bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of a Collagenous Implant on Deep Dermo‐Periosteal Defects in the Rabbit
Authors: Osaki Ken‐ichi , Miura Akemi , Koide Mikio , Katakura Takeo , Sugihara Tsuneki
Published: April 2015

In plastic surgey, extensive wounds with exposed bone and loss of the periosteum (i.e., deep dermo‐periosteal defects) are difficult to treat, even with split‐thickness skin grafts, because such grafts rarely survive. Even when these grafts do survive, functional impairment often occurs subsequently. The application of a collagen sponge (Terudermis®, Terumo, Tokyo) to such wounds has previously been reported to accelerate granulation tissue formation, resulting in would healing and graft survival. However, this previous report only presented data relating to gross morphological appearance

In this paper, we present histological evidence to demonstrate the beneficial effect of the collagen sponge on experimental dermo‐periosteal scalp defects in rabbits. About two weeks after the application of collagen sponge to the experimental wounds, a well‐vascularized granulation tissue was formed. Autologous split‐thickness skin grafts applied to this new granulation tissue were found to be viable one week after grafting.

The results confirm histologically that collagen sponge is effective for the treatment of deep dermo‐periosteal defects which would not have regenerated skin cover with conventional therapies such as skin grafting or the temporary use of dermoprotective materials followed by skin grafting.
A Case of Lymphocutaneous Nocardiosis with a Review of Lymphocutaneous Nocardiosis Reported in Japan
Authors: Ye Zushou , Shimomura Hiroshi , Kudo Shoichiro , Arao Tatsuyoshi , Sato Yasuhiko , Ono Tomomichi
Published: April 2015

An 82‐year‐old Japanese male developed nodules and ulcers along the lymphatics after a fall in the garden of his house resulting in injuries to the dorsum of his left hand which lasted for 3 months. Nocardia brasiliensis was isolated from a nodule, supporting a diagnosis of the lymphocutaneous type of nocardiosis. He had previously developed generalized bone metastasis from prostatic cancer, and his resulting depressed immunity might have played a part in the nocardiosis genesis.

Sixteen cases of the lymphocutaneous type of nocardiosis reported in Japan were reviewed.
Cutaneous Myiasis Due to Dermatobia hominis in Japan
Authors: Taniguchi Yoshiki , Yamazaki Satoshi , Ando Katsuhiko , Shimizu Masayuki
Published: April 2015

A 29‐year‐old man with a furuncle‐like lesion brought in a maggot on the next day after his first visit to our clinic. He said it moved out from the eruption spontaneously. He had previously visited Parana and Sao Paulo in Brazil before he noticed the symptom. The maggot was confirmed to be a third instar larva of Dermatobia hominis. Japanese cases of cutaneous myiasis are reviewed.
Nicergorine‐induced Lichen Planus‐like Eruption
Authors: Hatano Yutaka , Murakami Isamu , Takayasu Susumu
Published: April 2015

A case of a lichen planus‐like eruption due to nicergorine on the lower legs of an 84‐year‐old woman is reported. She presented with slightly pruritic, erythematous plaques of six months' duration. She had taken eight kinds of drugs, including nicregorine for cerebral arteriosclerosis, for two years. After nicergorine was discontinued, the eruption gradually disappeared. Readministration of nicergorine induced a similar eruption within two months. Histologic findings were identical in the two biopsy specimens obtained at the first visit and from the recurrent lesion. To our knowledge, this is the first report on nicergorine‐induced lichen planus‐like eruptions.
Immunohistochemical Detection of Ki‐67 in Epithelial Skin Tumors in Formalin‐fixed Paraffin‐embedded Tissue Sections Using a New Monoclonal Antibody (MIB‐1)
Authors: Matsuta Mayumi , Kimura Sadakatsu , Kosegawa Gen , Kon Saiichi , Matsuta Morimasa
Published: April 2015

The expression of the Ki‐67 antigen was investigated in 44 epithelial skin tumors using an immunohistochemical technique on formalin‐fixed, paraffin‐embedded tissue sections. Microwave oven heating was employed for retrieval of the antigen in these tissue sections.

The staining patterns varied among the epithelial skin tumors. The assessment of immunohistochemical staining was based upon the growth fraction (GF), defined as the number of Ki‐67 positive cells divided by the total number of tumor cells counted and expressed as a percentage. GF was 9.7 ± 3.1% in seborrheic keratosis, 19.5 ± 2.9% in keratoacanthoma, 23.1 ± 4.9% in basal cell carcinoma, 18.5 ± 6.3% in actinic keratosis, 37.1 ± 6.0% in Bowen's disease, and 32.9 ± 10.5% in squamous cell carcinoma. There was a significant difference in GF between the keratoacanthoma and squamous cell carcinoma (p<0.01). Actinic keratosis showed a relatively low GF, whereas Bowen's disease showed a high one. Furthermore, the GF tended to increase with tumor cell differentiation in squamous cell carcinoma: 23.7% (±5.0) in well‐differentiated, 35.0% (±6.2) in moderately‐differentiated, and 47.6% (±4.5) in poorly‐differentiated squamous cell carcinomas. Immunohistochemistry with MIB‐1 may give useful additional information in the differential diagnosis of KA and SCC.
An Infrared Video Camera System to Observe Nocturnal Scratching in Atopic Dermatitis Patients
Authors: Ebata Toshiya , Aizawa Hiroshi , Kamide Ryoichi
Published: April 2015

We used an infrared video camera and video tape recorder system to record and analyze nocturnal scratching in seven patients with atopic dermatitis (AD) and three non‐itchy healthy controls. The patterns and the locations of scratching were successfully observed. Scratching bouts lasting more than 5 sec were counted/and the summation of the duration of all the scratching bouts (total scratching time, TST) was used as an index of nocturnal scratching. TST in patients with AD turned out to be some hundreds to ten thousands of seconds; the TST in controls was between zero and a hundred seconds. The infrared video camera system measured nocturnal scratching simply and reliably without disturbing the patients' sleep.
An Ultrastructural Study of the Retention Hyperkeratosis of Experimentally Induced Comedones in Rabbits: The Effects of Three Comedolytics
Authors: Oh Chee Won , Myung Ki Bum
Published: April 2015

The precise pathologic processes of comedo formation in acne are not well understool. Retention hyperkeratosis may play an important role. To evaluate the effects of three topical comedolytics, 20% azelaic acid, 0.1% tretinoin and 5% benzoyl peroxide, on the retention hyperkeratosis of experimentally induced comedones (EIC), an ultrastructural study was done. After formation of EIC with 50% oleic acid in paraffin oil on the external ears of rabbits, each comedolytic was applied for 4 weeks. Biopsies were taken every week and, using a Hitachi H‐600 transmission electron microscope, morphologic observations were done in the upper portion of the follicular epithelium. In EIC, after application of each comedolytic, the markedly thinned horny layer was loosely adhered by extremely few desmosomes and desmosomal bodies. The number and size of tonofilaments and keratohyaline granules decreased, but the number of variable sized Odland bodies increased in the upper epidermis. These findings appeared 1 week after application of either azelaic acid or benzoyl peroxide, and 3 weeks after application of tretinoin. For the first 2 weeks of tretinoin application, EIC showed rather compact hyperkeratosis with more desmosomes and desmosomal bodies than before. Azelaic acid tretinoin and benzoyl peroxide increased the number of Odland bodies, and the horny cells became less adhesive. This lysis of retention hyperkeratosis resulted in comedolysis. During 4 weeks of treatment with these three comedolytics, only tretinoin normalized the keratinization process.
Behçet's Disease as a Part of the Symptom Complex of SLE?
Authors: Lee Won Soo , Kim Soo Jung , Ahn Sung Ku
Published: April 2015

Systemic lupus erythematosus and Behçet's disease are known to be induced by immunoregulatory defects and to have some identical manifestations. Although the possibility of the coexistence of these disorders exists only one example of an association of these disorders has been described previously by Lee et al. Therefore, we describe an example of typical SLE with additional symptoms of Behçet's disease as a part of the symptom complex of SLE.
Disseminated Cryptococcosis with Cutaneous Lesions
Authors: Mostafa Wedad Z. , Ishak Elia Anis , Ekladious Esmat M. , Arnaout Heba H.
Published: April 2015

A case of disseminated cryptococcosis in an HIV‐negative patient presenting with cutaneous lesions is described for the first time in Egypt. The patient, a 16‐year‐old male, presented with cough, expectoration, loss of weight, and cutaneous lesions, mainly on the face and trunk. The lesions consisted of vegetating crusted plaques discharging purulent to sanguinous fluid and flattened, shiny, erythematous to brownish plaques. Anorexia, headache and personality changes soon followed. Histopathological examination of lesions was highly suggestive of a deep mycosis, particularly cryptococcosis. The fulminant disease advanced with central nervous system involvement. The progression was not arrested when systemic antifungal therapy was administered late in the disease course. Pathological examination of lungs, liver, pancreas and spleen revealed disseminated infection with no evidence of other underlying pathology.

Disseminated cryptococcosis is a morbid infection, rare in an area where heightened awareness and raised index of suspicion will surely allow earlier diagnosis, management and better prognosis
Immunoglobulins and Their Receptors on Epidermal Langerhans Cells in Atopic Dermatitis
Authors: Okada Shigeru , Maeda Keisuke , Tanaka Yoichi , Anan Sadao , Yoshida Hikotaro
Published: April 2015

To elucidate the etiological role of immunoglobulin molecules on Langerhans cells (LCs) in atopic dermatitis, we conducted immunohistochemical studies on the localization of immunoglobulin G1 (IgG1), IgG2, IgG3, IgG4, IgA and IgM on epidermal LCs from 30 patients with atopic dermatitis (AD) and five non‐atopic healthy volunteers. We also investigated the types of receptors for the immunoglobulins (FcεRI, FcεRII, FcγRI, FcγRII, and FcγRIII) on epidermal LCs in the patients.

IgE positive epidermal LCs were observed in 28 of 30 AD patients, and 46.7% of the epidermal LCs were positive for IgE. Both IgG1‐ and IgG2‐positive epidermal LCs were obserbed in 70% of AD patients, and 21.8% and 28.7% of the total epidermal LCs were positive for IgG1 and IgG2, respectively. IgG3‐ or IgG4‐positive LCs were present in only small proportions of AD patients. IgA‐positive LCs were observed in 8 AD patients; our study suggested that the IgA bound on LCs was secretory IgA (S‐IgA). These surface immunoglobulins were observed significantly more frequently on epidermal LCs in the involved skin of AD than in clinically uninvolved skin. No IgM‐positive epidermal LCs were observed in the AD patients or healthy volunteers. In non‐atopic healthy controls, no immunoglobulin‐binding LCs were observed. In receptors for immunoglobulins, FcεRI and FcγRII were exclusively expressed on nearly all epidermal LCs from all AD patients and all non‐atopic controls.

These results suggested that not only IgE but also IgG and IgA may play some etiological role in the pathogenesis of AD.
Intermittent Therapy with Terbinafine for Dermatophyte Toe‐Onychomycosis: A New Approach
Authors: Alpsoy Erkan , Yilmaz Ertan , Basaran Erdal
Published: April 2015

Terbinafine, an orally active antifungal agent of the allylamine class, is effective in the treatment of dermatophyte onycomycosis. Its pharmacologic and pharmacokinetic properties give strong support to the possibility that intermittent treatment courses may be equally effective in onychomycosis in general.

The present randomized and controlled study was carried out to determine whether intermittent therapy with terbinafine was effective in dermatophyte toe‐onychomycosis. Sixty patients with mycologically proven toenail dermatophyte onychomycosis were included in the study. Patients were equally allocated to treatment groups in a random manner. Group 1 was given 250 mg/day of terbinafine for 3 months. Group 2 was given 500 mg/day of terbinafine for 7 days during the first week of each month for 3 months. Nails were examined clinically and mycologically at monthly intervals. All patients were followed up for 48 weeks after starting the treatment.

Of the patients who entered the study, 24 in Group I and 23 in Group 2 were evaluable for efficacy. At the end of the follow‐up period, the cure rate (negative microscopy and culture) was 79.2% in Group 1 and 73.9% in Group 2; this difference was not significant (p: 0.79).

The results indicate that intermittent therapy with terbinafine is as effective as 3‐month treatment in dermatophyte toe‐onychomycosis.
Heterotopic Salivary Glands Simulating Bronchial Cleft Fistular in the Lower Neck
Authors: Hwang Sang Min , Ahn Sung Ku , Lee Seung Hun , Lee Won Soo
Published: April 2015

A heterotopic salivary gland (HSG) in the lower neck is an unusual developmental anomaly rarely encountered by the dermatologist. Klimko and Horanyi (1) reported the first histologically documented case of HSG in the lower neck in 1958. To our knowledge, fewer than 100 such cases have been reported in the literature to date. The origin of HSG in the lower neck seems to be closely associated with the branchial apparatus. Because this condition is rarely encountered, dermatologists should be well informed about the clinical manifestations, development of various malignancies, and the differential diagnosis of HSG.
Cutaneous Sarcoid Reactions during Long Term Remission in a Patient with Acute Myelogenous Leukemia
Authors: Isoda Midori
Published: April 2015

A 68‐year‐old Japanese man with acute myelogenous leukemia, in long‐term remission, developed cutaneous sarcoid reactions on his trunk and extremities. This may suggest that sarcoid‐like granulomas be considered as a nonspecific cutaneous sign of underlying leukemia.
Solitary Mastocytoma Treated with Tranilast
Authors: Katoh Norito , Hirano Shinya , Yasuno Hirokazu
Published: April 2015

Two infants with solitary mastocytoma were treated with 5 mg/kg/day of tranilast [N‐(3‘,4‘‐dimethoxycinnamoyl)anthranilic acid], a mast cell stabilizing compound extracted from Nandina domestica. Tranilast was administered orally in three divided doses. In one infant, a topical corticosteroid was also applied in combination with the oral tranilast. Patients experienced symptomatic relief, and nodules resolved almost completely after eight weeks of treatment Tranilast therapy was continued for six months. No relapses were observed after discontinuation of therapy. We speculated that tranilast not only inhibited mast cell degranulation but also reduced the number of mast cells.
Giant Mixed Tumor of the Face
Authors: Kakuta Mie , Tsuboi Ryoji , Yamazaki Masashi , Sakuma Masahiro , Yoshikata Rie , Ogawa Hideoki
Published: April 2015

A 35‐year‐old Japanese man consulted our clinic with an eight year history of a 6 cm diameter subcutaneous tumor on the left cheek. Hematoxylin and eosin staining of the resected section showed histology corresponding to a benign chondroid syringoma. Keratin was positive in most of the constituent cells, and S‐100 protein was positive in the cells distant from the lumens and in myxomatous cells. A benign chondroid syringoma of this size has only been very rarely reported in the literature.
Subcutaneous Granuloma Annulare with Hodgkin's Disease
Authors: Miyamoto Toru , Mihara Motoyuki
Published: April 2015

We report an 85‐year‐old woman with subcutaneous granuloma annulare. Three nodules developed on her scalp and sacral regions and granually increased with tenderness. Histologically, a biopsy specimen of the nodule was interpreted as subcutaneous granuloma annulare because palisading granuloma was present in the dermis and subcutaneous fatty tissue. Laboratory tests, including RA, showed no remarkable changes except for hyperglycemia and glycosuria. These nodules spontaneously regressed without medication. One year later, she noted swelling of some lymph nodules in the left axillary region. These were diagnosed as Hodgkin's disease (mixed cellularity type). She was treated with chemotherapy, but died after two months. Subcutaneous granuloma annulare which occurs suddenly in the elderly may be a dermadrome of malignant blood disease.
Multiple Malignant Eccrine Poroma and a Linear Epidermal Nevus
Authors: Hamanaka Sumiko , Otsuka Fujio
Published: April 2015

A 68‐year‐old woman developed three reddish nodules on a linear epidermal nevus on the right arm. The nodules and linear lesion were resected. The histology revealed the two larger nodules to be eccrine porocarcinoma and the other to be eccrine poroepithelioma. The linear lesion was actually epidermal nevus. To our knowledge, this is the first description of adnexal tumors developing on epidermal nevus.
Isolated Collagenoma: A Case Report with a Review of Connective Tissue Nevi of the Collagen Type
Authors: Gautam Ram K. , Kar Hementa K. , Jain Rakesh K. , Bagga Gulshan R. , Sharma Shiv K. , Bhardwaj Minakshi
Published: April 2015

A 22‐year‐old male had had five skin colored tumorous growths on the mid‐palm, ring and little fingers of the right hand for the last 15 years. Histopathological examination with hematoxylin and eosin and special stains confirmed the diagnosis of connective tissue nevi of collagen type. There were no associated cutaneous or systemic findings; thus the case was designated as isolated collagenoma. A review of connective tissue nevi of the collagen type is presented.
A Case of Unusual Syringoma: Unilateral Linear Distribution and Plaque Formation
Authors: Chi Hyung‐In
Published: April 2015

We describe a 25‐year‐old woman with syringoma, clinically manifested by unilateral linear distribution and a plaque formation. Syringoma papules are located on the extensor aspect of the left upper arm, the left antecubital fossa, and the left side of the chest. The papules distributed in linear fashion on the left upper arm, and partially formed plaques on the left upper arm and the left antecubital fossa. Syringoma must be included in the differential diagnosis of unilateral linear papular or plaque skin lesions.
A Case of Pseudovascular Adenoid Squamous Cell Carcinoma of the Skin with Spindle Cell Pattern
Authors: Yamamoto Osamu , Yasuda Hiroshi
Published: April 2015

We report a case of pseudovascular adenoid squamous cell carcinoma which was in the form of a dome‐shaped, cherry red tumor on the right cheek of an 86‐year‐old Japanese woman. Histologically, two types of atypical cells were identified; round cells in the upper part and spindle cells in the lower part. In the upper part, inter‐anastomosing sinusoid‐like pseudolumina were observed between the cords of the tumor cells. Immunohistochemically, the tumor cells did not express Factor VIII‐related and CD34 antigens or bind Ulex europaes I agglutinin, except for only one anti‐cytokeratin antibody. Ultrastructurally, the tumor cells contained tonofilaments and desmosomes and represented acantholysis. From the electron microscopy, possible role of capillary hyperpermeability on the acantholytic process of the neoplastic cells was suggested.
Acetylcholine Is an Inducer of Itching in Patients with Atopic Eczema
Authors: Heyer Gisela , Vogelgsang Maria , Hornstein Otto P.
Published: April 2015

As previous experimental studies disproved histamine as the main mediator of eliciting pruritus in atopic eczema (AE), we examined the neurocutaneous sensations in 15 patients with AE and in 15 age‐ and sex‐matched non‐atopic controls after i.c. injection of acetylcholine (Ach, 0.5 M, 20 μl) or buffered saline. The sensory perceptions were rated by the participants of the study with regard to their quality and intensity using a visual analogue scale. Simultaneously, the vascular reactions to Ach were recorded by the examinators via laser Doppler fluxmetry as well as flare and wheal planimetry. In contrast to the approximately equal flare and wheal extensions in either group, the cutaneous sensations differed significantly. The patients complained of ‘pure’ itching that developed shortly after Ach injection, whereas the control subjects reported only burning pain. Moreover, the patients perceived their sensations significantly earlier and significantly longer than did the controls. The study provides evidence that Ach plays an important role in the pathogeny of pruritus in patients with AE. Further investigations of the neuronal mechanisms involved in this atopy‐related effect of Ach have to be performed.
Keratosis Lichenoides Chronica: A Variant of Lichen Planus
Authors: Grunwald Marcelo H. , Amichai Boaz , Finkelstein Eve , Kachko Leonid
Published: April 2015

In order to establish a possible relationship between keratosis lichenoides chronica (KLC) and lichen planus (LP), we performed a comparative study which included routine histologic examination, electron microscopy, and direct immunohistochemical studies from one case of KLC and several patients with LP. Our findings demonstrate that KLC and LP share many similarities; their differences are mostly quantitative. In KLC, the findings are more prominent; we therefore conclude that KLC is at one end of the spectrum of LP.
A Possible Case of Eccrine Poroma Arising in Seborrheic Keratosis with Partial Intermediate Malignancy and Tumor of the Follicular Infundibulum
Authors: Akasaka Toshihide , Kon Saiichi
Published: April 2015

An eighty‐year‐old woman presented with a eccrine poroma that appeared to have arisen in a seborrheic keratosis lesion on the right side of her abdomen. The tumor consisted of a brownish, flat, elevated lesion with an eroded nodule at its periphery. Histopathological analysis of the flat, elevated lesion revealed benign basaloid and squamoid cells that showed acanthotic upward proliferation, suggesting a seborrheic keratosis. The eroded nodule showed irregular proliferation of slight atypical squamoid cells with, in parts, ductal structures in the upper dermis, suggesting that it was an eccrine poroma with partial intermediate malignancy. In addition to the eroded nodule, an occult tumor clinically accompanied the seborrheic keratosis. Histopathology of the occult tumor revealed fenestrated columns and cords of pale epithelial cells attached to the base of the seborrheic keratosis lesion, which was diagnosed as a tumor of the follicular infundibulum. Although reports of seborrheic keratosis transforming into a sweat gland tumor are rare, the present case suggests that seborrheic keratosis may develop into benign or malignant adnexal tumors, including sweat gland and follicular tumors. Thus, seborrheic keratosis should be considered as a possible precursor of adnexal tumor.
Progressive Decrease in Hair Diameter in Japanese with Male Pattern Baldness
Authors: Ishino Akihiro , Uzuka Makoto , Tsuji Yoshiharu , Nakanishi Jotaro , Hanzawa Norio , Imamura Sadao
Published: April 2015

Fifty‐six Japanese with male pattern baldness were evaluated for changes in their hair diameters over three years. The mean hair diameter significantly decreased each year. The average decrease was 1.1 μm per year. Although the percentage of vellus hair increased by 3.6% over three years, this increase rate was lower than that found in Caucasians. To precisely examine the change in hair diameter, the mean distribution of this diameter was investigated. At the beginning of the study, clear peaks were observed at 95 μm in the twenties and 45 μm in the fifties. The number of thicker hairs decreased and the high frequency peak shifted to a thinner hair diameter over 3 years.

To quantify the change in the distribution of hair diameter, the percentage of hairs of more than 60 μm was examined. There was a statistically significant 5.61% decrease in the percentage of hairs with a diameter of more than 60 μm over three years. Our findings suggest that the progression of male pattern baldness in Japanese is slower than that of Caucasians and that the percentage of hairs of more than 60 μm is a sensitive index to evaluate the progression of male pattern baldness and the effects of hair growth or hair loss preventive agents.
Hereditary Palmoplantar Keratodermas in South India
Authors: Gulati Sanjeev , Thappa Devinder Mohan , Garg Bhagat Ram
Published: April 2015

Thirty‐one patients with inherited palmoplantar keratodermas (PPKs) were screened from 59,490 cases who visiting the OPD of JIPMER, Pondicherry. The prevalence rate was 5.2 per 10,000 population (1:2000 approx.). PPKs were more common in males (25 patients) than females (6 patients); the overall male to female ratio was 4.2:1. The incidence was highest in the group from 0–10 years of life (67.7% of cases). Unna‐Thost syndrome topped the list with 38.7% of cases and its prevalence 1:6000 (approx.), followed by Greither's disease (22.9%) and others‐Vohwinkel (3 cases), idiopathic punctate (2 cases), ichthyosis vulgaris associated PPK (2 cases) etc. This study has for the first time reported the prevalence and patterns of hereditary PPKs in South India.
Alopecia Areata Associated with Myasthenia Gravis and Thymoma: A Case of Alopecia with Marked Improvement Following Thymectomy and High Level Prednisolone Administration
Authors: Kamada Noriaki , Hatamochi Atsushi , Shinkai Hiroshi
Published: April 2015

A 57‐year‐old Japanese woman who suffered from alopecia areata associated with myasthenia gravis (MG) and thymoma responded well to thymectomy and high doses of glucocorticosteroid administration. Several treatments for alopecia areata including administration of systemic prednisolone were attempted, but loss of hair on the scalp progressed. After thymectomy and high level glucocorticosteroid administration for MG, the lesions on the scalp improved within four weeks. Consequently, we suggest that this thymectomy and high level glucocorticosteroid administration assisted in improving the immune dysfunction causing the alopecic lesions in this patient.
Papillary Eccrine Adenoma with a Pomegranate‐like Appearance
Authors: Ambo Midori , Kumakiri Masanobu , Kobayashi Hitoshi , Ohkawara Akira
Published: April 2015

Papillary eccrine adenoma (PEA) is a rare cutaneous tumor which histopathologically presents numerous intradermal tubular structures with inward papillary projections. Only a few cases of PEA have been reported recently. We report a case of PEA of a 58‐year‐old Japanese man. The marked hyperkeratosis and pits gave the tumor the clinical appearance of a burst‐open pomegranate. Compact hyperkeratosis within proliferated epidermis contained spiral ducts mimicking intraepidermal eccrine sweat ducts histopathologically. These keratinous structures were thought to correspond to the pores. Several tubular structures running up to the overlying thickened epidermis were observed in the upper dermis. With these findings and with immunohistochemical studies, we proposed that this tumor originated from eccrine sweat ducts.
Riehl's Melanosis‐like Eruption Associated with Sjögren's Syndrome
Authors: Miyoshi Ken , Kodama Hajime
Published: April 2015

A 58‐year‐old Japanese female complained of facial erythema and Riehl's melanosis‐like pigmentation. Histological examination showed liquefaction degeneration of the basal cells and pigment incontinence. Direct immunofluorescence revealed no deposition of immunoglobulins or complements at the basement membrane zone. Patch test and photopatch test using cosmetics and detergents she had been using were negative. She was diagnosed with Sjögren's syndrome based upon dryness of the mouth, dense periductal infiltration of lymphocytes and plasma cells in the labial salivary gland, positive Shirmer's test, hyper‐γ‐globulinemia, positive antinuclear antibody, and positive anti‐SSA (Ro) antibody. The pigmentation gradually faded away when she protected her face from ultraviolet irradiation while continuing use of the cosmetics and detergents. Riehl's melanosis‐like eruption could be a cutaneous manifestation of Sjögren's syndrome closely related with anti‐SSA (Ro) antibody.
Clinical Implications of Basic Research on Heritable Skin Diseases
Authors: Uitto Jouni
Published: April 2015

Spectacular success has recently been made in understanding the molecular basis of various heritable skin diseases. A prototype of such conditions is epidermolysis bullosa (EB), a heterogenous group of mechano‐bullous disorders, characterized by fragility of the skin and other specialized epithelia. The fragility of the skin in EB results from defective attachment of the epidermis to the underlying dermis due to genetic lesions within molecules of the basement membrane zone (BMZ) at the dermal‐epidermal junction. Specifically, distinct mutations have been disclosed thus far in ten different genes encoding the macromolecular components of the BMZ, and the combinations and the types of mutations as well as their positions along the altered gene products collectively reflect the phenotypic variability observed in this group of heritable skin diseases. This information has major implications for genetic counseling of families at risk for recurrence of EB in subsequent pregnancies and in future generations. Furthermore, examination of specific mutations in an affected newborn allows prognostication of the severity of the clinical outcome. Finally, mutation analyses have provided the basis to develop DNA‐based prenatal testing by chorionic villus sampling or early aminocentesis during the first trimester of gestation. Collectively, the advances on EB exemplify the potential of molecular biology for improved diagnosis and patient care of genetic skin disorders.
Immunocytochemical Characterization of Malignant Schwannoma‐derived Cells in Culture
Authors: Demitsu Toshio , Murata Satoru , Kakurai Maki , Kiyosawa Tomoharu , Yaoita Hideo
Published: April 2015

We recently demonstrated that cultured malignant schwannoma (MS)‐derived cells can support human skin mast cell (HSMC) survival in vitro. Cultured HSMCs were spindle‐shaped in close contact with MS‐derived cells, suggesting cell to cell interaction. To elucidate the mechanism of the enhanced HSMC survival in coculture with MS‐derived cells and the cellular interactions between HSMC and MS‐derived cells, we examined the immunocytochemical characteristics of MS‐derived cells using immunofluorescence. Morphologically, cultured MS‐derived cells were polygonal with abundant cytoplasm and resembled perineurial cells. The cultured cells immunoreacted positively with vimentin, fibronectin, laminin and collagen IV, but negatively with anti‐S100 protein, anti‐neuron specific enolase, and anti‐neurofilament (68 kd, 145 kd, 200 kd) antibodies. MS‐derived cells were distinct from Schwann cells in their lack of S100 protein and also distinguishable from endoneurial fibroblasts that produce fibronectin, but never expressed laminin or collagen IV. MS‐derived cells thus possess the characteristics of perineurial cells in their general morphology and their immunocytochemical properties.

Immunoreactivity for substance P (SP) and neurokinin A (NKA) was found in the cytoplasm of these cells, particularly around the nuclei. Vasoactive intestinal peptide, somatostatin, and calcitonin gene related peptide were negative.

From these findings, we characterized the MS‐derived cell's in vitro properties and concluded that it is similar to a perineurial cell. The extracellular matrix protein, laminin, and fibronectin expressed in the MS‐derived cell might contribute to HSMC survival and morphology through cell to matrix adhesion. Neuropeptides such as SP and NKA, expressed in the MS‐derived cell, might play some role in enhanced HSMC survival in vitro.
Hypergammaglobulinemic Purpura Associated with Sjögren's Syndrome and Chronic C Type Hepatitis
Authors: Yamamoto Toshiyuki , Yokoyama Akiko
Published: April 2015

Although hypergammaglobulinemic purpura usually occurs secondarily on the lower legs in several disorders, purpura has also recently been reported to be associated with chronic C type hepatitis (HCV). To define the differences in the clinical, histological and laboratory findings and the prognosis of hypergammaglobulinemic purpura associated with those two disorders, we examined ten patients with hypergammaglobulinemic purpura, 6 patients with hypergammaglobulinemic purpura associated with Sjögren's syndrome (SjS) and 4 patients with hypergammaglobulinemic purpura with chronic C type hepatitis. Five of 6 patients with SjS were female. Attacks of purpura occurred in the pretibial area in all cases. Triggering factors included long walks and prolonged standing. The mean duration of attacks was 6.4 days. No systemic manifestations were associated. Anti‐Ro/SS‐A and anti‐La/SS‐B antibodies were expressed in one case. Spontaneous regression was noted in all cases; however, recurrence was noted in one. On the other hand, all the 4 patients with hypergammaglobulinemic purpura associated with HCV were men. Purpura was indurated in a few cases. Involved sites included the knee, forearm, abdomen and thigh in addition to the lower leg. The mean duration of attacks was 12.6 days. Recurrent purpura was noted in one case. Cryoglobulin was positive in three cases. In one patient with severe recurrent purpura, attacks stopped with prednisolone 10 mg/day. Histologically, leukocytoclastic vasculitis was detected in three cases associated with SjS and two cases with HCV. In conclusion, hypergammaglobulinemic purpura associated with HCV appears to occur unilaterally with a sex predilection for men and the manifestations last longer than those associated with SjS. Severe palpable purpura was also noted in association with HCV; systemic prednisolone resulted in good control.
A Case of Congenital Ectopic Nails on Bilateral Little Fingers
Authors: Iida Naoshige , Fukuya Yasuhiko , Yoshitane Katsuyuki , Hosaka Yoshiaki
Published: April 2015

Congenital ectopic nails are a rare anomaly, but we observed a case of a 43‐year‐old woman with ectopic nails at the tips of her bilateral little fingers. On X‐ray, the distal phalanx of the each little finger appeared depressed. We surgically removed the ectopic nails. One year and 6 months later, no relapse had occurred. The histopathological examination revealed undifferentiated nail tissue including nail, nail matrix, and nail epithelium.
Primary Cutaneous Langerhans Cell Histiocytosis Treated with Photochemotherapy
Authors: Kwon Oh Sang , Cho Kwang Hyun , Song Kye Yong
Published: April 2015

A 23‐year‐old man with Langerhans cell histiocytosis presented with asymptomatic, purplish, slightly scaly, confluent papules of one year's duration. Histological studies of biopsy specimens revealed a dense infiltrate of histiocytic mononuclear cells beneath the epidermis; these cells reacted strongly with anti‐S‐100 antibodies. Extensive investigations failed to detect systemic involvement. He was treated with repeated oral 8‐methoxypsoralen (8‐MOP) plus ultraviolet A (PUVA) therapy three times a week for two months and then once or twice with maintenance phototherapy. The lesions did not recur during the four‐month follow‐up period.
Apoptotic Cell Death of Neutrophils in Development of Skin Lesions of Patients with Anaphylactoid Purpura
Authors: Banno Sumiyo , Tamada Yasuhiko , Matsumoto Yoshinari , Ohashi Masaru
Published: April 2015

The participation of apoptotic cell death of neutrophils in the development of skin lesions of patients with anaphylactoid purpura was examined by the in situ specific labeling of fragmented DNA. In the early stage of the skin lesions, there were few positively stained nuclei in infiltrating cells. The number of positive cells increased markedly in the fully developed stage of the lesions. A number of neutrophils were stained positively. Finally, a few fragmented nuclei were still positive in the late stage of the lesions. It was therefore suggested that fragmentation of neutrophils in the skin lesions from the patients might be due to apoptosis. Inducible nitric oxide synthase and nitrotyrosine were detected in infiltrates, and interleukin‐8 was also detected in vascular endothelial cells in those skin lesions. The roles of nitric oxide and interleukin‐8 in the apoptosis of neutrophils are discussed.
Extensive Facial Strawberry Mark Associated with Cerebellar Hypoplasia and Vascular Abnormalities
Authors: Matsui Tamano , Ono Tomomichi , Kito Masato , Yoshioka Susumu , Ikeda Tetsuo
Published: April 2015

Strawberry mark is considered a benign hemangioma with a tendency toward spontaneous regression and a benign prognosis (1). Recently, some papers have reported complications of large facial strawberry marks (2–6). We report a infant girl with an extensive strawberry mark on the left side of the face associated with ipsilateral cerebellar hypoplasia and Dandy‐Walker malformation. Abnormal branching of the aortic arch was also found.
Leiomyoblastoma and Leiomyomatosis of the Small Intestine in a Case of von Recklinghausen's Disease
Authors: Hamanaka Sumiko , Hamanaka Yuichiro , Yamashita Yoshimi , Otsuka Fujio
Published: April 2015

A 70‐year‐old patient with von Recklinghausen's neurofibromatosis 1 (NF1) developed a stomach ulcer and underwent a total gasterectomy. During the laparotomy, a leiomyoblastoma and multiple leiomyomas, which were histologically diagnosed as such later, were found in the small intestine and resected. It is quite possible that the association of gastrointestinal leiomyomas and NF1 is more than coincidental. It is thus important to take this complication into account in clinical treatment of patients with NF1.
Effects of Thallium Ion on Cellular Components of the Skin
Authors: Arbiser Jack L. , Alani Rhoda , Flynn Evelyn , Wooten Virginia , Byers Hugh Randolph
Published: April 2015

Thallium salts have been employed by dermatologists to cause depilation, and dermatologic features are prominent in thallium overdose. These features include alopecia and follicular hyperkeratosis. Administration of thallium to pregnant animals results in limb deformities, similar to those seen after thalidomide embryopathy. These findings suggest that thallium may act on keratinocytes, melanocytes, and endothelial cells. We show that thallium exerts pleiotropic effects on proliferation, cell shape and motility of multiple cell types. These findings may help explain the clinical findings of thallotoxicosis.
Reactive Perforating Collagenosis and Acquired Perforating Dermatosis: Presentation of Two Cases
Authors: Kyriaki Aroni , Ephtichia Zouridaki , Anna Liossi , Panagiotis Davaris
Published: April 2015

Two rare cases of patients suffering from diabetes mellitus and skin lesions with histological transepidermal elimination are presented. The clinical and histological findings confirmed the diagnoses of reactive perforating collagenosis and acquired perforating dermatosis. The relationship between the two entities and their pathogenesis are discussed.
Scleroderma Renal Crisis Complicated by Hemolytic Uremic Syndrome in a Case of Elderly Onset Systemic Sclerosis
Authors: Yamanaka Kei‐ichi , Mizutani Hitoshi , Hashimoto Kenji , Nishii Masami , Shimizu Masayuki
Published: April 2015

We report a case of renal crisis in a patient with elderly onset systemic scleroderma (SSc). A sixty‐one‐year‐old woman was diagnosed as having SSc with rapidly advancing generalized skin sclerosis. After experiencing an upper respiratory infection, she suddenly developed renal failure, hemolytic anemia and malignant hypertension. Laboratory examination revealed uremia with a significantly high plasma renin level. Ophthalmologic study revealed Keith‐Wagner's retinopathy Grade IV. Combination therapy including captopril, systemic corticosteroid and prostaglandin E1 venous infusion for the hemolytic uremic syndrome was effective and saved her from the renal crisis. However, her renal function deteriorated and she needs permanent hemodialysis. Rapidly progressive skin sclerosis in SSc, especially in elderly onset cases, suggests a high risk for renal crisis and indicates the need for careful consideration of hypertension and renal function.
Exercise‐Induced Urticaria and Angioedema: Reports of Two Cases
Authors: Kato Taizo , Komatsu Hiromi , Tagami Hachiro
Published: April 2015

Two Japanese patients presented with histories of exercise‐induced urticaria and facial angioedema, respectively. Each patient exercised by climbing steep stairs for 5 to 10 min at 22°C. A 19‐year‐old female student with atopic dermatitis initially developed lesions of cholinergic urticaria, which became confluent on her face, trunk and extremities and were followed by discomfort of her throat. In a 34‐year‐old female patient, the exercise induced angioedema on the right eyelids preceded by sneezing and rhinorrhea. Plasma histamine levels were elevated in the first patient. No changes in serum levels of complement systems were observed after the exercise challenge in either patient.
Lichen Planus Pigmentosus Presenting in Zosteriform Pattern
Authors: Cho Soyun , Whang Kyu‐Kwang
Published: April 2015

Lichen planus pigmentosus (LPP) has thus far been described as a condition of unknown etiology which clinically differs from the classical lichen planus (LP) by exhibiting dark brown macules and/or papules mostly in exposed areas and flexural folds and a longer clinical course without pruritus or scalp, nail or mucosal involvement. Histopathologically, LPP shows the typical changes seen in LP, but with thinning of epidermis. We report a case of LPP that developed in a unilateral, zosteriform pattern on the left flank of a 49‐year‐old man. This case seems to lie in the middle of the spectrum between classical LP and ashy dermatosis, and, to the best of our knowledge, is the first report of LPP presenting in the zosteriform pattern.
Merkel Cell Carcinoma and Multiple Bowen's Disease: Incidental Association or Possible Relationship to Inorganic Arsenic Exposure?
Authors: Ohnishi Yuko , Murakami Shinji , Ohtsuka Hisashi , Miyauchi Shunji , Shinmori Hideyo , Hashimoto Koji
Published: April 2015

An 81‐year‐old Japanese male was referred to our clinic in 1991 with multiple Bowen's disease. The associated hyperpigmentation of the trunk and extremities and palmo‐plantar keratotic nodules indicated that he had suffered from chronic arsenic poisoning. Interestingly, he was a native of Namikata in Ehime, Japan, where many residents have suffered from multiple Bowen's disease with internal malignancy. Arsenic exposure was strongly suspected. Two years later, Merkel cell carcinoma developed on the dorsum of his right hand, where Bowen's disease lesions were absent. Metastasis of this Merkel cell carcinoma led to his eventual death one year later. To our knowledge, this is the first report of Merkel cell carcinoma associated with multiple Bowen's disease. Chronic arsenic poisoning may be responsible for the association of these two rare skin neoplasms.
Giant Basal Cell Carcinomas: Report of Four Cases and Considerations
Authors: Betti Roberto , Inselvini Elena , Moneghini Laura , Crosti Carlo
Published: April 2015

Four cases of giant basal cell carcinoma (BCC) are reported and the problems of giant BCCs are briefly discussed. In particular, we consider the relationship between the size of the tumor and its clinical behaviour. The importance of the site location in tumor development, the histologic subtypes involved, the associated findings, and problems of treatment are also discussed.
Anti‐Oxidative Therapy with Oral Dapsone Improved HCV Antibody Positive Annular Elastolytic Giant Cell Granuloma
Authors: Igawa Ken , Maruyama Ryuji , Katayama Ichiro , Nishioka Kiyoshi
Published: April 2015

A 72‐year‐old fisherman who was positive for the HCV antibody developed an annular, erythematous, infiltrated lesions on sun‐exposed areas. The lesions were diagnosed as annular elastolytic giant cell granuloma both clinically and histologically. Topical corticosteroid and cryotherapy with liquid nitrogen for several months failed to improve the lesions. We then started dapsone, a known anti‐oxidant, at 50 mg/day. A month later, the margins of the erythematous lesions faded, and the infiltration gradually decreased. No recurrence has been observed for one year after the start of the therapy. Anti‐oxidative therapy appears to be effective for annular elastolytic giant cell granuloma and could be an alternate therapy for refractory granulomatous disease.
A Case of Pigmented Dermatofibrosarcoma Protuberans (Bednar Tumor)
Authors: Akasaka Toshihide , Ohyama Nobutaka , Kon Saiichi
Published: April 2015

The present paper reports a 67‐year‐old male with pigmented dermatofibrosarcoma protuberans (Bednar tumor) on his right shoulder. The lesion had recurred twice. Clinically, the lesion was a reddish‐brown, exophytic, multilobular, firm nodule with an irregular surface, which measured 6.4 times 4.2 cm. Histologically, the proliferated fibroblasts showed a cartwheel pattern and stained positively with CD34, similar to those of a common dermatofibrosarcoma protuberance. However, many melanin‐bearing cells that were positive for the S‐100 protein were found intermingled among the tumor cells.

Based on these findings, we concluded that the clinical manifestations, level of malignancy, and cytological features, as well as the exception of melanin‐bearing dendritic cells associated with pigmented dermatofibrosarcoma protuberans, suggest a common dermatofibrosarcoma protuberans. This supports the hypothesis that pigmented dermatofibrosarcoma protuberans is a pigmented variant of dermatofibrosarcoma protuberans. Thus, this type of tumor is not benign, but is an intermediate malignant tumor.
Apoptosis Is Induced by Anti‐Fas Antibody Alone in Cultured Human Keratinocytes
Authors: Sung Kyung Jeh , Paik Eun Mi , Jang Kyoung Ae , Suh Ho Seok , Choi Jee Ho
Published: April 2015

Fas is a well‐known cell surface receptor whose main function is the induction of apoptosis in many cell types including human keratinocytes. Several reports indicate that anti‐Fas antibody can induce apoptosis in cultured keratinocytes after interferon gamma (IFNγ) pretreatment.

Because IFNγ is synthesized by activated T cells, but not by keratinocytes, these results suggest that Fas may only be effective in apoptosis occurring in T‐cell mediated inflammatory skin diseases. We hypothesized that Fas alone might mediate apoptosis in normal human keratinocytes without any other help and thus play a role in normal epidermal homeostasis. By using Cell Death Detection ELISA, we observed keratinocyte apoptosis 24 hours after anti‐Fas antibody stimulation not only in IFNγ‐pretreated conditions but also in non‐pretreated conditions. Even though the percentage of cultured keratinocytes stained by anti‐Fas antibody increased from 7.8 to 25.8% 24 hours after IFNγ stimulation, the apoptotic rate of the anti‐Fas only group was the same as that of the anti‐Fas plus IFNγ treated group. In both conditions, we have verified apoptotic phenomena in cultured keratinocytes in situ by TUNEL staining. Some apoptotic bodies were phagocytosed by neighboring keratinocytes. Fas‐mediated apoptosis was not inhibited by the protein synthesis inhibitor cycloheximide and was enhanced by inhibitors of several protein kinases, including PKC and staurosporine. These results suggest that Fas‐mediated apoptosis may play a role in both T cell‐mediated skin diseases and normal epidermal homeostasis.