The activity of the Atopic Dermatitis Treatment Problem Committee of the JDA was reported. Last year, a cancer risk of tacrolimus ointment was proposed by the NPO organization and was reported in the newspapers. The Ministry of Health and Labor regired the doctors who prescribe this ointment, to provide informed consent of cancer risk. To help in the better understanding of this risk and to support the doctors to explain it to the patients, JDA published their opinion on this problem through the internets and other routs. Based upon more proper usage of tacrolimus ointmant both for adults and childran, the treatment guidlines were changed in 2003 and 2004. Some other problems related to adequate treatment of this disease were also reported.
We have investigated the actual conditions of pressure ulcers (PU) in 766 inpatients at Tokai University Hospital. The total number of PU patients was 28, which comprised 3.7% of all patients. Only 60.7% of the PU developed after admission to the hospital. The average age of PU patients was 60.5 years with two peaks of under-20 and over-70. Among all the PU patients, 92.9% were under insufficient care management. Regarding nutrition, 75.0% of PU patients had less than 11.0 g/dl hemoglobin and 57.1% of them had less than 3.0 g/dl albumin. The background diseases were malignant tumors (34.6%), brain/circulatory disorders (26.9%), and diseases related to bones and joints (15.4%). PU developed mainly on the sacrum (60.0%), the greater trochanter (10.0%) and the occiput (10.0%). Of the PU, 53.6% were classified as level II according to National Pressure Ulcer Advisory Panel (NPUAP). All 28 PU cases have been evaluated according to two systems : the DESIGN system has been found to be more accurate, especially for level II PU cases.
The concept of “Self-Efficacy (SE)”, the self-perception and expectation that “I can cope and do it”, is considered to be very important, with current discussion focusing on how to promote self-efficacy in the course of illness. The concept of self-efficacy is classified into two clusters “: general self-efficacy”, which refers to general daily life and behaviors; and “task-specific self-efficacy”, referring to expectations in the face of various tasks. Simultaneous evaluation of these two efficacies may be useful in determining the most effective remedy for each patient in the course of treatment. We evaluated the SE and their mental state of 160 patients with atopic dermatitis (AD) using three questionnaires in order to utilize the concept of SE in dermatological examinations. We then explored the relationships between the patients’ SE and severity of AD, psychiatric diagnosis, and mental state. This data was discussed in psychiatric interviews. The following findings were observed: 1) The self-efficacy of patients with AD was no lower than that in the normal controls or patients with other chronic diseases; 2) Higher levels of mental stress correlated with lower self-efficacy; and 3) It was useful to discuss how to promote the patients’ self-efficacy in individual interviews. Our study showed that dermatologists and nurses should understand the concept of self-efficacy in order to provide better treatment for AD patients.
The autosomal dominant epidermolysis bullosa simplex (EBS) results from mutations of keratin 5 (K5) or keratin 14 (K14), a cytoskeletal protein expressed in the basal keratinocytes of the epidermis. To date, a number of mutations of K5/14 have been demonstrated in EBS. In the present study, we collected 15 pedigrees with EBS from Japan and Poland, including clinically three major subtypes ; Weber-Cockayne, Köbner, and Dowling-Meara, as well as two cases of EBS with mottled pigmentation. Then we isolated genomic DNA and sequenced KRT5 and KRT14 to add to the mutation database. We identified ten different heterozygous missense mutations in 13 pedigrees : P25L, A180E, L325P, R331D, G476D, E477G, and E477K in K5 ; M119L, V133 A and V133M in K14, none of which were found in 100 control chromosomes. Mutations associated with Dowling-Meara (pedigrees 9-12) resided in the highly conserved 20 amino acids at the ends of the 1A or 2B domains in K5/14. Direct nucleotide sequencing of two cases of EBS with mottled pigmentation (pedigrees 14 and 15) revealed a heterozygous P25L mutation in K5. However, no genotype-phenotype correlation was identified in pedigrees with Weber-Cockayne or Köbner. Further molecular analysis of K5/14 will be necessary to extend genotype-phenotype correlation and to provide accurate diagnosis and genetic informed consent to families with EBS.
Primary osteoma cutis is a benign tumor which consists of normal bone construct in the dermis and adipose tissue. We describe a case of primary plaque-like osteoma cutis. A 27-year-old woman presented with a fourteen-year history of stony hard plaque on the left side of scalp. The skin biopsy demonstrated the typical pathological features of osteoma cutis. There was no history of any skin disease leading to osteoma cutis, or family history of Albright syndrome. Therefore we diagnosed this case as primary osteoma cutis. There are four maijor types of primary osteoma cutis based on clinical appearance. Primary plaque-like osteoma cutis is one of the rarer ones.