bluuebunny/crossref_metadata_2025 huggingface dataset:
Pneumomediastinum and Subcutaneous Emphysema Associated with Fatal Interstitial Pneumonia in Dermatomyositis
Authors: Nagai Yayoi , Ishikawa Osamu , Miyachi Yoshiki
Published: April 2015

We described a 65‐year‐old woman who died of acute interstitial pneumonia associated with dermatomyositis. Subcutaneous emphysema and pneumomediastinum simultaneously developed. The association of the pulmonary rupture with vasculitis has been assumed as the common cause in interstitial pneumonia. Diffuse alveolar damage, however, might have led to the pneumomediastinum and subcutaneous emphysema in our patient, who had no signs of cutaneous vasculitis.
Critical Evaluation of Food and Mite Allergy in the Management of Atopic Dermatitis
Authors: Hanifin Jon M.
Published: April 2015

The subject of allergic causation of atopic dermatitis (AD) has been a source of controversy for over sixty years. While there is general agreement of allergen‐induced asthma and allergic rhinoconjunctivitis, AD lesions cannot be readily or consistently induced by foods and inhalants. The most consistent perturbators of atopic conditions are irritants, probably reflecting the consistent inflammatory cell hyper‐reactivity due to elevated cyclic AMP‐phosphodiesterase activity. The immunologic reactions are another manifestation of that general cellular dysregulation.
30‐kDa Trypsin‐like Proteases in the Plantar Stratum Corneum
Authors: Chang‐Yi Cui , Takahashi Masae , Tezuka Tadashi
Published: April 2015

The casein digestible proteases in human plantar stratum corneum were determined to be about 75‐kDa, 30‐kDa and 25‐kDa in molecular weight by zymography. The enzymatic activity of the 75‐kDa and 25‐kDa proteases was specifically inhibited by chymostatin, which is an inhibitor of chymotrypsin‐like serine proteases, and the proteases around 30‐kDa were inhibited by leupeptin, a trypsin‐like serine protease inhibitor. The enzymatic activity of all these proteases was inhibited by aprotinin. The 30‐kDa trypsin‐like proteases were heat‐stable; their enzymatic activity still remained even after heating at 100°C for 60 minutes. Their optimal pH was around 9, and the activity was higher in the outer part of the stratum corneum than in the inner part.
Comparison of Personal History with Patch Test Results in Metal Allergy
Authors: Böhm Ingrid , Brody Marlene , Bauer Ralf
Published: April 2015

In order to compare the validity of patient personal history of contact sensitivity to metal alloys with patch test results, 160 patients with hand eczema were patch tested with a standard series according to the ICDRG after a special questionnaire. In 65%, history and patch test results were identical. Seventy‐eight (48.8%) patients thought they would be allergic to metal ions, whereas the patch test revealed a positive result in only 21.3% cases. Positive history but negative test was more frequent in women; in the male group, negative history and positive patch test was the most common finding. Although 82 patients had a negative history, the patch test was positive for contact sensitivity to metal allergens in 12 of them. Both false positive patch tests and false negative histories are possible. Since many factors influence a positive patch test, not only the patient's history but also a synopsis of the anamnesis and patch testing will help to achieve the correct diagnosis of metal contact hypersensitivity.
Cutaneous Disseminated Actinomycosis in a Patient with Acute Lymphocytic Leukemia
Authors: Takeda Hikaru , Mitsuhashi Yoshihiko , Kondo Shigeo
Published: April 2015

Actinomycosis is an uncommon infectious disease caused predominantly by Actinomyces israelii. The cutaneous disseminated form is usually caused by hematogenous dissemination from a primary extra‐cutaneous lesion. We report here cutaneous disseminated actinomycosis without any detectable extra‐cutaneous lesions in a 42‐year‐old Japanese woman with acute lymphocytic leukemia. Multiple soft nodules developed on her upper and lower extremities. Histopathological examination revealed “sulfur granules”, which are a specific finding for actinomycosis. Cultures from biopsy specimens were not successful. There were no cervicofacial, thoracic, nor abdominal lesions. These findings suggest that cutaneous disseminated actinomycosis in our patient developed primarily in the skin. Although the patient was immunocompromised, antibiotic treatment with minocycline was effective.
Malignant Melanoma In situ Arising in the Nail Unit of a Child
Authors: Kiryu Hiromaro
Published: April 2015

A very rare case of malignant melanoma in situ of the nail unit of a child is presented. Clinically, a pigmented streak was present on the finger nail of a 3‐year‐old girl, and the lesion increased in size and in darkness of the color associated with periungual pigmentation in the following two years. Histopathologically, sections showed proliferation of atypical melanocytes, arranged mostly in single units but some in nests, in and above the basal layer of the epithelium and admixed with long dendrites and a few mitotic figures. Pigmented lesions of nail units of children often show fading or loss of pigmentation clinically; however, a biopsy should be done when they show augmentative changes which clinically suggest malignancy, because subungual malignant melanoma can exist even in children, and proper biopsy can detect it in its early stages.
Merkel Cell Carcinoma: Report of Three Cases
Authors: Okamoto Osamu , Yoshiyama Masako , Takayasu Susumu , Yokoyama Shigeo
Published: April 2015

Three cases of Merkel cell carcinoma are reported: Case 1 on the upper eyelid with regional lymph node metastasis, Case 2 with spontaneous regression after repeated biopsies, and Case 3 presumably developing on the lesion of pre‐existing Bowen's disease. In Case 2, the biopsy specimen was characterized by numerous apoptotic cells in the periphery of the tumor nests surrounded by lymphocytic infiltration. In Case 3, the tumor developed after injury to the pre‐existing lesion of Bowen's disease.
Familial Reactive Perforating Collagenosis: A Case Report
Authors: Kumar Vijay , Mehndiratta Vibhu , Sharma Ravi C. , Narayan Shashi , Koranne Ravindra V. , Kakar Nirupama
Published: April 2015

Reactive perforating collagenosis is characterised by trans‐epidermal elimination of collagen and is hypothesized to be both autosomally dominant and recessive. We report a family in which two brothers and a sister had lesions of reactive perforating collagenosis.
Factors Influencing Psoriasis: An Analysis Based upon the Extent of Involvement and Clinical Type
Authors: Park Byung Soon , Youn Jai Il
Published: April 2015

A variety of external stimuli are accepted as important in modifying the severity of psoriasis. We sought to determine whether there is any difference in the influence of external factors on psoriasis in relation to extent of involvement or clinical type. A total of 870 psoriasis patients seen between 1982 and 1995 were categorized as mild, moderate, or severe on the basis of extent of the disease, and as guttate, nummular/plaque, or exfoliative/generalized pustular according to clinical type. We then performed a questionnaire survey concerning the influence of external factors such as seasonal changes, sunlight, stress, and pregnancy. These data sets were combined and analysed. The majority of patients stated favorable effects of summer, sunlight, and pregnancy and adverse effects of winter and stress. A statistically significant correlation was noted between the extent of psoriasis and the proportion of patients stating that their disease worsened at times of psychological stress (p<0.01). We confirmed that psoriasis patients with more extensive involvement experience greater fluctuations in their condition, notice these changes, and therefore relate them to psychological stress.
A Clinical Observation of Scleredema Adultorum and Its Relationship to Diabetes
Authors: Rho Young Woo , Suhr Ki Beom , Lee Jeung Hoon , Park Jang Kyu
Published: April 2015

Scleredema may occur secondarily to diabetes or independently. The course of scleredema is not known in either type. Twenty‐one scleredema patients were included in this study (13 females, 8 males). The patients were divided into two groups according to the presence or absence of diabetes. In the group (11 patients) of scleredema which was secondary to diabetes, lesions were partially improved in 5 patients who had controlled diabetes, although it was difficult to control diabetes with insulin or oral hypoglycemics in such patients. Scleredema appeared insidiously in nine of these eleven patients. The posterior neck was involved, but the face was not. In patients without diabetes, the scleredema lesions began acutely in eight of ten of them. The course of the disease was usually stationary rather than showing acute improvement. Facial involvement was found in half of all the patients. In conclusion, scleredema patients with diabetes may improve if their diabetes is controlled, and facial involvement may be related to scleredema without diabetes.
Reappraisal of Ikeda's Classification of Alopecia Areata: Analysis of 356 Cases from Chandigarh, India
Authors: Sharma Vinod Kumar , Muralidhar Sivaram , Kumar Bhushan
Published: April 2015

Three hundred and fifty six patients (234 males, 122 females) with alopecia areata were classified according to Ikeda's classification. The common type of alopecia areata was most frequently seen in 239 (67.13%) patients, followed by atopic in 60 (16.85%), prehypertensive in 48 (13.4%), and autoimmune/endocrine in 9 (2.52%) patients. Severe alopecia did not occur with a higher frequency in atopic or endocrine/autoimmune alopecia areata than in the common type (p>0.05). Prehypertensive alopecia areata had the lowest frequency of severe alopecia in the present study. The odds for developing severe alopecia were highest (2.6) when onset was before 16 years of age, followed by female sex (2.12), atopy (0.86), autoimmune/endocrine (0.53), and prehypertensive (0.28) types. Alopecia areata should be broadly classified as childhood (<16 years) and adult onset with subtypes of atopic, autoimmune/endocrine, and common type under both. The prehypertensive type should be combined with the common type of alopecia areata.
A Japanese Case of Neu‐Laxova Syndrome
Authors: Hirota Toru , Hirota Yoko , Asagami Chidori , Muto Masahiko
Published: April 2015

A 5‐day‐old Japanese female with Neu‐Laxova syndrome was presented. The patient had severe edema throughout the body, desquamation, and erosion of the skin. She also exhibited microcephaly, exophthalmos, and rocker‐bottom feet. Histologic examinations of a cutaneous specimen showed atrophy of the dermis and absence of the sebaceous glands. These represent embryonic abnormalities. Even though there was no hypoplasia of the cerebellum and lungs or hydramnios, we evaluated this patient as the first Japanese case of this sporadic disease. With intensive care, including dermatological treatment, the patient survived for 134 days.
The Analysis of mRNA Expression of Cytokines from Skin Lesions in Churg‐Strauss Syndrome
Authors: Fujioka Akira , Yamamoto Tatsuo , Takasu Hiroshi , Kawano Keiko , Masuzawa Mikio , Katsuoka Kensei , Jinno Satoru
Published: April 2015

We report our recent clinical experience with a patient suffering from Churg‐Strauss syndrome and the results of our investigation into the mRNA expression of cytokines in the patient's lesions as well as in the frozen sections from a previous patient. In both cases, blood IgG was at a high level.

Cytokine mRNA expression differed according to the degree of cellular infiltration. In the presence of marked infiltration, counteracting Th1 and Th2 cytokines were simultaneously detected; the former included IL‐12 and IFN‐γ, and the latter, IL‐6 and IL‐10. The concurrence of both types of cytokine could be attributed to several factors. For example, IL‐6 is involved through some mechanism in the formation of immune complexes by IgG, and IL‐12 and IFN‐γ appeared to participate in the development of granuloma. These suppositions support the suggested immunological etiology of the disease. It is also inferred that the dominance of one of the two types of cytokines depends on the clinical phase of the disease.
HIV‐Associated Eosinophilic Pustular Folliculitis: Successful Treatment of a Japanese Patient with UVB Phototherapy
Authors: Misago Noriyuki , Narisawa Yutaka , Matsubara Shinichi , Hayashi Shinichirou
Published: April 2015

We report the successful treatment with ultraviolet B phototherapy of a patient with HIV‐associated eosinophilic pustular folliculitis. We were able to observe the clinical and therapeutic course for about one year and three months. This 35‐year‐old homosexual Japanese man presented with disseminated, discrete, follicular, erythematous papules with intense pruritus over his face, neck, chest wall, and upper back. Initially, the eruption responded to therapy with topical or oral indomethacin and oral H1 antihistamine. However, the eruption was highly prone to recurrence, and it gradually failed to respond to these therapies. The eruption became chronic and persistent and manifested the excoriated, prurigo‐like nodules that are typical of reported pruritic papular eruption, suggesting that this skin disease and HIV‐associated eosinophilic pustular folliculitis are two forms of the same disease entity. UVB phototherapy in small doses was very effective for the persistent eruption, and no recurrence of the eruption was noted during or since the six‐month maintenance therapy (once a week at a dose equivalent to 0.75 of the minimal erythema dose) (9 months total). No unfavorable side effects have been observed during or after the UVB phototherapy (cumulative UVB doses of 2,320 mJ/cm2).
A Case of Bullous Pemphigoid in a Patient on Hemodialysis
Authors: Kamada Noriaki , Ino Noriaki , Hatamochi Atsushi , Shinkai Hiroshi
Published: April 2015

We describe a case of bullous pemphigoid (BP) in a patient with chronic renal failure maintained on hemodialysis. We diagnosed BP by histopathological and immunofluorescence studies. The relationship between BP and chronic renal failure and/or hemodialysis is not clear, but we believe that immune disarrangement due to chronic renal failure and/or hemodialysis may have influenced the pathogenesis of BP in our case.
Pretibial Myxedema with Graves' Disease: A Case Report and Review of Japanese Literature
Authors: Ishizawa Toshiyuki , Sugiki Hiroshi , Anzai Shin‐ichi , Kondo Shigeo
Published: April 2015

We report a case of pretibial myxedema with Graves' disease in an 18‐year‐old Japanese woman. The physical examination revealed waxy indurated plaques with prominent hair follicle openings and nonpitting edema disseminated on her lower legs. Histology from an edematous lesion revealed that the dermis was markedly thickened with abundant mucin, especially hyaluronic acid, and the collagen fibers in this portion were splitting up into fibrils. We also reviewed 112 cases of pretibial myxedema reported in the Japanese literature.
Permeability Barrier Abnormality of Hairless Mouse Epidermis after Topical Corticosteroid: Characterization of Stratum Corneum Lipids by Ruthenium Tetroxide Staining and High‐Performance Thin‐Layer Chromatography
Authors: Sheu Hamm‐Ming , Lee J. Yu‐Yun , Kuo Kou‐Wha , Tsai Jui‐Chen
Published: April 2015

Topical corticosteroids (TCS) are among the most frequently used topical therapeutics. Recently, it has been shown that TCS not only has antiproliferative actions, but also inhibits the differentiation of the epidermis and finally perturbates stratum corneum (SC) barrier function. It is well established that epidermal barrier function resides within the intercellular lipids of the SC. However, to date, little is known about the effects of TCS on the structure and composition of SC lipids. We therefore used hairless mouse skin to study the sequential changes of the SC permeability barrier and their intercellular lipids by ruthenium tetroxide staining and high‐performance thin‐layer chromatography (HPTLC) during topical use of corticosteroids. The results demonstrated a progressive increase in transepidermal water loss accompanied by a diminution in the SC intercellular lipid lamellae, which showed a normal structure of individual lamella. Analysis of lipid composition by HPTLC after a 6‐week application of TCS also showed an obvious decrease in all the main components of SC lipids, which are known to constitute the permeability barrier of the skin. In light of these results, our work provides direct morphological evidence that TCS deteriorates the permeability barrier of epidermis when applied to normal skin.
A Preliminary Study Aimed at the Detection of Leishmania Parasites in Subjects with Cutaneous Leishmaniasis Using Polymerase Chain Reaction
Authors: Uezato Hiroshi , Hagiwara Keisuke , Hosokawa Atsushi , Maruno Motoyoshi , Nonaka Shigeo , Oshiro Minoru , Furuya Masato , L Eduardo A. Gomez , Hashiguchi Yoshihisa
Published: April 2015

As a basic study for future diagnosis of cutaneous leishmaniasis, we tried to detect Leishmania parasites representing different species in the subgenera Leishmania and Viannia from subject patients with cutaneous leishmaniasis by using the polymerase chain reaction (PCR) with the subgenus Viannia specific primer. Four out of the 14 specimens revealed an amplified DNA of 70 bp specific for the subgenus Viannia (L. braziliensis comples). No bands were detected in the rest of the specimens belonging to the subgenus Leishmania and unclassified groups. The base sequences of the amplified DNA corresponded with those of the L. (V). braziliensis kinetoplast minicircle. We concluded that PCR using the present primer specific for the subgenus Viannia would be useful in detecting Leishmania parasites in lesions of cutaneous leishmaniasis caused by the L. braziliensis complex.
Topical PUVA Therapy for Chronic Hand Eczema
Authors: Gritiyarangsan Pimonpun , Sukhum Apiradee , Tresukosol Poohglin , Kullavanijaya Preya
Published: April 2015

Seventeen patients with persistent chronic hand eczema were treated with topical 0.1% 8‐methoxypsoralen and UVA (PUVA) for 8 weeks. Significant improvement was achieved in 5 cases (29%), moderate improvement in 9 (53%), and little improvement in 3 (18%). The mean number of PUVA treatments was 22.2, and the mean total UVA dose was 63.5 J/cm2. There was no association between clinical response and duration of hand eczema, positive patch test reaction, or atopic status. Since topical PUVA has no risk of systemic side effects, it should be considered as an alternative treatment for patients with chronic hand eczema who are resistant to other topical medications.
Treatment of Molluscum Contagiosum in Males with an Analog of Imiquimod 1% in Cream: A Placebo‐Controlled, Double‐Blind Study
Authors: Syed Tanweer A. , Goswami Jagdish , Ahmadpour Oliver Abbas , Ahmad Seyed Ali
Published: April 2015

The objective of this double‐blind, placebo‐controlled study was to evaluate in males the clinical efficacy in treating molluscum contagiosum and tolerance of an analog of imiquimod (1%) in cream. One hundred patients between 9 and 27 years of age (mean 16.3), with 733 lesions (mean 7.3), whose size ranged from 2 to 5 mm diameter (mean spot size 3.4 mm) and a biopsy‐confirmed diagnosis of molluscum contagiosum were randomized into two parallel groups. In a double‐blind manner, precoded 40‐g tubes were dispensed. Patients self‐administered the trial medication to their lesions at home three times daily for five consecutive days per week. The study was scheduled with 4 weeks of active treatment (maximum 60 topical applications) and 12 months (on a monthly basis) of follow‐up. Patients were examined on a weekly basis. Thirteen patients had atopic dermatitis. A clinically and histopathologically confirmed total elimination of lesions was considered as cured. After four weeks of treatment, 49 patients and 372 lesions were cured. Breaking the code revealed that imiquimod cream had cured 82% of the patients and 86.3% of the lesions. Placebo cleared 16% of the patients and 63 of the lesions (p<0.0001). During the treatment, 88% of the patients experienced no allergic, localized, or drug‐related adverse symptoms. Twelve patients, predominantly in the imiquimod cream group reported non‐objective, drug‐induced, mild reactions with no dropouts. The study was followed‐up for 12 months. Among 49 cured patients, 3 had relapses after 10 months. In conclusion, the study demonstrated that 1% imiquimod analog in cream with mild subjective side effects is significantly more efficacious than the placebo in curing molluscum contagiosum in males.
Diagnostic Pitfalls of Merkel Cell Carcinoma and Dramatic Response to Chemotherapy
Authors: Chang Sung‐Eun , Suh Jung‐Wha , Choi Jee‐Ho , Yoon Ghil‐Suk , Huh Jooryung , Sung Kyung‐Jeh , Moon Kee‐Chan , Kim Woo‐Gun , Koh Jai‐Kyoung
Published: April 2015

Merkel cell carcinoma (MCC) is an unusual malignant tumor that arises from neuroendocrine cells with features of epithelial differentiation. We describe a MCC patient with unusual clinical, histopathological, and immunohistochemical features. Although the microscopic, immunohistochemical, and ultrastructural characteristics of MCC have been well defined, diagnostic difficulties remain, particularly in distinguishing it from lymphoma involving the skin, as suggested by our case.

This is an unusual case in which dense lymphoid infiltration masked the true tumor. All the immunohistochemical markers of MCC except neuron‐specific enolase (NSE) were negative. The dramatic response to primary chemotherapy was also very noteworthy.
Spiny Keratoderma: A Common Under‐Reported Dermatosis
Authors: Horton Sharon L. , Hashimoto Ken , Toi Yoichiro , Miner John E. , Mehregan Darius , Fligiel Allan , Savoy L. Boyd , Aronson Peter
Published: April 2015

Spiny keratoderma is a dermatosis consisting of multiple projections located on the palms and soles, with a distinct histology characteristic of a parakeratotic column above a hypogranular epidermis. We report six cases discovered within a year and review the present literature on spiny keratoderma. The average age of the patients was 57 years. Fifty‐seven percent of the patients were male and forty‐three percent were female. The duration of lesions ranged from 4 months to 40 years. Symptoms were variable, however, lesions were often unnoticed by the patient. The location of the lesions involved the palms and soles or the palms alone. Past medical history was significant for hypertension and hyperlipidemia treated with HMG‐CoA reductase inhibitors. Lesions often occurred in patients involved in manual labor. Spiny keratoderma is a relatively common under‐reported dermatosis found most often in older patients with a history of manual labor and is possibly related to treatment with HMG‐CoA reductase inhibitors.
Long Term Follow‐up of Patients with Systemic Lupus Erythematosus
Authors: Xie Shang‐Kui , Feng Shu‐Fang , Fu Hua
Published: April 2015

To assess the impact of demographic and clinical factors on prognosis in patients with systemic lupus erythematosus (SLE), we studied a cohort composed of 566 patients in Huashan Hospital between 1959 and 1992 who were followed up to June 30, 1993. The survivorship was examined through life table analysis. The results showed that the survival rate from the time of SLE onset was 93% at 1 year, 73% at 5 years, and 60% at 10 years. On univariate analysis, we found that the following factors worsened the probability of survival: male, neuropsychiatric manifestations, pleurisy‐pericarditis, hematological disorders, renal involvement, hypocomplementemia, abnormal electrocardiograph, and high corticosteroid dose of treatment. The time that the C3 depression occurred in the course of SLE affected the survival more significantly than did its decreased levels. The earlier the occurrence of C3 depression, the lower the patient's survival probability. On multivariate analysis, the independent risk factors were male gender, abnormal electrocardiograph, hypocomplementemia, and high corticosteroid dose of treatment. All of these indicated that clinical features of SLE might have value as predictors for its prognosis and that the occurrence of the decreased C3 in the early course of SLE might be the most important factor.
Occult Basal Cell Carcinoma Arising in Seborrheic Keratosis
Authors: Endoh Kohki , Ohara Manabu , Kosegawa Gen , Akasaka Toshihide
Published: April 2015

The present study reports a case of an occult basal cell carcinoma that arose in seborrheic keratosis. The patient was a fifty‐six‐year‐old male who presented with a dark brown plaque on his back. Clinically, the lesion demonstrated no nodules or ulcerations suggesting that it was malignant. However, histopathological analysis of the lesion revealed an atypical basaloid cell mass that appeared to be a solid basal cell carcinoma beneath and surrounded by a seborrheic keratosis lesion. Thus, the coexistence of basal cell carcinoma and seborrheic keratosis is possible and should be considered when a malignant change in seborrheic keratosis is apparent.
A Case of Angiokeratoma Circumscriptum: Immunolocalization of Matrix Metalloproteinase (MMP)‐9
Authors: Kobayashi Takashi , Sakuraoka Koichi
Published: April 2015

We report a case of angiokeratoma circumscriptum which we have followed for one year. The skin lesion initially showed erythema and then changed to a dark reddish, raised, keratotic nodule. The lesion histologically showed dilated capillaries and hyperkeratosis. Using immunohistochemistry, matrix metalloproteinase (MMP)‐9 was localized in the epidermis just under the horny layer, particularly in the hyperkeratotic lesion. The expression of MMP‐9 might be related to the hyperkeratotic changes in this lesion.
Multiple Lentigines Syndrome: A Comparison of Normal Skin and Lentiginous Skin by Electron Microscopy and Immunohistochemical Staining
Authors: Choi Jinn‐Gill , Chang Sung Nam , Kim Soo‐Chan , Park Wook Hwa , Kwon Hyuk Jae
Published: April 2015

A 26‐year‐old Korean man exhibited generalized lentigines, a slight prominence of the chin, short stature, and a familial history consistent with the autosomal dominant mode of inheritance. The multiple lentigines appeared at the age of 1 and spread over his entire body including the scalp, palms, and soles by the age of 4. There were several large dark pigmented spots on the trunk, but no other skin abnormalities were found. We performed histologic studies of the normal skin and the lentigo by both electron and light microscopy with immunohistochemical stains. Routine hematoxylin‐eosin staining of the pigmented skin revealed heavily pigmented basal and spinous layers and prominent rete ridges. Fontana‐Masson stain showed enormous black pigmentations on the basal and spinous layers of the pigmented macule. S‐100 protein stain of the pigmented lesion demonstrated an increased number of melanocytes per unit skin area. Ultrastructural studies showed the presence of extensive aggregated melanosomes within the keratinocytes in the epidermis of lentigo, but not the presence of giant melanosomes in either normal skin or lentigines.
Cutaneous Mesenchymal Hamartoma on the Foot
Authors: Jang Kyoung‐Ae , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung , Choi Jee‐Ho
Published: April 2015

We report a 16‐year‐old man with a cutaneous mesenchymal hamartoma on the left foot since infancy. Clinically, the lesion was 10 × 6 cm in size, relatively ill‐defined, skin colored, and comprised of confluent nodules. Histopathologic examination revealed histology compatible with cutaneous mesenchymal hamartoma.
Efficacy of Topical Treatment of Pigmentation Skin Disorders with Plant Hydroquinone Glucosides as Assessed by Quantitative Color Analysis
Authors: Clarys Peter , Barel André
Published: April 2015

Hydroquinone is a well known reagent used in the treatment of pigmentation disorders. The instability of the quinones and the required active concentration make topical treatment rather difficult. We tested the efficacy of an ascorbate‐phytohydroquinone complex that inhibits the synthesis of melanin and promotes the degradation of the existing melanin. Lentigo senile lesions were evaluated before and after 1 month of treatment. Objective skin color evaluation was performed instrumentally.

After one month of treatment, a clear depigmentation of the macules was measured. None of the volunteers reported any side effects from the prolonged treatment with the hydroquinone containing product.
Hormonal Milieu in the Maintenance of Melasma in Fertile Women
Authors: Hassan Iffat , Kaur Inderjeet , Sialy R. , Dash R.J.
Published: April 2015

Melasma is a specific type of facial hyperpigmentation seen in women taking oral contraceptives, in non‐pregnant women who have not used oral contraceptives, and in some pregnant women during the progression of gestation, but rarely in men.

Circulating LH, FSH, PRL, and E2‐17β on day 5, 7, 9, and 11 of the menstrual cycle and progesterone (P) on day 17, 19, and 21 were measured in thirty‐six ovulating women with melasma (study group) age 25–35 years and twelve healthy controls (control group). Twenty‐seven subjects in the study group had normal pregnancies; 9 others were married or single and had no history of contraceptive pill use. Higher levels of FSH on day 7 (p<0.05); E2‐17β on 5, 7, 9 (p<0.05) and LH on day 9 (p<0.002) were observed in the study group than in the control group. There were no significant differences between the LH/FSH ratio in the two groups. Serum PRL was lower on day 9 in the study group (p<0.05) than in the control group. Serum P was similar in the patients and the controls. These findings indicate a possible role of high E2‐17β in the maintenance of melasma.
Malignant Chondroid Syringoma
Authors: Agrawal Vivek , Gupta Ram L. , Kumar Sharad , Mishra Kiran , Agarwal Sarla
Published: April 2015

Malignant chondroid syringoma (MCS) is a rare tumor, of the sweat gland; only a few hundred such cases are reported in literature. A female presented with a subcutaneous swelling on the scalp with repeated recurrence and positive regional lymph nodes. Adequate planning for the treatment of this case was possible as preoperative diagnosis of MCS was documented by fine needle aspiration cytology (FNAC). The case was successfully managed with a multimodal approach, which included radical surgery and subsequent radiotherapy. The patient is symptom free after 25 months. The possibility of this type tumor should be entertained when multiple recurrences occur following adequate excision. FNAC has a definitive role in planning rational therapy.
Subcutaneous Tissue Involvement of CD30‐Positive Large Cell Lymphoma
Authors: Park Seok Beom , Cho Kwang Hyun , Kim Chul Woo
Published: April 2015

There are several types of T‐cell lymphoma presenting with subcutaneous tissue involvement showing different clinical features and prognoses. The entity of subcutaneous involvement of T‐cell lymphoma should be differentiated. We report a case of CD30‐positive large cell lymphoma which initially presented with subcutaneous tissue involvement only, but progressed to systemic dissemination.
Intermittent Therapy for Melasma in Asian Patients with Combined Topical Agents (Retinoic Acid, Hydroquinone and Hydrocortisone): Clinical and Histological Studies
Authors: Kang Won Hyoung , Chun Sei Chung , Lee Sungnack
Published: April 2015

Melasma is a common problem in Asians, but treatments have not been satisfactory. In the present study, we evaluated the efficacy of a new formula containing 0.1% tretinoin, 5% hydroquinone, and 1 % hydrocortisone (RHQ) in Korean patients with melasma. Twenty‐five Korean females with therapy recalcitrant melasma applied RHQ on their faces for 4 months and were evaluated before and 4 weeks after treatment clinically and histologically. They were also evaluated clinically 4 months after treatment. To minimize unavoidable side effects (erythema or peeling), we applied RHQ twice a week instead of the usual daily application. However, we obtained clinical and histological results comparable to other reports from white populations. Statistically significant depigmentation in clinical and histological studies and increased subepidermal collagen synthesis were observed in this study. These effects were seen as early as 4 weeks after treatment with RHQ. We used mMASI scoring, a modified version of the original MASI, to quantify the effects of RHQ more objectively and easily.
Immune Thrombocytopenia Due to Tranilast (Rizaben®): Detection of Drug‐dependent Platelet‐associated IgG
Authors: Nagae Shonosuke , Hori Yoshiaki
Published: April 2015

Tranilast (Rizaben®)‐induced thrombocytopenia occurring in a 17‐year‐old man was reported. After withdrawal of the drug, he recovered within a week with oral prednisolone administration. Serological examination revealed no anti‐platelet antibody, but platelet‐associated IgG (PAIgG) was found. After incubation of peripheral blood of the patient with the drug in vitro, the level of PAIgG was significantly increased. These findings suggest the presence of a drug‐dependent anti‐platelet IgG in the patient's serum. This is the first report of immune thrombocytopenia caused by Tranilast. Our method for detecting drug‐dependent platelet antibody in vitro is safe and useful for diagnosing drug‐induced thrombocytopenia.
Erythema Dyschromicum Perstans: Report of a New Case and Critical Review of the Literature
Authors: Combemale Patrick , Faisant Monique , Guennoc Bernard , Dupin Michel , Heyraud Jean‐Denis
Published: April 2015

Erythema dyschromicum perstans (EDP), described by Convit et al. in 1961, is a rare dermatosis. Its relationship with ashy dermatosis (AD), described by Ramirez in 1957, is still a matter of debate. We report a typical case of EDP. The patient, of North African origin, had a dyschromic (hypo‐ and hyperpigmented) eruption on the chest and limbs for 2 years. The lesions were occasionally surrounded by a papular border which spread slowly and centrifugally. Histological examination showed a lichenoid infiltrate. A carcinoma of the lung was simultaneously discovered. No treatment was given. EDP is infrequent and often considered identical to ashy dermatosis in the literarure. However, the clinical aspects of the two diseases differ. The main features of these two diseases are reviewed and compared on the basis of a literature review. We conclude that EDP and AD are distinct clinical entities.
Figurate Purpuric Eruptions on the Trunk: Acetaminophen‐induced Rashes
Authors: Kwon Sang Jin , Lee Chang Woo
Published: April 2015

A 23‐year‐old man had recurrent erythematous purpuric patches in a transverse‐linear arrangement on his back and arms. One week prior to a recent episode, he took acetaminophen for 3 days. Four months earlier, he developed the same purpuric lesions at/around the same anatomical site when he took acetaminophen for pain‐relief. A biopsy specimen showed capillaritis and extravasation of erythrocytes in the papillary dermis. A provocation test with acetaminophen confirmed these lesions as drug‐induced rashes. The uncommon topographic and morphologic features of the purpuric lesion in this patient might be considered as an unusual expression of pigmented purpuric dermatosis caused by acetaminophen.
Korean Dermatological Association
Authors: Ro Byung In
Published: April 2015

The Korean Dermatological Association (KDA) was founded on October 27, 1945. The first annual meeting was held on November 15, 1947, and meetings have been held twice a year since 1975. The KDA 50th Annual Spring Meeting was on April 15–16, 1998. Korean Journal of Dermatology, the official journal of the KDA, was first published in 1960 and has been published bimonthly since 1978. Annals of Dermatology (Seoul), the English journal, was first published in 1989 and has been published quarterly since 1995. The American residency and specialty board system was introduced in 1954. Board specialty examination of dermatology candidates by the KDA requires four years of residency. Three hundred and twenty residents are now in the training course in the fifty‐nine resident training approved hospitals this year. KDA has seven regional dermatological societies; Seoul, Pusan, Taegu, Honam, Chungchong, Jeonbuk, and Kangwon. KDA has had eleven research subcommittees since 1981. There are two associated societies of the KDA; the Korean Society for Investigative Dermatology was founded in 1991, and the Korean Society for Medical Mycology was founded in 1994. The Korea‐Japan Joint Meeting of Dermatology has been held every two years since 1979 and the Korea‐China Joint Meeting of Dermatology and Mycology has been held since 1996. About three hundred papers were presented at the 49th Annual Autumn Meeting on October 21‐23, 1997. These included special lectures, invited lectures, educational lectures, oral presentations, and posters. About five hundred dermatologists participated in that meeting. KDA joined the International League of Dermatological Societies in 1973 with forty‐seven members. There are around 1200 members of the KDA including 320 residents in 1998.
Pulmonary Function Changes in Patients with Psoriasis on Methotrexate Therapy
Authors: Bedi Gursvaran Kaur , Kaur Inderjeet , Behera Digambar
Published: April 2015

Methotrexate is known to induce pulmonary fibrosis. The present study was undertaken to assess pulmonary toxicity, if any, in psoriasis patients on methotrexate therapy and correlate the dose and duration of the treatment with any changes in pulmonary function. Ten patients who had taken methotrexate for one year and ten patients receiving methotrexate were included in the present study. Detailed lung function studies including arterial blood gas analysis were carried out. In both groups, the only pulmonary function abnormalities detected were FEF200–1200, FEF25–75%, residual volume (RV), and RV/TLC%, which showed a decline after six months of treatment. However, this was not significant. No changes were detected in the arterial blood gas values following methotrexate therapy. Therefore, the present study did not find any significant deterioration of lung functions in psoriasis patients on methotrexate therapy.
Detection of Human Herpesvirus 8 in Korean Kaposi's Sarcoma Cases by Polymerase Chain Reaction and In situ Polymerase Chain Reaction
Authors: Jang Ho‐Sun , Park Jung‐Hum , Oh Chang‐Keun , Kwon Kyung‐Sool
Published: April 2015

Several infectious agents, including herpesvirus‐like particles, had been suggested as possible candidates for the development of Kaposi's sarcoma (KS), and a new herpesvirus, human herpesvirus 8 (HHV‐8), was recently identified in the vast majority of KS lesions, irrespective of their association with human immunodeficiency virus (HIV) infection. However, the etiologic role of HHV‐8 in KS remains controversial. We undertook this study to screen for and localize the presence of HHV‐8 in KS in Korea. A total of 46 paraffin‐embedded specimens were studied, including KS, hemangioproliferative disorders, and 10 non‐KS lesions from HIV‐positive patients. We performed nested polymerase chain reaction (PCR) and in situ PCR with HHV‐8 specific primers. HHV‐8 DNA sequences were detected in 8 of 11 KS specimens. All specimens of hemangioproliferative disorders, non‐KS lesions from HIV‐positive patients, and other skin samples were negative for HHV‐8. When sequencing PCR products, the sequences were almost identical with the prototypic sequence for HHV‐8. In PCR‐positive tissues, in situ PCR staining of HHV‐8 localized to nuclei of endothelial cells and perivascular spindle‐shaped tumor cells. The results of this study suggest that HHV‐8 is not widespread and has a certain causative role in the development of KS. Further studies, including serological and animal studies, will be helpful to appreciate an epidermiological link and pathogenetic mechanism between HHV‐8 and KS.
Erythema Elevatum Diutinum Complicated by Rheumatoid Arthritis
Authors: Nakajima Hideki , Ikeda Mitsunori , Yamamoto Yasuo , Kodama Hajime
Published: April 2015

A 53‐year‐old female developed erythema elevatum diutinum (EED) twelve years after the onset of rheumatoid arthritis. The arthritis had been well controlled for the last several years. Annular purpuric macules were characteristically complicated by common nodular and plaque lesions. Both leukocytoclastic vasculitis and fibrosis were observed in the macular lesions, indicating that the lesions were a manifestation of an early phase of EED. Both types of skin lesions disappeared with treatment with dapsone. They have not relapsed for two years after stopping the dapsone. The leukocytoclastic vasculitis was thought to have developed independently of the rheumatoid arthritis. She had noticed sicca symptoms two years before the appearance of EED, but she did not satisfy the diagnostic criteria for Sjögren's syndrome.
Low‐Dose Intravenous Immunoglobulin Therapy for Intractable Dermatomyositis Skin Lesions
Authors: Sadayama Takahiro , Miyagawa Sachiko , Shirai Toshihiko
Published: April 2015

We report a 45‐year‐old female patient with dermatomyositis whose corticosteroid‐resistant cutaneous manifestations improved with low‐dose (0.1 g/kg body weight/day for 5 days weekly for 2 weeks) intravenous immunoglobulin (IVIG) therapy.
Methotrexate Nodulosis
Authors: Jang Kyoung‐Ae , Choi Jee‐Ho , Moon Kee‐Chan , Yoo Bin , Sung Kyung‐Jeh , Koh Jai‐Kyoung
Published: April 2015

Methotrexate (MTX) nodulosis in patients with rheumatoid arthritis treated with MTX has become a well recognized phenomenon. It has not been described in patients receiving MTX for treatment of other diseases, e.g., dermatological or malignant diseases. Recently, MTX nodulosis was described in a patient with psoriasis and arthritis. The pathophysiology and treatment of MTX nodulosis are yet unsettled. We experienced a case with dermatomyositis who developed multiple subcutaneous nodules after treatment with MTX. In our patient, numerous, small, symmetrically distributed, grouped subcutaneous nodules were seen on a V‐shaped area of the anterior chest, both axillary areas, and the medial sides of both upper arms and thighs. We histopathologically examined a nodule and started treatment with hydroxychlroquine after discontinuation of MTX. The histopathology revealed septal panniculitis, and the nodules have been under regression.

MTX nodulosis may be a drug‐specific phenomenon. Discontinuation of MTX and replacement with hydroxychloroquine are recommended in severe cases. Awareness of this entity is important for diagnosing and treating cases of multiple nodules developing after the administration of MTX, which is widely used for many dermatological diseases.
Immunohistochemical Study of ACTH and α‐MSH in Vitiligo Patients Successfully Treated with a Sex Steroid‐Thyroid Hormone Mixture
Authors: Ichimiya Makoto
Published: April 2015

We previously reported that a sex steroid‐thyroid hormone (Metharmon‐F®; MF, 2 tablets daily) was a potent drug for treatment of vitiligo. Using five patients with generalized vitiligo who were successfully treated with oral administration of MF, we performed an immunohistochemical analysis to elucidate its action mechanism at the cellular level. Histopathologically, the repigmented skin after the treatment showed increased numbers of melanocytes and melanin granules. Immunohistochemically, there was little significant difference between the depigmented lesion before treatment and the repigmented lesion after treatment in terms of the reactivity to adrenocorticotropic hormone (ACTH) and α‐melanocyte‐stimulating hormone (α‐MSH) in keratinocytes. The immunoreactivity to ACTH in melanocytes both before and after the treatment was minimal, but α‐MSH in melanocytes became much stronger after the treatment, than before the treatment. The efficacy of MF in treatment of vitiligo was proven to be due to the stimulatory effect of melanocyte proliferation and melanin production via α‐MSH.
Erythroderma in Children: A Clinico‐Etiological Study
Authors: Sarkar Rashmi , Sharma Ravi C. , Koranne Ravindra V. , Sardana Kabir
Published: April 2015

Although there are various published studies on erythroderma from western and Asian countries, most of them have only included patients in the adult age groups. As we have an exclusively pediatric dermatology unit, we thought it would be intriguing to study the clinical, etiological and laboratory parameters of erythroderma in children.

Seventeen erythroderma patients of both sexes were inducted into the study between 1993 to 1998. The mean age of onset was 3.3 years and the male:female ratio was 0.89:1. Eight (47%) of the patients were infants; 9 (53%) others belonged to the preschool and school going age group (age range between 1 to 12 years). An acute onset of the disease was seen in 47% of the patients while 53% of the patients had a chronic onset.

The main presenting complaints were itching in 41% and burning in 18% of patients. Scalp involvement (71%), nail involvement (18%), and alopecia (6%) were the main cutaneous features observed while fever (53%), tachycardia (53%), pedal edema (12%), lymphadenopathy (18%), and hepatomegaly (12%) were the main systemic features observed in this study.

Etiologically, drugs (29%) showed the highest incidence, followed equally (18%) by genodermatoses, psoriasis, and staphylococcal scalded skin syndrome (SSSS). Two (12%) patients had erythroderma due to atopic dermatitis, while one was (5%) due to infantile seborrheic dermatitis coexisting with dermatophytosis. Laboratory parameters contributed little towards diagnosis of the underlying dermatological condition. Thus, though erythroderma is a striking entity, it is yet uncommon in the pediatric age group. Because the drug induced group was the largest in this study, we recommend that drugs should be suspected as important causative factors of erythroderma in children.
Encapsulated Necrosis Associated with Behçet's Syndrome
Authors: Takeda Ushio , Kuroda Kei , Shinkai Hiroshi
Published: April 2015

We reported a case of a 45‐year‐old woman with encapsulated necrosis associated with Behçet's syndrome. The lesions were characterized by multiple, small subcutaneous nodules on the extremities. Histologically, a nodule consisted of degenerative adipocytes encapsulated by fibrous tissue. A membranocystic lesion was also observed in the cavity of the nodule. The patient had a long‐term history of Behçet's syndrome and suffered from erythematous subcutaneous nodules, resembling erythema nodosum on the extremities with a tendency to recurrence. These observations indicate that Behçet's syndrome could be implicated in the development of encapsulated necrosis as an underlying disease.
A Case of Multiple Subungual Glomus Tumors Associated with Neurofibromatosis Type 1
Authors: Okada Osamu , Demitsu Toshio , Manabe Motomu , Yoneda Kozo
Published: April 2015

Glomus tumor is a distinctive neoplasm characterized by the presence of cells that resemble the modified smooth muscle cells of the normal glomus body, which is a specialized form of arteriovenous anastomosis. We report a case of multiple subungual glomus tumors associated with neurofibromatosis and review the literature on the pathophysiology of this association.
Keratoacanthoma Centrifugum Marginatum Arising from a Scar after Skin Injury
Authors: Watanabe Daisuke , Tachi Naoko , Tomita Yasushi
Published: April 2015

Among the variants of solitary keratoacanthoma, keratoacanthoma centrifugum marginatum (KCM) is characterized by the lack of a tendency toward spontaneous remission and by continuous centrifugal spread. We describe a case of KCM arising from the scar after an old skin injury. The lesion appeared on the dorsum of the right hand, grew peripherally for 30 months, and became a tumor with a multinodular margin and central atrophy. A biopsy specimen from the edge of the tumor showed features resembling typical solitary keratoacanthoma.