We have organized a committee in the Japanese Dermatological Association to address issues of atopic dermatitis treatment. The activities of this committee are widespread, some major ones are as follows. (1) Consultation systems for the patients by e-mail and direct facsimile. During the past two years, we have responded to 3670 consultations. (2) Publication of a guide book for patients that explains the treatment guidelines for atopic dermatis; this was compiled by the Japanese Dermatological Association. “Atopic dermatitis, which is easily explained by experts” was published by “Kurashi no techousha” in November 2001. (3) The committee exposed an Illegal Chinese ointment problem ; these products have been imported for the treatment for atopic dermatis. Several Chinese ointments were advatised and sold as “non-steroidal”, but they actually contained steroids. The above activities were successful, but the Japanese Dermatological Association needs to make more efforts to solve the confusion over atopic dermatitis treatments.
We used Southern blot to analyse HTLV-1 proviral DNA integration in peripheral blood mononuclear cells (PBMC) and skin lesion from 15 HTLV-1 antibody positive cases. Seven cases were positive for HTLV-1 proviral DNA integration in both PBMC and skin lesions, 5 cases were positive in the skin lesion only, and 3 cases were negative in both PBMC and skin lesions. The patients with positive HTLV-1 proviral DNA integration only in the skin lesion were older than those with positive results in both samples and showed rapid progression with a short clinical history of active skin lesions. No significantly different histopathological findings were obtained among the 3 groups. Elevated sIL-2R was observed in the patients with positive HTLV-1 proviral DNA integration in both tissues. The three of the cases with positive integration only in skin lesions had a poorer prognosis. Four out of the 5 cases with positive HTLV-1 proviral DNA integration only in the skin died after a short clinical course, contrasting with the good prognosis for the cases with positive HTLV-1 proviral DNA integration in both PBMC and skin lesions. These results indicate that the cutaneous type of ATL should be more widely recognized and more effective therapy is required to control skin lesions and prevent acute transformation to the leukemic stage.
In this report, we examined the circulating autoantibody titers to desmogleins during plasma exchange (PE) treatment of patients with pemphigus. Three patients with pemphigus vulgaris (PV), who were unresponsive to standard managements such as systemic steroid and immunosuppressive therapies, were enrolled in this study. As assessed by serial desmoglein enzyme-linked immunosorbent assays (Dsg ELISAs), their serum antibody titer for Dsgs 1 and 3 closely paralleled their disease activities which they were treated with double filtration plasmapheresis (DFPP). The DFPP treatment resulted in a successful reduction of the total steroid volume and improvement of clinical manifestations; however, two of three patients experienced some transient adverse effects. We discuss the usefulness of Dsg ELISA in monitering the complex clinical course of pemphigus during an intense treatment such as DFPP.
Intraocular pressure (IOP) was examined in 25 patients with intractable atopic dermatitis (AD). It was shown to be within the normal range in all the patients except one, who showed slightly elevated IOP. In the 25 patients with severe dermatitis on the face who required treatment with about 5g of topical steroid every month, the intraocular pressure did not increase during the follow-up period of 7 to 32 months. These results suggest that topical steroid treatment on the face, up to 5g monthly, does not affect IOP, though further studies of larger numbers of patients are necessary.
We report two cases of diabetic digital sclerosis, which we believe to be the first report in Japanese. Case l was a 62-year-old male who had had insulin-dependent diabetes mellitus for 20 years. Case 2 was a 69-year-old male who had had insulin-dependent diabetes mellitus for 40 years. Both cases showed digital sclerosis and limited joint mobility, but neither Raynaud’s phenomenon, nail phenomenon, nail fold bleeding, increased collagen fibers in the dermis pathologically. Immunological studies in the two cases revealed that anti-nuclear antibodies, anti-centromere antibodies, anti-Scl-70 andtibodies and anti-RNP antibodies were all negative. In differentiating these cases from other diseases which have sclerodactylia, we considered that most important background condition was diabetes mellitus. previous reports, which are few and written in English, have suggested that digital sclerosis is found in 18~34% patients with diabetes melitus. Since this disroder is not well to dermatologists in Japan, we insist that this rather common dermatosis with diabetes mellitus should be widely recognized as an important differential diagnosis of systemic sclerosis and its related disorders.
We report a 39-year-old female patient with a nodule on the right lower leg measuring 8mm in diameter. The nodule was asymptomatic, elastic hard in consistency, smoothly-surfaced, dome-like in shape, and brownish in color with a partial blackish hue and unclear border. Based on those features, we clinically suspected that it was malignant melamona. However, histologically, it was proved to be a variant of desmoplastic Spitz nevus, namely angiomatoid Spitz nevus, on the basis of the characteristic features of a predominance of solitary units or small nests of nevus cells which showed large plump-oval nuclei with prominent nucleoli and abundant cytoplasm. They were embedded in a fibrous stroma with many densely arranged, small blood vessels. The whole lesion was symmetrical in its architecture. Immunohistochemical studies showed the nevus cells were positive for S-100 protein and negative for HMB45. The tumor cells were positively stained in part for vascular endothelial growth factor and basic-fibroblast growth factor. It is thus considered that the nevus cells possibly release these growth factors, which may be related with the formation of prominent fibrous stroma and proliferation of small blood vessels.