bluuebunny/crossref_metadata_2025 huggingface dataset:
Superficial Granulomatous Pyoderma: A Case Report of Two Japanese Patients and Clinical Comparison with Foreign Patients
Authors: Kaneko Takahide , Tamai Katsuto , Yamazaki Takehiko , Harada Ken , Nakano Hajime , Hanada Katsumi
Published: July 2014

Superficial granulomatous pyoderma (SGP) is an unusual variant type of pyoderma gangrenosum characterized by a benign course and specific histological features; it is quite a rare cutaneous disorder in Japan. We reported two Japanese cases of SGP and compared the clinical features of 13 Japanese cases with those of 42 foreign cases. Case 1 was a 53‐year‐old female who presented with three indolent and ulcerative plaques with elevated edges on the back and the posterior portion of the left thigh. Case 2 was a 74‐year‐old female who presented with crusted and vegetative erythematous plaques on the left shoulder and left upper arm. Histological examinations revealed a characteristic three‐layer granuloma in each case. Laboratory and physical examinations found no abnormalities. Topical corticosteroid, oral administration of minocycline, and/or additional supplementation with corticosteroid were effective. In comparison with foreign cases, Japanese cases show a possible differentiation in the ratio of sex and distribution of the ulcer. Females have a high incidence and the extremities are frequently involved area in Japanese cases. Up to now, 11 cases of SGP have been reported in Japan. To our best knowledge, our patients are the first Japanese cases described in the English literature.
A Giant Cystic Hygroma on the Leg of a Newborn Infant Complicated by Hyponatremia
Authors: Tastekin Ayhan , Ermis Bahri , Polat Pinar , Yildirim Mustafa , Ors Rahmi
Published: July 2014

Cystic hygromas are large cystic masses resulting from failure of lymph drainage. The vast majority occur in the neck or axilla. Cases of cystic hygroma of the extremity are extremely rare. We present a newborn infant with a giant cystic hygroma on her left leg, complicated by severe hyponatremia.
Resolution of a Leg Ulcer after Hysterectomy for Huge Uterine Myoma
Authors: Ohtani Tomoyuki , Tanita Muneo , Tagami Hachiro
Published: July 2014

Venous ulcers are the most common type of leg ulcers, accounting for 80% to 90% of cases. We report a large, therapy‐resistant ulcer present for three months on the right leg of a 44‐year‐old woman who also had a huge uterine myoma. Without any other treatment, the leg ulcer regressed spontaneously three months after a hysterectomy for the uterine myoma that had been demonstrated in a CT image to be compressing the right common iliac vein in the pelvis. Uterine myoma can become the cause of venous insufficiency of the leg, when it is big enough to disturb the blood circulation in the pelvis in individuals who have incompetent perforating veins.
A Giant Melanocytic Nevus Treated with Combined Use of Normal Mode Ruby Laser and Q‐Switched Alexandrite Laser
Authors: Kono Taro , Ercocen Ali Riza , Kikuchi Yuji , Isago Tsukasa , Honda Takashi , Nozaki Motohiro
Published: July 2014

We report a combination procedure that can improve the effectiveness of laser removal of giant congenital melanocytic nevi (CMN). A 2‐year‐old girl with a giant CMN was seen in our outpatient clinic. Histological findings showed a compound nevus without any evidence of malignancy or dysplastic changes. The patient was treated with the normal mode ruby laser and Q‐switched alexandrite laser. The lesion was significantly improved in color and cosmetic appearance. Partial hypopigmentation and texture changes were observed. Histological findings showed a marked decrease in the number of junctional melanocytes and the nests in the papillary and reticular dermis. The combined laser treatment is an effective method for the treatment of giant CMN, but further study is warranted to follow‐up questions of recurrence and malignant change.
Malignant Melanoma of Soft Parts (Clear Cell Sarcoma): A Case Report
Authors: Seike Takuya , Matsumoto Kazuya , Nakanishi Hideki , Hashimoto Ichiro , Kubo Yoshiaki , Arase Seiji
Published: July 2014

A subcutaneous tumor localized on the sole of the foot of a 25‐year‐old Japanese man was diagnosed as a malignant melanoma of the soft parts. We performed a wide local excision, elective lymph node dissection, and chemotherapy. Eight years after treatment, the patient is alive without local recurrence or metastasis.
Dilated Pore: A Case Report and an Immunohistochemical Study of Cytokeratin Expression
Authors: Morikawa Takahito , Takizawa Hajime , Ohnishi Takamitsu , Watanabe Shinichi
Published: July 2014

We report a 71‐year‐old Japanese female with a dilated pore in the form of a nodule above her right eyebrow. Histologic examination revealed a flask‐shaped, keratinous cystic structure that was continuous with the surface epidermis and had numerous elongated rete ridges in the lower portion. An immunohistochemical study using a panel of monoclonal antibodies against cytokeratins (CKs) and involucrin detected CK1 and CK10 in the suprabasal cells of the cystic structure. CK8 and CK19 expression was observed in the outermost layer of some elongated rete ridges; it was composed of pallisading columnar cells. Most parts of the outermost layer of the cystic structure stained positively with AE1 antibody. From these immunohistochemical findings, we speculated that the dilated pore in our case was an isolated clinical entity is a follicular tumor differentiating mainly toward the infundibulum and partly toward the isthmus.
Lipoid Proteinosis in Two Siblings: A Report from India
Authors: Sethuraman Gomathy , Tejasvi Trilokraj , Khaitan Binod K. , Handa Kumud K. , Rao Satish , Singh Manoj K. , Sirka Chandrasekhar , Sharma Vinod K.
Published: July 2014

Lipoid proteinosis is an autosomally recessive genodermatosis characterized by widespread deposition of eosinophilic hyaline‐like material in the skin, mucous membranes, and other internal organs. Occurrence of lipoid proteinosis in siblings is very rare. We report two siblings from the Indian subcontinent with the classical features of lipoid proteinosis. Both the siblings had had hoarseness of voice and spontaneous vesicular eruptions healing with atrophic scars since their early childhood. They had diffuse waxy thickening of the skin along with beaded papules along the eyelid margin. The tongue was also infiltrated. Skin biopsy demonstrated periodic acid Schiff (PAS) positive eosinophilic material around the blood vessels and appendages.
A Case of Lupus Vulgaris with Unusual Location
Authors: Senol Mustafa , Ozcan Atilla , Mizrak Bulent , Turgut A. Ciler , Karaca Semsettin , Kocer Hulya
Published: July 2014

Tuberculosis (TB) is one of the oldest diseases of our planet; today, it still is a serious medicosocial problem in both developing and developed countries. Cutaneous tuberculosis is part of the small percentage of extrapulmonary forms of the disease and has considerable morphological variability. It is often confused with various cutaneous disorders and some other granulomatous processes of the skin. Here, we present a case of long‐standing and atypically‐located lupus vulgaris in an old man. The patient was successfully treated with triple antituberculous therapy.
Effects of Different Negative Pressures on Reduction of Wounds in Negative Pressure Dressings
Authors: Isago Tsukasa , Nozaki Motohiro , Kikuchi Yuji , Honda Takashi , Nakazawa Hiroaki
Published: July 2014

Negative pressure dressings stimulate the healing of tissue‐deficient wounds by applying continuous or intermittent negative pressure. This study was designed to determine the most effective negative pressure level for the reduction of the wound by using negative pressure dressings in animal studies. Fifty male Wister rats weighting 200–250 grams were used throughout the study. The animals were divided into five groups of ten animals each as follows: group 1: No negative pressure and a closed dressing method using a polyurethane foam and an adhesive drape. Group 2–5: 25, 50, 75 and 125 mmHg negative pressure and a closed dressing method using a polyurethane foam and an adhesive drape. The wounds were measured along the vertical and horizontal lengths of the body axis and the wound area was calculated. The reduction of the wound area was weaker in the group with a negative pressure of 25 mmHg, and similarly higher among the groups with negative pressures of 50, 75, or 125 mmHg. There were no significant differences in the reduction of the wound area among the latter three groups.
Painful Indurated Erythema Suggestive of Kikuchi‐Fujimoto Disease in a Patient with Primary Sjögren's Syndrome
Authors: Miyashita Yuko , Yamaguchi Masahide , Fujimoto Wataru
Published: July 2014

We report a patient with primary Sjögren's syndrome who developed pyrexia, cervical lymphadenopathy, and painful indurated erythema on the forehead, back, chest, abdomen, and limbs. Laboratory data showed an elevated erythrocyte sedimentation rate, C‐reactive protein and CH50 in addition to existing autoantibodies including anti‐nuclear antibody, anti SS‐A antibody, and anti SS‐B antibody. A skin biopsy specimen showed focal infiltration of histiocytes with non‐neutrophilic karyorrhetic debris in the dermis and subcutaneous fat tissue. Immunohistochemically the infiltrated cells were stained for CD68, suggesting cutaneous involvement of Kikuchi‐Fujimoto disease. All symptoms and laboratory data improved within three weeks after treatment with 20 mg/day of prednisolone. The present case suggests that a pathophysiological condition similar to Kikuchi‐Fujimoto disease can develop during the long‐term course of Sjögren's syndrome.
Melkersson‐Rosenthal Syndrome Caused by Saprodontia: A Case Report
Authors: Tadokoro Taketsugu , Ozawa Kentaro , Muso Yumi , Ito Haruyasu , Itami Satoshi , Yoshikawa Kunihiko
Published: July 2014

A 24‐year‐old female patient with Melkersson‐Rosenthal syndrome (MRS) in association with saprodontia is reported. She presented with lower labial swelling and left facial edema. Histological examination of the involved oral mucosa showed a noncaseating epithelioid granuloma. Results from the laboratory and imaging examinations were normal or negative. Her orofacial swelling disappeared after treatment of the saprodontia of the left first molar.
Primary Cutaneous Follicle Center Cell Lymphoma of the Scalp Successfully Treated with Anti CD20 Monoclonal Antibody and CHOP Combination Therapy with No Subsequent Permanent Loss of Hair
Authors: Imai Yasutomo , Isoda Ken‐ichi , Ito Emiko , Hakamada Arata , Yamanishi Kiyofumi , Mizutani Hitoshi
Published: July 2014

We present a primary cutaneous follicle center cell lymphoma (PCFCCL) patient who was successfully treated with Rituximab, a new anti‐CD20 monoclonal antibody. A thirty‐two‐year‐old male developed two asymptomatic tumors on the scalp. Histopathologically, the tumors were composed of diffuse and nodular infiltration of centrocytes and centroblasts. Immunohistopathologically, the tumor cells stained positively with anti‐CD20 antibody and anti‐kappa antibody, but not with anti‐CD5, anti‐CD10, or anti‐Bcl‐2 antibody. Radiation therapy is effective in treating PCFCCL; however, it usually results in the permanent loss of hair. This patient was treated with Rituximab and CHOP, and achieved a complete remission. He has had no recurrence in more than 12 months and no permanent loss of hair on the scalp.
Dermatological Side Effects of Brimonidine: A Report of Three Cases
Authors: Sodhi Punita Kumari , Verma Lalit , Ratan John
Published: July 2014

Brimonidine is a potential first line therapy for primary open angle glaucoma (OAG) and ocular hypertension (OHT). It is known to cause various ocular and systemic side effects. Being a newer drug, the whole spectrum of its adverse effects is not known. The dermatological side effects caused by brimonidine have rarely been reported before. We present three OAG patients who presented to us with contact dermatitis of periorbital skin and lichen planus of nail following the use of topical brimonidine (0.2% twice a day) for more than six months. These side effects slowly disappeared on discontinuing the drug but reappeared on reintroducing topical formulation. Such side effects from the use of brimonidine have not been reported before.
Estrogen Dermatitis That Appeared Twice in Each Menstrual Period
Authors: Murano Keimei , Koyano Taeko
Published: July 2014

A 23‐year‐old woman presented with millet‐sized red papules that were scattered over her chest and abdomen. She stated that since the age of 20, she had recurrently suffered from pruritic eruptions that coincided with ovulation and the time prior to menstruation, and that they persisted for a few days before vanishing spontaneously leaving some pigmentation. A skin biopsy specimen revealed spongiotic bullae in the epidermis and marked infiltration of lymphocytes accompanied by some histiocytes and eosinophils in the upper dermis. An intradermal test for conjugated estrogen showed an urticarial reaction that faded in about four hours. Although the test did not strictly meet the criterion (erythema to remain for more than 24 hours for papulovesicular eruptions), it was concluded that the timing of the episodes along with the result of the test suggested that a diagnosis of estrogen dermatitis was highly probable. There have been several reports of this condition since it was first reported as a distinct entity in 1995; but whatever the reasons, the flares were observed only before menstruation in these cases, despite the fact that the serum estrogen levels showed a double‐peaked pattern during each menstrual period. This is considered to be a rare case of estrogen dermatitis that flared twice in each menstrual period. Limited improvement was noted in the symptoms even without treatment.
A Case of Acute Generalized Exanthematous Pustulosis (AGEP) Possibly Induced by Iohexol
Authors: Atasoy Mustafa , Erdem Teoman , Sari Refik Ali
Published: July 2014

Acute generalized exanthematous pustulosis (AGEP) is an uncommon disease manifested as an erythematous pustular eruption. It is usually caused by systemic medication. We describe a patient with acute generalized pustular eruption induced by iohexol. A 52‐year‐old woman developed fever and a generalized pustular eruption on the neck, trunk and extremities three days after taking iohexol. The culture from pustules was sterile. Other systemic and laboratory examinations were normal. A skin biopsy from a lesion on the trunk showed the features of a drug‐induced pustular eruption as a subcorneal blister including neutrophils and eosinophils, mild spongiosis, and a sparse infiltrate at neutrophils and eosinophils in the papillary dermis. The patient had no history of psoriasis. The lesions resolved with systemic corticosteroid therapy within one week and did not relapse. According to our investigation, iohexol‐induced AGEP has not been previously reported. We present an interesting case.
Nasal Natural Killer/T Cell Lymphoma with Cutaneous Involvement: Case Report and Chinese Literature Review Reported in China Mainland
Authors: Liu Jie , He Zhixin , Xie Yong , Fang Kai , Gao Zifen , Wang Baoxi
Published: July 2014

Nasal natural killer (NK)/T cell lymphoma is an Epstein‐Barr virus (EBV) associated lymphoma that arises in the nasal area and aggressively invades surrounding tissues. Our patient was a 48‐year‐old male who had had nasal obstruction and nasal discharge for 2 years and infiltrating plaques and necrosis on his nasal dorsum for three months. He developed fever and fatigue two weeks before admission. Biopsy from both skin and nasal mucosa revealed atypical medium‐sized tumor cells infiltrating into the dermis. Immunohistochemical studies revealed that the tumor cells were UCHL‐1, cytoplasmic CD3, CD56, TIA‐1, and granzyme B positive, and CD8 and CD20 negative. In situ hybridization for EBV‐DNA was positive. Clonal TCRβ and TCRγ gene rearrangement were negative. The patient was treated with cyclophosphamide, vincristine, and prednisone (COP) and with local radiotherapy, but he died 20 days later. We reviewed the cases of nasal NK/T cell lymphoma reported in mainland China in the Chinese literature during the last 5 years.
Tissue Parasites in Patients with Chronic Urticaria
Authors: Demirci Mustafa , Yildirim Mehmet , Aridogan Buket Cicioglu , Baysal Vahide , Korkmaz Metin
Published: July 2014

Chronic urticaria is an important diagnostic and therapeutic problem. We aimed to investigate the sero‐prevalence of tissue parasites causing toxocariasis and fasciolosis in patients with chronic urticaria. All cases were analyzed for antibodies against Toxocara canis and Fasciola hepatica by modified (homemade) ELISA. The excretory/secretory products of Toxocara and Fasciola were used as antigens (ES‐ELISA) in the test. In this study, the highest toxocariasis seropositivity (29.0%) rate and the highest fasciolosis seropositivity (14.5%) rate were found in patients with chronic urticaria. Fasciolosis seropositivity and total seropositivity of toxocariasis and fasciolosis in patients with chronic urticaria was significantly higher than in healthy controls (p<0.05). Toxocariasis seropositivity in patients with chronic urticaria was not significantly higher than that in healthy controls (p<0.05). We suggest that parasitic infections should be considered as an important cause of chronic urticaria. Serological methods should be used to expose the diagnosis of tissue parasites in such cases.
Iatrogenic Hypercalcemia Due to Vitamin D3 Ointment (1,24(OH)2D3) Combined with Thiazide Diuretics in a Case of Psoriasis
Authors: Kawaguchi Masakazu , Mitsuhashi Yoshihiko , Kondo Shigeo
Published: July 2014

Tacalcitol is a synthetic vitamin D3 analogue developed for topical treatment of inflammatory skin diseases such as psoriasis. Hypercalcemia has not been previously reported during treatment with topical tacalcitol. We experienced a male patient with psoriasis and hypertension whose conditions were treated with tacalcitol ointment and thiazide, respectively, resulting in hypercalciuria and hypercalcemia. After initiation of topical vitamin D3 ointment (20 μg/g of tacalcitol) 10 g/day for the skin lesions, both the serum level of calcium and urinary excretion of calcium increased gradually. On day 28 of the treatment, his serum calcium levels had reached 3.55 mmol/l, and his urinary calcium excretion had also increased from 0.008 g/day to 0.475 g/day. The tacalcitol treatment was terminated, seven days later, the serum calcium level had returned to the reference range without any specific treatment. The present case is the first report of hypercalcemia induced by vitamin D3 ointment and thiazide simultaneously.
Churg‐Strauss Syndrome (CSS) Manifested as Necrosis of Fingers and Toes and Liver Infarction
Authors: Otani Yuichiro , Anzai Saburo , Shibuya Hiromi , Fujiwara Sakuhei , Takayasu Susumu , Asada Yuji , Terashi Hiroto , Takuma Masahisa , Yokoyama Shigeo
Published: July 2014

We report a case of Churg‐Strauss syndrome (CSS) with necrosis of the fingers and toes and liver infarction. A 59‐year‐old man with asthma suddenly noticed that his fingers and toes felt unusually cold. This condition worsened progressively, and some digits became necrotic within several weeks. Laboratory studies revealed hypereosinophilia and an extremely elevated serum level of IgE. Digital subtraction angiography of the extremities revealed extensive irregular narrowing of small and medium‐sized arteries in the extremities. Abdominal computed tomography (CT) revealed an area of low density at the periphery of the right lobe of the liver. Angiography revealed irregular narrowing of small arteries that corresponded to the ischemic area. A nerve conduction study suggested sensory nerve neuropathy. The preceding asthma, acute onset of digital necrosis, liver infarction, neuropathy, and hypereosinophilia strongly suggested a diagnosis of CSS. The patient was treated with 40 mg of prednisolone and 120 μg of intravenous prostaglandin E1 daily, and all the digits that had turned black and necrotic were amputated. After the amputation, the dose of prednisolone was gradually reduced, and no new lesions appeared on the skin or in the liver. The rare possible complications of CSS, including necrosis of digits and liver infarction, should not be ignored.
Lipoma of the Index Finger
Authors: Choi Hyoun‐Sung , Yi Ji‐Hyun , Kang Sung‐Ho , Yun Seok‐Kweon
Published: July 2014

Lipomas are common, benign tumors originating from adipose tissues. They can occur anywhere on the body but are rarely found on the finger. We report two lipomas of the right index finger in a 46‐year‐old man; this is the first report of a lipoma occurring on the fingers in Korea.
Eosinophilic Pustular Folliculitis Following Autologous Peripheral Blood Stem‐Cell Transplantation
Authors: Keida Tomoko , Hayashi Nobukazu , Kawashima Makoto
Published: July 2014

We describe a case of eosinophilic pustular folliculitis (EPF) occurring after autologous peripheral blood stem‐cell transplantation for non‐Hodgkin's lymphoma and successfully treated with oral and topical indomethacin. Including ours, the reported cases of EPF with HIV‐negative hematological disease have shown clinical features similar to those of HIV‐associated EPF, however the prognosis is better than that for HIV‐associated EPF, which usually shows a persistent course. EPF with HIV‐negative hematological disease can be classified as a unique group in EPF.
Eczema Herpeticum Localized to Area of Tinea Cruris
Authors: Kang Sung‐Ho , Yi Ji‐Hyun , Choi Hyoun‐Sung , Yun Seok‐Kweon
Published: July 2014

Eczema herpeticum (EH) has been reported in association with various skin abnormalities. We experienced a patient with tinea cruris who developed EH within a fungal infection. To our knowledge, dermatophyte infection as an underlying cutaneous disorder for EH has not been previously described in the English literature.
Characteristics of Skin Surface Morphology and Transepidermal Water Loss in Clinically Normal‐Appearing Skin of Patients with Atopic Dermatitis: A Video‐Microscopy Study
Authors: Suehiro Mitsuhiro , Hirano Shinya , Ikenaga Kenji , Katoh Norito , Yasuno Hirokazu , Kishimoto Saburo
Published: July 2014

In patients with atopic dermatitis (AD), it is debatable whether clinically normal‐appearing skin is equal to non‐atopic normal skin. The aim of this study was to quantitatively evaluate the characteristics of normal‐appearing skin of AD. We examined the value of skin surface morphological changes using a new, simple, computer‐assisted method with a video microscope. We also investigated the physiological function as represented by transepidermal water loss (TEWL) levels in 44 patients with AD and 15 normal controls. The morphological changes were represented by a variation coefficient score that reflected the irregularity of skin ridges, named the surface irregularity index (SII). There were significant differences between the normal‐appearing skin of AD and non‐atopic normal skin in both SII (P<0.001) and in TEWL (P<0.01). Especially for the SII, there were significant differences between AD subgroups subdivided by peripheral blood eosinophil count (Eo), serum lactate dehydrogenase level, and clinical score. TEWL values were significantly higher in the high‐Eo AD group (n=15) than in the low‐Eo AD group (n=29) (P<0.05). These findings indicate that clinically normal‐appearing skin of AD patients with high disease activity differs from non‐atopic normal skin in both surface morphology and physiology and that these changes reflect the current disease activity.
Clinical and Pharmacokinetic Studies of Continuous Itraconazole for the Treatment of Onychomycosis
Authors: Kawada Akira , Aragane Yoshinori , Tezuka Tadashi
Published: July 2014

Itraconazole, a triazole antifungal agent, has been widely used for onychomycosis with high cure rates. Unchanged itraconazole and a major metabolite hydroxy‐itraconazole reach the nail with a strong affinity for keratin. The aim of this study was to elucidate clinical effectiveness and pharmacokinetic profiles of a 6‐month continuous itraconazole treatment at a daily dose of 100 mg. Nail growth, the decrease in nail turbidity, and the nail concentrations of unchanged‐ and hydroxy‐itraconazole were investigated. The affected nails we examined demonstrated nail growth proportional to the decrease in turbidity and a quick increase in drug concentration with a long duration of a high concentration after cessation. Our results support the hypothesis that this continuous therapy is a good modality for onychomycosis.
Leprosy with Guillain Barre Syndrome: A New Neurologic Manifestation?
Authors: Grover Chander , Kubba Samir , Nanda Soni , Kumar Vijay , Reddy Belum Siva Nagi
Published: July 2014

A 19‐year‐old female patient of lepromatous leprosy with Type II reaction, on multidrug therapy and prednisolone, presented with acute onset flaccid quadriparesis. The cerebrospinal fluid examination revealed albumino‐cytologic dissociation. Nerve biopsy showed infiltration with lepra bacilli, features of vasculitis, and demyelination. There were no other identifiable precipitating factors for Guillain Barre Syndrome in this patient. Her condition improved without any steroid therapy. This case emphasizes the hypothesis that cell injury caused by Type II reaction can expose neural antigens and incite an autoimmune reaction in the form of Guillain Barre Syndrome.
Giant Suspensory Lipoma with Calcification
Authors: Kinoshita Ryoko , Yasuda Hiroshi , Yamamoto Osamu , Tokura Yoshiki
Published: July 2014

A seventy‐four‐year‐old woman presented with a giant lipoma suspended from her left upper arm. The surgically removed tumor weighed 2,600 g and included calcified areas in its periphery. Our histologic observations suggested that the calcification was generated in association with degenerated fat.
Peripheral Neuropathy in Behçet's Disease
Authors: Birol Ahu , Ulkatan Sedat , Koçak Mukadder , Erkek Emel
Published: July 2014

Behçet's disease (BD) is a multisystem disorder. Since its first description, the involvement of many organ‐systems has been studied. However, the involvement of the peripheric nervous system has not been well documented yet. Twenty‐six patients involved in the study were without prominent complaints of neuropathic symptoms. They were surveyed through the outpatient clinic of the department of dermatology. Each patient filled out a total neuropathy score (TNS) questionaire after their neurologic exam. A neurology specialist conducted the electrophysiological study. Our results were noteworthy because this complication was present without significant complaint. We hypothesized that the nerve dysfunction or peripheral neuropathy of BD is an axonal type of distal polyneuropathy and predominantly involves the lower extremities. We did not find a predominant motor or sensory nerve involvement. This complication is mentioned and reported rarely in BD.
A Case of Varicella‐Associated Idiopathic Thrombocytopenic Purpura in Adulthood
Authors: Hamada Manabu , Yasumoto Shinichiro , Furue Masutaka
Published: July 2014

We describe here an adult case of varicella‐associated idiopathic thrombocytopenic purpura (ITP). A 23‐year‐old Japanese male presented with generalized hemorrhagic vesicles and fever. Laboratory examinations revealed severe thrombocytopenia associated with anti‐platelet IgG auto‐antibody. The patient rapidly recovered within a few days after antiviral agent (vidarabine) administration, and the platelet count returned to normal with skin lesion improvement. Idiopathic thrombocytopenic purpura associated with viral infection in adulthood is relatively rare.
A Case of Persistent Subepidermal Calcified Nodule in an Adult Treated with CO2 Laser
Authors: Joo Young Hyun , Kwon In Ho , Huh Chang Hun , Park Kyoung Chan , Youn Sang Woong
Published: July 2014

A subepidermal calcified nodule (SCN) is an uncommon form of calcinosis cutis that is not associated with other dermatologic or systemic illnesses. Clinically, SCN presents as a solitary, firm tumor that can be white, white‐yellow, or erythematous. Most SCNs occur in children; they are extremely rare in adults. The treatment of choice is believed to be surgical excision. We describe a case of SCN on the right ear lobe of a 33‐year‐old male, which was treated using a CO2 laser and electrodessication.
Acrogeria with Decreased Gene Expression of α1(I) and α1(III) Collagen in Cultured Dermal Fibroblasts
Authors: Wu Jinghai , Hatamochi Atsushi
Published: July 2014

We report a case of acrogeria. A 47‐year‐old Japanese man presented with micrognathism, thin lips, radial wrinkles around his month, atrophy of skin and subcutaneous tissue, and mottled hyperpigmentation on his extremities. A biopsy of the lesional skin showed flat epidermis and atrophy of the dermal layer. The in vitro life span of the patient's fibroblasts (18 ± 2.2 PDL) was significantly shorter than that of control fibroblasts (42 ± 3.5 PDL). The early‐passage fibroblasts from the patient showed abnormal morphology which was also seen in the late‐passage (in vitro aging) of normal fibroblasts. In northern blotting analysis of cultured dermal fibroblasts, mRNA levels of α1(I) collagen and α1 (III) collagen were markedly reduced. These results revealed that patient fibroblasts might be in severe senescence in vitro and contribute to the phenotypes of this premature aging syndrome.
The Lesional Skin of Linear IgA Bullous Dermatosis Expresses Growth‐Regulated Peptide (GRO)‐α
Authors: Tsunemi Yuichiro , Ihn Hironobu , Saeki Hidehisa , Tamaki Kunihiko
Published: July 2014

The patient was a 62‐year‐old man with erythema with tense vesiculobullae and erosions on the bilateral elbows, right knee, and one buttock. A skin biopsy specimen revealed subepidermal blister formation with a predominant infiltration of neutrophils and papillary neutrophilic microabscesses. Direct immunofluorescence study showed linear deposition of IgA and weak deposition of IgG at the basement membrane zone of the lesional skin, and indirect immunofluorescence study showed linear deposition of IgA at the epidermal side of the 1M NaCl‐separated normal skin. He was diagnosed with linear IgA bullous dermatosis. Immunohistochemical study revealed that the lesional and perilesional keratinocytes expressed growth‐regulated peptide (GRO) ‐α, a potent chemoattractant for neutrophils. This suggests that GRO‐α plays a role in the infiltration of neutrophils into the lesional skin and in bulla formation in linear IgA bullous dermatosis.
A Case of Symmetrical Leukemia Cutis on the Eyelids Complicated by B‐Cell Chronic Lymphocytic Lymphoma
Authors: Ikeda Takaharu , Sakurane Mikihisa , Uede Koji , Furukawa Fukumi
Published: July 2014

We describe herein a case of symmetrical bilateral leukemia cutis on the eyelids, especially on the lower lids, in a patient with B‐cell chronic lymphocytic leukemia (CLL). The patient was a 63‐year‐old Japanese man who had been diagnosed with CLL. Eyelid swelling is well known to result from local skin or systemic diseases including tumors, hyperthy‐roidism, nephritic syndrome, and hypoalbuminemia. To our knowledge, symmetrical, bilateral, flesh‐colored leukemia cutis on the eyelids has not been previously reported.
A Case of Bowen's Disease Showing a Clinical Tendency Toward Spontaneous Regression
Authors: Nihei Nozomi , Hiruma Masataro , Ikeda Shigaku , Ogawa Hideoki
Published: July 2014

We present a case of Bowen's disease showing a clinical tendency toward spontaneous regression. The patient, a healthy 86‐year‐old woman, complained that erythema had appeared on her left forearm two years earlier and had gradually enlarged. At the first examination, we observed a well‐demarcated, 4 × 3 cm, erythematous plaque, partically covered with crusting and erosions near the wrist. Diagnosis of Bowen's disease was confirmed by a biopsy. Since the patient refused surgery and also discontinued hyperthermic treatment with disposable chemical pocket warmers after a brief trial, we decided to continue the observation of disease progression without any treatment. Two years after the initial visit, the lesion showed a clinical tendency toward spontaneous regression, with a fine erythematous plaque that showed the obscurely demarcated border of the lesion. After three years, although the patient exhibited a similar symptomatic improvement, a skin biopsy showed a few residual tumor cells. At the patient's request, we chose to observe the progress of the lesion. We review the literature of cases of Bowen's disease that have shown a similar tendency toward spontaneous regression, which have been rare.
Macrolactam Immunomodulators (Tacrolimus and Pimecrolimus): New Horizons in the Topical Treatment of Inflammatory Skin Diseases
Authors: Grunwald Marcelo H. , Amitai Dan Ben , Amichai Boaz
Published: July 2014

Tacrolimus and pimecrolimus are new macrolactam immunomodulators which were developed for the treatment of inflammatory skin diseases, mainly atopic dermatitis. In this article, we review the pharmacologic properties of the drugs, their side effects, and their clinical uses.
Efficiency of Benzoyl Peroxide‐Erythromycin Gel in Comparison with Metronidazole Gel in the Treatment of Acne Rosacea
Authors: Öztürkcan Serap , Ermertcan Aylin Türel , Şahin M. Turhan , Afşar F. Şule
Published: July 2014

Oral wide‐spectrum antibiotics are the linchpin of rosacea treatment. Oral and topical metronidazole, topical tretinoin, and topical benzoyl peroxide may also be used in the treatment of rosacea. We aimed to show that benzoyl peroxide‐erythromycin gel is efficient in the treatment of acne rosacea. Fifty‐six patients with acne rosacea were enrolled in our study. We administered benzoyl peroxide‐erythromycin gel to 27 patients and metronidazole gel to 29 patients. In all the patients, the intensities of erythema, telangiectasia, papules/pustules, and nodules were evaluated before, during and after the treatment. The positivity of Demodex folliculorum from skin scratches was compared between the two groups at each visit. At the end of the therapy on the third examination, in the benzoyl peroxide‐erythromycin group, 91.7% of the patients showed marked clinical improvement, and 8.3% of them showed complete remission. In the metronidazole group, 73.3% showed marked clinical improvement, and 26.7% of them showed complete remission. Clinical improvement in the papular component was 65.2% for the benzoyl peroxide‐erythromycin group, and 81.5% for metronidazole group. In the first examination, the clinical results of the agents were similar. Although both of the drugs were found to be effective in the second and third examinations, metronidazole gel was more effective than benzoyl peroxide‐erythromycin. Both of the drugs were found to be significantly effective especially in treating the papular component of rosacea. Demodex folliculorum was found to be positive in 74.1% of the benzoyl peroxide‐erythromycin group and in 62.1% of the metronidazole group at the beginning. In the benzoyl peroxide‐erythromycin group, 40.7% of Demodex folliculorum positive patients, became negative by the first examination. This was 17.2% for the metronidazole group. In the benzoyl peroxide‐erythromycin group, among the patients who were positive for Demodex folliculorum in the first examination, 37.5% of them became negative. This was 36.7% for the metronidazole group. Benzoyl peroxide‐erythromycin gel was superior to metronidazole gel in decreasing Demodex folliculorum by the first examination, but the effect of the two drugs on Demodex folliculorum was similar by the second examination. As a result, topically applied combined benzoyl peroxide‐erythromycin gel may be an alternative choice of treatment for acne rosacea.
Cornification (Keratinization) in Basal Cell Carcinoma: A Histopathological and Immunohistochemical Study of 16 Cases
Authors: Misago Noriyuki , Satoh Toshimi , Narisawa Yutaka
Published: July 2014

The concept of keratotic BCC is obscure and not well‐defined. To elucidate the histopathological and immunohistochemical properties of cornification in BCC and to clarify the concept of keratotic BCC, by careful examination of 600 BCC specimens, we selected 16 cases of BCC that showed cornification. We investigated the precise histopathological features of these 16 cases, and studied the immunohistochemical expression patterns of anticytokeratin (CK) antibodies (CKs 1, 10, 13, 14, 17) and other antibodies in these cornifying (keratotic) BCCs. We compared these data to those from normal adult hair follicles and three types of cornifying cysts (epidermal cyst, tricholemmal cyst and steatocystoma). Six types of cornification were observed in these BCCs; 1) infundibular type (4 cases) with thin laminated corneocytes expressing CKs 1 and 10, 2) tricholemmal (isthmus) type (9 cases) showing compact, homogenous cornified contents with CK 17 expression on the surrounding cells, 3) inner root sheath type (1 case) characterized by compact, blue‐gray corneocytes lined by CK 13 positive‐squamous cells with red trichohyalin granules, 4) sebaceous duct type (1 case) characterized by crenulated cornified cells expressing CK 17, 5) apocrine acrosyringium type (2 cases) characterized by small duct‐like structures lined by eosinophilic cuticle expressing CEA, in association with keratohyaline granules, and 6) cornifying microcyst type (10 cases) characterized by micro and small cystic structures containing the debris of cornified cells, which was associated with the infundibular or tricholemmal type and could be classified as having the primitive features of the tricholemmal type of cornification. The tricholemmal type could be subdivided into two groups: one with keratohyaline granules and the other without keratohyaline granules, and the cornified contents in approximately 30% of the cornified areas in this type were positive for CK 17. The matrical type of cornification (seventh type) was not seen in our study. The examples described as “keratotic BCC” thus far were similar to BCCs with cornification of the tricholemmal (isthmus) or infundibular type. The cornification in BCCs could be classified into seven types. Excluding the cornifying microcyst type, the tricholemmal type is the most common type of cornification. This type will be abnormal and incomplete in attempts to cornify in the form of an isthmus, occasionally with concomitant exhibition of lower infundibular differentiation. The keratotic BCC is considered to be BCC with cornification of the tricholemmal (isthmus) or infundibular type.
Microscopic Polyangiitis Presenting Urticarial Erythema and Henoch‐Schönlein Purpura: Two Case Reports
Authors: Maejima Hideki , Shirai Kyoumi , Shimamura Yumi , Harada Harumi , Eto Hikaru
Published: July 2014

Microscopic polyangiitis (MPA) is well known as a life‐threatening member of a group of systemic vasculitis diseases. We report two cases of MPA. Case 1 was a 79‐year‐old‐man who had been diagnosed with anti‐neutrophil‐cytoplasmic‐antibody associated vasculitis (ANCA associated vasculitis) with alveolar hemorrhage and crescentric glomerulonephritis (CrGN). He presented with urticarial erythema in the abdomen, legs and back. The skin biopsy specimens showed leukocytoclastic vasculitis on the upper dermis. Case 2 was a 74‐year‐old‐man, who presented with purpura on the abdomen, buttocks and legs that were similar to Henoch‐Schönlein purpura (HSP). He also suffered from interstinal pneumonia. His renal biopsy specimens showed glomerulosclerosis and the peripheral pattern anti‐neutrophil cytoplasmic antibody (P‐ANCA) was positive. We reviewed the skin eruptions that had been reported with MPA, including our cases.
Benign Cutanous Degos' Disease: A Case Report and Review of the Literature
Authors: Coskun Basak , Sarai Yunus , Cicek Demet , Ozercan Resat
Published: July 2014

We report a case of benign form of Degos' disease, a rare condition often characterized by multisystemic vasculopathy, and discuss the case by the light of the limited literature available. A 34‐year‐old male patient was admitted to our clinic with lesions on his neck and back and a history of not getting any benefit from previous acne medications. Dermatological examination revealed erythematous papules with hemorrhagic crusts on their surfaces and many well‐defined atrophic scar tissues. Histopathological evaluation of a biopsy obtained from a lesion revealed the findings of Degos' disease. Further evaluation did not reveal any sign of systemic involvement. He was diagnosed with the benign form of Degos' disease.
Mucinous Eccrine Nevus
Authors: Park Hyun Su , Lee Un Ha , Choi Jung Chul , Chun Duk Kyu
Published: July 2014

A 46‐year‐old man with an erythematous, tender, swollen patch on the dorsum of his left fourth toe visited us. The biopsied tissue showed a proliferation of normally structured eccrine glands and ducts surrounded with abundant materials confirmed as mucin by toluidine blue stain. Mucinous eccrine nevus is an extremely rare entity, and only two cases have been reported in the literature. We describe a case of mucinous eccrine nevus which was late in onset and presented as a swollen patch.
Genetically Modified Mice as a Tool to Study Inflammatory Skin Diseases
Authors: Haase Ingo , Pasparakis Manolis , Krieg Thomas
Published: July 2014

Although mice have a long tradition as models for human skin diseases, they have recently received increasingly more attention. This is because of the rapid advancement of genetic engineering methods which made it possible to create mice with precisely defined genetic changes. Many of these mice develop impressive and sometimes unexpected, puzzling phenotypes. Their interpretation is a major challenge to the basic researcher and can often be ameliorated by the input of an experienced dermatologist. Together with recent examples of genetically modified mouse models of inflammatory skin diseases we give a short overview of the methods used to generate such mice, describe possible ways to analyse them, and discuss problems that arise in the interpretation of the findings.
Drug Eruption Caused by Azathioprine: Value of Using the Drug‐Induced Lymphocytes Stimulation Test for Diagnosis
Authors: Mori Hitoshi , Yamanaka Keiichi , Kaketa Masato , Tamada Kyoko , Hakamada Arata , Isoda Ken‐ichi , Yamanishi Kiyofumi , Mizutani Hitoshi
Published: July 2014

Azathioprine (AZA) is an immunosuppressant commonly used for organ transplantation and autoimmune diseases. Allergic side effects of AZA are rare, and reported allergic skin eruptions from AZA are very limited in Japan. We report AZA‐induced drug eruption that developed in two cases of systemic scleroderma with polymyositis. One case presented with Stevens‐Johnson syndrome, and the other had systemic papular erythema. The stimulation indices of the drug‐induced lymphocyte stimulation test (DLST) for AZA in these two patients were as high as 2,180% and 430%, respectively, but those of healthy volunteers were under 120% without nonspecific suppression of lymphocyte proliferation. Other drugs used simultaneously were ruled out by patch and challenge tests. The challenge test for Stevens‐Johnson syndrome type drug allergy is very risky. DLST is a good diagnostic tool for AZA allergy, especially for severe drug allergy cases.
Mucinous Nodules on the Skin Overlying a Rheumatoid Arthritic Joint
Authors: Umebayashi Yoshihiro
Published: July 2014

A rare case of mucinous nodules on the skin overlying rheumatoid synovitis in a 79‐year‐old man is described. The patient had a five year history of RA. The patient had complained of arthralgia in the left elbow joint, and X‐ray demonstrated narrowing of the joint space along with bone destruction. He underwent an intraarticular injection of dexamethazone and lidocaine. Three weeks later, he noticed two dome‐shaped nodules about 5 mm in size developing on the elbow. Histopathological examination demonstrated poorly defined mucinous nodules in the upper dermis. The mucinous material positively stained with alcian blue and colloid iron, and was metachromatic with toluidine blue. These positive stainings disappeared after hyaluronidase digestion. Five to six weeks after being resected, both nodules recurred. Lesional injections of triamcinolone were effective. The intraarticular injections preceding the appearance of the nodules might have created channels from the joint space to the skin. Leakage of activated synovial cells, which produced hyaluronic acid, through the channels might have caused the mucinous stroma of the nodules.
Drug Eruption Due to Peplomycin: An Unusual Form of Stevens‐Johnson Syndrome with Pustules
Authors: Umebayashi Yoshihiro , Enomoto Hisako , Ogasawara Michio
Published: July 2014

A rare case of Stevens‐Johnson syndrome (SJS) due to peplomycin in a 48‐year‐old man is described. The patient had squamous cell carcinoma on the scalp and underwent preoperative neoadjuvant chemotherapy with peplomycin. On the fifth day of the chemotherapy, he developed a fever and multiple dusky violaceous erythematous areas and pustules on his trunk, thighs, and palms. Erosive erythema and erosions also developed on his soles, scrotum, and oral mucosa. A biopsy specimen taken from the eruption on the thigh revealed marked liquefaction degeneration of the basal layer of the epidermis. Laboratory examinations demonstrated aggravation of liver function. Additionally, the patient developed conjunctivitis and corneal erosions. Although he had some subcorneal pustules, we diagnosed the case as an unusual form of SJS because of severe mucous membrane involvement. Oral prednisolone was administered, and the symptoms subsided. Then the patient underwent wide local excision. One month after surgery, we performed patch tests and a lymphocyte stimulation test with negative results. Then we re‐administered peplomycin starting with 1/20 of a daily dose and gradually increasing the dose each day. After administration of the regular daily dose, the patient had a relapse of fever, eruptions, stomatitis, corneal erosions, and liver dysfunction. Therefore, a definite diagnosis of drug eruption due to peplomycin was made.
Behçet's Syndrome with Pyoderma‐Gangrenosum‐Like Lesions Treated Successfully with Dapsone Monotherapy
Authors: Joshi Arun , Mamta
Published: July 2014

Behçet's syndrome (BS) is a rare multisystem disorder belonging to a group of neutrophilic dermatoses. We report a 65‐year‐old male patient who had suffered from recurrent painful orogenital ulcers for 50 years from the age of 15 and started developing pustular and bullous lesions evolving into non‐healing ulcers similar to those seen in pyoderma gangrenosum (PG) two months prior to presenting to us. There was no evidence of systemic disease or malignancy. Routine baseline investigations were within normal limits. The patient was treated successfully with dapsone, antibiotics, and local wound care.
Anti‐Ribosomal‐P Antibodies in a Sjögren Syndrome Patient Associated with Lupus Erythematosus
Authors: Muro Yoshinao , Tomita Yasushi
Published: July 2014

We describe a 36‐year‐old woman who had Sjögren syndrome with anti‐ribosomal P antibodies and who developed erythema on her back and arms. The histological specimen showed lymphocytic infiltration around the sweat and salivary glands. Her serum reacted with ribosomal‐P0 protein in immunoblotting with HeLa cell extract and P0 recombinant protein. Although autoantibodies to ribosomal‐P proteins appear mainly in patients with systemic lupus erythematosus (SLE), a diagnosis of SLE in this patient could not be supported.
Multiple Basal Cell Carcinomas Arising in a Port‐Wine Stain with a Remote History of Therapeutic Irradiation
Authors: Kim Byung‐Soo , Lee Jae‐Bong , Jang Ho‐Sun , Kwon Yoo‐Wook , Kwon Kyung‐Sool , Oh Chang‐Keun
Published: July 2014

The coexistence of a basal cell carcinoma and a port‐wine stain is a very rare condition that may be associated with previous treatments. We present a case of multiple basal cell carcinomas developing within the boundaries of a port‐wine stain, which had been treated with a tholium X and argon laser. Our case suggests that port‐wine stains which were previously treated with irradiation or argon laser should be examined carefully and regularly by both physician and patient, because they may hide basal cell carcinomas.