Herpes zoster is a disease that is encountered relatively frequently in ordinary medical practice. Excellent antiviral drugs have been developed in recent years, and the treatment is standardized once the diagnosis has been established. However, pain control and evaluation are still not satisfactory. At present, the visual analogue scale (VAS) is the main method for objectively evaluating the degree of pain. This method is simple and said to provide a standard for evaluating pain. However, the VAS consists of the patient’s own subjective evaluations, so that there are large individual differences, and no quantitative analysis can be readily performed. Because of these issues, we have developed a quantitative pain measurement system for the purpose of evaluating pain. Using this equipment, we objectively evaluated the pre- and post-treatment pain of acute stage herpes zoster (with a pain ratio or a pain degree) and also examined the system in comparison with the conventional, subjective VAS approach. The subjects were 46 herpes zoster patients, 24 men and 22 women, 18–84 years of age. In the results, when a therapeutic effect was apparent with either means of measurement, there was a change in the values that indicated alleviation of pain. However, when we examined individual cases, we found that there were cases in which the pain ratio decreased despite the fact that VAS had increased, and there were also cases in which the reverse occurred. Upon examining these patients individually, we found that the VAS has a rather pronounced psychological element; it expresses factors that include the patient’s psychological state and dissatisfactions at a given time, rather than simply evaluating actual pain. A comparison between the two tests indicated that the pain ratio expressed the degree of pain objectively, whereas the patient’s psychological state had a considerable impact on VAS, which is a subjective pain evaluation method. Because it is possible to objectively evaluate the degree of pain using this new system, the method is of practical utility.
Propionibacterium acnes specimens isolated from facial acne vulgaris and healthy facial skin of Japanese volunteers were analysed by Randomly Amplified Polymorphic DNA-Polymerase Chain Reaction (RAPD-PCR). Numerous P. acnes strains were classified into four DNA-types (D1, D2, D3 and D1/D3 middle type). Of these types, P. acnes D3 was predominant in acne vulgaris. This strain showed higher lipase activity and produced greater amounts of coproporphyrin than did the other DNA types. These findings suggested that D3 may be the most influential DNA type of P. acnes in the pathogenesis of acne vulgaris. We consider that DNA-typing of P. acnes by RAPD-PCR is both practical and applicable.
We observed infiltrations of neoplastic cells into the adnexal epithelia of 164 cases of Bowen’s disease including 53 males and 111 females who were diagnosed histopathologically at the Sapporo Institute for Dermatopathology. The mean age at tumor resection was 73.7 years. In 61 out of 164 cases (37.2%), the neoplastic cells of Bowen’s disease were recognized in the epithelia of hair follicules. In 74 cases (45.1%), they were present in the epithelia of eccrine ducts. Therefore, the neoplastic cells of Bowen’s disease were noticed in the epithelia of hair follicules and/or eccrine ducts in 91 out of 164 cases (55.5%). Invasions of neoplastic cells into the epithelia of eccrine ducts were more frequently observed in males, but those into the hair follicles were more frequent in females. Infiltrations of tumor cells of Bowen’s disease into adnexal epithelia were seen in 43.8% of the patients with lesions of the upper extremities, in 57.8% with lesions of the trunk, in 63.6% with lesions of the genitalia, and 54.8% with lesions of the lower extremities. Invasions of tumor cells of Bowen’s disease into the epithelia of hair follicles were observed in 31.3% of the patients with lesions of the upper extremities, in 35.9% with lesions of the trunk, in 45.5% with lesions of the genitalia and 30.1% with lesions of the lower extremities, while those into the epithelia of eccrine ducts were seen in 31.3% with lesions of the upper extremities, in 46.9% with lesions of the trunk, in 36.4% with lesions of the genitalia, and 47.9% with lesions of the lower extremities. Infiltrations of neoplastic cells were less frequently observed in the cases arising on upper extremities, and the most frequently seen were those on genitalia. In female patients, invasions were more frequently seen in the cases arising on genitalia, although they were still less frequently observed in those on extremities. In male patients, infiltrations were more frequently seen in those on lower extremities, and less frequently observed in those on upper extremities and genitalia. In the histopathological diagnosis and treatment of Bowen’s disease, it is important that neoplasic cells frequently infiltrate into adnexal epithelia.
A 40-years-old man with dominant dystrophic epidermolysis bullosa (DDEB) developed a squamous cell carcinoma (SCC) on the left foot. No metastases were observed. The tumor was resected, and the wound was covered with autologous skin grafts. SCC is a frequent complication in the severe and inveterate forms of recessive dystrophic epidermolysis bullosa (RDEB); however, it is only rarely reported in the dominant type. This life-threatening complication should always be kept in mind and a biopsy taken of every chronic, non-healing ulceration and each atypical lesion in all types of epidermolysis bullosa hereditaria. We suggested that it is very important to inform patients and their relatives about this possibility and to teach them to recognize the early characteristics of SCC.
Among the 42,204 patients hosptalized in the National Kyushu Medical Center (700 beds, located in the central area of Fukuoka City) in the last three years and nine months (2001/1/1–2004/9/30), 712 patients were treated in our dermatology division. Most of them were admitted in the usual manner according to their treatment regimen, but 144 (20.2%) were abmitted on arrival. These patients included 81 females and 53 males, and their age ranged from 4 months to 102 years old. Systemic infections of varicella-zoster virus, herpes simplex (32%), bacteriae (14%), and drug eruptions, drug-related anaphylaxis, and generalized urticaria (12%) were the major causative diseases for urgent hospitalization. We also evaluated 135 the patients who were referred for dermatology consultation during their hospital treatment period among 5,795 inpatients who had been admitted as amergencies to other wards. Such cases were refered not for acute or serious skin manifestations, but rather for chronic skin changes such as seborrheic dermatitis, fungus infections, and decbitus.
We examined the efficacy and safety of ivermectin for the treatment of scabies in the elderly. Sixteen patients (average age ; 82.8 years) were treated with ivermectin (200 μg/kg) twice with an interval of one week. The patients were evaluated three weeks after the first treatment. Eleven of the 13 patients had no clinical or microscopic evidence of scabies. No abnormal laboratory findings were observed. As adverse events, mild and transient diarrhea and toxicoderma arose in two different patients. No recurrence was observed four months after the treatment. Taken together, our results indicate that ivermectin is effective and safe for the treatment of elderly scabies patients.