Recent advances in the pathogenesis and management of Sjögren’s syndrome were summarized. Major topics are the 1999 revised diagnostic criteria for Japanese patients with Sjögren’s syndrome, newly described pathomechanisms, and cutaneous manifestations of Sjögren’s syndrome. Recent topics on cutaneous lymphoma, QOL in postmenopausal female patients, mechanisms on photosensitivity, and hypoidrosis seen in Sjögren’s syndrome were described. On the management of Sjögren’s syndrome, the clinical effects of a newly marketed muscarine receptor agonist on sicca symptoms were briefly summarized. Because Sjögren’s syndrome is a relatively underestimated collagen disease in contrast to SLE, systemic sclerosis, and dermatomyositis, special care is needed not to misdiagnose Sjögren’s syndrome when we see patients with common skin diseases such as drug eruptions, infectious skin diseases or xerosis in daily practice.
The nail is commonly involved in patients with psoriasis. Various therapies for nail psoriasis have been attempted ; however, nail lesions are refractory to topical and systemic therapies including oral retinoid, cyclosporine A, and topical steroid. In this study, we investigated the effectiveness of topical high dose vitamin D3 therapy with occulusive dressing technique (ODT) on the nail lesions in 8 cases of psoriasis vulgaris and 3 cases of psoriaris pastulosa. We applied calcipotriol ointment (50 μg/g) to an affected nail and the periungual tissue once a day for a few weeks. The treatment was expanded to other nail lesions when the initial therapy was effective. The effectiveness was evaluated by using nail psoriasis severity index (NAPSI). The results revealed that three months of calcipotriol ODT treatment was effective in seven out of eleven patients. Adverse effects such as irritation, periungual scaling, erythema, and nail loss were observed. The psoriatic lesions on the trunk and extremities did not change during this therapy. Topical high dose vitamin D3 ODT therapy is effective for nail psoriasis and considered to be a useful and safe alternative for the treatment of nail psoriasis.
The purpose of this study was to determine the antifungal preventive effect of the topical terbinafine application. By the foot-press method, we counted the number of colonies of dermatophytes derived from the soles of the feet of volunteers who stepped on bath mats that a patient with tinea pedis had stepped on previously. Many colonies of dermatophytes were isolated from the volunteers without the terbinafine application who had stepped on the mats, but no colonies of dermatophytes were isolated from the volunteers with the application immediately after or just before stepping on the mats. Even an application one hour or three hours before stepping on the mats lessened the number of colonies. Washing out the terbinafine, which was applied three hours before, with soap and water just before stepping on them did not influence on the terbinafine’s preventive effect. Taken together, these results suggest that topical terbinafine is effective against infection by dermatophytes.
We performed sentinel node biopsies (SNB) in 30 melanoma patients using the techniques of blue dye and the combination of blue dye and radiocolloid. The sentinel node (SN) identified was assessed by routine HE (hematoxylin and eosin) stain and immunohistochemistry. SN was identified in 14 out of 18 cases by the technique of blue dye alone and in all of the 12 cases by the use of technique of blue dye and RI. Using RI in combination resulted in many SN being identified more accurately. On the other hand, interpretation of SN posed a problem in some cases. That is, there were cases in which two or more hot nodes were found by RI in the same and/or different lymph node regions, those in which accumulation to lymph nodes was found in a region different from the conventional lymph node region and those in which the SN could be identified by only the technique of blue dye with no accumulation being found by RI. These findings suggest the necessity of a combinational use of the techniques of blue dye and RI. On a histopathological study of SN, metastasis was found by HE stain in 5 out of 26 cases. Moreover, micrometastasis was confirmed in 3 cases by a combinational use of preparation of serial sections and immunohistochemistry (HMB45, Melan A). The results above suggest that using not only the technique of blue dye but also RI is useful for identifying SN and that performing immunohistochemistry using HMB45 and Melan A in addition to HE stain on the serial sections prepared as permanent specimens is useful for assessing SN.
A rare case of adult onset of inflammatory linear verrucous epidermal nevus (ILVEN) in a 57-year-old Japanese man is reported. The patient was noticed to have a verrucous lesion on the sole of his right foot 10 years previously. He scratched for years because of the pruritis, and the number of eruptions increased and spread in a linear fashion. He visited a dermatology clinic ; no clear diagnosis, but a suggestion of multiple verruca was given, and he visited our hospital for evaluation of the lesion. Skin biopsy revealed hyperkeratosis with foci of parakeratosis, acanthosis, elongation and thickening of the rete ridges with a psoriasiform appearance, papillomatosis and slight spongiosis with exocytotic lymphocytes in the epidermis. Characteristically, orthokeratosis and parakeratosis were alternated focally in the cornified layer. We diagnosed our case as ILVEN histologically and clinically. The pruritus and the eruption improved with oral etretinate and topical corticosteroid and vaseline containing salicylic acid.