To obtain evidence for the prognosis of pain in patients with herpes zoster, we are performing a one-year study in patients administered amenamevir. Herein we provide an interim report based on the participation of 753 subjects for 6 months. Disappearance of pain in patients with herpes zoster decreased around the 3rd month after treatment began, and the major pain switched from nociceptive to neuropathic pain. Our findings suggest that neuropathic pain (that is, risk of postherpetic neuralgia) increases in patients with more severer rash and pain at the start of treatment. Electrical shock-like pain, a feeling of numbness, and thermal pain tended to remain, and the incidence of persistent pain in the face, head, dorsal part of the thorax, and upper extremities were slightly higher.
We retrospectively analyzed efinaconazol 10% topical solution (efinaconazol) treatment outcomes for patients with various severities and clinical types of onychomycosis, including severe cases in which systemic therapy is typically recommended. A total of 240 patients who tested positive for fungi in toenails, 122 males and 118 females with a mean age of 65.5 years, were treated with efinaconazol for 1~36 months (mean 10 months) from December 2014 to September 2019. We investigated the changes in the infected areas of the most severely affected toenails. The rate of clinical types were DLSO 51%, TDO 37%, SWO 6%, PSO 3%, YS 3%; 86% of the toenails with more than 50% involvement. Notable healing began 1 month after the start of treatment. We observed the reduction of the affected nail areas until the 20th month. The complete cure rates were DLSO 54%, TDO 14%, SWO 100%, PSO 0%, YS 56%. It has been suggested that more severely affected toenails may be cured with about 2 years of treatment. Of our target toenails, 95% showed improvement. The only adverse events was contact dermatitis around local site (3.8%). Efinaconazol therapy exhibits an excellent balance between efficacy and safety, and it can serve as a useful treatmernt for some kind of onychomycosis.
A 70-year-old man presented with a dark red nodule on his left upper arm after 10 months after complete remission from chemotherapy for his acute myeloid leukemia. The location of the nodule matched the catheter insertion site for his chemotherapy. Histopathology showed a dense infiltration of tumor cells expressing identical markers to the primary acute myeloid leukemia. These findings led to a diagnosis of leukemia cutis. Leukemia cutis is a relatively rare condition recognized as a poor prognostic factor for leukemia that tends to develop after previous inflammation and trauma. Lesions relating to catheterization are not common, so dermatologists should be aware of this pathognomonic disease.
The patient was a 65-year-old man who had a-few-year history of skin tumor on his left cheek. He was treated with antibiotics elsewhere with no response other than gradual enlargement. When he then visited our hospital, he presented with a 40 × 38 mm in diameter, pale red, multi-nodular subcutaneous mass; it had an ulcerative lesion in the center. Lymph nodes were swollen in his left neck. Ultrasonography showed a multilocular cyst structure. Skin biopsy taken from the tumor and positron emission tomography-computed tomography identified squamous cell carcinoma (SCC) with left cervical lymph node metastasis. After the complete resection and cervical lymphadenectomy, he was treated with radiotherapy in conjunction with systemic administration of S-1. Histologically, the cystic structure was obvious in the resected specimen, and the SCC was consecutive with the cyst wall. Although SCC rarely generates from epidermal cyst, patients with this condition often have atypical clinical manifestations. It is important to understand its characteristics for an accurate diagnosis.