One of the basic approaches to wound management is moist wound healing. “Wrap Therapy”, which easily creates a moist environment by using the clear plastic wrap intended for foods, is based on this theory and is becoming more common in Japan. Although clear plastic wrap for foods is not approved for medical use, “Wrap Therapy” is inexpensive and effective as long as it is used by trained medical staff who have good knowledge of wound management. Unfortunately many people believe that it is an all-purpose therapy for healing any wound, and they apply “Wrap Therapy” without appropriate evaluation of wound conditions. Although many patients have been successfully treated with “Wrap Therapy”, we must realize that a considerable number of patients have suffered from severe complications. In this report, five representative cases of inadequate application of wet dressings that which caused severe infections are presented. I emphasize that imprudent use of “Wrap Therapy” should be strictly avoided.
Inpatient treatment for severe atopic dermatitis (AD) is useful for achieving rapidly improving dermatological symptoms. However, the effects of the relatively high-dose topical steroids used during hospitalization have not yet been determined. In this study, we measured serum cortisol levels at the times of admission and discharge and evaluated changes in levels. The study included 20 patients with severe AD. The serum cortisol level on admission was low at 3.7±5.7 μg/dl (mean±SD); that at discharge had increased to 11.6±4.4 μg/dl (p<0.05). The lengths of hospital stay ranged from 6 to 29 days. The mean duration of hospitalization required for return to levels above the lower normal limit was estimated to be 4.8 days. The amount of total topical steroids used for inpatient therapy was 8.6±6.3 g/day (groupII) and 4.8±5.8 g/day (group III). Most of the patients who required hospitalization exhibited suppression of adrenocortical function on admission. Of the 16 patients who exhibited levels below the lower limit of normal on admission, all but one exhibited higher levels at discharge. Our findings suggest that inpatient treatment for severe AD may rapidly improve dermatological symptoms and also normalize function of the endocrine system.
We report a case of type 1 hyper-IgE syndrome genomically diagnosed at the age of seven months. The patient had unique and specific skin rashes from the age of 3 weeks. They included impetiginous exudation-like seborrheic dermatitis, milia-like or comedo-like yellowish-white papules, herpes-like small crusted papules or pustules, subcutaneous cystic nodules, and subcutaneous abscesses with poor inflammation (cold abscess). Methicillin-resistant Staphylococcus aureus was frequently detected from skin culture. The rashes changed to solid papules resembling atopic dermatitis after treatment of the skin infections. Non-specific IgE was 2,120 IU/ml at the age of 3 months and reached more than 16,000IU/ml at the age of 9 months. Genomic analysis using peripheral blood lymphocytes revealed 1 amino acid transposition at the DNA binding domain in the signal transducer and activator of transcription 3 (STAT3) gene. The patientʼs mother also had the same abnormality, so the disease was inherited as an autosomal dominant. In cases of repeated infectious and recalcitrant dermatitis-like rashes from early infancy, we should consider the possibility of this syndrome.
We conducted a clinicopathological analysis of 132 cases of skin metastases of visceral malignancy (69 men, 63 women) in our hospital. Origins of the malignancies were in the breast (23.4%), lung (12.8%), and colon (10.6%). The chest was the most frequent (31.2%) region, followed by the neck (21.1%) and abdomen (16.4%). Of the 7 cases of skin metastases of unknown origin, 6 were found in the head and neck regions and 6 out of the 7 cases originated in the lung. The clinical appearance of the skin metastasis was most commonly a nodule/tumor (51.8%), but ulcer/erosion was also seen in 12.1% of the cases. Pathologically, adenocarcinomas were most frequent (66.7%), followed by squamous cell carcinomas (22.0%). Undifferentiated carcinomas were found in 8 cases (6.1%). The mean duration between the detection of original cancer and skin metastasis was 29.8 months. The mean survival time after detection of skin metastasis was 14.6 months. In breast carcinoma cases, the mean survival time after skin metastasis was 29.9 months, longer than the mean survival times for other malignancies. Cases with metastases other than skin metastasis had shorter survival times (8.5 months) than did cases with metastasis limited to the skin (23.7 months). It is important for dermatologists to diagnose metastatic skin tumors correctly and to understand the prognosis for each patient.
Burdock (Arctium lappa) is a kind of the root vegetable eaten mainly in Japan. We reported two cases of immediate hypersensitive reaction to burdock. In the skin prick-prick test, positive reactions were observed in response to burdock in both cases. In immunoblotting, we detected bands at MW 35 kDa and 17 kDa. The allergenic proteins were identified from the amino acid sequences of the peptide fragments:35 kDa protein as the peroxidase (POD) and 17 kDa protein as the [Cu-Zn] superoxide dismutase (SOD). Both of them are known to be defense-related proteins found in plants.