Amenamevir (Amenalief^® tablet 200 mg, hereinafter AMNV) is a novel anti-herpetic agent that has helicase–primase inhibitor activity and is labeled for herpes zoster. AMNV is currently available only in Japan and a mandatory observational survey is ongoing in order to collect real-world information on the safety and efficacy. This report is an interim cross-sectional analysis of the data at the time of AMNV administration and one month after. There are a total of 1,345 patients in the safety analysis set, and adverse drug reactions have been reported only in 11 patients (0.82%). Abdominal pain upper, diarrhea and pyrexia” were reported in 2 cases. Regarding safety issues related to the important potential risks identified in the Japanese Risk Management Plan, two cases, one of thrombocytopenia and one of gingival bleeding were reported as events associated with “platelets decreased” and one case of palpitation was reported as an event associated with “cardiovascular event”. None of these were serious. There are a total of 1,338 patients in the efficacy analysis set. A 50% reduction in the number of patients with skin lesions (erythema/papules and blisters/pustules) was reached at day８, a 50% reduction in the number of patients who did not achieved full crusting was reached at day 12 and a 50% reduction in the number of patients with pain was reached at day 22. In this report, we discuss patient backgrounds and treatment regimens from an epidemiological perspective and in consideration of the characteristics of AMNV. This study plans to enroll 3,000 patients in total. This interim report evaluates based on data from the earlier 1,446 patients. The full analysis will evaluate a stratified analysis of safety with background information for patients, as well as detailed effectiveness data related to things like lesions and pain.

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A 78-year-old woman presented with a one-year history of a painful skin tumor on her left forearm. Physical examination revealed a skin-colored, slightly elevated, smooth, elastic, and firm intradermal nodule, 4 mm in diameter. Histopathological examination revealed a well-demarcated nodular lesion in the lower dermis, which consisted of dense proliferation of spindle cells without nuclear atypia. Immunohistochemical staining showed that most nuclei and cytoplasm of the spindle-shaped tumor cells were positive for the S-100 protein, suggesting that the tumor cells originated from Schwann cells. Additionally, a subset of cytoplasm was positive for neurofilament, which appeared to be axons, and the surrounding capsule was positive for the epithelial membrane antigen (EMA). A diagnosis of palisaded encapsulated neuroma (PEN) was made based on these histopathological findings. PEN, also called as a solitary circumscribed neuroma, is a benign, solitary tumor of neural tissue that occurs most commonly in the head and neck area in middle-aged or older individuals. The occurrence of PEN on the extremities is rare. Immunohistochemical staining is required to narrow the differential diagnosis from other neural tumors such as neurilemmoma, traumatic neuroma, and neurofibroma. Particularly, neurilemmoma is positive for the S-100 protein in tumor cells and EMA on the capsule, but negative for neurofilament because of the lack of axons. Traumatic neuroma is positive for the S-100 protein and neurofilament, but negative for EMA on the surroundings of the tumor. Neurofibroma occasionally has axons that may be partially positive to neurofilament; however, it is negative for EMA because of the lack of a capsule. In conclusion, expression patterns of the S-100 protein, neurofilament, and EMA in PEN are characteristic features compared to those in other neural tumors. Thus, the use of immunohistochemical staining is feasible for the diagnosis of PEN.

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Lichen planus-like keratosis (LPLK) is a pathological process, in which seborrheic keratosis or solar lentigo naturally disappears over time. Here, we report two cases of LPLK in which facial lesions completely disappeared, and compare the dermoscopy findings with the three-stage classification of dermoscopic structures of spontaneous regression of LPLK. During the initial examination, pinkish areas showing inflammatory symptoms and annular granular structures were observed in case 1, annular granular structures were observed in case 2, and both lesions were classified as early stage according to the dermoscopy classification of spontaneous regression of LPLK. The dermoscopic features of case 2 changed with the passage of time, and blue-gray fine dots, which were of the late stage, was observed. The lesions completely disappeared after 2 years and 6 months for case 1 and after 4 years and 4 months for case 2. In the early stage of spontaneous regression of LPLK, annular granular structures were located next to the pinkish area presenting inflammatory symptoms. There were slight differences in the early stage dermoscopic findings between the two cases. As the LPLK lesions change over time, it might be difficult to distinguish them from malignant lesions, and a biopsy might be necessary. However, if the typical annular granular structures of the early stage or regular blue-gray fine dots of the late stage of spontaneous regression were observed, malignant lesions can be ruled out by the dermoscopic findings. When malignant lesions are excluded, spontaneous regression can be confirmed by regular follow-up without a biopsy.

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We describe 8 patients with bullous pemphigoid (BP) who underwent dialysis. All patients underwent hemodialysis for the management of diabetic nephropathy and received a dipeptidyl peptidase-4 (DPP-4) inhibitor. Only one patient continued to use a DPP-4 inhibitor. Systemic steroids were administered in 7 of the 8 cases, one of which required plasma exchange. Considering clinical course and laboratory data, our study perphaps included patients with the usual form of BP, those with DPP-4 inhibitor-induced BP, and those with dialysis-induced BP. Comparing past literatures, we considered that BP that develops during dialysis might show a more severe presentation. BP secondary to DPP-4 inhibitors usually improves after discontinuing the oral administration of these agents, and many patients do not require oral administration of steroids. However, BP with DPP-4 inhibitor that develops during dialysis may include these 3 types as described above. Oral steroids should be considered in patients with BP who do not improve after discontinuing DPP-4 inhibitor administration.

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Sebaceous carcinoma is a rare malignant epithelial tumor histologically characterized by cells differentiating into sebaceous glands. Sebaceous carcinoma predominantly occurs in elderly patients on the head and neck, particularly on the eyelids.  We report two cases of sebaceous carcinoma occurring in the inguinal region. Case 1: A 50-year-old Japanese man had 1-year history of a reddish tumor in his right inguinal region. This tumor has grown to erosive red-colored tumor （approximately 60×40 mm in size）. Case 2: A 77-year-old Japanese woman had 20-year history of a slow-growing cutaneous tumor in her left inguinal region. The tumor has changed into an ulcerated reddish-brown nodule （27×15 mm in size）. The both tumors were radically extirpated. Histopathological examination of excised specimens revealed atypical cells with foamy cytoplasm in the center and atypical cells with flat nuclei at the tumor nest margins, indicating sebaceous differentiation. On immunohistochemical examination, tumor cells showed immunopositivity for epithelial membrane antigen （EMA） and immunonegativity for Ber-EP4 （anti-CD326 antibody）. Additionally, adipophilin-positive cells were observed in some areas of the tumor nests. Based on these findings, both specimens were diagnosed with sebaceous carcinoma. The final diagnosis was a well-differentiated sebaceous carcinoma in Case 1, whereas it was poorly-differentiated sebaceous carcinoma, primarily composed of squamoid cells in Case 2. The differential diagnosis usually includes basal or squamous cell carcinoma in patients with this presentation; therefore, immunohistochemical evaluation for EMA, Ber-EP4, and adipophilin expression is essential, especially in case of poorly differentiated sebaceous carcinoma, as was observed in Case 2. Sebaceous carcinoma is rare in the inguinal region, which is attributable to the low level of ultraviolet light exposure in this area. Further studies would be necessary to clarify the tumorigenesis of sebaceous carcinoma in the inguinal region.

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The clinical value of systemic antifungal medications for onychomycosis using F-RVCZ has been shown in patients of 75 years or younger. However, its value for elderly patients has not been investigated. The purpose of this research is to clarify the value of this drug in patients of 75 years or older. A retrospective analysis of clinical investigation was conducted in 49 elderly patients (> or =75 years old) with dermatophyte onychomycosis who were treated by F-RVCZ (100 mg RVCZ) p.o. once daily for 12 weeks. At 48-60 weeks after initiation of treatment, a complete cure was obtained in 16 of 23 patients (69%) and at 24-60weeks, a marked clinical improvement was obtained in 44 of 48 patients (93%). The major adverse reactions included laboratory abnormalities (n=4), chest discomfort (n=1) and gastrointestinal disorders (n=4) with no severe symptoms, suggesting good tolerability. F-RVCT appears to be a clinically useful drug for the treatment of onychomycosis for elderly patients.

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The patient was a 23-year-old man, who noticed tumors around the anus 1 year prior to visiting the hospital. These tumors had increased in size over the previous two months. Condyloma acuminatum was suggested, and the patient was referred to our division. Two tumors measuring 2.5 cm and 2.0 cm in diameter, respectively, were found around the anus. Histopathological examination revealed that the entire dermis was infiltrated with inflammatory cells and epithelioid granulomas were formed. Fever, abdominal pain, and a bloody bowel discharge developed 3 weeks after the operation. Crohn’s disease was diagnosed in acknowledgment of the granulomas in the lower part of the gastrointestinal tract on endoscopic biopsy. Based on the above findings, we made a final diagnosis of perianal skin tags related to Crohn’s disease that developed before digestive symptoms. Crohn’s disease is frequently associated with anal lesions that often precede abdominal symptoms. When patients present with tumors around the anus, it is necessary to consider the perianal skin tags of Crohn’s disease as part of the differential diagnosis.

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