bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case of Recessive Dystrophic Epidermolysis Bullosa with Esophageal Stenosis Treated with Endoscopic Bougienage
Authors: Lee Chan‐Woo , Song Ki‐Hoon , Kim Ki‐Ho
Published: July 2014

Abstracts

Recessive dystrophic epidermolysis bullosa (RDEB) is a rare, hereditary, chronic, noninflammatory mechanobullous disease. Esophageal involvement is invariable in RDEB patients. A 15‐year‐old girl visited with protracted vesiculobullous skin eruptions since birth. On physical examination, bullae, atrophic scars, milia, crusts and erosions were noted primarily on the distal extremities. Loss of entire nails and syndactyly of the right fourth and fifth toes were seen. Diagnosis of RDEB was confirmed by clinical, histopathologic, immunofluorescent and electron microscopic findings. Endoscopic and esophagographic studies revealed a stenosis and several hemorrhagic bullae and erosions. She successfully underwent bougienage under endoscopic and fluoroscopic control
Localized Involutional Lipoatrophy: Report of Six Cases
Authors: Yamamoto Toshiyuki , Yokozeki Hiroo , Nishioka Kiyoshi
Published: July 2014

We herein report six cases of localized involutional lipoatrophy, who presented with a depressive plaque on the lateralis of the upper arm. All patients were female, and three had previous injections for allergic rhinitis at the affected sites before the development of lipoatrophy. One patient received intramuscular injection at the affected site when she had a cold. Histological examination showed fat lobules composed of small lipocytes in the hyaline connective tissue. Immunohistochemical examination revealed a number of CD68‐positive macrophages in the fat lobules. We consider that localized involutional lipoatrophy is more common than has been reported, and is occasionally induced by local injections.
Idiopathic CD4+ T Lymphocytopenia Associated with Disseminated Flat Warts and Alopecia Areata
Authors: Gubinelli Emanuela , Posteraro Patrizia , Girolomoni Giampiero
Published: July 2014

Idiopathic CD4+ T lymphocytopenia is a very rare condition characterized by persistent depletion of circulating CD4+ T lymphocytes, without evidence of HIV or HTLV infection, or other identifiable causes of immunodeficiency. The syndrome can present with dermatological diseases, including viral, fungal and bacterial infections, as well as Kaposi's sarcoma, epithelial cell malignancies, lymphoma and inflammatory dermatoses. We report the case of a 47‐year‐old woman with idiopathic CD4+ T lymphocytopenia who presented with a 10‐year history of disseminated and refractory flat warts from which human papillomavirus type 3 DNA was identified. The patient also had alopecia areata.
A Case of Hypersensitivity Syndrome due to Phenytoin
Authors: Nagai Yayoi , Hattori Tomoyasu , Ishikawa Osamu
Published: July 2014

We report a 30‐year‐old female with hypersensitivity syndrome (HS) due to phenytoin. Her disease course was typical with elevation of the antibody titer for human herpes virus 6. Three courses of methylpredonisolone pulse therapy were required to control the disease activity. Since the pathogenic mechanism and treatments for HS have not been established, further clinical analyses are warranted.
New Aspects of Cutaneous Mosaicism
Authors: Happle Rudolf
Published: July 2014

The concept of cutaneous mosaicism has today been proven at the cellular level in at least fifteen different skin disorders. We can distinguish five different patterns of mosaicism, including the phylloid pattern and the lateralization pattern. Etiologically, cutaneous mosaics can be divided into two large categories, epigenetic mosaicism and genomic mosaicism. All forms of epigenetic mosaicism known so far, including the various patterns of X‐inactivation, appear to be caused by the action of retrotransposons. A new concept is functional autosomal mosaicism transmittable through the action of retrotransposons, which has been described in mice and dogs and may explain, for example, the familial occurrence of pigmentary mosaicism along the Blaschko lines in human skin. Among the examples of mosaicism of autosomal lethal mutations, phylloid hypomelanosis is a recently recognized neurocutaneous entity caused by mosaic trisomy 13. Possible examples of a type 2 segmental manifestation now include at least fifteen different autosomally dominant skin disorders. This phenomenon is most frequently found in glomangiomatosis, cutaneous leiomyomatosis, and disseminated superficial actinic porokeratosis. Recently proposed examples of didymosis (twin spotting) include cutis tricolor, paired patches of excessive or absent involvement in Darier disease, and didymosis aplasticosebacea characterized by coexistent aplasia cutis congenita and nevus sebaceus. To the list of possible examples of paradominant inheritance, cutis marmorata telangiectatica congenita and speckled lentiginous nevus syndrome have now been added. Revertant mosaicism giving rise to unaffected skin areas in autosomally recessive cutaneous traits will certainly likewise be recognized more often when clinicians are bearing this concept in mind. Such cases can be taken as examples of “natural gene therapy”.
Initial Recruitment of Interferon‐γ‐Producing CD8+ Effector Cells, Followed by Infiltration of CD4+ Cells in 2,4,6‐Trinitro‐1‐Chlorobenzene (TNCB)‐Induced Murine Contact Hypersensitivity Reactions
Authors: Okazaki Fusako , Kanzaki Hiroko , Fujii Kazuyasu , Arata Jirô , Akiba Hitoshi , Tsujii Kazuhide , Iwatsuki Keiji
Published: July 2014

Contact hypersensitivity (CHS) is an antigen‐specific, T‐cell‐mediated skin reaction in sensitized individuals. Recent studies have demonstrated that the murine CHS reaction to 2,4‐dinitrofluorobenzene (DNCB) is mediated by CD8+ T cells and down‐regulated by CD4+ T cells. We studied cellular events and functions of infiltrating cells in CHS reactions to 2,4,6‐trinitro‐1‐chlorobenzene (TNCB) in the skin and draining lymph nodes (LN) of BALB/c mice and compared them with the CHS reaction to a house dust mite antigen, Dermatophagoides farinae (Df). Mice were sensitized with TNCB or Df antigens, and CHS reactions elicited with the corresponding antigens were examined immunohistologically. Cytokines produced by individual cells isolated from the CHS reactions were analyzed by flow cytometry, and the expression of cytokine mRNA was assayed by reverse transcription‐polymerase chain reaction (RT‐PCR). Results demonstrated that the intensity of TNCB‐elicited CHS skin reactions reached its peak at 24 hr after elicitation and decreased gradually. Flow cytometric analysis of isolated cells from the TNCB‐elicited CHS reactions demonstrated that the infiltrating cells were composed of approximately 25% CD4+ and CD8+ cells at 12, 24, and 36 hr after challenge, although infiltrating cells became dense at 36 hr by histological observation. The percentage of IFN‐γ‐producing CD8+ cells (Tc1) in the cell fractions reached its peak at 12 hr and decreased gradually. The peak infiltration of IFN‐γ‐producing CD4+ cells (Th1) was observed at 24 hr. IL‐4‐producing cells, however, were always below 5% in the cell fractions. The RT‐PCR method demonstrated that IFN‐γ mRNA was detected in the TNCB‐elicited skin reactions at 12, 18 and 24 hr after elicitation, became weak at 48 hr, and disappeared at 72 hr. No IL‐4 mRNA was detected from 12 to 72 hr. In the draining LN cells, however, the percentages of both IFN‐γ‐producing CD8+ (Tc1) and CD4+ cells (Th1) decreased 12 to 36 hr after TNCB elicitation. CHS reactions of Df antigens were predominantly composed of infiltrations of CD4+ cells in to the skin, associated with the expression of IL‐4 mRNA from 12 to 48 hr after elicitaion. The expression of IFN‐γ mRNA was detected at 48 hr or later. Our findings indicate that the CHS skin reaction to TNCB is induced by early recruitment of IFN‐γ‐producing CD8+ effector cells (Tc1), followed by infiltration of IFN‐γ‐producing CD4+ cells (Th1), whereas IL‐4‐producing T cells (Th2) induce the early CHS response to Df antigens.
Erythema Gyratum Repens Responding to Cetirizine Hydrochloride
Authors: Miyagawa Fumi , Danno Kiichiro , Uehara Masami
Published: July 2014

We report a case of erythema gyratum repens (EGR) in a 59‐year‐old man with inoperable pancreatic cancer and liver metastasis. The patient had a widespread erythema with concentric marginal band spreading in waves over the trunk and extremities. Numerous vesicles were seen on the margin of the erythema. The skin lesions were severely pruritic, and his peripheral blood showed marked eosinophilia. He also had palmoplantar hyperkeratosis. A biopsy specimen of the erythema disclosed spongiosis, microvesicles filled with eosinophils, infiltration of eosinophils into the epidermis, and a perivascular infiltrate in the dermis. The skin lesions and pruritus cleared quickly after the administration of cetirizine hydrochloride.
A Keratin 9 Gene Mutation (Asn160Ser) in a Japanese Patient with Epidermolytic Palmoplantar Keratoderma
Authors: Tsunemi Yuichiro , Hattori Naoko , Saeki Hidehisa , Adachi Makoto , Komine Mayumi , Nakagawa Hidemi , Tamaki Kunihiko
Published: July 2014

We described a 5‐year‐old Japanese girl with epidermolytic palmoplantar keratoderma and examined her for a keratin 9 gene mutation. Physical examination disclosed diffuse yellowish hyperkeratosis with an erythematous border limited strictly to the palms and soles. Histological examination revealed hyperkeratosis with vacuolar degeneration in the spinous and granular layers of the epidermis. Sequence analysis demonstrated an A to G transition at the middle position of codon 160 in the 1A domain of the keratin 9 gene. The amino acid at codon 160 was deduced to have changed from asparagine (Asn) to serine (Ser). This is the first case with an Asn160Ser mutation in a Japanese. The substitution of Ser for Asn at codon 160 of the keratin 9 gene is assumed to be fatal for keratin filament assembly regardless of race or ethnicity.
Psoriasis Vulgaris and Poland's Syndrome in the Same Patient
Authors: Sasmaz Sezai , Coban Y. Kenan , Boran Cetin , Gumusalan Yakup
Published: July 2014

Most common anomalies associated with Poland's syndrome are in the chest wall. This type of anomaly causes important psychological distress, especially in adolescent girls. A 19‐year‐old female with Poland's syndrome having psoriatic plaques on her trunk, knees, and elbows is reported in this paper. Such an association of Poland's syndrome with psoriasis has not been described previously.
A Case of Polypoid Dermatofibroma
Authors: Sogabe Yoko , Takahashi Ayumi , Tamura Atsushi , Ryuzaki Keiichiro , Ishikawa Osamu
Published: July 2014

Dermatofibroma is a common benign cutaneous tumor that usually appears as a slowly growing firm nodule. Polypoid nodular dermatofibroma is a variant type that is rarely encountered. We reported a case of polypoid dermatofibroma with a review of the previously reported cases. Polypoid dermatofibroma tends to arise on the leg, especially below the knee. Its size is often larger than that of common dermatofibroma. It is speculated that both the underlying firm tissue and long‐term development may lead the tumor to form a polypoid appearance.
Co‐Existence of Variants of Porokeratosis: A Case Report and a Review of the Literature
Authors: Kaur Sukhjot , Thami Gurvinder P. , Mohan Harsh , Kanwar Amrinder J.
Published: July 2014

Rarely, different variants of porokeratosis may coexist in an individual patient or their family members. A patient with the linear form of porokeratosis present since birth subsequently developed the disseminated superficial actinic form at a later age. A review of the literature pertaining to the coexistence of variants of porokeratosis suggests a significant association between the linear and disseminated superficial actinic forms. Genetic linkage between different variants and the basis for their association is discussed.
Intradermal Nodular Fasciitis of the Face
Authors: Kang Sook‐Kyoung , Kim Hyoung‐Hun , Ahn Se‐Jin , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: July 2014

Nodular fasciitis represents reactive myofibroblastic proliferative lesions in the subcutaneous tissue, skeletal muscles, and fascia. Uncommon clinical and pathological variants of nodular fasciitis, such as intravascular, cranial, ossifying, and proliferative fasciitis, have been described. Six cases documenting a dermal location of nodular fasciitis have been reported in the English literature. Some authors have described that the histopathological features of intradermal nodular fasciitis are virtually identical to those of postoperative/posttraumatic spindle cell nodule of the skin. We herein report a 41‐year‐old Korean woman presenting with a 0.5 cm facial papule in which nodular fasciitis occurred in the dermis.
Wolf's Isotopic Response: A Case of Zosteriform Lichen Planus
Authors: Türel Aylin , Öztürkcan Serap , Şahin M. Turhan , Türkdoğan Peyker
Published: July 2014

Lichen planus is a lichenoid disorder characterized by shiny, flat papules. In addition to the classical appearance, there are several variants. Zonal or zosteriform lesions have been described. A 25‐year‐old male with a complaint of increasing numbers of erythematous swellings on his left groin for twenty days was admitted to our out‐patient clinic. He had a history of herpes zoster in the same localization which had been treated with topical acyclovir two weeks prior to his admission. Dermatological examination revealed multiple, shiny, erythematous, umblicated papules localized to the left inguinal region in a linear pattern. A biopsy was taken from the lesions. According to the clinical and pathological findings the diagnosis was zosteriform lichen planus. Zosteriform lichen planus is a rare variant of lichen planus; its differentiation from zona zoster and other linear dermatoses is difficult. We presented our case because of its rarity as a variant of lichen planus and its appearance in the area of healed herpes zoster as an isotopic response.
Colon Carcinoma with Synchronous Subcutaneous and Osseous Metastasis: A Case Report
Authors: Camci Celalettin , Türk H. Mehmet , Büyükberber Süleyman , Karakök Metin , Koruk Mehmet , Beyazity Yildirim , Inalöz H. Serhat
Published: July 2014

Colon cancer usually metastasizes initially to regional lymphatics and later through the bloodstream. Hematogenous metastasis usually includes the liver, lungs, and brain. In colorectal cancer, osseous and/or subcutaneous metastasis without liver metastasis is a very uncommon event. We present here a case of colon adenocarcinoma, which synchronously metastasized to facial and other subcutaneous tissue and to bone within a short period after definitive therapy. Although such a pattern is uncommon, diagnostic biopsy for any new or suspicious lesion of the skin and bone scintigraphy for symptomatic patients should be done for patients with a colorectal cancer history.
Papular‐Purpuric Gloves‐and‐Socks Syndrome with Bloody Bullae
Authors: Higashi Natsuko , Fukai Kazuyoshi , Tsuruta Daisuke , Nagao Jun , Ohira Hidehiro , Ishii Masamitsu
Published: July 2014

Papular‐purpuric gloves‐and‐socks syndrome (PPGSS) is a disease characterized by itchy, painful acral erythema with edema, confluent papules, and purpura in a gloves‐and‐socks distribution and is associated with fever and mucosal lesions. Parvovirus B19 and other viral infections have been proven to be causative agents of this syndrome. Its histological findings have been the non‐specific ones of interface dermatitis. Here, we report a case of PPGSS in a 44‐year‐old man that we believe to be the first such case in Japan. He developed, within one day, a painful edematous eruption with confluent papules and purpura on his hands and feet accompanied by high fever. A unique clinical manifestation in this case was multiple bloody bullae on the toes, which have not been previously described. Serological tests were negative for parvovirus B19, cytomegalovirus, and measles virus.
Detection of Herpes Simplex Virus DNA in Serum and Oral Secretions during Acute Recurrent Herpes Labialis
Authors: Youssef Randa , Shaker Olfat , Sobeih Sherine , Mashaly Heba , Mostafa Wedad Z.
Published: July 2014

Although herpes simplex virus (HSV) has been detected in the peripheral blood of immunocompromised patients and in neonates with disseminated disease, the extent to which the virus may be present in the blood during a localized infection in otherwise healthy patients is still unknown. Literature on patterns of HSV shedding into the oral cavity at the prodromal stage of the disease, during recurrences, and also during asymptomatic periods is still lacking. The present study aims at the detection of HSV DNA in the serum and oral secretions during acute herpes labialis using a highly sensitive technique, the polymerase chain reaction (PCR). The study included 10 patients with acute herpes labialis and five healthy controls. Using PCR, herpes simplex virus DNA was detected in the serum of seven patients (70%) and in the saliva of nine patients (90%). One of the control cases showed positive HSV DNA in the saliva (20%). There was good statistical agreement between the presence of HSV DNA in the serum and saliva. Frequency of attacks, patient's age, and gender had no statistically significant effect on the presence of the virus in serum or in saliva. It is concluded that HSV viremia during attacks of recurrent herpes simplex is more frequent than previously appreciated.
Effect of Two Consecutive Earthquakes on Outbreaks of Alopecia Areata
Authors: Kavak Ayse , Yesildal Nuray , Parlak Ali Haydar
Published: July 2014

The pathogenesis of alopecia areata (AA) is still unknown. We investigated whether two consecutive earthquakes in Duzce, Turkey within a 3‐month interval could precipitate AA. Patients who developed AA after the first earthquake in Duzce were included in this study. The admittance rate and demographic characteristics of AA patients admitted in the same period of the previous year (BE=before earthquake group) were compared to that of AA patients admitted after the earthquake (AE=after earthquake group). The admittance rate and onset of AA after the first earthquake were investigated retrospectively. In addition, possible relationships between the earthquake and age at the first attack, severity of the disease, and ophiasis were studied. The ratio of AA patients in the BE group was 12/1121 (0.9%), while this value was 26/1430 (1.8%) in the AE group (p=0.07). There were no significant differences with regard to sex, age of the first attack, severity of the disease, or ophiasis between the two groups. AA appeared between 18–28 weeks after the first earthquake in 14 (53.8%) of the patients. The earthquake did not increase the admittance rate of AA significantly. This finding suggests that a stressful event such a natural disaster is not a unique factor in AA outbreaks.
Frictional Hair Loss in Iraqi Patients
Authors: Sharquie Khalifa E. , Al‐Rawi Jamal R , Al‐Janabi Hassan A
Published: July 2014

A total of 50 Iraqi male patients with frictional hair loss were studied. Their ages ranged from 27–55 years with a mean ± SD of 40.60 ± 7.82 years. The age of onset ranged from 26–50 years with a mean ± SD of 38 ± 7.3 years. The duration of disease was 1–5 years, mean ± SD 2.2 ± 1.3. Middle age was the most common age group affected. Patterns of hair loss were as follows; bilateral thighs & legs 13 (26%), bilateral thighs alone in 9 patients (18%), bilateral shins & calves (legs) in 4 patients (8%), abdomen alone in 8 patients (16%), thigh and abdomen 4 (8%) patients, legs & abdomen 4 (8%) patients, and all sites in 12 patients (24%). The pattern of patchy hair loss showed some etiological preference. It was found to be due to continuous pressure from socks, trousers and bed. Skin biopsies from five patients showed apparently normal histology. Twenty‐six (52%) of the cases were healthy. There were no important medical or dermatological associations, such as alopecia areata or peripheral neuropathy in any patient although unrelated medical conditions were seen in 24 (48%). To the best of our knowledge, this type of patchy hair loss has attracted very little attention in the past, and the literature appeared to be deficient in references to this problem.
Arsenic Keratosis and Pigmentation Accompanied by Multiple Bowen's Disease and Genitourinary Cancer in a Psoriasis Patient
Authors: Park Je Young , Rim Jong Hyun , Choe Yong Beom , Youn Jai Il
Published: July 2014

We report a case of arsenic keratosis and pigmentation accompained by multiple Bowen's disease and genitourinary cancer in a 64‐year‐old man. He was a psoriasis patient with a history of herbal medication for about thirty years. He showed multiple hyperkeratotic plaques on the bilateral palms, soles, and multiple, brownish, scaly, elevated papules on the back in addition to diffuse hyperpigmentation. Biopsy confirmed arsenic keratosis and Bowen's disease. Transitional cell carcinoma was also detected on his ureter and bladder during follow‐up. The skin lesions were treated with topical 5‐fluorouracil, etretinate, and excision with improvement.
Seasonal Variation in Acne Vulgaris—Myth or Reality
Authors: Sardana Kabir , Sharma Ravi C. , Sarkar Rashmi
Published: July 2014

A traditional opinion proposed by Western dermatologists is that acne improves in summer and worsens in winter. We studied 452 patiens with acne vulgaris and asked them about seasonal variation in their acne. A total of 229 patients (50.67%) complained of a seasonal variation; a significant proportion (56.33%) noticed an aggravation in summer, while 16.16% improved in summer and only 11.35% worsened in winter. Apparently winters did not affect the severity of acne in a majority of patients (64.20%). Significantly, a majority (80.62%) of patients noticed a summer aggravation due to sweating and increased humidity. Thus our study is at variance with the existing literature, with summer aggravation being the predominant complaint. We would like to propose that the increased temperature, marked humidity, and sweating might explain the results seen in our region.
Lupus Erythematosus Associated with C1 Inhibitor Deficiency
Authors: Koide Masayo , Shirahama Shigeho , Tokura Yoshiki , Takigawa Masahiro , Hayakawa Masakatsu , Furukawa Fukumi
Published: July 2014

We report here a patient with skin lesions of lupus erythematosus (LE) associated with a type 1 hereditary C1 inhibitor deficiency. She had not experienced any episodes of angioedema. A histological examination of the affected skin lesions demonstrated liquefaction of the basal cell layer in the perifollicule. Direct immunofluorescence staining revealed the granular deposition of IgM along the dermo‐epidermal junction. Blood laboratory examinations revealed low levels of CH50, C1q, C4, C2 and C1 inhibitor, but the C3 and C5 levels were within normal limits. Similar reductions in the C1 inhibitor levels were observed in 2 out of 3 sisters. Although one sister has been asymptomatic until now, the other has suffered from SLE. The antinuclear antibody titer was negative initially, but has changed to positive. The skin lesions became pigmented following topical corticosteroid therapy, but the deficient complement component levels remained unchanged. We also reviewed 23 cases in the literature of hereditary C1 inhibitor deficinecy associated with SLE, DLE, LE‐like eruption, and SCLE and discussed several common characteristics such as a female predominance, a high incidence of antinuclear antibodies, cutaneous manifestations, and photosensitivity.
A Case of Hereditary Hemorrhagic Telangiectasia (Rendu‐Osler‐Weber's Disease) with Dystrophic Calcinosis Cutis and Retinal Lesions
Authors: Takahama Hideto , Noto Shigemitsu , Ito Masaru , Nishimoto Hiroyuki , Tadokoro Mamoru
Published: July 2014

A 65‐year‐old Japanese female developed a nodule on the distal interphalangeal joint of her right thumb. She also had multiple telangiectasias on her face, oral mucosa, tongue, nasal mucosa and upper extremities. A lip biopsy showed irregularly dilated capillaries and venules lined by flat endothelial cells. The nodule in the right thumb was resected. Histopathology revealed calcium deposits in the dermis. This case was diagnosed as dystrophic calcinosis cutis within hereditary hemorrhagic telangiectasia. Ophthalmologic examination showed bilateral retinal vascular lesions with dilated and tortuous retinal venules.
A Case of Multiple Bowen's Disease with Squamous Cell Carcinoma of the Larynx and Adenocarcionoma of the Prostate
Authors: Rho Nark‐Kyoung , Choi Suk‐Jin , Lee Eil‐Soo
Published: July 2014

Bowen's disease, or cutaneous squamous cell carcinoma in situ, has been regarded as a cutaneous marker for internal malignancy. However, the relationship of Bowen's disease to visceral cancers remains controversial. We present a 76‐year‐old male with multiple lesions of Bowen's disease, who later developed laryngeal cancer and subsequent prostate cancer with distant metastases. Efforts to detect possible common etiologic agents including human papillomavirus and chronic arsenicism revealed no association between Bowen's disease and the internal malignancies. Despite the controversy, we suggest that a conservative cancer workup is ethically indicated in patients with multiple Bowen's disease.
Cutaneous Hyalohyphomycosis and Onychomycosis Caused by Onychocola canadensis: Report of the First Case from Turkey
Authors: Erbagci Zülal , Balci Iclal , Erkiliç Suna , Zer Yasemin , Inci Ramazan
Published: July 2014

We present the first Turkish case of skin and nail infection due to Onychocola canadensis in an otherwise healthy farmer who frequently worked barefoot on soil. Cutaneous involvement consisted of scaly and hyperkeratotic lesions resembling tinea pedis, erythematous plaques, and dermal papulonodules of various sizes simulating Majocchi's granuloma. Repeated cultures from nail plates, skin scrapings and needle aspiration materials from papules or nodules all yielded the same mold on Sabouroud dextrose media with and without cycloheximide, trichophyton agar, and potato dextrose agar at 26°C. The causal isolate was identified as Onychocola canadensis Sigler gen. et sp. nov., a slow‐growing arthroconidial hyphomycete, on the basis of its colonial and microscopic morphology. While skin lesions were responsive to daily itraconazole in a dose of 200 mg for three months, the onychomycosis was resistant to therapy. To our knowledge, this is the first presentation of O. canadensis as the cause of cutaneous hyalohyphomycosis to date.
Solitary Mastocytoma Improved by Intralesional Injections of Steroid
Authors: Kang Nam‐Gyu , Kim Tae‐Heung
Published: July 2014

Solitary mastocytoma is an uncommon disease characterized by monotonous infiltrations of mast cells that extend from papillary dermis to subcutaneous fat. They usually resolve by adulthood, and there is no satisfactory treatment other than waiting. A two‐month‐old Korean male infant with deep solitary mastocytoma was treated intralesionally with triamcinolone acetonide. His mastocytoma in medial malleolus was very distressing because it was very sensitive to friction, and he was just reaching the crawling stage. After three injections, his skin lesion flattened with marked decrease of erythema and subjective symptoms. His skin lesion has continued to have a good clinical response for 9 months after the last treatment.
Roles of Stress, Stress Perception and Trait‐Anxiety in the Onset and Course of Alopecia Areata
Authors: Brajac Ines , Tkalčić Mladenka , Dragojević Danijela Malnar , Gruber Franjo
Published: July 2014

Clinical observations suggest that the nervous system, including psychological factors, can influence the onset and course of alopecia areata (AA). The aim of this study was to determine whether stressful life events, stress perception, and trait‐anxiety are risk factors in the onset and course of AA. A group of 45 patients diagnosed with AA and a group of 45 healthy controls were participants in the study. The patients with AA were divided into two subgroups: patients with a first episode of AA and patients with recidivism of the disease. All participants completed questionnaires addressing sociodemographic, clinical and psychological aspects of their disorder. The frequency and types of stressful life events experienced over the previous six months were recorded. Lemyre and Tessier's Mesure de Stress Psychologique was used to measure emotional, cognitive, behavioral, and physiological aspects of distress. Anxiety was evaluated by the Spielberg's Trait Anxiety Inventory. The subgroups of AA and the control group, using the same numbers of subjects matched for age and sex, education level, marital and employment status, were statistically compared. The number of patients with four stressful life events over the previous 6 months was significantly higher in the group of AA patients with recidivism of disease compared to the control group (P=0.004). There were no differences among the other groups with respect to the frequency of life events. Examination of the relationships between the two groups regarding anxiety, as well as perceived distress, revealed that the groups differed significantly with respect to psychosocial variables studied. A significantly higher degree of trait‐anxiety and perceived distress were observed among patients in both AA subgroups (first onset and recidivism of AA) than in the healthy control group. The highest scores for anxiety and stress perception among examined groups were obtained in the group with recidivism of AA (33.42 ± 12.71 and 90.32 ± 50.74, respectively). Trait‐anxiety and stress perception constitutes risk factors that may influence the onset and exacerbation of AA. The present study does not provide evidence of a significant role of stress in the onset of AA. Life events may play an important role in triggering of some episodes.
Tinea Capitis among Children and Adolescents in the Farwaniya Region of Kuwait
Authors: Nawaf Al‐Mutairi , Joshi Arun , Zaki Amr , Nour‐Eldin Osama , Al‐Sheltawy Mazen , El‐Adawy Ibtesam , Sharma Ashok K.
Published: July 2014

Analysis of 325 patients (182 males, 143 females) of mycologically proven tinea capitis (TC) seen over a period of two years from January 2001—December 2002 in the Farwaniya region of Kuwait is presented in this study. The age range was 8 months to 17 years. Peak incidence was observed in the 3–14 year age group (79.6%). Positive family history and contact with pets were noted in 22% and 36.7% of the cases, respectively. The non‐inflammatory ‘gray patch’ variety was the most common clinical type, seen in 163 (50.2%) children, followed by the black‐dot variant in 100 (30.2%) patients. A significant proportion of the cases (16.6%) had the uncommonly reported seborrheic dermatitis or dandruff like pattern. Highly inflammatory kerion was encountered infrequently (2.5%). Seven species of dermatophytes were isolated; Trichophyton violaceum in 135 (41.5%), followed by Microsporum canis in 89 (27.4%), Microsporum audouinii in 48 (14.8%), Trichophyton mentagrophytes var. mentagrophytes in 31 (9.5%), Trichophyton verrucosum in 15 (4.6%), Trichophyton tonsurans in 6 (1.9%) and Microsporum gypseum in 1 (0.3%) patient. T. violaceum was the most common fungus responsible for the black‐dot variety (89/100) and kerion (4/8) patients. Three cases of kerion (33.3%) grew T. verrucosum. M. canis was the most common species isolated from the ‘gray patch' cases (79/163; 48.5%) followed by almost equal prevalences of T. violaceum (16.6%), M. audouinii (15.3%), and T. mentagrophytes var. mentagrophytes (12.3%). Among the seborrheic type of cases, M. audouinii was the most common fungus isolated in 20/54 (37%) followed by T. violaceum in 15 (27.8%), T. mentagrophytes var. mentagrophytes in 9 (16.7%), M. canis in 8 (14.8%) and T. verrucosum and T. tonsurans in one (0.3%) patient each. The results are significantly different from those in earlier studies in Kuwait.
A Case of Intravascular Large B‐Cell Lymphoma with Multiple Organ Involvement
Authors: Yanagihori Hirokatsu , Oyama Noritaka , Kawakami Yoshio , Sakuma‐Oyama Yohko , Nakamura Koichiro , Iwatsuki Keiji , Kaneko Fumio
Published: July 2014

Intravascular large B‐cell lymphoma (IVL) is a rare systemic disease characterized by clonal proliferation of neoplastic lymphoid cells within the capillary lumina of small blood vessels. The most common sites of involvement are cerebrovascular or sinusoid areas, resulting in a wide variety of neurologic deficits. Herein we describe a case of IVL that presented with multiple internal and external organ involvements, including the skin, bilateral kidneys, and lung, and with an aggressive clinical course. The confirmative diagnosis was based on the microscopic findings of the skin lesion with a B‐cell immunophenotype. The patient suffered from repeated severe dyspnea, hypoxemia, and high‐grade fever with a simultaneous increase in serum lactate dehydrogenase and soluble IL‐2 receptor levels. These manifestations responded dramatically to intravenous injection of corticosteroid (500 mg/day for 3 days). Despite various clinical presentations, no neurological abnormality was observed until the patient died 12 months after the initial combination chemotherapy.
P‐Cadherin Expression in Skin Peeled with Phenol or Trichloroacetic Acid (TCA)
Authors: Yamamoto Yuki , Uede Koji , Ohtani Toshio , Wakita Hisashi , Furukawa Fukumi
Published: July 2014

P‐cadherin expression patterns were studied in trichloroacetic acid (TCA) or phenol treated skin. The expression was absent or very weak on the basal cell surfaces by day 2. Seven days after peeling, P‐cadherin was clearly distributed in a continuous granular pattern over the cell surface of the entire epidermis of the 40% TCA treated skin, in a weak granular pattern on a few suprabasal cells and basal cells of the phenol treated skin, and very weakly expressed on the lateral surfaces and in the cytoplasm of basal cells of the 60% TCA treated skin. Based on the present results and previous reports, it is likely that there are distinct patterns of P cadherin expression. Furthermore, a specific type of P cadherin expression might be involved in wound healing in general, which could provide new insights into tissue repair mechanisms after chemical peeling.
Role of Foods in Irregular Aggravation of Atopic Dermatitis
Authors: Uenishi Toshiaki , Sugiura Hisashi , Uehara Masami
Published: July 2014

Although it is well known that patients with atopic dermatitis often show unpredictable, irregular aggravation of skin lesions, there are no previously published studies examining trigger factors for such unpredictable aggravation. We investigated whether foods play a role in the unpredictable, irregular worsening of atopic dermatitis. The patient group included 195 Japanese adult patients with atopic dermatitis who showed unpredictable, irregular aggravation of skin lesions. They were hospitalized and openly challenged with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. Challenge‐positive foods were determined by evaluating the comparable before‐after challenge photographs. One to three (average: 1.7) challenge‐positive foods were confirmed in 86 (44%) of the 195 patient examined. Predominant offending foods were chocolate, cheese, coffee, yogurt and some Japanese foods such as glutinous rice cake, soy sauce and fermented soybeans. Specific IgE values to the offending foods were mostly negative. Patients were asked to exclude challenge‐positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a progressive improvement of the disease. These results suggest that foods play an important role in unpredictable, irregular aggravation of skin lesions in patients with atopic dermatitis.
Severe Palmo‐Plantar Hyperkeratosis in Koebner Epidermolysis Bullosa Simplex
Authors: Shirakata Yuji , Tamai Katsuto , Nakaoka Hiroki , Tokumaru Sho , Sayama Koji , Murakami Shinji , Hashimoto Koji
Published: July 2014

A 22‐year‐old Japanese woman with Koebner epidermolysis bullosa simplex presented with severe palmo‐plantar hyperkeratosis. Skin biopsy specimens from the palm revealed hyperkeratosis and acanthosis with blistering in the basal cell layer. An electron microscopic study showed cytolysis of basal cells and clumping of tonofilaments forming thick bundles and perinuclear electron‐dense bodies. Hand contractures were released and covered with full thickness autografts or split thickness autografts. The donor site was successfully treated with cultured epidermal autografts.
Bilateral Scalp Necrosis with Giant Cell Arteritis
Authors: Matsushima Midori , Yamanaka Keiichi , Mori Hitoshi , Murakami Takaaki , Hakamada Arata , Isoda Ken‐ichi , Mizutani Hitoshi
Published: July 2014

We present a patient with bilateral scalp necrosis caused by giant cell arteritis (temporal arteritis). A 67‐year‐old woman, who had been treated with 5 mg of oral prednisolone every other day for polymyalgia rheumatica, developed painful egg‐sized regions of necrosis on both of her temples. Doppler pulsemetory revealed bilateral obstruction of the temporal arteries. Biopsy revealed ischemic necrosis of the skin and necrotic angiitis of the temporal arteries with giant cell infiltration. Bilateral stenosis of the internal carotid arteries and moderate retinal bleeding were revealed by angiography. Daily administration of prednisolone (20 mg/day) with intravenous and topical limaprost alphadex markedly improved her condition. The ulcers reepithelized without surgical treatment. There are few reports of bilateral scalp necrosis. Rapid and complete obstruction of the temporal artery may result in this condition. Simultaneous development of two ulcerative lesions in the ventro‐parietal cranial regions is thought to correspond to systemic arterial involvement, including involvement of the internal carotid arteries.
Solar Facial Porokeratosis
Authors: Sharquie Khalifa E. , Al‐Baghdady Bahaa A.
Published: July 2014

Porokeratosis is comprised of a heterogeneous group of disorders that are inherited in autosomally dominant fashion. It has a wide variety of manifestations. In the last ten years, we have treated cases of porokeratosis that don't fit into the well known categories of porokeratosis. For this reason, the present study was carried out. This study included 15 cases whose ages ranged from 19–37 years with a mean ± SD of 26.93 ± 4.52. There were 12 females and 3 males. The duration of the disease ranged from 1–10 years with a mean ± SD of 4 ± 2.85 years. Their lesions were located only on the face, mostly on the distal part of the nose and the surrounding perinasal area. The number of lesions on each patient ranged from 1–15, with a mean ± SD of 4.73 ± 4.35. The morphology of these lesions consisted of papules with a size range from 0.1–1 cm and a warty appearance. They were skin colored and surrounded by a keratotic rim in the form of a collar. The histopathology showed the picture of porokeratosis with cornoid lamellae and additional features characteristic of this disease. We concluded that facial solar porokeratosis is a variant of porokeratosis and is a disease of the nose of young females with a characteristic clinical and histopathological picture.
Cutaneous Undifferentiated Small (Merkel) Cell Carcinoma, that Developed Synchronously with Multiple Actinic Keratoses, Squamous Cell Carcinomas and Basal Cell Carcinoma
Authors: Aydin Abdullah , Koçer N. Emrah , Bekerecioğlu Mehmet , Sari Ibrahim
Published: July 2014

Merkel Cell Carcinoma (MCC) is an uncommon undifferentiated neuroendocrine tumor, arising in skin mainly on sun‐exposed areas. We present an unusual case of primary cutaneous undifferentiated small cell carcinoma that co‐existed with six other lesions; 2 actinic keratoses, 3 squmaous‐cell carcinomas and a basal‐cell carcinoma. HE stained sections revealed MCC located in the mid‐dermis, co‐existing with severe actinic keratosis. Immunohistochemically, the tumor cells reacted to cytokeratin 20, epithelial membrane antigen, chromogranin and neuron specific enolase. This is an unusual case of cutaneous MCC co‐existing with six other different lesions. The concurrent development of MCC, squamous‐cell and basal‐cell carcinoma in the same patient indicates the pluripotent epidermal stem cell origin of these tumors. Further research is needed to enlighten the factors inducing this divergent differentiation.
Purpura with Cold Urticaria in a Patient with Hepatitis C Virus Infection‐Associated Mixed Cryoglobulinemia Type III: Successful Treatment with Interferon‐β
Authors: Ito Akiko , Kazama Takashi , Ito Kaoru , Ito Masaaki
Published: July 2014

We describe a 54‐year‐old man with hepatitis C virus (HCV) infection‐associated cryoglobulinemia type III. The patient had suffered from cold‐induced urticaria that left purpuric eruptions up to 1 cm in diameter, intermittent migratory joint pain for seven years and mild liver dysfunction for nine years. Hemophilia A was diagnosed when the patient was 26 years old, and he was then given infusions of factor VIII for a short time. In both skin biopsy samples from urticarial and purpuric eruptions, mild inflammatory infiltration by polymorphonuclear leukocytes with nuclear dust, extravasation of erythrocytes and deposition of IgM and C3 in the superficial blood vessels were observed. After antiviral treatment with interferon‐β, the clinical symptoms and the cryoglobulin and HCV‐RNA in the serum disappeared. There has been no recurrence in the subsequent nine years.
A Case of Bullous Pemphigoid Successfully Treated by Plasmapheresis: Assessment of the Change in Titers of Circulating Antibodies by Immunoblotting and Enzyme‐Linked Immunosorbent Assay
Authors: Lee Jee Bum , Fumimori Takeaki , Kurose Koichiro , Mori Osamu , Hashimoto Takashi
Published: July 2014

We report a case of bullous pemphigoid successfully treated with double filtration plasmapheresis. The changes in titers of circulating autoantibodies were assessed by immunoblotting and enzyme‐linked immunosorbent assay (ELISA) using a recombinant protein of the non‐collagenous 16a (NC16a) domain of the 180 kDa bullous pemphigoid antigen (BP180). The ELISA was shown to be more sensitive in detecting disease‐specific antoantibodies in the bullous pemphigoid sera. The reduction of titers of circulating autoantibodies in the sera correlated well with the decrease in the disease activity in both the first and second rounds of plasmapheresis treatment in this case.
A Case of Nodular Cutaneous Lupus Mucinosis
Authors: Terao Hiroshi , Moroi Yoichi , Urabe Kazunori , Koga Tetsuya , Furue Masutaka
Published: July 2014

The patient was a 44‐year‐old female. She was diagnosed as having systemic lupus erythematosus at the age of 21 years and had been receiving systemic steroid treatment (5 mg prednisolone/day). Nodules began to appear on her neck, chest and back from June in 2000, and she was referred to our clinic for examination and treatment. Examination of a biopsy sample of an eruption on the neck revealed mucin deposition in the dermis. Based on the clinical and histopathological findings, she was diagnosed as having typical nodular cutaneous lupus mucinosis. The dose of steroid was increased, and the eruptions gradually disappeared.
Vitamin D and the Skin
Authors: Kira Masahiro , Kobayashi Teruaki , Yoshikawa Kunihiko
Published: July 2014

Vitamin D was originally discovered as a factor that regulates calcium and bone metabolism. Recent advances in investigation have shown that vitamin D also functions as a regulator of cellular growth and differentiation in various tissues. The skin is not an exception from such effects of vitamin D; it is regarded as a site of its activation and action. Evidence has accumulated showing that the active form of vitamin D and its analogs suppress growth and stimulate the terminal differentiation of keratinocytes. In psoriatic lesions, epidermal keratinocytes exhibit hyper‐proliferation and impaired differentiation triggered by inflammation. Therefore, it is quite reasonable that vitamin D is effective on psoriasis. Indeed, within the past decade, analogs of vitamin D3 have been used as topical therapy for psoriasis. In this review, we summarize the fundamental features of vitamin D and the development of vitamin D therapy for psoriasis. Clinical application to other skin diseases and the future of vitamin D therapy in dermatology are also discussed.
Cutaneous Concerns of Scleroderma Patients
Authors: Paquette Dana L. , Falanga Vincent
Published: July 2014

The clinical features of facial and oral involvement in scleroderma are striking. We conducted a survey of patients with systemic sclerosis (scleroderma). The purpose of our study was to ascertain what was most bothersome aesthetically to scleroderma patients. We also looked at the differences between age groups and genders. The survey was mailed to 1,000 individuals who subscribe to a national lay group organization. We received 303 completed surveys indicating the patient's age, gender, age at onset of disease, and a checklist of 14 physical variables involving the central face and non‐face. The respondents were asked to rate their level of concern [on a scale of great (1) ‐moderate (2) ‐little (3) ‐none (4)] in regards to 14 different physical variables. The respondents consisted of 92% females and 8% males. The mean age was 59 years +/– 13 (SD), and the median age was 60. The mean and median age at diagnosis was 45 years +/– 15 (SD). The percentage of respondents expressing concern for specific features was the following: for thin lips (73%), mouth furrows (80%), loss of facial lines (68%), and a smaller, tighter mouth (77%). There was less concern over the non‐face features. The percentage of respondents expressing no concern was the following: for absence of sweating (57%), skin darkening (50%), nail dystrophy (57%), and skin atrophy (63%). There was a highly statistically significant difference (p<0.0001) between those respondents concerned with central face features vs. non‐face features. With advancing age and longer disease duration, there was increased concern over the aforementioned central face features (p<0.0001). The vast majority of patients with systemic sclerosis have great concerns over changing facial features, and this worsens with age.
Effectiveness of Iontophoresis with Alternating Current (AC) in the Treatment of Patients with Palmoplantar Hyperhidrosis
Authors: Shimizu Hirokazu , Tamada Yasuhiko , Shimizu Junko , Ohshima Yuichiro , Matsumoto Yoshinari , Sugenoya Jun‐ichi
Published: July 2014

Conventionally, iontophoresis employing direct current (DC) has been used in the treatment of palmoplantar hyperhidrosis, but this is accompanied by side effects such as pain and burns. In the present study, a prototype apparatus using alternating current (AC) was constructed, and iontophoresis with AC was performed in palmoplantar hyperhidrosis patients to determine its effectiveness. The average amount of perspiration of the palmoplantar hyperhidrosis patients was significantly reduced after the third session when iontophoresis treatments were performed once per week. By the eighth treatment, perspiration was reduced to nearly the normal level, and there were no particular side‐effects during the treatment period. This treatment therefore appears to be both safe and effective. The treatment effect tended to appear sooner when alternating current iontophoresis was combined with the administration of anticholinergic drugs than when alternating current iontophoresis was used alone. Alternating current iontophoresis is an effective treatment for palmoplantar hyperhidrosis. Guidelines for this treatment for patients with palmoplantar hyperhidrosis will need to be established in the future.