We conducted a questionnaire-based survey covering past and present treatment, degree of treatment satisfaction, pattern of topical ointment application, and quality of life (QOL) in elderly patients with psoriasis in order to assess their compliance with treatment and their QOL as patients as well as to improve the quality of treatment for psoriasis. In addition, we conducted the same survey with younger psoriasis patients and compared the results to those obtained from elderly patients for objective evaluation. The results of our survey revealed that the degree of stress with the use of an ointment is significantly lower in elderly patients than in younger patients. Moreover, there is less influence on QOL in elderly patients than in younger patients, especially with regard to “the option to wear some clothes” and “the influence on circumstances by dandruff from affected lesions”. Furthermore, the elderly tend to prefer topical ointment to oral treatment and to apply an ointment correctly following the doctor’s instructions. In contrast, the elderly do not have the positive image of new treatments, that younger patients do. The results of our survey indicate that the compliance with treatment and QOL is less impaired in elderly patients than in younger patients. Based on these results, we suggest that it is important for clinicians to treat elderly patients mainly with topical ointments accompanied by proper instructions, so that they can maintain a high level of compliance with the treatment.
We analyzed the clinical statistics from 60 Behçet’s disease（BD）patients（33 males and 27 females）who visited the dermatological department of Kitasato University Hospital from 1983 to 2004. The average age of appearance of disease was 39 years old. Twelve patients had the complete type of BD, and 48 had the incomplete type of BD. Oral aphtosis and skin eruption were seen in about 98% of cases. About 70% suflered from genital ulcers, and 45%, from ocular involvement. As skin eruptions, about 60% had papulopustular lesions and erythema nodosum. The rate of positivity for HLA-B51 was 55.9%.These frequencies corresponded well to current reports. Although the usual treatments for the disease were NSAIDs and colchicines, the rate of using steroid showed a tendency to increase. We compared the type of treatment with each classification. There was no significant correlation between severity of symptoms and steroid use. We also searched for cases who had been able to be observed for ten years or more. There were no cases in whom the disease activity had continued for a long term. Half of the cases had been able to either decrease treatment or to discontinue it.
Fabry disease is an inherited deficiency of the lysosomal hydrolase alpha-galactosidaseA (α-GalA) due to the mutation of Gal gene at Xq22. This results in intra-lysosomal accumulation of glycosphingolipids, mainly globotriaosilceramide (GL-3). Males with the classical phenotype of Fabry disease have no or very low levels of α-GalA activity and show a number of well-recognized clinical features, such as angiokeratomas, hypohidrosis, acroparesthesias, transient ischemic attacks and stroke, heart disorders, and progressive renal failure. Enzyme replacement therapy using recombinant agalsidase α or β is currently recommended. We treated a 26-year-old patient with the classical type of Fabry disease by the administration of recombinant human α-GalA for 1 year and evaluated the effects by skin biopsy and changes in symptoms. As a result, accumulation of GL-3 on the vascular endothelial cells, vascular smooth muscle cells and perineurium was reduced or disappeared, but symptoms such as increase in angiokeratomas, pain, and hypohidrosis, did not change.
We reported a case of 83-year-old woman with a burnt umber nodule on the abdomen, which previously had been histologically diagnosed as a nevocellular nevus on biopsy at another hospital. However, as the nodule gradually enlarged, we have established a diagnosis of superficial spreading melanoma uslng dermoscopy findings demonstrating an atypical pigment network, irregular streaks, irregular globules, and a blue-whitish veil.The lesion consisted of atypical tumor cells and nevoid cells with mild atypism and the latter showed weak reactivity with HMB-45 staining. However, they both demonstrated strong reactivity against PCNA staining and a continuity with pagetoid tumor cells. We concluded that these cells were a series of malignant cells. These biological and morphological variations must be an evidence of malignancy.