We report a case of a 54-year-old woman who developed allergic piercing granuloma. A persistent nodule appeared at the site of piercing on her right earlobe 5 years after metal-piercing in both earlobes. Although resected, the nodule soon reappeared. Because histological examination of the nodule demonstrated the presence of non-caseating epithelioid cell granuloma and patch testing revealed positive allergic responses to gold and platinum, we made the diagnosis of piercing granuloma due to a delayed-type allergy to piercing metals. In foreign countries, increasing cases of allergic piercing granuloma consisting of sarcoidal epithelioid cell granulomas have recently been reported. We should pay attention to the possibility that similar cases can also increase in Japan.
We analyzed 1,657 samples from bacteria-associated cutaneous disorders seen during the summer periods from June to September for 7 years from 1998 to 2004 in our dermatological out-patient office. Among the 1,960 bacterial isolates, 1,372 Staphylococcus (S.) aureus [1,064 methicillin-sensitive S. aureus (MSSA) and 308 methicillin-resistant S. aureus (MRSA)], 165 coagulase-negative staphylococci, 128 hemolytic streptococci, and 295 other bacterial species were identified. Thus, 22.4% of the isolated S. aureus were MRSA. Nasal cultures from patients with MRSA-isolated skin lesions in 2004 indicated 54.1% nonsymptomatic MRSA residence in the nasal cavities of these patients. Bacterial susceptibility to antibiotics was analyzed with NCCLS (CLSI) criteria for Kirby-Bauer disc method. Almost all the MSSA isolates were susceptible to cephem antibiotics. However, the MSSA susceptibility to gentamicin decreased from 43.8% to 30.9%. Susceptibility of MRSA in 1998 and 2004 were 100% and 96.3% to minocycline, 78.6% and 77.7% to fosfomysin, and 71.4% and 70.4% to tetracycline, respectively. All the cases of MRSA-isolated skin lesions in 1998 and 2004 were followed completely to confirm the effect of chemoterapy. They were all cured, mostly with therapy combining cefdinir and fosfomysin or with minocycline alone.
We examined 421 cases of poroid cell neoplasms and sorted them into four histopathological subtypes and a mixed type. There were 188 cases (69.4%) with Pinkus type (so-called eccrine poroma), 14 cases (5.2%) with Smith-Coburn type (hidroacanthoma simplex) , 2 cases（0. 7%) with Winkelmann-McLeod type (dermal duct tumor) , 66 cases (24.4%) with Mayer type (hidradenoma), and 151 cases (35.9%) with a mixed type (more than two histopathological subtypes). Because the mixed type was observed at high frequency, we advocate a comprehensive theory classifying all of them as poroid cell neoplasms rather than as four discrete entities. We propose that the four recognized histopathologocal subtypes, Pinkus type, Smith-Coburn type, WinkelmannMcLeod type and Mayer type, are all variants of poroid cell neoplasms.
The clinical and laboratory features of 22 patients with psoriasis arthropathy (PsA) were assessed at the time of starting treatment in our hospital. There were 17 males and 5 females, their mean age was 40.2 years old. The clinical forms of PsA as defined by Moll and Wright had a polyarticular pattern (9 patients), followed by oligoarticular (7 patients), distal (2 patients), mutilans (2 patients), and spondyloarthropathy (2 patients). The mean Psoriasis Area and Severity Index (PASI) score and the mean C-reactive protein (CRP) were 10.2 (n＝15) and 3.1mg/dl (n＝22), respectively. There was a mean of 6.8 inflamed joints (n＝21). A retrospective study of a Japanese version of the Stanford Health Assessment Questionnaire (J-HAQ) was conducted in 17 patients at the time of the most severe arthralgia. The mean disability index of the J-HAQ was 1.23. The overall disability index of the J-HAQ did not show any significant correlation with the CRP, the number of inflamed joints, or the PASI score. However, when patients are limited to those whose arthralgia was the most severe at the time of starting treatment in our hospital, the disability index of J-HAQ showed positive correlations with the CRP and the number of inflamed joints.