In the fronto—parietal scalp in androgenetic alopecia, hair follicles gradually become minuaturized, and the anagen period becomes shorter. Recent clinical findings clearly show that the type 2 isozyme of 5 α-reductase（5 αR2）, which converts testosterone to dihydrotestosterone, plays a crucial role in beard growth and the development of androgenetic alopecia. Patients with 5 αR 2 deficiency possess less facial hair and do not become bald. In addition, finasteride, a 5 αR 2 inhibitor, partially reverses hair loss in androgenetic alopecia. There is considerable evidence to suggest that the dermal papilla plays a key role in hair growth and mediates the action of androgen. 5 αR of cultured beard dermal papilla cells shows the characteristics of the type 2 isozyme；the isozyme pattern of 5 αR in those from balding scalp remains unknown. Follicular epithelium such as the outer root sheath and hair matrix exhibits the activity of 5 αR 1. Freshly isolated hair follicles, containing both epithelial and mesenchymal portions, have been shown to have both 5 αR1 and5 αR 2 activities, and those from balding scalp have three times higher activity of 5 αR 2 than those from the occipital scalp.
To define the interactions reguired for the filament assembly of differentiation-specific keratins, active copies of mouse hair keratin mHa 1 and mHb 4 genes were introduced into a rat kangaroo kidney epitherial cell line (PtK 2) and a rat stratified squamous epitherial cell line (rat epidermal keratinocyte). In PtK2 transient transfectants, when introduced individually or in combination, mHa 1 and mHb 4 formed aggregates of ring-like structures of various sizes at the perinuclear region with no evidence of organization into a keratin network. These aggregates altered the distribution of the endogeneous keratins and vimentin. In most of the cells carrying the ring-like structures of mHa 1 and mHb 4 around their nuclei, the endogenous keratin network collapsed and localized around the nucleus. Furthermore, the densely accumulated endogenous keratin surrounded the ring-like aggregates with partial co-localization. However, when transfected into the rat epidermal keratinocytes, mHa 1 and mHb 4 were able to co-localize with the well-developed cytoskeleton of endogenous keratins. These results showed that, in constrast to keratin pairs K5/K14and K8/K18, the mHa 1/mHb 4 pair is unable to develop an extensive keratin network on its own, and that there are possible defferential abilities among these hair keratins and other keratins to form well-developed cytoplasmic networks.
Radiotherapy plays an important role in the management of appropriately selected skin carcinomas. We reported four patients with cutaneous squamous cell carcinomas treated with four different types of radio therapy: preoperative, intraoperative, postoperative, and irradiation without operation. The purposes of pre and intraoperative radiotherapy are to enable operations in patients with inoperable carcinomas by reducing tumor size, and to suppress the spread of carcinoma cells during the operation. Irradiation subsequent to surgery (postopeative radiotherapy) is chosen as an adjuvant therapy in order to eliminate possible residual tumor cells. The indications for irradiation alone (without operation) are limited to patients who are not healthy enough to undergo surgery, but, even in such patients, irradiation is often very effective, and an absolute cure can even be expected if their squamous cell carcinomas are sensitive enough to irradiation. There are a number of available options for the primary management of skin carcinomas. The appropriate roles of dermatologists treating skin carcinomas are to be well versed in radiotherapy and to choose the most effective and QOL-preserving treatment among various therapeutic options.
We report four cases of erythema induratum (EI), which has been though to be an uncommon disorder in Japan. Histopathologically, all the cases showed lobular panniculitis with vasculitis, caseation necrosis, and typical tulercle formation. However, these clinical pictures, other than the consistent findings of strongly positive PPD tuberclin reactions, were not suggestive of EI. None of the cases had any ulcerative changes on the skin lesions. Case 1 developed pulmonary tuberculosis after indurated erythema of the lower extremities had disappeared spontaneously, so we reached the diagnosis of EI retrospectively. Only after the development of liches scroflosorum on the trunk in Case 2 could we make the diagnosis of indurated erythema on the legs, which had initially been considered to be subcutaneous sarcoidosis. These two cases made it possible for us to reach the correct diagnosis in the next two in spite of their unusual clinical presentation of EI. The acid-fast staining of the lesional skin biopsy specimens did not show any acid-fast baccili in any of the cases, and the polymerase chain reaction (PCR) from lesional skin biopsies also failed to amplify of M. tubercurosis specific sequence in any of them. Tuberculosis has been reported to be increasing in the past ten years in Japan. Our cases tell us that we should consider tuberculosis when we see patients with erythematous induration on the legs and a positive tuberculin skin test.
We describe a 64-year-old male case of systemic sclerosis with anti-Th/To antibody. He had diffuse skin sclerosis, Raynaud’s phenomenon, pitting scars, a short sublingual frenulum, diffuse pigmentation, and arthralgia. Detailed examination revealed no internal organ involvement. An indirect immunofluorescent test using HEp-2 cells as the substrate showed intense nucleolar staining. Using RNA immunoprecipitation technique, a 7-2 RNA and an 8-2 RNA were precipitated, indicating the presence of anti-Th/To antibody. The clinical features of patients with systemic sclerosis positive for anti-Th/To antibody are discussed.
A 58-year-old woman was diagnosed with systemic sclerosis and polymyositis in 1983. In February of 1999, she noticed a subcutaneous nodule in her right trunk and then developed fever, appetite loss and fatigue. Skin biopsy specimen revealed infiltrates of large atypical lymphocytes and histiocytes showing a “bean bag” appearance in dermis and subcutis. Immunohistochemical findings revealed B-cell lymphoma. Bone marrow showed similar cytophagia without atypical lymphocytes. We diagnosed her with malignant lymphoma associated with hemophagocytic syndrome (HPS). There are only 21 previous cases reported as B-cell lymphoma associated with HPS. Only two of them were related to skin lesions.
A 41-year-old male patient first came to our hospital with severe lymphedema of the right leg caused by chronic filariasis eighteen years ago. Besides, chylous lymphorrhea occurred on the surface of the scrotum six years ago. These symptoms worsened year by year in spite of several treatments. However, after we started administration of cilostazol from the summer of 1999, the severe lymphorrhea of over 1,500 ml/day gradually improved to an amount of less than 500 ml/day. Moreover, the lymphedema also gradually ameliorated after six months administration. We suggest that one pharmacological action of cilostazol, an increase of blood flow with vasodilatation, could promote absorption of lymph through blood vessels by a mechanism such as a water-flow aspirator. Our results suggest that cilostazol would be an effective drug for a treatment of lymphedema and lymphorrhea.