The Japanese Journal of Dermatology
Online ISSN : 1346-8146
Print ISSN : 0021-499X
ISSN-L : 0021-499X
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Volume 134, Issue 2
Displaying 1-9 of 9 articles from this issue
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Guidelines
Seminar for Medical Education
Original Articles
  • An Observational Study of Atopic Dermatitis Educational Hospitalization Intervened by a Nurse Certified by the Japanese Dermatological Association
    Chie Kuno, Yuko Higaki, Kayoko Suzuki, Kyoko Futamura, Kayoko Matsunag ...
    2024 Volume 134 Issue 2 Pages 309-319
    Published: February 20, 2024
    Released on J-STAGE: February 20, 2024
    DOIhttps://doi.org/10.14924/dermatol.134.309
    JOURNAL RESTRICTED ACCESS
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    From November 2018 to April 2021, 67 AD patients underwent 2-week educational hospitalizations, during which topical therapy and skin care instruction were provided by a Japanese Society of Dermatology certified nurse who is an expert in skin care. The nurse was present in the bathroom during bathing on the first day of admission and observed how patients washed and shampooed their skin. The nurse found that many patients were using inappropriate method, such as scrubbing or not lathering soap enough. The nurse instructed them to lather the soap thoroughly and wash with the palms of their hands without rubbing. Regarding topical therapy, 65% of the patients did not know the proper amount of ointment. Therefore, we taught them the 1-FTU method. After the instruction, all patients responded that they now understood how to wash their skin and apply topical agents appropriately and that they could continue these skin care methods after discharge. The median POEM score at discharge decreased significantly from 19 points to 4 points (p<0.001), compared to admission. However, four weeks after discharge, the score increased to 7, a significant level compared to discharge (p=0.02). Measuring quality of life by the Skindex-16, the scores on the symptoms, emotions, and functioning scales improved significantly at discharge and were maintained throughout the observation period. However, compared to scores at discharge, symptom scores were significantly higher 4 weeks post-discharge (p=0.01). All patients were "satisfied" with educational hospitalization, topical therapy, and skin care instruction. These results suggest that topical therapy and skin care guidance by skin care specialists, who are nurses certified by the Japanese Dermatological Association, are effective in controlling AD skin conditions and improving patients' quality of life. Additional guidance within 4 weeks after discharge from the hospital may help patients to continue with more appropriate skin care.

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Case Reports
  • Disseminated Cutaneous Leishmaniasis Presenting as Multiple Skin Ulcers Was Misdiagnosed and Treated as Refractory Pyoderma Gangrenosum: A Case Report
    Yuki Kobayashi, Takayuki Fusumae, Mai Wada, Sayuka Arakawa, Chizu Sanj ...
    2024 Volume 134 Issue 2 Pages 321-328
    Published: February 20, 2024
    Released on J-STAGE: February 20, 2024
    DOIhttps://doi.org/10.14924/dermatol.134.321
    JOURNAL RESTRICTED ACCESS
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    A 54-year-old man with a travel history in South America presented at our hospital with an ulcer on his left elbow that initially appeared 3 years earlier. He was initially diagnosed with a nontuberculous mycobacterial infection and received antibiotic treatment at a hospital. Subsequently, he was diagnosed with pyoderma gangrenosum and treated with systemic steroids, immunosuppressive drugs, and TNF-α inhibitors at a different hospital. The ulcers remained unresponsive to treatment, resulting in progressive deterioration of his condition. Due to the immunosuppression, the patient was complicated with invasive pulmonary aspergillosis and underwent a right upper lobectomy. When he arrived at our hospital, he had multiple skin ulcers on his face and trunk, erosions and crusts on the left nasal mucosa and the lip. The skin biopsy specimen from the previous hospital revealed infiltration of dense inflammatory cells, necrotic lesions, granulomatous changes, and kinetoplast-bearing parasites. ELISA using Leishmania protozoan antigen (thiol-specific antioxidant) was strongly positive. PCR analysis of the specimen confirmed the presence of Leishmania infantum, establishing the diagnosis of disseminated cutaneous leishmaniasis. Oral steroids were tapered, and he received liposomal amphotericin B and itraconazole to treat invasive pulmonary aspergillosis, significantly improving his general condition and healing the skin lesions. Although leishmaniasis is one of the Neglected Tropical Diseases and is extremely rare in Japan, his worsened condition was primarily due to iatrogenic complications and delayed diagnosis. Leishmaniasis should be considered as a differential diagnosis in patients with refractory ulcers who have a travel history to endemic area for leishmaniasis. This case emphasizes the importance of a comprehensive evaluation when managing refractory ulcers.

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