bluuebunny/crossref_metadata_2025 huggingface dataset:
Profiles of Activated T Lymphocytes in Peripheral Blood of Kuwaiti Psoriasis Vulgaris Patients
Authors: Abul Habib , Mahmoud Fadia , Al‐Saleh Qassem , Khajeji Mehdi , Haines Donald
Published: July 2014

We have previously reported unexpected immunological features of psoriasis among Kuwaitis, suggesting novel patterns of immune reactivity contributing to the disease. To better define this phenomenon, we herein describe profiles of major populations and immunologically activated subsets of peripheral blood lymphocytes in a cohort of Kuwaiti psoriasis vulgaris patients. Whole venous blood from fifteen psoriatic and twenty eight normal, healthy subjects was analyzed by 2‐color flow cytometry for levels of major lymphocyte species and their immunologically activated subsets. When compared to normal subjects, psoriatic blood contained lower cell densities of CD2+, CD8+ (p=0.002 respectively) and B lymphocytes (CD19+) (p=0.003), with a trend toward a lower CD4+ density (p=0.072). Within each major lymphocyte population, activated lymphocytes were present at higher percentages in psoriatic than in healthy blood. These included CD4+ HLA‐DR+ (p=0.002), CD4+CD25+ (p=0.043), CD4+CD54+ (p=0.005), CD8+CD25+ (p=0.015), CD8+ HLA‐DR+ (p=0.046) and CD3+CD16+CD56+ (p=0.023) Additionally, psoriatic patients were found to have an expanded ratio of memory to naïve T cells (CD45RO+CD45RA+) relative to control subjects; this was expected on the basis of increased immune activation. Our findings are consistent with a picture of psoriasis as a disease mediated by activated lymphocytes.
Unusual Clinical Features of Cutaneous Tuberculosis in an Immune Compromised Patient
Authors: Tanaka Asayo , Kato Yukihiko , Arai Keitaro , Oh‐i Tsunao , Koga Michiyuki
Published: July 2014

We report a case of an unusual form of cutaneous tuberculosis in an 82‐year‐old woman. She visited our hospital because of an intractable ulcer on the fifth finger of her right hand. While examining the ulcer surrounding half of her right fifth finger and covered with necrotic tissue, we also perceived a nodule with crust on the forearm, multiple subcutaneous nodules on the right forearm and upper arm, and a hen's‐egg‐sized agglomerative nodule on the axilla. All the lesions were located on her right arm. Skin biopsy specimens showed granulomatous tissue with necrosis in the lesions. Mycobacterium tuberculosis was identified by culture of a biopsied specimen, so the diagnosis was confirmed. Further examination revealed that she also had pulmonary tuberculosis. Cutaneous tuberculoses are classified morphologically with reference to host immune status, but no satisfactory classification exists. The present case can't be classified into any of the types which have been proposed so far. She is elderly and suffers from liver cirrhosis, hepatocellular carcinoma and myelodysplastic syndrome. The resulting acquired immunosuppression may have caused a unique form of cutaneous tuberculosis.
Proteus Syndrome
Authors: Roma Pandhi , Murlidharn R , Kumar Bhushan
Published: July 2014

Proteus syndrome is a rare congenital hamartomatous entity. We report some new findings in a boy with this syndrome, in addition to the classical clinical and radiological features of subcutaneous masses, partial gigantism of hands and feet, bony abnormalities, and epidermal nevi. We also discuss how to reach a difinitive diagnosis by using an established rating scale.
Report of Eight Infants with Acute Infantile Hemorrhagic Edema and Review of the Literature
Authors: Çaksen Hüseyin , Odabaş Dursun , Kösem Mustafa , Arslan Şükrü , Öner Ahmet Faik , Ataş Bülent , Akçay Gürbüz , Ceylan Nesrin
Published: July 2014

Acute infantile hemorrhagic edema (AIHE) is a cutaneous leukocytoclastic vasculitis, clinically characterized by the symptom triad of fever, large purpuric skin lesions, and edema. The clinical picture has a violent onset, a short benign course, and spontaneous complete recovery. In this article, we present eight patients who were admitted with rashes on the skin and edema on the eyelids and extremities, and were diagnosed with AIHE according to their clinical and histopathological features (immunohistological study was also performed in three of them). Our purpose was to emphasize that, aside from Henoch‐Schönlein purpura, meningococcemia, septicemia, and purpura fulminans, AIHE benign disorder should also be considered in the differential diagnosis to determine the clinical course and treatment protocol in patients with purpuric rashes.
Papillon‐Lefevre Syndrome: A Case Report
Authors: Pratchyapruit Walai‐orn , Kullavanijaya Preya
Published: July 2014

We report the first diagnosed case of Papillon‐Lefevre syndrome in Thailand. The patient is the youngest child of consanguinous parents, and she has had symmetrical hyperkeratotic plaques on both plantar surfaces since birth with a history of chronic gingivitis, periodontitis, and premature loss of primary dentition. The histologic study revealed compact hyperkeratosis with epidermal acanthosis. Radiologic studies of the skull were normal. The radiographic panoramic view of the oral cavity revealed generalized severe vertical and horizontal alveolar bone loss. The immunologic analysis of polymorphonuclear leukocyte phagocytic function by nitrobluetetrazolium test (NBT test) showed decreasing response to latex stimulation. Serum parathyroid hormone, calcium, phosphate, and alkaline phosphatase levels were within normal limits. The skin lesions were temporary relieved with topical keratolytic agents. The oral lesions were improved by the extraction of hopeless teeth and conventional periodontal treatments.
Diffuse Cutaneous Mastocytosis: Pseudoxanthomatous Variant
Authors: Jain Rajesh , Dogra Sunil , Verma Shikha , Mohanty Sambit K , Handa Sanjeev
Published: July 2014

Diffuse cutaneous mastocytosis is one of the extremely rare benign forms of mastocytosis that have varied clinical presentations. The pseudoxanthomatous variant is an extremely rare multinodular nonpigmented entity. Only two cases have been reported so far in the literature. We report a 21 year old female patient who had diffusely infiltrated skin with multiple papulo‐nodular lesions resembling xanthomas and the classical histopathological features of mastocytosis.
Perianal Ulceration in a “Healthy” Chinese Man with Disseminated Tuberculosis
Authors: Ho Man Hon , Lee King Chung , Chong Lai Yin
Published: July 2014

Orificial tuberculosis (OTB) is a rare form of cutaneous Mycobacterium tuberculosis infection affecting the mucosa and skin around orifices in patients with advanced internal tuberculosis and poor general health. We report a 72‐year‐old Chinese man who had a 10‐year history of OTB with disseminated tuberculosis infection of the lungs and urinary tract. He appeared surprisingly healthy and had been free from systemic symptoms all along despite widespread tuberculosis. The diagnosis of OTB was established by the microscopic presence of acid‐fast bacilli (AFB) in the tissue section and was rapidly confirmed by polymerase chain reaction (PCR) to be Mycobacterium tuberculosis. PCR shortens the time of diagnosing rare presentations of cutaneous tuberculosis and prevents delays in treatment. Conventional culture is still important in confirming the diagnosis and screening for drug resistance.
Announcement—Important!
Authors: Shimada Shinji
Published: July 2014

We are happy to announce that this journal, “The Journal of Dermatology” has recently been selected for coverage by Current Contents—Clinical Medicine (Institute for Scientific Information, Inc®) from Vol. 28, No. 1, 2001. This means that we will have an impact factor in the near future.
Unilateral Generalized Morphea in Childhood
Authors: Nagai Yayoi , Hattori Tomoyasu , Ishikawa Osamu
Published: July 2014

We report a 6‐year‐old boy with unilateral generalized morphea distributing on the right side of his lower leg, trunk, and upper arm. A skin biopsy from the right thigh showed accumulation of thick collagen bundles extending from the middle dermis to the subcutaneous fat tissue. The levels of antinuclear antibodies, rheumatoid factor, and anti single‐stranded DNA antibody were elevated. No severe deformity or functional disabilities were noted. With topical corticosteroid therapy, the sclerotic skin became gradually softer, and no progression of sclerosis has been noted for one year.
Inhibition of the Proliferation of a Malignant Peripheral Nerve Sheath Tumor Cell Line by Gamma Interferon Gene Transfection
Authors: Nakayama Juichiro , Tanaka Toshihiro , Furumura Minao , Takahashi Akira , Yamaguchi Takahiro , Shimura Hideo , Ikeda Seiyo , Kuroki Masahide
Published: July 2014

A solitary malignant peripheral nerve sheath tumor was resected, and a tumor cell line was obtained using an explant culture. The morphology of this cell line was quite similar to those of cell lines of dermal neurofibromas of neurofibromatosis 1, except for the fact that the malignant peripheral nerve sheath tumor cell line could be cultured for more than two months. When the tumor cell line was transfected with human gamma interferon gene, the growth rate was remarkably abolished, as previously observed in neurofibroma cell lines transfected with the gamma interferon gene. This new finding suggests the potential for treating either solitary or neurofibroma‐related, inoperable, malignant peripheral nerve sheath tumors by local gamma interferon gene transfection in vivo.
Weight Loss‐Induced Calciphylaxis: Potential Role of Matrix Metalloproteinases
Authors: Munavalli Girish , Reisenauer Amy , Moses Marsha , Kilroy Susan , Arbiser Jack L.
Published: July 2014

Calciphylaxis is an uncommon and often devastating syndrome of calcification of small vessels, leading to tissue infarction. The mechanism of how calcium deposits on small vessels is unknown. Recently, metalloproteinase digestion of elastin has been shown to enhance deposition of calcium, suggesting a possible mechanism of calciphylaxis. We describe a case of a patient who developed calciphylaxis after rapid weight loss, but had normocalcemia and normal renal function. She was found to have high levels of matrix metalloproteinases, which may have chemically altered elastin, allowing deposition of calcium on small vessels. Inhibitors of matrix metalloproteinases may be useful in the prevention and treatment of calciphylaxis.
Lupoid Sycosis of Pubic Area
Authors: Manchanda Yashpal , Khanna Neena , Pandhi Ravinder Kumar , Das Sudip , Sirka Chander Shekhar
Published: July 2014

Lupoid sycosis is a rare cicatricial form of chronic folliculitis commonly seen in men after puberty. It usually involves the beard area and is refractory to treatment. We here report two cases of lupoid sycosis; one had additional involvement of the pubic area. Both patients showed complete clearance with minocycline.
Negative‐Pressure Dressings in the Treatment of Pressure Ulcers
Authors: Isago Tsukasa , Nozaki Motohiro , Kikuchi Yuji , Honda Takashi , Nakazawa Hiroaki
Published: July 2014

Applying negative pressure to wounds may speed the formation of granulation tissue, decrease the amount of localized edema, increase blood flow, and accelerate healing. In the present study, we treated ten patients with stage IV chronic pressure ulcers using this negative pressure dressing technique. The long (A) and short (B) diameters of each ulcer were measured to determine size, and the vertical distance from the skin to the deepest point of the ulcer was measured to determine depth. Lesions were measured initially and at weekly intervals. The area of each lesion was taken to be 3.14 x A/2 x B/2 (cm2). When we compared the area of ulcer before and after the treatment, the area had been reduced in all cases, and the average reduction was 55.1%. The depth of ulcer also decreased in all cases, and the average reduction was 61.2%. Over the period of evaluation, the method was considered markedly effective in reducing the size and depth of ulcers.
Disseminated Cytomegalovirus Disease as a Cause of Prolonged Fever in a Bullous Pemphigoid Patient under Systemic Steroid Therapy
Authors: Casals Daniel Sesto , Nunes Eduardo de Azevedo , Maruta Celina Wakisaka , Aoki Valeria , Santi Claudia Giuli , Nico Marcello Menta Simonsen , Correa Maria Cassia Mendes , Leite Olavo Henrique Munhoz , Rivitti Evandro A.
Published: July 2014

We present the first reported case of disseminated cytomegalovirus (CMV) in association with prednisone therapy in bullous pemphigoid (BP). A 66‐year‐old black male patient was admitted to our hospital presenting cutaneous pruritic lesions represented by tense blisters, with serous content on the arms, abdomen and legs. Laboratory findings confirmed the diagnosis of BP. After two weeks of prednisone therapy, the patient developed prolonged fever, which was caused by CMV disseminated disease, with prompt clinical recovery after ganciclovir administration.
Hydroa Vacciniforme‐like Eruptions in a Patient with Chronic Active EB Virus Infection
Authors: Katagiri Yoshiyuki , Mitsuhashi Yoshihiko , Kondo Shigeo , Kanazawa Chikako , Iwatsuki Keiji , Tsunoda Takahiko
Published: July 2014

We report a case of chronic active Epstein‐Barr (EB) virus infection (CAEBV) associated with skin eruptions mimicking hydroa vacciniforme (HV) in a 4‐year‐old boy. The patient had repeated episodes of vesiculo‐necrotic eruptions on the face, scalp, and bilateral forearms one year before the first visit to our department. General symptoms including fever, hepatosplenomegaly, abnormal liver function, and cervical lymph node swelling were noted three months before the first visit. At the first visit, small, bean‐sized, erythemic papules with central necrosis were observed on the face and anterior chest wall. Thumb‐sized ulcers with crust were present on the bilateral forearms. Histopathological examination of an erythematous lesion in the submandibular area revealed parakeratosis with a thick crust, mild spongiosis in the epidermis, and a dense infiltration of lymphoid cells into the dermis and perivascular space. Laboratory examination showed EBNA x40, EBV VCA IgG x 1,280, and EBV DNA (PCR) 8 times 104. EBV‐encoded small nuclear RNA (EBER) positive cells were detected in the dermis by an in situ hybridization (ISH) method. Large granular lymphocytes (65%) with the NK cell phenotype were found in the peripheral blood. A real time PCR method showed 171,741 copies/μg DNA in CD 16 positive cells. Although latent EBV infection‐associated eruptions have been documented, detailed skin manifestations in CAEBV are less well known.
Oral Ivermectin Treatment in Two Cases Of Scabies: Effective in Crusted Scabies Induced by Corticosteroid but Ineffective in Nail Scabies
Authors: Ohtaki Noriko , Taniguchi Hiroko , Ohtomo Hiroshi
Published: July 2014

We report two cases of scabies treated with oral ivermectin (200 μg/kg). Case 1, a 72‐year‐old man, developed crusted scabies with the use of oral corticosteroids due to a misdiagnosis by an earlier physician. The patient was successfully treated with two doses of oral ivermectin at a 7 day interval with concomitant topical use of crotamiton and keratolytic agents. However, the nail scabies in this patient failed to respond to these treatments. Live mites were detected from all his toenails two weeks after the second dose of ivermectin. A complete cure of the nail scabies was achieved by occlusive dressing of 1% γ‐BHC on all toenails for one month. Case 2, a 52‐year‐old woman, had been treated with oral corticosteroid for mesangial nephritis. She developed common scabies, but a topical scabicide, crotamiton, was not effective. Two weeks after treatment with a single dose of oral ivermectin, eggs were still detected from a burrow on her trunk. Her treatment was completed after a further two doses of oral ivermectin were administered at 7 day intervals. In both patients, the administration of oral ivermectin did not induce any clinical or laboratory side effects. Oral ivermectin is effective for crusted scabies, but not effective for nail scabies. Two doses of oral ivermectin, administered with a one‐week interval, is an appropriate treatment regimen.
Treatment of Persistent Severe Atopic Dermatitis in 113 Japanese Patients with Oral Psoralen Photo‐Chemotherapy
Authors: Uetsu Naoko , Horio Takeshi
Published: July 2014

Oral administration of psoralen and whole body exposure to UVA (oral PUVA) has been used for the treatment of 113 patients with severe atopic dermatitis (AD). 8‐Methoxypsoralen (8‐MOP) was given at a dose of 0.5–0.6 mg/kg two hours prior to UVA (3‐8 J/cm2) irradiation. Patients were treated three times a week while hospitalized. Other medications which had been given before PUVA therapy were permitted. At four and eight weeks after PUVA therapy, the severity score of AD had decreased by 51% and 80%, and the cumulative doses of UVA were 51.2 J/cm2 and 115.3 J/cm2, respectively. The amounts and strength of topical cortico‐steroids were decreased during PUVA therapy. No adverse effects that required discontinuation of the PUVA therapy were observed. After discharge, maintenance therapy with UVB phototherapy and/or conventional treatment of AD kept the patients in remission in the outpatient clinic. The QOL of patients was greatly improved. Photochemotherapy with oral 8‐MOP can be indicated in patients with severe, widespread AD, especially if standard therapy fails. This is the first report of oral PUVA therapy in a large series of Japanese patients with AD.
Pharmacological Profiles of High‐Concentration (20 μg/g) Tacalcitol Ointment: Effects on Cutaneous Inflammation, Epidermal Proliferation, and Differentiation in Mice
Authors: Sato Hiroaki , Ogino Yasuhiro , Takagi Hideko , Hata Junko , Asano Satoshi , Ohta Tomohiro , Komoriya Keiji
Published: July 2014

This study focused on the effects of tacalcitol (1,24(R)(OH)2D3, TV‐02) ointment (20 μg/g) on cutaneous inflammation, epidermal proliferation, and differentiation and compared them with tacalcitol ointment (2 μg/g) and other anti‐psoriatic ointments using hairless mice. Tacalcitol ointment (0, 2 and 20 μg/g) significantly inhibited 12‐O‐tetradecanoylphorbol 13‐acetate (TPA)‐induced cutaneous inflammation, histopathologically. The effect of tacalcitol ointment (20 μg/g) on cutaneous inflammation was much stronger than that of tacalcitol ointment (0, 2 μg/g), and as effective as calcipotriol ointment (50 μg/g) or betamethasone valerate ointment (1.2 mg/g). Tacalcitol ointment (20 μg/g) also significantly inhibited TPA‐induced myeloperoxidase (MPO) activity, as effectively as calcipotriol ointment (50 μg/g) or betamethasone valerate ointment (1.2 mg/g). The effect of tacalcitol ointment on epidermal proliferation [ornithine decarboxylase (ODC) activity] and differentiation [transglutaminase (TGase) activity] was dose‐dependent from 0 μg/g to 20 μg/g. The effect of tacalcitol ointments on epidermal proliferation was significant at the doses of 2 μg/g and 20 μg/g, and that on epidermal differentiation was significant at the doses of 0.2 μg/g or more. The effect of tacalcitol ointment (20 μg/g) on epidermal differentiation was significantly stronger than tacalcitol ointment (2 μg/g). In this study, tacalcitol ointment (20 μg/g) was found to have a marked effect on cutaneous inflammation and improved effect on epidermal differentiation, although tacalcitol ointment (2 μg/g) also had significant effects on epidermal proliferation and differentiation. These findings support the clinical effectiveness of tacalcitol ointment (20 μg/g) against psoriasis.
Dyshidrosiform Pemphigoid: Report of a Case
Authors: Sugimura Chieko , Katsuura Junko , Moriue Tetsuya , Matsuoka Yoshie , Kubota Yasuo
Published: July 2014

A Japanese woman had bullous eruptions on her palms and soles for two months, histopathologic examination, immunofluorescence microscopy, and ELISA for BP180 antigen led to the definitive diagnosis of dyshidrosiform pemphigoid (DP). This paper also includes a study of 15 other cases of DP.
The Pattern of Mucocutaneous Infections and Infestations in Renal Transplant Recipients
Authors: Sandhu Kamaldeep , Gupta Somesh , Kumar Bhushan , Dhandha Raman , Udigiri Naval Kishore , Minz Mukut
Published: July 2014

Immunosuppression‐related mucocutaneous lesions are a significant problem in renal transplant recipients. Infections account for the majority of these manifestations. The aim of this study was to determine the spectrum of mucocutaneous infections and infestations in renal transplant recipients. Over a period of three years, all the renal transplant recipients presenting with mucocutaneous lesions (only with infectious etiology) were included in the study. Diagnosis was based on the clinical appearance and appropriate investigations like scraping for KOH, Tzanck smear, cultures, and skin biopsies whenever necessary. In order to study the temporal effect of immunosuppression on these mucocutaneous infections, the patients were divided into six groups—with durations of graft survival ranging from 0–2, 2–6, 6–12, 12–24, 24–60, and more than 60 months in Groups A–F, respectively. A total of 104 renal transplant recipients presented with 117 infections and infestations. The mean age at presentation was 35.9 ± 1.2 years (15–65yrs), and the mean duration after the transplant was 23.3 ± 3.5 months (1–175). The mean serum creatinine level at the time of clinical presentation was 1.4 ± 0.07 mg/dl (0.7–6). Twenty‐seven patients were on a two‐drug regimen, prednisolone and azathioprine, and the rest were on a three‐drug regimen with cyclosporine in addition. Out of the total of 117 infections in 104 patients, 57 were viral, 49 were fungal, and 8 were bacterial. Two patients had scabies and one had cysticercosis. The mean time interval for the occurrence of infections after the transplant was earlier in patients on three‐drug immunosuppression (12.4 ± 2.3 months) than in those on the two‐drug regimen (51.3 ± 1.8 months), (p<0.01). The viral infections had the shortest mean time interval for presentation following transplant, 15.8 ± 1.2 months (p<0.05). We did not find any statistically significant difference with regard to age or sex of the patients, duration after the transplant, or the pattern of infection. Careful examination of transplant patients is essential for early detection and proper treatment, because the mucocutaneous infections can have atypical morphologies and are likely to become extensive if not treated early.
Pemphigus in Korea: Clinical Manifestations and Treatment Protocol
Authors: Seo Pan Gyo , Choi Won Woo , Chung Jin Ho
Published: July 2014

Pemphigus, a rare, chronic blistering disease of the skin and mucous membranes with severe morbidity and occasional mortality, is the most common autoimmune bullous disease in Korea. The purpose of this study was to evaluate the clinical features and propose a treatment strategy for patients with pemphigus. A retrospective analysis was conducted of 51 pemphigus patients seen between 1993 and 2001. Pemphigus vulgaris (PV) was the most common type with 32 cases, followed by 19 cases of pemphigus foliaceus (PF). The male to female ratio was 1:1.3, with females predominating, particularly among PV patients (PV, 1:1.5; PF, 1:1.1). The average ages at onset of PV and PF were 44.3 and 51.0 years old, respectively. Mucosal involvement was noted in 27 cases (84.4%) of PV but in only 3 cases (15.8%) of PF. Most patients initially received relatively low to intermediate doses (0.3–1.0 mg/kg/day) of prednisolone, and 23 (71.9%) PV patients and 10 (52.6%) PF patients also received immunosuppressive agents. Oral prednisolone and azathioprine (100 mg/day) formed the mainstay of treatment for our patients (47.1%). At the time of writing, 25.5% (13/51) of patients are in complete remission, and 72.5% (37/51) are undergoing maintenance therapy. One patient died due to sepsis during the treatment. For the treatment of pemphigus, a course of the lowest possible corticosteroid dosage in combination with immunosuppressive agents appears to be effective and less toxic than a high corticosteroid dosage.
Clinical Evaluation of Roxithromycin: A Double‐Blind, Placebo‐Controlled and Crossover Trial in Patients with Acne Vulgaris
Authors: Ferahbas Ayten , Utas Serap , Aykol Deniz , Borlu Murat , Uksal Umit
Published: July 2014

We clinically evaluated roxithromycin (ROM) in a double blind, placebo‐controlled, and crossover trial in patients with inflammatory acne. Patients with inflammatory acne who were attending our outpatient clinic for treatment and who had not received topical or systemic treatment for the previous month were enrolled in this study. Patients were randomly separated into two groups. Group I consisted of 26 patients. The patients received 2 × 150 mg/day ROM orally in the first period and 2 × 1 placebo tablets/day in the second period. Group II consisted of 20 patients. These patients received 2 × 1 placebo tablets/day in the first period and 2 × 150 mg/day ROM orally in the second period. The first period was the first four weeks, and then there was a washout period of two weeks (5th and 6th). The second period was the next four weeks (7th to 10th weeks) after the washout period. Median acne scores had clearly decreased in both groups at the end of the study. Differences of median acne scores were statistically significant in both groups between at baseline and at the end of the study (p< 0.001). The results showed that ROM is a safe and effective alternative in the treatment of inflammatory acne with few side effects and good compliance.
A Case of Anti‐Epiligrin Cicatricial Pemphigoid Associated with Lung Carcinoma and Severe Laryngeal Stenosis: Review of Japanese Cases and Evaluation of Risk for Internal Malignancy
Authors: Matsushima Satoko , Horiguchi Yuji , Honda Tetsuya , Fujii Shinobu , Okano Takayuki , Tanabe Masahiro , Wakayama Toshiaki , Hashimoto Takashi , Yancey Kim B.
Published: July 2014

A 68‐year‐old Japanese male with a five‐year‐history of lung carcinoma showed recurrent blisters and erosions on the oral and genital mucosae and the skin. The patient complained of dyspnea due to severe laryngeal stenosis and underwent a tracheostomy. A skin biopsy specimen showed a subepidermal blister and linear deposits of IgG and C3 at the basement membrane zone of the epidermis. Indirect immunofluorescence examination demonstrated circulating IgG anti‐basement membrane zone autoantibodies that reacted to epiligrin on immunoblotting. Based on a diagnosis of anti‐epiligrin cicatricial pemphigoid, he was treated with prednisolone, minocycline hydrochloride and nicotinamide. Although no new skin lesions appeared, he died of lung carcinoma five months after the tracheostomy. A review of reported cases with anti‐epiligrin cicatricial pemphigoid in Japan disclosed that 5 of 16 cases (31.2%) were complicated by internal malignancies.
Benign Fibrous Histiocytoma of the Eyelid with an Unusual Clinical Presentation
Authors: Kargı Eksal , Kargı Şebnem , Gün Banu , Hoşnuter Mübin , Altinyazar Cevdet , Aktunç Erol
Published: July 2014

Benign fibrous histiocytoma is a common soft tissue tumor that can be deep or superficially located. Although the deep type of fibrous histiocytoma has a predilection for the orbit, the eyelids are an unusual location for the cutaneous type. A 42‐year‐old woman had bilateral yellowish nodular masses of the eyelids for two years. Pathological examination after excision revealed benign fibrous histiocytoma. Our case is an unusual clinical presentation of cutaneous fibrous histiocytoma as well as a rare location such as the eyelids.
Swan‐Neck Deformity and Paresthesia Following Giant Orf
Authors: Uzel Murat , Sasmaz Sezai , Ozkul Aykut , Cetinus Ercan , Bilgic Erkal , Karaoguz Ahmet
Published: July 2014

Orf is a zoonotic infection caused by a parapoxvirus that primarily infects sheep and goats. Human orf infection can take place when abraded skin comes into contact with infected animals. It occurs most commonly on the index finger. The characteristic lesion resembles a tumor and resolves spontaneously, usually without any complications. However, rare complications such as lymphangitis, adenitis, erythema multiforme, erysipelas, papulovesicular eruption, Pseudomonas aeruginosa infection, and bullous pemphigoid have been reported. Herein, we report a case of giant orf causing swan‐neck deformity and paresthesia. These complications have not been previously reported in the literature.
Delayed Development of Foreign Body Granuloma from an Implanted Permanent Cardiac Pacemaker
Authors: Kootiratrakarn Tanawatt , Kimura Yutaka , Matsunaga Jun , Tagami Hachiro
Published: July 2014

We report a case of a late‐developing cutaneous mass on the chest wall that proved to be non‐specific mixed cell granuloma adjacent to the lead‐electrode parts of a permanent cardiac‐pacemaker that had been implanted in the left chest of an 81‐year‐old man 6 years previously. The lesion was treated by cardiac surgeons, whose management consisted of cutting only the intradermal part of the lead‐electrodes followed by tissue curettage, leaving the other portion embedded in the subendocardium because its removal could cause serious complications. Dermatologists should be alert to such late complications of embedded permanent pacemakers. Their removal requires close cooperation with cardiac surgeons to avoid unexpected complications.
Intermittent Topical Corticosteroid/Tacrolimus Sequential Therapy Improves Lichenification and Chronic Papules More Efficiently than Intermittent Topical Corticosteroid/Emollient Sequential Therapy in Patients with Atopic Dermatitis
Authors: Nakahara Takeshi , Koga Tetsuya , Fukagawa Shuji , Uchi Hiroshi , Furue Masutaka
Published: July 2014

Atopic dermatitis (AD) is a common, chronic, relapsing, severely pruritic, eczematous skin disease. Topical steroids are the mainstay of treatment. However, the adverse effects of steroids on hormonal function are the major obstacle for their use as long‐term topical therapy. Intermittent dosing with potent topical steroids and/or combination therapy with steroid and tacrolimus have been frequently used in the daily management of AD to overcome the problems accompanying the long term use of steroids. We compared the clinical effects of topical steroid/tacrolimus and steroid/emollient combination treatments in 17 patients with AD. An intermittent topical betamethasone butyrate propionate/tacrolimus sequential therapy improved lichenification and chronic papules of patients with AD more efficiently than an intermittent topical betamethasone butyrate propionate/emollient sequential therapy after four weeks of treatment. Only one out of 17 patients complained of a mild, but temporary, burning sensation after tacrolimus application. The intermittent topical steroid/tacrolimus sequential therapy may be a useful adjunctive treatment for AD.
Assessment of Cadexomer Iodine against Staphylococcus aureus Biofilm In vivo and In vitro Using Confocal Laser Scanning Microscopy
Authors: Akiyama Hisanori , Oono Takashi , Saito Masakazu , Iwatsuki Keiji
Published: July 2014

Cadexomer iodine releases iodine (0.9% weight/weight) slowly from beads of dextrin and epichlorhydrin. This preparation is an effective debridement and antiseptic agent for chronic exdudative wounds. The purpose of the present study is to examine the influence of cadexomer iodine against glycocalyx production of Staphylococcus aureus isolated from furuncle lesions on cut wounds in mice using confocal laser scanning microscope (CLSM), and the increase in and glycocalyx production of S. aureus in vitro. In the present study, distinct S. aureus cells and glycocalyx were not detected in the dermis around the cadexomer iodine beads or within those beads, while S. aureus cells encircled by glycocalyx were soaked up by the cadexomer beads and were detected within them in vivo and in vitro. We suggest that cadexomer iodine soaks up S. aureus cells encircled by glycocalyx, directly destroys biofilm structures, and collapses glycocalyx during dehydration, and further, that iodine can subsequently kill S. aureus cells within biofilm. Cadexomer iodine is a promising treatment to clear S. aureus cells within biofilm from skin lesions of exudative or infectious wounds and to prevent wound exacerbation.
A Case of Generalized Hair Follicle Hamartoma Associated with Systemic Lupus Erythematosus
Authors: Tsuru Kenta , Ohashi Akiko , Ueda Masato
Published: July 2014

A hair‐follicle hamartoma (HFH) may be localized or diffuse. Generalized HFH is frequently associated with an autoimmune disease such as myasthenia gravis or systemic lupus erythematosus (SLE). We report here a female patient with SLE who developed typical generalized HFH. This is the fourth case of generalized HFH associated with SLE.
The Clinical Importance of Demodex folliculorum Presenting with Nonspecific Facial Signs and Symptoms
Authors: Karincaoglu Yelda , Bayram Nalan , Aycan Ozlem , Esrefoglu Muammer
Published: July 2014

Demodex folliculorum (D. folliculorum), found in the pilosebaceous unit, is the most common ectoparasite of humans. Various clinical forms such as pustular folliculitis, papulopustular scalp eruptions, perioral dermatitis, and blepharitis have been defined, although in general, the disease has been classified into three main groups as “pityriasis folliculitis”, “rosacea‐like demodicidosis”, and granulomatous rosacea‐like“demodicidosis gravis”. Our aim was to test for the presence of D. folliculorum in pathogenic numbers in patients who came to our clinic with non‐specific symptoms such as facial itching with or without erythema, seborrheic dermatitis‐like or perioral dermatitis‐like lesions, papulopustular lesions, and an acneiform clinical appearance without telengiectasia or flushing. Twenty‐eight (87.5%) female and 4 male (12.5%), patients and 33 age‐and‐sex matched healthy subjects enrolled in this study. D. folliculorum was sought in the lesion sites using the noninvasive method known as the Standardised Skin Surface Biopsy (SSSB). The discovery of more than five parasites in an area of 1 cm2, was evaluated as pathogenic. For treatment, 5% permethrine cream was applied twice daily for 15 to 30 days. The clinical symptoms of the patients were classified into clinical groups and evaluated as facial itching in 2 (6.3%), nonspecific erythema and itching in 21 (65.6%), erythema and pityriasiform squamous lesions in 3 (9.4%), acneiform in 3 (9.4%), papulopustular lesions in 1 (3.1%), granulomatous rosacea‐like in 1 (3.1%), and perioral dermatitis‐like symptoms in 1 (3.3%), D. folliculorum density was determined as 5>D/cm2 in all clinical lesions. A significant clinical healing and density of D. folliculorum at <=5 D/cm2 was determined in all but two patients after treatment. We consider that D. folliculorum presentation with different symptoms and signs than classical forms is not rare. For this reason, we suggest that it is useful to test for D. folliculorum in patients with non‐classical presentations like facial itching, itching accompanied by non‐specific erythema, itching and non‐specific pityriasiform squamous lesions, and acneiform lesions.
Cutaneous Ulcerations Following Subcutaneous Interferon β Injection to a Patient with Multiple Sclerosis
Authors: Inafuku Hisashi , Khan Mohammed Abul Kasem , Nagata Tomoko , Nonaka Shigeo
Published: July 2014

We report a case treated with interferon beta‐1b for multiple sclerosis (MS), who developed severe cutaneous ulcers after six months of therapy. Interferon beta‐1b had been used in a regimen of 8 million IU administered subcutaneously through oblique direction of the needle, twice a week. The cutaneous ulcers developed at inoculation sites, as a result of penetration of interferon beta into dermis. Other underlying diseases of coagulative or bleeding disorders or secondary infection were excluded. Histological features of non‐specific inflammatory reactions including hyperplastic changes of blood vessels without any evidence of vasculitis were the prominent features in this case. Corticosteroid and interferon beta‐1b therapy was continued on restricted sites on the extremities with care not to repeat injections at the same sites previously used. The administration of interferon beta into subcutaneous fatty tissues vertically reduced the incidence of dermal penetration of drug and occurrence of ulcerations in this patient. We review other case reports of severe cutaneous reactions associated with interferon beta‐1b therapy in MS patients and conclude that local cytokine‐mediated, adverse, immune reaction or non‐specific cutaneous inflammatory reaction to interferon beta‐1b initiated the skin ulceration long after institution of therapy at the injection sites, and the reaction might be related to the depth of injection.
The Characteristics of Patients with Atopic Dermatitis Demonstrating a Positive Reaction in a Scratch Test after 48 Hours against House Dust Mite Antigen
Authors: Katoh Norito , Hirano Shinya , Suehiro Mitsuhiro , Masuda Kouji , Kishimoto Saburo
Published: July 2014

The clinical characteristics of patients in whom an IgE‐mediated reaction against house dust mite (HDM) antigens that contribute to the pathogenesis of atopic dermatitis (AD) remain unclear. This study attempted to elucidate the characteristics of patients who exhibit a positive reaction 48 hr or later against HDM in scratch tests. The reactions after epicutaneous application of the allergen to skin with prior scratching were observed for one week in sixteen AD patients showing positive immediate‐type hypersensitivity reactions for HDM. Fifty percent of the patients demonstrated positive reactions at 48 hours after epicutaneous application of HDM. Significantly higher values were demonstrated in the group positive for HDM after 48 h in serum total IgE, specific IgE for Der f1, and lactate dehydrogenase, peripheral eosinophil counts, eruption score, and the area of eruption than in the group negative for HDM after 48 h. Domestic exposure to Der f1 was also higher in the group positive for HDM after 48 h than in the negative group. These results indicate that the patients in whom the HDM‐induced reaction continuing more than 48 h and contributing to their real eczematous eruptions are characterized by considerably increased levels of specific IgE for HDM antigens, high disease activity in AD, and increased exposure to domestic HDM.
Acquired Dermal Melanocytosis: A Case with Conjunctival and Gingival Pigmentation
Authors: Wang Wenqing , Fujiwara Sakuhei , Seguchi Shun‐ichiro , Yokoyama Shigeo , Mizoguchi Masako
Published: July 2014

A 28‐year‐old Japanese woman was referred to us because of widespread bilateral blue‐gray and brown pigmentation on her face. Pigmentation was apparant on both sclerae, the alae of the nose, the lower lip and the gingiva; and it was also evident on her extremities. A biopsy specimen revealed melanin‐containing cells and numerous mononulear cells in the upper dermis, particularly, near the small vessels. The melanin‐containing cells immunoreacted with S100‐specific antibodies but did not react with CD68‐specific antibodies, these observations indicated that they were melanocytes. A diagnosis was made of acquired dermal melanocytosis (ADM), even though ADM is very rarely associated with conjunctival and mucosal involvement. Dermal melanocytes and large numbers of mononuclear cells adjacent to small vessels in the upper dermis have not previously been reported in ADM. Such melanocytes might play an important role in protecting blood cells from ultraviolet light. The presence of mononuclear cells close to melanocytes suggests that an inflammatory reaction might have initiated the activation of these dermal melanocytes.
Pigmentation: A Potential Cutaneous Marker for AIDS?
Authors: Grover Chander , Kubba Samir , Bansal Shikha , Nanda Soni , Reddy Belum Siva Nagi
Published: July 2014

Pigmentation of skin, nails and mucosae has frequently been described in HIV positive patients. Various causes for this phenomenon have been ascribed, which include intake of various drugs like zidovudine, opportunistic infections like toxoplasmosis and adrenocortical suppression. However, there has been no uniform explanation. We describe three AIDS patients with different personal and disease profiles but essentially the same pattern of pigmentation. This pattern of pigmentation is thereby discussed. We also propose that this pigmentation could be a result of late stage HIV disease per se and thus could serve as a useful cutaneous marker for the same.
Prurigo Pigmentosa in a Patient with Primary Biliary Cirrhosis and Sjögren Syndrome
Authors: Togawa Yaei , Shinkai Hiroshi , Utani Atsushi
Published: July 2014

A 44‐year‐old Japanese woman suddenly developed severely pruritic erythematous papules on her trunk in a symmetrical distribution. Biopsy specimens showed the typical histopathological findings of prurigo pigmentosa. She had had recurrent episodes of high fever spikes for several years, and lost 10 kg in the last year. She was diagnosed as primary biliary cirrhosis (PBC) associated with subclinical Sjögren syndrome (SjS). Predonisolone (60 mg/day) for two weeks was effective for the PBC and fever, but not for the prurigo pigmentosa. PBC may be involved in the pathogenesis of this rare skin disease.
Oxidative Stress‐Mediated Skin Damage in an Experimental Mobile Phone Model Can Be Prevented by Melatonin
Authors: Ayata Ali , Mollaoglu Hakan , Yilmaz H. Ramazan , Akturk Onur , Ozguner Fehmi , Altuntas Irfan
Published: July 2014

Most mobile phones emit 900 MHz of radiation that is mainly absorbed by the external organs. The effects of 900 MHz of radiation on fibrosis, lipid peroxidation, and antioxidant enzymes and the ameliorating effects of melatonin (Mel) were evaluated in rat skin. Thirty Wistar‐Albino rats were used in the study. The experimental groups were the control group, the irradiated group (IR), and the irradiated+Mel treated group (IR+Mel). A dose of 900 MHz, 2 W radiation was applied to the IR group every day for 10 days (30 min/day). The IR+Mel group received 10 mg/kg/day melatonin in tap water for 10 days before the irradiation. At the end of the 10th day, a skin specimen was excised from the thoracoabdominal area. The levels of malondialdehyde (MDA) and hydroxypyroline and the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH‐Px), and catalase (CAT) were studied in the skin samples. MDA and hydroxyproline levels and activities of CAT and GSH‐Px were increased significantly in the IR group compared to the control group (p<0.05) and decreased significantly in the IR+Mel group (p<0.05). SOD activity was decreased significantly in the IR group and this decrease was not prevented by the Mel treatment. These results suggest that rats irradiated with 900 MHz suffer from increased fibrosis and lipid peroxidation (LPO). Mel treatment can reduce the fibrosis and LPO caused by radiation.
Angiotropic B‐Cell Lymphoma with Telangiectasia, Accompanied by Panniculitic Formation
Authors: Nishiyama Hiromi , Tanei Ryoji , Motegi Takashi , Ohta Masatsugu , Sawabe Motoji
Published: July 2014

A 67‐year‐old female presented with diffuse edema, generalized telangiectasia, and indurated skin plaques. Histopathological findings of the skin lesion included CD45+/CD79+/CD20+ large lymphoma cells that filled the vascular lumina and infiltrated the subcutaneous tissues with panniculitic formations. Three cycles of a CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) chemotherapy regimen resolved the skin manifestations. After five cycles of CHOP, however, she developed dementia‐like symptoms. Three cycles of additional intrathecal chemotherapy (methotrexate, cytarabine and prednisolone) did not improve the neurological symptoms.
A Case of Systemic Osteomyelitides Due to Mycobacterium avium
Authors: Yamashita Toshiharu , Endo Takao , Hamamoto Yasuo , Akiba Hidenari , Ono Ichiro , Jimbow Kowichi
Published: July 2014

A case of multiple osteomyelitides due to Mycobacterium avium (M. avium) infection with osteosclerotic bone lesions is reported. A 67‐year‐old male had been suffering from persistent fever and back pain since October 1999, and 20.0–2.5 mg prednisolone per day was prescribed for continuous inflammatory symptoms in January 2000. Six months later, computed tomography revealed osteosclerotic lesions in the left femur and thoracic vertebrae, but no skin lesion associated with mastocytosis or internal malignancy was identified. In September of 2002, a dome‐shaped, soft subcutaneous tumor developed on the upper sternum. Histopathological findings revealed subcutaneous adipose tissue with several foci of tiny abscesses. Two weeks later, creamy pus was discharged through a draining sinus at the center of the wound. M. avium was demonstrated in the pus by Zeel‐Nielsen staining and microplate hybridization.
Metaplastic Ossification in a Cutaneous Pyogenic Granuloma: A Case Report
Authors: Kim Eun Sung , Kim Kyoung Jin , Chang Sung Eun , Lee Mi Woo , Choi Jee Ho , Moon Kee Chan , Koh Jai Kyoung
Published: July 2014

Cutaneous ossification may occur in association with a variety of cutaneous neoplasms and inflammatory conditions, such as pilomatricomas, basal cell carcinomas, nevi, chondroid syringomas, venous stasis, and scars. However, it has rarely been reported in pyogenic granuloma, a relatively common benign vascular tumor of the skin and mucous membranes. We herein presented a rare case of cutaneous pyogenic granuloma with ectopic ossification on the big toe of a 37‐year‐old man, with high recurrence despite repeated CO2 laser ablations. We propose the hypothesis that vascular endothelial growth factor (VEGF) and bone morphogenetic proteins (BMPs) play pathologic roles in the development of ectopic bone formation in pyogenic granuloma.
Elastin Gene Expression in Blepharochalasis
Authors: Kaneoya Kyoko , Momota Yutaka , Hatamochi Atsushi , Matsumoto Fumiaki , Arima Yaeno , Miyachi Yoshiki , Shinkai Hiroshi , Utani Atsushi
Published: July 2014

Blepharochalasis is a rare condition characterized by recurrent episodes of eyelid edema lead to an atrophic eyelid skin with fine wrinkles and peculiar bronze discoloration. A 32‐year‐old female presented with loose and redundant skin of the bilateral eyelids. We diagnosed her disease as blepharochalasis by clinical features and by disappearance of elastic fibers from the dermis in the biopsied specimen. Because elastic fibers diminish in the late phase of blepharochalasis, we performed RT‐PCR to analyze the mRNA expression of elastin, a major component of elastic fiber. Elastin mRNA expression in the patient's cultured fibroblasts had not decreased compared with that in the control fibroblasts. This result suggests that environmental factors or other matrix components of elastic fibers may be involved in the loss of elastic fiber.