We present a case of 76-year-old man with a medical history of laryngeal cancer, rectal cancer, and rheumatoid arthritis. Two weeks before the first visit, a reddish tumor appeared on his left abdominal skin, and he was referred to our department. Indurated erythema was observed with a major axis of 5 cm on the left abdominal skin, and a hemispherical dark reddish tumor was noted with a major axis of 2 cm on the erythematous lesion. Histopathological examination of skin biopsy revealed large, well-defined atypical cells with nucleoli proliferating throughout the dermis. Immunostaining revealed positive findings for CD4, CD56, CD123, and TCL1, and we diagnosed the patient with a blastic plasmacytoid dendritic cell neoplasm. CHOP chemotherapy was performed. It was initially effective for the skin lesions, but gradually became refractory to treatment. Over time, many reddish tumors and indurated erythema appeared on the trunk and limbs. Radiation therapy performed for the skin lesions was effective in local control. Although this disease is extremely rare, it is a fatal disease that transfers to the leukemic phase at a high rate. Most cases develop from skin lesions, so dermatologists should be able to recognize this entity. In general, radiation therapy for blastic plasmacytoid dendritic cell tumors is effective in local control of skin lesions, although it does not contribute to prolonged prognosis.

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A 75-year-old man, with a five-year history of rheumatoid arthritis and interstitial pneumonia treated using predonisolone and tacrolimus, presented with a chief complaint of a red nodule in the right groin, which appeared three months ago. Clinically, the lesion showed a red sharply marginated nodule measuring 1 cm. It presented a wet surface without scaling. Dermoscopic examination showed irregular papillomatous projections in the nodule. Histopathology of the biopsy specimen showed papillomatous lesions, hyperkeratosis, acanthosis, and atypical keratinocytes with obvious pleomorphism in the entire epidermis without vacuolated koilocytes. Atypical keratinocyte invasion into the dermis was not observed. Immunohistochemistry staining showed p16 positivity in the nucleus and cytoplasm of atypical keratinocytes. It was diagnosed as Bowenoid papulosis and a total excision with 5 mm margin was performed according to guidelines for cutaneous squamous cell carcinoma (SCC). No recurrence has been observed for 2 years. Human papillomavirus (HPV 66) was detected in the excision lesion using the HPV DNA PCR (SRL, Nagoya Japan). Some HPV types are confirmed to be carcinogenic in humans, causing mucosal lesions in cervical, penis, anal, and oropharyngeal cancers. To our knowledge, HPV 66, a probable high-risk mucosal HPV, was detected only in one case of SCC in the ungual and periungual area. Ungual and periungual SCC are well known and sometimes indicate sexually transmitted diseases. These studies suggest the possibility that mucosal high-risk HPV types in cervical cancer might also be risk factors for SCCs. Recently, HPV vaccines have been used globally. Although they do not prevent infection with most of the HPV types currently, but it is expected to spread in Japan.

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A fifty-five-year-old Japanese woman presented with multiple small red eruptions on her trunk and extremities, which had been present for 10 years. The patient was diagnosed with breast cancer at the age of 43 years, and received chemotherapy with epirubicin, cyclophosphamide, and paclitaxel, as well as hormonal therapy following mastectomy. Physical examination revealed 36 red nodules (approximate size, 5 mm). Dermoscopy findings of glomerular vessels and a whitish network indicated poromatosis. Chest nodule biopsy revealed findings typical of poroma and confirmed the dermoscopic diagnosis of poromatosis. As no enlargement or no development of new lesions were noticed after biopsy, we kept the patient under observation and planned to excise the other lesions only if they enlarged. The reports of multiple poromas have increased in the recent years. The occurrence of multiple poromas is associated with hematopoietic tumors (such as malignant lymphoma or leukemia) in most cases and solid carcinomas in a few cases. Poroma is thought to occur on the palms and soles, but in the present case, the palms and soles lacked red nodules. We reviewed the literature on poromatosis cases, including the site of occurrence.The characteristic dermoscopic findings are useful for the diagnosis of poromas, especially in cases of multiple poromas, and as a noninvasive tool.

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A 70-year-old man presented with annular, erythematous lesions on his trunk and limbs. He had been treated with topical steroids for a few years, at another hospital. However, the lesions had persisted for decades. At his first visit to our hospital, he presented with annular, erythematous plaques on the neck, back, and arms. The plaques had slightly elevated borders. Annular elastolytic giant cell granuloma (AEGCG) was diagnosed based on the histological findings of loss of elastic fibers, and formation of a granuloma consisting of histiocytes as well as multinucleated giant cells. The giant cells demonstrated phagocytosis of fragmented elastic fibers. The rash appeared to fade following treatment with tranilast for 7 months, but it relapsed two months later, despite continued treatment with tranilast. In addition, nausea occurred as an adverse effect and tranilast had to be discontinued. Subsequently, the patient was observed without any treatment. Temporary remission of the rash was observed after the excision of a colon polyp and a vertebral compression fracture. However, the rash relapsed yet again and persisted for a long duration. Although several treatment options are available for AEGCG, no definite treatment has been established thus far. We present conservative observation as a viable option in the management of patients with AEGCG.

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Fosravuconazole (NAILIN^®), a novel triazole antifungal drug developed in Japan, has been used to treat onychomycosis since 2018. We conducted a real-world multicentric retrospective study of oral fosravuconazole therapy to assess its efficacy, safety, and consistency. In total, 350 patients were enrolled between June 2019 and April 2020. The treatment consistency rate was 83.4% at 12 weeks and 32.6% at 48 weeks. The clinical and complete cure rates after 48 weeks were 78.9% and 57.8%, respectively. Most patients were clinically cured at 36 weeks. The median treatment duration was 41.9 weeks. In total, 76 side effects were observed in 18.3% of patients (64/350) and 15 patients discontinued the treatment. However, there were no serious adverse drug reactions. Overall, our study reveals the therapeutic benefits of fosravuconazole, including high efficacy, tolerance, and consistency in real-world clinical practice, and suggests that short-duration fosravuconazole treatment may contribute to patient compliance and adherence.

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Objective: This study investigated the safety and efficacy of delgocitinib ointment (0.5%), a novel Janus kinase (JAK) inhibitor, in 352 adult Japanese patients with atopic dermatitis (AD) based on disease severity. Methods: Results of a Japanese phase III multicenter, uncontrolled, open-labeled, long-term, 52-week study in adult patients with mild to severe AD were analyzed post hoc. Then, the safety and efficacy of the delgocitinib ointment were assessed using a 50% and 75% reduction in the cumulative modified eczema area and severity index (cumulative mEASI50/75) based on disease severity, as measured using the investigator’s global assessment (IGA) score at the start of treatment, and on concomitant use of topical corticosteroids (TCS). Results: Patients who experienced adverse drug reactions were 23/110 patients (20.9%), 45/215 patients (20.9%), and 1/27 patients (3.7%) with IGA 2 (mild), IGA 3 (moderate), and IGA 4 (severe), respectively, at the start of treatment. Moreover, the total number of patients with adverse drug reactions with and without the TCS treatment was 43/224 patients (19.2%) and 25/128 patients (19.5%), respectively. In the population using delgocitinib ointment alone (128 patients), the percentage of patients achieving cumulative mEASI50 and mEASI75 was 87.0% and 69.6%, 72.2% and 62.5%, and 85.7% and 14.3% in the IGA 2, IGA 3, and IGA 4 subpopulations, respectively. However, in the overall population, the percentage of patients achieving cumulative mEASI50 and mEASI75 was 78.8% and 54.8%, 62.8% and 43.7%, and 74.0% and 37.0% in the IGA 2, IGA 3, and IGA 4 subpopulations, respectively. Conclusion: Since no significant difference in adverse drug reactions was observed at any IGA level of AD and the efficacy was demonstrated through improved skin rash during AD, the delgocitinib ointment is considered safe regardless of disease severity. It is essential not only to control AD with delgocitinib ointment alone, but also to consider the use of TCS in combination as appropriate for the disease severity and symptoms.

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The efficacy and safety of benzoyl peroxide 2.5% lotion (BPO-L) in patients with acne vulgaris were evaluated in a randomized, vehicle-controlled, double-blind, parallel-group, multicenter study. In this study, patients with moderate acne vulgaris aged 12 to 49 years applied BPO-L or vehicle once daily for 12 weeks to the entire face after washing the face. A total of 222 randomized patients (109 in the BPO-L group and 113 in the vehicle group) received the study drug. The least squares mean percentage reduction in the primary endpoint of total lesion count (total number of inflammatory and non-inflammatory lesions) from baseline after 12 weeks of treatment was 63.0% in the BPO-L group and 26.5% in the vehicle group, indicating that BPO-L significantly reduced total lesion counts (P < 0.0001). The numbers of inflammatory and non-inflammatory lesions, secondary endpoints, were also significantly reduced (P < 0.0001 for both). The incidence of adverse events was 29.4% in the BPO-L group and 23.9% in the vehicle group. The incidence of adverse events related to the study drug was higher in the BPO-L group (11.9%) than in the vehicle group (6.2%). Most adverse events were mild and occurred on the sites to which the study drug was applied, and all recovered or improved with the exception of 3 cases that were classified as unrecovered. BPO-L was well tolerated in patients with acne vulgaris, and the total lesion count decreased from 2 weeks after the start of treatment. This finding suggests that BPO-L can expand the available treatment options for BPO that were previously confined to gel-only products and provide early and aggressive treatment for acne vulgaris. Study Registration Number jRCT2031200251.

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