Recent advances in extracellular matrix research concerning skin diseases were reviewed. Several different forms of amino terminal splicings of type VI collagen were identified ; these might contribute to binding with decorin or biglycan. Type XVI collagen is synthesized by nonadherent and proliferative fibroblasts. This collagen is expressed in dermal dendrocytes and might contribute to their anchorage in the papillary dermis. Dermatopontin, which is a low molecular weight component abundant in dermis, interacts with decorin and TGF-β1, and modulates the action of TGF-β1. The null mouse for this molecule showed dermal thinning and increased elasticity. Only a little is known about the molecular defect of congenital cutis laxa, but elastin gene mutations have been reported in patients with autosomal dominant cutis laxa. The gene targeted mouse for fibulin 5 has recently been reported ; it mimics human cutis laxa with vascular and pulmonary involvement. Myofibroblasts play important roles in fibrosing diseases such as hypertrophic scar, keloid, and interstitial reaction against epithelial tumors. Transforming growth factor beta1 is one of most potent inducers of myofibroblasts from fibroblasts, and the expression of EDA, a splicing form of fibronectin, leads this phenotypic change. Antifibrotic therapy that involves blocking connective tissue growth factor or regulating other transcription factors, e. g. Sp1 or hcKrox, is expected in the future.
I gave the YG test to 504 inpatients with atopic dermatitis, 202 males and 302 females, and to 164 healthy controls, 45 males and 119 females. There were significant differences between male patients (MP) and male controls for the personality factor D (depression) , I (inferioity feeling) , N (nervousness) and G (general activity). Female patients (FP) were lower on the scale of Ag (aggressiveness) and R (rhathymia) than female controls, who had higher scores of D, C and I, and lack emotional stability by nature compared with males. However, MP had higher scores on the personality factors N, Ag and R and a lower score on S (social extraversion) than FP. MP had higher scores on D and C and lower on S in proportion to the clinical severity when going into hospital, but there was no significant differences between D, C, and clinical severity, considering their treatment. FP had lower scores on G and S with more severe eczema of their faces. MP with erythematous or hypertrophic·lichenificated type had higher scores on I, N, and Co (lack of coorperativeness) and lower scores on Ag, G, R, A (Ascendance) and S than those with the erythematous+papular or nummular types. MP treated with 0 g/month of oral steroid before going into hospital had a lower score on Ag than those with less than 5 g/month or 5~50 g/month. MP and FP with higher serum IgE had a higher score on D and a lower score on R, respectively. MP and FP with lower cortisol had a higher score on O (Lack of Objectitivity) and higher scores on D and I, respectively. In conclusion, MP are often inclined to be emotionally labile types, with depression, feelings of inferiority, insecurity, misanthrope, and isolating themselves. FP were more dependent and indecisive ; especially when their eczema of face exacerbated, they presented with misanthrope and melancholy. The personality may have an influence on the skin symptoms.
Combination therapy with interferon and ribavirin was started as a new modality for chronic hepatitis C in December of 2001. The therapy was performed on 56 patients at this hospital as of September 2002, of whom 14 developed exanthema as an adverse reaction. Of the 14 patients, 13 were male and 1, female. The exanthema was edematous erythema in 7 patients, petechial purpura in 5, lichen planus in 1, and psoriasis in 1. Histopathologically, the petechial purpura was characterized by edema of the dermal papillary layer, ruptured capillaries, erythrocyte leakage, and perivascular infiltration by lymphocytes, but there were no signs of vasculitis. The exanthema appeared at various times 1 to 90 days after treatment initiation. It appeared within 1 week of treatment initiation in half the number of patients. The exanthema resolved in all but one patient with psoriasis during the course of treatment. The incidence of exanthema was higher with the combination therapy with interferon and ribavirin than with interferon alone. Purpura was observed with high frequency in our series.
We examined the histopathological findings associated with 775 specimens of acquired melanocytic nevus. We examined the histopathological findings : melanocytic multinucleated giant cells, pseudovasculature, neurotization, epidermal changes resembling seborrehic keratosis, erosion or ulcer, dilated follicular infundubulum, comedo, follicular cyst, lamellar fibroplasia around rete ridges, fibroplasia between nevus cells, lipocytes between nevus cells, hypervasculature, bone formation, and suppurative inflammation. Then, we calculated the frequency of these histopathological findings for each clinico-pathological type (Unna’s, Miescher’s, Spitz’s and Clark’s type) and histopathological type (junctional, compound and dermal type). We believe that it is useful to know how these histopathological findings are associated with acquired melanocytic nevus for histopathological and clinical diagnosis.
A 38 year-old woman who had been suffering from epilepsy since 1977 has been treated with sodium valproate 1,000 mg daily for the most recent seven years. In April of 2001, she had a convulsive episode, so carbamazepine was added to her medication at that time. On June 5th, she suddenly had a high fever, pruritic skin rash, and leukocytosis with eosinophilia (27%). The biopsy specimen revealed features resembling those of drug-related eruptions. DLSTs for carbamazepine and sodium valproate were negative. On patch testing, carbamazepine induced a positive reaction and the same pruritic skin rash over the area tested. We diagnosed this case as drug-related eruption due to carbamazepine and flare caused by patch testing. This was a rare case of flare from patch testing with carbamazepine.
A 68-year-old male patient had a black macular lesion with a subcutaneous nodule on his left cheek. Histopathological findings of the superficial lesion included proliferation of atypical melanocytes in solitary units or small nests. The findings of the subcutaneous nodule showed marked proliferations of fibrous tissue containing atypical spindle tumor cells without melanin pigments. Immunopathologically, the spindle tumor cells were positive for vimentin and S-100 protein but negative for HMB-45. The diagnosis of desmoplastic malignant melanoma was established.
We report the cutaneous side-effects of gefitinib (Iressa®), a new anticancer agent that acts by inhibiting epidermal growth factor (EGF) receptor signal transduction. A 74-year-old man treated with 250mg daily gefitinib developed seborrhea and erythema on his face and dry skin on his lower legs within ten days. Then the acne-like eruption began on his face, chest, upper back, and upper arms as well as dry skin within 2 weeks. The frequency of development of acne-like eruption has been reported in patients treated with gefitinib in the previous trial.