bluuebunny/crossref_metadata_2025 huggingface dataset:
Patent Odontogenic Sinus Tract Draining to the Midline of the Submental Region: Report of a Case
Authors: Urbani Carlo Enrico , Tintinelli Roberto
Published: April 2015

We report a case of a 65‐year‐old woman with a cutaneous sinus tract located on the midline of the submental region secondary to a periapical abscess of the right lateral mandibular incisor. The lesion was nodulocystic and chronically drained purulent fluid. Previous topical and systemic treatments were uneffective. Radiologic examination of the mandible demonstrated diffuse radiolucency involving the apices of four affected incisors. A further radiologic sinogram revealed both the exact origin and the high grade patency of the fistolous tract. Appropriate conservative endodontic therapy led to quick resolution of the sinus tract within sixteen days. In the presence of a single chronic suppurative or nodulocystic lesion of the face, it is always useful to perform a radiologic evaluation of the maxillary and mandibular regions to promptly exclude a possible odontogenic background.
Extramammary Paget's Disease: A Report of 22 Cases in Chinese Males
Authors: Chang Yun‐Ting , Liu Han‐Nan , Wong Chu‐Kwan
Published: April 2015

Extramammary Paget's disease (EMPD) is more frequently seen in Caucasian females than in males (3.2:1 female: male ratio). During the past 14 year period, we have collected 22 patients, all Chinese males, with EMPD. They presented with eczema‐like lesions in the early stages in the genital or perianal regions. Histological sections showed Paget cells within the epidermis or skin appendages and even within the dermis. No underlying adnexal carcinoma or adjacent internal carcinoma could be detected after thorough examinations. Mode of therapy and outcome are presented. EMPD seems to affect more males than females in Orientals. The incidence of concomitant malignancy in Chinese male patients with genital Paget's disease seems to be much lower than that in Caucasians. However, if EMPD involves the glans penis or perianal area, a search for internal malignancy is still warranted.
Coexistence of Plaque‐Type Blue Nevus and Congenital Melanocytic Nevi
Authors: Aroni Kyriaki , Georgala Sophia , Papachatzaki Elektra , Liossi Anna , Davaris Panagiotis
Published: April 2015

A rare case of development of plaque‐type blue nevus adjacent to congenital nevi in a 44‐year‐old woman is presented.
Antiphospholipid Syndrome Associated with Progressive Systemic Sclerosis
Authors: Chun Woo Hyung , Bang Dongsik , Lee Soo Kon
Published: April 2015

We report a case of secondary antiphospholipid syndrome (APS) occuring in a progressive systemic sclerosis (PSS) patient who took herbal medication.

Clinical findings compatible with APS included positive IgM anticardiolipin antibody (ACL), thrombocytopenia, and obstruction of the left radial artery on digital subtraction angiography (DSA), Clinical findings compatible with PSS included sclerodactyly and digital ulcers, Raynaud's phenomenon, pulmonary fibrosis and pulmonary hypertension, proteinuria and renal mesangial reaction, and myocarditis.
A Case of Stasis Papillomatosis Associated with Psoriasis Vulgaris
Authors: Sato Toshihiro , Katagiri Kazumoto , Itami Satoshi , Takayasu Susumu
Published: April 2015

A markedly obese, 41‐year‐old Japanese man who had suffered from psoriasis vulgaris for several years visited us with elephantiasis‐like swelling of his lower legs of three months' duration. His right lower leg showed marked papillomatosis with thick scales, and the left lower leg was eroded and papillomatous. Although direct lymphography of his lower extremities showed no abnormality, indirect lymphography revealed local lymphatic damage in the involved skin. Histological examination showed hyperkeratosis, marked papillomatosis, proliferation of capillaries in the upper dermis, and lymphectasia in the lower dermis. The lesions were much improved by washing and topical use of corticosteroids for two months. It was suspected that obesity and the preceding psoriatic lesions caused local lymphatic disturbances, followed by the development of stasis papillomatosis.
Serum Levels of Eosinophil Cationic Protein Reflect the State of In vitro Degranulation of Blood Hypodense Eosinophils in Atopic Dermatitis
Authors: Miyasato Minoru , Tsuda Shingo , Nakama Takekuni , Kato Keiko , Kitamura Naohisa , Nagaji Junko , Sasai Yoichiro
Published: April 2015

In patients with atopic dermatitis (AD), serum levels of eosinophil cationic protein (ECP) have been shown to be a good reflector of disease severity. To elucidate what serum levels of ECP actually reflect, ECP levels in serum and plasma and cytological aspects of blood eosinophils were examined in AD patients (n=27) and compared to healthy subjects (n=12). Significantly elevated levels of serum ECP were noted in AD patients, while plasma ECP were uniformly recorded at nadir levels in both AD patients and normal subjects. In addition to blood eosinophilia, AD patients had significantly increased numbers of hypodense eosinophils (HEo) with morphological characteristics consistent with an activated state. Serum ECP levels strongly correlated with HEo numbers rather than with total eosinophil counts. These results indicate that elevated levels of serum ECP may be a consequence of in vitro degranulation of “activated” HEo, not of ECP supplementation from lesional skin. In addition, the dynamic correlations of eosinophil‐associated parameters (total eosinophil counts, HEo numbers, and serum ECP levels) with AD severity suggest that inflammatory events in lesional skin may be involved in causing not only eosinophilopoiesis in bone marrow, but also development of HEo in the periphery, whose degree in turn may be mirrored in the levels of serum ECP in vitro.
Inflammatory Linear Verrucose Epidermal Nevus Coexisting with Lichen Amyloidosus
Authors: Zhuang Lihua , Zhu Wenyuan
Published: April 2015

The clinical and histopathological findings in a case of inflammatory linear verrucose epidermal nevus coexisting with lichen amyloidosus are presented. A 33‐year‐old woman had had linear verrucose lesions which were histopathologically compatible with ILVEN, and with which no amyloid deposits were associated, on her left lower leg for 30 years. She had noticed keratotic papules around the verrucose lesions on the left leg for the last 3 years. Histopathology of these papules revealed amyloid deposits in the upper dermis under the hyperkeratotic and acanthotic epidermis. Topical application of DMSO liniment with dexamethasone successfully treated the ILVEN. This remission of both lesions and itching also alleviated the keratotic papules on the left leg.
Two Cases of Pachydermodactyly
Authors: Kim Tae‐Heung , Cho Yoon‐Hyang , Park Heung‐Bae
Published: April 2015

We report two cases of pachydermodactyly. Case 1 was a 16‐year‐old girl who complained of asymptomatic, bulbous, firm swellings which developed insidiously on both sides of the proximal interphalangeal (PIP) joint of her right middle finger. Case 2 was a 14‐year‐old boy with similar lesions on the sides of the PIP joints of the index and middle fingers of both hands. They both had histories of mild, repetitive mechanical trauma of the fingers.

Radiologic findings showed soft tissue swellings without any bony or articular abnormalities. Histopathologic findings from the bulbous swellings revealed marked hyperkeratosis, slight epidermal hyperplasia, and a markedly thickened dermis with a deposition of mucinous material among the collagen fibers. Ultrastructural examinations of both cases showed decreased diameters of collagen fibrils. The lesions temporarily improved with intralesional injection of triamcinolone acetonide.

Pachydermodactyly is more commonly found in boys and the affected fingers are more numerous in boys. Both of the present cases had the habit of rubbing and gripping their fingers unconsciously. Mechanical trauma of the fingers around puberty may play an important role in pachydermodactyly.
Multiple Milia Localized to the Vulva
Authors: Kanekura Takuro , Kanda Akira , Higo Akiko , Kanzaki Tamotsu
Published: April 2015

Milia are most commonly observed on the cheeks and eyelids. We studied a case of multiple milia localized to the vulva in a 64‐year‐old female. A review of English and Japanese literature for the last 20 years failed to uncover any reports of milia limited to this area.

We describe this case in detail and provide a short review of the literature on cysts of the genitalia.
Scleroedema in a Child
Authors: Mitsuhashi Yoshihiko , Kondo Shigeo , Shimizu Yukitoshi
Published: April 2015

A 3‐year‐old Japanese girl with scleroedema was reported. She had had no signs of diabetes but did have a preceding bacterial infection in the tonsils three weeks before the skin lesion appeared. The skin on the face, shoulders, extensor aspect of the upper arms, and proximal half of the forearms was indurated. The skin lesions expanded from the middle part of the forearms to the wrists during the observation period. Thereafter, the induration gradually disappeared. A literature review revealed there were only six reports of scleroedema in children under 15 years old before 1996 in Japan; a total of 166 cases of the disease was reported in the same period. Five out of these six cases were not diabetes‐associated. All but one of these six patients were female. Juvenile scleroedema seems to be rare in Japan.
Human Leukocyte Interferon‐α in a Hydrophilic Cream versus in a Gel for the Treatment of Genital Herpes in Males: A Placebo‐Controlled, Double‐Blind, Comparative Study
Authors: Syed Tanweer A. , Ahmadpour Oliver Abbas , Ahmad Seyed Ali , Ahmad Seyed Hamzeh
Published: April 2015

The aim of this double‐blind, placebo‐controlled, comparative study was to differentiate the clinical efficacy and tolerability of human leukocyte interferon‐α incorporated (2 times 106 IU/g) in a hydrophilic cream and in a gel to heal males afflicted with first episodes of genital herpes. Patients (n=60), aged 18–40 years (mean 23.2) with culture‐confirmed diagnosis of herpes genitalis were randomized to three parallel groups. Each patient was allocated a precoded 40‐g tube, containing either preparation or placebo. Cream or gel was applied three times daily for 5 consecutive days. The duration of the active treatment was two weeks. Patients were examined after 48 hours of initial treatment, and thereafter two times a week. A reepithelialized lesion with some residual erythema was recorded as healed. The study demonstrated that patients treated with leukocyte interferon‐α cream had both significantly shorter mean duration of lesions than gel and placebo recipients (5.3 days vs. 8 days, 13 days respectively; p<0.001) and a higher number of healed patients (80% vs. 55%, 20% respectively; p<0.001). Of the 60 patients, 49 (82%) complained of no drug‐related side effects. Eleven patients predominantly in the cream/gel groups reported non‐objective transitory increase in their body temperature (>38°C) with moderate headache, malaise and myalgia. The study was followed‐up for 24 months after the first day of the treatment, and out of 31/60 cured patients, 4 had a relapse after 18 months.

In conlusion the study affirmed that human leukocyte interferon‐α (2 times 106 IU/g) in a hydrophilic cream is more efficacious than its incorporation in gel or placebo, thus suggesting that leukocyte interferon‐α in a hydrophilic cream, with a profile of non‐objective mild to moderate drug‐induced indications, may be considered an alternative and effective treatment modality to cure male patients afflicated with first episodes of genital herpes.
Lupus Panniculitis Treated by a Combination Therapy of Hydroxychloroquine and Quinacrine
Authors: Chung Hae‐Shin , Hann Seung‐Kyung
Published: April 2015

Lupus erythematosus panniculitis (LEP) is an unusual clinical variant of lupus erythematosus (LE) in which the cutaneous inflammatory reaction occurs primarily in the deeper corium. The common clinical features of LEP includes asymptomatic, firm, sharply defined nodules. The histologic findings are characterized by nonspecific panniculitis composed of lymphoid cells, plasma cells, and histiocytes with varying degrees of necrobiotic changes with fibrinoid deposits.

In our case, a 24‐year‐old male patient visited our clinic with non‐tender, hard, plaquelike lesions and overlying erythema on the left zygomatic, nasal, and submandibular area. Histopathologic and direct immunofluorescent findings of the lesion were compatible with LEP. His skin lesions waxed and waned with systemic steroid or hydroxychloroquine therapy. He has responded well to a combination therapy of hydroxychloroquine and quinacrine.
Neonatal Lupus Erythematosus Occurring in Identical Twins
Authors: Shimosegawa Masako , Akasaka Toshihide , Matsuta Mayumi
Published: April 2015

The patients were one‐month‐old identical twins. Scaly erythema was noted mainly on the trunk, face, and scalp of one twin starting about three weeks after birth and starting about two weeks after birth in the other. The patients' courses were observed without treatment; the eruptions tended to disappear two months after birth. The mother had a past history of transient facial erythema. Both twins and mother were positive for anti‐nuclear antibody, anti‐SS‐A antibody, and anti‐SS‐B antibody. The histopathological findings corresponded to those of discoid lupus erythematosus (DLE). The class of HLA typing revealed Cw3 in both twins, which is frequently observed in neonatal lupus erythematosus (NLE), and A24 in the mother, which is frequently observed in mothers of babies with NLE.
Zeis Gland Carcinoma
Authors: Kato Naoko , Sotodate Akihiro , Tomita Yuki
Published: April 2015

Sebaceous carcinoma of the Zeis gland of the cilia is a rare malignant tumor. A 90‐year‐old Japanese man with a Zeis gland carcinoma on the left upper eyelid is reported. The tumor was a 12 times 3‐mm, reddish, partially yellow, papillomatous nodule accompanied by loss of several lashes. Histologically, two types of tumor cells, a dark basaloid cell and a larger pale cell, showed lobular and comedo‐acinar growth patterns. The carcinoma did not recur during the 8 months following surgery; however, the patient died of gastric carcinoma.
Erythema Nodosum Leprosum in Histoid Leprosy: A Case Report
Authors: Kumar Vijay , Mendiratta Vibhu , Sharma Ravi C. , Kakar Nirupama , Bajaj Promila
Published: April 2015

A 28‐year‐old married female developed histoid papules and nodules de novo over her face, extremities, back, buttocks and thighs. She had developed erythema nodosum leprosum lesions without any antileprosy treatment. Histopathology from a histoid nodule showed well defined nodular collections of plump, spindle‐shaped histiocytes. A few globi were also seen with Ziehl Neelson staining. Leucocytoclastic vasculitis was present in the ENL lesion. The CD4: CD8 ratio was 1.5:1.
Prolidase Activity in Chronic Wound and Blister Fluids
Authors: Oono Takashi , Fujiwara Yutaka , Yoshioka Toshiko , Arata Jirô
Published: April 2015

We investigated prolidase activity in samples derived from wound fluid as well as blister fluid. Prolidase activity was elevated in fluid samples collected from wounds over the levels in sera collected from patients with chronic wounds (P<0.05). Prolidase activity was also present in samples taken from blister diseases. However, prolidase activity in blister fluid was not higher than that in sera collected from patients with blister diseases. Our results indicate that prolidase may play a role in wound healing.
Toxic Epidermal Necrolysis Possibly Linked to Hyperacute Graft‐versus‐Host Disease after Allogeneic Bone Marrow Transplantation
Authors: Takeda Hikaru , Mitsuhashi Yoshihiko , Kondo Shigeo , Kato Yu‐ichi , Tajima Katsufumi
Published: April 2015

Toxic epidermal necrolysis (TEN) is a severe blistering skin disease of high mortality. TEN may occur after bone marrow transplantation (BMT). In such cases, TEN have been attributed to graft‐versus‐host disease (GVHD) or an adverse drug reaction. It is very difficult to distinguish the causes of TEN after BMT. We report a 21‐year‐old Japanese man who developed TEN eight days after BMT, evaluate the differential diagnosis of hyperacute GVHD and an adverse drug reaction, and deduce that hyperacute GVHD was the more likely pathogenesis of TEN in this patient.
An Autopsy Case of Angioimmunoblastic T‐cell Lymphoma with a High Content of Epithelioid Cells in the Lymph Node: Immunohistochemical and Genomic Analyses
Authors: Morita Kazumasa , Matsumura Yumi , Kudo Hitoshi , Fujii Kimio , Tachibana Takao , Ohta Keiji , Kamoto Toshiyuki , Okamoto Hiroyuki , Yamabe Hirohiko , Imamura Sadao , Fukumoto Manabu
Published: April 2015

A 79‐year‐old female developed red papulonodular eruptions on her extremities, facial erythema, generalized lymphadenopathy and high fever. Histopathology of an affected lymph node showed the features of angioimmunoblastic T‐cell lymphoma with a high content of epithelioid cells. She died about two years after the onset despite therapy. Genomic Southern blotting and immunostaining of the lymph nodes were performed twice. In August of 1993, Southern blotting did not show any rearrangement of the immunoglobulin or the T‐cell receptor (TCR) gene. Small or medium‐sized lymphoid cells were positive for CD4 or CD8 (CD4:CD8=2:1). However, in September of 1994 (at autopsy), rearrangements of TCR Cβ1, Jβ2 and Jγ genes were observed. Small or medium‐sized lymphoid cells were positive for CD4, but negative for CD8. Several large cells were positive for Latent Membrane Protein 1 (LMP1) of the Epstein‐Barr virus (EBV). Our results proved that selective oligoclonal proliferation of tumor cells (probably CD4+) accompanied the disease progress.
A Case of Contact Dermatitis Due to Sodium Bisulfite in an Ophthalmic Solution
Authors: Nagayama Hirotoshi , Hatamochi Atsushi , Shinkai Hiroshi
Published: April 2015

We report a case of contact dermatitis due to sodium bisulfite in Tathion® eye drops. A 72‐year‐old woman was treated daily with two solutions including Tathion® eye drops for senile cataract for two years and three months. She developed edema, swelling, erythema, and vesicles on her eyelids. Because contact dermatitis due to a topical medication was suspected, patch testing was performed after disappearance of her eruption. A positive reaction to sodium bisulfite in Tathion® eye drops was confirmed. Therefore, we diagnosed her eruption as contact dermatitis due to sodium bisulfite. The reaction to sodium sulfite in the next patch testing was negative. To the best of our knowledge, this is the first report from Japan about contact dermatitis caused by this medication.
Acute Gout of the Right Sacroiliac Joint
Authors: Abraham Zeev , Glück Zahava
Published: April 2015

An eighty‐year‐old woman suffered from acute idiopathic gout of the right sacroiliac joint and tophaceous deposits in two fingers of her right hand. Hyperuricemia and findings consistent with gout detected by histological examination of a biopsy specimen taken from the digital nodules supported the diagnosis. The radiological workup revealed osteolytic changes at the bases of the phalanges in Roentgenograms of the feet. Various aspects of the very rare incidence of sacroiliac gout are discussed.
Arteriovenous Malformation in the Buttock: Treatment with a Combination of Selective Embolization and Excision
Authors: Ishihara Tsuyoshi , Hirooka Minoru , Ono Tomomichi
Published: April 2015

Arteriovenous malformation (AVM) in a 22‐year‐old Japanese female is reported. The malformation presented as a nontender, pulsating tumor. An area of marked hypervascularity was revealed in the dermis and muscles of the right buttock by arteriography. The tumor was removed after embolizing the right superior and inferior gluteal arteries, which were the main feeding arteries. Histological examination revealed a number of artery‐like vessels, encircled by proliferating capillaries. Follow‐up three years after excision showed no clinically remarkable changes. Selective embolization was useful for the excision.
Epidermal Differentiation and Squamous Metaplasia: From Stem Cell to Cell Death
Authors: Jetten Anton M. , Harvat Beth L.
Published: April 2015

Epidermal differentiation is a multi‐step process defined by a cascade of interrelated changes in the expression of growth‐regulatory and differentiation‐specific genes (Fig. 1). Irreversible growth arrest is an early event in epidermal differentiation which occurs when cells transit from the basal to the innermost suprabasal layer of the skin and begin to express squamous‐specific genes. In culture, interferon γ, phorbol esters, confluence and growth in suspension are effective signals to induce irreversible growth arrest and differentiation. The induction of differentiation‐specific genes occurs either concomitantly with or following growth arrest and is believed to be linked to the molecular events that control irreversible growth arrest. Such a link has been demonstrated in other cell systems undergoing terminal differentiation, such as myogenesis and adipogenesis. Genes encoding proteins involved in the formation of the cross‐linked envelope are one set of squamous‐specific genes which are induced in the suprabasal layers and include transglutaminase I and III, involucrin, loricrin and cornifins/small proline‐rich proteins. Squamous‐specific genes exhibit not only different patterns of tissue‐specific expression but are also induced at different stages during differentiation, suggesting that transcription of individual genes is regulated by distinct mechanisms. The latter is supported by the identification of different sets of regulatory elements controlling the transcription of these genes. The importance of understanding both the mechanisms that regulate growth arrest and the differentiation program is emphasized by the association found between specific skin diseases and genetic alterations in growth‐regulatory genes as well as differentiation markers. In addition, studies into those mechanisms will provide insight into the control of squamous metaplasia and the development of squamous cell carcinomas.
Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis Are Severity Variants of the Same Disease which Differs from Erythema Multiforme
Authors: Roujeau Jean‐Claude
Published: April 2015

A new classification, based on the pattern and distribution of cutaneous lesions, separates erythema multiforme major from Stevens‐Johnson syndrome. A retrospective reclassification of 76 cases supported the validity of that separation by demonstrating differing causes and pathology. Another prospective international case‐control study found differing demographic characteristics and risk factors between erythema multiforme major on the one hand and Stevens‐Johnson syndrome or toxic epidermal necrolysis on the other. Erythema multiforme major was mainly related to Herpes virus infection, while Stevens‐Johnson syndrome and toxic epidermal necrolysis were associated with drug reactions.
Hyperkeratosis of the Nipple: Report of Two Cases
Authors: Alpsoy Erkan , Yilmaz Ertan , Aykol Ayten
Published: April 2015

Hyperkeratosis of the nipple and areola is a rare condition; its characteristic properties are verrucous thickening and brownish discoloration of the nipples and areola. The nevoid form of the disease is extremely rare, usually seen in women in the second or third decade of life. The nipple is seldom affected alone.

We report two cases of the nevoid form of hyperkeratosis of the nipple. In both female patients, lesions developed after puberty and were confined to both nipples alone. One of the patients' lesions became darker and more verrucous during pregnancy, making breast feeding impossible.
Rupioid Psoriasis Associated with Arthropathy
Authors: Wang Jung‐Luh , Yang Jen‐Hung
Published: April 2015

We reported a rare case of rupioid psoriasis associated with arthropathy. A 28‐year‐old male had suffered from severe arthritis for 6 months and had limpet‐like, cone‐shaped skin lesions on the extremities for 3 months. The histopathology revealed remarkable Munro's and Kogoj microabscesses, intense dermal edema, and moderate inflammatory cell infiltration. The radiological examination showed bilateral sacroilitis. The skin lesions and arthritis responded dramatically in three weeks to i.m. methotrexate combined with topical steroids and emollients and occlusive dressing technique. There was no recurrence of such skin lesions during the two year follow‐up period.
Pilomatricoma with a Bullous Appearance
Authors: Inui Shigeki , Kanda Ryoji , Hata Seiichiro
Published: April 2015

A 15‐year‐old Japanese girl had an asymptomatic nodule on the right thigh of seven months' duration. The clinical appearance was similar to that of a bulla. There was a history of blunt trauma from dog scratch to the skin over the tumor shortly before tumor growth. Histopathological findings were consistent with pilomatricoma. In the overlying dermis, the collagen bundles were compressed to the tissue surrounding the tumor and the large space was seen. Around the tumor, some dilated endothelium‐lined vascular channels were found, which were identified as lymphatic vessels.
A Case Report of Twenty‐Nail Dystrophy
Authors: Ohta Yukinori , Katsuoka Kensei
Published: April 2015

A case report of twenty‐nail dystrophy in a 21‐year‐old woman is presented. All her finger nails were affected with numerous small superficial pits. The histological findings showed the focal spongiotic change in the nail matrix reflecting the clinical appearance of the nail plate surface.
Immunohistochemical Localization of Nitric Oxide Synthase in Normal Human Skin: Expression of Endothelial‐type and Inducible‐type Nitric Oxide Synthase in Keratinocytes
Authors: Shimizu Yoshinori , Sakai Masao , Umemura Yoshiki , Ueda Hiroshi
Published: April 2015

Nitric oxide (NO) is a critical mediator of various biological functions. NO is generated from L‐arginine by nitric oxide synthase (NOS), which has three isoforms; endothelial‐type NOS (eNOS) and brain‐type NOS (bNOS) are constitutive enzymes, and inducible‐type NOS (iNOS) is expressed after stimulation. We investigated the expression of NOS in normal human skin by an immunohistochemical technique and western blotting analysis. In human skin, epidermal keratinocytes and the outer root sheath were labeled with not only eNOS antibody but also with iNOS antibody. Both eNOS and iNOS protein in epidermal keratinocytes were confirmed by western blotting. eNOS immunoreactivity was observed in endothelial cells, fibroblasts, the arrector pili muscle, apocrine secretory gland, eccrine coiled duct, and eccrine secretory gland. bNOS immunoreactivity was observed in mast cells. No staining with anti‐bNOS antibody was observed in any other cell type. Our present findings suggest that epidermal keratinocytes in normal human skin contain both eNOS and iNOS.
Acquired Dermal Melanocytosis on the Wrist
Authors: Kuniyuki Shuichi
Published: April 2015

A 50‐year‐old Japanese man had a blue‐black patch on the dorsum of his right wrist. Light and electron microscopic study of the lesion revealed dermal melanocytes containing mature melanosomes, predominantly in the upper dermis. This case was diagnosed as acquired dermal melanocytosis confined to the right wrist.
Cutaneous Mixed Tumor Containing Ossification, Hair Matrix, and Sebaceous Ductal Differentiation
Authors: Akasaka Toshihide , Onodera Hanae , Matsuta Mayumi
Published: April 2015

A 58‐year‐old Japanese male presented with a cutaneous mixed tumor containing ossification and hair matrix differentiation on the left side of the chin.

Histologically, the tumor consisted almost exclusively of apocrine‐type epithelial ductal structures and chondroid stroma. Strands and aggregation of basaloid cells which contained keratinous cystic structures with a column of shadow cells arising from basophilic basaloid cells, sebaceous duct‐like structures, and ossification in the stroma were also evident. These findings suggest that cutaneous mixed tumors with ossification and hair matrix differentiation are related to both the whole hair follicle and the sweat aparatus.
A Case of Recessive X‐Linked Ichthyosis: Scale‐Specific Abnormalities of Lipid Composition May Explain the Pathogenesis of the Skin Manifestation
Authors: Hamanaka Sumiko , Ujihara Mayumi , Serizawa Shigeo , Nakazawa Schuichi , Otsuka Fujio
Published: April 2015

We analyzed the lipid content of the scales, red blood cells, and plasma from a recessive X‐linked icthyosis patient. The patient's scales accumulated cholesterol sulfate, had decreased levels of free sterols, sterol esters and sphingolipids, and lacked phospholipids. Although the accumulation of cholesterol sulfate was found in the patient's red blood cells and plasma as well as in the scales, other lipid composition abnormalities were specific for scales. Such scale‐specific abnormal lipid composition may explain the pathogenesis of generalized hyperkeratosis and abnormal scaling of the disease.
Regional Eruptive Neurofibromas
Authors: Betti Roberto , Cerr Amilcare , Gualandri Lorenzo , Moneghini Laura , Crosti Carlo
Published: April 2015

A 71‐year‐old woman presented with multiple, flesh‐colored, papular lesions on the left dorsal side of the hand which had erupted 5 years earlier. No café‐au‐lait spots, freckles, or Lisch nodules were detected. Family history did not disclose neurofibromas or abnormal pigmentation. Two biopsy specimens of the lesions showed circumscribed, non‐encapsulated neurofibromas. Segmental neurofibromatosis is characterized by the unilateral, segmental appearance of neurofibromas and/or café‐au‐lait spots in the absence of genetic transmission. The authors discuss the significance of localized multiple cutaneous neurofibromas in the absence of family history and suggest the possibility of a cutaneous hamartoma.
Mo2+ HLA‐DR– Monocytosis in Varicella Zoster Virus Infection
Authors: Horiuchi Yasuhiro
Published: April 2015

Two‐color analysis using Mo2 (CD14) monocytes and HLA‐DR class II monoclonal antibodies confirmed monocytosis in varicella zoster virus (VZV) infection in eight cases of herpes zoster and two cases of varicella. Only three cases, one being varicella, showed extensive Mo2+ HLA‐DR– monocytosis of more than 12%. Accordingly, monocytosis in VZV infection may not be specific to the VZV antigen.
Secretion of Different Types of Gelatinases from Cultured Human Keratinocytes
Authors: Kobayashi Takashi , Hattori Shunji , Nagai Yutaka , Sakuraoka Koichi , Nishikawa Takeji
Published: April 2015

We investigated gelatinolytic enzymes derived from cultured human keratinocytes. Using a zymograph, we detected 92 kDa and 72 kDa gelatinases as major components and 83 kDa as a minor component from a conditioned cultured medium (BSL‐K110, Kyokutoseiyaku Co.) of keratinocytes. After several passages, the 72 kDa band disappeared, and the 83 kDa band became dominant in another conditioned culture medium (K‐GM, Kurashikibouseki Co.); these keratinocytes had a relatively differentiated appearance. These results suggest that some mechanism may regulate the secretion of selected types of gelatinase from keratinocytes under different conditions.
Evaluation of an Avidin‐Biotin‐Peroxidase Method with a Monoclonal Antibody to Type IV Collagen in the Differential Diagnosis of Bullous Pemphigoid and Epidermolysis Bullosa Acquisita
Authors: Bowszyc‐Dmochowska Monika , Hashimoto Takashi , Dmochowski Marian , Nishikawa Takeji
Published: April 2015

There are reports in which an immunohistochemical technique with a monoclonal antibody to type IV collagen has been employed for differentiating between bullous pemphigoid (BP) and epidermolysis bullosa acquisita (EBA). The aim of this study was to determine whether this method could be used routinely. Biopsies (paraffin‐embedded lesional skin containing a blister) from currently diagnosed patients with clinical features suggesting BP or EBA were examined by an avidin‐biotin‐peroxidase (ABC) technique. Sera were tested by indirect immunofluorescence on salt‐split skin (IF) and immunoblotting (IB). In all cases which exhibited clear type IV collagen staining, the results of the ABC technique agreed with results of both IF and IB. In one confirmed EBA case, it was impossible to unequivocally localize type IV collagen, because it stained very faintly. Taking into consideration the results of our study, data indicating that the level of blistering might not coincide with the localization of immunoreactants in EBA cases and the possibility of an enzymatic destruction of lamina densa, we conclude that the ABC method is unsuitable for differentiation between BP and EBA.
Hormonal Profiles and Prevalence of Polycystic Ovary Syndrome in Women with Acne
Authors: Timpatanapong Penwadee , Rojanasakul Aram
Published: April 2015

One of the important etiologic factors in acne is an increase in sebaceous gland activity, which is androgen dependent. Acne is a common manifestation of hyperandrogenemia. Therefore, acne may not only cause cosmetic concern but may also be a sign of underlying disease. In females, the most common cause of hyperandrogenemia is polycystic ovary syndrome (PCOS). The purpose of this study was to determine the hormonal profiles of women with acne and the prevalence of PCOS in women attending the dermatological clinic with acne problems.

The diagnostic criteria of PCOS were clinical findings of menstrual disturbances and hyperandrogenism (acne, seborrhea, hirsutism), pelvic ultrasound imaging of PCO (multiple subcapsular ovarian cysts 2–8 mm. in diameter, with dense echogenic stroma), and an elevated luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio. There were 51 women with acne; 20 regularly menstruating volunteers without acne served as a control group.

PCOS was found in 19 out of 51 patients with acne (37.3%) and none of the control group. Twenty acne patients had abnormal menstruation (39.2%). Acne cases had higher mean levels of serum total testosterone (T), free T, dehydroepiandrosterone sulfate (DHEAS) and prolactin (PRL). No statistically significant difference was observed for LH, FSH or sex hormone binding globulin (SHBG).

Because of this high prevalence of PCOS in women with acne, all women presenting with acne should be asked about their menstrual pattern and examined for other signs of hyperandrogenemia. Hormonal profile determination as well as pelvic ultrasonography for ovarian visualization should be performed to confirm the diagnosis of PCOS in female acne patients who have menstrual disturbances.
Natural History of Psoriasis: A Study from the Indian Subcontinent
Authors: Kaur Inderjeet , Handa Sanjeev , Kumar Bhushan
Published: April 2015

Clinical and epidemiological data from 1220 patients with psoriasis is presented. Psoriatics accounted for 2.3% of the total dermatology outpatients. There was a distinct male preponderance. Mean age of onset was lower in women at 27.6 years, although the severity of the disease was the same in both sexes. Family history was positive in just 2% of patients.

Plaque type disease was the most common, seen in over 93% of the patients. Lesional pruritus was a problem in 65%. Remission in summer was experienced by 43%. The scalp was the first site of onset in 25.2%. Nail and joint involvement were seen in 55.7% and 4.4%, respectively. Complete remission of disease activity was experienced by 35% of the patients during some part of the year in the course of their disease.
Panniculitis with Eosinophilic Infiltration Due to Gabexate Mesilate (FOY®): Possibility of Allergic Reaction
Authors: Nakayama Fumiaki
Published: April 2015

A 59‐year‐old Japanese man developed septal panniculitis with eosinophilic infiltration in both forearms and the dorsum of the left hand after a gabexate mesilate intraveous drip infusion for acute pancreatitis through catheters implanted in these sites. Gabexate mesilate at a dose of 1000 mg per day had been given continuously for 8 days, and antibiotics were added by the same infusion route twice a day. All the infusion routes, however, became occluded one after the other. Reddish swelling first occurred at the left wrist 6 hours after occlusion of the infusion route, and, on both forearms, reddish swelling occurred about one week after the occlusion of each route. Patch testing revealed a ++ reaction to gabexate mesilate (10% pet) at days 3 and 7, and skin testing revealed indurated erythema to gabexate mesilate (0.1% aq) at days 2 and 3. The specimens biopsied from the positive skin testing reaction sites showed perivascular infiltrate and slight septal panniculitis. The inflammatory infiltrate consisted predominantly of lymphocytes with small numbers of eosinophils. Staining of the specimen biopsied from the right forearm lesion with anti‐eosinophil cationic protein (ECP) antibodies (EG1 and EG2) showed deposition of eosinophil‐derived granule proteins at the damaged septal connective tissues of the panniculitis. The panniculitis improved with topical steroid treatment. This case suggested that the concentration of infused gabexate mesilate may have been high enough to damage blood vessels and that gabexate mesilate may have leaked into the surrounding connective tissues, inducing allergic reactions and resulting in leions.
Traumatic Aneurysm of the Temporal Artery: A Report of Five Cases
Authors: Inoue Yuji , Iwamoto Takashi , Kitoh Masato , Yoshimura Kouji , Ono Tomomichi
Published: April 2015

Five cases of traumatic aneurysm of the superficial temporal artery are reported. Four patients clearly stated that they had sustained traumatic injuries within 3 months prior to the appearance of the pulsating aneurysms; in the remaining case, more than two years had passed before the appearance of the nodule, and it was without pulsation. Color Doppler echography was very useful for observing the circulation in these aneurysms. Histologically, these cases were pseudoaneurysms composed of small vessels with internal elastic lamina and adjacent connective tissue proliferation, suggesting a break in the arterial wall.
A Unique Case of Squamous Cell Carcinoma Showing Adenocarcinomatous Features with Focal Apocrine Differentiation
Authors: Yamamoto Osamu , Yasuda Hiroshi , Murayama Minoru , Asahi Masakazu
Published: April 2015

We report an 85‐year‐old man with squamous cell carcinoma on the right pinna. Two years after the excision of the lesion, metastatic foci were found extending from the right retromandibular to the mastoid region and into the parapharyngeal space. Histopathologically, the primary tumor showed interconnecting nests of atypical cells invading into the dermis from multiple epidermal and infundibular foci. The tumor had both squamous and glandular differentiation. A peculiar finding was the presence of decapitation secretion in the glandular foci. To our knowledge, definite apocrine differentiation in squamous cell carcinoma has not previously been reported.
A Case of Dermatopathia Pigmentosa Reticularis
Authors: Bux Tai‐Sung , Kim Young‐Keun , Whang Kyu‐Uang
Published: April 2015

Dermatopathia pigmentosa reticularis (DPR) is a very rare disorder with the diagnostic triad of generalized reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. Many other dermatologic findings have been associated with this triad, including adermatoglyphia, hypohidrosis or hyperhidrosis, palmoplantar hyperkeratosis, and nonscarring blisters on the dorsa of the hands and feet. The mode of inheritance is unclear but may be autosomally dominant. To our knowledge, only 11 cases have been reported in the world, and none has previously been described in the Orient. We present a Korean patient with the typical features of the DPR triad, along with adermatoglyphia, hypohidrosis, and nonscarring blisters on the dorsa of the feet.
Ulcerative Lichen Planus: A Rare Variant of Lichen Planus
Authors: Isogai Zenzo , Koashi Yusuke , Sunohara Akiyo , Tsuji Takuo
Published: April 2015

A 54‐year‐old Japanese man with ulcerative lichen planus is reported. He had a painful erythema with ulcers on his soles and nail dystrophy. Mucous involvement was present on his lip. His hairs were intact. Histopathological findings confirmed the diagnosis of lichen planus.
A Case of Estrogen Dermatitis
Authors: Kim Kab‐Hyeong , Yoon Tae‐Jin , Oh Chee‐Won , Kim Tae‐Heung
Published: April 2015

A 29‐year‐old Korean woman had erythematous papular patches on her face for six months. The eruptions recurred in a cyclic fashion along with her menstruation. The patient responded positively to an intradermal skin test for estrogen and showed marked improvement with the antiestrogen drug, Tamoxifen. We concluded that sensitivity to her own estrogen caused this dermatitis, that an intradermal skin test with progesterone and estrogen should be carried out routinely in patients with cyclic premenstrual flares, and that tamoxifen can be used as a specific therapy. To the best of our knowledge, this woman is the first patient with estrogen dermatitis reported in Korea.
Disaggregation of Corneocytes from Surfactant‐treated Sheets of Stratum Corneum in Hyperkeratosis on Psoriasis, Ichthyosis Vulgaris and Atopic Dermatitis
Authors: Shukuwa Tetsuo , Kligman Albert M.
Published: April 2015

To elucidate the pathogenesis of impaired barrier function and the influence of surfactant on the stratum corneum in hyperkeratosis, we investigated morphological alterations of the corneocytes with soap solution. Groups of five patients each with psoriasis vulgaris (PV), ichthyosis vulgaris (IV), atopic dermatitis (AD), and normal controls were examined. Four samples of the horny layer were obtained from the same site by cyanoacrylate adhesive biopsy. The first sample was used for the superficial layer, and the fourth, for the basal horny layers. Each sample was agitated in 1% stirred soap solution at 60°C. The number and size of isolated corneocytes and the morphologic changes were investigated. The release of corneocytes was greater and the swelling and morphological changes of corneocytes exposed to soap solutions were less in PV and AD than in IV or in healthy subjects. In IV, the release was markedly less than in controls. The release and swelling were greater in the superficial than in the basal horny layers.

It was concluded that the cohesiveness of corneocytes was probably less in PV and AD and greater in IV than in normals. It was also suggested that the cohesion of corneocytes from the superficial horny layer was less than that from the deep layer. The permeability of the cornified envelope in PV and AD patients was less than in IV or healthy subjects. It was confirmed that highly potent soaps induce loss of many corneocytes and reduce the barrier function of the stratum corneum.
Langerhans Cell Histiocytosis (Histiocytosis X) with Morphologic Expression of Desmosomes and Microvillous Structures
Authors: Furukawa Masuyo , Suzuki Hiroyuki
Published: April 2015

An unusual case of Langerhans cell histiocytosis in a 7‐year‐old female is presented. She had ultrastructural evidence of desmosomal biogenesis and formation of gland‐like structures by lesional cells; their apical plasma membranes were folded into large numbers of microvilli. Despite the presence of these structures characteristic of epithelial cells, an infiltrated plaque on the abdominal skin of this patient was interpreted as cutaneous involvement of multiple system Langerhans cell histiocytosis because the immunohistochemical staining of the lesional cells for CD1a, S100, PNA, CD4, EN‐4, and HLA‐DR was positive, and numerous Birbeck granules were ultrastructurally identified in some lesional cells. Other clinical data included the presence of scaly erythematous skin lesions on the forehead and lytic osseous lesions in the maxilla, which were also histologically diagnosed as Langerhans cell histiocytosis. The absence of any internal malignancy in this patient readily ruled out the other diagnostic possibility of a metastatic adenocarcinoma showing glandular differentiation with brush border morphogenesis. The possibility that the desmosome‐linked lesional epithelioid cells were actually cells of sweat glands entrapped in the histiocytic proliferation was also ruled out. The functional significance of the desmosomes and microvillous structures in the present case of Langerhans cell histiocytosis remains to be clarified. Awareness of this variant of Langerhans cell histiocytosis will be important for averting potential misdiagnosis in favor of epithelial tumors, especially metastatic adenocarcinomas.
Concurrent Cytomegalovirus, M. Tuberculosis and M. Avium‐Intracellulare Cutaneous Infection in an HIV Patient
Authors: Núñez María , Miralles Enrique S. , Hilara Yolanda , Pintado Vicente , Harto Antonio , Ledo Antonio
Published: April 2015

We report a 25‐year‐old HIV‐positive man with a past medical history of disseminated cytomegalovirus (CMV) infection, who developed cutaneous lesions during a disseminated mycobacterium infection. The histological changes of CMV and acid‐fast bacilli were seen on histopathology of the lesions. Cultures were positive for M. tuberculosis and M. avium‐intracellulare (MAI). CMV is frequently isolated from HIV patients, but skin involvement is rare. The association of CMV and mycobacteria can occur in cutaneous lesions of AIDS patients, but concurrent cutaneous involvement of CMV, M. tuberculosis, and MAI is unusual. These findings emphasize the polymorphous presentation of infectious disorders in AIDS patients and the need for multiple biopsies and for special stains in such patients.
Plantar Thrombotic Nodules with Marked Neovascularization in Diabetes: A Symptom Which Has Been Overlooked?
Authors: Akimoto Sachiko , Ishikawa Osamu , Miyachi Yoshiki
Published: April 2015

Absract

A 69‐year‐old woman with diabetes has had multiple subcutaneous nodules on the soles for 11 months. She suffered from uncontrolled diabetes mellitus, hypercholesteremia, and cardiovascular thrombosis and had a past history of photocoagulation therapy for proliferative diabetic retinopathy. Histological examination revealed vascular thrombosis surrounded by neovascularization in the subcutaneous tissue. The basement membranes of vessels were thickened and strongly stained with periodic acid‐Schiff. An increased serum concentration of von Willebrand factor antigen was observed. With control of her diabetes, the nodules almost disappeared. Her curious skin manifestation is speculated to be a diabetes‐mellitus‐related change in which endothelial injury and the subsequent induction of angiogenetic factors may play important roles. It is possible that this kind of skin manifestation has been overlooked or not examined histopathologically.
Penicillamine‐Induced Degenerative Dermatoses: Report of a Case and Brief Review of Such Dermatoses
Authors: Iozumi Ken , Nakagawa Hidemi , Tamaki Kunihiko
Published: April 2015

We describe a case of elastosis perforans serpiginosa with additional findings of degenerative skin changes. A 20‐year‐old man with hepatolenticular degeneration, under prolonged treatment with D‐penicillamine, presented with a circular or serpiginous arrangement of nuchal papules. Histopathologically, transepidermal channels were accompanied by granulomatous reactions, with several giant cells engulfing elastic fibers. In addition to these findings of a typical elastosis perforans serpiginosa, we observed scar‐like skin changes inside the circular arrangement of the papules. At the scar‐like tissue, we found electron‐microscopical evidence of randomly aggregated thin collagen fibers with no tendency toward systemic combined bundle formation, which is a characteristic feature of normal collagen fiber formation. Pseudoxanthoma‐elasticum‐like changes were observed on his neck. On his axillae and groin, slight skin thickening and wrinkling were detected. The diagnosis of elastosis perforans serpiginosa does not represent all of the manifestations or the pathological background described above. The skin manifestations described here represent not only an elastosis but also a total degenerative dermatosis with over‐healed collagenosis. Thus, those dermatoses should be summarized as one entity, penicillamine‐induced degenerative dermatosis. After considering the pathogenic background and clinical similarities, we further propose to simplify the penicillamine‐induced skin manifestations to three categories: acute sensitivity reactions, bullous dermatoses, and degenerative dermatoses.