To improve the quality of treatment for psoriasis, we conducted a questionnaire-based survey for both physicians and patients with psoriasis using a larger study group than our previous survey and collected 685 cases for analysis. The questionnaire addressed a broad range of topics, including symptoms, degree of improvement, stress, and satisfaction evaluated by patients themselves. Among the results, 9.8% of the respondents reported that they were “very satisfied” with their current treatment. With regard to overall satisfaction, encompassing treatment effectiveness, and improvement in stress, 19.0% of the responders reported that they were “very satisfied” or “satisfied.” Similarly to the previous survey, the treatment satisfaction of Japanese patients with psoriasis was confirmed to be low. Moreover, 67.4% of the respondents reported that they felt stress which was caused by “skin lesions being looked at” and “treatment with topical agents.” As factors contributing to overall satisfaction, “the patients’ evaluation of symptomatic improvement” was the most influential factor with 52% of the contribution rate, suggesting the importance of an understanding of symptomatic improvement from the patient’s perspective. Our data also suggest that there was a gap between the physicians’ and patients’ evaluations of improvement. These results indicate that qualitative improvement in psoriasis treatment requires an understanding of patient satisfaction, derived by asking such questions as how they feel about their improvement in skin symptoms or whether their skin symptoms and topical treatment impair their daily life. The understanding of patient satisfaction gained should then serve as the basis for selecting the appropriate treatment, thereby achieving patient-oriented therapy for psoriasis and a high level of patient satisfaction.
Microscopic examinations following staining with Zoomblue® fungal staining solution were used to achieve highly sensitive visualization of mites, eggs, and scybala (fecal pellets) of Sacroptesscabiei var. hominis. Soaking in the solution for 30 minutes resulted in mites and eggs that were barely stained. Some scybala were stained red-purple; however, others were only slightly stained. After soaking for 12 hours, however almost all of the scybala were intensely stained a blue-purple color. While Zoomblu® is useful for detecting scybala of S. scabiei var. hominis, the Chlorazol black E fungal staining solution seems to be more useful, because it can stain scybala within five minutes. These data suggest that if no clues indicating scabies are found at the first microscopic examination with these fungal staining solutions, samples should be re-evaluated again after a longer staining period.
Hospitalization medical treatment is the present standard although NB-UVB treatment is effective for psoriasis. Therefore, we decided to assess the NB-UVB treatment of 43 psoriasis outpatients. As a result, we found that it is necessary to treat two or three times during each week to achieve 75% score improvement. However, 50% score improvement did not show a significant difference between one and three times during a week. Therefore, although two or three times per week of NB-UVB treatment in psoriasis is optional, even one treatment per week appears to be enough to sufficiently raise a patient’s QOL.
Inflammatory cells consisting of mast cells as well as lymphocytes are observed in the lesions of alopecia areata, and the involvement of mast cells in the pathogenesis of alopecia areata has been suggested. In the present paper, a clinical observation was made of the efficacy of ebastine, a second generation antihistamine, in the treatment of alopecia areata. Twenty-three patients, the ebastine group, were treated with 10 mg of ebastine given as a single dose once a day for three months (ebastine group). An other 9 patients were treated with 2 mg of diazepam given as a single oral dose once a day for three months (diazepam group). In the ebastine group, 14 out of the 23 patients (60.9%) showed hair regrowth during the three months of ebastine administration, while only one out of the 9 patients (11.1%) in the diazepam group showed hair regrowth. The rate of the patients showing hair regrowth in the ebastine group was significantly higher than the rate in the diazepam group (p=0.0179). Furthermore, six out of the 8 patients without hair regrowth in the diazepam group did regrow hair during three months of ebastine administration performed after the three months of diazepam administration. These results suggest the efficacy of ebastine for alopecia areata. In the ebastine group, the mean age of patients with hair regrowth (45±16.9) was significantly higher (p=0.0088) than that of patients without hair regrowth (25.3±9.3), suggesting that younger patients may show more resistance to ebastine therapy.
A 15-year-old boy had had a painful ulcer with pigmentation on his left lower leg from May of 2004. He consulted our hospital in August. His laboratory findings showed thrombocytopenia, prolonged APTT, positive antiphospholipid antibody, and positive lupus anticoagulant, all of which still remained positive after six weeks. In addition, his anti-SS-A/Ro antibody titer was 303.6 U/ml (ELISA), but his anti-SS-B/La antibody was negative. Histopathological examination of the lesion showed lymphocytic infiltration around the arterioles and venules and thrombosis in the subcutaneous fat tissue. The findings of chest computerized tomography (CT), lung perfusion, and ventilation scintigraphy showed a pulmonary infarction. Thrombosis in the inferior vena cava was revealed in the abdominal CT image. A diagnosis of antiphospholipid antibody syndrome (APS) was made from these findings. Treatment with 30 mg/day prednisolone was effective, resulting in disappearance of the skin ulcer. The dose of prednisolone was tapered off within 11 weeks. He has also been treated with warfarin, and the dose was determined by monitoring with an international normalized ratio. In addition, a temporary inferior vena cava filter was inserted. We reviewed the literature of child cases with primary APS. There were more cases with cerebral ischemic lesions than cases with pulmonary infarction in pediatric primary APS cases compared to adult cases.
We report two Japanese patients with prolonged, self-inflicted dermatoses mimicking a bullous disease and Ehlers-Danlos syndrome. The first patient, a 61-year-old woman, consulted for her ill-controlled erythematous macules with a five year history that had been diagnosed histologically as pemphigus foliaceus. Skin lesions were seen on the chest, abdomen, buttocks and bilateral thighs ; they were densely distributed within the reach of her hands. Individual lesions were erosive, erythematous, spherical macules of up to 1.5 cm, their long axes were along the movements of her hands and fingers. The second patient, a 27-year-old woman, presented complaining of a long-standing ulcer on her face that developed after excisional surgery of her right accessory ear. Successful reconstruction of the facial ulcer was followed alternatively by numerous erosive macules/patches on her trunk and extremities. Those skin lesions of the present cases were characterized by their 1) non-anatomical distribution, 2) linear arrangement with parallel long axes, 3) relatively uniform size and shape, and 4) discrepancy with the findings obtained by laboratory investigations.