We reviewed the clinicopathology of four cases with livedo reticularis with summer ulceration (LRSU), whose clinical follow-up continued over long time periods (2–15 years). Clinically, all the cases initially presented with livedoid eruption and eventually developed skin ulcers on the lower extremities. These skin manifestations tended to exacerbate during the summer. Although the histology of LRSU usually reveals thrombogenic vasculopathy in the lesional dermis and/or subcutaneous tissues, these findings were not always evident in our cohort. During the clinical follow-up, one case suffered from persistent leg ulcers throughout several years, caused by uncontrolled disease activity, and another showed a clinical overlap with antiphospholipid syndrome. All four cases were treated with a variety of combination regimens using anti-coagulants and circulatory drugs, but neither with systemic corticosteroids nor non-steroid anti-inflammatory agents. Two of them obtained successful results in terms of preventing the summer ulceration. A long-term follow-up of such patients may therefore need to address the overall disease presentation underlying the pathogenic nature of LRSU. Our present report provides information not only about the therapeutic interventions possible for a long-standing vasculopathy, but also further insight into the comprehensive management leading to the improvement of quality of life in affected individuals.
We experienced two cases of ectopic breast cancer referred from the surgical departments of two major hospitals in Fukuoka city under the tentative diagnosis of appendage skin tumors. The first case was a 54-year-old woman presenting with a firm erythematous nodule of 1.5 cm in diameter on her left precordial region which had grown slowly during the previous 4 years. It’s glossy appearance implied an eccrine-origin malignancy. The other was a 45-year-old woman who presented with a firm induration of 2×2 cm in her right axilla that had expanded slowly during the previous 18 months. The lesion had been previously incised as an epidermoid cyst. Manmmography revealed no abnormalities in either case. A wide resection with lymphoidestomy revealed no metastasis in the first case, but many invasive lymph nodes in the second one. We dermatologists can contribute for further improving the prognosis of patients with breast cancer by properly diagnosing such unusual adenocarcinomas that developed from ectopic mammary grands.
Ten cases with from five to thirty lesions each of Japanese spotted fever (JSF) were observed by dermoscopy. Arborizing vessels, erythema, purpura, milky-red globules, and whitish-veil were noticed in the exanthema. Erythema was found in all cases. Arborizing vessels and milky-red globules were observed in nine cases, and purpura was demonstrated in seven. Whitish-veil was noticed in two cases. Minocycline is an effective treatment for JSF, while β-lactams and penicillin are ineffective. Therefore an early diagnosis is very important. Based on these findings, we concluded that dermoscopy could be a useful tool for the early diagnosis of JSF.
A case of Kerion celsi is described in a 6-year-old boy, who returned to Japan from Singapore. Physical examination revealed ill-demarcated alopecia lesions without black dots on the parietal and right temporal regions. Microscopic examination with potassium hydroxide of broken hairs revealed endothrix spores. An identification of Trichophyton tonsurans was made by fungal culture and DNA analysis. The patient’s scalp cleared after oral administration of terbinafine, 62.5 mg per day, for 13 weeks. In recent years, many cases of T. tonsurans infection have been reported in those who participate in judo or wrestling, and the problem of group infection among such players has been pointed out. A literature review can help to clarify the mycological characteristics of T. tonsurans in Japan.