It is usually difficult to get confirmative diagnosis of drug eruptions using only histopathological findings. In severe drug eruptions, it is sometimes too late to start treatment no matter how immediately the typical histopathological features are detected; consequently, the prognosis is poor. Therefore, early diagnosis and treatment are absolutely necessary. We examined and evaluated the characteristics of the histopathological findings of severe drug eruptions and determined that the interface changes of dermoepidermal junction were the most important findings. In many cases, infiltrates of eosinophils was found in the dermis. When the interface change is severe with obvious cleft formation, accompanied by many necrotic keratinocytes in the epidermis, we must consider Stevens-Johnson syndrome or toxic epidermal necrolysis, and early systemic high-dose steroid therapy is necessary. On the other hand, when the interface change is slight and few necrotic keratinocytes are observed, an erythema multiforme-type drug eruption or drug-induced hypersensitivity syndrome (DIHS) starting from erythema multiforme-like eruption should be considered. Systemic steroid administration at a moderate-dose should be a choice of therapy. When there are many necrotic keratinocytes, however, a high dose of steroid therapy is needed.
We treated thirty-two scabies patients with imported permethrin cream (include nine patients who were treated for prevention of scabies). Nineteen cases were cured with permethrin cream alone applied over the entire body except for the head (but including the head in infants) twice with a one week interval. Four patients (two elderly patients, one patient with crusted scabies and another who took oral steroid for another disease) were treated with oral ivermectin and permethrin cream. Three of these four cases were cured after two doses of permethrin cream, but the patient with crusted scabies needed three doses. Nine cases were treated once with permethrin cream for prevention of scabies, because they had to keep in contact with patients with crusted scabies. These nine cases were not subsequently infected for more than six months. In all thirty-two cases, no side effects such as contact dermatitis wereseen. In five cases who underwent blood tests before and after external applications, no liver dysfunction or renal dysfunction were dectected. We hope that permethrin cream will be permitted for medical use in Japan, because it is so effective against mites and is so nontoxic that it is can be used to treat infants over two months old, pregnant women, and nursing mothers.
We examined MR microscopy imaging from 60 cases of cutaneous and subcutaneous lesions using a 40-mm microscopic surface coil at our hospital from April 2007 to September 2008. Nineteen males and 41 females were enrolled in the study. We compared clinical, ultrasonographic, and MR microscopic diagnoses based upon pathological diagnosis in 27 cases. In 17 of 27 cases (63%), the MR microscopic diagnosis was identical to the pathological diagnosis. In 8 of 27 cases (30%), the clinical diagnosis was consistent with the pathological diagnosis. The concordance rate was significantly higher in MR microscopy than in clinical diagnosis by Fisherʼs exact test (P<0.05). We demonstrated the usefulness of MR microscopy using a microscopic surface coil for preoperative evaluation of cutaneous and subcutaneous lesions.
Three patients (two 71-year-old men and one 57-year-old man) had colorectal cancer with liver metastasis. We attempted several types of chemotherapy after their operations. The next step was therapy with cetuximab, which has an epidermal growth factor receptor inhibitor;it was performed by weekly infusion from October to November of 2008. Two days after the second infusion of cetuximab, acneiform skin lesions appeared on the face and parts of the trunks of all patients. In patient 1, it was possible to see the infiltration of the neutrophils in/out of the hair follicle. All of patients started skin treatment using steroid and antibiotic ointments. Because we did not see any clinical improvement of the acneiform eruption on patient 2 after using steroids and antibiotics, we then treated him with topical tretinoin cream, which was very effective.