We evaluated the usefulness of two evaluation methods, “Self-check test on topical treatments for psoriasis” and “Points of topical treatments for psoriasis,” which were both designed to improve treatment adherence in patients with psoriasis. Fifty patients with psoriasis vulgaris entered this study. We performed the same test at initiation of the survey and one month later using five questions that included patient quality of life (QOL), compliance, and related parameters listed on the “Self-check test on topical treatments for psoriasis”. Then we assessed changes in total test scores. After an initial discussion based on the results of the self-check test with the patient, modified treatments for next month were selected mainly by the patient. The “Points of treatments for psoriasis” was utilized by physicians for guidance of topical treatment. The mean total scores of the self-check test increased from 10.0 at the start of the survey to 11.0 after one month. In particular, for the 22 patients whose initial total scores were 9.0 or less, the mean score of 7.2 at the start of treatment increased significantly to 10.5 after one month (p<0.001, Wilcoxon signed-rank test). Moreover, using the Psoriasis Severity Index (PSI) as an indicator, each patient evaluated a selected target lesion for early improvement. Mean PSI scores significantly decreased from 5.9 at the start of treatment to 4.4 after one month (p<0.001, Wilcoxon signed-rank test). These findings suggest that the QOL and treatment compliance by psoriasis patients improved as a result of continuous application of treatment decided mainly by patients and based on the results of the “Self-check test on topical treatments for psoriasis.” These findings also suggest that improvement of QOL and compliance favorably affected efficacy. We therefore conclude that the “Self-check test on topical treatments for psoriasis” and the “Points of topical treatments for psoriasis” are useful in improving treatment adherence in patients with psoriasis.
We reported a 41-year-old Japanese man who presented with a 10-year history of a nail thickening of the right fourth toe. Clinically, there were thickening, ridging changes in the nailwith yellowish discoloration and transverse over-curvature. Close examination revealed splinter hemorrhage and longitudinal black and white lines in the nail. There was mildly edematous erythema in the dorsal finger. Other nails were normal in appearance. Fungus was not detected in the involved nail by potassium hydroxide examination. After nail avulsion, a filiform tumor appeared within the proximal nail matrix. The thickened portion of the nail was made up of small hole-like cavities. Histopathologically, the tumor was a fibroepithelial tumor originating from the nail matrix. It had epithelial projections with outward growth that penetrated the corresponding nail plate with a finger-glove appearance. The tumor was surrounded by delicate collagen fibers with many spindle-shaped cells. In the nail, we observed multiple cavities filled with serous fluid in addition to nail differentiation without a granular layer. These were consistent with the features of onychomatricoma described in 1992 by Baran& Kint. This is the first publication of onychomatricoma in the dermatology literature in Japanese.
We investigated and studied the cutaneous manifestations of diabetes mellitus in 267 inpatients. The mean age of the patients was 58 years (female 59 years, male 57 years), the mean duration of the disease was 13.2 years, and the mean HbA1c at the time of hospitalization was 9.13%. Most of the cutaneous infections were fungal ones. Notably, tinea pedis accounted for 74.1% (198 cases) of the cases in this study. Candidal infections were found in only 5.2% (14 cases) of the cases. About half of these cases with candidal infections had complicating diabetic triopathy. Diabetic rubeosis, carotenodermia, and palmar erythema, as comparatively characteristic skin manifestations of diabetes mellitus, were noted in 53 cases, 36 cases, and 23 cases, respectively. Dupuytrenʼs disease (17 cases), diabetic dermapathy (6 cases), and scleredema diabeticorum (5 cases) were associated with diabetic triopathy at a high frequency. In this study, palmo-plantar pigmented macules were noted in 43 cases. The pigmented macules were predominantly observed in the males, although the clinical relationships between these pigmented macules and diabetes mellitus remain unknown. This study clarified the frequency of the skin manifestations in diabetes mellitus and showed the relationships between these skin manifestations and the pathogenesis of diabetes mellitus.
Monilethrix is an autosomally dominant hair disorder characterized by a beaded appearance of the hair due to periodic thinning of the shaft. This disorder is caused by mutations in the helix termination motif of any of three type II cortex keratins, hHb1, hHb3, and hHb6. We analyzed the genomic sequences of these keratins for a Japanese pedigree with monilethrix that included a 27-year-old woman and her 5-year-old son. We detected a heterozygous point mutation at E413K (change of GAG to AAG at codon 413) in exon 7 of the hHb6 gene in both pedigrees. Scanning electron microscopy revealed a constricted, internodal, alternating pattern in the hair samples from these patients. Topical application of minoxidil and careful hair care were effective in recovery of hair volume.
We assessed the clinical features of 55 patients with anal condyloma acuminatum (CA) who were seen at our hospital between November 2003 and October 2007. Fifty-three cases were male and two were female; the average age was 31 years. Of the 55 patients, 27 (49%) had CA in the perianal and intra-anal regions, 23 (42%)in the perianal region only, and five (9%) in the intra-anal region only. Twenty-nine cases (53%) were HIV-positive, 18 (32%) were HIV-negative, and eight (15%) were unchecked. Various treatments for CA were performed including electro-cauterization, liquid nitrogen cryotherapy, and topical fluorouracil application. The average treatment period for the 36 successfully treated (cured) cases was 8.4 months. Nineteen patients (34%) elected to terminate their treatment before achieving a complete cure. Care should be exercised when treating anal CA patients in consideration of the high incidence of HIV infection.