We describe two patients with dermatomyositis (DM) who presented with unique follicular keratotic papules in addition to the classical skin manifestations of DM. Histopathological evaluation of cutaneous specimens revealed columnar dyskeratosis, clusters of keratinocytes, lymphocytic vacuolar interface dermatitis, dermal melanophages, vasodilatation in the superficial dermis, and extensive dermal mucin deposition. DM characterized by follicular keratotic papules is referred to as Wong-type DM. The papules were detected in our patients with classical skin manifestations of DM; therefore, we propose that "Wong's papule" would be an appropriate term to describe such lesions.
Topical immunotherapy with SADBE or DPCP is one of the most effective therapies for alopecia areata. It has been utilized for more than 40 years and recommended in several international clinical guidelines. However, its positioning in medical and business laws has not been fully updated in Japan. Now, The Evaluating Committee for Highly Difficult New Medical Technologies in Kagawa University Hospital has approved this topical immunotherapy under the Ordinance for Enforcement of Medical Care Act in Japan. This process can be a model for the approval of topical immunotherapy in other advanced treatment hospitals in Japan.