The sweating response to moderate thermal stress was studied in patients with atopic dermatitis (AD) by simultaneous recording of the sweat volume on the lesional and non-lesional skin. The sweat volume was measured continuously by a local sweat volume recorder (SKINOS-SKD2000) in 40 patients (mean age of 28.8 years, range 14～60 years) and 14 non-atopic controls (mean age of 27.2 years, range 24～34 years). A foot bath (mean temperature 42°C) was used as the thermal stress and the measurement was performed on the upper back skin. No sweating at all was recorded of the 6 AD patients. The sweating response started after 30 min on both the lesional and the non-lesional skin in the other 6 AD patients; in contrast, the sweating response started within 20 min in all the controls. There were no significant differences between the sweat volumes released from the lesional and non-lesional AD skin. Trans-epidermal water loss (TEWL) at the lesional skin was high and correlated negatively with sweat volume. Our study suggests that the low sweating response to moderate thermal stress in AD patients was due to a dysfunction of the autonomic nervous system related to the sweating response.
We clinically analyzed 94 patients with drug-induced hypersensitivity syndrome reported between 1998 and 2004 in Japan (50 males and 44 females, age range 0–89 years old, mean age 48.2 years old). The main causative drugs were anticonvulsants (62 patients) containing carbamazepin (40 patients). The clinical features appeared at an average of 34.5 days after administration of the causative drugs. The average was longer in patients with HHV-6 reactivation. Maculopapular rash and erythroderma were the most common type of eruptions accompanied by facial edema, pustules, and bullae in some patients. Recurrence of symptoms was observed in 42.2% of the patients. Human herpes virus 6 (HHV-6) reactivation was observed in 76 of 94 patients. HHV-7, cytomegalovirus, and Epstein-Barr virus reactivation were observed in 10 of 19, in 8 of 15, and in 1 of 7 patients studied, respectively. In many of these patients, HHV-6 reactivation was also detected. Four patients who had HHV-6 reactivation died of myocarditis, multi-organ failure, and sepsis. There were no significant differences in clinical features between the patients with and without HHV-6 reactivation other than the interval between the first drug administration and the onset of the rash.
PD-PSV is a rare inflammatory disease of unknown pathogenesis, characterized by pustular and vegetating mucocutaneous lesions. Its association with inflammatory bowel disease is well established. We report the case of a 26-year-old man who had suffered from ulcerative colitis for nine years. Three years earlier, multiple pustules and erosions appeared on his gingivae, and, in 2000, exudative vesiculopustular plaques appeared on his scalp and inguinal regions. A skin biopsy showed microabscesses with neutrophils and eosinophils within the hyperplastic epidermis. Direct immunofluorescence studies revealed negative results, and anti-desmoglein 1 and 3 antibodies were negative. This case suggests that PD-PSV is an entity distinct from pemphigus vegetans.
In order to test the effectiveness of rapid immunoassay kits for the detection of group A streptococcal antigen, we compared the positive rates using these kits with those using a culture method for testing throat swab specimens from 103 patients with suspected group A streptococcal infections (scarlet fever). The kits showed 95.7% and 89.3% for sensitivity and specificity, respectively. All 47 samples of S. pyogenes cultured were sensitive to all of the 16 antibiotics that we tested. The positive rates were lower in patients who had begun treatment with antibiotics 2～3 days before testing and remarkably lower in patients receiving antibiotics for more than 4 days before testing. Based upon these findings, we conclude that the rapid diagnostic immunoassay kits for early detection of group A streptococcal antigen are effective. However, we should take into account the influence of prior antibiotic treatment, the possible presence of bacteria with antigens in common with group A streptococcal antigen, and the quality of the throat swab specimens.
Although acne vulgaris is a common skin disorder, its pathogenetic mechanisms are complicated, and many unknown factors still remain to be clarified. Propionibacterium acnes (P. acnes), an indigenous hair follicle bacterium, is thought to be one of the most important bacterial factors involved in the pathogenesis of acne. Because the onset of acne is correlated with an increased bacterial count of P. acnes, antibacterial agents are often used for treating acne to reduce the bacterial count. In addition, various kinds of vitamin preparations are widely used as adjuvants. However, the mechanisms of their therapeutic action are not yet clarified nor have the direct effects of the vitamins upon P. acnes adequately been investigated. Therefore, in the present study, we examined the effects of various vitamins on P. acnes under in vitro experimental conditions. P. acnes was incubated in a liquid culture medium to which various concentrations of vitamins were added, and then the turbidity and lipase activity of the culture medium were determined. The results revealed that vitamins B2, K3, and K5 suppressed the growth of P. acnes and that vitamins K3 and K5 also suppressed the lipase activity in parallel with the bacterial growth suppression, while vitamin B5 suppressed only the lipase activity without affecting bacterial growth. These findings may provide a therapeutic rationale for using vitamins B2, B5, K3, and K5 in treating acne.