We evaluated the clinical efficacy and adverse events of cepharanthin combination therapy for alopecia areata in 71 patients aged 16 years or older. The drugs or therapies used with cepharanthin were a glycyrrhizin preparation, an external steroid preparation, liquid carpronium chloride, and liquid nitrogen. The clinical efficacy of this study of 71 patients, was a complete response in 8 patients (11.3%), an effective one in 34 patients (47.9%), a minor response in 23 patients (32.4%), no change in 5 patients (7.0%) and aggravation in 1 patient (1.4%). Therefore, 42 of these 71 patients had positive responses (59.2%). Nine patients with alopecia areata monolocularis were treated with dual therapy, and 7 of them (77.8%) were treated with the combination of cepharanthin and an oral glycyrrhizin preparation. Amomg the patients with alopecia areata multilocularis, there were no significant differences in clinical efficacy between the group with dual treatments and those without them Within the dual therapy groups, the most successful treatments were the combination of cepharanthin with an external preparation of carpronium chloride liquid (8 patients, 88.9%), and the combination of cepharanthin with a steroid external preparation (3 patients, 75.0%). However, the combination of oral cepharanthin and an oral glycyrrhizin preparation was effective in only 11 patients (45.4% which is significantly (p<0.05) lower than the combinations of oral and external preparations. Our data indicate that the combination of oral cepharanthin and external preparations such as carpronium chloride or a steroid, may be more effective than the combination with oral cepharanthin and an oral preparation.
Case 1: A 68-year-old man had a 10-year history of repeated episodes of exudative erythema with pruritus on his upper and lower extremities. Cervical and axillary lymphadenopathy, parotid and submandibular sialoadenitis, and renal dysfunction with proteinuria also developed during this time. Histopathologically, renal biopsy specimens showed an IgG4-positive plasmacyte infiltration, and skin biopsy specimens showed an infiltration of IgG4-positive plasmacytes and eosinophils into the dermis based on these histopathological findings and the increased serum IgG4, he was diagnosed with IgG4-related disease. His clinical findings disappeared after administration of oral steroids, but relapsed after discontinuation of the drug. Case 2: A 74-year-old man visited our department for evaluation of red papules with strong pruritus on his lower extremities and CT findings of sclerosing cholangitis, pulmonary fibrosis, and retroperitoneal fibrosis. Histopathologically, duodenal diverticulum biopsy specimens showed IgG4-negative plasmacyte and eosinophil stromal infiltration, which was compatible with asymptomatic cholangitis. Skin biopsy specimens showed IgG4-negative plasmacyte and eosinophil upper dermal infiltration. IgG4-related disease was diagnosed based on these histopathological findings, CT findings of mass lesions with fibrosis, and increased serum IgG4. The skin eruptions in both of our cases were considered to be symptoms of IgG4-related disease. The combination of the dermal eosinophil infiltration, serum eosinophilia, and increased TARC level suggests that Th2 cells might be involved in the pathogenesis of these lesions.
We examined the psychosomatic peculiarities of 1,458 female patients frequenting our ambulatory clinic between 2004 and 2010. Among 3,414 diagnoses, 37.3% had eczema/dermatitis, (344 cases of atopic dermatitis, 228 of asteatotic eczema, 81 of hand eczema, 74 of seborrheic dermatitis, and 305 cases of other eczemas). Furthermore, there were 17.2% with skin-appendage disorders (442 cases of acne, 47 of alopecia areata, and 44 of rosacea-like dermatitis). We diagnosed 23.9% of all patients with psychosomatically induced skin ailments (129 atopic dermatitis cases, 48 acne, 47 other eczemas, 27 urticaria). The main stressors could be classified according to the DSM-IV/4th axis in 79.4% of psychosomatic cases (42.3% occupational troubles, 35.5% family-related problems; the major factors were interpersonal relationships). The 21–39 yr group had mainly occupational problems, but the 40–59 yr group suffered mainly from family-related problems. The 20.6% if stressors not covered by DSM-IV were non-dermatological somatic ailments, mental afflictions, and inadequate interpersonal coping with unclear stressors. Among our female patients, psychosomatic skin ailments are not unusual. Ideally, we try to grasp what stresses these patients and, at the same time, to give them the ability to cope with the stress, especially to become more skillful in interpersonal relations. In our opinion, parallel psychosomatic approaches should be used.