In a variety of skin diseases, tissue eosinophilia is observed. However, the mechanism of eosinophil infiltration into the skin remains to be clarified. Interleukin-5 (IL-5) is well known as an important eosinophil chemotactic factor. To date, a number or chemokines that potently chemoattract eosinophils, such as eotaxin, eotaxin-2, eotaxin-3, regulated upon activation in normal T-cells expressed and secreted (RANTES), macrophage inflammatory protein-1 α (MTP-1 α), monocyte chemotactic protein-3 (MCP-3), MCP-4 and MCP-5 have been reported. Among them, eotaxin is a selective and strong chemoattractant for eosinophls in vitro and in vivo. Local administration of eotaxin induces eosinophil accumulation in the skin, lung, and peritoneal cavity. IL-5 expression is observed in most skin diseases with tissue eosinophilia, including atopic dermatitis, bullous pemphigoid, and malignant lymphoma. Recently, eotaxin expression has also been demonstrated in atopic dermatitis, bullous pemphigoid, drug eruption, and malignant lymphoma. Cooperation between IL-5 and eotaxin is reported to strongly induce eosinophil infiltration into skin. IL-5 and eotaxin may be the most important factors in eosinophil accumulation in the skin.
We have administrated botulinum toxin type A (BTX-A) to 20 patients with axillary hyperhidrosis and examined its efficacy. Fifty units of BTX-A (Dysport®) were injected intracutaneously into each axilla. Sweating areas were evaluated by Sakurai-Montagna Sweating Test before and after the treatment. Sweating areas were decreased less than 30% in 26 of 33 regions at 1 month and in 4 of 7 regions by 3 months after treatment. Further administrations were needed in 2 of 7 case at 3 month. In summary, intracutaneous administration of BTX-A is a quite effective and safe method in treatment of axillary hyperhidrosis.
A 9-year-old boy was admitted to our Department of Dermatology on June 14th, 2000, with erosion of the lip and eyelid mucous membrane, vesicle formation on the face and chest, severe erythema, and high fever (more than 39°C). For several days, he had taken on medication (acetoaminofen and antibacterial drugs) for common cold-like symptoms such as chills, nausea, and fever (38°C). A drug eruption with tonsillitis was suspected. After we started him on intravenous hydrocortisone and subsequent dexamethasone (10 mg/day), the eruption resolved with desquamation. Histopatholigical features of the lesion revealed focal hydropic and vacuolar degeneration of epidermal basal cells and vesicle formation with exocytosis of mononuclear cells. The eruption was completely resolved by the end of August. The result of the drug lymphocyte stimulation test were 8.5 times higher than the control for acetoaminofen, although the skin scrach patch test was negative. HHV-6 infection is also thought to be involved in this case, because of a positive finding in DNA (PCR) method.
A 62-year-old Japanese male had exhibited typical psoriasis plaques on the entire body for the previous month. He has suffered from ichthyosis since birth. The ichthyotic changes are prominent the flexor sites of his extremities. In the family history, four male relatives through three generation have had the same ichthyotic skin, but none have suffered from psoriasis. The biochemical assay disclosed very low value of steroid sulfatase activity, confirming X-linked ichthyosis. X-linked ichthyosis is a rare disease itself, and an association of psoriasis is very rarely reported. There have been only two cases among sixty-one X-linked ichthyosis patients in the Japanese literature in the recent 30 years. Although genes responsible for psoriasis are proposed on the chromosomes 1, 4, 6, and 17, the X chromosome (22), in which the steroid sulfates gene is located, is not a candidate for psoriasis. The association between X-linked ichthyosis and psoriasis seems to be incidental based upon the genetic background and the pathogenesis. However, the incidence of psoriasis in two out of sixty-one X-linked ichthyosis patients is too high to conclude that the association is incidental. Other complicated symptoms of X-linked ichthyosis in the literature were also discussed, and it was speculated that the same causative factors of abnormal keratinization may be involved in both diseases.
An 18-year-old woman was admitted to our hospital with high fever and skin eruptions. She was diagnosed with measles and was improving with symptomatic treatment when she suddenly exhibited severe thrombocytopenia two weeks after admission. Bone marrow biopsy showed many foamy cells phagocytosing platelets and other blood cells. She was diagnosed with virus-associated hemophagocytic syndrome due to measles virus. The thrombocytopenia began to improve without any treatment and returned to normal within a week. Virus-associated hemophagocytic syndrome should be considered as one of the differential diagnoses of severe thrombocytopenia associated with measles, and proper bone marrow assessment should be considered.
We earlier reported that a considerable number of colonies of dermatophytes were isolated by the foot-press method from healthy volanteers' feet after bathing in public baths or swimming pools. This time, we tried to isolate dermatophytes from bare feet of a healthy volunteer after she walked in a dormitory for office warkers and in the locker rooms of the office. The trials were carried out in summer (July, 2000) and also, in the dormitory only, in winter (December, 1998). We isolated quite a few colonies from the feet of the volunteer after walking in many areas of the dormitory and the locker rooms, in both summer and winter in the latter case. The species of isolated dermatophytes Trichophyton mentagrophytes were for the most part. Many colonies were isolated from the volunteer after walking on the carpet in the dressing room, on the weighing machine of the male bath room, and on the carpet in the Japanese-style lounge. In the dormitory, there were at least four patients with Tinea pedis from whose feet we isolated T. mentagrophytes by the foot-press method, so we suppose that they scattered dermatophytes in the dormitory.