Myopericytoma is a benign subcutaneous tumor that occurs in the limbs of adults; a rare variant of myopericytoma occurs intravascularly. A 43-year-old man presented with a 3-year history of a 15-mm mass in the subcutis of his right inner thigh. The patient had no history of trauma, although due to his work he had to stand for 8 hours per day. Several tumor lesions were scattered in the subcutaneous tissue. Oval and spindle cells with no atypia were collected around the endothelial cells in a concentric arrangement. By immunostaining, tumor cells were positive for smooth muscle actin and negative for desmin, CD31, CD34, and factor VIII, which suggests the tumor was present in a vessel. Based on these findings, the lesion was diagnosed as intravascular myopericytoma (IVMP). To clarify the etiology of IVMP, we compared our case with 15 previously diagnosed cases of intravascular myopericytoma by age, sex, duration, site, and morphology. Thus, we hypothesized that venous reflux could be a cause of intravascular myopericytoma in the legs due to prolonged standing at work.

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Japanese spotted fever was first reported in 1984 in Tokushima Prefecture，and around 300 cases have been reported annually． In our department，we experienced 6 cases with this disease between April and October in 2020． Herein，we report the clinical features and abnormal laboratory findings． Among its triad of fever，skin rash and bite spot，the former two were observed in all 6 cases，whereas the bite spot was observed in 3 cases． As the clinical appearance of this disease is similar to that of febrile toxic rash，drug eruption or cutaneous vasculitis，sometimes it is difficult to diagnose，if the bite spot is missing． Moreover，fatal cases have been reported due to multiple organ failure followed by disseminated intravascular coagulation syndrome． In recent years，the number of the cases are increasing not only in western，but also in eastern part of Japan in accordance with expansion of the distribution area of rickettsia-transmitting ticks． It is important to take notice of laboratory findings，social history，and lifestyle of patients and the epidemic area of Japanese spotted fever in addition to triad of symptoms to confirm the diagnosis without delay．

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We reported a case of primary cutaneous aspergillosis in a female neonate who was born by cesarean section at 22 weeks weighing 326 grams. She was on ventilator management in an incubator at the neonatal intensive care unit. On day 3 after birth, she developed a blister that extended from the right chest to the abdomen and soon expanded to the right thigh. Blood examination revealed a serum β-D-glucan level of 5330 pg/mL. Chest radiography showed no evidence of pulmonary aspergillosis. Fungal elements were found out by direct microscopy from skin lesions. Cultures using Sabouraud dextrose agar yielded colonies that showed a suede-like surface with blue-green pigmentation. The slide-culture findings were characteristic of Aspergillus fumigatus, and the strain was identified as the same based on gene sequence analysis. Fluconazole was administered immediately on day 6 after birth. Though the dose was increased and the therapy was switched to amphotericin B on day 7 after birth, her skin lesions progressed and showed necrosis. Her general condition worsened, and she died on day 16 after birth. Later, antifungal susceptibility test revealed that micafungin, an echinocandin antifungal agent, was the most effective for this strain. Since 1980, there have been some reports of primary cutaneous aspergillosis occurring in low-birth-weight neonates. Most of them are treated with amphotericin B alone, but the latest guidelines in Japan recommend echinocandin antifungal drugs as the first choice. Dermatologists rarely administer echinocandin antifungal drugs, and clinical susceptibility tests for fungi are not routinely performed. In this case, amphotericin B administration did not improve the symptoms, and it was considered that administration of echinocandin antifungal drug should be considered. The number of patients with a similar clinical presentation is likely to increase in future. Close coordination between neonatologists and dermatologists is warranted to effectively treat this disease.

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Topical therapy is the basic treatment for the patients with psoriasis vulgaris. Patient education about topical therapy should include the nature of the drug, the method of application, the amount of the drug, etc. However, there is no guidance on topical therapy in Japan. Moreover, we need to keep in mind that adherence to topical therapy is poorer than that to oral therapy. In this study, we examined the optimal patient education about topical therapy by conducting a web questionnaire survey of physicians and psoriasis patients to find out what physicians told patients about topical therapy for psoriasis vulgaris and the actual use of topical drugs by the patients. The survey results suggested that there were discrepancies between what physicians taught and how patients applied topical drugs. To maintain/improve adherence, topical therapy education needs to be provided repeatedly. In addition, it is important to practice by reaching out to individual patients, making sure that each patient's goal of long-term treatment for psoriasis is appropriate, and involving the patients in treatment selection.

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Ozenoxacin lotion (Zebiax® Lotion 2%) is a topical quinolone antimicrobial agent approved for the treatment of inflammatory acne and superficial skin infections in September 2015. The safety and effectiveness were evaluated in the Drug Use-Results Survey starting in April 2016 with a 12-week observation period for inflammatory acne in clinical practice. From 17 adverse drug reactions observed in 14 out of 1014 cases (1.38%) in the safety analysis set, all were non-serious. The number of facial skin lesions were reduced by a median of 77.3% for inflammatory, 60.0% for non-inflammatory, and 66.7% for total skin lesion count after 12 weeks. With regard to overall improvement at the final evaluation, "markedly improved" and "improved" accounted for 73.0% (737/1010) of facial lesions and 62.1% (59/95) of non-facial lesions, respectively. No influence was observed in the effectiveness by presence or absence of concomitant adapalene and/or benzoyl peroxide at the start of treatment. This may be attributable to each physician in charge having appropriately selected the necessary concomitant therapy depending on the conditions such as severity and the degree of inflammation of skin lesions and, as a result, a high therapeutic effect was observed in all patients. Regarding the safety, there was no influence of concomitant use of adapalene and/or benzoyl peroxide on the onset of adverse reactions of this drug. These results indicate that ozenoxacin lotion (Zebiax® Lotion 2%) is useful in acute-phase treatment of inflammatory acne in real clinical settings.

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Background: It has become clear that primary axillary hyperhidrosis significantly impairs QOL and reduces the productivity, with tremendous economic loss in the sufferers, but it seems that most sufferers do not consult a physician. Objective: Awareness of primary axillary hyperhidrosis by individuals and their willingness to consult a physician, as well as the effect of the disease on daily life, were investigated. Methods: Of 707,358 individuals registered with a survey panel owned by an Internet questionnaire survey company, 608 respondents who had a hyperhidrosis disease severity scale score of 3 or more for excessive axillary sweating and met at least two of Hornberger's diagnostic criteria were extracted as potential patients with severe axillary hyperhidrosis and included in an Internet questionnaire survey. Results: Of all respondents, 92.3% replied that "I have heard" the name of hyperhidrosis, and 17.1% replied that "my studies and work have been affected" by axillary sweating, with the most common reply (6.6%) being "I have given up my desired occupation/job." As an action taken for axillary hyperhidrosis, 9.5% replied that "I visited a medical facility." Of respondents who had never visited a medical facility, 58.9% replied that "I know that hyperhidrosis can be treated at a medical facility," and 64.0% replied that "I want to be treated for hyperhidrosis at a medical facility." While more than half knew that axillary hyperhidrosis can be treated or wanted to be treated, many sufferers do not visit a medical facility. Conclusion: Physicians need to actively treat axillary hyperhidrosis, which may significantly affect a patient’s life, however, many individuals suffering from excessive axillary sweating do not consult a physician. It is necessary to expand the treatment options for axillary hyperhidrosis in a medical facility, and to improve the suffers’ understanding of the disease.

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