The hair follicle is the only periodically and regularly regenerating organ system throughout the lifetime of the mammalian adult ; therefore, the hair follicle is the ultimate model for the study of morphogenesis, tissue remodeling, and stem cells. Many growth factors and transcription factors such as FGF, BMP, tabby/downless, EGF family, Wnt-Frizzled-β-Catenin-Lef-1, and Shh-Patched have been identified as morphogenic molecules, and some genes are directly involved in the development of skin tumors. Several genes are specifically involved in the remodeling of hair follicles. Stat3 is a downstream signaling molecule of cytokines and growth factors including EGF and HGF. Conditional targeting using the K5-Cre/loxP system allowed us to generate keratinocyte-specific Stat3 knockout mice. Comprehensive analysis of skin development as well as wound healing and hair cycling in these keratinocyte-specific, Stat3-null mice revealed that Stat3 plays pivotal roles in skin remodeling. Another typical example of the signal transduction in the hair follicle is the androgen-androgen receptor system. Human dermal papilla cells (DPC) are targets of androgens. Insulin-like growth factor-I (IGF-I) was identified as one of the androgen dependent paracrine growth factors needed for hair growth. In contrast, frontal scalp DPC inhibit the growth of follicular epithelial cells in an androgen-dependent manner. TGF-β may be involved in this growth suppression.
We studied 59 patients with systemic sclerosis (SSc) to evaluate their association with Hashimoto disease. Hashimoto disease occurred in 23 of these 59 patients (39.0%). Of the 19 patients with diffuse-type SSc and the 40 patients with limited-type SSc, 9 (47.4%) and 14 (35.0%), respectively, had Hashimoto disease. Of the 29 patients in whom SSc coexisted with Sjögren’s syndrome, 14 (48.3%) had Hashimoto disease. The patients with both SSc and Hashimoto disease were more likely to have facial scleroderma than the patients without Hashimoto disease. Additionally, among patients with both SSc and hypothyroidism, those with Hashimoto disease had statistically significantly more severe facial scleroderma than those who did not have Hashimoto disease. Thus, we observed a high tendency of association between Hashimoto disease and severe facial scleroderma. Also, it appeared that hypothyroidism was clearly associated with facial scleroderma. We recommend routine testing for antithyroid antibodies in patients with SSc, because of the possible association between these factors and Hashimoto disease.
Chymase is a proteolytic enzyme present in mast cell granules that is released by mast cell degranulation with tryptase, histamines, and other mediators. To elucidate the roles of mast cells in various biological processes, including fibrosis and wound repair, it is necessary to know the effects of chymase on fibroblasts and vascular endothelial cells. We examined the effect of human chymase on human dermal microvascular endothelial cells (HDMEC) and human dermal fibroblasts (HDF). Chymase did not affect HDMEC growth, but it did stimulate the proliferation of HDF at 1nM concentration. This growth-promoting activity was completely inhibited by the addition of the chymase substrate peptide, Suc-Val-Pro-PheP (OPh)2. Chymase did not have any effect on ICAM-1 or VCAM-1 expression in HDMEC and HDF. The present study suggests that the mitogenic effect of chymase released from mast cells on dermal fibroblasts may be involved in some pathological and physiological processes. Another chymase inhibitory agent, which is a quinazoline derivative, stimulated the growth of HDMEC and enhanced VCAM-1expression in the cells, suggesting an angiogenic effect.
Stress seems to be related to the exacerbation of atopic dermatitis (AD); however only a few papers have examined flares in specific anatomical areas in relation to stress to date. We conducted an epidemiological survey of lesions on the dorsa of the hands in 102 patients with AD for over a one-year period. The relationship between AD and stress was then analyzed. The patients’ ages ranged from 15 to 47 years with an average of 28.5 years and a male/female ratio of 1.5. In the year from 1999 to 2000, dermatitis on the dorsa of the hands appeared in 78 (76.5%) patients, and 74 (94.9%) patients noticed itching in that area at the same time. Sixty (59.0%) patients showed no clinical difference of severity between the two hands. Stress, as reported by 51.3% of patients, seemed to exacerbate the dermatitis on the dorsa of the hands more than irritation factors (35.9%) did. With stress, 75 (73.5%) of the patients complained of itching on various parts of the body ; the dorsa of the hands (24.5%) were the most common sites, and the secondary site was the face (20.6%). We concluded that stress seemed to be the most significant factor for exacerbation of AD on the dorsa of the hands in AD.
We report five patients with adult measles from an outbreak occurring at a foster care facility. All had delayed mental development and had been residents of a foster care facility located near Dokkyo University School of Medicine for more than 20 years. The five patients developed measles essentially simultaneously and had a favorable clinical course during inpatient treatment. Titers of antibody against measles, rubella, mumps, and varicella zoster had been measured in all the residents of this facility in 1999 (61 patients) and were helpful in the early prediction of the outbreak and establishing the diagnosis. Although all the residents of this facility are adults, the viral seroprevalence was 86.9% for measles, 45.9% for rubella, 67.2% for mumps, and 93.4% for varicella zoster. The seroprevalences for measles and rubella were lower than those in the general adult population ; this may be due to a higher number of unvaccinated individuals and a lower likelihood of infections at a residential facility in an environment located away from the general society. Attention is required because of the increased risk of outbreaks among those living in a group setting in a closed environment. Based on our experience, we believe that viral titer screening may be useful at other similar facilities.
We report a 54-year-old female with yellow nail syndrome (YNS). The patient first noticed hypertrophic, yellowish nails with slow growth five years ago and then was diagnosed with bronchiectasis two years later. She has sometimes also experienced lymphedma on her face and inferior limbs, so she has the triad sign of YNS. Chronic sinusitis was also associated. As sinusitis has been reported to be accompanied with 20～25% cases of YNS, it should be emphasized that sinusitis is one of the characteristic changes of YNS. Oral therapy with clarithromycin resolved the pleural effusion and sinusitis, and topical therapy with steroids and vitamin D3 improved the nail changes. The present case indicates that macrolide antibiotics should be tried for the treatment of YNS, although there have been no reports showing the therapeutic effects of this medication on YNS.