses. The autoimmune disease or altered immunity, or both, may have played a role in the pathogenesis of these conditions.
A Case of Chromomycosis with Tumor‐like Growth
Authors: Usuki Kazunari , Yotsumoto Shin‐ichi , Hamada Hiroshi , Shimada Tokihiko , Fukumitsu Ken , Kanzaki Tamotsu
Published: April 2015

A 66‐year‐old man who lived on Tokunoshima Island, a small and remote southern island of the Japanese archipelago, had suffered from chromomycosis for more than 30 years and presented with a tumor‐like growth on the posterior crural region of his right leg. Fonsecaea pedrosoi was identified as the pathogen from its growth pattern and micromorphological characteristics. The patient was successfully treated with 5‐fluorocytosine, itoraconazole, and topical thermotherapy.
Multiple Eccrine Hidrocystomas Associated with Graves' Disease
Authors: Nagai Yayoi , Ishikawa Osamu , Miyachi Yoshiki
Published: April 2015

A 24‐year‐old woman presented with multiple translucent papules on the periorbital and malar areas. Histological examination demonstrated cystic structures lined with a few layers of flattened epithelial cells. These cells were positive for carcinoembryonic antigen, confirming the histological diagnosis of eccrine hidrocystoma. Physical examination revealed a goiter along with finger tremor and hyperhidrosis. The diagnosis of Graves' disease was established by endocrinological studies. The skin lesion as well as clinical symptoms disappeared as the thyroid function normalized with treatment. Graves' disease should be considered as one of the underlying diseases or conditions related to the development of the multiple eccrine hidrocystomas.
Familial Atypical Mole Syndrome Manifesting as Polypoid Melanoma: A Case Report and Review of the Japanese Literature
Authors: Misago Noriyuki , Kohda Hiromu
Published: April 2015

A family with atypical mole syndrome which manifested as polypoid melanoma in one member is reported. A 46‐year‐old man presented with a polypoid tumor on his lower back, which was excised under clinical diagnosis of soft fibroma. The tumor proved to be polypoid melanoma. He was referred to our clinic, and examination revealed that he had the atypical mole syndrome phenotype. The clinicopathological screening of his first‐degree relatives confirmed that his 58‐year‐old sister had the same phenotype. In addition to our discussion of the clinical significance of polypoid melanoma, we also attempted to elucidate the characteristics of the reported Japanese cases of melanomas with atypical moles from a survey of the literature, which revealed the following characteristics: 1) younger mean age than that of total Japanese melanoma cases, 2) sun sensitive skin, 3) unexpectedly and frequently observed familial incidence (Kraemer's D1 and D2), 4) frequent site of the melanoma on the trunk and none on the sole of the foot, and 5) high incidence of superficial spreading melanoma and nodular melanoma, and 6) no cases of acral lentiginous melanoma.
Photoallergic Drug Eruption Due to Pyridoxine Hydrochloride
Authors: Tanaka Masaru , Niizeki Hironori , Shimizu Satoko , Miyakawa Shun‐ichi
Published: April 2015

Photoallergy to vitamin B6 is very rare; only a few cases of contact dermatitis and one case of photosensitive dermatitis due to pyritinol have been reported. We report here the first case of photoallergy drug eruption due to pyridoxine hydrochloride.

A 71‐year‐old man developed papulo‐squamous erythemata which were confined to sun‐exposed sites. Photopatch testing, together with the clinical course, was helpful in reaching the initial diagnosis; this was confirmed by an oral challenge test.

Photoallergic drug eruption due to vitamin B6 should be considered a rare cause of photosensitive dermatitis.
Atypical Melanosis of the Foot
Authors: Nogita Toshitatsu
Published: April 2015

We present a case of a seemingly malignant pigmented lesion on the foot, arising in a Japanese female. Clinically, the lesion was characterized by irregular borders and variegated pigmentation closely mimicking those of acral lentiginous melanoma in situ. However, the histologic findings revealed only focal, slight, melanocytic hyperplasia with minimal cytologic atypia along the basal layer. Despite the malignant clinical features, thorough histologic examination failed to disclose any area with significant melanocytic atypia or evidence of malignancy. To the best of our knowledge, no similar lesions with the clinical appearance of melanoma in situ and completely lacking histologic evidence of malignancy have been reported. We, therefore, prefer to designate this lesion as atypical melanosis of the foot, to highlight the clinically atypical findings and to distinguish this from malignant melanoma in situ of the foot (1).
Congenital Atrophic Plaque
Authors: Mihara Ichiro , Minesaki Yoshinori
Published: April 2015

The patient is a 13‐year‐old female who had had a patchy lesion on her back since birth which increased in size proportional to her age. When she visited our hospital at the age of 13, the lesion was a 30 times 43 mm, slightly depressed, well defined, irregularly shaped, atrophic plaque. Differential clinical diagnoses at that time included macular atrophy, congenital melanocytic nevus, and mastocytosis. Histopathologically, the lesion was characterized by patchy and scattered infiltrates of oval to spindle cells throughout the dermis extending into the subcutaneous fat tissue. Nerve fibers were found in each of the infiltrates. The tumor cells had oval nuclei with relatively abundant cytoplasm and were similar to nevus cells. They were negative for markers such as S‐100 protein, neuron specific enolase, epithelial membrane antigen, HMB‐45, Leu 7, Desmin, and α smooth muscle actin. However, the histopathological findings suggest that the lesion is a melanocytic or neurogenic tumor, possibly a congenital melanocytic nevus or a cellular neurothekoma, though a definite diagnosis could not be made.
The Effect of Methotrexate on the Expression of a Cysteine Protease Inhibitor (Type 2 Cystatin) in Rat Sebaceous Glands
Authors: Cohen Robert E. , Chien Hua‐Hong , Neiders Mirdza E. , Comeau Robin L.
Published: April 2015

The purpose of this study was to assess whether rat cystatin S, a cysteine proteinase inhibitor, is present in rat sebaceous glands, and to measure the effects of methotrexate on the expression of cystatin in these glands. With methotrexate treatment, the number of skin sebaceous cells expressing cystatin increased from 13.9% to 34.3% (P<.05). A smaller increase (from 15.3% to 23.9%; P=.1) was observed in Zymbal sebaceous glands. Type 2 cystatin could not be detected in the major salivary glands, nor in trachea, lung, stomach, small intestine, large intestine, spleen, liver, kidney, or pancreas, in any of the rats given either saline or methotrexate. Our results suggest that type 2 cystatin is a constituent of normal sebaceous glands, and that the amount of cystatin present in these glands increases with methotrexate administration. We speculate that, in addition to the protective functions ascribed to sebaceous lipids, sebum may augment the physical barrier of skin through secretion of cysteine proteinases that may be pharmacologically modulated.
Systemic Scleroderma Associated with Graves' Disease
Authors: Anzai Hidemi , Tajima Shingo
Published: April 2015

We describe a case of systemic scleroderma associated with Graves' disease and review six previously described cases associating the two diseases. Our case seems to be unique in that Graves' disease preceded the occurrence of systemic scleroderma.
Satisfactory Remission Achieved by PUVA Therapy in Langerhans Cell Hisiocytosis in an Elderly Patient
Authors: Sakai Hiroyuki , Ibe Masaki , Takahashi Hidetoshi , Matsuo Shinobu , Okamoto Kensaku , Makino Isao , Oomori Yukio , Iizuka Hajime
Published: April 2015

Langerhans cell histiocytosis is currently regarded as a reactive proliferative process of Langerhans cells rather than a malignancy. The disease is characterized by Langerhans cell infiltration of skin, lung, bone and other organs. We report a 74‐year‐old man with Langerhans cell histiocytosis who had generalized hemorrhagic and crusted papules. He also had diabetes insipidus. Because he did not have any severe constitutional symptoms or failure of vital organs, we applied topical PUVA treatment to his skin lesions, which responded well to the therapy. Diabetes insipidus, however, remained, in spite of X ray radiotherapy for the pituiary lesion.