Recently in Japan, misunderstandings about the pathogenesis of atopic dermatitis (AD) and the strategies for the treatment of this disease, especially about the use of topical steroid, have led to a rapid increase of severe cases of AD caused by inadequate treatment. This prompted us to establish and distribute standard guidelines for AD therapy. In this guideline, the necessity of dermatological training to examine severe cases of AD is emphasized. It is stated that the present standard therapies for AD consist of the use of topical steroid and thaclolimus ointment (only for adult patients) for inflammation and emollient for dry and barrier—disrupted skin as the first line of attack, anti-histamines and anti-allergic drugs for pruritus, avoidance of apparent exacerbating factors, psychological counselling, and advice about daily life. The importance of correct selection of topical steroid according to the severity of the lesion is emphasized.
Elastic fibers are fibrous proteins in the dermis, then include elastin, fibrillins and microfibril-associated glycoproteins. Typical cutaneous disorders in which elastic fibers are primarily involved are pseudoxanthoma elasticum, actinic elastosis, cutis laxa, elastosis perforans serpiginosa, middermal elastolysis, and pseudoxanthoma elasticum-like papillary dermal elastolysis. Recent advances in the molecular pathology of these disorders were presented.
Background: Patients with diabetic foot gangrene usually have many other systemic diabetic complications, and occasionally have a poor vital prognosis. Purpose: To investigate the risk factors for the vital prognosis of gangrenous patients. Methods: Of 140 cases with diabetic foot gangrene who were treated in our institution from 1994 to 2001, 19 cases died. We retrospectively analyzed their clinical data and assessed the risk factors by the analysis of Kaplan-Meier survival curves and Cox regression model. Results: The 19 dead cases had poorly-controlled diabetes, and their mean HbAlc was 9.5%, which was higher than that of the 121 survivors (7.8%). They had more intensive foot gangrene and more serious diabetic complications including blindness as a result of retinopathy (2 cases) and long-term hemodyalysis due to nephropathy (11 cases). All the dead cases had severe arteriosclerosis obliterans, and 70% of them had undergone major limb amputation. These factors were statistically significantly different between the two groups. The most frequent causes of death were heart failure (5 cases) and sudden death (5 cases). Cox regression analysis demonstrated increased an risk ratio for the following three factors: major limb amputation (9.93, 95% confidence interval (95%CI) 3.48–28.30), HbAlc (1.61, 95% CI 1.26–2.05), age (1.10, 95% CI 1.02–1.19). Conclusion: According to these results, careful attention should be paid not only to the foot lesions but also to the control of diabetes and other systemic complications.
We analyzed the usefulness of serum MIA levels is Japanese melanoma patients. Serum MIA measurements were performed using an ELISA system. The cut-off was determined at 9.6 ng/ml. The mean values of serum MIAS from 73 patients at various stages were as follows, stage I, 6.5 ng/ml ; stage II, 7.8 ng/ml ; stage III, 8.2 ng/ml ; and stage IV, 32.9 ng/ml. We then analyzed a total of 200 samples taken from 31 melanoma patients (stage I, 9 ; stage II, 14 ; and stage III, 8) who had been under periodical follow-up for 12 to 77-monthpostsurgery of primary tumors. Nine of thirty-one patients had a relapse during the follow-up period. All of the serum MIA levels at the time point of the first clinical relapse in 9 patients were abnormal value. Furthermore, 8 patients showed abnormal values 4 to 53 months prior to the clinical detection of melanoma metastasis. In contrast, in 22 patients without relapse, 8 patients showed abnormal serum MIA values at least one time and 6 patients showed them repeatedly. These results show that MIA is useful in monitoring melanoma patients after the primary surgery. The repeated elevation of serum MIA levels may predict the presence of clinically undetectable occult metastases and warrant careful follow-up for relapse.
We investigated the correlation between the clinical severity scores and desmoglein (Dsg) titers in differently diluted sera, from 13 patients with pemphigus exhibiting high levels of Dsg titers over 150 (Index value) by using regular enzyme-linked immunosorbent assays (ELISA) during their clinical time courses. They were including pemphigus vulgaris with predominant mucosal lesion (n=3), mucocutaneous lesion (n=5), and typical pemphigus foliaceus (n=5). Their sera were diluted in the ordinal rate (×100) and compared at different dilution rates (×400 and ×1600) in Dsg titers detected by Dsg ELISA. In this system, Dsg titers showed more specific correlation with the clinical severity scores in the sera diluted at 1,600 times than in the sera diluted at 100 or 400 times. Even in the cases who showed only one step change in clinical severity score, this tendency was clearly shown. The results indicate that the Dsg titers in highly diluted sera exhibite clearer correlation with the clinical severity scores in patients with Dsg titers over 150 in regular ELISA. It is of interest that the Dsg titers in highly diluted sera seemed to clearly monitor the decrease in the titers in cases showing stable clinical presentations during the time course (4/10 cases). These data indicate that the Dsg titers in highly diluted sera enable us to detect the subclinical activity of pemphigus patients and help us to plan treatment. Conclusively, in patients with pemphigus showing very high Dsg titers by reqular ELISA, the measurement of Dsg titers in more highly diluted sera will help us to assess the true disease activity.
Clinical analysis on the effect of substitution or removal of dental materials was conducted on the patients with metal patch test-positive patients at the Department of Dermatology, Nagasaki University, School of Medicine between 1984–1999. The total patient numbers enrolled in this study were 51 cases, including 18 cases with pustulosis palmaris et plantaris, 7 cases with contact dermatitis, and 3 cases with atopic dermatitis. Metal components in the dental materials were analyzed by microanalyzer, and materials containing positive metals as revealed by the metal patch test were removed or substituted with new dental materials which did not contain positive metals. Favorable clinical effects were obtained in 21 out of 42 cases (50%) after removal or substitution of suspected dental materials. This effect was more apparent when the suspected metals were present in the dental materials (67%) than in the group without microanalysis (21%). Substitution or removal of dental materials in metal patch test-positive patients can be an alternate and promising approach to managing patients with refractory dermatological disease after metal patch test and microanalysis of dental metals.
We examined aerobic and anaerobic bateria isolated from 53 inflamed and 22 uninflamed epidermoid cysts between July 1998 and April 2002. The main bacteria were coagulase negative staphylococci and Corynebacterium which were aerobically isolated from both inflamed and uninflamed cysts. Anaerobic bacteria included Peptostreptococcus, Propionibacterium, Veillonella, Prevotella. More Propionibacteriumacnes (P. acnes) and gram nagative cocci were anaerobically isolated from inflamed cysts than uninflamed cysts. We could isolate more bacteria from cases that have not received antimicrobial treatment than from those treated before specimens were obtained. However, the bacteria were isolated from most cysts. Treatment or lack of treatment had no influence on whether the cyst was inflamed or uninflamed. The presence of anaerobic flora such as P. acnes and/or some gram nagative cocci may lead to inflamation in some cysts.
A case of menstrual dermatitis is reported. A 31-year-old woman presented in September of 2000 with a three-year history of a papular eruption on her trunk. The eruption occurred cyclically, appeared approximately five days prior to the menses, and resolved following the memses. She was treated on several occasions with corticosteroids, antibiotics, antihistamines, or androgen-progesterone complex hormone without much improvement. Physical examination revealed slightly itchy, indurated papules on her frontal trunk. Laboratory tests results including antinuclear antibodies and various hormones were mostly within the normal range. Histopathological examination showed an inflammatory infiltrate around dermal vessels and exocytosis. The cells were mostly lymphocytes. An intradermal skin test for progesterone was administered ; the result was negative. We diagnosed the cases menstrual dermatitis. However, no intradermal skin test for estrogen has been administered ; this test has produced positive results in cases of estrogen dermatitis. Further tests are required to determine the diagnose and therapy in this case.