This patient was a 55-year-old man with a blackish brown papillary nodule that appeared in the umbilical region 5 months prior to the initial examination and gradually increased in size. Seborrheic keratosis was diagnosed at another hospital and treatment was initiated; however, there was no improvement and the patient was referred to our department. A blackish brown papillary nodule measuring 10 mm was noted in the umbilical region. Histopathological findings revealed koilocytosis as a fenestration around the nuclei of epidermal keratinocytes. was negative using K1H8 and 4C4 Anti- human papillomavirus (HPV) monoclonal antibody immunostaining. However, HPV6/11 probe was positive with in situ hybridization. As such, condyloma acuminatum was diagnosed. Electrocautery and liquid nitrogen cryotherapy were performed on the nodule. The nodule disappeared in 3 months after combined topical treatment with active vitamin D3 ointment and imiquimod. Condyloma acuminatum is a sexually transmitted disease that commonly occurs around the genital area and the anus. There are few cases of occurrence at other sites and, there is no report of condyloma acuminatum occurring in the umbilical region. Examples of skin tumors in the umbilical region include seborrheic keratosis, basal cell carcinoma, and metastatic skin cancer. However, condyloma acuminatum has rarely been considered as differential diagnosis in this region. We report this case, to shed some light on the diagnosis, treatment, and prevention of infection.

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We conducted a retrospective clinical investigation of 50 patients who were treated at this hospital for chronic idiopathic urticaria that were switched to bilastine (Bilanoa^Ⓡ) due to inadequate response to second-generation antihistamines (patients with a severity score of at least level 3 and an urticarial activity score [UAS] of at least 3). Significant reduction in UAS was observed 2 weeks after switching to bilastine and this reduction was maintained until 8 weeks after switching. Further, significant UAS score reduction at 2 weeks after switching bilastine was observed regardless of the prior drugs (piperidine/piperazine/tricyclic antihistamine). This analysis indicated that the reduction in UAS was maintained beyond 2 weeks after switching from fexofenadine, olopatadine, levocetirizine, bepotastine, or loratadine to bilastine, but that the reduction in UAS was not maintained beyond 2 weeks after the switch from epinastine. The results of our retrospective investigation suggest that bilastine is effective after switching from most second-generation antihistamines. However, further research on specific drugs is required.

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In the treatment of acne vulgaris, the need to promote proper use of antimicrobials has been increasing. This study involved 18 dermatologists with expertise in acne who were provided a questionnaire regarding their use of antimicrobials in the treatment of facial acne vulgaris, and the medical records of their patients were examined to review the actual prescriptions of topical and oral antimicrobials. The results revealed typical usage duration of antimicrobials was less than 3 months, although continuous prescription of topical and oral antimicrobials for more than 3 months was reported by 16 and 11 dermatologists, respectively. The reasons the antimicrobial prescription exceeded 3 months were most commonly “strong request by the patient” for topical antimicrobials and “severe disease with insufficient improvement” for oral antimicrobials. According to the medical record review, among all cases in which antimicrobials were prescribed at the initial visit, the duration of continuation was “90 days” in 61 of 81 cases (75.3%) for topical antimicrobials, and in 78 of 82 cases (95.1%) for oral antimicrobials. Successful shift to maintenance therapy was attained in 35 of the 61 cases (57.4%) with 90-day continuation of topical antimicrobial use, and in 44 of the 78 cases (56.4%) with 90-day continuation of oral antimicrobial use. The study found that, although prolonged antimicrobial use is unavoidable in some patients, the acne experts were conscious of the proper use of antimicrobials in treating acne, and had shifted to maintenance therapy for more than half of the cases.

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