Exposure to ultraviolet radiation (UVR) is one of major environmental factors that produce pleomorphic reactions in the whole organism and the skin. These include the well-described carcinogenic potential of UVR, the erythemogenic effects (sunburn), photoaging and suppression of cellular immune responses. Skin functions not only as an immune target organ but also as an immune effector organ. After exposure of the skin to noncytotoxic doses of UVB radiation, keratinocytes (KC), a major component of the epidermis, are directly or indirectly stimulated to express cytokines and other mediators such as prostaglandin E2, cis-urocanic acid, neuropeptides, and oxygen radicals. These factors are involved in the modulation of immune reactions. Such modulation of cutaneous and systemic immune responses by UVR has been examined by concentrating on the effects of UVR on cutaneous cellular components. Furthermore, an attempt has been made to investigate the effect of UVA on UVB-induced immune suppression by examining the production of cytokines from KC exposed to UVA. Although UVA seems to play an important role in suppressing immune reactions, UVA exposure after UVB irradiation has been shown to reverse UVB-induced suppression of contact hypersensitivity in mice. Our study showed that KC-derived IL-10 and IL-12 are regulated differentially by UVA and UVB. UVA (less than 20 kJ/m2) induced IL-12, a potent antagonist to UVB-induced immune suppression, but not IL-10, a Th2 cytokine responsible for the suppressed CHS by UVB. Our findings suggest that UVA seems to have a complex role in regulating the immune response by modulating cytokine profiles in the skin.
We report a phase I trial in melanoma patients using tumor-lysates pulsed dentritic cells (DCs). DCs were generated from peripheral blood in the presence of granulocyte/macrophage-colony stimulating factor and inrterleukin 4 and were pulsed with autologous tumor lysates. Three patients with advanced melanoma received 5～8 intra-lymph-node infusions of DCs. Although regression of individual skin metastasis was evident in one patient, increased size of metastases and/or development of new lesions were observed in all three patients during the therapy. Clinical side effects were mild. Two patients developed vitiligo after DC vaccinations. DTH reactivity toward tumor lysates was induced in two patients. Resolution of skin metastases and positive DTH response site were accompanied CD8+/CD45RO+ lymphocytic infiltration. Immunohistochemical study revealed down-regulation of HLA class I antigen and β2 microglobulin in both primary and metastatic lesions of these three patients. These results suggested that HLA-class 1 down-regulation plays a role in immune escape from cytotoxic T cells.
Growth patterns in scalp hair were studied in 79 Japanese female subjects (aged 17～66 y) complaining of diffuse scalp hair loss and in 27 normal Japanese female subjects (aged 24～53 y.o.). A combination of phototrichogram, a non-invasive quantitative method, and the measurement of hair shaft diameter by micrometer was used to calculate the rate of hair growth, the ratio of anagen hairs to the number of hairs per unit, the hair shaft diameter, and the percentages of thick and short hairs. The correlation between diffuse alopecia and other diseases, such as endocrine dysfunctions and anemia, was also assessed. Our quantitative analysis revealed that these 79 hair loss patients could be divided into eight categories on the basis of hair loss pattern. Ten of the 79 patients exhibited a normal hair growth pattern ; the remaining 69 had the hair loss patterns characterized by thinning only, low growth rate only, or low growth rate and thinning, none of which were previously distinguishable by unaided visual inspection. These results suggest that the method described above is useful for evaluating hair growth patterns in female patients complaining of diffuse scalp hair loss.
During the period from March, 1994, to March, 2001, 74 strains of streptococci were isolated from skin and skin structure infections. Group A, B, C and other streptococci were isolated from 43, 17, 5 and 9 patients, respectively. Group B streptococci (Streptococcus agalactiae) were frequently isolated from abscess, cellulitis, and impetigo. Half of the patients had an underlying disease such as diabetes mellitus or atopic dermatitis. Group C streptococci (Streptococcus equisimilis) were frequently isolated from impetigo and cellulitis together with Staphylococcus aureus. Other streptococci isolated from skin infections were viridans streptococci, Enterococcus faecalis and Streptococcus pneumoniae.
A statistical study of 100 cases diagnosed as Bowen’s disease or Bowen carcinoma at Kurume University Hospital between January of 1995 and December of 2000 was performed. These 100 patients included 58 men and 42 women (the male : female ratio was 1.4 : 1), and the average age of first visit was 74.0 years old. The frequency of Bowen’s disease and Bowen carcinoma among newly visiting outpatients was 0.54%, which was higher than the frequencies reported by other institutes in Japan. Fifteen patients had multiple lesions, among whom eleven were associated with internal malignancies and six with other cutaneous malignant tumors. Although clear arsenic exposure as an etiologic factor could not be confirmed, almost all the cases had consumed water from wells. Kurume University Hospital is located in the Chikugo area of Fukuoka prefecture, where arsenic pollution of subterranean water has been proven, and the causes of this pollution are currently under investigation. The majority (74.3%) of the patients from the Chikugo area were residing in areas of higher concentrations of arsenic in the wells. These results suggested a possible relationship between intake of water from arsenic-polluted wells and the high frequency of the disease in the Chikugo area.
A total of 79 foot and hand warts in 27 patients was included in this study. Photodynamic therapy with topical application of 20% 5-aminolevulinic acid for 12 hours using excimer dye laser was used to treat the recalcitrant warts. The rate of complete reduction in the wart area was 63.3%.A means of 7 sessions of treatment was necessary for complete reduction. Photodynamic therapy with topical 5-aminolevulinic acid for recalcitrant warts might provide beneficial results without severe side effects.
We report a case of subcutaneous nodular fat necrosis associated with islet cell carcinoma. A 56-year-old male began to notice redness and swelling in the right knee joint around August of 1998. Clinical symptoms improved with administration of antibiotics. From around September, a dark red subcutaneous induration appeared on the posterior aspect of both legs; thereafter, redness, swelling and pain began to appear on the backs of both feet and hands. Polyarthritis was also found. Histopathological examination revealed inflammatory cell infiltrations of subcutaneous adipose tissue and necrosis of fat cells. An increase in the serum amylase level was found during the clinical course. A 7 cm diameter tumor in the pancreatic body was confirmed by abdominal CT. Lipase, trypsin, and phospholipase A2 also showed abnormally high values. In January of 1999, the tumor was totally resected. It was found to be an AFP-productive islet cell carcinoma. After resection of the tumor, the dermal and articular symptoms subsided. In January of 2000, however, the pancreatic enzymes increased again, and the dermal and articular symptoms recurred with metastasis to the liver. Hepatic arterial infusion chemotherapy was administered, but his general condition worsened gradually, and he died on September 10.