Topical therapy is the primary therapeutic option in the treatment of mild to moderate psoriasis. In Japan, topical corticosteroids and/or vitamin D₃ analogues have been commonly used. Corticosteroids exhibit rapidly and notable efficacy for psoriasis, but have local side-effects such as skin atrophy, telangiectasia and folliculitis when corticosteroids are used in excessive duration. Topical corticosteroids can lead to a pustular flare of psoriasis once discontinued when used in high doses. Vitamin D₃ analogues have similar efficacy with strong corticosteroids, but have few side-effects, including skin irritation. Although as monotherapy, vitamin D₃ analogues are less effective than very strong or the strongest class of corticosteroids, individual combination regimens of corticosteroids and vitamin D₃ analogues were reported. Recently, the new two-composed product of corticosteroid and vitamin D₃ analogue was introduced in Japan. Clinical trials demonstrated that this combination product was more effective than either agent used alone, and side-effects were decreased compared with long-term monotherapy with corticosteroids. The combination product of corticosteroid/vitamin D₃ analogue is recommended as first-line induction therapy for mild to moderate psoriasis.

　Psoriasis is a chronic inflammatory skin disease, and topical treatments are basic and important modalities. However, compliance with topical treatments is poor because they are complex, time consuming, and stigmatic. In this study, we demonstrated the best way to introduce topical applications to psoriasis patients based on our clinical experience.

　Japanese Dermatological Association Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016 recommends three primary measures : (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for inflammation ; (ii) topical application of emollients to treat the cutaneous barrier dysfunction ; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. This review introduced summaries of topics regarding the topical corticosteroids in the guidelines.

　Peripheral blood eosinophil count, serum levels of LDH, and total IgE have traditionally been employed as biomarkers for disease severity and activity of atopic dermatitis. Chemokine TARC (thymus and activation-regulated chemokine) has been introduced as a new biomarker. TARC plays important roles in the pathogenesis of atopic dermatitis ; and serum TARC levels are much higher in patients with atopic dermatitis than in those with other skin diseases, and vary with disease severity, reflecting disease activity. Moreover, their value changes rapidly and greatly. Therefore, they are more useful than conventional biomarkers, for this type of monitoring. In addition, using serum TARC levels, it is possible to show patients therapeutic outcomes as mathematical values, and thereby enhance motivation for treatment. Monthly measurements of serum TARC are covered by insurance in Japan. A novel measurement method was developed, whose results can be obtained in a very short time, enabling doctors to review them before examining patients.

　Kathon CG is an isothiazolinone preservative that is widely used in hair care products, cosmetics and wet wipes. A concern recently reported is that the frequency of positive Kathon CG patch test results has been increasing. We present the case of a woman who experienced recalcitrant dermatitis on her scalp, face, upper arms and back for 5 years. In the Japanese standard allergen 2008 series, the patch test was positive for Kathon CG. Contact dermatitis caused by haircare products containing Kathon CG was suspected. The haircare products and facial cleanser that she routinely used did not cause a reaction, although they all contained Kathon CG. The skin rash was recalcitrant, with occasional flare-ups on her scalp, face and back even after discontinuing the products. We believe that the flare-ups may have been caused by the presence of Kathon CG in some other products that she routinely used.

　We have investigated 15 cases with positive Kathon CG patch tests. Fourteen were in women, who had frequent cutaneous lesions on the face and hands. Atopic dermatitis detected in six of the cases was considered to have resulted from relatively frequent exposure to Kathon CG.

　Background : We have reported the positive rates of Japanese standard allergens (JSA) since 1994. Objective : To examine JSA-positive rates. Subjects : 2,209 cases (male, n=533 ; female, n=1,676) in 2013 and 1,929 cases (male, n=424 ; female, n=1,505) in 2014. Results : The positive rates in 2013 and 2014 were high for the following allergens : nickel sulfate (15.1 and 16.7%, respectively) , urushiol (10.5 and 12.5%, respectively) , cobalt chloride (8.8 and 8.4%, respectively) , p-phenylenediamine (7.2 and 7.7%, respectively) , fradiomycin sulfate (7.7 and 7.6%, respectively) , gold sodium thiosulfate (5.2 and 5.7%, respectively) , and fragrance mix (6 and 5.6%, respectively) . The positive rates by gender in 2014 were higher for urushiol, potassium dichromate, lanolin alcohol, epoxy resin, and primin in males and nickel sulfate, gold sodium thiosulfate, fradiomycin sulfate, fragrance mix, and p-phenylenediamine in females.

　A 50-year-old woman was admitted to the neurosurgery department for cerebral aneurysm and subarachnoid hemorrhage. Neurosurgeons performed burr-hole drainage and internal carotid artery trapping. Administration of Lansoprazole was started 8 days before our first medical examination. Five days after lansoprazole administration, skin eruptions distributed on the trunk were observed. We had stopped the administration, but the erythematous skin lesions spread all over her body, accompanied by skin erosion and detachment. She developed skin detachment involving 36% of the skin surface. Histopathology of the skin revealed necrotic keratinocytes in the epidermis and liquefaction degeneration in the basal layer of the epidermis by HE staining. Therefore, we diagnosed the rash as toxic epidermal necrolysis. As we could not exclude the possibility that she had pneumonia, we administered intravenous immunoglobulin at a dose of 20 g/day for 5 days. Three days after intravenous immunoglobulin administration, the rash stopped spreading. Therefore, we did not add oral prednisolone therapy after intravenous immunoglobulin. This case implies that intravenous immunoglobulin monotherapy may be a useful treatment for certain kinds of toxic epidermal necrolysis.

　An 87-year-old man presented with reddish and violaceous, partially annular shaped plaques on the trunk and extremities. After discontinuation of sustained-release theophylline intake, the eruption resolved. Histopathology revealed lichenoid interface dermatitis with eosinophils. Although detailed drug tests were not permitted, the patient was diagnosed with lichenoid drug eruption due to theophylline. Theophylline-induced drug eruption has been rarely reported. Interestingly, lichenoid drug eruption due to theophylline has been reported in drug combination therapy. It seems difficult to diagnose drug eruption caused by theophylline because it is not linked with a specific type of drug reaction and it is usually prescribed for a long period. Dermatologists should be reminded that theophylline prescribed for a long period can be a cause of several types of drug eruptions.

　We report the case of a 17-year-old male student who exhibited wheat-dependent exercise-induced anaphylaxis after consuming frozen spaghetti. The final diagnosis was made because the patient developed anaphylactic symptoms during exercise after consuming aspirin and spaghetti. He did not experience such symptoms after he ate bread and then rode to school by bicycle. A prick test for wheat flour (Torii) produced a positive reaction, and prick-to-prick tests for bread wheat (weak flour and strong flour) and durum wheat flour also produced strong positive reactions. A test for wheat flour-specific IgE was positive, but tests for gluten-, ω-5 gliadin-, and high-molecular-weight glutenin-specific IgE were negative. Immunoblot analysis using bread wheat and durum wheat flour revealed several intense bands around 40 kDa, 50 kDa, 60 kDa, and 28-30 kDa in the lane for durum wheat flour. Further analysis revealed a protein band at approximately 60 kDa in the lane for water-soluble albumin, which was suggested to be the causative antigen in this case.