We examined the histopathological diagnosis of 1,527 patients that had been clinically diagnosed with keratoacanthoma (KA) at Sapporo Dermatopathology Institute. Of these 1,527 patients, 873 were male, 650 were female, and 4 were of unknown gender. Those lesions were most frequently located on the face (in about two thirds of cases). In 999 patients (65.4%), the histopathological architecture of KA was observed (KA lesion). The mean age at resection of KA lesion (68.3±15.1 years old) was significantly higher in these patients than in patients without KA histopathological architecture (non-KA lesion) (61.0±20.5 years old). In sun-exposed areas, the rate of KA lesions was high; 28.5% of the patients had malignant neoplasms. Notably, in patients over 60 years old, 39.0% of cases were malignant. The rate of malignant lesions was highest in sun-exposed areas in elderly patients. The mean age at resection of malignant lesions (77.5±11.5 years old) was significantly higher than for benign lesions (61.1±17.3 years old). The 1,527 cases included 1,397 (85.9%) epithelial tumors, 99 (8.5%) non-epithelial tumors, and 31 (2.0%) inflammatory lesions. Based on our finding, lesions clinically suspected as KA should be totally resected as soon as possible, especially on the faces of elderly patients.
We describe two cases of refractory psoriatic uveitis treated successfully with infliximab. Case 1: A 54-year-old man was diagnosed with erythrodermic psoriasis at the age of twenty-eight. He had suffered from severe and uncontrollable psoriatic skin lesions, and he developed uveitis in the right eye after ten years. He was orally treated with prednisolone (15 mg/day), but blindness resulted in the right eye due to intractable uveitis. He consulted our hospital for his continuous skin and eye disorders in 2011. His symptoms improved promptly after treatment with infliximab (5 mg/kg), although he presented with recurrence of the skin and eye symptoms before the seventh infliximab treatment. However, they are now being controlled well by an increased dose of infliximab (6.6 mg/kg). Case 2: A 34-year-old woman was diagnosed with psoriasis vulgaris at the age of nineteen. After delivering her first child in 2010, the skin rash suddenly disseminated over her trunk and extremities. She also suffered from severe arthritis in several joints and the arthritis responded poorly to the oral methotrexate treatment (6 mg/week). Moreover, ophthalmological examination revealed uveitis and optic neuritis in the right eye. Her symptoms improved promptly after applying infliximab (5 mg/kg) in addition to oral methotrexate treatment. Although in the skin, joint, and right eye symptoms exacerbated slightly before the fourth infliximab injection, they are now controlled well by increasing dose of infliximab (6.2 mg/kg) and methotrexate (8 mg/week). We also review five cases of psoriatic uveitis in our hospital, including the above mentioned cases, and discuss some risk factors for the development of psoriatic uveitis.
Nineteen patients with severe atopic dermatitis, including 12 males and 7 females (ages: 21～73 year-old, body weight: 33～80 kg) visiting Aichi Medical University Hospital between October 2009 and February 2011, were enrolled in this study. Patients were given 100 mg cyclosporin microemulsion (Neoral®) once daily, regardless of their weight or skin condition, before breakfast. We assessed the Severity Classification of Atopic Dermatitis by the Japanese Dermatological Association (simple method), quality of life by Skindex16, itching and drowsiness by Visual Analog Scale (VAS), and the results of blood examinations, including peripheral blood eosinophil count, serum total IgE, lactate dehydrogenase (LDH), and thymus and activation-regulated chemokine (TARC) levels. In all patients, improvement of skin manifestations was achieved with 20～85% (average 63%) improvement of skin scores after 8 weeks of cyclosporin treatment and without any adverse side effects. Peripheral blood eosinophil count, LDH, and TARC levels were also decreased. When the patients were divided into two groups based on skin scores after treatment (less than 5 or 5 and more), rapid and significant reduction of serum TARC levels were observed in the improved group, indicating that serum TARC levels seem to be a good marker for effectiveness in this low-dose cyclosporine treatment of atopic dermatitis.
The IgE-binding epitope in red meat allergy is recently reported to be oligosaccharide galactose-α-1,3-galactose in patients residing in the U.S.A. We evaluated 20 patients with red meat allergy referred to the Department of Dermatology, Shimane University Hospital, and found that all of them had specific IgE antibodies against beef, pork, and cetuximab in their sera, indicating that the IgE reacted to oligosaccharide galactose-α-1,3-galactose. Interestingly, 15 of the 20 patients with red meat allergy also had episodes of a hypersensitivity reactions to flounder roe. Absorption experiments revealed that the flounder roe allergen has cross reactivity with the red meat allergen. Most of our patients reside in a high prevalence area of Rickettsia japonica and have a dog as a pet, although none of the patients has a previous history of Rickettsia japonica infection. Therefore, not a rickettsial infection but a tick bite, and a dog as a pet, may possibly correlate with red meat allergy in our patients, as suggested for the patients in the U.S.A.