[Purpose] To clarify incidence and difference of gender and age in skin disorders of dermatological patients in the early 21st century in Japan. [Methods] Nationwide cross-sectional and seasonal multicenter study was conducted by 76 university hospitals, 55 district-based pivotal hospitals and 59 private clinics (190 clinics in total). In each clinic, information on diagnosis, age and gender was collected from all of the out-patients and in-patients visited on any one day of the second week of May, August and November 2007 and February 2008. Average high and low monthly temperature and humidity reports were collected from the Meteorological Agency. [Results] The information on 67,448 cases from 170 clinics (69 university hospitals, 45 district-based pivotal hospitals and 56 private clinics) participated in all of the 4 seasonal examination, was analyzed. Top 20 skin disorders were, in high incidence order, miscellaneous eczema, atopic dermatitis, tinea pedis, urticarial/angioedema, tinea unguium, viral warts, psoriasis, contact dermatitis, acne, seborrheic dermatitis, hand eczema, miscellaneous benign skin tumors, alopecia areata, herpes zoster/postherpetic neuralgia, skin ulcers (nondiabetic), prurigo, epidermoid cysts, vitiligo vulgaris, sebborheic keratosis, and drug eruption/toxicoderma. The vast majority (85.34%) of dermatological patients were covered under the top 20 disorders. Each disorder showed its own specific age distribution. The number of patients was correlated with average high and low monthly temperature in disorders such as atopic dermatitis, contact dermatitis, urticarial/angioedema, prurigo, insect bites and tinea pedis. Male-prone (psoriasis, erythroderma, diabetic dermatoses, e. t. c.) and female prone (erythema nodosum, collagen diseases, livedo reticularis/racemosa, hand eczema, e. t. c.) diseases were clearly evident. [Conclusion] This study apparently highlights the present situation of dermatological patients in the early 21st century of Japan. It is necessary to continue to perform the similar study periodically from social dermatological point of view.
A 52-year-old Japanese man developed pharyngalgia and arthralgia at the beginning of April, 2007. He had a high fever and erythema on the legs and trunk and was hospitalized on April 7. Physical examination revealed erythema multiforme-like skin lesions on the legs and trunk, hyperemic conjuntiva palpebrarum, and swelling of the neck lymph nodes. Blood tests showed a normal white blood cell count, reduced number of lymphocytes, highly positive CRP, and a mild abnormality in liver function. Histopathology showed spongiosis in the epidermis and liquefaction degeneration and interface dermatitis in the dermoepidermal junction. Viral tests were positive for IgM anti-human parvovirus B19 antibody, and the patient was treated only for his symptoms. During the disease course, he developed transient atrial fibrillation. In addition to CRP and RAPA, the measurements of IL-6 and IL-8 were useful in assessing the disease activity. In addition to atypical skin lesions, adult human Parvovirus B19 infection shows abnormal general conditions, such as fever and arthralgia and, rarely, myocarditis. We should be careful to look for these complications.
Anti-U3 RNP antibody (anti-U3 RNP) is one of the representative anti-nucleolar antibodies and is considered to be highly specific for systemic sclerosis (SSc). In this study, we examined the clinical characteristics of 8 Japanese SSc patients who presented to our hospital (6 females and 2 males: median age, 44 yrs) with anti-U3 RNP. These patients were grouped into 4 patients with diffuse SSc (dSSc) and 35 patients with limited SSc (lSSc). All the patients had Raynaud’s phenomenon, and most of them had pitting scars, contracture of phalanges, and diffuse pigmentation. These skin involvements are often seen in dSSc patients. In contrast, internal organ involvements such as pulmonary fibrosis, scleroderma, renal crisis and heart failure were not frequent, and the degree of these symptoms was not severe, except in one patient who developed a renal crisis 14 years after disease onset. Oral corticosteroid administration was given to 6 patients, and skin sclerosis improved in all 6 of them. It has been reported that anti-U3 RNP-positive SSc patients in Caucasian and/or African-American populations generally have dSSc, and their internal organ involvements, such as pulmonary fibrosis, renal crisis, and heart failure due to myocardial fibrosis, are severe, which could result in higher mortality compared to other SSc subgroups. Notably the, skin involvement of Japanese SSc patients with anti-U3 RNP is similar, but the internal organ involvement appears to be less severe compared to that of Caucasian and/or African American patients with anti-U3 RNP. However, further study will be required to identify the characteristics of Japanese patients with anti-U3 RNP, as the patient number in this study is relatively small.
We report 61 patients with scabies (the mean age of 56 years; ranging from 8 to 94), who were treated with oral ivermectin in our department. We studied its clinical efficacy and safety and concluded that cases with complications, positive findings of microscopic tests for eggs in the first medical examination at our clinic, or systemically administered steroids tended to require oral ivermectin more than twice and to require an extended term for successful treatment. Twelve patients (19.7% of the study) were cured with only oral ivermectin. No remarkable side effects were observed in our patients. Oral ivermectin is considered to be simple and useful for treatment of scabies, but recurrent cases can arise even after two administrations of ivermectin. We should follow patients with microscopic tests and watch for a serial recurrence of scabies.
The patient was a 1-month old male who was the product of a normal delivery and weighed 2,990 g at birth. At approximately one week of age bloody stools and fever were noted, and because oral aphthae and folliculitis were also observed, at first a Behçet’s-syndrome-like disease was suspected in a patient, who was then treated sequentially with mesalazine enemas, systemic steroid therapy, and finally with cyclosporine and thalidomide, but no improvement was seen in his general condition. When his intestinal bleeding increased and persisted, a subtotal colectomy was performed at the age of 8 months. Beginning at the age of 10 months, the patient developed a rash consisting mainly of eczematous lesions, then contracted carinii pneumonia and sepsis, and repeatedly developed phlegmons, suggesting immunodeficiency. Because the thrombopenia was accompanied by decreased platelet size, Wiskott-Aldrich syndrome (WAS) was suspected. When we examined the WAS protein gene, a mutation was detected in exon 4, and we made a definitive diagnosis of WAS.