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 tacrolimus ointment 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 counseling, and advice about daily life. Tacrolimus ointment was used initially only for adult patients and recently low density ointment is available for 2-15year old patients. The importance of correct selection of topical steroid according to the severity of the lesion is emphasized.
Epidermal keratinocytes are characterized by a fine balance between growth and differentiation. Primary keratinocytes of either human or murine origin provide an ideal experimental system to elucidate early signaling events involved in the control of epithelial differentiation. Transcription factors regulate keratinocyte differentiation by mediating the final steps in cell-differentiating signals. In this review we summarize the evidence that transcription factors, including activator protein 1 (AP1) AP2, Sp1/Sp3, POU factors, nuclear factor κB, and several other factors, are key regulators of keratinocyte differentiation.
We conducted animal and clinical studies of the usefulness of linear polarized near infrared light irradiation in the treatment of skin ulcers. The clinical investigation revealed differences in the effectiveness of this treatment method according to the etiology of skin ulcer. Healing or improvement was seen in patients with diabetic ulcers, decubitus ulcers, and burn ulcers, but no therapeutic benefits were gained for patients with stasis dermatitis or skin ulcers caused by varicose veins. This difference may be because linear polarized near infrared light irradiation is locally effective in improving blood flow in the microvasculature and promotes angiogenesis, but has minimal effects on impaired blood flow of deep veins with a caliber greater than a certain size. Animal studies showed an increase in temperature at the ulcer site within one minute after irradiation. After 5-10 days, histopathological examination disclosed angiogenesis and cell proliferation as well as a diminished ulcer area. We concluded that this therapeutic modality may be useful for treating skin ulcers and that its mechanism of action appears to involve increasing skin blood flow and promoting angiogenesis and cell proliferation.
A 73-year-old man visited our outpatient clinic with active indurated ulcer on his left abdomen. He had been medicated with luteinizing hormone releasing hormone analog for prostate cancer by subcutaneous injections of leuprorelin acetate once a month since August of 2000. In November of 2002, the leuprorelin acetate dosage was changed to a once a three month type drug. Local erythema and induration developed at the injection site after the first injection. Three months later, he developed induration and an ulcer with leakage after the second injection. The biopsied specimen revealed epithelioid cells and giant cells collected together to form a granuloma. For the final diagnosis, we performed an intradermal test with leuprorelin acetate. A positive allergic granulomatous reaction was induced by leuprorelin acetate in this case.
A case of phalangeal microgeodic disease is reported. A 6-year-old-girl had chilblain-like symptoms, such as spindle-shaped swelling and redness on the left middle finger. This case was diagnosed as phalangeal microgeodic disease by the clinical manifestations and plain radiographic findings. At follow-up five months later, the swelling had almost resolved and only a deformity of the middle phalanx of the left middle finger was observed without any dysfunction. It is known that this disease is self-limiting and no therapy is needed. However epiphyseal damage has been reported in some cases. It is very important to follow up patients with this disease carefully.
1) Study of the Cause of Ingrown Toenail Ingrown toenail occurs when the tissue of lateral nail fold is pushed up from the ground side, and the toenail plate consequently grows into the tissue of lateral nail fold. A major cause of ingrown toenail is increased pressure on the first toe, which is the toe most frequently affected by this disease. This pressure increase is caused by dysfunction of the foot, deformation of the foot and other disorders. A dysfunction of the foot frequently observed in ingrown toenail patients is reduced dorsal flexion angle of the ankle joint and the first metacarpophanangeal joint (hitherto referred to as 1st MTP joint). Reduced dorsal flexion angle of the ankle joint deflects the center of gravity of the body weight bearing on the sole towards the first toe during walking. Reduced dorsal flexion angle of the first MTP joint leads to increased pressure load on the first toe during rising from the bed. Diseases that cause foot deformation include spread foot, calcaneus valgus, pollex valgus and unequal leg lengths. These abnormalities lead to outward abduction of the first toe and reduced dorsal flexion angle of the first MTP joint. Inequality of leg lengths leads to increased pressure load on the shorter leg. 2) Study of the Efficacy of the VHO Regimen We applied the VHO (Virtuous Human Orthonyxie) regimen (hereafter referred to as the regimen), one of the non-invasive therapies for ingrown toenai (1,2), to 61 cases of this disorder. The patients consisted of 11 men and 50 women, their ages ranged from 13 to 76 year (means age : 41.1 years). Of the 54 cases in whom the clinical course was evident, early disappearance of pain was achieved in 38 cases (70.3%). However, 6 patients needed subsequent operations. Our study showed that this regimen is a non-operative therapy with little invasiveness and is particularly effective for cases with mild symptoms.
Sixty-eight cases of cutaneous neoplasms characterized by the proliferation of neoplastic cells mimicking follicular germinative cells were divided into trichoblastoma (TB) and basal cell carcinoma (BCC) according to the histopathological criteria suggested by Ackerman and co-workers. We histopathologically investigated the presence or absence of symmetricity of the lesions, fibroepithelial unit (FEU), ulceration, necrosis, keratinous cyst, differentiation towards hair germ and papilla, and mitotic figures in these two groups. All cases showing differentition towards hair germ and papilla are TB, although some cases of TB aldo not show such differentiation. All cases of TB showed FEU, and cases of BCC lacked FEU. These results suggest that recognition of the FEU is significant in histopathologic differential diagnosis of BCC and TB.
We report a case of sialodochitis fibrinosa accompanied by urticaria and anaphylaxis-like symptoms. This 72-year-old lady had a two-year history of recurrent attacks of painful swelling of parotid glands and systemic urticaria with occasional chills and dyspnea during or shortly after meals. Results of blood tests, skin tests, and provocation tests for food allergies were all negative or within their normal ranges. Temporary elevation of serum amylase levels during the attack and the discharge of eosinophil-rich fibrin masses from the markedly dilated Steno’s duct lead us to diagnose her disease as sialodochitis fibrinosa. A skin test using patient’s saliva was negative. Although the exact mechanism of this disorder is still unknown, it seems possible that type-1 hypersensitivity occurs in both parotid glands and the skin. Therefore, this disorder should be considered if we encounter patients with both urticaria and swelling of parotid glands. To our knowledge, a total of 26 cases, including ours, have been reported in Japan, and this is the first case in the dermatological literature.