The usefulness of dermoscopy, which is used in various clinical settings, has been established in the observation of findings associated with pigmented skin lesions. We herein report the usefulness of this technique in the observation of findings related to conditions other than pigmented skin lesions that are often encountered in daily medical care settings (scabies, molluscum contagiosum, and verruca vulgaris), the treatment course for verruca vulgaris, and symptoms of dryness associated with asteatosis. A diagnosis of scabies can be confirmed when a direct microscopic examination of the crust reveals Sarcoptes scabiei. However, the Guideline for the Diagnosis and Treatment of Scabies states that a diagnosis of scabies can also be made if the presence of S. scabiei is confirmed via dermoscopy. Dermoscopic findings of scabies include gray delta structures that represent the bodies of S. scabiei, the “jet with contrail” signs that represent scabies tunnels, and the “wake” sign. Molluscum contagiosum can often be diagnosed based on macroscopic findings. However, small lesions and white fibrous papulosis of the neck, which are associated with atopic dermatitis, are difficult to diagnose from macroscopic findings in some cases. Dermoscopic findings of molluscum contagiosum include white coloration within the lesion and ring-shaped scales at the lesion center with surrounding crown vessels. In cases of verruca vulgaris, dermoscopy is useful for confirming small lesions and observing the healing course. Furthermore, dermoscopy can be used to confirm keratinization and the presence or absence of dotted vessels that are difficult to identify macroscopically. Patients with asteatosis are prescribed topical moisturizing agents for macroscopically confirmed skin dryness. However, patients in whom dryness cannot be confirmed often discontinue the application of topical agents. In such patients, dermoscopy can be used to confirm the degree of dryness at the time of examination; therefore, this technique is also a useful tool for enhancing adherence to the use of topical moisturizing agents.

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Case 1 : A 70-year-old man who had a past history of surgery for basal cell carcinoma （BCC） on his chest and back seven years previously presented with black plaque on his left parietal region. Dermoscopic examination confirmed the clinical diagnosis of basal cell carcinoma; there were multiple blue-gray globules and arborizing vessels. A diagnosis of BCC was confirmed by histopathology. Furthermore, a complete skin examination revealed small pits measuring 2 to 3mm in diameter on each palm and sole. Dermoscopy improved the visualization of these pits by showing small pink-colored, irregular-shaped depressed lesions with sharp borders. In the pits, red globules are located on the furrows of the skin showing regular linear distribution. Histopathologically, thinning of keratin layer, irregularity of the epidermal rete ridges, and inflammatory infiltrate of lymphocytes in the epidermis and papillary dermis perivasucular lesion were observed, corresponding to pits. Additional history-taking showed previous surgery for a jaw cyst （keratocystic odontogenic tumor） and a family history of jaw cyst. CT scans revealed calcification of the cerebral falx. Thus the diagnosis of nevoid basal cell carcinoma syndrome （NBCCS） was confirmed. Case 2 : A 60-year-old man with palmar and plantar pits and relapsing jaw cyst since 30 years old, who was diagnosed NBCCS by his previous doctor, presented to our department complaining of tumors on the left thigh and right lower abdomen. Histopathologic study of these lesions was consistent with the diagnosis of BCC. His palmar and plantar pits measured approximately 1mm in diameter. Under dermoscopy, red globules showing linear distribution in the pitting lesions were observed. Histopathologic examination showed mild perivasucular infiltrates of the reticular dermis. We report these cases to emphasize on significance of observing palms and soles using dermoscopy for diagnosing NBCCS in case of multiple BCCs.

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Tungiasis is a parasitic skin disease caused by infection of the flea called Tunga penetrans is distributed in tropical and subtropical regions of the world, including Africa, South America and the West Indies. Adult females penetrate into the skin of their hosts, forming an enlarged structure known as the neosome, which cause tungiasis. These may occur around foot nails and interdigital. The lesions become painful and itching sensation. Treatment is excision of the flea. Secondary bacterial infections are not uncommon with tungiasis. Antibiotics should be used for the secondary bacterial infections. Diagnosis is usually based on the history of travel to epidemic areas, macroscopic inspiration of the lesions due to its characteristic appearance and isolation of the flea and eggs from the lesion. We report a case of tungiasis diagnosed by using Direct KOH examination to find out flea body and eggs from the lesion. A 67 year-old man returned from a working trip to United Republic of Tanzania with an infection of Tunga penetrans located on his left second toe around the nail. When a patient is first seen, the part of left second toenail came off the nail bed and around the nail was purple and edematous. The tip of the toenail was composed of elevated yellowish papule with central darkening. We suspected tungiasis and removed the affected region including nail. In our case, clinically the flea was unapparent because the lesion was degenerated and necrotic. So we did Direct KOH examination and we could find the part of flea body and many eggs. The Flea body structure was also found through a pathological examination. The wound healed by removing the affected lesion and using ointment for ulceration and antibiotics. When the flea and eggs were unapparent from the lesion, Direct KOH examination is helpful to diagnosis of tungiasis.

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The patient is a 77-year-old man with black nodular lesions on his right temple. He had been aware of the lesions for some time. A part of the nodule had broken off; the patient was worried if it might be skin cancer and visited us. Dermoscopy of the black nodule showed a pseudonetwork in some area, but the major part of the lesion is occupied with a uniform structureless which covers the hair follicles completely below the nodules, blue-gray globules were scattered in a pinkish-white backgrand. These findings indicate the regression structure and are frequently observed in the regressing part of invasive malignant melanoma. Although regressing melanoma was suspected clinically, the pathological specimen revealed a regressing seborrheic keratosis. So the active treatment was not perfomed. When the patient visited us four years later, the lesion had disappeared completely. Reported cases of regressing seborrheic keratosis are very few in number and not well known. In such cases, clinical diagnosis and differentiation from malignant melanoma could be difficult even after dermoscopical observation, histopathological examination is therefore mandatory.

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OBJECTIVE : A post-marketing surveillance study was performed to investigate the efficacy and safety of PenlesⓇ Tape 18 mg containing 18 mg of lidocaine for pain relief during molluscum contagiosum removal in children. RESULT : A total of 593 patients were enrolled between January 2013 and January 2014, of which 500 patients were included in a safety analysis. Molluscum contagiosum has a high incidence in 3-5 years old. Of the patients enrolled in this study, 40.2% were aged “ 4 years. About 53.9% of the patients exhibited “No physical response on removal,” 37.1% of the patients showed “Slight physical response on removal” and this was considered the pain threshold level, and 8.5% of the patients showed “Considerable physical response on removal.” Adverse drug reactions （ADR） included 4 cases of erythema and 2 cases of contact dermatitis in 6 patients （incidence : 1.20%）. All ADRs were localized, reversible, and not serious. ADRs related to the anesthetic action of lidocaine were not observed. About 68.2% and 25.8% of the doctors rated PenlesⓇ Tape 18 mg as “Very Useful” and “Useful,” respectively. Therefore, we believe that this drug has very high utility. CONCLUSION : The results of the present study confirmed the efficacy and safety of PenlesⓇ Tape 18 mg for pain relief during molluscum contagiosum removal in children including those younger than 4 years.

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Abstract Purpose : To investigate the efficacy of topical active vitamin D₃ and steroid combination therapy(topical drug combination)in Japanese patients with psoriasis vulgaris. Methods : Efficacy of the topical combination treatment was explored by performing a subanalysis of a double-blind, 3-group, parallel comparative study in which patients with psoriasis vulgaris were randomized to the topical combination drug(applied once daily)group, calcipotriol(applied twice daily)group, or betamethasone dipropionate(applied once daily)group, and received treatment for 4 weeks. The time to onset of improving effect of the topically applied drug combination was examined using the physician's assessments and patients' self-assessments, and the possible factors affecting the therapeutic effect were investigated. Results : Both physician's assessment(percent change in m-PASI, composite severity score for target disease, global assessment of disease severity)and patient's self-assessment(global assessment of disease severity)demonstrated the combination treatment to have a superior effect 1 week after initiation compared to that of topical calcipotriol or betamethasone dipropionate. Furthermore, a similar effect was observed after 4 weeks. The effect of the topical combination therapy slightly decreased in obese patients(BMI ” 30) ; however, this decrease was lower than that observed for topical betamethasone dipropionate. The other investigated factors did not have any effect on the efficacy of the topical combination therapy. Conclusion : Once-daily application of the topical drug combination promptly improved the skin symptoms in patients with psoriasis vulgaris 1 week after initiation of treatment regardless of the patient factors.

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