Fifteen patients with adult-onset Still’s disease (AOSD) who visited our department from January of 1995 to December of 2005 were assessed for their clinical features. One patient was male and the others were female. The mean onset age was 35.8 years (range 19–67 years). Although the typical skin rash arises as nonpruritic salmon pink macules that develop with febrile attacks, only 4 patients (27%) displayed an evanescent rash following defervescence. By contrast, the skin rash of 9 patients (60%) tended to disappear and reappear independently of fever. Six patients (40%) complained of pruritis. Therefore, we should recognize that urticarial rash with or without pruritis is also a common cutaneous feature of AOSD. Furthermore, we attempted to determine whether any characteristics present before treatment were of prognostic significance. Seven of the 14 patients that we followed up for more than 1 year exhibited a relapse of the symptoms that was dependent on the reduction of steroid dosage. None of the symptoms or laboratory data were predictive of relapse ; however, cases with a skin rash that had preceded fever and/or arthralgia showed a lower rate of recurrence. Although further large and longitudinal studies are needed, the subset of patients who have the skin rash as an initial symptom may show a better clinical course than do other patients.
We performed a clinicopathological study of secondary neoplasms involving 243 cases of nevus sebaceous. Secondary neoplasms were observed in 33 cases (13.6%). The 43 lesions included 33 lesions of benign neoplasms and 10 malignant neoplasms were also observed in those 33 cases. The cases with secondary neoplasms increased in number after puberty, and, in 11 out of 21 cases (52.4%) who were more than 50 years old, secondary neoplasms were observed. Malignant neoplasms were seen only in cases more than 30 years old. Secondary neoplasms were most frequently observed in cases with lesions on the face. We compared the histopathological findings between the cases with and without secondary neoplasms. There were no statistically significant differences between these two categories other than an association with independent sebaceous glands. We compared these findings with formerly reported ones in Japan and foreign countries. Although the incidence of secondary neoplasms was almost equal to that in other reports in Japan, it was lower than that in foreign countries. The incidence of malignant neoplasms was as low as that reported in reports from foreign countries. Based upon these findings, we recommend that resection of a nevus sebaceus should be perfomed for esthetic reasons in cases before young adulthood, and also when any tumor is associated, with the nevus in cases over 30 years old.
Five patients were diagnosed with livedo vasculitis (LV) based upon pathological findings such as thick-walled, small blood vessels with fibrin thrombi in the superficial dermis (males, 2; females: 3; mean period of illness, 3.4 years). Despite being refractory to several kinds of treatment including antiplatelet therapy, the painful leg ulcerations of the cases responded dramatically to oral warfarin sodium therapy. Treatment with warfarin may be beneficial therapy for patients with LV resistant to antiplatelet and vasodilator drugs.
Objective: Recently, the importance of improving a patient’s quality of life (QOL) has been emphasized for skin diseases. The aims of this study were to evaluate the QOL of patients with psoriasis and their satisfaction with their current treatment. Methods: This was a prospective, open study performed at Tokyo Medical University Hospital. The patients were asked to complete both the Skindex-16 and General Health Questionnaire (GHQ)-28 questions and a Visual analogue (VAS) scale rating of itching, nail lesions, joint pain and stress experienced while applying ointment. They also reported the time spent applying ointment and rated their level of satisfaction with the therapy. Results: The emotional scales of Skindex-16 were particularly impaired. In QOL measures with GHQ-28, 39.3% were revealed to be possible cases of non-psychotic psychiatric disorders. Some patients had impaired QOL despite low PASI scores. When the duration of applying ointments lasted more than 10 minutes, patients felt stress. Half of the patients reported dissatisfaction with the current treatment. Discussion: The evaluation of QOL should be considered for patient-orientated treatments. It is very important for physicians to ask questions about QOL during each clinical consultation in order to better understand each patient’s outcome.