The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 69, Issue 3
Displaying 1-18 of 18 articles from this issue
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Color Atlas
Mini Review
Clinical Case Reports
  • Successful Treatment of Severe Anaphylactoid Purpura with Tonsillectomy
    Saori TOMIMURA, Fumihide OGAWA, Shinichi SATO
    2007 Volume 69 Issue 3 Pages 244-247
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.244
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    A 44-year-old man had purpura and edema on his lower legs and forearms after common cold. His urine protein excretion was strongly positive, and urine occult blood was also positive. Skin biopsy revealed leukocytoclastic vasculitis. Immunofluorescent studies indicated IgA and C3 deposition predominantly in the upper blood vessel walls of skin. Anaphylactoid purpura was diagnosed by these clinical and pathological features. Because of no significant improvement in purpura with oral prednisolone administration (30 mg daily), tonsillar focal infection was suggested as an exaggerated factor, and this patient was successfully treated with tonsillectomy.
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  • A Case of Bullous Systemic Lupus Erythematosus with Ultraviolet-induced Exacerbation in Unexposed Area
    Ai SHIMIZU, Keiko KOBAYASHI, Yoichi SHINTANI, Akimichi MORITA, Shogo B ...
    2007 Volume 69 Issue 3 Pages 248-254
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.248
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    We report a 23-year-old man with systemic lupus erythematosus (SLE) with marked bullous lesions on his face, head and trunk. The biopsy specimen of bullous lesions revealed subepidermal blisters with neutrophil-predominant infiltration in the upper dermis. Direct immunofluorescence showed linear IgG, IgM and C3 depositions on the basement membrane zone and IgA around the hair follicles. Results of analysis of1M NaCl-split skin were negative. Based on immunofluorescence analysis, circulating autoantibody against type VII collagen was not detected in the serum. During his hospital stay the bullous lesions disappeared gradually. However, a few days after returning home, bullous lesions appeared on his upper trunk. This suggested that ultraviolet exposure might have induced the bullous lesions. Taking the clinical and pathological features together, this patient was diagnosed as having type 3 bullous SLE.
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  • A Case of Adult Staphylococcal Scalded Skin Syndrome Occurring in a Patient with Dermatomyositis
    Hiroyuki TAKAHASHI, Makiko KAGAYA, Yuko GOTODA, Shunji MURAOKA, Akira ...
    2007 Volume 69 Issue 3 Pages 255-258
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.255
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    We report an adult case of staphylococcal scalded skin syndrome (SSSS) in a 73-year-old female patient who had diabetes mellitus and dermatomyositis. Four days after leaving the hospital, bullous lesions appeared on the body with subsequent generalization. The patient had not been administered any new drugs in the past 6 months. We performed a serological examination, including that for the detection of serum anti-BP180 antibody, skin biopsy and bacterial culture from fresh vesicles. The lack of mucosal involvement, presence of Nikolsky reaction, detection of S. aureus from vesicles, and epidermal necrotic changes shown by histological examination indicated that the condition initially started from bullous impetigo and subsequently resulted in adult SSSS. Skin lesions, including bullous lesions and painful erosions, quickly responded to intravenous administration of penicillin. Only a few cases of adults with SSSS have been reported. All clinical data strongly suggested that the present case developed SSSS due to immunosuppression induced by the systemic administration of corticosteroid for the treatment of dermatomyositis. Therefore, a careful follow up of patients with an immunosuppressive condition is required to prevent a serious systemic infection such as SSSS.
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  • A Case of Dermatomyositis with Acute Myelogenous Leukemia
    Kanako ONTSUKA, Miho OGATA, Takuya INOUE, Junji NAKAFUSA, Noriyuki MIS ...
    2007 Volume 69 Issue 3 Pages 259-262
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.259
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    A 70-year-old man with pruritic erythema on his back was reported. The erythema had been present for 4 months and expanded to both knees and dorsal surface of both hands. Muscle weakness of the lower limbs was also recognized. Based on various clinical and histopathologic examinations, the patient was diagnosed as having dermatomyositis. Peripheral blood examination revealed pancytopenia and atypical lymphocytes. Additional bone marrow aspiration confirmed the diagnosis of acute myelogenous leukemia. It is well known that dermatomyositis tends to accompany internal malignancies. However, only 3 cases of dermatomyositis accompanied by acute myelogenous leukemia have been reported worldwide.
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  • A Case of an Atypical Lipomatous Tumor on the Right Upper Back
    Toshihide TANOUE, Takehiko NAKAMURA, Seiji FUKUDA, Shinichi MASUGUCHI, ...
    2007 Volume 69 Issue 3 Pages 263-265
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.263
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    A 55-year-old male presented with an atypical lipomatous tumor. Thirteen years previously, he had been diagnosed as having myositis ossificans traumatica of his right upper back. Ten years after this diagnosis, a tumor arose at this site and was excised. Then a year and 7 months later, the tumor recurred at the same site. Histopathological examination revealed a circumscribed tumor, which was composed of multinucleated cells, bizarre stromal cells, lipoblasts in the fibrilliform collagenous stroma of mature fat cells and fibrosis. The tumor was clinically and histopathologically diagnosed to be an atypical lipomatous tumor.
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  • A Case of Thrombotic Angiokeratoma
    Naomi KINASHI, Kaori ICHIHASHI, Hideya TAKENAKA, Norito KATOH, Saburo ...
    2007 Volume 69 Issue 3 Pages 266-268
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.266
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    We report a case of thrombotic angiokeratoma. A 13-year-old girl had noted a red papule on her left thigh 6 months previously. She had no apparent history of trauma. Three months after the papule developed, she scratched the lesion and it became black. On physical examination, a 4×3 mm black, encrusted papule was observed on her left thigh. Examination by dermoscopy showed grape-shaped structures with homogeneous black areas. The biopsy specimen revealed a hypertrophic epidermis with elongated ridges and the papillary layer contained dilated vascular spaces filled with erythrocytes. The hypertrophic horny cell layer contained thrombi. We made the diagnosis of a solitary angiokeratoma. Sometimes a solitary angiokeratoma is indistinguishable from melanoma, nevus pigmentosus and basal cell carcinoma because it grows rapidly, is black and has thrombi. Our case suggested that dermoscopy is a useful diagnostic technique.
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  • A Case of Interdigital Verrucous Carcinoma:
    Preservation of the Digits with Minimal Excision after Selective Intra-arterial Infusion Chemotherapy
    Taku FUJIMURA, Ryuhei OKUYAMA, Akira HASHIMOTO, Satoshi HASEGAWA, Mari ...
    2007 Volume 69 Issue 3 Pages 269-272
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.269
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    The diagnosis of verrucous carcinoma is often not easy because its histopathology mimics verruca vulgaris and other benign diseases. We describe a 62-year-old Japanese man with verrucous carcinoma on his IV interdigital area. Magnetic resonance imaging disclosed tumor invasion up to the subcutis, which suggested malignancy. However, repeated biopsies did not show malignant features in the tumor. For treatment, we performed intra-arterial infusion chemotherapy and oral intake of 5-fluorouracil. After the tumor reduction, we excised the tumor with a sufficient margin. There was no evidence of tumor recurrence 1.5 years later.
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  • A Case of Extramammary Paget's Disease after Excision of Bilateral Breast Carcinoma
    Satoko KUMAZAWA, Kou DAN, Teiichi MASUDA, Kazunori URABE, Masutaka FUR ...
    2007 Volume 69 Issue 3 Pages 273-276
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.273
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    We report a 58-year old female with itchy perianal erythema that developed gradually over a 5-year period and was histologically diagnosed as extramammary Paget's disease (EMPD). Right breast carcinoma had been excised 10 years previously and left breast carcinoma 4 years previously. Recently, it has been suggested that androgen receptor expression and overexpression of erbB-2 onco-protein may play a part in the progression of EMPD. On the other hand, estrogen, estrogen receptor expression and overexpression of erbB-2 onco-protein have also been associated with the onset and progression of breast carcinoma. Immunohistochemically, estrogen receptor expression and overexpression of erbB-2 onco-protein were observed in this patient's bilateral breast carcinoma and EMPD samples.
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  • A Case of Drug Eruption due to Cyanamide
    Kazunari USUKI
    2007 Volume 69 Issue 3 Pages 277-279
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.277
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    A 61-year-old Japanese man who had been administered cyanamide for alcoholism presented with pruritic erythema on the trunk. We considered it to be a drug-induced eruption and he stopped taking cyanamide. After a week, the erythema spread over his body accompanied by a high fever. We suspected the symptoms to be drug-induced hypersensitivity syndrome. We then prescribed predonisolone at 30 mg/day. The eruptions and symptoms improved within 5 weeks. There was no necurrence after withdrawal of predonisolone. Titers of HHV-6 IgG antibodies were not significantly elevated. A biopsy specimen showed dermal edema and perivascular lymphocyte-dominant inflammatory cell infiltration. Patch test for cyanamide revealed positive reaction. A diagnosis of a maculo-papular type drug eruption due to cyanamide was thus made.
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  • A Case of Pyoderma Vegetans
    Satoko KUMAZAWA, Teiichi MASUDA, Kazunori URABE, Masutaka FURUE
    2007 Volume 69 Issue 3 Pages 280-283
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.280
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    A 56-year-old man presented with a 10-month history of multiple progressive nodules on the face. These multiple exudative nodules were resistant to antibiotics, and erythematous indurated plaques developed on the neck and chest. According to the clinical course and histopathological examination, a diagnosis of pyoderma vegetans was made. Direct immunofluorescence test using IgG, IgA, IgM, C3 was negative. Administration of oral prednisolone, 30 mg/day, immediately resulted in a reduction in the size of the skin lesions.
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Review
Therapy
  • Negative Pressure Dressing for the Skin Graft Fixation
    Shinichi IMAFUKU, Akari TASHIRO, Keisuke MORITA, Hiroto TOMOEDA, Yoich ...
    2007 Volume 69 Issue 3 Pages 290-294
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.290
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    Negative pressure dressing is a new technique for acute and chronic wound treatment. We applied this method for the fixation of the skin grafts of five cases (nine ulcers) and had excellent graft take. Compared to the conventional tie-over bolster, this method provides tight and equal pressure on the grafts located on the complicatedly curved surface, better drainage without surgical skill. Negative pressure dressing can be a useful option for dermatologic surgical reconstruction.
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  • Combination Therapy with Steroid Pulse Therapy and Plasmapheresis in the Treatment of Pemphigus
    Kimiko NAKAJIMA, Mayuko ISHIGURO, Tomoya TAKADA, Rie HAMADA, Masato IW ...
    2007 Volume 69 Issue 3 Pages 295-299
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.295
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    We have treated 7 patients with pemphigus foliaceus and 1 patient with pemphigus vulgaris by the combination of corticosteroid pulse therapy and plasmapheresis. The skin lesions in 7 patients showed a dramatic improvement after this combination therapy. Dosage of the orally administered prednisolone has been reduced gradually without recurrence in 4 cases. Slight recurrence was observed in 3 cases long after completion of the combination therapy. We consider that the excellent therapeutic effect of this therapy depends on the direct removal of the anti-desmoglein antibodies by plasmapheresis and the suppression of inflammation and acantholysis by corticosteroid pulse therapy. This combination therapy can be recommended as the initial therapy for pemphigus.
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  • Randomized Study of an Anti-dermatophytic Agent M-732 in Patients with Tinea Pedis
    —Non-inferiority Study of Liquid to Cream—
    Akio TANEDA, M-732 Clinical Trial Group
    2007 Volume 69 Issue 3 Pages 300-308
    Published: 2007
    Released on J-STAGE: July 06, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.69.300
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    M-732 (liranaftate) is a novel thiocarbamate with high antifungal activity towards dermatophytes. Its 2% cream, (Zefnart® cream 2%) is marketed by Torii Pharmaceutical Co., Ltd. in Japan for the treatment of tinea. This multi-center, open-label and randomized study was conducted to demonstrate the non-inferiority of M-732 liquid (test agent) to M-732 cream (control agent) with regard to efficacy. Outcome criteria were that the 95% confidence interval (CI) of the difference between the two preparations would not be below the margin of -10% in both the dermatophyte disappearance rate (negative conversion rate) and skin symptom improvement rate (skin improvement rate). The negative conversion rates for the liquid and cream were 74.8% (101/135) and 70.1% (96/137), respectively; the lower end of the 95% CI of the difference was -5.9%. The skin improvement rates for the liquid and cream were 97.0% (131/135) and 94.9% (130/137), respectively; the lower end of the 95% CI of the difference was -2.5%. Such adverse events as local irritation that might be related to preparations were observed in 2.1% (3/146) of subjects treated with liquid and in 2.8% (4/144) of subjects treated with cream (p=0.722). Abnormal laboratory findings were found in one subject treated with liquid (elevated AST) and one subject treated with cream (elevated urine glucose). Based on the above results, we concluded that M-732 liquid is not inferior to M-732 cream in efficacy and that the liquid is as safe as the cream.
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Dermatologists around the World
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