Guideline has been prepared by the Japanese Dermatological Association to ensure proper diagnosis and treatment of scabies, as oral therapy became available on August, 2006 under health insurance and its clinical use was expected to increase. For making proper diagnosis following three points should be taken into consideration, clinical findings, detection of the mite (Sarcoptes scabiei var. hominis), and epidemiological findings. The diagnosis is confirmed if the mites or eggs are identified by microscopic examinations or dermatoscopy examination. Sulfur-containing ointments, with only limited usefulness, are only available drugs approved by health insurance coverage for treating scabies. Currently crotamiton cream, benzyl benzoate lotion, and γ-BHC ointment are also used clinically. It is important to apply the ointment to the whole body, including hands, fingers and genitals. The dosage for ivermectin is a single oral administration of approximately 200 µg/kg body weight with water on an empty stomach. Administration of a second dose is considered, if new specific lesions develop or the mites are detected. For treating hyperkeratotic (crusted or Norwegian) scabies, concomitant administration of oral ivermectin and the topical ointments as well as removal of thick scabs and infected regions in nails should be considered. Some safe and useful ointments are needed to be approved by health insurance
The lesional skin of patients with atopic dermatitis is sensitized to itch, so that the intracutaneous application of histamine induces much more intense itch there than in their non-lesional skin. To determine whether the regular dosage of histamine H1-receptor blockers would be effective for this intense itch, we prescribed either epinastine hydrochloride (H1 blocker) orally at the regular dosage (20 mg) or placebo to ten patients with atopic dermatitis and investigated the effect on the reactions induced by histamine-iontophoresis in their skin. All of the reactions were suppressed, almost completely by the H1 blocker 3 hours after the intake and at least significantly more strongly compared with placebo 30 minutes after the intake. This result shows that the regular dosage of H1 blocker is also effective for the intensified histaminergic itch in sensitized skin. In reality, however, in patients with atopic dermatitis, itch still remains 3 hours after the intake of H1 blocker. These results suggest that substances other than histamine play significant roles in the itch of atopic dermatitis.
We report a case of a 53-year-old Japanese woman with a malignant eccrine spiradenoma on her right waist, which developed from a tiny subcutaneous nodule that had been present unchanged for almost 30 years. The nodule started to grow rapidly to the size of 7×6×4cm five months before excision, associated with pain and inflammation. Lymph node involvement became evident during the previous 2 months in the right axilla and the right groin. We excised the skin lesion with wide and deep margins and performed axillary and inguinal lymphoidectomy. A total of 30Gy of electron beam irradiatich was applied to the entire area of the possible lymph drainage basin of individually metastizing cells. Histology revealed that the lesion simultaneously combined the typical eccrine spiradenoma（ES）with and malignant changes with various differentiations. Multiple metastases were found in her lung and bones ten months after the treatment.
We report a 22-year-old male with pyoderma gangrenosum (PG) and ulcerative colitis (UC)．He was diagnosed with UC at the age of 18 and treated with oral corticosteroid. Two months before his initial visit, the UC had recurred, and oral corticosteroid was restarted. About one month later, a painful reddish swelling appeared in his right foot. Repeated debridement and antibiotics were ineffective. The swelling later transformed into an ulcer with pus and yellowish necrotic tissue. Frequent bacteriological cultures were negative. Two weeks later, subcutaneous fluid collections with redness and tenderness appeared on his chest and both shins. Yellowish syrupy pus was drained from his right shin by debridement. He was admitted in our hospital for further treatment. Computer tomography of the legs revealed lens-shaped fluid accumulation above the fasciae. He was diagnosed with PG based on his clinical appearance, complication with UC, and absence of microorganisms. Increasing the dose of oral corticosteroids from 20 to 60 mg per day healed the skin ulcer and subcutaneous abscesses and resulted in the remission of the UC. PG along with cellulitis and subsequent subcutaneous abscess is rare, and it should be distinguished from infectious diseases by careful observation of clinical features, bacteriological studies, and imaging.
Dermalive is an injectable skin filler composed of 60% pure hyaluronic acid and 40% acrylic hydrogel particles, the latter of which is a non-absorbable material which usually remains in the injected site for many years. We report a 63-year-old Japanese woman with one-month history of indurated, nodular lesions that distributed symmetrically on the nasolabial folds and perioral skin. She had undergone injections of a cosmetic filler to the corresponding areas ten months prior to the onset. Histopathologically, the lesion consisted of a granulomatous tissue reaction in the dermis and subcutaneous tissue, including numerous, translucent or pinkish particles with polygonal shapes, histiocytes, and multinucleated giant cells. These histological features were consistent with foreign body granuloma induced by acrylic hydrogel particles, excluding granulomas induced by other permanent cosmetic fillers.