Background: Most of the cutaneous melanoma patients with stage 2 or 3 disease in Japan have offered to undergo adjuvant therapy with intradermal injection of interferon beta (IFNβ). Nearly half of the patients in Japan develop melanoma in the hand or foot, severe pain due to the intradermal injection has been a problem. Materials and methods: To investigate the possibility of pain improvement by using a thinner 34 G needle when injecting IFNβ intradermally, we conducted a clinical trial by scoring pain using visual analog scale (VAS). While using 29-gauge (G) needle for a control group and 34 G needle for a trial group, this study was conducted as a single-group, single-blind test. Each enrolled patient were assigned the fixed schedule of using either 29 G or 34 G and was injected IFNβ for 10 treatment days. The mean VAS score for each needle gauge was calculated in each patient to calculate the difference in VAS (δVAS) and this difference was analyzed statistically. Results: A total of 38 patients were enrolled in this study with a total injection number of 308 times and 8.1 injections per each patient. The mean VAS scores for 29 G and 34 G were 55.9 mm and 43.5 mm, respectively (P<0.00001, Wilcoxon test). The mean δVAS was -12.4 mm which means a 22% reduction in VAS. Conclusion: Although the reduction of VAS partly depended on the injection schedule and the site, injection of IFNβ using a 34 G needle was shown to reduce the VAS scale in most of the patients. Reduction of pain due to the IFNβ resulting from using thinner needle may lead to the higher compliance in adjuvant therapy.
This study investigated the detection of rubella virus genome by pharyngeal swab polymerase chain reaction (PCR) for differentiation of rubella from measles and maculopapular type drug eruption. A total of 36 patients who visited our hospital between November 2012 and October 2013 were clinically diagnosed or suspected as having rubella virus infection, and the results of pharyngeal PCR and enzyme immunoassay (EIA) from sera were compared. We also examined specific clinical symptoms and the results of haematology and biochemistry that were significantly associated with confirmed cases. Among 34 cases who underwent the EIA test, 27 were confirmed as either rubella or non-rubella affected. Two cases were not examined by EIA. Of a total of 36 cases, 28 were confirmed with rubella based on a PCR result; 7 cases were detected by PCR alone. Fever of ≥38°C, thrombocytopenia, elevated liver enzymes (AST and ALT), and elevated C-reactive protein (CRP) were significantly associated with confirmed rubella cases. In this study, rubella cases were identified more effectively, and at earlier time points, by the PCR test than by EIA. These results indicate that PCR testing may allow for more rapid treatment of patients and prevention of further transmission of rubella virus, thus preventing hospital infection or mass outbreak.
A 46-year-old man developed erythema and a few papules on the trunk and extremities, accompanied by a fever and headache. Laboratory data revealed leukocytopenia, decreased platelet count, and liver dysfunction. Tsutsugamushi disease was initially suspected; however, a case of a patient domestically infected with dengue fever reported to the Ministry of Health, Labour and Welfare prompted examination of this patient for dengue fever. The patient was positive for the IgM antibody to the dengue virus. Three weeks after the onset, the systemic symptoms and skin eruptions disappeared with desquamation of the palm and sole. The number of patients domestically infected with dengue fever may increase in Japan. Therefore, Japanese dermatologists should learn to recognize dengue fever-related skin manifestations for early diagnosis.
Quantitative evaluation of itch is important in assessing the treatment efficacy of itchy skin diseases. Especially for the evaluation of a specific anti-pruritic therapy, itch measurement should be performed according to a unified worldwide standard criterion. For this purpose, validation and harmonization studies of representative itch scales, such as the visual analogue scale, have been established. The 5D itch scale is made up of a simple self-administered questionnaire evaluating 5 domains of itch: duration, degree, direction, disability, and distribution. It was developed in USA in 2009 and has the advantage of providing a score. In this study, we created a Japanese version of the 5D itch scale using the standardized forward/backward translation method with a pretest.