SLE is characterized by a variety of cutaneous and multiple organ symptoms and abnormal laboratory findings. The cutaneous manifestations of SLE include LE-specific lesions and the lesions non-specific but common to other collagen diseases. The accurate analysis of cutaneous manifestations is useful for the early diagnosis of SLE and for evaluation of the patient’s prognoses. The sera from patients with SLE may contain a variety of autoantibodies, including anti-DNA, anti-U 1 RNP, anti-Sm, anti-SS-A, and anti-SS-B, some of which are related to specified clinical symptoms or are useful for the evaluation of the patient’s prognoses. Recent studies have elucidated the respective autoantigen recognized by each autoantibody. The pathogenesis of SLE may involve the disruption of tolerance against autoantigens in both T and B cells or the abnormal regulation of cytokines. For the appropriate treatment of SLE patients, the physician needs to accurately determine the pathological status of the patients and to select those cases who need systemic administration of immunosuppressants including corticosteroids. Anti-phospholipid syndrome can also be associated with SLE: it requires anti-coagulation therapy.
We have carried out an epidemiological suvey about atopic dermatitis (AD) in students entering Nagasaki Univesity every year from 1995 to 2000. The results of these six years of survey were analyzed. The fluctuation in morbidity was from 4.9 to 7.3% with an average rate of 6.2%.The prevalence of AD was higher in female students at 7.7% than in male students at 5.3%. There were no differenes in severity of AD, family his tory, or medical history of allergic disease between gender groups or among years. As exacerbation factors, house dust and mite were accepted as the worst factors by over 50% of the AD studennts in 1995; however this elevated level decreased to 41% in 2000; however, sweating (54%) and emotional stress (18%) were increased in 2000. The positive rate of the serum non-specific IgE antibody titer in randomly selected students from the entire group including AD cases was stable from 1987 to 1999 (1987: 33.2%, 1991: 37.2%, 1995: 43.6%, 1999: 37.0%). In contrast, the positive rates of specific IgE antibody titers for cedar pollen, Dermatophagoides farinae, and Dermatophagoides pteronyssinus in 1995 (52.8%, 53.6%, and 46.4%, respectively) and 1999 (54.0 %, 50.0%, and 43.7%, respectively) rose over those in 1987 (36.8%,35.6%,and 23.6%,respectively). InAD students, the positive rates in both patch tests and serum specific IgE antibody titers for mites, house dust, and candida antigen were higher respectively, in contrast to low titers for food allergens.
We examined staphylococcal coagulase types and serotypes of exfoliative toxins (ET) of Stahylococcus aureus (S. aureus) isolated from bullous impetigo (impetigo) and staphylococcal scalded skin syndrome (SSSS) between July 1999 and February 2001. Thirty-four strains of S. aureus were isolated from 34 impetigo patients and 6 more strains were isolated from SSSS patients. Sixteen strains of methicillin resistant S. aureus (MRSA)were isolated from impetigo and 5 strains of MRSA were isolated from SSSS. The coagulase types and serotypes of ET were compared between methicillin sensitive S. aureus (MSSS) and MRSA. Among the coagulase types of the isolates from impetigo (18 strains of MSSA), 8 isolates were type I and all produced ETB, and 10 isolates were type V. of the latter, 8 isolates produced ET-A and 2 produced both ET-A and B (double producers). Of the isolates from impetigo (16 strains of MRSA) 13 were coagulase type I and all produced ET-B;3 were toype III and all produced ET-A. All the S. aureus strains isolated from SSSS belonged to coagulase type I, and all produced ET-B. Of the coagulase types of 40 stains of S. aureus isolated from impetigo and SSSS, 65% (26 isolates) were type I, 27.5% (11 isolates) were type V, and 7.5% were type III (3 isolates). Coagulase type I belonged to ET-B, and type V belonged to ET-A. All the isolates of coagulase type V were MSSA. We suspect that the coagulase type and serotype of ET of S. aureus may have some influence on the drug resistance.
One hundred and twenty-five patients (49 males, 76 females) with severe alopecia areata were sensitized and treated with topical squaric acid dibutylester (SADBE), and 54 patients who did not respond to SADBE were subsequently sensitized and treated with 2,3-diphenylcyclopropenone-1 (DPCP). Fifty-seven patients (45.6%) showed cosmetically acceptable hair regrowth, suggesting that topical immunotherepy with SADBE or DPCP in patients with severe alopecia areata is beneficial, but not yet satisfactorily effective. This study revealed that the type of this disease is an important factor of prognostic significance for treatment with SADBE or DPCP, while other factors such as the presence of nail changes, the duration of the disease, and the age of onset showed no statistically significant correlations. Further effective treaments need to be developed in the future for extraordinarily intractable alopecia areata.
We report two cases of juvenile generalized pustular psoriasis treated with cyclosporin A. Case 1: A 6-year-old boy was treated with cyclosporin A at a dose of 5 mg/kg/day. Eruptions mostly disappeared within 1.5 months. Case 2: A 14-year-old girl was treated with cyclosporin A at a dose of 4.4 mg/kg/day. Eruptions were well controlled in two weeks. We discuss the dosage, effects, side effects and problems encountered during cyclosporin A therapy in seven cases including our two cases. The initial dose was 3~5 mg/kg/day and the mean duration of this therapy was 4.75 months. The disease was effectively controlled in all the cases within an average of 11.8 days. Relapses were observed in three cases during the period of reducing the dosage or after withdrawal. To prevent from relapses during the treatment with cyclosporin A, it is important to reduce doses slowly while monitering laboratory tests and clinical condition, to pay attention to infection and to use topical steroids or Vit D3 ointment in combination. To switch to PUVA therapy after completion of cyclosporin A therapy may be one way to control erupitons. Cyclosporin A is found to be more effective for the treatment of juvenile generalized pustular psoriasis in terms of its effectiveness and side effects than systemic corticosteroid or etretinate.
To verify the area of tumor cell invasion, photodynamic diagnosis (PDD) was conducted in two cases of extramammary Paget’s disease. In Case 1, the PDD-positive area virtually coincided with the erythematous portion, and tumor cells were found in the biopsy. Case 2 had a recurrence of extramammary Paget’s disease. With PDD, the fluorescent staining was recognized not only in the erythematous area but in also the obviously normal skin graft region, and the biopsy confirmed the presence of tumor cells. In these findings, the area of Paget cell invasion virtually coincided with the PDD-positive part. PDD is therefore considered an effective way to diagnose the area of the tumor cell invasion.
We describe a 19-year-old man with a tumor on the right lower thigh. A small nodule had been noticed two years earlier and had gradually increased in size. The tumor was a 4.5×4×3 cm, multiple tassel, hard, brown polypoid nodule. Magnetic resonance imaging showed a nodule extending from the dermis to epifascial level. Histologic examination demonstrated a multinodular growth pattern and a demal myxoid lesion composed of vessels and spindle-shaped stromal cells. The myxoid area was positive for Alcian blue staining and digested by hyaloronidase, indicating hyaluronic acid. Immunohistochemically, the tumor cell was negative for S 100 protein and smooth muscle actin, positive for vimentin, and focally positive for CD-34. The tumor was diagnosed as a superficial angiomyxoma.