The structural integrity of the skin is maintained by cell-cell adhesion mediated by desmosomes, which has desmoglein as an important transmembrane component. Now it is known that desmoglein is targeted by two skin diseases, pemphigus and staphylococcal scalded skin syndrome (SSSS). Pemphigus is a group of autoimmune blistering diseases of the skin and mucous membranes that are caused by IgG autoantibodies against desmoglein. Patients with pemphigus vulgaris and pemphigus foliaceus have IgG autoantibodies against desmoglein 3 and desmoglein 1, respectively. Even complex clinical variations of pemphigus are logically explained by desmoglein compensation theory. SSSS and its localized form, bullous impetigo, are caused by exfoliative toxin (ET) produced by S. aureus. Now it is Known that all three serotypes of ET, ETA, ETB, and ETD specifically recognize desmoglein 1 and digest desmoglein1 once after glutamic acid residue 381 between extracellular domains 3 and 4.
Photodynamic therapy (PDT) using excimer-dye laser was given following external application of 5-aminolevulinic acid (ALA) primarily to patients presenting with 34 actinic keratoses cases with 48 lesions, 15 Bowen’s disease cases with 20 lesions and 1 superficial basal cell carcinoma case with 4 lesions. Following the one time application of topically 20% ALA based PDT, response rate for total disappearance, or shrinkage greater than 50% to lesions was noted ; 83.4% in actinic keratoses population, 65.0% in Bowen’s disease population, and 100% in the superficial basal cell carcinoma population, and also to cases those were 88.2%, 66.7% and 100% respectively. This research indicated that ALA-PDT afforded a less invasive treatment and provided a better cosmetic outcome. When it was applied to elderly patients, it caused only negligible stress during application. In the treatment of superficial cutaneous carcinomas, it proved to be an extremely useful treatment modality.
High frequency B-mode cutaneous ultrasound apparatus was performed on 60 patients with systemic sclerosis (SSc) to measure the dermal thickness and echo intensity of the right forearm, dorsum of the right hand, and right middle finger. Results were compared between these patients and 60 healthy individuals, and relationships between these parameters and modified Rodnan total skin thickness score (m-Rodnan TSS) were assessed. At all three locations, dermal thickness was significantly greater for SSc patients than for healthy individuals, while echo intensity for SSc patients was significantly lower. In addition, comparisons between patients with diffuse cutaneous SSc and limited cutaneous SSc revealed increased m-Rodnan TSS and dermal thickness and reduced echo intensity for the former. Furthermore, at all three locations, m-Rodnan TSS had a positive correlation with dermal thickness and a negative correlation with echo intensity. As cutaneous ultrasound is easily performed and non-invasive, this technique is useful for assessing the severity of sclerotic skin changes in SSc patients and evaluating the effectiveness of therapy.
We examined 1162 HE stained specimens of melanocytic nevi from the entire body. We divided the body into 17 parts ; head, face, neck, chest, abdomen, back, axilla, inguinal area, genital area, upper extremity, palm, dorsal hand, lower extremity, sole, dorsal foot, oral mucosa, and nail bed. First, we classified these melanocytic nevi histopathologically into three groups based on the location of the tumor cells ; junctional, compound and dermal. Then we classified them clinico-pathologically based on the classification advocated by Ackerman AB ; Unna’s, Miescher’s, Spitz’s and Clark’s nevus. The most common types of melanocytic nevus differed in different regions of the body ; (a) on the head and face ; the dermal type of Miescher’s nevus (b) on the neck, trunk, upper and lower extremities ; the dermal type of Unna’s nevus, (b) on the sole and palm—the junctional type of Clark’s nevus. We concluded that the characteristics of the melanocytic nevi on various parts of the body differed.
We propose a new classification system for neoplasms with sebaceous differentiation. In this classification, neoplasms without differentiation other than sebaceous gland are classified into three categories : 1) sebaceoma, which is benign, 2) low grade sebaceous carcinoma, 3) sebaceous caroinoma. Based upon this classification, we histopathologically diagnosed 10 cutaneous tumors taken from a patient with Muir-Torre syndrome with a proven abnormality of a mismatch repair gene. One of the tumors was sebaceous carcinoma, seven were low grade sebaceous carcinoma, and two were sebaceoma. We partially disagree with the opinion of Ackerman and co-workers who claimed that sebaceous adenoma is sebaceous carcinoma and that neoplasms in all organs’ of Muir-Torre syndrome are carcinomas.
An 18-year-old female patient with a one-year history of right arm numbness presented with a six-month history of livedo on her bilateral dorsal pedis and pretibial regions. A biopsy specimen from an area of livedo showed thrombosis of the small vessels of the deeper dermis. Based on the typical clinical and histopathologic features in addition to the existence of lupus anticoaglant and deep vein thrombosis, she was diagnosed with primary antiphospholipid antibody syndrome and treated with platelet aggregation inhibitors and warfarin. However, the livedo expanded to her trunk and arms, and median nerve paralysis suddenly occurred due to arterial infarction. Immunoadsorption therapy was implemented four times, and oral predonisolone was administered simultaneously. In order to prevent rebound autoantibody production, methylprednisolone pulse therapy was performed. After immunoadsorption therapy, the lupus anticoaglant became negative, and her paralysis improved.