We carried out a questionnaire survey of dermatologists and patients with acne vulgaris to investigate their actual condition and need for treatment of postinflammatory erythema (PIE) and postinflammatory hyperpigmentation (PIH). The psychological impacts of PIE and PIH on patients were as strong as those of inflammatory lesions and atrophic scars. Although approximately 80% of dermatologists were willing to treat PIE and PIH in response to patients' wishes, the actual number of patients who received treatment for PIE and PIH were only 41.3% and 29.0%, respectively. Although the most frequent treatment for PIE and PIH was topical or oral vitamin C, only half of dermatologists and patients were satisfied with this treatment. Since the treatment options for PIE and PIH are limited, we recommend appropriate treatment for the acute inflammatory phase followed by maintenance therapy for comedones and inflammatory eruptions to prevent consequent PIE and PIH.
A 56-year-old male patient initially presented with a nodule in the lower leg and subsequently with an enlarged inguinal lymph node 2 months later. Biopsy of the nodule revealed the presence of proliferative CD30-positive large atypical cells. These cells stained negative for anaplastic lymphoma kinase (ALK) and positive for cutaneous lymphocyte antigen (CLA), so the patient was initially diagnosed with primary cutaneous anaplastic large cell lymphoma (pcALCL) of the lower limb with inguinal lymph node infiltration. During the course of treatment, the lesions were restricted to the lower limb and inguinal lymph node. Unfortunately, the treatments including surgical resection, radiation therapy, systemic chemotherapies, and brentuximab vedotin, were not effective and the patient died one year after the onset of the disease. Because the lesion stained positively for epithelial membrane antigen (EMA), the patient was diagnosed with ALK-negative systemic ALCL. Given the difference in prognosis, it is important to distinguish between pcALCL and ALK-negative ALCL. EMA-positivity was an important indicator of systemic disease.
We report on the epithelialization rate of refractory ulcers after grafting cell sheet derived from self-epidermal skin (JACE®, a procedure now covered by insurance) against intermediate dystrophic epidermolysis bullosa of 69-year-old woman (case 1) and 48-year-old woman (case 2). In Case 1, at 12 weeks after surgery, the epithelialization rate of ulcers on 7 sites on the back and 7 sites on both legs were 93.9% and 100%, respectively; 10 sites fully epithelialized. In Case 2, at 11 weeks after surgery, the epithelialization rate of the ulcers on 4 sites on the back and 10 sites on the right side of the abdomen were 53.5% and 87.9% respectively; 6 sites were fully epithelialized. In both cases, good reduction in ulcer area were obtained using cell sheet derived from self-epidermal skin.