We have developed a hand-washing device using weak alkaline electrolyzed tap water(WAETW), and examined its antibacterial and side effects. After washing with WAETW, the reduction rate of the bacterial colony number on the hand stamps was 55% (medical staff, n=46), 42% (nursing school students, n=12, and 50% (staff at school for the handicapped, n=12). The reduction rate of colonies on hands washed with WAETW was significantly lower than with tap water 5 and 30 minutes after washing. WAETW also completely suppressed the growth of the following bacterial strains at 10³ CFU/ml in vitro;Staphylococcus epidermidis and Pseudomonas aeruginosa for 1 minute, Escherichia coli for 5 minutes, and Staphylococcus aureus for 10 minutes. No cutaneous or systemic side effects were observed during this study;therefore, WAETW washing is a potent sanitizer for hands with reduced environmental load.

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In this study, 28 patients with mild or moderate atopic dermatitis were randomized to 4-week treatment with betamethasone valerate ointment (A group) or with loratadine tablet add-on (B group) to investigate changes in VAS for itch, SCORAD index, sIL-2R, TARC, and CTACK in serum. The VAS value, sIL-2R, and TARC significantly decreased in only B group. The SCORAD index in B group significantly decreased more than that of A group. A good positive correlation in changes between the serum TARC value and SCORAD index has been shown. Thus, the serum TARC value was considered a useful clinical marker. Furthermore, synergy effects of the combination therapy of topical corticosteroid and loratadine for the treatment of atopic dermatitis has been confirmed.

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In 23 patients treated for scabies infection in our hospital, serum IgE concentrations were abnormally elevated in 12 patients and normal levels in 11. Statistical analysis revealed that it requires a longer time to diagnose scabies in elevated IgE individuals than in normal IgE individuals, although the clinical symptoms were not significantly different. That result suggests that it is difficult to detect scabies in elevated IgE individuals because few scabies mites induce severe eruptions. It has been generally believed that skin manifestations of infectious diseases in large part depend on the host-parasite relationship. In the same way, cutaneous symptoms of patients with scabies are probably attributed not only to the number of mites infested but also to their constitution.

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A 52-year-old man had a history of localized scleroderma. One month after topical application of difluprednate ointment for localized scleroderma, he developed a rash of itchy erythema, papules and vesicles on the ointment-applied area of his left flank and right lower leg. The skin rash also spread to the non-applied area, such as the back and perianal regions. The patch test results of difluprednate ointment were negative, 1+, 3+ at 48 hours, 72 hours, and 7 days after application, respectively. A patch test using components of difluprednate ointment demonstrated a positive reaction only to polyoxyethyleneoleyl ether (1%, 0.1%), which is a non-ionic surfactant, so he was diagnosed with contact dermatitis syndrome due to polyoxyethyleneoleyl ether.

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A 61-year-old woman was clinically diagnosed with anaphylactoid purpura, and was treated with leg rest, high-dose corticosteroid and Factor XIII concentrate. Although purpura almost disappeared, deep vein thrombosis and pulmonary embolism were found during the course. As pulmonary embolism, one of the major complications of deep vein thrombosis, can be causative factor of sudden death, she was immediately and successfully treated with a temporary inferior vena cava filter and anticoagulant therapy. This case had several risk factors for deep vein thrombosis, such as obesity, leg rest, corticosteroid therapy and diabetes mellitus, some of which might have been responsible for thrombus formation.

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The patient was a seventeen-year-old male diagnosed with Ewing’s sarcoma in the sacrum at age 13. Sacroiliac tumorectomy and fixation with metal bolts and plates had been performed at age 15. He had been in bed for 6 months prior to his first visit to our department due to paralysis of the bilateral sciatic nerve caused by tumorectomy. Development of an ulcer consistent with the site of extrusion of a fixed metal bolt in the sacral region was observed. Since removal of the bolt was judged to be difficult, conservative treatment was conducted. Prevention of infection was considered essential since the metal bolt was attached to the plate supporting the pelvis. The patient was treated in our department on consecutive days to control infection and to reduce the pressure as much as possible. No infection occurred in the lesion for 8 months until death due to the tumor.

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A 57-old-man presented with eruption after taking carbamazepine for 38 days. Sixteen days after onset, he was admitted to the hospital and was complicated with DIC. He improved by treatment with steroid mini-pulse therapy. Intravascular immunoglobulin therapy was not performed. Multiple drug allergy, which was not DIHS, occurred after hospital discharge. Clonazepam caused eruption, renal impairment, and thrombocytopenia. He was treated with corticosteroid therapy and improved. Over-the-counter drugs and cefpodoxime proxetil also caused drug eruption. We performed a patch test with carbamazepine etc. twice, and the trunk and extremities became erythematous after each test. Such eruption relapses after the patch test sometimes occur in DIHS patients.

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We report two Japanese patients with Stevens-Johnson syndrome (SJS) who were investigated for HLA gene markers associated with SJS and toxic epidermal necrolysis. Patient 1 was a 53-year-old woman. She developed eruptions in oral provocation tests and was diagnosed with SJS due to allopurinol, clarithromycin, and loxoprofen sodium. Gene analysis revealed HLA-B^∗5801. Patient 2 was a 54-year-old man. He was positive on a carbamazepine patch test and drug-induced lymphocyte stimulation test, and was diagnosed with SJS due to carbamazepine. HLA-B^∗1502 was not detected on gene analysis.

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A 62-year-old man with a 5-year history of dyshidrosiform dermatitis on the palms and soles presented with whole body exacerbation of the eruptions accompanied with severe itch. Physical examination revealed widespread erythematous macules and papules with erosions and tiny ulcers due to scratches on the body surface, as well as lichenoid and pruriginous eruptions on the proximal extremities. No large blister was found. On the palms and soles, dyshidrosiform and hemorrhagic vesicle, small blisters and erosive eruptions are distributed. Histological examination revealed ghost basal cells (eosinophilic masses in which the nuclei disappeared) arranged beneath the previous blister roof, newly formed bullae, that looked intraepidermal but channeled to the dermis, in the renewed epidermis, and severe eosinophilic infiltration in the upper dermis.Direct immunofluorescence revealed linear deposits of IgG and C3 along the basement membrane zone of the epidermis. ELISA examination disclosed anti-BP 180 antibodies (index 320) in the patient’s serum. Based on the diagnosis of dyshidrosiform pemphigoid with widespread exacerbation, combination therapy of prednisolone (30mg/day at first dosage), minocyclin (150mg/day) and nicotinamide (900mg/day) was started and the eruptions vanished in the following several days. We concluded this case as a type of pemphigoid widespread from dyshidrosiform pemphigoid due to exacerbating factors.

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A 75-year-old female patient visited our hospital with itchy erythema and blisters on the trunk and extremities for about 2 weeks. Histopathological examination revealed a subepidermal blister and immunofluorescence study showed C3 deposit on the basal membrane. Serum level of anti-BP180 antibody was high. We diagnosed bullous pemphigoid (BP) and commenced oral prednisone therapy (40mg/day). On the 7th day of treatment, she vomited a cast of esophageal mucosa with blood and food. Gastric endoscopy revealed exfoliative esophagitis on the entire esophagus developing toward the esophagogastric junction. Both esophageal and cutaneous lesions were improved in 2 weeks by steroid pulse therapy. Exfoliative esophagitis has been infrequently reported in BP and esophagitis dissecans superficialis is a rare involvement. Our case suggests that the possibility of esophageal mucosal involvement should be considered in the differential diagnosis.

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A 75-year-old woman had been suffering from oral multiple erosions. Both anti-desmoglein (Dsg) 1 antibody and anti-Dsg3 antibody were detected by ELISA ; however histopathological examination and immunofluorescence studies showed no specific features of pemphigus, and this case was diagnosed as oral lichen planus. Oral betamethasone, DDS, etretinate and tacrolimus ointment were effective for the lesions. During the course, there was no correlation between the ELISA (antibody) titer and oral erosions. Although oral erosions were aggravated repeatedly, neither anti-Dsg1 nor anti-Dsg3 ELISA index was elevated.

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A 62-year-old man developed sclerotic and glossy skin mainly on the extremities, and the partial abdomen and lumbar regions. Limited digital, elbow and knee joint movement, and hair loss on bilateral lower legs, axilla and head were associated. Laboratory data showed eosinophilia, hyper-gammaglobulinemia, positive antinuclear antibody, and increased soluble interleukin-2 receptor (sIL-2R). Histopathologically, infiltration of eosinophils to fascia and hypertrophy of fascia were observed. We diagnosed eosinophilic fasciitis and administered prednisolone. Although hair loss in patients with systemic scleroderma has been reported, systemic hair loss with eosinophilic fasciitis is unusual. The pathomechanism of hair loss is discussed.

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A 66-year-old man with no history of drinking underwent proximal gastrectomy for gastric cancer 1 year prior to the first examination. Since difficulty in walking, myoclonus of the extremities, and delirium developed around February 2006 and gradually progressed, he was admitted to the Department of Neurology of our hospital for further evaluation, and referred to our department for the evaluation of skin eruptions that appeared on the dorsum of the hands from March 2006. Dermatological examination revealed reddish-brown, pruritic erythema and fissures, but no eruptions on the exposed areas of the skin.The characteristic skin eruptions and neurologic findings of myoclonus and delirium associated with diarrhea and macrocytic anemia led to the diagnosis of pellagra. Serum nicotinic acid levels were slightly decreased. The intravenous administration of 100 mg/day nicotinic acid amide markedly improved his symptoms, and enabled him to engage in everyday conversation within 2 weeks.

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We report a case of lichen planus-like keratosis. A 43-year-old man presented with a slightly elevated violaceous plaque on the edge of the left eyebrow. Lichen planus-like keratosis was mostly suspected from the clinical course and dermoscopic features. Histological examination revealed a lichenoid reaction, and we diagnosed this case as lichen planus-like keratosis. After the diagnosis, we treated this patient with liquid nitrogen cryotherapy.

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A 73-year-old man visited our hospital in June 2007. He had noticed erythema on his right thigh a few years previously. He presented with right inguinal lymphadenopathy and right leg swelling at his first visit. Histological examination of the erythema revealed nests of poroma cells and ductular structures lined with cuticular material in the epidermis. In the superficial dermis, many atypical cells proliferated without nest formation and also invaded lymph vessels. Metastasis to many lymph nodes was found by FDG-PET-CT. The diagnosis was eccrine porocarcinoma (pT1N1M1: stage IV). Chemotherapy was not effective for the tumor. The level of SCC-related antigen increased progressively and he died nine months after the first visit. At autopsy, there was metastasis to many lymph nodes, bilateral kidneys, bilateral lungs, the liver, gallbladder, pancreas, spine and Douglas’pouch.

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We report a case of median raphe cyst of the penis. A 37-year-old man had had a penile subcutaneous tumor for 20 years, which had been slowly increasing in size. We resected the tumor under local anesthesia. Histopathologically there were two cysts in the dermis. The cyst wall consisted of stratified squamous epithelium and cuboidal epithelium. We diagnosed this case as a median raphe cyst of the penis based on these clinical findings and histopathological findings. Although the etiology of the tumor remains unknown, we think that a secondary factor was involved in the formation of median raphe cyst of the penis because the tumor, which has been left for a long time in our case, began to increase in size during the course. Parameatal cyst is another disease which causes a penile cyst; however, parameatal cyst could differ from median raphe cyst because there have been few reports of a cyst wall consisting of squamous epithelium in parameatal cyst, whereas the cyst wall consists of squamous and cuboidal epithelium in median raphe cyst. Further study is needed to differentiate these two diseases.

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We describe an 83-year-old Japanese man with a 1-year history of erythematous lesions with erosions in the genital and left axillary regions. A granulomatous nodule was seen in the genital lesion. He was diagnosed with double extramammary Paget’s disease by skin biopsy. An extended excision was performed and pathological examination of the genital nodule revealed the invasion of tumor cells into the dermis. Fifteen months later, the patient had neither local recurrence nor metastasis.

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A 73-year-old woman had first exhibited a brown macule on her right cheek approximately 8 years earlier. In November 1999, she visited a nearby plastic surgery clinic to undergo laser treatment for the cheek. In March 2000, the black-brown macule recurred and expanded while gradually deepening in color in the same region, and thus she visited our department. Based on the biopsy results, histological examination revealed a malignant melanoma. After total resection of the melanoma, local injection of interferon β was given at thirty million IU. At present, 2.5 years after the surgery, no local redevelopment of metastasis has been confirmed. We consider that laser treatment should be performed carefully for pigmented lesions after biopsy.

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A 55-year-old woman had a congenital melanocytic nevus on her left chest wall. A 5 mm nodule had appeared on the nevus one month before the first consultation, and was gradually enlarging. She consulted a local dermatologist after she noticed a subcutaneous tumor in the left axilla. Under a diagnosis of malignant melanoma, the whole nevus, including the nodule, was surgically resected, and lymphadenectomy of the left axilla was performed, followed by DAV-feron therapy. She presented with vertebral metastases one month later, and then lung and liver metastases occurred. The patient died four months after the initial consultation at our hospital.
Malignant melanoma can occur within any congenital melanocytic nevi, and the larger the nevus size, the higher the risk. It has been reported that melanomas in medium-sized melanocytic nevi tend to develop at or after puberty. Because of this, prophylactic excision before puberty is one of the treatment choices.
In our case, it was hard to recognize the development of the nodule within the nevus with a warty surface, and that led to a delay in medical consultation.
In addition, dermatologists should educate patients during their initial clinical examination that there is a potential for malignancy to arise within nevi.

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Multiple symmetrical lipomatosis (MSL) is a rare disease, characterized by the formation of multiple lipomas with a symmetrical distribution and sparing of distal arms and legs. The disease is more prevalent in males, and is associated with high ethanol intake.
We present a case of MSL treated with liposuction and surgical removal under endoscopic assistance. Due to the firmness of fat tissue and slow progress of aspiration, treatment with liposuction in the nuchal part is very difficult. On the other hand, we suggest that treatment by surgical removal under endoscopic assistance is very useful for a direct safety check through the monitor.

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We report a case of infantile myofibromatosis (solitary type) in a 2-day-old male. A dark reddish tumor of 25×20mm was found on a nuchal lesion after birth. We suspected a fibrous tumor on magnetic resonance imaging (MRI) findings. On histological examination, spindled cells and ovoid cells were arranged in short bundles and fascicles. On immunohistochemical examination, α-smooth muscle actin and vimentin stains were positive and Azan-Mallory stains were dyed blue. Based on these findings, we diagnosed this tumor as infantile myofibromatosis (solitary type).
Infantile myofibromatosis is a rare tumor of infancy, and cases often have a good prognosis with spontaneous regression of the lesions. The patient was therefore followed without antitumor therapy, and the tumor regressed gradually.

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We report a case of glomus tumor in a 69-year-old man with a lesion on his back. Histopathological examination showed that the tumor was composed of sheets of uniform cells with clear eosinophilic cytoplasm and oval nuclei. On immunohistological examination, vimentin and α-smooth muscle actin (α-SMA) stains were positive, while von Willebrand factor (vWF), and CD31 and CD34 stains were negative. Based on these findings, we diagnosed this lesion as glomus tumor proper. The tumor was resected together with a 1cm peripheral margin and deep margin including superficial fascia. Since the surgery, no recurrence has been observed for 1 year.

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Case 1 : A 59-year-old man had been suffering from itching eruption on the axilla and inguinal areas 7 months before visiting our hospital. Itching eruptions gradually worsened even though the patient had been treated at another hospital. Clinical findings were characterized by brown indurative papules and nodules on the axilla, inguen, navel and nipple. A biopsy specimen revealed infiltration of atypical lymphocytes in the dermis around blood vessels and appendages, which were CD30-positive. Molecular analysis did not show monoclonal rearrangement of the TCR and HTLV-1 antibody was negative. We therefore diagnosed lymphomatoid papulosis. Oral PUVA therapy was started with 4J/cm² UVA, and the eruptions disappeared almost completely after 14 exposures. Case 2 : A 38-year-old woman had had self-resolving, recullent eruptions on the right arm since 14 years of age. The eruptions had worsened from 20 years of age and she had been diagnosed with lymphomatoid papulosis by skin biopsy at another hospital 1 year before visiting our hospital. Oral PUVA therapy was started with 3-4J/cm² UVA, and the eruptions disappeared almost completely after 3J/cm²×8 and 4J/cm²×20 exposures. Oral PUVA therapy is recommended for the treatment of lymphomatoid papulosis when other therapies are not effective.

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A 39-year-old Japanese man visited our hospital with serious atopic dermatitis. After several days, he was admitted due to fever, general fatigue, appetite loss, cervical pain, and disseminated pustules on his whole body. On admission, he showed multiple erosions, crusts on the scalp, auricle and wrist joint with swelling around dorsal hands. Laboratory examination revealed hepatorenal function disorder and elevated serum ASO titer and a positive skin culture for group A β-hemolytic streptococcus. We confirmed the dermatological diagnosis as streptococcal impetigo.
Eruption and constitutional symptoms improved immediately with rest and drip infusion of flomoxef sodium, but the swelling around the wrist joint and dorsum of his hand persisted. He did not fulfill the modified Jones criteria for a diagnosis of acute rheumatic fever, and was diagnosed with poststreptococcal reactive arthritis. Treatment with NSAIDs did not provide symptomatic relief; however, prednisone starting at 30 mg/day orally with tapering resulted in complete relief of symptoms.
We report here the first case of poststreptococcal reactive arthritis occurring after severe streptococcal impetigo.

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In this study, we evaluated the clinical usefulness of yokukansankachimpihange, which is expected to be effective for controlling chronic excitation symptoms, in AD patients. The subjects were 25 outpatients with AD. All subjects demonstrated a nervous predisposition and were obsessively self-concerned, frequently complaining of symptoms including easy fatigue, and all were readily excitable. As the test drug, yokukansankachimpihange (Kracie) was prescribed for 6 weeks in principle. Significant improvements were observed in the Kampo-based diagnosis of the symptoms as well as itching and irritation scores on VAS, and scores on Skindex 16 compared with before treatment. Based on the findings of this study, yokukansankachimpihange is considered to control itching or skin-specific symptoms that affect the quality of life in AD patients by suppressing emotional reactions that exacerbate the symptoms.

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