Cultured epidermal sheets and composite skin have already been used to treat clinical cases such as severe burn patients ; however, hair follicles and sweat glands are not regenerated in vitro from adult somatic cells. To obtain better artificial skin with appendages, it is necessary to isolate the stem cells and to understand their characteristics. In the bulge region of the hair follicle, there are epidermal stem cells which can differentiate into interfollicular epidermis, sebaceous glands, and hair follicles. The stem cells of melanocytes also exist in the same area. Multipotent stem cells which can differentiate into neurons, glial cells, and smooth muscle cells can be obtained from the dermis, and mesenchymal stem cells are localized in the addipose tissue. Side population cells which have a strong capability to efflux dye (Hoechst33342) are regarded as candidates for stem cells in various tissues. They also exist in the skin. Taken together with the potentials of cell plasticity of keratinocytes and fibroblasts, we might be able to use skin as a stem cell source or a bioreactor for producing useful proteins by gene modification.
Clinical trials using allogeneic cultured dermal substitutes (CDS)，newly developed in the R&D Center for Artificial Skin of Kitasato University are supported by the Millennium Project of the Ministry of Health, Labour and Welfare. We report herein clinical cases successfully treated with allogeneic CDS. This therapy has proven extremely effective for deep skin ulcers that expose tendon and bone, resulting in dramatic improvement in comparison with previously available treatments for skin ulcers.
Three male patients developed various skin lesions including erythema, red papules, and lichenificated plaques. The lesions spared the large folds of the abdomens. They gradually worsened even though they were treated with topical corticosteroid. Histological findings revealed mild acanthosis in the epidermis and an infiltration predominantly of lymphocytes and eosinophils in the upper dermis. Laboratory examinations revealed hypereosinophilia (Case 1: 24%, Case 2: 29%, Case 3: 17%) without atypical lymphocytes. Based on the clinical and histological findings, they were diagnosed as having papuloerythroderma (Ofuji). We treated all three patients with bath-PUVA therapy. The eruptions disappeared almost completely after the treatments (Case 1: ×16, 41.4 J/cm2; Case 2: ×13, 30.4 J/cm2; Case 3: ×18, 50.5 J/cm2). Hypereosinophilia was improved simultaneously.
We reported two patients who developed hypercalcemia during treatment of psoriasis vulgaris with topical application of maxacalcitol. We hypothesized that four factors decide the occurrence frequency and the severity of hypercalcemia. They are the excess application of Vitamin D3 (VitD3), the increasing percutaneous absorption of the skin condition, the existence of a complication (especially renal dysfunction), and the oral administration of an internal medicine which may elevate serum calcium. Previously reported cases have shown that severe hypercalcemia tends to occur in patients with renal dysfunction. Our two cases also had the complication of renal dysfunction. So, although the dose of the maxacalcitol we used was within the recommended limit, serious hypercalcemia might have occurred. We suggest that when we use an external preparation of VitD3 topically, especially maxacalcitol, for patients with the above-mentioned risk factors, it is necessary to make a careful choice and reduce the quantity of the VitD3.
We sent a questionnaire to members of Tokyo Clinical Dermatologist’s Association and Kanagawa Dermatologic Association to get an overview of scabies patients in the year 2001. The rate of collection was approximately 44%. On average, each dermatologist saw eight scabies patients. About 20% of the dermatologists visited the patients’ houses to see them. Half of the scabies patients were infected in their hospitals, therefore proper effective measures should be taken to control their situation. Approximately half of the scabies patients were more than 70 years old, and they were staying in the hospitals or in the homes for the elders. Crotamiton ointment, and sulfur-containing preparations were used in many clinics. Gamma-BHC and benzyl-benzoate were also used in some dermatologists in Tokyo Metropolitan Area and Kanagawa Prefecture. In Tokyo, benzyl-benzoate was used more frequently than that in Kanagawa; and in Kanagawa, gamma-BHC was used more frequently than that in Tokyo.
We report a 31-year-old female patient with a linear and progressing erythema on her lower abdomen of ten days duration. When she was referred to our hospital, the erythema, fourteen cm in length was noted on her inguinal region. The patient was diagnosed as larva migrans and admitted into our hospital. We resected the skin lesion, measuring 6×13 cm and including the tip of the erythema, and a hair was discovered in the resected specimen. Histological findings showed that the hair existed in the upper dermis and was surrounded by lymphocytic infiltration. In the Japanese literature, ten similar cases have been reported. The hair was invisible in seven cases, and extensive skin was resected including the tip of the erythema in five of them. We concluded that this condition is important as a differential diagnosis of larva migrans.
We report a case of a 73-year-old woman with angiosarcoma on the left upper extremity, which had been swollen for as long as four years because of lymphedema. For twelve years, she had been bed ridden with complete left hemiplegia due to cerebral hemorrhage. The left shoulder and elbow joints had been fixed in a contracting posture, which may be the cause of the lymphedema of the left upper extremity. Five months after amputation of the affected limb, the tumor recurred at the amputation edge and in the lung. She died of bilateral pneumohemothorax and disseminated intravascular coagulation syndrome. Many other conditions have been described that can induce lymphedema on which angiosarcoma could arise, such as congenital anomaly, obesity, and filariasis. However, no previous report has mentioned cerebro-vascular disease as a cause of angiosarcoma. It must be noted that lymphedema of the contracted limb due to cerebro-vascular disease may cause Stewart-Treves syndrome.