The association of gastric antral vascular ectasia (GAVE), which is an unusual vascular abnormality, and systemic sclerosis (SSc) has recently attracted much attention. In this study, we investigated clinical features of SSc patients complicated by GAVE. The prevalence of anti-RNA polymerase III antibody and modified Rodnan total skin thickness score were significantly higher, while hemoglobin levels were significantly lower in SSc patients with GAVE than in those without. Longitudinal observation of GAVE with endoscopy suggested the potential therapeutic effects of intravenous cyclophosphamide pulse and tocilizumab on this complication associated with SSc. Given that GAVE can cause severe acute or chronic gastrointestinal blood loss even in the early stage of SSc, screening with upper endoscopy is quite important for SSc management.

A 7-month-old breast-fed infant presented to our hospital for perioral and buttock eczematoid lesions and erosions. He was a full-term infant and the third child. He had been treated with topical corticosteroids for the skin lesion for two months, but his symptoms did not improve. Diarrhea and hair loss on the occipital region were also observed. His siblings (9 years old and 7 years old) had also been completely breast-fed, but no similar symptoms had been observed. The serum zinc concentration in the patient and the zinc concentration in the breast milk of the mother (35 years old) were both low. We performed a sequence analysis of the SLC30A2 gene using a peripheral blood sample after obtaining written informed consent from the mother; however, no gene mutation was detected. The patient was finally diagnosed with zinc deficiency due to low-zinc milk. The diarrhea improved promptly after starting 0.1 g of polaprezinc (containing about 3.4 mg zinc) daily, and the serum zinc concentration in the patient was within the standard value 2 weeks later. The skin lesions began to improve. One month later, uniform hair growth was observed at the occipital region. With the start of baby food, the polaprezinc was tapered and discontinued six months later. Following the discontinuation, no recurrence of the skin lesion was observed in the next year.

A 78-year-old Japanese male was referred to us with 14-month history of a red colored nodule on his left upper arm. It was 2 cm in diameter, painless, dome-shaped reddish-brown nodule with epidermal erosion. Histopathologically, scattered alveolar nodules was composed of neoplastic cells in the dermis: there were no connections with overlying epidermis. Numerous lymphocytes and plasma cells had infiltrated around the nodules. We diagnosed him with lymphoepithelioma-like carcinoma of the skin (LELCS). However, the total excisional specimen revealed the findings of Bowen's disease and squamous cell carcinoma, which were not observed in the biopsy specimen initially, so he was finally diagnosed as squamous cell carcinoma with LELCS findings.

A delayed large local reaction is the most common cutaneous adverse reaction after mRNA-1273 (Moderna, Inc. MA, USA) vaccination against SARS-CoV-2; it is characterized by erythema, subcutaneous induration, and tenderness that persists for approximately 7-11 days after the injection. We encountered three cases of delayed large local reactions after a first injection of the mRNA-1273 vaccine. All the cases resolved without treatment or with only symptomatic treatment, although the size of the erythema and level of tenderness differed among the cases. It is relatively straightforward to diagnose delayed large local reactions based on their characteristic clinical course. Because any delayed large local reaction after the second injection is usually weaker, it is not necessary to avoid a second injection even if this reaction occurs after the first one.

Psoriasis treatment mainly involves topical treatments, but these are often inadequate in terms of convenience and effectiveness for widespread lesions, severe cases, and intractable areas. Although topical combination formulations that minimize these problems are considered first-line therapy, a new treatment in the form of foam has become available. We evaluated calcipotriol / betamethasone dipropionate (Cal / BDP) foam considering its new mechanism of action, efficacy, safety, PROs, and usefulness as a new treatment for difficult-to-treat lesions. Based on our results, we recommend Cal / BDP gel as it is already used for the scalp and propose Cal / BDP foam as a promising new topical treatment option for the body and intractable areas.