Standard guideline for management (diagnosis, severity scoring and therapy) of atopic dermatitis (AD) is established. In this guideline, the necessity of dermatological training is emphasized in order to assure the diagnostic skill and to enable to evaluate the severity of AD. The present standard therapies for AD consist of the use of topical steroids and tacrolimus ointment for inflammation as well as emollients for dry and barrier-disrupted skin as the first-line topical applications, systemic anti-histamines and anti-allergic drugs for pruritus, avoidance of apparent exacerbating factors, psychological counseling, and advice about daily life. Tacrolimus ointment (0.1%) and its low density ointment (0.03%) are available for adult patients and 2-15 year old patients, respectively. The importance of correct selection of topical steroids according to the severity of the lesion is also emphasized. Deliberate use of oral cyclosporine for severe recalcitrant adult AD is also referred.
We assessed the scores of plasma coagulation factor XIII in the 21 patients with anaphylactoid purpura of all generations that we have diagnosed at Nippon Medical School Hospital in order to evaluate the significance of plasma coagulation factor XIII in anaphylactoid purpura. We examined a series of 21patients (ten males and eleven females) with anaphylactoid purpura. Eight (38.1%) of them had decreases in score of coagulation factor XIII. Five (62.5%) of them had joint symptoms, and two (25.0%) of them had abdominal symptoms. In the group with low levels of coagulation factor XIII, patients had more frequent and more severel renal abnormalifies, such as hematuria (50.0%) and proteinuria (87.5%). The activity of plasma coagulation factor XIII appears to have a predictive value for renal function in patients with anaphylactoid purpura.
In cases of crusted scabies, transmission by scales in clothing or a bed can occur without skin-to-skin contact, because the body of an infested patient contains several million mites. A male patient with ATL was diagnosed with crusted scabies after having been hospitalized for about one month from December 2005 in our Department of Internal Medicine. From February to July of 2006, 17 patients (11 males and 6 females) visited our Department of Dermatology with complaints of erythemas, papules, and nodules with intense itching on interdigital lesions, axillae, and genitalia. They were all diagnosed as having scabies. All of the infested patients were immunocompromised hosts, and they had been hospitalized during the same period as that of the index case and in the same internal ward. The period in which contact with the index case was possible was 1 to 33 days (median: 17.4 days) and the latent period was 1 to 6 months (mean: 3 months). None of the 17 patients had been in the same room as that of the index case. Another male patient with leukemia developed crusted scabies and was the index case for a second outbreak of scabies in another hospital 9 months later. Two of the medical staff in our hospital and 9 family members were also infested, and 3 people residing with the index case had repeated relapses of scabies. Clinical diagnosis of scabies in immunocompromised hosts is difficult because such patients have various rashes. It is therefore important to perform a KOH examination and to examine eruptions by dermoscopy in order to prevent outbreaks of scabies.
Superficial acral fibromyxoma is a rare, benign, soft tumor that mainly affects the digits. We report a case of a 73-year-old woman with a hemisphere-shaped nodule 20×15 mm in size on the tip of her right thumb. It had been present for about 8 years and had gradually increased in size. Histopathological examination showed a well-circumscribed, uncapsulated tumor in the dermis and subcutis. The tumor cells consisted of spindle-shaped or stellate fibroblast-like cells embedded in a myxoid stroma. Numerous mast cells were observed in the tumor. An immunohistochemical study revealed that the neoplastic cells were positive for CD34 and vimentin. We diagnosed the tumor as superficial acral fibromyxoma.
Cutaneous T-cell lymphoma (CTCL) is relatively benign in its early stages, but survival rates decrease dramatically as the disease progresses. The goal of therapy in CTCL is preventing or delaying progression from the early disease stage. The aim of this study was to evaluate the influence of bath-PUVA therapy on patients with early stage mycosis fungoides (MF). Twenty-seven patients with MF, who were treated with bath-PUVA in Nagoya City University Hospital from 2004 to 2007, were included in this study. Peripheral blood samples and skin biopsies were obtained before and after the therapies. The clinical efficacy, CD4+ cell infiltration into skin lesions, serum IL-2R and serum LDH were evaluated before and after bath-PUVA therapy. Bath-PUVA induced significant remission in 24 patients with mycosis fungoides (89%). All parameters were significantly reduced by this therapy. In conclusion, our data indicate that bath-PUVA therapy is useful in preventing and delaying progression of mycosis fungoides.