The archive of the Tokyo University Medical School Library includes personal effects of Professor M. Ota. Recently a letter has been found that was addressed to Ota in 1944 when he was a professor at Tokyo University and the chairman of Japan Dermatological Association. It was written by Professor I. Miyake at Kumamoto University. This unpublished letter reveals to us the era and the situations surrounding the 44th Annual Meeting of JDA, whose program was carried out only on its journal.
“Stomahesive” powder is used as a skin-care product for the management of stomas. We successfully treated a 3-month-old boy who had an intractable skin ulcer on his buttocks with this skin-protection powder. His ulcer emerged on the left sacral region where he had an erythematous patch from birth. Although he had been treated with various ointments, the ulcer rapidly expanded after the onset of diarrhea. We implaced a urine catheter and started daily application of the skin-protection powder “Stomahesive” on the ulcer after washing. A gel formed from the powder and wound discharge covered the wound and moistened it like a hydrocolloid dressing and prevented skin irritation from the feces due to its pH buffering system and absorption of excess water. After each evacuation, we removed the feces and gel and then re-applied the skin-protection powder without re-washing the wound. The “Stomahesive” powder may be considered as one of the useful therapeutic option for intractable ulcers, especially on the buttocks or vulva, where there is often irritation from feces or vaginal discharge.
A 72 year-old Japanese male had asymptomatic erythematous plaques with erosions on both dorsal hands and fingers. Histopathological features included dense dermal neutrophilic infiltration with collagen fibrolysis and absence of vasculitis. Four weeks later, concurrently with ulceration of the lesions on the hands, varied eruptions appeared on the other sites, including erythematous plaques and folliculitis, purpuric papules on the legs, and pustulosis palmoris et plantaris-like eruptions on both palms. Histopathological features of the purpuric papules included vasculitis with neutrophilic and lymphocytic infiltration. All the eruptions improved after 3 weeks of treatment with minocycline and topical steroid, and no scars remained. Based on the clinical and histopathologic findings, our case fits into the category of neutrophilic dermatoses. The various histopathological patterns of neutrophilic infiltration in the epidermis and dermis account for the diverse eruptions. Physicians should be aware that pyoderma gangrenosum-like lesions occurring on the dorsal hands that are similar to lesions of atypical mycobacterium may present as the initial manifestation of a neutrophilic dermatosis.
In 1998, a 31-year-old man visited us with a 7 year history of recalcitrant psoriasis. He was treated with topical corticosteroid, vitamin D3, oral etretinate, methotrexate, and PUVA. In 2004, without any prodromal symptoms, high fever and painful pustules developed within psoriatic plaques with erosions of oral mucosa. A diagnosis of Kaposiʼs varicelliform eruption was made and followed by an intravascular administration of acyclovir. The fever subsided in a few days. However, bullae and erosions developed at the margin of the psoriatic plaques. A skin biopsy of a bulla revealed acantholytic blister, and a direct immunofluorescence test showed intercellular depositions of IgG and C3 in the epidermis. A diagnosis of pemphigus vulgaris was made, and the patient was treated with oral prednisolone 60 mg/day and methylprednisolone pulse therapy (1 g/day, three days). The coincidence of pemphigus vulgaris with psoriasis vulgaris is a rare phenomenon, and the development of psoriasis vulgaris precedes that of pemphigus vulgaris in most cases. According to some previous case reports, a herpes simplex virus infection can provide a clue to a diagnosis of pemphigus.
A sixty-year-old Japanese female with severe articular contracture caused by a brain tumor and infarction had an erythematous plaque on her right labina major and perianal region. Biopsy revealed Pagetʼs cells in the epidermis. Using immunostaining, carcinoembryonic antigen (CEA) and cytokeratin 7 (CK7) were positive in the tumor cells. No abnormal findings were observed in urethral, vaginal, or intestinal epithelium. Computed tomography showed no lymph-node swelling or distant metastasis. Thus the tumor was diagnosed as extramammary Pagetʼs disease of T1N0M0, stage IA. Neither surgery nor radiation therapy could be applied because of severe contracture of the hip and knee joint, so topical imiquimod 5% cream was applied topically and washed out 7 hours later. The treatment was repeated three times per week. The lesion resolved after 6 weeks of treatment. Rebiopsy showed no residual tumor, and both CEA and CK7 were negative. The patient was free from recurrence during five months of observation. She complained of irritation, but the problem was resolved by topical application of steroid ointment. No severe adverse effects were was observed. We conclude that topical imiquimod therapy is worth trying for the treatment of an early stage of extramammary Pagetʼs disease, when surgery is not a viable option.