A 70-year-old Japanese woman had been diagnosed and treated with oral administration of steroid along with potassium iodide in the division of gastroenterology and the division of dermatology of her hometown hospital for a ten-year history of Sweet disease (SD) accompanied by Crohn’s disease. Since 2003, she had been treated in the division of gastroenterology with maintenance therapy with oral prednisolone 7.5 mg daily along with potassium iodide 900 mg daily. On April, 2009, severe indurated and ulcerated erythema appeared on her trunk, expanding to her head and the fingers without exacerbation of CD. The histopathology revealed neutrophilic and lymphocytic infiltrations throughout the dermis. She was diagnosed as pyoderma gangrenosum (PG). Severe anemia and decreased platelets were associated problems. A bone marrow biopsy showed atypical plasmacytoid myeloma cells. In addition, she had an increased level of IgA lambda chain by serum electrophoresis and positive Bence-Jones protein by urine test. Thus the association of multiple myeloma (IgA lambda type) was established. The cutaneous manifestations were successfully treated with increased prednisolone 30 mg daily. In contrast, the MM has been refractory and complicated with persistent biphasic cytopenia, repeated pneumonitis, and dyspnea, despite treatment with MP (prednisolone, melphalan) therapy or intravenous bortezomib injection, so she is now under treatment. We believe this case falls within the spectrum of the neutrophilic dermatosis of myeloproliferative disorders. When PG develops without exacerbation of CD, we should consider and test for an association of malignancy of intestinal or other organs. Such a case of PG following MM in a patient with CD and associated with SD has never previously been described, to the best of our knowledge.
To objectively evaluate the efficacy of moisturizers with regard to differences of application volume and frequency, we examined their effects on the artificially dried skin (experimentally-induced dry skin) of healthy subjects. Heparinoid preparations (Hirudoid® lotion or Hirudoid® soft ointment) were applied at 0.5 mg/cm2, 2 mg/cm2 and 3 mg/cm2 once daily in the morning or 2 mg/cm2 twice daily in the morning and evening after bathing to acetone/ether-water-dried skin of the inside forearms for 14 days. The conductance of the stratum corneum was measured before the application and at 1, 2, 5, 6, 7, 8, 9, 12, 13 and 14 days after the application. With both preparations, there were no significant differences in the conductance of the stratum corneum among the application volumes. Compared with the once-daily application, the twice-daily application resulted in significantly higher conductance of the stratum corneum at almost all points of measurement in both applications. This study suggested that twice-daily application of Hirudoid preparations was more effective than oncedaily application.
About 7 years ago, a 57-year-old man presented with a subcutaneous nodule about 1cm in diameter on his right lower leg. It became hard and painful after massage. Ultrasonography revealed a hypoechoic, slightly heterogeneous, subcutaneous mass. Color Doppler examination showed high vascularity in the tumor, but blood flow disappeared when it was massaged and it became hard and painful; the flow reappeared when we warmed it. Histopathological examiniation revealed it to be an angioleiomyoma, which is known for paroxysmal pain. Such a change in ultrasound sonography findings before and after pain has never been reported.