We experienced four cases of group A streptococcal (GAS) deep tissue infections, including three cases of toxic shock-like syndromes (TSLS). None of them were immunosuppressed, but all of them had antecedent flulike symptoms, injury, or tinea pedis, which was supposed to be the cause of the GAS infection. Test exploration was very important and useful, because we could test the exudate with rapid immunoassay kits for antistreptolysin O (ASO) and Gram stain and promptly decide which antibiotics to use. Test exploration also enabled us to proceed to swift intervention when necrotic soft tissue, lack of bleeding, thrombosed vessels, and white-yellowish exudate were found, thus avoiding amputation.
We performed a clinico-pathological study of 211 cases of spiradenoma diagnosed at the Sapporo Dermatopathology Institute. These 211 cases included 104 males and 107 females, and the mean age at resection was 52.8±15.9 years. The lesions were located most frequently on the trunk (84 cases: 40.6%), followed by the face (45 cases: 21.8%).The mean size of the lesions in the 186 case reports that included this information was 14.1±9.0 mm. Forty cases (19.0%) were reported as painful. Cylidroma was observed histopathologically in four cases (1.9%) and spiradenocarcinoma in three (1.4%). In the slides that still remained from 58 cases of spiradenoma, we retrieved detailed histopathological findings. Cystic structures were observed in 28 cases (48.3%). Histopathologically, we divided the cases into a vascular proliferatiing type (25 cases: 43.1%) that exhibits granulation tissue with edema, proliferation of blood vessels, and inflammatory cell infiltrations into the stroma and a more common type (33 cases) without those findings. The age at resection of the vascular proliferating type (mean 59.1±12.9 years) was significantly higher than that of the common type (mean 49.6±14.7 years). The size of the lesion in the vascular proliferating type (mean 18.6±9.9 mm) was also significantly larger than that of the common type (mean 12.1±6.3 mm).
Among the pediatric patients taken to the outpatient clinic of the Department of Dermatology at Juntendo University Urayasu Hospital between April 2008 and December 2012, 7 cases of suspected child abuse (physical abuse) were detected. The ages of these pediatric patients ranged from 8 months to 3 years 10 months. All were brought to our hospital for skin burns and were admitted because child abuse was suspected based on inexplicable burn patterns, inconsistency between the injury circumstances/time courses that were obtained from the parents, and clinical findings of rash, etc. While these pediatric patients were hospitalized, we carefully observed them and their parents in cooperation with the Child Rescue Team. Because the burns were determined to have been caused by child abuse, all 7 cases were reported to the Child Guidance Offices in the areas where these pediatric patients lived. In this article, along with descriptions of the clinical courses of the 7 cases, we also discuss how to handle child abuse cases, which are considered to be challenging.
The increased use of molecular-targeted cancer drugs results in challenges for the management of dermatological adverse reactions. We conducted an online survey of dermatologists in Japan to analyze these challenges. Methods: Two questionnaires were distributed online from December 2011 to January 2012 to dermatologists subscribing to CareNet. Results: The primary survey on the treatment experience of molecular-targeted drug-induced dermatological reactions revealed that 88.5% (154/174) of hospital doctors and 61.0% (61/100) of general practitioners had relevant experience. A secondary survey included a wider range of dermatologists with treatment experience and found that 85% of practitioners had treated ≤5 patients while many hospital doctors had approximately 10 patients annually. Nearly 90% of the patients treated by hospital dermatologists were within-hospital referrals; about 70% of patients treated by practitioners sought treatment spontaneously. The primary drugs of choice for the majority were topical steroids, oral tetracyclines and topical moisturizers. Discussion: Although many dermatologists already manage dermatological disorders associated with molecular-targeted drugs, their cooperation with oncology departments is not fully established. To facilitate supportive care for patients, dermatologists should recognize their crucial role in developing and providing effective management strategies and should strive for further studies and closer cooperation with the oncology professionals to optimize this role.