Psoriasis is recognized as a T-cell-mediated inflammatory skin disease. Therapies using new biologics that target T cells or inhibit post-secretory cytokines have been developed to treat the immunologic basis of psoriasis. Alefacept and efalizumab inhibit T cell activation by blocking co-stimulatory signals. Etanercept, infliximab, and adalimumab inhibit the activity of TNF-α. Alefacept, efalizumab, and etanercept have been approved by FDA, and infliximab and adalimumab are in the late stages of clinical development in the USA. Clinical trial data have supported the efficacy and safety of these biologic therapies. Broad-spectrum immunosuppressive agents and phototherapy have limitations and toxicities associated with their use. These new biologics have the potential to provide patients with options for safe and effective long-term control of their psoriasis.
We summarize our 2003 results concerning species and subspecies level identification of fungal isolates from superficial skin lesions. Our identifications were based on RFLP patterns of PCR products of the internal transcribed spacer regions of the ribosomal RNA genes digested with restriction enzymes Mva I and Hin f I. Of 131 isolates, of which 74 had been identified by local mycological laboratories or clinics and 57 remained unidentified, Trichophyton tonsurans type DNA was observed in 98, T. mentagrophytes var. interdigitale in 11, T. rubrum in 8, Arthroderma vanbreuseghemii in 4, A. benhamiae in 2, and Microsporum canis / M. ferrugineum in 3. Sixty-six isolates of T. tonsurans were identified by their morphological features, and all of them showed DNA profiles characteristic of T. tonsurans. Four isolates could not be identified by the PCR-RFLP, but one of them was later identified as Fusarium oxisporum by a DNA sequence analysis of the same region. The PCR-RFLP method requires less time than sequence analysis and is suitable for identifying a large number of isolates.
In pemphigus vulgaris, the assessment of disease severity is usually performed arbitrarily. Computer-assisted measurement of the overall area of skin lesions would be useful in the assessment of the severity of pemphigus vulgaris. Because various skin lesions are observed in patients with pemphigus vulgaris, it is not possible to extract lesions simply based on image brightness. The aim of the present study was to extract skin lesions on the back based on red color information using CIE L*a*b* color measurement and Gauss filter with an image analysis program. Active lesions could be extracted at a color difference (ΔE) of 13 or more with a 0.3% point margin of error. We also calculated the ratio of the total area of the skin lesions to that of the normal skin. The ratio did not correlate well with desmoglein titers measured by enzyme-linked immunosorbent assay. Our results indicated that measurement of the area of the skin lesions by image analysis is accurate and could be potentially useful clinically for the objective assessment of disease severity in pemphigus vulgaris.
We used photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) to treat ten patients with skin lesions (8 of the systemic type, 2 of the skin type) of sarcoidosis. Improvements were seen in the eruptions in all ten cases, and in two of these cases, disappearance of epithelioid cell granuloma was also confirmed histologically. Skin lesions of sarcoidosis are often generally resistant to treatment. ALA-PDT for the treatment of cutaneous sarcoidosis is a convenient, non-invasive treatment with excellent cosmetic results.
We report an eight-year-old girl with a one month history of annular erythema on her right cheek. She had also parotid gland swelling and arthralgia and she complained of dry mouth but not of dry eyes. In the laboratory examination, antinuclear antibody (titer: 1,280, speckled pattern), anti Ro/SS-A antibody and anti La/SS-B antibody were positive. Her right parotid gland showed delayed excretion in parotid gland scintigraphy, and the Saxon test was positive. A diagnosis of Sjögren’s syndrome was made from these findings. We summarized 108 child patients with Sjögren’s syndrome in the past 42 years in Japan including our patient. Sjögren’s syndrome in children shows different clinical features from those in adult patients. Child patients with Sjögren’s syndrome complain frequently of parotid gland swelling and arthralgia, but rarely of dry eyes or dry mouth.
We report a case of genital Paget’s carcinoma with multiple bone metastasis that responded to combination chemotherapy. The patient is a 64-year-old male. He visited our hospital in October of 2000. Palm-size erythema with nodules was present on the right side of his scrotum. The erythematous lesion, right inguinal and common iliac lymph nodes were resected in December of 2000. We also perfomed some adjuvant chemotherapy. Two years after tumor removal, multiple bone metastases with hypercalcemia were recognized. Therefore, he underwent weekly PET therapy [Cisplatin: 30mg/m2 , epirubicin: 50 mg/m2, Paclitaxel: 120 mg/m2 (day1), G-CSF: 300 μg (day 3–5)]. The metastatic tumors were responded well to the therapy ; their size was reduced by computed tomography, and his serum levels of CEA and calcium were normalized.
We report Japanese sisters (aged 7 years, totalis, and 12 years, universalis) with long-standing and severe types of alopecia areata. Serological screening of both patients showed a remarkable increase in thyroid autoantibody titers, especially anti-thyroid peroxidase antibody, without clinical evidence of thyroid diseases. Examination of HLA-DNA typing revealed that the common HLA class II antigens typed for the sisters were HLA-DQB1*0301 (DQ7) and -DRB1*0401 (DR4), both of which have recently been considered to be characteristic markers of an early-onset form with long duration and greater severity of alopecia areata in the Caucasian population. To our knowledge, this is the first Japanese case of familial occurrence with two common HLA class II antigens that have been recognized as markers of severe types of the disease. In addition, this case seems to support the concept that the pathogenesis of alopecia areata may be closely associated with genetic and autoimmune factors including characteristic patterns of HLA-DNA typing as well as an increase in thyroid autoantibody titers.