In order to evaluate the hormonal environment in adolescent women with acne, we measured serum luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), free testosterone (FT), sex hormone binding globulin (SHBG), androstenedione (Δ4A), dihydrotestosterone (DHT), and dehydroepiandrosterone sulfate (DHEA-S) levels in 65 female patients with acne vulgaris, and 38 healthy controls with regular menstrual cycles. Only the serum DHEA-S levels in acne patients were significantly higher than those in the controls (p<0.001). There was also correlation between DHEA-S levels and acne severity (p<0.001). Thus there is the possibility that DHEA stimulates the activity of sebaceous glands in vivo. In this study the in vitro effects of DHEA on proliferation and lipid synthesis in cultured hamster sebaceous-gland-derived cells were assessed. DHEA stimulated the proliferation and lipid synthesis of cultured hamster sebaceous-gland-derived cells in a significant dose dependent manner (cell proliferation ; 10-9M : p<0.05, 10-8, 10-7, 10-6M : p<0.01, lipid synthesis ; 10-7, 10-6M : p<0.05). These in vivo and in vitro results suggest that DHEA may play a important role in the etiology of acne vulgaris.
Recently, introduction of narrow band UVB phototherapy has significantly improved the therapeutic efficacy and safety of classical broad band UVB phototherapy. The efficacy of narrow band UVB phototherapy in severe chronic adult type atopic dermatitis (AD) was reported. Eleven outpatients with adult type AD were subjected to narrow band UVB phototherapy. We used two clinical scores, the patient score (PS) and the clinical score (CS), for evaluating the severity of AD patients. The PS is the global severity score of the dermatitis using a simple from filled out by a patient. The CS is the score by clinicians using a method based on the characteristic symptoms of adult AD. We compared the PS with the CS befor phototherapy, after 10 times phototherapy, and after 20 times phototherapy. The mean values of the PS significantly decreased from 17.6 to 13.9 at 10 times phototherapy (P=0.0183). The mean values of the CS also significantly decreased from 168 to 125 (P=0.0006). In seven patients, We measured blood eosinophil counts, serum LDH and serum IgE before phototherapy and after 20 times phototherapy. The serum LDH level significantly decreased from 420 IU/ml to 217 IU/ml (P=0.0037). The serum IgE level also significantly decreased from 12,036 IU/ml to 7,812 IU/ml (P=0.0006). We concluded that narrow band UVB therapy was effective for treating adult type AD.
In this study, dermatologists and psychiatrists investigated psychiatric disturbances in patients with atopic dermatitis (AD). Patients were classified into four groups by their psychiatric diagnoses; “psychological factors affecting medical conditions”, “adjustment disorders”, “other psychiatric diagnoses”, and “no diagnosis”. The prevalence of psychiatric diagnoses was higher in new patients than in patients who first visited the clinic before the beginning of the study. “adjustment disorders” were observed more in the new patients and with severe dermatitis patients. Every psychiatric symptoms as anxiety and depression were recognized in the patients with adjustment disorders. These symptoms seemed to influence the treatment of dermatitis. Those who had a history of “adjustment disorders” comprised 48.1% of those patients who visited before the beginning of the study. The prevalence of adjustment disorders was so high that the importance of adjustment disorders should be recognized by dermatologists.
Two patients with atopic dermatitis who were diagnosed with “adjustment disorders” or “psychological factors affecting medical conditions” were treated by dermatologists and psychiatrists in cooperation. Psychological interventions were performed on those patients. It seems to be important to dermatologists to pay attention to the social stigma deriving from dermatitis, which itself can be a stressor, to understand the psychological characteristics of patients with dermatitis, and then to try to develop each patient’s abilities to cope with stressors.
We analyzed 44 measles patients who visited Kitami Red Cross Hospital, and were 15 years old or older. The ages of these patients actually ranged from 15 to 41 (the mean age was 20.6 years old). Among the 44 patients, only 4 (9%) had been previously vaccinated against measles. Regarding the symptoms, all the patients had fevers. Additional symptoms included sore throat (98%), cough (93%), diarrhea (52%), and nausea/vomiting (34%). Koplik’s spots were seen in 96% of the cases and were useful for diagnosis. Comparison of laboratory results of measles with those from patients aged less than 15 years who visited the Kitami Red Cross Hospital during the same period disclosed that thrombocytopenia and liver dysfunction were more commonly observed in the older age group. Complications included bacterial pneumonia (1 case) and measles encephalitis (1 case). Three of the patients were pregnant women, two of whom showed signs of threatened abortion or prematurity. These three cases were adequately treated with successful delivery and the delivered infants had no evidence of malformation or other abnormalities. Recently, measles infection has been observed in older age groups. This results in considerable numbers of cases of measles in pregnant women. We suggest that measles vaccination is desirable for adolescents and adults who are susceptible to measles, which may be accompanied by more serious symptoms in older age groups.
Dermoscopy has been recently applied to diagnose pigmented tumors. But the criteria for differential diagnosis between nodular melanoma (NM) and basal cell carcinoma (BCC) have not been fully established. We examined 3 cases of NM and of BCC dermoscopically, all of which were not diagnosed clinically. As a result, a pigment network (PN) was found in all cases of NM, but not in any cases of BCC. On the other hand, treelike telangiectasia (TT) was observed in all cases of BCC, but in no cases of NM. Our results indicate that dermoscopic features of PN and TT are specific for NM and BCC, respectively, and are valuable for the differential diagnosis between NM and BCC.
Two cases of neurofibromatosis type 1 (NF1) with glomus tumors are reported. Case 1 was a 19 years old female with NF1 and a subungual painful glomus tumor on the right little finger. Case 2 was a 37 years old female with NF1 who had painful subungual glomus tumors on the left ring finger and left thumb. Both cases had family histories of NF1, but not of glomus tumors. Recently a linkage to the locus VMGLOM (1p22-p21) has been found for familial glomus tumors. The NF1 locus is 17q11.2. We showed that the glomus tumors associated with NF1 clinically more resembled sporadic glomus tumors than familial glomus tumors. We suspected that a mutation of the NF1 gene could be responsible for the pathogenesis of such glomus tumors seen with NF1.
A case of dermatomyositis associated with multiple skin ulcers and interstitial pneumonia is reported. The patient was a 53-year-old woman who presented with erythema on her face, back, and dorsa of both hands in April of 1999. In December of 2000, she developed dyspnea and generalized fatigue without muscle manifestations. In March of 2001, skin ulcers with large pockets appeared on the patient’s elbows, shoulders, and bilateral knees. Laboratory findings revealed no paticular abnormality except an elevated serum KL-6 level. Histological findings of the skin taken from the left cheek revealed liquefaction necrosis of basal cells, and edema in the upper dermis. Oral prednisolone therapy, hyperbaric oxygenation therapy, fibroblastic growth factor (Fibrast Spray®), and surgery were employed, and the skin ulcers improved. Similar cases of dermatomyositis associated with skin ulcers are discussed. Adult dermatomyositis associated with skin ulcers is more common in women, and then more often develop interstitial pneumonia and internal malignancy than does cases of dermatomyositis without skin ulcers. The rate of complication by interstitial pneumonia is high, but the rate of complication by malignant tumor is low.
An 87-year-old woman had erythema with slight itcing in her left forearm. Although cryptococcosis was suspected histopathologically, laboratory culture test for fungi was negative. For PCR analysis, DNA was extracted from both frozen sections and formalin-fixed, paraffin-embedded specimens of this case. DNA was also extracted from Cryptococcus neoformans (C. neoformans) strains ; two reference strains and two clinical strains isolated from cases of cryptococcal meningitis with AIDS. From all these DNA samples, a 416-bp fragment was amplified by PCR using primers specific for C. neoformans. Sequencing analysis confirmed that a specific region of C. neoformans genome was amplified. The PCR and sequence analysis revealed C. neoformans DNA from two additional culture-negative cases, a case of pulmonary cryptcoccosis associated with AIDS (paraffin-embedded lung specimens) and a case of meningitis (spinal tap liquor sample). PCR and sequencing analysis might be useful for diagnosis of cryptococcal infections when culture data are not available.