Eleven topical antifungal drugs clinically available in Japan were examined in vitro for their minimum inhibitory concentration（MIC）against Candida albicans and dermatophytes of the genus Trichophyton using standardized broth micro-dilution methods. The antifungal spectrum and activity of each drug was related to its chemical structure. Terbinafine, butenafine, and liranaftate had high activity levels against the Trichophyton spp., but rather low ones against C. albicans. On the other hand, amorolfine and the azole drugs such as luliconazole, lanoconazole, neticonazole, clotrimazole, bifonazole, miconazole and ketoconazole showed greater potency against C. albicans. Among the drugs tested, luliconazole and lanoconazole exerted the most potent antifungal effect against the Trichophyton spp. The MIC of luliconazole against T. rubrum, one of the major causes of dermatomycoses, was in the range of ≦0.00012-0.00024μg/ml. The results obtained in this study will help physicians make the most appropriate choices from among the various topical antifungal remedies available for the treatment of superficial fungal infections.
We report a case of infundibulocystic basal cell carcinoma in a 17-year-old man with nevoid basal cell carcinoma syndrome. He had multiple skin-tag-like nodules on his neck, one of which had recently become black. Histology revealed an intradermal basaloid cell tumor composed of anastomosing epithelial cords. There were some infundibular cystic structures containing corneocytes lined by follicular infundibular epithelium and bud-like structures simulating the follicular germs. Follicular bulbs and papillae were absent. The stroma was scant and not highly fibrocytic. The tumor was diagnosed as infundibulocystic basal cell carcinoma. Since Tozawa and Ackerman, in 1987, described it as an uncommon variant of basal cell carcinoma with a unique combination of follicular differentiation toward infundibula and follicular germ, there has been much controversy over the issue of whether it is truly a variant of basal cell carcinoma or it is actually a trichoepithelioma. The fact that our case occurred in the patient with nevoid basal cell carcinoma syndrome argues that this infundibulocystic basal cell carcinoma was not a trichoepithelioma, but rather a variant of basal cell carcinoma.
After combined therapy with pegylated interferon alfa-2b and ribavirin was started for the treatment of chronic hepatitis C in a 34-year-old male Jamaican, finger-tip-sized nodules appeared all over his body. Histopathological examination of these nodules resulted in the diagnosis of sarcoidosis. High resolution CT of the chest revealed bilateral hilar lymphadenopathy, and ophthalmologic examination revealed bilateral uveitis. The patient was started on oral prednisolone, and immediate symptomatic improvement followed.
Six patients who had each experienced a systemic reaction to a hymenoptera sting received rush immunotherapy. Medical indications for venom immunotherapy are patients who have had a history of systemic reactions such as hypotension, unconsciousness, and dyspnea. The venom extracts were imported from Hollister-Stier, USA. The patients had received subcutaneous injections 2 to 4 times a day for 2 weeks with hospitalization, and then they had received maintenance injections once a month as outpatients. All the patients had local side effects, and one developed generalized urticaria during immunotherapy. Two patients suffered re-stings during the maintenance therapy. One had no reaction, and another one exhibited a full anaphylactic reaction again, but he recovered with emergency treatment. We recommend that our patients carry an EpiPen during maintenance therapy.