A 55-year-old woman had been experiencing an itchy sensation in the vulva for two years prior to the initial visit, and a mass had been observed in the vulva and perianal area for two months. The patient was referred to our department after topical imiquimod failed to improve the lesion. From the vulva to the perianal area, a grayish-white mass, 9.5 cm × 3 cm in size, with a chicken-crown-shaped elevation was observed. Histopathologically, the epidermis was thickened in an externally directed, papillomatous shape with hyperkeratosis. There was parakeratosis and koilocytosis of keratinocytes in the epidermis. No findings suggestive of malignancy were found. Based on the clinical and histopathological findings, a diagnosis of giant condyloma acuminatum (GCA) was made. The patient was treated with topical zinc oxide starch powder to reduce the size of the mass. Surprisingly, the masses disappeared in two months. We have not confirmed whether GCA has recurred since the patient stopped coming to our hospital. GCA is defined as a cauliflower-shaped tumor that appears malignant but is histopathologically benign. Although surgical resection is considered the most reliable treatment, recurrence rates are as high as 50% even after surgical resection. In 2010, two cases of GCA were reported in which treatment with zinc oxide starch powder was effective. If the tumor is large and is treated as it is, the resulting skin defect will also be large and healing will take time. The application of topical zinc oxide starch powder to the tumor may reduce its size, or there might be complete regression of the mass.

View full abstract

Efficacy and safety were investigated in 106 patients who were treated with fosravuconazole and followed up for at least 5 months. The turbidity ratios were obtained based on clinical images and were observed over time. Patients with turbidity ratios of 9 and 10 showed a rapid decrease from 89% at the start of the administration to 55% at 4 weeks and to 26% at 8 weeks. Patients with a turbidity ratio of 5 or less started to get cured after 4 weeks, increasing to 28% after 12 weeks, to 45% after 4 months, and to 62% after 5 months. The complete cure rate after 1 year was 67%. A comparison of the groups with and without total dystrophic onychomycosis (TDO) revealed that the group without TDO showed a better improvement tendency, indicating that TDO is intractable. When nail clipping was used in combination with TDO, an increased tendency for improvement was observed. Long-term follow-up showed cases of recurrence. Four patterns of recurrent cases were seen, namely, from distal and lateral subungual onychomycosis (DLSO) to DLSO, from TDO or superficial white onychomycosis (SWO) to SWO, and from dermatophytoma to dermatophytoma. In patients with recurrence from DLSO to DLSO, after some improvement, the recurrence seemed to be delayed. In these patients, the nail plate was separated from the nail bed, and we anticipated a possibility of survival for the dermatophytes in that area, which then recurred as there was no penetration of the drug from the nail bed. Hepatic dysfunction was seen in 26.4% of the patients, but the γ-GTP level was aberrant in half of the patients, and only two failed to complete the treatment. Hepatic dysfunction often develops after the initial 6 weeks of treatment, and hence, periodic checkups are necessary after 6 weeks.

View full abstract

Background: In Japan, the number of drug options for onychomycosis with insurance coverage has increased, and the guideline for the treatment of dermatomycosis was revised in 2019. These may lead to changes in the treatment patterns of onychomycosis in clinical practice. Objectives: To investigate the latest drug treatment patterns. Methods: A web-based questionnaire survey was performed among dermatologists in Japan who prescribed drug to more than 10 patients with onychomycosis within the past one month. Results: Regarding the survey participants, 336 dermatologists, the mean number of patients treated with drugs for onychomycosis within the past one month was 42.1 patients/dermatologist. Distal and lateral subungual onychomycosis (DLSO) was the most common subtype (56.2%), followed by total dystrophic onychomycosis (TDO) (17.2%), spike-shaped (11.1%), superficial white onychomycosis (SWO) (9.0%), and proximal subungual onychomycosis (PSO) (5.8%). Topical agents with insurance coverage (topical agents) (60.0%), oral agents (35.7%), and other (4.3%) agents were prescribed. Regarding first-line treatment by disease type, 69.3% of the dermatologists used topical agents for mild DLSO, 56.8% for spike-shaped, and 69.0% for SWO, whereas 80.1% prescribed oral agents for severe DLSO, 62.8% for PSO, and 73.5% for TDO. For moderate DLSO, 54.5% and 44.3% used oral and topical agents, respectively. Regarding first-line treatment by patient background, 61.9% of the dermatologists prescribed topical agents for patients aged≥75 years, 73.2% for patients taking multiple oral agents for other diseases, and 89.6% for patients with hepatic dysfunction, whereas 58.3% prescribed oral agents for patients with tinea pedis complications and 69.3% for patients with ≥3 affected nails. Conclusions: In Japan, there are many drug options for onychomycosis with insurance coverage, including three oral and two topical agents. Regarding drug treatment for onychomycosis in clinical practice, agents appeared to be selected by Japanese dermatologists, considering disease type, patient age, and underlying disease.

View full abstract

We treated a scabies outbreak in a group home setting for elderly individuals with dementia while monitoring the patients via DERMOCAMERA (Casio Computer Co., Ltd., Tokyo, Japan) as telemedicine. At the first house visit, 6 female residents with a mean age of 94.3 ± 6.5 years old found to be scratching themselves. A diagnosis was made according to the 2020 International Alliance for the Control of Scabies Criteria, resulting in three confirmed scabies cases, two clinical cases and one suspected case. All patients were treated with ivermectin (200 µg/kg). The patients were further followed via DERMOCAMERA as telemedicine. DERMOCAMERA can quickly switch dermoscopic between macroscopic modes. Mite and scabies burrows were observed in dermoscopic mode. Video-based treatment in telemedicine is performed between a doctor and a patient with a care-worker (D to P with H). Ivermectin (mean number of doses: 2.7 ± 0.5) terminated the scabies outbreak. DERMOCAMERA as telemedicine can complement face-to-face treatment with scabies.

View full abstract

Tralokinumab, a fully human monoclonal antibody, specifically binds to interleukin (IL)-13 of the type 2 cytokines involved in the pathogenesis and development of atopic dermatitis (AD) and inhibits IL-13 mediated signaling. It is approved for treating moderate-to-severe AD in several countries. The efficacy and safety of tralokinumab in moderate-to-severe adult AD patients were evaluated for Japanese subgroup of ECZTRA 1, a global clinical study of tralokinumab monotherapy, and ECZTRA 8, for which the study design was the same as that of a global clinical study (ECZTRA 3) of combination therapy with topical corticosteroids (TCS). Tralokinumab monotherapy and combination therapy with TCS in the Japanese cohort showed safety results consistent with both global clinical studies. Tralokinumab improved the signs and symptoms of AD in Japanese patients. However, efficacy results were not highly similar to those of the two global clinical studies, likely affected by the severity of illness at baseline, frequency of rescue therapy, and the amount of TCS used in ECZTRA 8. Long-term treatment up to 68 weeks was well tolerated in ECZTRA 1. These findings suggest that tralokinumab will be a valuable therapeutic option in adult Japanese patients with moderate-to-severe AD.

View full abstract