Tumor necrosis factor-alpha (TNF-α) has been recognized as playing a key role in the pathogenesis of psoriatic arthritis. Several TNF-α inhibitors, including infliximab, etanercept, and adalimumab, have shown superb efficacy in double blind controlled trials for psoriatic arthritis in the United States and Europe. In this report, we present the first Japanese case of psoriatic arthritis successfully treated with infliximab. A 39-year-old Japanese male presented with a 10 year history of psoriasis and a 3 year history of arthritis. He had suffered from severe pain in the axial and acral joints. His skin presented with erythroderma. We used infliximab (3 mg/kg) in addition to methotrexate, and his pain was superbly alleviated on the next day after the treatment. Finally, he gained improvement of the arthritis within 6 week (ACR70) as well as the skin lesion (PASI score 25.2→2.7). This result suggests that infliximab can be a crucial therapy for psoriatic arthritis.
Concomitant with the recent rise in HIV infections in Japan is an increase in cases of mixed infections of HIV and syphilis. Co-infection by HIV and syphilis was observed in 77 or 20% of the 341 patients serologically positive for syphilis who were seen between January of 1992 and October of 2003, in the dermatology and laboratory medicine departments of Tokyo Medical University Hospital. All the patients co-infected with HIV and syphilis were men, among whom 33 were homosexual. Patients co-infected with Syphilis recenta and HIV showed characteristically higher titers as a result of the rapid plasma reagin (RPR) and Treponema pallidum hemagglutination test (TPHA) than syphilitic patients alone. The treatment was regular doses of penicillins, mainly amoxicillin (AMPC). The dosage periods were various ; in 23 or 43% of the 53 patients, doses of four or less than four weeks were enough to treat the Syphilis recenta infection.
We studied the efficacy of a 585 nm pulsed dye laser for treating 16 cases of psoriasis vulgaris. Phototherapy, including PUVA and narrow-band UVB therapies, are considered as the second line for treating psoriasis vulgaris when the lesions are resistant to topical treatments such as steroid or vitamin D3. Because of photocarcinogenesis, a new method of therapy for psoriasis that targets only the lesional area has become a goal recently. There are some reports from foreign countries on the efficacy of 585 nm pulsed dye laser for psoriasis. Sixteen Japanese patients with refractory psoriasis vulgaris were enrolled to this study. Seven patients (44%) showed significant clinical improvement and two of them remained in remission for more than two years. The system appeared to be more effective in the treatment of plaques of the trunk than of those of the extremities. No severe adverse effects of laser irradiation on the plaques were recorded. Based on the evidence that the refractory psoriasis vulgaris responded well to 585 nm pulsed dye laser, we propose that 585 nm pulsed dye laser can be recommended as an alternative therapy for psoriasis vulgaris.
A case of systemic lupus erythematosus（SLE) presented with reddish-brown macules on her buttock of 22 years duration. She had been treated for SLE with oral predonisolone. Histological examination of the macule showed sclerotic cells in the dermis, and fungal culture showed chromomycosis. The macules improved with the treatment of intravenous fluconazole infusion. An ulcer with necrotic tissue was found on the her left dorsal side of hand. Histological examination showed yeast-like cells in the entire dermis. Fungal culture showed cryptococcosis. The ulcer improved with the treatment of intravenous fluconazole infusion. This case showed decreased CD4 positive lymphocytes and decreased IgG in her peripheral blood. These findings indicated that the decreased immune response led to the complication of chromomycosis and cryptococcosis for SLE.
We report the case of a 61-year-old male with diabetes mellitus（DM）who presented with both diabetic digital sclerosis and diabetic scleredema. He had been suffering from type two DM for 26 years. In 2003, he visited our department complaining of a stiff neck. Histological findings demonstrated abundant collagen bundles separated by widened clear spaces throughout the thickened dermis. A diagnosis of diabetic scleredema was made. Furthermore, we found digital sclerosis. A biopsied specimen from the finger revealed abundant collagen bundles in the mid- to lower dermis without thickened collagen bundles. An association of diabetic scleredema with diabetic digital sclerosis has rarely been reported; however, we insist that digital sclerosis is one of important symptoms of DM.