bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated B‐Lymphocyte Levels in Lesional Tissue of Non‐Arthritic Psoriasis
Authors: Mahmoud Fadia , Abul Habib , Saleh Qassem Al , Naby Hussein Hassab‐El , Kajeji Mahdi , Haines Donald , Burleson Joe , Morgan Gareth
Published: April 2015

Psoriasis is a chronic inflammatory skin disorder characterized clinically by maculopapular skin lesions and on the cellular level by increased T‐lymphocyte activation in die peripheral blood and migration of activated T‐lymphocytes into the lesions. The lymphocyte subpopulations in peripheral blood from 21 Kuwaiti patients showed elevated levels of the T‐lymphocyte activation marker CD25, as well as increased expression of HLA‐DR compared with a group of age and sex‐matched controls, confirming published findings on psoriasis. In addition, there was a tendency towards a significant increase in the CD4+/CD45RO+ (memory cell) population that was also consistent with peripheral T‐lymphocyte activation. Immunohistological studies showed a heavy infiltrate of all cell types into the lesional tissue including, as expected, activated T‐lymphocytes. An unexpected finding was significantly higher levels of B‐lymphocytes infiltrating the psoriatic lesions; they numerically exceeded the T‐lymphocyte infiltrate. This has previously been reported only in cases of psoriasis with concurrent arthritis. None of the subjects had arthritis, suggesting an immunopathological variant of psoriasis possibly specific to this population group.
Epstein‐Barr Virus‐Associated Lymphoproliferative Skin Lesion with Recurrent Necrotic Papulovesicles of the Face
Authors: Jung Doo Yeoul , Kim Ji Won , Lee Sook Kyung , Lee Won Woo
Published: April 2015

A 24‐year‐old man showed recurrent necrotic papulovesicles of the face. The cutaneous lesions started with erythema, followed by vesicles, necrosis, and crusting, and leaving depressed scars. Light avoidance did not prevent the development of the lesions. Histologic examination revealed lymphoproliferative lesions confined to the skin. Latent Epstein‐Barr virus (EBV) infection was detected in the lymphoid cells from the skin lesions by in situ hybridization. A moderate to high dosage of corticosteroids suppressed the development of new skin lesions, but relapses occurred when these systemic corticosteroids were tapered.
Giant Cell (Temporal) Arteritis Involving Both External and Internal Carotid Arteries
Authors: Noguchi Mikimasa , Tatezawa Takashi , Nakajima Shigeyuki , Ishikawa Osamu
Published: April 2015

A 76‐year‐old woman with giant cell (temporal) arteritis was described; she presented with a one year history of headache and tinnitus. Histopathological findings from a superficial temporal artery showed arteritis with granulomatous changes. Bilateral carotid arteriograms demonstrated the stenoses of both internal carotid arteries as well as the narrowing of the superficial temporal arteries. Although we dermatologists rarely encounter the disease in daily clinical practice, it is of clinical importance to perform cerebral angiography in patients suspected of temporal arteritis.
A Case of Prurigo and Lichenified Plaques Successfully Treated with Proton Pump Inhibitor
Authors: Ohtsuka Tsutomu , Yamakage Akio , Yamazaki Sqji
Published: April 2015

A case of prurigo and lichenified plaques successfully treated with proton pump inhibitor is presented. She presented with pruritic eruptions, which showed marked lichenification and prurigo nodules, on her trunk and extremities. She had been treated with steroid ointment and H1‐histamine receptor antagonist without success. Laboratory examinations revealed increased eosiophils and elevated lactate dehydrogenase. The skin biopsy specimen showed moderate acanthosis with spongiosis and lymphocytic and eosinophilic infiltration into the upper dermis. Because of vomiting and epigastralgia, endoscopical examination was performed, and an ulcer was found at the angle of her ventricle. A biopsy specimen disclosed a benign gastric mucosa with moderate inflammation within the lamina propria, and organisms consistent with Helicobacter pylori. Treatment for gastric ulcer with proton pump inhibitor (omeprazole) and alminium hydroxide gel improved her eruptions and her pruritus resolved. She was discharged with complete cure of her eruption and ventricular ulcer. Our case indicates that gastric lesions induced by Helicobacter pylori infection may play an important role in dermatological diseases. Proton pump inhibitors including omeprazole are one of the choices for the treatment of some dermatological diseases including prurigo and lichenified plaques.
Ichthyosis and Psoriasis in a Patient with Down Syndrome
Authors: Nomura Kazuo
Published: April 2015

A 24‐year‐old man with Down syndrome presented with prominent ichthyosiform skin on his extremities and psoriatic plaques on his chest, back and scalp. The late onset of his ichthyosis without family history suggested that it was not a heritable form but was associated Down syndrome. Such an association with ichthyosis and psoriasis has not been described previously.
Neck Location of Basal Cell Carcinomas: A New‐Significant Variant?
Authors: Betti Roberto , Vergani Raffaella , Gualandri Lorenzo , Pazzini Claudia , Crosti Carlo
Published: April 2015

Basal cell carcinoma of the neck has been suggested to have a distinct clinical, histological and prognostic significance. The aim of our study is to verify this assumption. Among 1,185 basal cell carcinomas, we have observed 42 tumors localized on the neck. The mean age did not differ from that of patients with basal cell carcinomas on other sites, and there was no difference in incidence between sexes. The frequence of recurrence was 4.76%, similar to the recurrence rate of basal cell carcinomas on other sites. The lesions were typed histologically according to accepted criteria. The patterns observed were: nodular (62.8%), superficial (21.1%), mixed (4.7%), micronodular (5.9%), and infiltrative (5.7%). These frequencies did not differ significantly from those observed in the basal cell carcinomas on other sites. Thus, in comparision with the overall basal cell carcinoma population, the tumors of the neck do not represent a particular clinical and histologic subtype and do not have a particular recurrence potential. We think that basal cell carcinomas localized on the neck do not represent a particular subtype of these tumors; their treatment can be the same as that of basal cell carcinomas on other regions.
A Case of Systemic Sclerosis Associated with Gastric Cancer
Authors: Matsuta Mayumi , Chiba Chie , Akasaka Toshihide , Terashima Masanori
Published: April 2015

We report the case of a 47‐year‐old woman who began to experience stiffness and Raynaud's phenomenon of her fingers and toes as well as easy fatigability approximately one year before initial evaluation. Histopathologic examination revealed dense fibrosis and perivascular lymphoid cell infiltration in the dermis. The patient's diagnosis was systemic sclerosis (SSc). Esophageal sclerosis was not revealed, but an early type IIb carcinoma of the gastric antrum was noted by endoscopic examination. Other recent reports have discussed the association of SSc with various malignant carcinomas. We also reviewed the literature for associations between SSc and gastric cancer in Japanese patients.
Fine Needle Aspiration Cytology of Basal Cell Carcinoma of the Skin: A Clinical and Cytopathological Appraisal
Authors: Fang Xinzhi , Ma Bowen
Published: April 2015

This report describes the fine needle aspiration cytologic findings of 22 cases of basal cell carcinoma of the skin. The series consisted of 17 men and 5 women with a mean age of 60.7 years (range, 35–80). All the patients were from south of Xinjiang and were outdoor workers with histories of prolonged exposure to strong sunlight. Histopathologic study was performed in all cases. Using fine needle aspiration cytology (FNAC) in evaluating basal cell carcinoma, there were no false‐positive cases, but one false‐negative one giving a diagnostic accuracy of 95.65%. Cytologic features suggestive of basal cell carcinoma included increased numbers of small, uniform hyperchromatic, relatively little cytoplasmic cell clusters. The peripheral cells appeared in monolayer form as a papillated outline with very strong cellular cohesion. Scattered tumor cells were seldom seen. The differential diagnosis of basal cell carcinoma in FNAC includes poorly differentiated squamous cell carcinoma, eccrine gland carcinoma, and neuroendocrine carcinoma of the skin. FNAC diagnosis of basal cell carcinoma is essential in order to ensure proper treatment.
Vitiligo: Clinical Findings in 1436 Patients
Authors: Handa Sanjeev , Kaur Inderjeet
Published: April 2015

We retrospectively analyzed the clinical and epidemiological profiles of patients with vitiligo attending the pigmentary dermatoses clinic. One thousand four hundred and thirty‐six patients were seen between 1989 and 1993. Males constituted 54.5% of the group and females 45.5%. Mean age of the patients was 25 years, and average disease duration at the time of hospital visit was 3.7 years.

Vitiligo vulgaris was the commonest form of the disease in 1002 (69.8%) patients followed by focal vitiligo in 214 (14.9%) and segmental vitiligo in 72 (5.0%). The sites of onset were the face, trunk, and legs in descending order of frequency. Less than 20% body area involvement was seen in 1356 (94.4%) of the patients. Leukotrichia was present in 165 (11.5%), and Koebner's phenomenon was observed in 72 (5.0%). Twenty nine (2.0%) patients had associated halo nevi. Of the various diseases associated with vitiligo, atopic/nummular eczema was seen in 20 (1.4%) patients, bronchial asthma in 10 (0.7%), diabetes mellitus in 8 (0.6%), thyroid disease in 7 (0.5%), and alopecia in 6 (0.4%). A family history of vitiligo was present in 165 (11.5%) patients.
Cataract and Retinal Detachment in Patients with Severe Atopic Dermatitis Who Were Withdrawn from the Use of Topical Corticosteroid
Authors: Taniguchi Hiroko , Ohki Orina , Yokozeki Hiroo , Katayama Ichiro , Tanaka Akiko , Kiyosawa Motohiro , Nishioka Kiyoshi
Published: April 2015

Many patients with severe atopic dermatitis (AD) in Japan are afflicted with persistent erythema of the face (atopic red face) that is not only resistant to topical corticosteroid, but often becomes worse with its use. During a three‐year period (1991–1993), we treated 79 inpatients with severe AD by a combination of careful daily skin care, use of emollients, and exclusion of exacerbating factors. Occular complications before and after treatment were examined in these cases. After withdrawal of topical corticosteroid, almost all of the patients showed a temporary worsening of their skin condition. Immediately thereafter, their occular symptoms did not change. Cataract was found in 20 cases (25.3%), and retinal detachment in 9 (11.4%). After 2 months, 11 cases of cataract and 5 cases of retinal detachment in the peripheral retina were observed. However, these incidences were similar to the numbers reported in Japan during conventional treatment with topical corticosteroid.

The development of cataract or retinal detachment had no relationship to serum IgE levels, personal history of respiratory atopy, the duration of topical corticosteroid use on the face, or treatment with systemic corticosteroid. Our obsevations suggest that patients who habitually tap or rub their faces strongly tend to develop cataract or retinal detachment at a statistically significant higher frequency.

Patients wih AD should have ophthalmologic examinations every one to two months for at least one year after a facial oozing attack or withdrawal of corticosteroid.
A Case of Perineal Schwannoma Resembling a Skin Tag
Authors: Kim Young Koo , Ahn Sung Ku , Lee Seung Hun
Published: April 2015

We describe a case of perineal schwannoma (neurilemmoma) that resembled a skin tag. The structure was composed of a 1.5 cm × 1.4 cm × 1 cm sized mass and a movable stalk. After excision of the mass from the stalky root with scissors, H & E staining of the specimen revealed an encapsulated intradermal mass composed of Antoni‐A type and Antoni‐B type tissue.
Current Consensus and Update on Psoriasis Therapy: A Perspective from the U.S.
Authors: Koo John Y. M.
Published: April 2015

Psoriasis is one of the more common forms of chronic dermatitis in the world. The latest U.S.‐wide epidemiological study conducted by the author revealed a prevalence rate of 2.6% of the population, which translates to over 6 million Americans (1). Psoriasis comes in many different degrees of severity and responsiveness to treatment modalities. Some cases are very mild and quite responsive to treatment, while others are so severe, chronic and recalcitrant that they test the skill and ingenuity of the best clinicians. Fortunately, there are also many different treatment options. Topical therapies include crude coal tar, anthralin, corticosteroids, calcipotriol, and tazarotene. Phototherapy may be a better choice in patients with more extensive psoriasis; UVB or psoralen plus subsequest UVA (PUVA) can be used. There are also a host of systemic therapies (cyclosporine, methotrexate, acitretin), which can be chosen in recalcitrant cases, or when topical or phototherapy is impractical. Importantly, significant increases in efficacy can be obtained by combining multiple therapies (Re‐PUVA, topical calcipotriol plus topical halobetasol) and significant decreases in side effects can be obtained by transitioning through or rotating between therapies (cyclosporine transitioning into acitretin).
Analysis of the T Cells that Are Potentially Involved in Autoantibody Production in Pemphigus Vulgaris
Authors: Hertl Michael , Riechers Regine
Published: April 2015

Pemphigus vulgaris (PV) is a classical example of an antibody‐mediated autoimmune disease of the skin. Direct evidence exists that autoantibodies against the desmosomal adhesion molecule, desmoglein 3 (Dsg3), are critical in the pathogenesis of this disease. The transfer of serum IgG antibodies reactive with Dsg3 into newborn mice induces a bullous skin disease resembling PV. Autoreactive T cell responses to Dsg3 may be critical in the pathogenesis of PV because 1) antibody production generally requires T cell help, 2) the involvement of CD4+ T lymphocytes in PV has been suggested by the strong association with distinct HLA class II alleles, and 3) T cell recognition of epitopes of Dsg3 may be crucial for the initiation and perpetuation of the production of Dsg3‐specific autoantibodies by B cells. We and others have identified autoreactive T cells recognizing distinct epitopes of the extracellular portion of Dsg3 in PV patients. These autoreactive CD4+ T cells preferentially produced TH2 cytokines such as IL‐4, and IL‐10. Autoantibodies of the TH2‐dependent IgG4 subtype are preferentially seen in active stages of PV disease, while autoantibodies of the TH1‐dependent IgG1 subclass are predominant upon remission of PV. Healthy individuals who carried HLA class II alleles similar or identical to those found to be highly prevalent in PV also developed autoreactive T cell responses to Dsg3. Autoreactive T cells from PV patients produced both TH1 and TH2 cytokines; autoreactive T cells from normals produced TH0 cytokines. These observations suggest that Dsg3‐specific T cells may provide targets to eventually modulate the T cell‐dependent production of pathogenic autoantibodies in PV.
Clinicopathologic Analysis of 124 Cases of Adult T‐Cell Leukemia/Lymphoma with Cutaneous Manifestations: The Smouldering Type with Skin Manifestations Has a Poorer Prognosis than Previously Thought
Authors: Setoyama Mitsuru , Katahira Yoshihiko , Kanzaki Tamotsu
Published: April 2015

Adult T‐cell leukemia/lymphoma (ATLL) commonly involves the skin as well as peripheral blood and lymph nodes. During the last 15 years we have studied 124 cases of ATLL with specific skin manifestations. Twenty‐one patients (16.9%) were classified as acute, 21 (16.9%) as chronic, 26 (21.0%) as lymphoma, and 56 (45.2%) as smouldering according to Shimoyama's classification. Many patiens had nodules/tumors (34.7%), erythematous plaques (22.6%), and erythematous papules (19.4%) similar to those occurring with other cutaneous T‐cell lymphomas. Some patients displayed characteristic skin manifestations resembling non‐neoplastic cutaneous disorders.

The median survival time (MST) of all patients was 12.0 months. The MSTs of individual clinical types were: acute type, 4 months; chronic type, 14 months; lymphoma type, 7 months; and smouldering type, 16 months. In the smouldering type, cases with a deeper infiltration pattern (MST, 14 months) had a more aggressive course than those with a superficial infiltration pattern (MST, 24 months) (p<0.05). The results indicate that smouldering type ATLL with skin manifestations may have a worse prognosis than without skin manifestations. Moreover, some cases of the smouldering type with specific skin lesions should be classified into another group with a much poorer prognosis.
Characteristics of Streptococcus Species Isolated from Infectious Skin Diseases
Authors: Higaki Shuichi , Kitagawa Taro , Morohashi Masaaki , Yoshida Ikuko , Yamagishi Takayoshi
Published: April 2015

During the period from January of 1995 to June of 1998, 27 β‐hemolytic streptococci were isolated from 25 cases of infectious skin diseases including secondary infections, impetigo, phlegmone, and paronychia. The rate of β‐hemolytic streptococci among all kinds of the isolates was found to be similar during those 4 years, ranging from 3.5% to 5.6%. Staphylococcus aureus were found to coexist with β‐hemolytic streptococci in 20 (80%) out of 25 cases. β‐hemolytic streptococci were also often associated with coagulase‐negative staphylococci, gram‐positive rods, or other species. Twelve cases (48%) carried β‐hemolytic streptococci predominantly. Most β‐hemolytic streptococci showed high susceptibilities to all antimicrobials tested; however S. agalactiae showed no susceptibility to gentamicin. The evaluation of characteristics of Streptococcus species is very important for selecting the right antimicrobial agents and the proper term of chemotherapy.
Encephalocraniocutaneous Lipomatosis: A New Case Report and Review of the Literature
Authors: Romiti Ricardo , Rengifo Jaime A. , Arnone Marcelo , Sotto Mirian N. , Valente Neusa Y. , Jansen Thomas
Published: April 2015

Encephalocraniocutaneous lipomatosis is a rare neurocutaneous syndrome characterized by lipomatous hamartomas ranging in size from a few millimeters to several centimeters and affecting the head. Ocular anomalies and a variable degree of mental retardation with or without convulsions are usually observed. This disorder should be distinguished from other mosaic neurocutaneous phenotypes such as Proteus syndrome, oculocerebrocutaneous syndrome, and nevus sebaceous syndrome. We report the clinicopathologic findings of a 4‐year‐old Brazilian girl affected by this syndrome and review the literature. To our best knowledge, this is the first documented case of encephalocraniocutaneous lipomatosis occuring sporadically in South America.
Primary Cutaneous Mucormycosis in a Trauma Patient
Authors: Song Won Keun , Park Hyang Joon , Cinn Yong Woo , Rheem Insoo , Pai Hyunjoo , Shin Jong Hee
Published: April 2015

We report a rare case of primary cutaneous mucormycosis caused by Rhizopus oryzae that occurred in an immunocompetent trauma patient. The patient had encrusted erythematous plaques with pustules on the left shin, which had been abraded in a traffic accident. Histologic examination revealed widespread granulomatous inflammation and characteristic broad, non‐septate hyphae with right‐angle branching in the dermis. The infection was cured with intravenous amphotericin B therapy.
Port‐Wine‐Stain (Nevus Flammeus), Congenital Becker's Nevus, Café‐au‐lait‐Macule and Lentigines: Phakomatosis Pigmentovascularis Type Ia—A New Combination
Authors: Joshi Arun , Garg Vijay Kumar , Agrawal Sudha , Agarwalla Arun , Thakur Amarnath
Published: April 2015

A 16‐year‐old male had brown macules in a geographic pattern with increased terminal hair on the back and dusky red partially blanchable non progressing macules on his left thigh since birth. Clinical diagnoses of Becker's nevus and port‐wine‐stain were made and confirmed histopathologically. In addition, he had multiple lentigines on the face and trunk and a single café‐au‐lait‐macule on his chest.
Letter to the Editor
Authors: Shimizu Takahiro , Murakami Tomoyuki , Oga Atsunori , Furumoto Hiroko , Nakano Junji , Muto Masahiko
Published: April 2015

Prognostic Significance of Expression of p53 Protein and Ki‐67 Antigen in Well‐Differentiated Squamous Cell Carcinoma of the Skin
Mucha‐Habermann Disease‐like Eruptions Due to Tegafur
Authors: Kawamura Keiko , Tsuji Takuo , Kuwabara Yoshiyuki
Published: April 2015

The first case of Mucha‐Habermann disease‐like drug eruptions due to Tegafur is reported. A 59‐year‐old man noticed various skin lesions after he had taken 300 mg of Tegafur daily for about 200 days. The patient had papulonecrotic eruptions on his trunk and extremities. The histology from a papular lesion revealed epidermal necrosis surrounded by spongiosis, perivascular inflammatory infiltrations composed of lymphocytes and erythrocytes, and endothelial swelling. The etiology of Mucha‐Habermann disease is not known, but an immune mechanism may be supported by our case.
Detection of Human Papilloma Virus Type 58 in a Case of a Perianal Bowen's Disease Coexistent with Adult T‐cell Leukemia
Authors: Uezato Hiroshi , Hagiwara Keisuke , Maruno Motoyoshi , Ramuzi Saeef Taher , Khaskhely Noor Mohammad , Oshiro Minoru , Asato Tsuyoshi , Nakashima Yasutsugu , Nonaka Shigeo
Published: April 2015

A case of Bowen's disease (BD) that appeared in the perianal region of a 65‐year‐old Japanese woman coexistent with chronic adult T cell leukemia (ATL) is described. Histopathological findings revealed that irregularly arranged tumor cells with atypical nuclei throughout the epidermis, which itself disclosed hyperkeratosis, dyskeratotic cells, and clumping cells. Positive staining for HPV antigens was immunohistochemically seen in several nuclei of the tumor cells. Electron microscopic study of the tumor tissue disclosed virus particles of about 50 nm in diameter form the squamous cells. A positive band at 256 bp was obtained by PCR using HPV‐L1 primer. The amplified DNA by L1 primer completely corresponded to that of HPV‐58.
A Case of Multiple Sebaceous Epithelioma: Analysis of Microsatellite Instability
Authors: Ueda Masato , Wang Yin , Sugimura Haruhiko , Tamura Shingo , Kondoh Masafumi , Ichihashi Masamitsu
Published: April 2015

Sebaceous gland tumor is a rare disease that is a sign of Muir‐Torre syndrome, an autosomal, dominantly inherited genodermatosis characterized by the presence of at least one sebaceous gland tumor and a minimum of one internal malignancy. Recent studies have indicated that defective DNA mismatch repair occurs in Muir‐Torre syndrome. Cutaneous lesions may occur before diagnosis of the internal cancer. We describe a 64‐year‐old male patient with multiple sebaceous epitheliomas with no evident internal malignancy. Microsatellite instability, determined by examining dinucleotide CA repeats at the microsatellite loci, was observed in DNA from one sebaceous epithelioma but not from the other two sebaceous epitheliomas or from one basal cell epithelioma with sebaceous differentiation, suggesting that this condition is unlikely to be due to germ‐line mutation of mismatch repair genes.
A Poroid Neoplasia Arising Close to a Seborrheic Keratosis and a Trichoepithelioma
Authors: Nagore Eduardo , Díaz Felipe , Sánchez‐Motilla José M. , Prats Amelia , García‐Castell Julia , Aliaga Adolfo
Published: April 2015

A 69‐year‐old woman had a well‐defined, slightly raised, brownish, keratotic plaque with an excentric group of roughly circular, bluish, dome nodules on her right scapular area. Histological study revealed the presence of an eccrine poroma demonstrating features of eccrine poroma, hidroacanthoma simplex, and dermal duct tumor and arising in a lesion of seborrheic keratosis and a trichoepithelioma. In the eccrine poroma region, an area with malignant changes was evident. The findings in this case support the view of eccrine poroma as a spectrum of histological variants and the possibility of malignant transformation from a eccrine poroma towards porocarcinoma. The association with seborrheic keratosis is most probably coincidental, and the trichoepithelioma was probably due to induction of the tumoral stroma on adjacent follicular epithelia.
Sweat Gland Adenoma with Predominant Myoepithelial Differentiated Features: Case Report and Immunohistochemical Study
Authors: Xinzhi Fang , Zhineng Yu , Zizen Wang
Published: April 2015

A 56‐year‐old man presented with a subcutaneous mass adjacent to the sternoclavicular joint region, which had predominant spindle‐shaped myoepithelial cells and a small number of tubular or trabecular epithelial cells that resembled eccrine differentiation under a light microscope. Immunohistochemical studies showed positive staining for muscle‐specific actin and vimentin in the myoepithelial cells, but staining was negative for S‐100 protein and keratin. The tubular and trabecular epithelial cells stained positively for keratin, EMA and CEA. We believe that this rare tumor had the potential for biphasic differentiation and should be differentiated from other biphasic differentiated or mixed tumors in this site. Immunohistochemical staining was useful for diagnosis and differential diagnosis.
Postoperative Alveolar Hydatid Disease with Cutaneous‐Subcutaneous Involvement
Authors: Ambo Midori , Adachi Kouichi , Ohkawara Akira
Published: April 2015

The first Japanese case of alveolar hydatid disease with cutaneous‐subcutaneous lesions is reported. The patient, a 58‐year‐old man who developed an indurated subcutaneous tumor on the right side of the abdomen, had had partial hepatectomy of the right lobe for echinococcosis thirteen years earlier. Clinically, the tumor was adherent with a fistulosis communication to deeper structures. Histopathologically, multiple PAS‐positive cuticular layers with foreign body granulomas and fibrosis were observed between the dermis and subcutaneous fatty tissue. Surgical excision of the swelling provided the patient with temporary relief. To our knowledge, only eight cases of subcutaneous alveolar hydatid disease have been reported throughout the world. Ours, the ninth case, highlights the importance and difficulty of treating of alveolar hydatid disease.
Unilateral Schamberg Disease in a 14‐Year‐Old Japanese Boy
Authors: Nagata Ken , Danno Kiichiro , Tanaka Souichi
Published: April 2015

We report a 14‐year‐old Japanese boy who has had asymptomatic, multiple, reddish‐brown macules and petechiae distributed segmentally only in the right lower extremity for the last 6 months. Histological examination showed a perivascular lymphohistiocytic infiltrate in the papillary dermis, extravasation of red blood cells, and hemosiderin deposition. Treatment with tranilast and topical corticosteroid was dramatically effective. Although the histological findings were compatible with those of Schamberg disease, this case was unusual because the patient was very young and only one extremity was affected.
Acute Generalized Exanthematous Pustulosis Induced by Salazosulfapyridine in a Patient with Ulcerative Colitis
Authors: Kawaguchi Masakazu , Mitsuhashi Yoshihiko , Kondo Shigeo
Published: April 2015

We report a case of acute generalized exanthematous pustulosis (AGEP) induced by salazosulfapyridine in a patient with ulcerative colitis. A 26‐year‐old Japanese man, who had been receiving medical attention for ulcerative colitis for one year, presented with diffuse erythema and pustules on his face and trunk, malaise, and fever up to 39°C one day after the administration of salazosulfapyridine. A skin biopsy specimen disclosed intracorneal pustule composed of neutrophils and lymphohistiocytic infiltrate in the dermis. A drug lymphocyte stimulation test for salazoslufapyridine was positive, but the patch test was negative. Immunological mechanisms are suggested in the pathogenesis of psoriasis and ulcerative colitis. We suspect that a similar immunological pathway played a role in the pathogenesis of AGEP appearing in psoriasis and ulcerative colitis.
Follow‐up of Clinical Efficacy of Iontophoresis Therapy for Postherpetic Neuralgia (PHN)
Authors: Ozawa Akira , Haruki Yasuo , Iwashita Kenichi , Sasao Yuki , Miyahara Motomi , Sugai Junichi , Matsuyama Takashi , Iizuka Mariko , Kawakubo Yo , Nakamori Michiyo , Ohkido Muneo
Published: April 2015

A great variety of therapies have been attempted for PHN, including pharmacotherapy and physical therapy. However, there has been no decisive treatment, and reports of the clinical efficacy of all available therapies have been rather controversial. Almost all studies conducted so far have looked only at short‐term therapeutic efficacy, and only a few investigators have conducted long‐term observations or studies on long‐term outcome. We followed up the clinical efficacy of iontophoresis therapy using lidocaine and methylprednisolone in 197 PHN patients. Monitoring conducted for an average of 4 years after completion of the treatment showed that pain remained unchanged or improved compared to pain observed upon completion of the treatment in 90.4% of patients. Although 42.6% of patients were still continuing some treatment, 90.9% were found to be able to take care of themselves. Findings obtained were reviewed and discussed from various viewpoints. Our findings showed that iontophoresis therapy is not only effective at the end of the treatment, but its efficacy is maintained over a long period of time, indicating that it is clinically very useful for the treatment of PHN.
Topical Tocoretinate Improved Hypertrophic Scar, Skin Sclerosis in Systemic Sclerosis and Morphea
Authors: Mizutani Hitoshi , Yoshida Toshimichi , Nouchi Nobuhiro , Hamanaka Hiroko , Shimizu Masayuki
Published: April 2015

Four patients with systemic scleroderma (SSc), 4 patients with morphea, and 4 patients with hypertrophic scar were treated with topical tocoretinate for 6 months to 3 years and studied clinically and histopathologically. Clinically, all of the lesions responded to this therapy. The stiffness of the skin lesions, glossy appearance of the lesions, and telangiectasia improved. Histopathologically, the proliferated collagen fibers decreased in thickness, and the inter‐fiber spaces increased. Immunoreactive tenascin‐C expressed in the proliferated deep dermal fibers of the SSc and hypertrophic scar lesions was markedly decreased compared with the level before the topical tocoretinate therapy.

Topical tocoretinate has been used for the treatment of ulcers; it is also a potent treatment for sclerotic skin diseases.
Differential Expression of Interferon Gamma by Mitogen‐Stimulated Peripheral Blood Mononuclear Cells among Kuwaiti Psoriasis Patients
Authors: Mahmoud Fadia , Abul Habib , Al‐Seleh Qassem , Morgan Gareth , Haines Donald , Al‐Ramly Mahmoud , Burleson Joe , Kreutzer Donald
Published: April 2015

Most diseases exhibit characteristic profiles of cytokine expression, broadly subdivided into Th1, involving primarily cell‐mediated responses, of which Interferon‐gamma (INF‐γ), Interleukin‐2 (IL‐2) and Tumor Necrosis Factor‐alpha (TNF‐α) are hallmarks, and Th2 prcesses, which often involve activation of the humoral arm of the immune system, resulting in elevated levels of IL‐4, IL‐5 and IL‐10. Psoriasis, a disorder chracterized by disfiguring skin lesions and elevated levels of activated CD4+ T helper lymphocytes in both peripheral blood and lesional tissue, exhibits a profile of cytokine expression that includes high levels of TNF‐α and IFN‐γ, with low IL‐5 and IL‐10, indicating that immunologically, the pathogenesis of the disease is Th1.

In this study, we report the results of an investigation of peripheral blood mononuclear cell cytokine expression among Kuwaiti psoriasis patients; we demonstrated two patterns of IFN‐γ production which may suggest differing pathogeneses. Whole, haparinized blood was donated by 17 patients with active psoriasis and 11 healthy control subject. Mononuclear cells were isolated by density centrifugation and cultured for 3 days in the presence or absence of a mitogen (PHA). Supernatants were assayed for IFN‐γ (a Th1 marker) and IL‐10 (a Th2 marker) by enzyme‐linked immunoabsorption assay (ELISA). IFN‐γ expression by both PHA‐stimulated and unstimulated cultures from psoriatics significantly exceeded that of controls (p<0.001), whereas no significant differences in IL‐10 expression were noted between psoriatic and control subjects. Stimulation indices (cytokine concentration in PHA‐stimulated/unstimulated cultures, SI) for psoriatic subjects were significantly higher than those of controls for IFN‐γ (p=0.000), but not for IL‐10. Ratios of SI (SI IFN‐γ/SL IL‐10) for the psoriatic subjects also were significantly greater for the psoriatic subjects than for the controls (p=0.003). However, within the psoriatic group, eight patients failed to show the expected elevation of IFN‐γ/IL‐10 ratio as a result of high unstimulated levels of IFN‐γ production. The divergence of IFN‐γ expression within the psoriatic group may indicate two different modes of T lymphocyte activation contributing to the pathogenesis of psoriasis in this study.
Current Topics in Diagnosis and Treatment of Tinea Unguium in Japan
Authors: Tanuma Hiroyuki
Published: April 2015

The number of patients with tinea unguium accounts for 0.5% to 2% of the total number of outpatients in Japan.

The diagnosis of tinea unguium can be relatively easily made on the basis of clinical symptoms and direct microscopic findings. However onychomycosis due to fungi other than dermatophytes should always be suspected if no dermatophytes are cultured despite positive findings in direct microscopy. In such cases, it is necessary to repeat cultures and conduct histopathological evaluation using PAS‐staining technique or enzyme antibody technique. At present, oral administration of griseofulvin and terbinafine are the treatments covered by health insurance in Japan. In the future, however, other orally active antifungal drugs such as itraconazole and fluconazole will become available for use by in‐patients who do not respond to griseofulvin. It is essential to patiently continue treatment even if oral therapy is impossible, because other therapies such as ODT therapy using topical antifugal agents and urea ointment or abrading affected nails as much as possible with a file or dental drill may be effective without oral therapy.
Genital Angiofibromas in Tuberous Sclerosis: Two Cases
Authors: Nico Marcello Menta Simonsen , Ito Luci Mari , Valente Neusa Yuriko Sakai
Published: April 2015

Cutaneous lesions are an important feature of tuberous sclerosis (TS). Facial angiofibromas usually begin to appear at the end of the first decade of life and are considered to occur in about 88% of adults with TS. They are only rarely reported on sites other than the face or front. In this paper, we report two patients with the complete syndrome of TS that had, in addition to classic facial lesions, multiple papules on the genital area. Histopathology confirmed the diagnosis of angiofibroma. One patient's lesions were misdiagnosed as genital warts and were so being treated before the correct diagnosis was made. Although we don't know the incidence of genital angiofibromas in TS patients, we believe that they might be underreported, because dermatologists generally don't look for them when they see these patients.
Giant Nevus Lipomatosus Cutaneus Superficials: Case Report and Review of the Literature
Authors: Bergonse Fabiane N. , Cymbalista Natalia C. , Nico Marcello Menta S. , Santi Cláudia G. , Golcman Benjamin , Golcman Ronaldo , Sotto Miriam N.
Published: April 2015

Nevus lipomatosus superficialis is a rare disorder characterized by a nevoid fatty growth within the papillary and reticular dermis. Lesions more often occur in the sacral, abdominal, or pelvic regions. A 36‐year‐old Brazilian female with giant nevus lipomatosus is reported. Our case seems to be the biggest reported in the literature.
Angiolymphoid Hyperplasia with Eosinophilia Showing Characteristics of Kimura's Disease
Authors: Chung Tae‐Suk , Kim Dong‐Kun , Yoon Moon‐Soo , Yang Woo‐Ick
Published: April 2015

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign condition affecting principally the head and neck region of young females. We describe a 42‐year‐old female patient of ALHE showing the typical changes of endothelial cells and features similar to Kimura's disease in histologic and immunohistochemical findings.
Large Annular Purpura and Paraneoplastic Purpura in a Patient with Sjögren's Syndrome and Cervical Cancer
Authors: Nakajima Hideki , Ikeda Mitsunori , Yamamoto Yasuo , Kodama Hajime
Published: April 2015

We report a 79‐year‐old female with anaphylactoid purpura on her legs and unusual large annular purpura on the trunk. Histopathological characteristics of leukocytoclastic vasculitis were observed in the upper and middle dermis of both types of skin lesions. She was complicated by Sjögren's syndrome and advanced cervical cancer. The annular purpura spontaneously resolved in a week and did not recur. However, the anaphylactoid purpura relapsed more frequently and spread more widely following the elevation of her serum SCC antigen levels from the onset of purpura until her death. We consider that the characteristic annular configuration was caused by the complication of Sjögren's syndrome and that the recurrent anaphylactoid purpura indicated paraneoplastic vasculitis primarily caused by the tumor specific protein immune complexes. Complication by Sjögren's syndrome many also play a role in the development of allergic vasculitis.
Lichen Planus with Involvement of All Twenty Nails and the Oral Mucous Membrane
Authors: Takeuchi Yoshio , Iwase Nanae , Suzuki Mari , Tsuyuki Shigeaki
Published: April 2015

A 57‐year‐old man had had deformities of all ten fingernails for one and a half years before presentation and deformities of all ten toenails for the previous six months. The surfaces of the nails were rough, with excessive longitudinal striations. The bases of the nails were slightly hypertrophic, and the tips were atrophic and itchy. A longitudinal nail biopsy including the nail matrix revealed the typical histology of lichen planus. Reticulated pigmentation, maceration, and erosion on the buccal mucous membrane were also discovered. Histological analysis of the buccal mucous membrane revealed lichen planus intermingled with eosinophils. Immunological blood analysis revealed elevated CD4+ T cells and CD4/CD8 ratio. He worked as a tinsmith and had dental metal. The metal series patch test revealed positive reactions to chromate and tin. Treatment with systemic steroids was quite effective in treating the nail lesions.
Primary Pachydermoperiostosis: A Case Report
Authors: Thappa Devinder Mohan , Sethuraman Gomathy , Kumar G. Ravindra , Elangovan S.
Published: April 2015

Pachydermoperiostosis (PDP), a rare genodermatosis, occurred in a 38‐year‐old Indian male. He presented with progressive thickening of the skin on the face and scalp of 15 years duration. Widening of his wrists and ankles and broadening of the fingers and toes had also developed since then. He was born of a consanguineous marriage and had no family history of a similar disorder. He had the typical findings of complete form of PDP including cutis verticis gyrata, coarse facial features, clubbing of the digits in the skin, and periostosis and cortical thickening at the distal ends of long bones of the extremities and small bones of the hands and feet. PDP has two different forms—primary and secondary. These two entities are differentiated by family history and presence or absence of a primary lesion, usually in the lungs. Clinically, in secondary PDP, the cutaneous findings (pachydermia, seborrhoea, oiliness) are less severe than primary PDP; osteoarthropathy is more severe and painful in secondary PDP, especially with congenital heart disease. The present case was suffering from primary PDP that had expressed itself in its complete form.
Complete Remission of Hypereosinophilic Syndrome after Interferon‐α Therapy: Report of a Case and Literature Review
Authors: Yoon Tae‐Young , Ahn Gwang‐Bum , Chang Seung‐Ho
Published: April 2015

Hypereosinophilic syndrome (HES) is a multisystem disease with a significant mortality rate. It is characterized by peripheral blood eosinophilia and infiltration of eosinophils into many organs including skin. We describe a patient with cutaneous, pulmonary, and gastric symptoms of HES. He was first treated with systemic and topical corticosteroids, antihistamines, and photochemotherapy. Therapy was switched to interferon‐α, because we had to consider side effects of corticosteroids and no significant improvement had been achieved. During the period of usage of interferon‐α for 50 weeks, his symptoms of HES nearly cleared. There has been no recurrence in the eight months since the discontinuation of interferon‐α therapy.
Tinea Capitis: Current Concepts
Authors: Čeburkovas Olegas , Schwartz Robert A. , Janniger Camila K.
Published: April 2015

Tinea capitis is an important fungal infection that may at times be a clinical, diagnostic and therapeutic challenge. It is common in childhood around the world, becoming almost epidemic in some communities. The central European and American experience with it is somewhat variable, due to different etiologic fungi. The use of topical antifungal agents and other approaches is stressed as of value alongside the use of systemic antifungal medication.
Pityriasis Rubra Pilaris (PRP): Report of Four Cases
Authors: Sehgal Virendra N. , Bajaj Pramila , Jain Sanjeev
Published: April 2015

Four patients with pityriasis rubra pilaris are reported. The diagnosis in each was based upon well‐recognized clinical features. Two of them, a mother and son, had the disease since childhood and were marked by relative remission in spring and exacerbation in autumn. Moderate to severe pruritus was a common dominator. Erythroderma was a presenting feature in one case. Although histopathology was considered imperative, it only supplemented the clinical expression. Vitamin A in heavy dosage, supplemented by vitamin E and stanozolol in tandem, was the mainstay of treatment.
A Case of Erythromelalgia Successfully Controlled by Systemic Steroids and Pentazocine—Is It Related to a Unique Subtype of Neutrophilic Dermatosis?
Authors: Suh Dae Hun , Kim Sang Duck , Ahn Jong Seong , Han Kwang Ho , Cho Kwang Hyun , Eun Hee Chul , Youn Jai Il
Published: April 2015

Erythromelalgia is a rare cutaneous disorder characterized by erythema, burning discomfort, and warmth of the extremities. Its form may be adult‐ or early‐onset, and it may be further classified as idiopathic or secondary. Its pathogenesis and histopathologic findings have not yet been clearly defined. Various treatment modalities have been tried, but, for the idiopathic type, none has been successful.

We present a case of adult‐onset idiopathic erythromelalgia with unusual histopathological findings which showed a remarkable response to corticosteroids and pentazocine.
Cassiopeia Flap: Modification of Limberg Flap for Saving Normal Skin
Authors: Mizutani Hitoshi , Isoda Ken‐ichi , Asahi Kunihiko , Yamanaka Keichi , Shimizu Masayuki
Published: April 2015

Local flaps have the advantages of texture matching and increased flap survival rate. The proper local flap planning for each lesion causes the dermatologist to be reluctant to employ them. We propose a modified local flap, the “Cassiopeia flap”, with three simple marking points made on the ends of the diameter and on the equidistant point along the diameter; two points from equilateral triangles form a “W (Cassiopeia)”. We applied this modification to ten lesions on the face, scalp, trunk and thigh with excellent results.
A Case of Combined Nevus: Compound Nevus and Spindle Cell Spitz Nevus
Authors: Jin Zhao‐hui , Kumakiri Masanobu , Ishida Hisaya , Kinebuchi Shoichi
Published: April 2015

Combined nevi consisting of a Spitz nevus and an acquired nevus are unusual, and, to our knowledge, the combination of a spindle cell Spitz nevus and an overlying compound nevus has not been previously reported. We report a 17‐year‐old girl with a nodule on the left anterior lower extremity. The nodule was asymptomatic, firm, brown, symmetrical, dome‐shaped, 8 mm in diameter, and not found with ulceration. Histological findings showed proliferation of spindle‐shaped cells with an overlying compound nevus. The spindle‐shaped cells were large, non‐pigmented, uniform in size and shape, with rare mitoses and without nuclear atypia, and arranged in a storiform pattern in thick collagen bundles. They stained positively for S‐100 and negatively for HMB‐45. The lesion was considered to be a new type of combined nevus consisting of a spindle cell Spitz nevus and an overlying compound nevus.
Analysis of T‐Cell Antigen Receptor γ Chain Gene Rearrangement by Polymerase Chain Reaction in Combination with Denaturing Gradient Gel Electrophoresis in the Differential Diagnosis of Cutaneous T‐Lymphoproliferative Diseases
Authors: Nagasawa Tomohiko , Nakatsuka Shin‐ichi , Miwa Hideaki , Kanno Hiroyuki , Itami Satoshi , Yoshikawa Kunihiko , Aozasa Katsuyuki
Published: April 2015

A polymerase chain reaction (PCR)‐based strategy has been developed for analysis of clonal rearrangement of the T‐cell receptor γ gene (TCRγ) and was shown to be useful for detection of clonal T‐cell populations. In this study, we performed PCR combined with denaturing gradient gel electrophoresis (DGGE) on fresh frozen biopsy samples from 16 patients with cutaneous T‐lymphproliferative diseases in whom a definite diagnosis was difficult to make on morphological and immunohistochemical grounds alone. Ages of the patients at biopsy ranged from 28 to 81 (median 62) years, and the subjects consisted of 8 men and 8 women. They presented with erythema on the extremities in 5 cases, trunk in 7, buttock in 2, and papules on the trunk and face in one case each. Clonal rearrangement of TCRγ was observed in 3 of 16 cases. Clinical diagnoses of these three cases were mycosis fungoides, cutaneous invasion of adult T‐cell leukemia (ATL), and large granular lymphocytic leukemia (LGL) of T‐cell type, respectively, but they were histologically difficult to differentiate from reactive cutaneous T‐cell proliferation. The skin lesions of the LGL case worsened, and this patient died two years after biopsy. Another patient with suspected mycosis fungoides in the plaque stage died due to dissemination of tumors 22 months after biopsy. The remaining one patient with ATL survived with cutaneous lesions for over four years. Clonality was not demonstrated in the remaining 13 cases, and their clinical courses were favorable. These findings showed that demonstration of clonal TCRγ gene rearrangement using the PCR‐DGGE method is very helpful for diagnosis of cutaneous T‐cell neoplasms.
Hyalinizing Spitz Nevus
Authors: Lee Mi‐Woo , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: April 2015

A seventeen‐year‐old Korean girl had a reddish‐brown papular lesion on the nose. Histopathologically, it proved to be a “hyalinizing Spitz nevus” with the characteristic features of a discohesive growth pattern of nevus cells and hyalinized stroma. Immunohistochemical stains showed positive reactivity of nevus cells with S‐100 protein and Vimentin and negative stainings with HMB45, CD68, CEA and low molecular weight cytokeratin. Hyalinizing Spitz nevus may represent a variant in the spectrum of Spitz nevus.
A Case of Pseudogout
Authors: Usuki Kazunari , Yamashita Miki , Kanzaki Tamotsu
Published: April 2015

We report a 56‐year‐old Japanese male with a gout‐like acute attack of synovitis and panniculitis in his right wrist without hyperuricemia. Calcium pyrophosphate dihydrate (CPPD) crystals were found in the synovial fluid of the affected joint. A diagnosis of pseudogout was made. The attack subsided two days after medication with 30 mg of predonisolon. Although this is a relatively common disease in elderly people, we rarely encounter such case reports in dermatological journals.