The gypsy moth (Lymantria dispar) is a member of the family Lymantriidae, which is found not only in Japan but also throughout the northern hemisphere. Infestations of this moth sometimes erupt into large numbers, and it is a well-known forest pest. First instar larvae of gypsy moths have poisonous hairs that cause dermatitis, although there are only a few reports of the problem. Moreover, community-wide outbreaks of dermatitis have not been previously reported in Japan. Between May and June 2008, we treated 58 caterpillar dermatitis patients caused by gypsy moth caterpillars that had significantly increased in number in Kuzumaki Town in Iwate Prefecture. The patients had pruritic, erythematous, papular, and occasionally vesicular lesions on exposed areas of the body such as the neck and arms. A questionnaire survey given to the residents of Kuzumaki Town revealed that 926 people had dermatitis thought to be caused by gypsy moth caterpillars. The fact that first instar larvae of gypsy moths cause dermatitis should be more widely recognized.
Pemphigus vegetans is a rare variant of pemphigus vulgaris characterized by flaccid bullae that become eroded and form vegetations or papillomatous lesions, especially in intertriginous areas. The standard treatment for pemphigus vegetans has been oral administration of corticosteroids. We reported a case of pemphigus vegetans in a 67-year-old Japanese female with a high titer of anti-desmoglein 3 autoantibodies (index value of 14,433.3) treated with double filtration plasmapheresis (DFPP) and pulse cyclophosphamide therapy. The treatment schedule consisted of repeated DFPP with the use of albumin solution as the substitution fluid and subsequent administration of high-dose cyclophosphamide (12 mg/kg; total dose of cyclophosphamide pulse was 600 mg) and 2.5 mg/kg/day of methylprednisolone. The skin lesions were cured after three treatments with DFPP and cyclophosphamide, and the titer of anti-desmoglein 3 autoantibodies decreased to an index value of 26. No significant adverse effects were observed. Afterwards, she was treated with low dose systemic steroid and tacrolimus. DFPP combined with synchronized pulse cyclophosphamide may be a useful treatment regime in the management of pemphigus vegetans.
We studied the clinical characteristics of 48 cases of dermatomyositis associated with malignancy seen in our department. The results can be summarized in the following 7 points. 1. The common types of malignancy in dermatomyositis were stomach cancer (13 cases), lung cancer (10 cases), and malignant lymphoma (6 cases). 2. Malignancies of the female sexual organs, such as ovarian carcinoma (5 cases) and breast cancer (5 cases), were associated with dermatomyositis in female patients. 3. We reviewed the time relationships between dermatomyositis and malignant neoplasms. In the group of dermatomyositis arising during the course of malignant neoplasms, breast cancer and ovarian carcinoma were most common (4 out of 5 cases). In the group of patients in whom dermatomyositis and cancer arose simultaneously, the type of cancer was mainly stomach cancer (9 out of 13 cases). Lung cancer was the most common in the group of patients in whom cancer occurred after the diagnosis of dermatomyositis (4 out of 8 cases). 4. The most specific skin symptom in dermatomyositis associated with cancer was obvious edematous facial erythema. Heliotrope erythema was also seen in the cancer-associated group, but did not reach statistical significance. 5. All of the 8 cases of dermatomyositis with skin bulla formation were associated with cancer. 6. The frequency of the myositis was not statistically significantly different between cancers associated or not associated with dermatomyositis. However, about 40% of the cases of cancer associated with dermatomyositis, were notably resistant to therapy and exhibited prolonged muscle weakness. 7. In the group of dermatomyositis patients associated with cancer, 8 cases (16.7%) had interstitial pneumonia. This pneumonia was not fatal in any of them.
We investigated the presence of reticulate pigmentation of the neck in 108 adult patients with atopic dermatitis. Twenty-six patients (24.1%) had reticulate pigmentation in this region. Patients with neck pigmentation showed significantly increased overall eczema severity and higher serum IgE levels than those without neck pigmentation; there were no significant differences in the age of onset or disease duration between the two groups. The association of asthma was significantly more frequent in pigmentation group than in non-pigmentation group, but there was no difference in the association rate of allergic rhinitis. These results suggest that reticulate pigmentation of the neck is closely related to the severity, but not to the duration, of the disease. Skin biopsies showed numerous melanin deposits and mild perivascular infiltrates in the upper dermis, which is consistent with previous reports. We treated this reticulate pigmentation of the neck with Q- switched ruby laser in 10 patients. Satisfactory results were obtained in all patients without any signs of recurrence after the follow-up period of up to 2 years and 10 months. Because the laser therapy has quick and definite effects on the neck pigmentation, it appears to be a useful treatment option for patients with refractory pigmentation of the neck.
The collagen fiber attack reaction is a type of tissue reaction proposed by Arai in 2005. It exhibits a vessel-independent pattern of infiltration by histiocytes. Collagen fibers at the site are eosinophilic and swollen. Degenerated collagen fibers are surrounded by migrating histiocytes, which are attacking these fibers. We have observed this type of tissue reaction in eruptions associated with systemic lupus erythematosus (SLE), Sjogrenʼs syndrome, mixed connective-tissue disease (MCTD), dermatomyositis, and rheumatoid arthritis. This report describes the clinical characteristics of 8 cases of SLE with evidence of collagen fiber attack reaction. Highly infiltrative regions of eruption with unclear margins appeared with fever and resolved in about two weeks. Nonspecific reactions observed include increases in white blood cell count, CRP, and LDH, with only minimal changes in SLE-specific serological markers. The clinical courses of affected patients were similar to those in cases of exudative erythema or neutrophilic erythema. The collagen fiber attack reaction resolves within a short period of timeʼ therefore, it is probably not autoimmune-mediated.