In contrast to allergic contact dermatitis, irritant contact dermatitis is mediated by non-allergic mechanisms, The irritants stimulate keratinocytes to produce cytokines/chemokines and proteases or damage them directly because of their toxic properties. The extremely severe type is termed acute irritant contact dermatitis, which is generally synonymous with chemical burn. Fluoric acid, cement, and kerosene are representatives of chemical burns agents, and hydrogen peroxide is another chemical important in examining the mechanisms of such extremely irritant skin reactions. Chemical burns caused by fluoric acid are the most dangerous of all injuries caused by acids and need special treatment. Skin eruptions caused by cement are divided into three types : mechanical injuries, cement burn caused by its alkaline moiety, and allergic contact dermatitis to 6+Cr. In kerosene dermatitis, kerosene induces epidermal necrosis as well as keratinocyte production of interlekin-8, which may exaggerate skin inflammation. Hydrogen peroxide also damages keratinocytes, but the induction of oxygen bubbles by this chemical characterizes its unique dermatitis.
In recent years, cultured autologous epidermal keratinocytes have been successfully applied to covering skin defects caused by burn injury. Instead of epidermal keratinocytes, the authors tried to culture outer root sheath (ORS) cells from plucked hair follicles, which are more accessible than epidermis. This report describes a simple method for culturing ORS cells using a non-collagen-coated dish and serum-free medium. We carried out the explant culture of ORS cells using plucked human scalp hair follicles, and studied the influence on growth of ORS cells of several factors, including age, sex, and plucking regions. After plucking the hair follicles from 11 males aged from 7 to 83 years, and 12 females aged from 9 to 81 years, ORS cells were cultured. There was no significant differences found with regard to age, sex, or plucked region. Four types of explant culture method were compared as follows : ① plating the hair follicles simply on a culture dish, ② plating the hair follicles after treatment with 0.3% trypsin and 0.4% EDTA, ③ fixing the hair follicles with glass coverslips, and ④ fixing hair follicles with glass coverslips after treatment with 0.3% trypsin and 0.4% EDTA. We found that fixing hair follicles with glass coverslips on culture dish gave us good results ; ORS cells could be cultured easily. In this study, a rather simple method was established for culturing the stratified ORS cell sheet from plucked hair follicles. First, the hair follicles were placed on non-collagencoated dish, and then fixed with glass colverslips. Next, the hair follicles were cultured in DMEM supplemented with 10% fetal calf serum (high Ca medium). After the colony of ORS cells was recognized, the culture medium was changed to low Ca medium. When the monolayer cells become confluent, the culture medium was changed back to a high Ca medium, and a stratified ORS cell sheet was finally obtained. Using this culture system, cultured autologous ORS cells could easily be repeatedly established from the patient’s follicles, avoiding additional wounding in skin donor sites, and cultured ORS cells could be utilized as epidermal grafts on skin defects.
A case of pigmented dermatofibrosarcoma protuberans (Bednar tumor) arising in the back of a two-year-old girl is herein presented. The lesion was a reddish-purplish tumor with a slight elevation, measuring 45×25 mm in size. The histopathological examination revealed a proliferation of spindle-shaped and fibroblast-like cells together with melanin-bearing dendritic cells. Immunohistochemical studies showed that the spindle-shaped cells were positive for CD34 and vimentin, and negative for S-100 protein, similar to the findings for conventional dermatofibrosarcoma protuberans. On the other hand, the melanin-bearing cells were positive for vimentin and S-100 protein, and negative for CD34, HMB45, SMA (α-smooth muscle actin), EMA (epithelial membrane antigen), Factor XIII, and desmin. The tumor was surgicaly excised with a two cm margin, and no local recurrence has been seen for nine months.
Superior vena cava syndrome occurs when extrinsic compression or intraluminal occlusion impedes blood flow through this vessel. The most common underlying cause is a malignant neoplasm, especially lung cancer. Superior vena cava syndrome generally appears in accordance with the development of a malignant neoplasm. We report a case with a massive pulmonary cancer manifested by facial flushing. The patient was a 62-year old man. He consulted our clinic in March of 2003 with a one-month history of flushing and edema of the face and neck. He also complained of palpitations and anorexia. On the initial consultation, the classical signs of superior vena caval obstruction with prominent venous collaterals over the chest and abdomen were present. A chest CT scan showed a mass in the mediastinum, and three-dimensional CT demonstrated stenosis of the superior vena cava and development of collaterals. A bronchoscopic biopsy specimen showed lung cancer (adenocarcinoma). The patient has been treated with chemotherapy, radiation, and stenting, with some improvement of symptoms.
Long-term systemic steroid therapy is required for some patients with certain dermatological diseases. However, there have been only a few studies of steroid-induced osteoporosis based on clinical evidence. During the past eight years, we measured the bone mineral density (BMD) of the lumbar spine periodically in eight cases of collagen diseases, nine cases of autoimmune bullous diseases, and 18 cases of other inflammatory dermatological diseases who underwent long-term regimens of systemic steroid. Our follow-up study showed that the patients who received high doses of steroids for prolonged periods had marked decreases in BMD, of which osteoporosis accounted for 29.4% and osteopenia 47.1%, while those who received low doses of steroids had lesser decreases in BMD. The risk factors for osteoporosis, including advanced age and menopause, were considered to have additive effects on the decrease in BMD. Taking these risk factors together, dermatological patients treated with long-term steroid therapy should be monitored for osteoporosis by BMD measurement, and must be provided with early prophylactic and therapeutic measures.
Objective : We wanted to evaluate how the psoriasis patients themselves evaluated their present treatment, in order to grasp the patient needs for treatment of, and to use the results of survey to develop future treatment, thus, improving the treatment satisfaction of patients. With these objectives in mind, we surveyed the degree of treatment satisfaction of patients based on treatment effectiveness, the degree of treatment satisfaction, QOL, and so on. Method : We drafted a questionnaire to be completed by patients and physicians with 18 questions and conducted this survey at the eight medical institutes. Result : We had 262 respondents to the questionnaire at the eight institutes and summarized their replies. The total of the respondents who were “satisfied” or “somewhat satisfied” with the present treatment of psoriasis (this total is defined as general degree of satisfaction) was 49%, which means that there remains room for improvement. We also surveyed satisfaction about treatment effectiveness against the present symptoms. The respondents who were “worried” or “somewhat worried” (this total is defined as degree of worry) mentioned “appearance” first of all, followed by “dandruff amount” and “itch”. In the social life and psychological aspect, the highest “degree of worry” was that the patients wanted to avoid the eyes of others when they are traveling, sea bathing, swimming, visiting hot springs, etc. where they meet many strangers. Most of the respondents who “wanted high effectiveness of treatment” were men and severely affected patients, while most of the respondents who “did not want side effect” were women. Furthermore, patients with different profiles wanted different items to be improved. This result clarifies the necessity of treatments which take the profile of individual patient into full account. It also suggests the importance of giving patients full information about treatment and assisting them in their social life and psychological adjustment.