A 10-year-old girl developed itchy erythema on her cheek. She had no symptoms of collagen disease, and no history of taking any medicine. Since it was regarded as a contact dermatitis to something encountered in her environment, patch tests to some plants were performed. A patch test with a water extract of the leaves of Podocarpus macrophyllus var. chinensis (Roxb.) Maxim showed a positive reaction at D2(++) and D3(++). Patch tests with extracts of three other grasses were negative. A diagnosis of contact dermatitis to Podocarpus macrophyllus var. chinensis (Roxb.) Maxim was thus made. To the best of our knowledge, this is the first report of allergic contact dermatitis caused by Podocarpus macrophyllus var. chinensis (Roxb.) Maxim, although contact dermatitis to other Podocarpus species has been reported.

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A case of occupational contact dermatitis due to epoxy resins is reported. A 27-year-old man, with a 6-year history of pruritic eruptions on his hands consulted our clinic. We treated him with topical steroids and antiallergic agents, however, the lesions gradually worsened. He was thereafter given a series of patch tests using various products in his work place to find the causative product. The patch test demonstrated positive reactions to bisphenol A epoxy-resin. After making changes in the work environment, his symptoms improved.

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Two patients developed telangiectasia after taking calcium antagonist. One also showed gingival hyperplasia. A complete resolution was observed after they stopped taking the drug. This is the first report of calcium antagonist induced telangiectasia in Japan.

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A 19-year-old female presented with a tightening sensation on her palms after contact with water of one month’s duration. After immersion in water, her palms became edematous and demonstrated a whitish pebbly appearance with in one minute. About 20 minutes after drying, the skin returned to normal. This is the first report of aquagenic palmoplamtar keratoderma in Japan.

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A 0-day old girl was referred to our hospital with the chief complaint of multiple dark red nodules, measuring 2 to 5mm in size and covering her entire body. She was delivered at term with a 2,845g birth weight by normal spontaneous vaginal delivery. A biopsy specimen from the nodule of the trunk showed capillary hemangioma. Two hemangiomas of the liver were also identified by ultrasound. Since her hemangiomas were limited to the skin and liver, we diagnosed her to have benign neonatal hemangiomatosis. Since the hemangiomas grew in size during her first month of life, she was treated with oral prednisolone (2mg/kg/day). A month later, the hemangiomas began to improve, and thereafter the prednisolone was slowly withdrawn over a month-long period. As a result, the cutaneous hemangiomas resolved completely, and a hepatic hemangioma also disappeared.

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We report a case of multiple cutaneous leiomyomas arising in a 70-year-old Japanese female. She had been suffering from multiple tumors on her trunk for 15 years. The skin lesions gradually increased in size and number. The lesions showed firm, red to brownish colored tumors, of measured up to 6mm in diameter. She had also been suffering from recurrent attacks of severe pain in the lesions. The tumors showed the typical histological findings of leiomyoma, which were well-defined dermal tumors, consisting of spindle cells with characteristic long, thin ’cigarshaped’ nuclei. Ordinary analgesics had no effect on the pain. She was treated with Nifedipine, a calcium channel blocker, for a month. However Nifedipine was not very effective in reducing the pain. Thereafter doxazosin, an alpha adrenoceptor blocker, was given for 3 months to relieve pain. The pain mostly disappeared after this treatment. Surgical excisions were performed on some large tumors. We consider that Doxazosin or Nifedipine may thus be useful for relieving pain from multiple cutaneous leiomyoma due to their ability to relax arrectores pilorum muscle.

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Case 1: A 63-year-old man visited our hospital in August 2000 with a 10-year history of a black tumor on his left eye. His whole left eye was surgically removed. On August 14, 2001, he had a sudden severe stomachache and was found to have visceral disseminated metastasis. He received two courses of chemotherapy with dacarbazine, nimustine, cisplatin and tamoxifen (DAC-Tam) and one course of chemotherapy with cisplatin, dacarbazine and vindesine (CDV). As a result, most of his metastatic lesion disappeared. Case 2: A 49-year-old woman visited our hospital in July 2001 for an examination of subcutaneous tumors in the right inguinal region. She had first noticed a tumor in November 2000, and the number of tumors had since gradually increased. Although an extensive examination did not reveal the primary lesion, another metastatic lesion was found in her lung. She received five courses of CDV with interferon-β After the third course, the lung lesions completely disappeared and the metastatic tumors in the inguinal lymph nodes had decreased in size. The right inguinal lymph nodes were thereafter completely resected. In both cases, no new metastases have been found for more than 4 weeks.

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A 26-year old Japanese male noticed an unsymptomatic subcutaneous nodule measuring 10mm in size on his right cheek about 6 months ago. The tumor enlarged gradually became enlarged and reached to 25mm in diameter. The tumor was locally excised under the diagnosis of benign tumor. However, histological and immunohistochemical studies indicated a diagnosis of apocrine adenocarcinoma, and thereafter a wide resection with a 10mm margin was performed. About one year later, follow-up CT scanning revealed a metastasis on the right cervical lymphnode, and a radical neck dissection was thus performed. The patient was further treated with low dosage of 5-fluorouracil (5-FU)and cisplatin (CDDP).

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A 73-year-old woman was referred to our department for an evaluation of an erythematous lesion with an induration on her right cheek. A histological examination revealed irregular and anastomosing vascular channels from the dermis to the subcutaneous tissue, consisting of aggregates of tumor cells with atypical oval or spindle nuclei and eosinophilic cytoplasm, indicative of angiosarcoma. The patient was treated with an intra-arterial injection of recombinant interleukin 2(rIL-2) and local radiotherapy, thus resulting in complete resolution of the lesion which was confirmed histopathologically. However, the angiosarcoma recurred, and the patient died after seventeen months of rIL-2 treatment. Autopsy revealed that although the tumor was localized in her right cheek, other metastatic regions were not detected, thus suggesting that the rIL-2 treatment prevented metastasis. Immunotherapy by an intra-arterial injection of rIL-2 has been considered to be a useful treatment for angiosarcoma, however, our experience has shown this to only be a temporary measure. Therefore, it is necessary to establish a more conservative treatment for patients with angiosarcoma.

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We report a case of AILD in a 67-year-old Japanese male who presented with fever, generalized lymphadenopathy, cutaneous eruption, hypergammaglobulinemia, hepatosplenomegaly and other symptoms which developed within a short time. Histopathologically, the involved lymph node showed a complete destruction of the architecture, and the widespread proliferation of the arborizing small blood vessels which is a characteristic feature of AILD. Infiltrated lymphocytes had a T cell marker, and no T cell receptor gene rearrangement was recognized. A diagnosis of AILD was thus made. In spite of our treatment with predonisolone and cyclosporin the patient’s condition deteriorated rapidly and he eventually died of a pulmonary infection three months after admission.

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We report the findings of a six-year-old boy who was bitten by a tick Ixodes ovatus in Okinawa, Japan. He went on an excursion into a mountainous area of Okinawa on August 12, 2001. One week later, his family noticed an egg-shaped tick on the right temporal portion of his head. But he had no subjective symptoms. We diagnosed a tick bite, and this tick was excised under local anesthesia. By light and electron microscopic examinations, this tick was identified to be Ixodes ovatus. Five cases of such a tick bite have been reported in Okinawa. These cases contained four Amblyomma testudinarium cases and one Rhipicephalus sanguineus case. The present report is the first case of a tick Ixodes ovatus in Okinawa Prefecture.

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Case 1: A twenty-two-year old male, who worked at of a shop handling pet animals, noticed a ringworm lesion of one-week’s duration on his face and scrotum. Case 2: The mother of the case 1, a 46-year-old female, also demonstrated a ringworm lesion on her face with a duration of 3 weeks. They had been keeping a rabbit with partial hair loss in their house for 6 weeks. A potassium hydroxide mount examination of the scales taken from the lesions revealed hyphal bodies and Arthroderma benhamiae was isolated by a culture. The rabbit were screened by the brush sampling method and was confirmed to be suffering from the same fungus. Patient 1 was treated by a combination of oral griseofulvin and topical antifungals, while patient 2 was treated by topical anitifungal alone. Both patients showed favorable results. The rabbit was also sucsessfully treated by a topical antimycotic.

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We studied 910 cases of collagen diseases (80 cases), Raynaud’s disease (RD)(43 cases) and various skin diseases (787 cases) for one and half years in our department. The mean age of the patients was 52.6 years old and there were 334 male and 576 female cases. The existence of a past history of chilblain is predominant in the patients from 30 to 60 years of age and females were predominant. The localization of chilblain was in both hands and feet, feet only, hands only, etc. A total 67.5% showed complications with collagen diseases (SSc 81.5%, RD 72.4%, incomplete SSc 67.5%, SLE 68.8%, Sjögren syndrome (Sjs) 66%, Behçhet’s disease 57.1%, sarcoidosis & RA 54.5%, and dermatomyositis 50%), especially cases with positive anti-centromere antibodies were numerous (75%). The occurrence pattern of chilblain is classified into four types; younger type (onset of infant and diminished in 20-year-old patients), middle-aged type (continued by middle age), continuous type and delayed/recurrence type. Collagen diseases and RD are predominant in delayed/recurrence type case. A decrease in the wave-height in prethismography after cold water (15°C) exposure (10 min.) for both hands is especially observed in continuous type cases. Chilblain is seen in patients with a labile body temperature; especially a delayed/recurrence type. Therefore examining a past history and occurrence patterns of chilblain is considered to be useful for differentiating collagen diseases such as SSc, Sjs, SLE etc.

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To evaluate the actual situation of glucocorticoid treatment by dermatologists and the importance for the preventive treatment for glucocorticoid-induced osteoporosis, we conducted a quastionnaire study among 399 dermatologists working either at hospitals or in private practice in Shizuoka, Wakayama and Nagasaki prefectures. Responses were obtained from 218 dermatologists, including 81 dermatologists at hospitals and 135 dermatologists in private practice and 2 other dermatologists. Most of the dermatologists in private practice (95.6%) and at hospitals (92.6%) usually administer oral glucocorticoids to patients. A dermatologist in private practice administered oral glucocorticoids to 48.3 patients in a month and a dermatologist in hospital, 14.9 patients. This data demonstrated that dermatologists in private practice more frequently give oral glucocorticoids to patients, however, dermatologists in private practice seldom carry periodic checks for osteoporosis induced by glucocorticoid (5.2%), on the other hand dermatologists at hospitals sometimes carry periodic checks for osteoporosis (29.6%). Regarding the preventive treatment for osteoporosis, a dermatologist in private practice sometimes gives preventive therapy (38.5%), while dermatologists at hospitals often give preventive therapy (50.6%). The dermatologists started the preventive therapy for osteoporosis based on individual criterion such as the length of glucocorticoid treatment, the amount of glucocorticoid at each treatment or the total amount of glucocorticoid for used during the treatment. In conclusion, it is necessary for dermatologists to study more evidence of osteoporosis induced by glucocorticoids and to establish National guidelines for the preventive treatment of glucocoricoid-induced osteoporosis.

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Palmoplantar pustulosis (PPP) is a chronic, recurring skin disorder characterized by sterile pustules and erythema, occurring predominantly on the palms and soles. Topical steroid is commonly used. However, it is sometimes difficult to manage these lesions. This study investigated the efficacy of local PUVA-bath therapy in 22 out-patients with palmoplantar pustulosis who were resistant to topical steroid treatment. Excellent or good effects were achieved in 64% of the patients. No phototoxic reactions were observed. Local PUVA-bath therapy is effective for palmoplantar pustulosis resistant to standard topical treatment.

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A follow-up study of 101 patients with atopic dermatitis who were treated with topical tacrolimus ointment at Kurume University Hospital was carried out to evaluate its efficacy, side effects and outcome after reducing the ointment application dosage. After the erythema in the applied area disappeared, the patients reduced the ointment application dosage randomly in one of three ways; (1) they stopped it completely, (2) they decreased the frequency to once a day, thereafter to once every 2 days and finally stopped all application if the dermatitis did not recur, (3) they decreased the frequency to once every 2 or 3 days, and finally stopped all application. In all groups it was recommended to restart applying the ointment twice a day as soon as any signs of recurrence were encountered. A facial improvement was observed in 93 (93%) out of 99 patients, in the neck in 8 out of 9 patients, and in other areas in 8 out of 12 patients. Skin irritation was reported in 30%, and other adverse drug reactions included acne or folliculitis (6%), Kaposi’s varicelliform eruption (5%) and a worsening of the dermatitis (3%). No severe adverse reaction was observed. After all symptoms disappeared, 5 mild cases in the first group stopped taking tacrolimus abruptly and all of them showed a good course. Most (4/5) of the moderate cases and severe cases had recurrences within 3 days after stopping the application of topical tacrolimus. In the second group, all 14 cases showed good control with once-a-day applications, and 7 of these were later able to reduce the application freguency of the ointment. In the third group 7 of the 8 cases showed a good control of dermatitis when an application of once every 2 or 3 days was maintained. Among them, gradual decrease from once a day to once every 2 days (protocol 2) was the most accepted treatment protocol, which suggested that the patients did not want to experience recurrences due to a reduction of the application freguency.

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