bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Acceleration Plethysmograms in Dermatology—Efficacy of Lipo PGE1 Preparations against Herpes Zoster and Neuralgia Following Herpes
Authors: Okuda Tomoki , Oh‐i Tsunao , Koga Michiyuki
Published: April 2015

Reports published in recent years indicate that administration of lipo PGE1 is effective against herpes zoster and neuralgia following herpes. However, there are presently no standards to objectively assess efficacy. We therefore looked into the possibility of achieving this goal by using an acceleration plethysmograph. The results showed a significant difference in the rate of change of pulse waves after initiation of drip infusion as compared to before drip infusion among the effective group, the control group, and the non‐effective group. This method appears to be useful to objectively assess both the analgesic effects of lipo PGE1 and the efficacy of drugs in general, based on data analysis. Our results suggest that investigations using this method may be able to predict the therapeutic effects of vasodilators and analyze hemodynamic disorders of the skin.
Dermatomyofibroma (Plaqueförmige Dermale Fibromatose)
Authors: Tani Masashiro , Komura Akihiko , Ichihashi Masamitsu
Published: April 2015

We reported a patient with dermatomyofibroma and reviewed the literature to characterize the immunohistochemical features of dermatomyofibroma.

A 25‐year‐old woman presented with an asymptomatic, well‐circumscribed, red‐brown plaque on the left posterior shoulder. Microscopic examination revealed a non‐encapsulated but well‐circumscribed tumor in the mid‐dermis extending into the upper subcutaneous fatty tissue. The tumor was composed of faintly eosinophilic, thin, wavy collagen fibers arranged as intersecting fascicles with an arrangement predominantly parallel to the skin surface. Embedded among the wavy fibers, there were a fair number of nuclei that were elongated, vesicular, and uniform in size. Immunohistochemical studies using a peroxidase‐antiperoxidase technique disclosed that the cytoplasm of the tumor cells was positive for muscle actin. The tumor cells were negative for α‐smooth muscle actin, desmin, factor XIIIa, S‐100 protein, and CD34. Clinical, histopathologic, and immunohistochemical analysis confirmed dermatomyofibroma.
Potential Efficacy of Low Metal Diets and Dental Metal Elimination in the Management of Atopic Dermatitis: An Open Clinical Study
Authors: Adachi Atsuko , Horikawa Tatsuya , Takashima Tsutomu , Komura Tokiko , Komura Akihiko , Tani Masahiro , Ichihashi Masamitsu
Published: April 2015

We performed an open clinical study on the effects of low metal diets and/or dental metal elimination on 27 patients with moderate to severe atopic dermatitis (AD), who showed positive patch tests for metal allergens and/or clinical exacerbation by oral provocation tests with metal salts. All the patients were recommended to ingest low metal diets for 3 months and/or undergo dental metal elimination. Marked or moderate improvement was noted in 18 patients (67%); 7 patients (26%) showed marked improvement and 11 patients (41%), moderate improvement. Nine patients (33%) showed minimal improvement or no change. In the patients who showed marked or moderate improvement, we observed statistically significant decreases (p<0.05) in both peripheral blood eosinophil counts and serum LDH levels after 3 months of treatment. The present study suggests that restriction of ingested metal allergens to which patients have positive patch tests and/or oral challenge tests may be useful in the management of some patients with AD who have metal sensitivity.
Lichen Planus and Sjögren‐type Sicca Syndrome in a Patient with Chronic Hepatitis C
Authors: Tanei Ryoji , Ohta Yukinori , Katsuoka Kensei
Published: April 2015

We report a 54‐year‐old Japanese male with lichen planus and Sjögren‐type sicca syndrome, accompanied by the latent complication of chronic hepatitis C. The patient first showed erythematous and erosive lesions with white irregular striae in the buccal mucous membrane, and blepharitis and hyperemia of conjunctiva in his eyes. He later had two small erosions on the glans penis, and flat‐topped violaceous papules on the dorsa manus and nape. A biopsy specimen of the lower lip lesion demonstrated a lichenoid tissue reaction at the basement membrane zone, and lymphocytic focal accumulations in the salivary glands. Immunohistochemical study of this specimen revealed CD45RO+ (T) cells associated with the expression of HLA‐DR antigens predominantly in both the lichenoid tissue reaction and the lymphocytic sialadenitis. Objective keratoconjunctivitis sicca was confirmed by the Schirmer and Rose‐Bengal tests. Anti‐DNA antibody was positive; however anti‐SS‐A, and anti‐SS‐B antibodies were negative. Increased levels of transaminase enzymes, TTT, ZTT, and IgG were observed in first laboratory examinations; thereafter, anti‐hepatitis C virus (HCV) antibodies and HCV‐RNA were detected. The high serum amylase level, in which salivary amylase predominated, was normalized by etretinate therapy in parallel with the clinical improvement of the oral LP lesions. Our case is considered to support the hypothesis that an etiologic association may be present among lichen planus, Sjögren's syndrome, and chronic hepatitis C.
Evaluation of Soluble Cell Adhesion Molecules in Atopic Dermatitis
Authors: Koide Masayo , Furukawa Fukumi , Tokura Yoshiki , Shirahama Shigeho , Takigawa Masahiro
Published: April 2015

Recent studies have indicated the importance of cell adhesion molecules (CAMs) between the vascular endothelium and activated leukocytes in various inflammatory skin diseases. Soluble forms of CAMs (sCAMs) have also been detected in sera from such diseases. In order to elucidate the role of the soluble forms in skin inflammation, we determined the serum levels of E‐selectin, vascular cell adhesion molecule‐1 (VCAM‐1), and intercellular adhesion molecule‐1 (ICAM‐1) in patients with atopic dermatitis (AD). Using an enzyme‐linked immunosorbent assay, we quantified sCAMs levels in 21 patients with atopic dermatitis and in 16 healthy controls. In severe AD patients, levels of these three types of sCAMs were markedly elevated. sE‐selectin was significantly elevated in severe AD over the levels in mild AD. A positive correlation with individual clinical activity was found for changes in the sE‐selectin and sVCAM‐1 levels. sE‐selectin levels were correlated with the serum IgE levels and the number of eosinophils. The sVCAM‐1 level was also significantly correlated with the number of monocytes. Among these three molecules, sE‐selectin appeared to be the most sensitive clinical parameter in monitoring the clinical course of AD patients.
Lymphoepithelioma‐like Carcinoma of the Skin
Authors: Ko Toshiko , Muramatsu Tsutomu , Shirai Toshihiko
Published: April 2015

We report a case of lymphoepithelioma‐like carcinoma of the skin on the right cheek of a 67‐year‐old man. Histologically, the entire dermis was occupied by multiple lobules of atypical epithelial tumor cell nests surrounded by inflammatory cells. Immunohistochemical examination showed that the epithelial tumor cells were positive for cytokeratin and epithelial membrane antigen. The inflammatory cells were positive for leukocyte common antigen and T‐cell marker. Among the tumor nests, small ductal structures were positive for carcinoembryonic antigen. Ultrastructurally, these epithelial tumor cells had well‐developed desmosomes and were joined to each other; no tonofilaments were observed in the cytoplasm. These findings strongly suggest that these tumor cells tended to differentiate to the adnexa of the skin.
Ultrastructure of the Lesions of Psoriasis Vulgaris Transplanted into the Subcutaneous Tissue of Nude Mice by the Skin Fenestrating Transplantation Method
Authors: Ueda Keiichi , Yanagihara Makoto , Fujita Tomozo
Published: April 2015

We have developed a new skin transplantation method, called the skin fenestrating transplantation method, in which the nude mouse skin covering the lesion was removed one week after the transplant was embedded. One week later, transplanted psoriatic skin was biopsied and specimens were examined by electron microscopy. The basal cells and the nuclei of transplanted psoriatic epidermis were long and slender. Projections of basal cells extended to the dermis. Erythrocytes and lymphcytes were seen in the intercellular space. In the spinous cell layer, the cytoplasm and the nuclei were round. In the cytoplasm, mitochondria and endoplasmic reticuli were abundant, and tonofibrillar formation was poor. In the upper part of the epidermis, the cells were horizontally elliptic and, in the cytoplasm, short tonofibril bundles were formed. In the uppermost layers, in the cytoplasm of flat cells, degenerated flat nuclei, low dense lipid droplets and clumps of ribosomes were observed. These findings resembled the findings of intact psoriasis lesions more closely than those obtained by the skin embedding transplantation method.
A Case of Adult T‐cell Leukemia/Lymphoma (ATLL) with Angiocentric and Angiodestructive Features
Authors: Ohtake Naoki , Setoyama Mitsuru , Fukumaru Seita , Kanzaki Tamotsu
Published: April 2015

This report describes a case of adult T‐cell leukemia/lymphoma (ATLL) with angiocentric and angiodestructive features. The patient was a 66‐year‐old Japanese woman who began developing widespread skin lesions ten months prior to admission. The diagnosis of ATLL was made on the basis of her having an antibody to human T‐cell lymphotropic virus type ‐1 (HTLV‐1) and typical flower cells (ATLL cells) in peripheral blood smears. Once hospitalized, the course of her disease was very acute and severe, as is seen with angiocentric lymphoma. Based on histological features, this case was judged not to be angiocentric lymphoma; however, it may lie within the spectrum of angiocentric immunoproliferative lesions (AIL). The findings in this case strongly suggest that HTLV‐1 can be a pathogenic factor in the expression of angiocentric and angiodestructive features in ATLL, as is Epstein‐Barr virus (EBV) (1–4). To our knowledge, the present case is the sixth reported in the literature of lymphoma in which these features are associated with HTLV‐1 infection (5–7).
Bullous Pemphigoid in an HB Virus Carrier: Interaction between Corticosteroids and HB Virus
Authors: Inadomi Toru , Saito Tamiko , Kaneko Miki , Hashimoto Takashi , Suzuki Hiroyuki
Published: April 2015

A case of bullous pemphigoid (BP) in a 47‐year‐old female hepatitis B virus (HBV) carrier is reported. Disseminated bullae covered the patient's entire body including the hands and feet. BP was diagnosed on the basis of pathological and immunological observations examining immunofluorescence and cross reactions to both bullous pemphigoid antigen (BPAG) 1 and BPAG 2. Although oral prednisolone (80 mg daily) rapidly healed the eruption, liver function failed to respond, resulting in the patient's death. This liver dysfunction was attributed to the HBV infection. Use of the polymerase chain reaction showed that HBV in this case had transformed into its precore mutation form during the therapy. Standard tests on first examination did not detect HBV in this patient, but later detailed analysis suggested that she had been an HBV carrier since birth. Such carriers sometimes test negative for HBs antigen, when only a little HBV is present in the liver. Great care should also be exercised when using high doses of corticosteroids to treat bullous diseases in HBV carriers, because these drugs may aggravate HBV infections and cause liver failure.
Fixed Drug Eruption Caused by Iopamidol, A Contrast Medium
Authors: Yamauchi Ritsuko , Morita Akimichi , Tsuji Takuo
Published: April 2015

We report a patient who developed a fixed drug eruption caused by the contrast medium, Iopamidol. We diagnosed it by her episode pattern and the results of patch tests. This substance has not been previously implicated as a cause of fixed drug eruption. Immunohistochemical studies showed Fas expression in keratinocytes of the lesion, but not in the uninvolved skin. This finding may explain the preferential localization of fixed drug eruption.
Foot Ulcer Due to Arteriovenous Malformation: Report of a Case
Authors: Lee Sang Goang , Ohtoshi Eriko , Matsuyoshi Norihisa , Ohta Keiji , Horiguchi Yuji , Imamura Sadao
Published: April 2015

A 41‐year‐old woman had erosive eruptions surrounded by irregularly shaped pigmentation on the lateral aspect of her right foot, where she had noted gradually increasing warmth and pain for 10 years. The eruptions waxed and waned without complete healing, and an ulcer which had formed one year previously did not respond to topical treatments. Arteriography performed on the right lower extremity disclosed multiple diffuse arteriovenous malformations in the right lower leg and foot. The ulcer was treated by bed rest, surgical debridement, and topical application of bucladesine sodium ointment. After three months, the ulcer healed, leaving a shallow scar and pigmentation.
A Case of Apple‐Shaped Pedunculated Lipofibroma
Authors: Kwon Kyung‐Sool , Seo Kyung‐Hyung , Jang Ho‐Sun , Chung Tae‐Ahn
Published: April 2015

In 1975, Mehregan et al (1) proposed the term pedunculated lipofibroma for the solitary form of NLCS in the view of its distinctive clinicopathologic features. Subsequently, Nogita et al reported and reviewed 32 cases of pedunculated lipofibroma in 1994. Pedunculated lipofibroma is a relatively rare form of benign connective tissue proliferation abnormality characterized by ectopic adipose tissue in the dermis. We observed a case of pedunculated lipofibroma with a prominent stalk containing feeding vessels, a history of congenital onset, a remarkable globular apple‐shaped mass and an accompanying small sessile lesion. We report this case with a review of the literature.
A Case of Linear IgA Disease: An Immunofluorescent Study Using Confocal Laser Scan Microscopy
Authors: Kobayashi Takashi , Konohana Akira , Hattori Shunji
Published: April 2015

A 79‐year‐old Japanese woman presented with erythema and bullae on her trunk and limbs. Histological examination of the skin lesions showed subepidermal bullae and polymorphonuclear leukocyte infiltration into the papillary dermis. A direct immunofluorescent study showed the linear deposition of IgA, but not of IgG or IgM, in the basement membrane zone. Indirect immunofluorescence of the serum using confocal laser scan microscopy showed IgA, but not IgG, reactivity in the basement membrane zone. In double immunostaining experiments, IgA reactivity was also observed on the epidermal side; laminin 5 was detected on the dermal side.
Two Cases of Basal Cell Carcinoma Arising in Seborrheic Keratosis
Authors: Akasaka Toshihide , Kon Saiichi
Published: April 2015

The present study reports two cases of basal cell carcinoma arising in seborrheic keratosis. The first case is a seventy‐three‐year‐old female who presented with a blackish nodule arising from a pigmented lesion on her chest. Histopathological analysis of the nodule and the pigmented lesion revealed a basal cell carcinoma with hair follicular differentiation and an acanthotic seborrheic keratosis, respectively. The second case is a seventy‐year‐old female with a blackish nodule arising from a pigmented lesion on her back. Histological analysis of the nodule revealed an atypical basaloid cell mass surrounded by a seborrheic keratosis lesion. In addition to the coexisting seborrheic keratosis with the basal cell carcinoma, a basaloid follicular hamartoma that showed muliple hamartomatous hair follicles or small cysts replaced by a branching cord or lace‐like network of basaloid cells surrounded by fibrovascular stroma was identified. We concluded that both cases presented a rare combination of a seborrheic keratosis which underwent a malignant change to basal cell carcinoma. It appears that both basal cell carcinomas and seborrheic keratosis may derive from a similar source: pluripotential cells of either the epidermis or hair follicle epithelium.
In vitro Comparison between Mouse B16 and Human Melanoma Cell Lines of the Expression of ICAM‐1 Induced by Cytokines and/or Hyperthermia
Authors: Nakayama Juichiro , Guan Xiao‐Chun , Nakashima Manabu , Mashino Toshihiko , Hori Yoshiaki
Published: April 2015

The expression of intercellular adhesion molecule‐1 (ICAM‐1) in mouse B16 and human melanoma cell lines was investigated by indirect immunofluorescence using a FACScan analyzer. Mouse B16 melanoma cell lines (B16‐F1 and F10) did not express ICAM‐1 under ordinary culture conditions. Neither in vitro hyperthermia at 41°C for 3 or 6 hr nor cytokines such as γ interferon (IFN‐γ) or tumor necrosis factor α (TNF‐α) induced ICAM‐1 expression in B16 melanoma cell lines. A combination of IFN‐γ with TNF‐α caused slight induction of ICAM‐1 expression in the B16‐F10 melanoma cell line. Hyperthermia at 41°C for 3 hr in combination with the cytokines induced a slight expression of ICAM‐1 in the B16‐F1 melanoma cell line. Hyperthermia at 41°C for 3 hr or 6 hr did not induce de novo ICAM‐1 expression but hyperthermia at 43°C for 6 hr caused rather suppression of the expression of ICAM‐1 in the three human melanoma cell lines tested. In contrast, they showed a clear increase in the expression of ICAM‐1 after treatment with either with IFN‐γ or TNF‐α, and the expression was further augmented by a combination of the two cytokines. Treatment with cytokines in combination with hyperthermia at 41°C or 43°C for 3 hr did not augment the expression of ICAM‐1 over that in cytokine‐treated human melanoma cell lines, at normal temperatures. Thus, it is concluded that mouse B16‐F1 and F10 melanoma cell lines are different from human melanoma cell lines in terms of induction of ICAM‐1 expression by cytokines and/or hyperthermia.
Phenotypic Differences between Human Blood Monocyte Subpopulations in Psoriasis and Atopic Dermatitis
Authors: Zheng Min , Mrowietz Ulrich
Published: April 2015

Peripheral blood monocytes seem to be of importance in the initiation and maintenance of cutaneous inflammatory disorders such as psoriasis and atopic dermatitis. Functional abnormalities of monocytes have been observed in both diseases. We sought to determine whether these abnormalities are reflected by an altered phenotypic expression of functionally active surface molecules. Peripheral blood monocyte subsets varying in cellular density and cell size from patients with psoriasis and atopic dermatitis were investigated using FACS analysis employing a panel of monoclonal antibodies (CD14, CD16, HLA‐DR, HLA‐DQ, FcɛRII, IL‐2R, ICAM‐1, CR3). Furthermore, the modulation of expression by interferon‐γ in monocyte subsets from patients was compared to normal controls. The results show that HLA‐DR and ‐DQ expression on monocyte subsets in psoriatic patients was significantly decreased; “large” monocytes expressed significantly less HLA‐DR than “small” monocyte subpopulations. Decreased HLA‐DR and ‐DQ expression could be upregulated by incubation of psoriatic monocytes with IFNγ. In atopic dermatitis, a different phenotype pattern of monocyte subsets was demonstrated: HLA‐DR expression and HLA‐DQ expression were both decreased in both “large” and “small” monocytes as compared to normal controls. However, there were no significant differences in HLA‐DR and HLA‐DQ expression between “large” and “small” monocyte subpopulations in atopic dermatitis. Moreover, the ICAM‐1 and IL‐2R expression of “large” and “small” monocyte subpopulations was significantly decreased in atopic patients from levels in normal controls and psoriatic patients. The altered expression of HLA‐DR, ‐DQ, ICAM‐1 and IL‐2R could be upregulated by incubation of atopic monocytes with IFNγ. In addition, there was a significant increase in the percentage of monocytes in the differential count of patients with psoriasis or atopic dermatitis. We conclude that the differential phenotype pattern of surface molecules on monocytes in psoriasis and atopic dermatitis may reflect an abnormal monocyte maturation/differentiation state. This may explain the functional abnormalities of monocytes observed in patients with psoriasis and atopic dermatitis.
Ultrastructural Study of Anti‐Tumor Effects of Tamoxifen in Two Malignant Melanoma Patients
Authors: Hirota Toru
Published: April 2015

In order to clarify the mode of action (tumor cell death) of tamoxifen in treatment for estrogen receptor (ER) negative malignant melanoma, we administered the usual adult dose (20 mg/day) or a low dose, 1/4 of the usual dose (5 mg/day), of tamoxifen for 2 months to 2 male patients and investigated ultrastructural changes in their melanoma cells from metastatic lesions before and after the treatment. After the 2‐month adminisration, metastatic nodules in both patients were reduced in size by approximately 50%. Histologically, their reduced nodules presented coagulation necrosis around the blood vessels. Electron microscopy of the necrosis revealed that melanoma cells were degenerated and disappeared; numerous aggregated melanosomes, free melanosomes, granular endoplasmic reticula, and lysosomes were present in the extracellular matrix and in the space between collagen fibers. The remaining melanoma cells had swollen cytoplasm and mitochondria with vacuolar changes. Cristae of mitochondria had disappeared. There was no infiltration of lymphocytes or histiocytes into the nodules. The organic changes of necrosis lesions were not observed. Because our two patients were ER negative, these effects of tamoxifen could be attributable to an action not mediated by ER.
Severe Cutaneous and Venous Damage after DIC Therapy
Authors: Yuasa Tetsuya , Taniguchi Yoshiki , Yamada Eigo , Inachi Shin , Shimizu Masayuki
Published: April 2015

A 79‐year‐old woman with skin ulcers caused by disseminated intravascular coagulation (DIC) therapy is reported. The patient had been treated by injection of drugs, including gabexate mesilate, into the right great saphenous vein. The maximum concentration of gabexate mesilate was calculated as 0.893%. Although the drugs did not extravasate, purpura initially appeared around the affected vein, followed by brown pigmentation with infiltration and ulcers with widely necrotic tissue from the middle portion of her thigh to the malleolus along her right great saphenous vein. As the ulcer showed no tendency to heal for more than 3 months, surgical debridement and skin grafts were performed.
A Case of Multicentric Reticulohistiocytosis, Systemic Sclerosis and Sjögren Syndrome
Authors: Takahashi Machiko , Mizutani Hitoshi , Nakamura Yasuo , Shimizu Masayuki
Published: April 2015

We report the case of a 42‐year‐old Japanese woman who developed multicentric reticulohistiocytosis (MR) complicated by systemic sclerosis (SSc) and Sjögren syndrome (SS). The patient complained of tender nodules on the left hand, polyarthralgia in the finger joints and knees, and xerostomia. The skin nodules were distributed mainly on her hands and fingers with skin sclerosis. The serum anti‐nuclear test revealed anti‐centromere antibody and the discrete speckled pattern of anti‐nuclear antibody. The biopsy specimens from the finger nodule and the sclerotic finger skin showed a perivascular infiltration of multinucleated giant cells with ground‐glass cytoplasm and dermal thick collagen proliferation, respectively. The lip biopsy and sialography specimens showed periductal lymphocyte infiltration and apple tree‐like changes. Systemic corticosteroid treatment improved the polyarthritis, xerostomia, and skin sclerosis rapidly but suppressed the nodular lesions only gradually. This is the first report of a combined case of MR, SSc and SS. This multiple autoimmune complication suggests the involvement of an immunological disturbance in the pathogenesis of MR.
Unusual Multiple Keratoacanthoma in a Child Successfully Treated with 5‐Fluorouracil
Authors: Singal Archana , Mohanty Sandeep , Bhattacharya Sambit Nath , Baruah Manik C. , Singh Navjeevan
Published: April 2015

A rare case of a child with multiple keratoacanthoma (KA) on the lower half of the body successfully treated with topical and intralesional 5‐fluorouracil (5FU) is described to confirm the therapeutic efficacy of 5FU in such cases.
Ingrown Nails: A Comparison of the Nail Matrix Phenolization Method with the Elevation of the Nail Bed‐Periosteal Flap Procedure
Authors: Mori Hiroki , Umeda Tadashi , Nishioka Kiyoshi , Iida Hideo , Aoki Kazuhiro , Yokoyama Akiko
Published: April 2015

Seventy‐five procedures were performed on 62 patients with ingrown nails from 1992 to 1996. Those consisted of 51 nail matrix phenolization methods (NMP) and 24 elevation of the nail bed‐periosteal flap procedures (ENF). Ingrown nails were classified into type A (normal nail plate) and type B (incurved nail plate). The duration and intensity of postoperative pain were assessed, and the recurrence rate was monitered.

The recurrence rate was 3.9% in the NMP group and 4.1% in the ENF group. Concerning the recurrence rate, there was no statistical significance between ENF and NMP in both types. Postoperative pain intensity was less in the NMP group than in the ENF group in both types (P<0.01). The same tendency was seen in postoperative pain duration. However, the NMP group had longer duration of wound healing compared with the ENF group in type A (P<0.01).

We conclude that NMP is a recommendable treatment for most ingrown nails.
Acral Lentiginous Nevus
Authors: Han Kwang‐Ho , Cho Kwang‐Hyun
Published: April 2015

In non‐Caucasians, malignant melanoma most frequently affects the sole of the foot. To improve the prognosis in such patients, accurate diagnosis of early lesions is extremely important, and, to avoid potentially mutilating surgery, it is equally important to identify benign acral nevus. Clemente and colleagues recently proposed a new clinicopathological entity, designated acral lentiginous nevus (ALN) of the plantar skin. The clinical and histopathological characteristics of these nevi enable clinicians to distinguish them from ordinary nevi and melanoma. We report four additional cases of ALN, which can be classified as belonging to the “pseudomelanoma” group.
Ultrastructural Observation of Platelets from Patients with Progressive Systemic Sclerosis (PSS)
Authors: Maeda Manabu , Kachi Hisayo , Mori Shunji
Published: April 2015

We observed the ultrastructure of platelets from patients with PSS (7 cases; 48.2 ± 12.3 y‐old; M:F= 1:6) and healthy controls (HC) (5 cases; 44.8 ± 8.0 y‐old; M:F=1:4) by using transmission (TEM) and freeze‐fracture electron microscopy (FEM). The open canalicular system (OCS) connected with the plasma membrane (PM) formed pinhole‐like invaginations (50 nm in diameter) in the cleaved face (P‐face) of the plasma membrane seen from the outside of the platelets and sharply elevated structures in the cleaved face (E‐face) of PM seen from the inside of the platelts by FEM. The density of OCS on the surface of the platelets from PSS patients was 3 ± 1/μm2, which was higher than that from HC (1 ± 0.5/μm2) (p<0.02). Dome‐shaped structures, which clearly differ from OCS and were 80–150 nm in diameter without intramembranous particles, were seen in the P‐face, and the complementary depressed structures were seen in the E‐face. These structures were thought to be vesicles fused onto the PM of the platelets. The total volume of platelets (7.62 ± 0.11 μm3), total volume of granules (0.79 ± 0.01 μm3) and vacuoles including OCS (0.78 ± 0.05 μm3), and the total surface area of platelets (17.25 ± 1.30 μm2) from four PSS patients calculated by the morphometrical method were similar to those from four HC (7.32 ± 0.25 μm3, 0.76 ± 0.03 μm3, 0.80 ± 0.05 μm3, 18.75 ± 0.35 μm2, respectively); there were no statistical significances between the data from PSS patients and HC. The total volumes of vacuoles in platelets from both PSS patients and HC significantly decreased after a 2 min‐vibration stress of the hands (p<0.02) and the total volume of granules in platelets from PSS patients decreased significantly after the same stress (p<0.002), although that from HC showed no similar significant change. However, there were no statistically significant differences in total volume or total surface of platelets from PSS patients and HC after the stress. These data may suggest that depletion of granules occurred due to activation of platelets from PSS patients following a secretion of their proteins, because their plasma protein levels were elevated after the stress (Jpn J Dermatol, 98; 1205, 1988). Higher density of OCS on the surface of the platelets from PSS patients may play an important role in secretion of their proteins, although the detailed mechanism of secretion of specific proteins derived from platelet granules is still unknown. These ultrastructural abnormalities of platelets may correlate with some involvement of a platelet disorder and with a possible role for the activation of platelets from PSS patients.
Topical Anthralin Therapy for Refractory Nail Psoriasis
Authors: Yamamoto Toshiyuki , Katayama Ichiro , Nishioka Kiyoshi
Published: April 2015

The nail is commonly involved in psoriasis; however, very few therapies are satisfactory. In this study, we treated for 20 cases of psoriasis vulgaris with nail involvement with topical anthralin therapy. An ointment of 0.4–2.0% anthralin in petrolatum was applied to the affected nail bed once a day and washed away with water after 30 minutes. Then, 10% triethanolamine cream was applied to prevent undesired pigmentation. Within five months of therapy, twelve out of twenty psoriatic patients (60%) showed moderate and obvious improvement, four patients (20%) showed no response to this regimen. Onycholysis and pachyonychia both responded clinically, and the number of pitting was markedly decreased in some cases. The main side effect of anthralin therapy was reversible pigmentation of the nail plate. Topical anthralin therapy is effective for nail psoriasis and considered to be a useful treatment for refractory nail psoriasis.
Suplatast Tosilate (IPD®), a New Immunoregulator, Is Effective in Vitiligo Treatment
Authors: Nihei Yoshimichi , Nishibu Akiko , Kaneko Fumio
Published: April 2015

The major type of vitiligo is considered to be an autoimmune disorder. Anti‐melanocyte antibodies are frequently detected in sera of patients with this disease. Interleukin (IL)‐4 released from Th2 cells is an important factor in stimulating autoantibody production by B‐cells. In this study, seven patients with vitiligo treated with suplatast tosilate (IPD), three showed repigmentation and improvement of their lesions after administration of the drug. IPD halted the continuous spread of the lesions in three of the other patients, and, in two of them, also reduced microsome test and thyroid test titers. The efficacy of IPD in treating vitiligo was thought to be due to the suppressive effect of this drug on IL‐4 production. No side effect was observed. Thus IPD may represent a new alternative in vitiligo treatment due to its inhibition of autoimmunity by the suppression of IL‐4.
Intralymphatic Embolic Cells with Cutaneous Endometriosis in the Umbilicus
Authors: Ichimiya Makoto , Hirota Toru , Muto Masahiko
Published: April 2015

Endometriosis is defined as the presence of both functioning endometrial glands and stroma outside their usual location lining the uterine cavity. It has been identified in virtually all tissues and organs of the female body with the exception of the spleen. There have been many theories proposed regarding the etiology and pathogenesis of endometriosis. One is the transport of cells through lymphatics and blood vessels. A 44‐year‐old female suffering from an episode of endometriosis of the umbilicus, left inguinal, uterus, and bilateral ovaries in association with a Müllerian anomaly is presented. Histopathological findings of a skin biopsy from her umbilicus showed aggregated cells within the lymphatic vessel of the upper dermis. This case provides evidence suggesting that cutaneous endometriosis could occur by transport of endometrial cells through lymphatics or blood vessels.
Epidermal Cytokine mRNA Expression Induced by Hapten Differs from that Induced by Primary Irritant in Human Skin Organ Culture System
Authors: Matsunaga Tsuyoshi , Katayama Ichiro , Yokozeki Hiroo , Nishioka Kiyoshi
Published: April 2015

Epidermal cells produce various kinds of cytokines and express cell adhesion molecules. To analyze early events which induced in human epidermis by stimulation with various chemicals, we analyzed mRNA of cytokines expressed in epidermis in a human skin organ culture system. After painting haptens, primary irritants or vehicle control on human skin specimens sliced to 1 mm thickness and cut into approximately 5×5 mm blocks, the pieces were cultured in serum‐free medium. After separating epidermis from dermis, total RNA was extracted and mRNA of cytokines was assessed by the reverse transcriptase‐polymerase chain reaction. Only haptens induced IL‐1β mRNA at 1–3 hours. TNF‐α mRNA was induced 9 hours after application of haptens and 1 hour after application of primary irritants. IL‐1α mRNA was not induced by either haptens or primary irritants. Thus, cytokine mRNA expression induced by haptens in epidermis differs from that induced by primary irritants.
Multiple Cutaneous Epithelioid Hemangioendothelioma: A Case with Spindle Cells
Authors: Kato Naoko , Tamura Ayumi , Okushiba Mikiyo
Published: April 2015

A case of multiple cutaneous epithelioid hemangioendothelioma (EH) in a Japanese male is reported. The patient was a 52‐year‐old Japanese bureaucrat. Clinically, about 10 purplish‐red, elastic soft or hard papules and nodules had appeared on both lower extremities and the left buttock over the past 20 years. They were excised, but some of them recurred. Histologically, the papules and nodules were well‐circumscribed tumors located in the superficial and deep dermis. They appeared to arise from medium‐sized vessels and were composed of proliferations of characteristic epithelioid endothelial cells with intracytoplasmic vacuolization and spindle cells. No other extracutaneous tumors were found. We diagnosed the present case as multiple cutaneous EH with spindle cells. The presence of epithelioid endothelial cells and absence of pleomorphism and mitoses of nuclei of spindle cells made differential diagnosis from Kaposi's sarcoma possible. The protracted clinical course seems characteristic of EH in various organs including skin.
Pachyonychia Congenita Associated with Steatocystoma Multiplex
Authors: Kim Joong Uhk , Nogita Toshitatsu , Terajima Satomi , Kawashima Makoto
Published: April 2015

We present an unique case of pachyonychia congenita associated with steatocystoma multiplex. A 33‐year‐old Japanese man had thickening and gray‐brown dicoloration of all nails and a large number of nodules or tumors over his entire skin. No palmar and plantar hyperkeratosis, leukokeratosis of the mucous membranes, or follicular keratosis were observed. Histology of these tumors revealed the typical features of steatocystoma multiplex.
Schönlein‐Henoch Purpura in Association with Duodenal Ulcer and Gastric Helicobacter pylori Infection
Authors: Cecchi Roberto , Torelli Ettore
Published: April 2015

We report a 62‐year‐old man who presented with Schönlein‐Henoch purpura (SHP) associated with duodenal ulcer and gastric Helicobacter pylori (HP) infection. The recurrent purpuric rash faded after HP eradication with amoxycillin, clarythromycin, and omeprazole treatment. These findings suggest a causative role for HP in the occurrence of SHP.
The Levels of Plasma Interleukin‐2 and Soluble Interleukin‐2R in Behçet's Disease: A Marker of Disease Activity
Authors: Çayirli Erkan Alpsoy Çiçek , Er Hanife , Yilmaz Ertan
Published: April 2015

It is well known that patients with Behçet's disease (BD) have an activated immune system, probably mediated by soluble factors in the circulation. The purpose of our study was to examine the roles of plasma interleukin‐2 (IL‐2) and soluble interleukin‐2 receptor (sIL‐2R) in the pathogenesis of BD.

Thirty‐two patients with BD diagnosed according to the Criteria of the International Study Group for Behçet's Disease and 20 age‐matched healthy persons were included in the study. The plasma levels of cytokines were measured by ELISA.

Plasma levels of IL‐2 and sIL‐2R were increased in BD over controls, but the differences were not statistically significant. sIL‐2R levels in patients with active disease were significantly higher than in either patients with inactive disease (p<0.001) or the control group (p<0.05).

Our results suggest that the level of sIL‐2R in BD seems to be related to disease activity.
Pruritus Gravidarum: A Clinical and Laboratory Study
Authors: Shanmugam Srikanth , Thappa Devinder Mohan , Habeebullah Syed
Published: April 2015

Five hundred pregnant women attending obstetrics OPD were screened for the presence of pruritus. The patients with other dermatological causes of pruritus (other than specific dermatosis of pregnancy) were excluded from the study. The selected patients were further subjected to routine laboratory investigations including liver function tests and HBs Ag detection. The prevalence of pruritus in pregnancy was found to be 4.6% (23 cases). Ten patients were found to have specific dermatoses of pregnancy, including four cases of pruritus gravidarum and four of pruritic urticarial papules and papules of pregnancy. The prevalence of pruritus gravidarum was 0.8% of pregnancies. All the patients with pruritus gravidarum were primigravidae and had no clinical overlap with other specific dermatoses of pregnancy, jaundice, or intrahepatic cholestasis. One case of perinatal death was recorded among the pruritus gravidarum cases. This study has been helpful in determining the prevalence and severity of pruritus gravidarum in South India.
Acquired Reactive Perforating Collagenosis with IgA Nephropathy
Authors: Iwamoto Ikuyo , Baba Shunichi , Suzuki Hiroyuki
Published: April 2015

A 25‐year‐old Japanese man developed numerous discrete umbilicated papules on his face, trunk, and both forearms at the onset of IgA nephropathy. The newest lesion was a nonumbilicated skin‐colored papule. On histopathologic examination, alteration of capillaries was observerd in both newer and umbilicated papules. In our case, a primary cause of the reactive perforating collagenosis could be an alteration of the capillaries.
Flame Figures Associated with Bullous Pemphigoid
Authors: Watanabe Hideaki , Sueki Hirohiko , Kitami Amane , Kakuchi Chikako , Ikeda Yusuke , Nagata Shigeki , Hashimoto Takashi , Iijima Masafumi
Published: April 2015

We report a case of bullous pemphigoid showing the histological features of flame figures. An 80‐year‐old man was admitted with multiple, tense, thumb‐sized blisters among erythematous plaques on his trunk and limbs. A biopsy showed accumulations of eosinophil granules on the collagen fibers, forming characteristic “flame figures”, in addition to the features of bullous pemphigoid. We retrospectively examined biopsy specimens from 34 patients with bullous pemphigoid treated in our department over the last 10 years for the presence of flame figures. They were observed in 3 of these patients (8.8%), all of whom were more than 80 years of age. Our retrospective study indicates that the association of flame figures with bullous pemphigoid is not rare, considering the fact that the present case is only the third report of this association. Our data also suggest that the degree of dermal eosinophilia and the formation of flame figures could be related.
Necrobiosis Lipoidica‐like Skin Lesions in Systemic Sarcoidosis
Authors: Igawa Ken , Maruyama Ryuji , Satoh Takahiro , Yokozeki Hiroo , Katayama Ichiro , Nishioka Kiyoshi
Published: April 2015

A 62‐year‐old woman with systemic sarcoidosis developed erythematous plaques on her lower legs. Clinically, two kinds of skin lesions were distinguished; one type formed brownish‐red plaques with induration suggesting plaque‐type skin sarcoid, and the other formed purplish erythematous plaques with atrophic centers resembling necrobiosis lipoidica. In spite of this clinical appearance, a biopsy specimen from one of the latter lesions revealed typical skin sarcoid histology composed of discrete non‐caseating granulomas, while that from one of the other lesions showed necrobiotic changes of collagen bundles surrounded by epitheloid histiocytes and foreign‐body giant cells. Because cutaneous involvement of sarcoidosis may mimic necrobiosis lipoidica clinically and/or histologically, we diagnosed her skin lesions as necrobiosis‐like skin sarcoid.
A Case of Carotenodermia Caused by a Diet of the Dried Seaweed Called Nori
Authors: Nishimura Yurika , Ishii Norihisa , Sugita Yasuyuki , Nakajima Hiroshi
Published: April 2015

Carotenodermia may arise from excessive dietary intake of carotene containing foods. We reported a 22‐year‐old woman who had eaten excessive amount of carotene‐rich seaweed to lose weight. Her skin color changed to orange‐yellow, and her serum β‐carotene was 573 μg/dl. After stopping the ingestion of seaweed, her skin color returned to normal.
Combination Therapy with Low‐Dose Etretinate and Eicosapentaenoic Acid for Psoriasis Vulgaris
Authors: Danno Kiichiro , Sugie Nobuo
Published: April 2015

A randomized open study was undertaken to compare the therapeutic effects between low‐dose etretinate alone and low‐dose etretinate combined with eicosapentaenoic acid in 40 patients with chronic, stable psoriasis vulgaris. Better and more rapid improvement was obtained with the combination therapy for 12 weeks than with low‐dose etretinate monotherapy. Eicosapentaenoic acid was safe, and adverse reactions due to low‐dose etretinate were mild or tolerable. The combination regimen, therefore, has a satisfactory effect on psoriasis without marked adverse reactions.
A Case of Pre‐Sézary Syndrome Preceded by Hand Lesions
Authors: Lee Nam Ho , Lee Se‐Won , Choi Eung Ho , Lee Won‐Soo , Ahn Sung Ku
Published: April 2015

Pre‐Sézary syndrome is an erythroderma with a chronic course, clinical findings of Sézary syndrome, lymphocytic subepidermal band infiltration at times, and repeated cycles of circulating Sézary cells of less than 1,000 cells/mm3. Duration of the pre‐existing skin diseases preceding pre‐Sézary erythroderma varies from a few weeks to 20 years. Before the erythroderma develops, these patients are diagnosed with contact dermatitis, neurodermatitis, chronic dermatitis, atopic dermatitis, or asteatotic eczema. Hand lesion also precedes the pre‐Sézary erythroderma. This condition has been controlled by three cycles of chemotherapy consisting of vincristine, Cytoxan, doxorubicin, and prednisolone. We describe a case of pre‐Sézary syndrome preceded by hand lesion and treated with chemotherapy.
Clinical and Histopathological Characteristics of Basal Cell Carcinoma in Korean Patients
Authors: Cho Soyun , Kim Myung‐Hwa , Whang Kyu‐Kwang , Hahm Jeong‐Hee
Published: April 2015

Seventy‐eight Korean patients with basal cell carcinoma (BCC) between 1984 and 1998 were retrospectively examined at Ewha Womans University Tongdaemun Hospital, Seoul, Korea. We analyzed the annual incidence, age and sex distribution, site of the lesions, clinical appearance, including the proportion of clinically pigmented tumors, modalities of treatment, incidence of recurrence and metastasis of the tumors, the histopathological patterns, and whether solar elastosis, microscopic pigmentation, or adamantinoid feature were associated. The male‐to‐female ratio was 0.902, and the average age of the patients at first examination was 58.2 years. Eighty percent of the tumors occurred on the head and neck, most commonly on the nose (26.9%), followed by the cheek, eyelid, and upper lip. Ulcerated nodules were the most common clinical presentation. Clinically, 55% of the tumors were pigmented. Six tumors recurred; none metastasized. Surgical excision was the most common modality of treatment. The most frequent histopathological pattern was the solid type (60.3%), followed by the superficial (11.5%) and fibrosing (9.0%) types. The occurrence of the superficial type was significantly associated with truncal lesions (p<0.001). Solar elastosis was present in 62.1% of the tumors on the head and neck, compared with 8.3% in those of the trunk and limbs (p<0.001), indicating the significance of sun exposure in the pathogenesis of BCC on exposed areas. Microscopic pigmentation was seen in 69.2% of the tumors. The focal adamantinoid feature was found in 14.1%, which is much higher than the previously reported incidence.
A Case of Lipodystrophia Centrifugalis Abdominalis Infantilis with Morphea
Authors: Ikoma Akihiko , Tanaka Toshihiro , Miyachi Yoshiki
Published: April 2015

A 5‐year‐old female developed three depressed lesions sequentially on her left hip, left upper arm and left Achilles tendon; we diagnosed them as lipodystrophia centrifugalis abdominalis infantilis (LCAI). She also developed two sclerotic lesions, at almost the same time, on her left upper arm and left forearm; we diagnosed them as morphea. Clinical and histopathological examination revealed that the LCAI and morphea seen in our case were completely different. Although two other cases of co‐existing LCAI and morphea have already been reported, they were not described in detail and their morphea lesions were adjacent to their LCAI lesions. We herein report a case of LCAI with morphea in which the lesions were not adjacent.
New Technologies toward Dendritic Cell‐Based Cancer Immunotherapies
Authors: Matsue Hiroyuki , Morita Akimichi , Matsue Keiko , Takashima Akira
Published: April 2015

Immunologically naive T cells are activated most efficiently or even exclusively by special subsets of antigen presenting cells, termed dendritic cells (DC). Members of the DC family have been identified in virtually all epithelial tissues that are constantly exposed to environmental antigens or infectious microbes. For example, skin is equipped with at least two members of this family, epidermal Langerhans cells (LC) and dermal DC. DC have been shown to play pathogenic roles in several different inflammatory/immunological disorders and protective roles against infectious pathogens and cancer development. In this review article, we will overview the recent progress in the development of DC‐based immunotherapies for the prevention and treatment of cancers.
Vascular Tumors Arising in Port‐Wine Stains: Two Cases of Pyogenic Granuloma and a Case of Acquired Tufted Angioma
Authors: Kim Tae‐Hyun , Choi Eung Ho , Ahn Sung Ku , Lee Sung Hun
Published: April 2015

Three female patients affected by intradermal vascular tumors were presented. The lesions were acquired and developed from preexisting port‐wine stains (PWS). Among the three patients observed, two had a pyogenic granuloma (PG) and the third patient had tufted anigomas. As reported earlier, formation of a PG within the lesion of a PWS supports the assumption that arteriovenous anastomoses are associated with its pathogenesis. Occurrence of tufted angioma from a PWS, as well as coexisting but separate PWS, has been reported. However, the tufted angiomas of our patient were located in different sites, one in the PWS and others separate from the PWS. This has never previously been reported.
A Case of Pediatric Behçet's Disease with Intestinal Involvement
Authors: Yamazaki Sayuri , Koyano Taeko
Published: April 2015

We report a 6‐year‐old girl with recurrent oral aphthae, genital and perianal ulcers, and folliculitis‐like erythema followed by intestinal symptoms. No ocular lesions were found. Her ailment was diagnosed as incomplete Behçet's disease with intestinal involvement. According to the literature, pediatric Behçet's disease is characterizesd by a low incidence of ocular lesions and a high incidence of intestinal involvement, as exhibited in this case. As intestinal lesions in pediatric Behçet's disease are often life‐threatening, a barium enema must be given to exclude the possibility of intestinal involvement when pediatric patients with Behçet's disease complain of abdominal pain