A 77-year-old man presented with tense blisters on both legs and petechiae on his toe. He had a 14 year history of rheumatoid arthritis resistant to systemic steroids and bucillamine. The histopathological findings revealed a dense, dermal, mainly neutrophilic infiltrate without any features of vasculitis. Treatment with 75 mg/day dapsone was enough to improve his eruptions. Bullous rheumatoid neutrophilic dermatosis (RND) is one type of RND that often needs to be ruled out from bullous pemphigoid. Most cases of bullous RND have been reported in Japan. Thus, it is suspected that bullous RND may have a genetic component.
Many atopic dermatitis patients are treated with topical steroid of inadequate strength or with mixtures of two or more topical product such approaches can result in chronic severe inflammation with lichenificated plaque. We treated 46 such refractory atopic dermatitis patients, who visited our outpatient clinic from 2012 to 2014, with only way strong or strangest topical steroids, and examined the period of time till remission. All the patients were successfully induced into remission, within an average of 9±4 days. In order to induce remission atopic dermatitis patients, we concludethat treatment utilizing topical steroid of adequate strength appears to be the most important.
A 77-year-old man with septic shock induced by calculous cholangitis was treated with dopamine (DOA) administered through the great saphenous vein, resulting in dopamine gangrene, necrosis, and blister formation around the insertion site on the bilateral lower legs. The leg ulcers were topically treated after debridement; however, he died from multi-organ failure. Even a low-dose of DOA can cause contraction of the peripheral vessels because the elevated local concentration of the drug, resulting in extensive skin necrosis.