One recent problem faced by the Japanese medical care system is an imbalance in the distribution of doctors and healthcare resources among the various regions of the country. In Kumamoto Prefecture, the numbers of both doctors and certificated dermatologists per 100,000 people are higher than the average number per 100,000 people in Japan. However, there is still a marked imbalance in the distribution of doctors and dermatologists among the various districts of the prefecture. To investigate this issue, we examined the National Health Insurance claims made throughout May of 2009. The local consultation rate in the Kumamoto, Yatsushiro, and Kuma Medical Districts was greater than 90%, while it was only 22% in the Aso Medical District. Patients from the northern Kumamoto area often went to the Kumamoto Medical Districts, and patients in the Aso Medical District often went to the Kikuchi or Kamimashiki Medical Districts. Patients aged 15 to 64 years went to other medical districts more frequently than did patients in other age group. Approximately 75% of the patients suffering from skin diseases consulted dermatologists in the Kumamoto Prefecture, and 78% of the patients consulted dermatologists within the Kumamoto Medical District.
A 57-year-old woman had a history of drug eruptions caused by antibiotic and antipsychotic drugs. A rash appeared over her whole body with fever one day after oral administration of sinus medicine A (chlorpheniramine maleate, belladonna total alkaloids, pseudoephedrine hydrochloride, dipotassium glycyrrhizinate, anhydrous caffeine), an over-the-counter medicine for rhinitis. Her symptoms worsened, even after the start of oral antihistamine and steroid ointment, and facial swelling arosed. A urinary tract infection was indicated by urinary findings and imaging studies. Systemic administration of antibiotics and steroid improved both her rash and urinary findings. Drug lymphocyte stimulation testing and patch testing were positive for sinus medicine A and for belladonna total alkaloids among the components of the drug. Although belladonna total alkaloids are present in a number of over-the-counter drugs, similar cases have never been reported. Therefore, attention should be paid to this possibility.