bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Pruritic Papular Dermatitis in Adult Men: A Variant of Prurigo
Authors: Chang Sung Nam , Kim Soo‐Chan , Chun Yoon‐Sun , Kim Kyun Tae , Ahn Sung Ku , Park Wook Hwa
Published: April 2015

Chronic recurrent pruritic papular eruptions in which a specific diagnosis cannot be established becomes a baffling experience to the dermatologist. We have met adult male patients with chronic recurrent pruritic papular eruptions, but their clinicopathological features are not described in English language textbooks. Our purpose was to study the clinical and histological features of this entity and review the various existing taxonomy. We conducted a study of 20 patients over a six year period by taking histories, performing skin biopsies, screening patch tests, and doing immunofluoresence studies. The eruptions occured exclusively in male adults and had a predilection for the trunk and proximal extremities. The lesions were characterized by severely pruritic, nonfollicular, monomorphic, erythematous urticarial papules. There was no evidence of atopic diathesis or history of insect bite. Most patients had normal levels of serum eosinophils and IgE. The predominant histopathologic finding was a presence of perivascular infiltration of mononuclear cells with eosinophils. The patients followed a chronic course of at least six months with waxing and waning; systemic corticosteroids were the only effective treatment. Finally, all other pruritic erythematous papular dermatoses were ruled out. These cases comprise a distinct entity that has previously been mentioned in a few reports. Clear definition of this entity with an appropriate designation is in order to avoid confusion among dermatologists, and we propose the disease name “chronic papular dermatitis in adult men” as a variant of prurigo.
A Clinical and Bacteriological Examination of Mycobacterium leprae in the Epidermis and Cutaneous Appendages of Patients with Multibacillary Leprosy
Authors: Hosokawa Atsushi
Published: April 2015

In the specimens examined at Ryukyu University Hospital, acid‐fast bacilli (AFB) were observed in the epidermis, cutaneous appendages and endotherial cells of capillaries. These specimens were taken from non‐ulcerating skin lesions of patients with multibacillary leprosies such as LL and borderline lepromatous leprosy (BL). Of the 211 specimens examined, 23 (10.9%) were AFB‐positive [AFB (+)] in the above mentioned skin regions. These AFB (+) samples were taken from nine leprosy patients; six cases (17 samples) of LL, two cases (5 samples) of BL, and one case (one sample) of BB. The AFB positive rate [AFB (+)‐rate] in the above mentioned skin regions was high in the unmedicated LL sample (50.0%, 7/14) and low in the medicated mid‐borderline leprosy (BB) samples (0.0%, 0/10). Particularly in the intraepidermal eccrine sweat duct (acrosyringium), a relatively high number of AFB were observed. The AFB (+)‐rate appears likely to be higher in non‐ulcerating skin lesions with minor inflammation or in lesions with leprosy reaction than typical skin lesions such as papules, nodules, and infiltrated punched out skin lesions. Although the possibility that viable bacilli could be excreted from non‐ulcerating skin lesions appeared to be small, these lesions were suspected of being a possible source of infection.
Generalized Atrophic Benign Epidermolysis Bullosa: A Case of Severe Hemidesmosomal Deficiency
Authors: Hashimoto Ken , Shwayder Tor
Published: April 2015

A case of generalized atrophic benign epidermolysis bullosa was followed from birth to 14 years of age. Electron microscopy of the blistered skin showed either the absence or greatly reduced hemidesmosomes of a very poorly developed type. In perilesional skin, the frequency of hemidesmosomes was 1/3 to 1/2 of the normal controls. These hemidesmosomes were small and lacked normal ultrastructures. Anchoring filaments did not cluster underneath them, and the anchoring fibrils were also diminished. In view of the published data correlating the genotype to the phenotype, this patient seems to have a homozygous nonsense mutation of the COL17A1 gene encoding collagen XVII. An accumulation of data may eventually enable electron microscopists to estimate the types of gene mutation.
Basosquamous Carcinoma after Ultraviolet Therapy with Artificial Sunlight
Authors: Miyamoto Hideaki , Okajima Mitsuya
Published: April 2015

We report a 63‐year‐old Japanese man with basosquamous carcinoma developing after ultraviolet therapy with artificial sunlight. Because he had had an eczematpus lesion on the right leg five years previously, he had received ultraviolet therapy with artificial sunlight from a mercury‐quartz lamp for a total of 30 sessions over a 3‐year period. Physical examination revealed an irregular erythematous plaque measuring 5 times 6 cm, with slight eruptions and erosions, on the right leg. A brownish plaque, measuring 9 times 12 cm, surrounded the erythematous plaque. Histopathologically, in the nests of atypical cells in the dermis, nuclear palisading was present at the edge of each tumor cluster. Adjacent clusters exhibited transitions to squamous cells and contained horn pearls. Most of the cells of the epidermis and adnexa were atypical, but cells of the normal adnexal epithelium extended over the atypical cells of the epidermis in an umbrella‐like fashion in other lesions. We believe that, in the present case, artificial sunlight therapy caused solar keratosis and that this developed into basosquamous carcinoma. To our knowledge, skin cancer developing after ultraviolet therapy with artificial sunlight without PUVA has not previously been reported in the English literature.
Sneddon's Syndrome and Antithrombin III
Authors: Bolayir Ertugrul , Keçeci Hulusi , Akyol Melih , Taş Ayşenur , Polat Murat
Published: April 2015

Sneddon's syndrome, an uncommon disorder, is characterized by multiple cerebrovascular accidents along with ideopathic livedo reticularis. In this article, two cases who had increased amounts of antithrombin III and were diagnosed with Sneddon's syndrome are presented.
Twice Weekly 5 mg Dexamethasone Oral Pulse in the Treatment of Extensive Alopecia Areata
Authors: Sharma Vinod Kumar , Gupta Somesh
Published: April 2015

Thirty patients (20 males, 10 females) with widespread alopecia areata (25 extensive alopecia areata, 5 alopecia areata) for a mean period of 4.2 years were included in the study. All patients above 12 years were administered 5 mg dexamethasone oral pulse on two consecutive days every week. Three children (<12 years) received 2.5 mg to 3.5 mg dexamethasone oral biweekly pulse. Patients who had received treatment for a minimum period of 12 weeks were evaluated for terminal hair growth. Complete to excellent (75–95%) hair growth was observed in 16 (63.3%) patients. Growth was good (50–74%) in 2 cases and poor (<50%) in 3 (10%) cases. Six (20%) patients has no growth of terminal hair. Complete to excellent growth of hair was obtained after a mean period of 5.35 months (range 3–10 months). Relapse occurred in one case each after three and six months but hair regrew with re‐treatment.

Side effects of corticosteriods were frequent, seen in 8 (26.6%) patients, but were mild. In only one case, treatment had to be discontinued. We propose that twice weekly 5 mg dexamethasone oral pulse for six months may be considered as one of the modalities in the treatment of extensive long standing alopecia areata.
Mast Cell “Densities” in Vascular Proliferations: A Preliminary Study of Pyogenic Granuloma, Portwine Stain, Cavernous Hemangioma, Cherry Angioma, Kaposi's Sarcoma, and Malignant Hemangioendothelioma
Authors: Hagiwara Keisuke , Khaskhely Noor Mohammad , Uezato Hiroshi , Nonaka Shigeo
Published: April 2015

The “densities” of mast cells (MCs) in six kinds of vascular proliferation, pyogenic granuloma, portwine stain, cavernous hemangioma, cherry angioma, Kaposi's sarcoma, and malignant hemangioendothelioma (MHE), measured per mm2 were studied using respective specimens prepared with tryptase stain and a personal computer. The average densities of MCs in pyogenic granuloma and MHE were 103.5 ± 25.2/mm2 (n=10) and 106.3 ± 40.2/mm2 (n=10) [mean ± standard deviation (SD)]; that in normal skin was 6.85 ± 4.9/mm2 (n=20) (mean ± SD). is a significant difference [t‐test (p<0.0001) and Wilcoxon‐test (p<0.01)]. The results in portwine stain (n=4), cavernous hemangioma (n=9), cherry angioma (n=4), and Kaposi's sarcoma (n=4) were 68.6 ± 28.9/mm2, 105.7 ± 56.9/mm2, 85.3 ± 45.6/mm2, 82.2 ± 28.4/mm2 (mean ± SD), respectively, all of which were greater than that in normal skin by a simple comparison. The results of immunofluorescence microscopy were positive with basic fibroblast growth factor staining in the tissues of pyogenic granuloma, Kaposi's sarcoma and MHE. These facts may morphologically indicate a role of MCs in the angiogenesis of these vascular tumors.
Adult Onset of Inflammatory Linear Verrucous Epidermal Nevus
Authors: Kawaguchi Hiroshi , Takeuchi Mizue , Ono Hideki , Nakajima Hiroshi
Published: April 2015

Adult onset of inflammatory linear verrucous epidermal nevus (ILVEN) is reported in a 44‐year‐old Japanese man. A mild pruritic eruption appeared one year earlier and extended from the left dorsal foot to the gluteal region. Histologically, acanthosis and papillomatous thickening of epidermis as well as spongiotic edema and exocytosis with lymphocytes and neutrophils were observed. Topical tacalcitol was not effective, but the pruritus as well as the eruption slightly improved with topical corticosteroid and vaseline containing salicylic acid. This adult onset of ILVEN is considered to be a rare case.
Panniculitis Showing Membranocystic Changes in the Dermatomyositis
Authors: Lee Mi‐Woo , Lim Yeon‐Soon , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: April 2015

Clinically obvious panniculitis in association with dermatomyositis is rare. We reported a patient with panniculitis showing membranocystic changes in the dermatomyositis.
Alopecia Areata, Stress and Psychiatric Disorders: A Review
Authors: García‐Hernández María José , Ruiz‐Doblado Sergio , Rodriguez‐Pichardo Antonio , Camacho Francisco
Published: April 2015

Although the results of some studies have proven negative, the influence of psychological factors in the development, evolution and therapeutic management of alopecia areata is, in general, well documented. Life events and intrapsychically generated stress can play an important role in triggering of some episodes. The comorbidity of psychiatric disorders, mainly generalized anxiety disorder, depression, and phobic states, is high. The role of treatment of concomitant psychopathological disorders is a vital one. Indeed this treatment can positively affect how the patient adapts to his/her alopecia and social setting and perhaps can even lead to a better dermatological evolution of the alopecia. Therefore, controlled studies analyzing the possible links between psychiatric symptoms, treatment with antidepressants or benzodiacepines, evolution of alopecia, medium term prognosis, and immune function are necessary. Basic psychotherapeutic support may prove to be of use in many cases and can be carried out by the dermatologist, although a subgroup of patients may need psychopharmacological or psychotherapeutic specialized treatments. Studies using operative diagnostic criteria and structured interviews are still scarce. Therefore, it seems necessary to design studies using modern psychiatric methodology. Controlled clinical trials to test the efficiency of psychoactive drugs and psychotherapy in the disease are also needed. By studying in depth these and other related aspects, we may improve the clinical management of our patients.
Characterization of Early and Late Onset Psoriasis in the Korean Population
Authors: Youn Jai Il , Park Byung‐Soon , Park Seok‐Beom , Kim Sang‐Duck , Suh Dae‐Hun
Published: April 2015

It has been proposed that two types of psoriasis can be characterized based upon age of onset. The purpose of our study was to investigate the characteristics of early and late onset psoriasis in the Korean population. A total of 986 psoriasis patients were included in this study, and the age of onset frequency proved to be bimodal. Family history in the first‐degree relatives was significantly higher in the early onset group (<40 years old) when compared with the late onset group (≥40 years old). A series of statistical analyses concerning the correlation between the extent of involvement and age of onset showed that earlier onset is related to more extensive involvement. A questionnaire survey concerning the influence of various external factors upon their psoriasis was given to a subgroup of 800 psoriasis patients. Multiple logistic regression analysis, controlled for confounding factors such as current age, sex and extent of involvement, revealed that early onset psoriasis patients showed significantly increased tendencies to worsen at times of psychological stress and in winter, and to improve in summer, compared with late onset psoriasis patients. In conclusion, distribution of the age of onset revealed two peaks in Korean psoriasis patients, and psoriasis with an onset prior to the age of 40 years was associated with increased inheritability, greater susceptibility to seasonal changes and more psychological stress than psoriasis with later onset.
A Case of Acquired Autoimmune Bullous Disease Associated with IgM Macroglobulinaemia
Authors: Morita Eishin , Horiuchi Kenji , Yamamoto Shoso , Hashimoto Takashi
Published: April 2015

A variety of autoimmune bullous dermatoses have been reported to develop in association with lymphoproliferative disorders. We report a patient with IgM macroglobulinaemia, who presented with a skin fragility similar to but somewhat milder than that seen in epidermolysis bullosa acquisita. Immunofluorescence detected circulating IgM autoantibodies reacting with the basement membrane zone, which reacted predominantly with dermal side of 1 M NaCl‐split skin. Immunoblotting of the epidermal and dermal extracts with the patient's serum showed no specific reactivity. Further studies are needed to identify the antigenic molecules responsible for the IgM deposition.
A Case of Pachyonychia Congenita with Oral Leukoplakia and Steatocystoma Multiplex
Authors: Lim Tuk‐Woo , Paik Jong‐Hyun , Kim Nack‐In
Published: April 2015

Pachyonychia congenita (PC) is an uncommon autosomal dominant genodermatosis affecting the nails and other ectodermal tissues. The most striking features are symmetrically thickened dysmorphic nails and hyperkeratotic skin lesions.

We report a case of pachyonychia congenita in a 30‐year‐old male patient who had thickening and gray‐brown discoloration of all nails and many nodules on his back and neck. He also had hyperkeratotic skin lesions on both feet. His tongue had irregularly‐shaped, whitish plaques. Histology of these nodules revealed the characteristic features of steatocystoma multiplex. After treatment with oral retinoic acid, his hyperkeratotic skin lesions improved.
A Case of Werner's Syndrome Associated with Osteosarcoma
Authors: Murata Kaoru , Hatamochi Atsushi , Shinkai Hiroshi , Ishikawa Yuichi , Kawaguchi Noriyoshi , Goto Makoto
Published: April 2015

We described a case of Werner's syndrome associated with osteosarcoma. A 37‐year‐old Japanese man was diagnosed as having Werner's syndrome by the presence of juvenile cataracts, skin sclerosis and hyperpigmentation of the feet, high‐pitched voice, characteristic bird‐like appearance of the face with beak‐shaped nose, thinning of the entire skin and hyperkeratoses on soles, hyperlipemia, hyperuricemia, diabetes melitus, and the mutated responsible gene (WRN). He had a 3‐month history of a tumor on his left forearm. Histologically, the tumor included four histological patterns; a malignant fibrous histiocytoma‐like, a desmoid‐like, a dermatofibrosarcoma protuberans‐like, and a chondrosarcoma‐like pattern. Tumoral osteoid formation was also found in the tumor. Therefore, the tumor was diagnosed as osteosarcoma.
Colchicine Therapy for Low‐Dose‐Methotrexate‐Induced Accelerated Nodulosis in a Rheumatoid Arthritis Patient
Authors: Abraham Zeev , Rozenbaum Michael , Rosner Itzhak
Published: April 2015

Accelerated nodulosis developed on the fingers of a woman successfully treated with low dose methotrexate for rheumatoid arthritis. Colchicine therapy resulted in regression of these nodules for twelve months. To our knowledge, this is the first report in the dermatological literature on this relatively new entity in which the skin is also involved.
Bowen's Diseases and Basal Cell Carcinomas in a Patient
Authors: Kim Hee Joong , Min Hyung Geun , Lee Eil Soo
Published: April 2015

Bowen's disease is a well‐known precancerous lesion, in which invasive squamous carcinoma may develop. However, it is rare that Bowen's disease, basal cell carcinoma, and internal malignancy develop in a single patient.

We report a case of a 54‐year‐old male patient with Bowen's disease, basal cell carcinoma of the skin, and squamous cell carcinoma of the lung. Multiple scaly erythematous patches had developed several years earlier and were diagnosed as Bowen's disease by skin biopsy. The number of lesions increased and, five months ago, a right lower lobectomy was done for squamous cell carcinoma which was detected on a chest X‐ray. Skin biopsies of two different sites revealed Bowen's disease and basal cell carcinoma. The arsenic level was increased in his hair specimen. Cryotherapy was applied.
Treatment of Severe Drug Eruptions
Authors: Roujeau Jean‐Claude
Published: April 2015

Severe drug eruptions are rare, life‐threatening events. The management begins with the withdrawal of the suspect drug(s). We recently confirmed that an earlier withdrawal of drugs with short elimination half‐life was associated with a better survival of patients with Stevens‐Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). In cases of “acute skin failure” (exfoliative dermatitis, extensive SJS or TEN), management of patients must be undertaken in specialized intensive care units or in burn units. The main principles of symptomatic therapy are the same as for major burns: warming of the environment, correction of electrolyte disturbances, high caloric intake, and prevention of sepsis. The suspected immunologic orgin of drug eruptions prompted the use of corticosteroids, immunosuppressive drugs, and anti‐cytokines. Systemic corticosteroids are useful in “hypersensitivity syndrome” when visceral lesions depend on infiltration by activated eosinophils. Systemic corticosteroids were shown to be deleterious in cases of advanced TEN. Their potential usefulness at earlier stages of SJS or TEN remains controversial. High intravenous doses of cyclophosphamide or oral cyclosporin have been administered to a few patients with TEN, most often following ineffective treatment with corticosteroids for 1 to 5 days. It remains doubtful that the progression of the lesions was shortened. A few patients appeared to benefit from treatment with pentoxifyllin, a drug suppressing the production of TNF. Thalidomide, another suppressor of TNF production, significantly increased the death rate when tested in a double‐blind placebo controlled trial in patients with early TEN. High dose intravenous immunoglobulins were used in 10 patients with TEN on the basis of their ability to inhibit fas‐fas ligand mediated apoptosis. The potential benefit of this treatment needs confirmation by further studies. Patients and their first degree relatives should be advised to avoid the responsible drug and chemically related compounds. Regulatory agencies should be notified of such cases.
How to Survive and Thrive under Managed Care: Lessons from U.S. Dermatologists
Authors: Emmet Steven D.
Published: April 2015

Dermatologists in the US have had many years experience in dealing with managed care and some lessons for survival and even thriving have become clear. First is to try to prevent managed care. By pointing out its history of failure in many countries it is still possible to prevent the catastrophe, to patient, physician and final payer, that managed care does represent. If prevention is not possible, minimizing its impact by promoting direct access, unbundling, and wider coverage is important. In addition, dermatologists will need to maximize reasonable sources of direct pay alternatives.
Itch and Atopic Dermatitis: An Overview
Authors: Wahlgren Carl‐Fredrik
Published: April 2015

Itching is the hallmark of atopic dermatitis, and a vicious itch‐scratch circle is easily established. Itching and scratching are important factors in the maintenance of symptoms and can have a significant impact on the sufferer's quality of life. The pathophysiology of itch in atopic dermatitis is still not understood. Unlike in urticaria, histamine is not considered to be a major pruritogen in atopic dermatitis. In fact, the peripheral pruritogens and their cellular origin(s) still remain to be identified in this disease.

Various treatments are used to relieve the skin inflammation, itching, and scratching in patients with atopic dermatitis, but no specific antipruritic therapy is available. However, several nonspecific therapies can effectively break the vicious itch‐scratch circle. The use of topical corticosteroids and emollients and the elimination of individual trigger factors are still first‐line measures.
Subcutaneous Nocardial Abscesses in a Patient with Bullous Pemphigoid during Immunosuppressive Therapy: Report of a Case and Review of the Japanese Literature
Authors: Kakurai Maki , Hiraga Takeshi , Yamada Tomoko , Usui Keitaro , Kiyosawa Tomoharu , Nakagawa Hidemi
Published: April 2015

We describe a rare case of multiple, subcutaneous nocardial abscesses. A 67‐year‐old Japanese male with bullous pemphigoid was admitted to our hospital, and systemic prednisolone and double filtration plasmapheresis were administered. During the combination treatment, he noted a solitary subcutaneous nodule on the right upper arm. The lesions gradually increased in number and disseminated. The microbial diagnosis was thought to be a Nocardia species. Administration of combination chemotherapy with minocycline and diamino‐diphenyl sulfone failed to eliminate the nodules completely, so he was treated with daily injection of amikacin sulfate into the nodules. The lesions dramatically responded to this therapy and resolved in four weeks.
Treatments of Generalized Pustular Psoriasis: A Multicenter Study in Japan
Authors: Ozawa Akira , Ohkido Muneo , Haruki Yasuo , Kobayashi Hitoshi , Ohkawara Akira , Ohno Yoshiyuki , Inaba Yutaka , Ogawa Hideoki
Published: April 2015

This study analyzed data from treatments of 385 cases of generalized pustular psoriasis (GPP) from 325 hospitals in Japan. Retinoid treatment was effective in 84.1% of patients, methotrexate in 76.2%, cyclosporine in 71.2%, oral PUVA therapy in 45.7%, and tonsillectomy in 16.7%. Short‐term therapy with systemic corticosteroid for GPP during only the phase with severe systemic clinical findings may be also effective (75.4%). However, these treatments for GPP each differed in clinical effects, prognosis, and side effects. These findings may be useful in creating guidelines for treatment of generalized pustular psoriasis. Further studies based on these specific clinical effects are necessary.
Linear IgA Bullous Dermatosis Associated with Ulcerative Colitis
Authors: Chi Hyung‐In , Arai Masayo
Published: April 2015

A 41‐year‐old woman developed skin vesicles one week before examination. She had been suffering from ulcerative colitis since the age of 30. Histologic examination of a vesicle showed a subepidermal bulla accompanied by mononuclear leukocyte infiltration intermingled with eosinophils and neutrophils. Eosinophilia was also noted. Direct immunofluorescent test revealed linear deposits of IgA in the basement membrane zone.
Pemphigus Vulgaris Preceded by Herpetiform‐like Skin Lesions with Negative Immunofluorescence Findings
Authors: Muramatsu Tsutomu , Iida Takashi , Honoki Kumiko , Nakatani Chie , Hatoko Mitsuo , Shirai Toshihiko , Vanittanakom Pramote
Published: April 2015

We report a case of pemphigus vulgaris in a 63‐year‐old woman. At the first onset, she developed herpetiform‐like skin lesions. Their histology showed eosinophilic spongiosis and intraepidermal blister formation with an infiltrate of eosinophils. Both direct and indirect immunofluorescence studies were negative. She remained in remission for 6 years. At the second onset, she developed bullous skin lesions; histological examination disclosed suprabasal acantholysis and infiltration of eosinophils. Direct immunofluorescence revealed IgG and C3 deposits at the cell surface, predominantly in the lower epidermis. Indirect immunofluorescence using normal human skin as a substrate demonstrated anti‐cell surface IgG antibodies at a titer of 1:160. Immunoblot analysis showed that the patient's serum reacted only with a 130kD protein. This case indicates that pemphigus vulgaris can follow herpetiform‐like skin lesions with negative immunofluorescence findings after a long remission time.
Alteration of Skin Protein Kinase C α Protein and mRNA Levels during Induced Mouse Hair Growth
Authors: Li Lin‐feng , Chang Bey‐dih , Roninson Igor B. , Fiedler Virginia C. , Kumar Raj
Published: April 2015

Protein kinase C (PKC) has been implicated in regulation of hair growth. In this study, the role of PKC α in induced mouse hair growth was studied. Hair growth in C57BL6 mice, a well known model for hair growth research, was induced by plucking the telogen hair. PKC α protein levels during the induced hair growth cycle were analyzed by Western immunoblot and mRNA levels were measured by RT‐PCR. At 1 day and 4 days postdepilation, when the induced hair cycle was in early and midanagen, the PKC α protein level was decreased. At 10 days after depilation, when the induced hair cycle was in mature anagen, the PKC α protein level was increased. At 17 days after plucking the hair, when the induced hair cycle was in early catagen, PKC α protein returned to the control level. PKC α mRNA was relatively unchanged at 1 day and 4 days after plucking the hair but significantly elevated at 10 days postdepilation. At 17 days after hair growth induction, PKC α mRNA reverted to the control level. These results suggest that: 1) in early and mid anagen of the induced hair growth cycle, PKC α was downregulated posttranscriptionally. This downregulation may play a role in the induction of hair growth; 2) in mature anagen of induced hair growth cycle, PKC α was overexpressed, and this overexpression may play a part in maintaining the hair growth. Since the expression of PKC α was roughy correlated with mouse skin pigmentation, we hypothesize that PKC α may regulate hair growth partially through modulation of skin melanogenesis.
Leukemia Cutis in Acute Lymphocytic Leukemia Masquerading as Viral Exanthem
Authors: Chao Sheau‐Chiou , Lee J. Yu‐Yun , Tsao Chao‐Jung
Published: April 2015

Leukemia cutis is a specific skin lesion caused by infiltration of leukemic cells into the skin. It is uncommon in acute lymphocytic leukemia (ALL). It typically manifests as red or violaceous papules, nodules, or plaques, mainly on the face. Leukemia cutis presenting with a generalized viral exanthem‐like maculopapular eruption appears to be rare in the English literature. We report such a case. A 19 year‐old man presented with a generalized purpuric maculopapular eruption of eight day's duration. Hematologic studies showed changes of acute lymphocytic leukemia, T‐cell type. A skin biopsy specimen revealed a cuff‐like, dense, perivascular infiltration of atypial lymphocytes in the upper and mid‐dermis, consistent with leukemia cutis. The rash resolved in two weeks after chemotherapy. Our case illustrates that leukemia cutis should be considered in the differential diagnosis of a generalized morbilliform viral exanthem‐like eruptions. Skin biopsy is important in estabishing the diagnosis.
Specific Cutaneous Lesions of the Scalp in Myelodysplastic Syndrome with Deletion of 20q
Authors: Namba Yumi , Koizumi Hiroko , Nakamura Hideki , Tarumi Takashi , Sawada Ken'ichi , Ohkawara Akira
Published: April 2015

We reported a specific skin lesion on the scalp in a patient with myelodysplastic syndrome (MDS), treated as refractory anemia with excess of blasts (RAEB). Histologically, a specimen from a nodule of the scalp consisted of a diffuse infiltration of atypical cells in the dermis and subcutaneous tissue. The patient died of acute leukemia 3 months later. Chromosomal examination of bone marrow cells revealed deletion of 20q and 21 trisomy. The specific cutaneous lesions in this patient were associated with acute transformation. The deletion of 20q and specific cutaneous lesions are regarded as signs of poor prognosis.
A Case of Classical Kaposi's Sarcoma of the Penis Showing a Good Response to High‐Energy Pulsed Carbon Dioxide Laser Therapy
Authors: Chun Yoon‐Sun , Chang Sung‐Nam , Park Wook Hwa
Published: April 2015

Isolated Kaposi's sarcoma (KS) of the glans penis is rare; only 37 cases are reported in the literature. Treatment of KS consists mostly of old modalities, some old methods in updated improved versions, and some new and experimental therapies. We report a case of isolated classical Kaposi's sarcoma involving multiple sites of the penis in a 54‐year‐old man who was treated with high‐energy pulsed carbon dioxide (CO2) laser therapy, resulting in complete resolution of the lesions and no evidence of recurrence.
Cerebriform Intradermal Nevus: A Case of Scalp Expansion on the Galea
Authors: Hashimoto Ichiro , Urano Yoshio , Nakanishi Hideki , Oura Hajimu , Kato Shoji , Arase Seiji
Published: April 2015

We report here a 7‐year‐old Japanese girl with cerebriform intradermal nevus (CIN). By placement of expanders on the galea, her scalp was expanded more easily with less discomfort than is expected when the expanders are placed under the galea. An immunohis‐tochemical study on the expression of proliferating cell nuclear antigen suggested higher proliferative activity of nevus cells from the CIN lesion than that of cells from congenital or acquired intradermal nevi. The high proliferative activity appeared to be associated with a growth spurt of the lesion.
Identification of Several Clinical Isolates of Dermatophytes Based on the Nucleotide Sequence of Internal Transcribed Spacer 1 (ITS 1) in Nuclear Ribosomal DNA
Authors: Mochizuki Takashi , Kawasaki Masako , Ishizaki Hiroshi , Makimura Koichi
Published: April 2015

Nucleotide sequences of internal transcribed spacer 1 (ITS 1) in nuclear ribosomal DNA from seven morphlogically unidentified dermatophyte isolates were determined. The sequences were compared with those of typical isolates of Trichophyton (T.) mentagrophytes var. interdigitale, T. rubrum, and Epidermophyton floccosum. Two of the isolates were classified as T. rubrum and the other five as T. mentagrophytes var. interdigitale. The results did not conflict with identifications using other molecular techniques, including random amplification of polymorphic DNA (RAPD) analysis and restriction enzyme analysis of mitochondrial DNAs. Thus, the nuclotide sequence of ITS 1 is possibly a good molecular marker for identification of these major anthropophilic dermatophyte species.
Clinico‐Bacteriological Study of Pyodermas in Children
Authors: Kakar Nirupama , Kumar Vijay , Mehta Geeta , Sharma Ravi C. , Koranne Ravindra V.
Published: April 2015

One hundred cases of pyodermas in children were investigated clinically and bacteriologically. Nasal and throat swabs from all cases were subjected to bacteriological examination. Most of the children (42%) were in the 1–4 year age group. The majority (58%) belonged to lower socio‐economic groups with poor standards of hygiene. A history of overcrowding was obtained from 87% of cases, 82% were undernourished. Most of the children (68%) reported during the hot and humid months of June, July, August, and September. Primary pyodermas were observed in 72% of the children, and secondary pyodermas in 28%. Impetigo was the commonest primary pyoderma (48.61%); among secondary pyodermas, infected scabies was noted predominantly (42.86%). The face and legs were more commonly involved.

Bacteriological cultures from pyoderma lesions revealed a single microorganism in the majority of the patients (84%). Staphylococcus aureus was isolated in pure culture from 48% and pure beta‐hemolytic streptococci from 36%. A combination of both was obtained from 16%. No other organism was isolated from any case. A similar pattern was also observed in cultures from the nose and throat. Only 46 out of the 64 strains (84.3%) of Staphylococcus aureus isolated from pyoderma were typable. The majority (39.1 %) showed a mixed pattern of phages; the second commonest was the non‐allocated phage type (30.4%). Nasal flora had more of the non‐allocated phage type (50%); two out of the three strains (66.6%) isolated from the throat showed a mixed pattern. All the strains of beta hemolytic streptococci, isolated either from lesions of pyoderma, nose, or throat belonged to group A. Staphylococcus aureus and showed a high sensitivity to netilmycin (100%), ofloxacin (98.4%), amoxycillin/clavulanic acid (96.9%), ciprofloxacin (89.1%) and gentamycin (84.4%) but a high resistance to penicillin (85.9%). A greater correlation was noted between nasal flora and organisms causing pyodermas.

A change in the pattern of organisms causing pyodermas in children and their antibioic sensitivities in this part of the globe has been observed in this study. The role of endogenous nasal and throat flora in the causation of pyodermas has also been highlighted.
The Spectrum of Mucocutaneous Manifestations during the Evolutionary Phases of HIV Disease: An Emerging Indian Scenario
Authors: Singh Ajit , Thappa Devinder Mohan , Hamide Abdoul
Published: April 2015

Third world countries, including India, lack sophisticated investigations to assess the progression of HIV disease. Hence, this study was undertaken to determine the clinical mucocutaneous markers of HIV disease and to establish its relationship with the stage of the disease. This was an observational institutional study of 75 patients with mucocutaneous disorders and HIV infection recruited over a period extending from September of 1996 to June of 1998. The patients with mucocutaneous lesions were staged according to the Centers for Disease Control classification system for HIV infection (1986). The most frequent mode of acquisition of HIV infection was heterosexual contact (96%). The patients were broadly categorized into two groups. The AIDS group was comprised of patients who were in group IV and the early HIV infection group included patients in group II and III; none were detected in group I. Forty‐eight cases belonged to the AIDS group, and 27 belonged to the early HIV infection group. A total of 207 dermatoses were diagnosed and grouped as fungal, viral, bacterial, or miscellaneous. The common mucocutaneous disorders in order of frequency observed in this study were: candidiasis, dermatophytosis, herpes simplex, oral aphthae, xerosis/ichthyosis, scabies, HPV infection, molluscum contagiosum, and psoriasis. Xerosis/acquired ichthyosis and giant molluscum contagiosum were characteristically seen in group IV of HIV disease, whereas oral candidiasis, oral aphthae, papular dermatitis of HIV, and psoriasis were early warning signs. The mean number of dermatoses per patient in group IV was 3.15; in group III, it was 2.41; and in group II, it was 1.5. There was a statistically significant difference between the early HIV infection group and AIDS group with regard to number of dermatoses. Apart from syphilis and human papilloma virus infection, the treatment outcomes were satisfactory.
Macular Amyloidosis: Etiological Factors
Authors: Eswaramoorthy V. , Kaur Inderjeet , Das Ashim , Kumar Bhushan
Published: April 2015

Macular amyloidosis is the commonest form of primary localized cutaneous amyloidosis; its etiology remains unclear. Various incriminating factors include genetics, sunlight, and fricition. Seventy‐five patients with a clinical diagnosis of macular amyloidosis (confirmed by at least two observers) were enrolled in the study. A detailed history was elicited in relation to the etiological factors and followed by cutaneous examination. Skin biopsy was performed in 44 patients. Amyloid deposits were demonstrated in 21 (48%) of the biopsies. The female to male ratio was over 3:1. Patients with skin type V had a more delayed onset than those with skin types III and IV. Two patients gave histories of regularly subjecting their skin to friction. There was no correlation between the sites affected and the sites subjected to friction, hair style of the patient, or the use of cosmetics. Family history was present in 7 (9.3%) patients. A majority, 44 (58.7%) of the patients, had involvement of both sun‐exposed and sun‐protected sites. To conclude, there was no direct correlation between macular amyloidosis and atopy, sunlight, or friction to the skin in our patients. Multiple factors may play a collective role in the genesis of macular amyloidosis to variable degrees. These include racial, familial, and environmental factors, atopy, sunlight, friction, and female gender.
Progeria (Hutchinson‐Gilford): A Case Report
Authors: Sivaraman Devinder Mohan Thappa , D'Souza Mariette , Ratnakar Chagantt
Published: April 2015

A new case with the typical features of progeria (Hutchinson‐Gilford) occurred in India. Histopathology of the skin showed atrophic epidermis and diffuse fibrosis of dermis with loss of appendages. Roentgenographic findings were characteristic of progeria. The child also had a gangrenous ulcer over the left foot, a finding not highlighted in the literature.
Aggregated Dilated Pores
Authors: Konohana Akira , Kobayashi Takashi
Published: April 2015

We report a 74‐year‐old Japanese man who had a 10‐year history of approximately 20 open comedones crowded onto his lateral neck. An excisional biopsy revealed that each comedo was histologically a dilated pore. Dilated pores are usually solitary. The multiple and aggregated dilated pores seen in our case have never been reported.
Evaluation of Thyroid Function in North Indians with Alopecia Areata: Response to Intravenous Injection of 100 μg Thyrotropin Releasing Hormone (TRH)
Authors: Sharma Vinod K , Sialy Ravinder , Kumar Bhushan , Gupta Somesh
Published: April 2015

There is a lack of agreement on the overall prevalence of thyroid disease and thyroid function abnormalities in alopecia areata. Only one study is available from the Indian subcontinent. All patients with alopecia areata attending a dermatology outpatient clinic between 1983 and 1997 were screened for the presence of clinical thyroid disease. Sixty‐two consecutive patients during the year 1994 were evaluated in detail for thyroid functions by measuring T3, T4, TSH levels and testing for antithyroid and antimicrosomal antibodies. Twenty‐two patients randomly selected from the above‐mentioned sixty two were studied for TSH response to intravenous injection of 100 μg TRH at ‐20, 0 and 20, 60, and 120 minutes after TRH injection. Thyroid disease was clinically evident in 16 (0.85%) of the 1700 patients with alopecia areata seen over the last fifteen years. All sixty‐two patients evaluated for thyroid functions were clinically euthyroid. Seven (11.3%) out of these 62 patients had abnormal thyroid hormone levels. Antithyroid and antimicrosomal antibodies were found in five patients; all five had abnormalities in thyroid function. TSH response to TRH was suggestive of hypothyroidism in 4 (18%) of the 22 patients studied. Manifest thyroid disease is infrequently associated with alopecia areata. Abnormalities in thyroid functional status were more frequent; they were found in 7 (11.3%) out of 62 patients. TSH response to intravenous TRH was abnormal in an even higher proportion [4 (18%) out of 22 patients]. There was no apparent correlation with duration or type of alopecia areata.
Paraneoplastic Syndromes of Leukocytosis, Thrombocytosis, and Hypercalcemia Associated with Squamous Cell Carcinoma
Authors: Kato Naoko , Yasukawa Kana , Onozuka Takashi , Kimura Kumiko
Published: April 2015

Paraneoplastic syndromes including leukocytosis, thrombocytosis and hypercalcemia are occasionally seen in patients suffering from progressive malignant disorders. Recent studies have revealed the production of several humoral factors by tumor cells and normal splenic cells of tumor‐bearing patients to be the major cause of these reactions. Granulocyte‐macrophage colony‐stimulating factor (GM‐CSF), granulocyte‐colony stimulating factor (G‐CSF), parathyroid hormone‐related peptide, interleukin (IL)‐1, IL‐6, and tumor necrosis factor (TNF) have been implicated.

We describe a 58‐year‐old Japanese man with squamous cell carcinoma (SCC) on the left sole, which developed in a deep linear scar after a train crash. He developed pulmonary and lymph node metastases, then leukocytosis (57,110/mm3 with 95% neutrophilia), thrombocytosis (86.3 × 104/mm3), and hypercalcemia (7.0 mEq/1), and finally cachexia, followed by death. Serum G‐CSF, IL‐1α, IL‐1β, and TNF‐β were determined; revealing G‐CSF and IL‐1β levels were above the upper limits of their normal ranges at 39.2 pg/ml and 4.63 pg/ml, respectively. It is probable that these humoral factors were partially responsible for the paraneoplastic syndromes induced by the cutaneous SCC with metastasis in the present case.
Pentazocine Induced Widespread Cutaneous and Myo‐Fibrosis
Authors: Jain Annu , Bhattacharya Sambit Narh , Singal Archana , Baruah Manik Chandra , Bhatia Arati
Published: April 2015

We report a case of extensive subcutaneous and muscle fibrosis in a 26‐year‐old Indian woman caused by repeated intramuscular pentazocine injections over five years to highlight the extent and sequelae of this avoidable condition.
Kaposi's Varicelliform Eruptions during the Course of Steroid Withdrawal in a Senile Erythroderma Patient: Cure of Regional Erythrodermic Lesions Following Infection
Authors: Horiuchi Yasuhiro
Published: April 2015

The author encountered a case of Kaposi's varicelliform eruptions on both axillar regions during the course of steroid withdrawal in a 68‐year‐old male with eythroderma following eczema. Immnohistochemical study gave positive indication of herpes simplex virus type I in epidermal keratinocytes in lesional vesicles. Following cure of the varicelliform eruptions, erythrodermic lesions in the axillar regions cleared up completely. For those at other sites, considerably more time was required for cure, with steroid withdrawal being a factor of this period.
Histiocytic Necrotizing Lymphadenitis (Kikuchi's Disease): The Necrotic Appearance of the Lymph Node Cells Is Caused by Apoptosis
Authors: Ura Hironobu , Yamada Nobuo , Torii Hideshi , Imakado Sumihisa , Iozumi Ken , Shimada Shinji
Published: April 2015

We report a case of histiocytic necrotizing lymphadenitis in a 28‐year‐old woman. The biopsy specimen of the enlarged lymph node showed lymphocytes, histiocytes, and a large amount of nuclear debris as well as marked eosinophilic deposits. We found DNA fragments by means of the modified TUNEL method, especially in the transitional area between intact cells and the foci of eosinophilic deposits and the cells positive for anti‐Fas antibody in the biopsied lymph node. Therefore, the necrotic appearance of the lymph node was thought to be caused by apoptosis induced by the Fas‐Fas ligand system. We hypothesize that the apoptosis was strongly related to the pathogenesis of this disease.
Eruptive Vellus Hair Cyst in a Patient with Pachyonychia Congenita
Authors: Lee g‐Tak , Chang Seung‐Ho , Yoon Tae‐Young
Published: April 2015

Pachyonychia congenita is characterized by symmetrical nail dystrophy, palmoplantar keratoderma, oral leukokeratosis, and follicular hyperkeratosis. In addition to these features, multiple cutaneous cysts of various kinds have been described.

We report a case of pachyonychia congenita associated with eruptive vellus hair cyst.
Clinical and Immunological Characterization of Patients with Systemic Sclerosis Overlapping Primary Biliary Cirrhosis: A Comparison with Patients with Systemic Sclerosis Alone
Authors: Akimoto Sachiko , Ishikawa Osamu , Muro Yoshinao , Takagi Hitoshi , Tamura Taeko , Miyachi Yoshiki
Published: April 2015

Limited cutaneous systemic sclerosis (ISSc) or CREST syndrome is sometimes complicated by primary biliary cirrhosis (PBC). To characterize the clinical and immunological features of patients with SSc overlapping PBC (SSc‐PBC), the clinical and laboratory data of 11 SSc‐PBC were studied. Since all of the SSc‐PBC were ISSc, the features of SScP‐BC were compared with those of 266 patients with ISSc alone. The sera from SSc‐PBC showed a significantly higher positivity for anti‐centromere antibody (ACA) (p<0.0005) and higher reactivity to centromere protein‐C. Although SSc‐PBC more frequently exhibited calcinosis and telangiectasia (p<0.05), there was no statistical difference in other features of CREST syndrome. There was no statistical difference in other scleroderma‐related features either. SSc‐PBC were more frequently complicated with Sjögren syndrome (p<0.05). The most prominent feature of SSc‐PBC was a higher incidence of ACA than in ISSc alone.
A Japanese Case of Dengue Fever with Lymphocytic Vasculitis: Diagnosis by Polymerase Chain Reaction
Authors: Ishikawa Hiroshi , Okada Shigeru , Katayama Ichiro , Mazaki Hironori , Nagatake Takeshi , Hasebe Futoshi , Igarashi Akira
Published: April 2015

A 37‐year‐old Japanese male was admitted to Nagasaki University Hospital with abrupt onset of biphasic fever, general malaise and myalgia 9 days after coming back to Japan from Manila. He developed a rubella like erythematous rash 3 days after admission and purpuric eruption one week after admission. A biopsied specimen from the purpura revealed lymphocytic vasculitis with T cell dominance and without immunoglobulin or complement deposition around the blood vessels. RT‐PCR analysis on peripheral blood mononuclear cells using dengue virus specific primers confirmed the diagnosis of type 3 dengue fever.

PCR analysis using virus specific primers is a rapid and valuable method for making a correct diagnosis of dengue fever.
A Case of Hypohidrotic Ectodermal Dysplasia
Authors: Park Jin Woo , Hwang Jae Young , Lee Sung Yul , Lee Jong Suk , Go Myoung Kwon , Whang Kyu Uang
Published: April 2015

Hypohidrotic ectodermal dysplasia (HED) is a rare, hereditary, congenital disease that affects several ectodermal structures. It is characterised by the following: anhidrosis or hypohidrosis, dental abnormalities, hypotrichosis, and a characteristic facies. The face shows prominent frontal bosses, supraorbital ridges and depressed bridges.

We experienced a case of hypohidrotic ectodermal dysplasia in a 43‐year‐old male who had four characteristic features. A skin biopsy from the palm showed a total absence of the eccrine glands. The diagnosis was made on the basis of clinical features and skin biopsy findings.
Hydroxyurea‐Related Leg Ulcers in a Patient with Chronic Myelogenous Leukemia: A Case Report and Review of the Literature
Authors: Kato Naoko , Kimura Kumiko , Yasukawa Kana , Yoshida Kouki
Published: April 2015

The unusual appearance of extensive skin ulcerations has been reported in patients with chronic myelogenous leukemia (CML) undergoing continuous chemotherapy with hydroxyurea. It is thought that hydroxyurea, an antineoplastic agent with selective cytotoxicity for cells that divide most actively (such as those of the skin), causes these ulcerations through impairment of normal wound healing in areas of common trauma. The most common site of ulcers is the leg, where the ulcers are often extremely painful, with violaceous macules surrounding them, and are associated with extensive edema. On biopsy, histological vascular changes include leukocytoclastic vasculitis, perivascular lymphocytic infiltration, formation of thrombus, swelling of the endothelial cells, and thickening of the vascular walls. We report successful split‐thickness skin grafting on hydroxyurea‐related leg ulcers after preoperative discontinuation of hydroxyurea treatment in a patient with CML. The possible pathogenesis of hydroxyurea‐related leg ulcers is discussed.