We report here sixteen cases treated with targeted irradiation with 308-nm monochromatic excimer light (male: female=7:9, mean age: 35). Among them, 11 were the non-segmental type, and 5. the segmental type. Treatments were given once a week for a minimum period of 2 months. Efficacy was assessed based on the percentage of repigmentation. An excellent response (75-100% area of repigmentation) was obtained in 1 patient (6.2%). a good response (25-75%) in 4 (25%), and a moderate response (5-25%) in 8 (50%). In summary, 37.5% of our patients had more than 25% repigmentation. Adverse events were limited and transient. Therefore, 308-nm monochromatic excimer light therapy may be a valid therapeutic option worthy of consideration in the treatment of vitiligo.
Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells with overtly malignant cytological features and is considered a higher-grade variant of Langerhans cell histiocytosis (LCH). In 2001, the World Health Organization (WHO) categorized malignant neoplasms derived from Langerhans cells into two categories: LCH and LCS. LCS is principally diagnosed by histopathological findings. There have only been 27 LCS cases reported thus far. LCS originating from the skin is rare; only 10 cases have been reported. We report a 76-year-old woman who had a plaque on the scalp. Hematoxylin-eosin stained images showed a malignant, pleomorphic component with diffuse proliferation of tumor cells with grooved nuclei, distinct nucleoli, and an abundant cytoplasm from the dermis to the subcutaneous layer. An immunohistochemical study revealed positive CD1a, langerin, and S-100 protein staining. While the MIB-1 index was high (90%), mitosis was 20/10 under a high-power field, which does not fulfill the WHO 2008 criteria (criterion is >50/10 under a highpower field). However, we considered that our case was not LCH, but LCS, because of the distinction of LCH is in the clinical appearance, which differed from previous cases described in textbooks. Utilizing a comparative review of the clinical appearance 10 examples of LCS occurring from the skin reported thus far, we compared them with our case. With regard to the site of occurrence, four of seven cases were found in the extremities, two cases were found in the abdomen, and one in the scalp. The lesions were mostly solitary tumors or plaques, in contrast to LCH, which mostly consists of multi-centered eczematous or papular lesions.
Patients diagnosed with primary cicatricial alopecias (PCAs) at the dermatology outpatient clinic at Tokyo Medical University between April of 2002 and March of 2010 were collected and clinically analyzed. Sixty-five patients were diagnosed with PCA during this 8-year period. This number represented 0.1% of the total number of dermatological consultations (n=54,371) and 1.9% of the total number of trichogenic consultations (n=3,421) at our hospital. The study population included 41 female and 24 male Japanese subjects with a female/male ratio of 1.7:1. The age of onset ranged from 0 to 84 years (mean age: 41.1±19.9 years). The mean duration of the condition was 5.4±5.1 years. Thirty-seven patients (56.9%) had subjective symptoms such as pruritus and pain. The patients were subdivided as follows: chronic cutaneous lupus erythematosus, 14 cases (21.5%); lichen planopilaris, 17 patients (26.2%; frontal fibrosing alopecia, 7 patients (10.8%; classic pseudopelade of Brocq, 5 patients (7.7%); folliculitis decalvans, 10 patients (15.4%); dissecting cellulitis, 1 patient (1.5%); folliculitis keloidalis, 9 patients (13.8%); not categorized, 2 patients (3.1%). The patients classified in the lymphocyte infiltration group were treated mainly with corticosteroids, and those classified in the neutrophil infiltration group were treated with both corticosteroids and antibiotics. More than half of all the patients showed improvement of inflammation and suppression of further expansion of alopecia lesions.