The present study retrospectively reviewed the electronic medical records of 28 patients with Mpox who visited the Department of Dermatology at Tokyo Medical University Hospital between January 1, 2023 and June 9, 2023. All the patients were men who have sex with men, and most were in their 20’s to 40’s (mean age: 38.9 years). The primary symptom was a rash consisting of erythema, erythematous papules, bullae/pustules, ulcers, and crusts in the genital area in 15 cases, trunk and extremities in 22 cases, face in ten cases, and palms and soles in five cases (including duplicate cases). Other clinical symptoms included fever in 25 cases, lymphadenopathy in eight cases, pharyngitis in three cases, headache in two cases, malaise in one case, and analgia in four cases (including duplicate cases). Twenty-four of 27 patients (including previously infected patients) were HIV-positive, 21 of 25 patients (including previously infected patients) were syphilis-positive, and 15 of 17 patients were positive for pre-existing hepatitis B. Twelve patients were positive for the HIV-syphilis-hepatitis B antigen triad. In the entire cohort, sexual activity was the transmission route in 26 patients; 27 patients were followed up without treatment only; and one patient was admitted for the tecovirimat clinical trial and recovered. The present study found a particularly high incidence of HIV among patients in the dermatology department as well as cases of various, other, sexually transmitted disease. Because the skin symptoms of Mpox vary, diagnosis without prior information, such as HIV positivity, is often difficult. If Mpox is suspected in a patient with no such information, it is important to ascertain if there is a history of homosexual intercourse or sexually transmitted disease; in addition, the relevant health department should be consulted, and care should be taken not to puncture or remove any vesicles without wearing protective clothing.

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Direct microscopy of potassium hydroxide test is needed for correct diagnosis of fungal diseases. Since the accuracy of the diagnosis is correct or not is questioned so that twelve questionable regarding various lesions and samples were administered to 40 dermatologists, who were grouped based on their experience periods: A) within 5 years of training, B) 5–20 years, C) >20 years without any presentation or published papers related to micology and D) >20 years with published papers. Points were allocated to each question. The points of group D were the highest (12.7±3.9 points), followed by groups A (11.7±2.4 points) and C (11.6±3.5 points). Group B (11.5±6.4 points) had the lowest points. The study results indicate that postgraduate education and training for identifying fungal elements in potassium hydroxide test of tinea is very important. Additionally, the algorithm proposed here is supposed to be useful for easy identification.

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Approximately 5700 patients came to our dermatology clinic in the past 27 months (2020-2022). Sixty-four out of 5700 patients were diagnosed as toxic eruption. The incident rate was 1.1%. These toxic eruption patients were classified into following six groups, group A: drug-induced type, B: idiopathic or infection-induced type, C: unclear drug/infection-induced type, D: a type developed after removal of Helicobacter pylori, E: a type developed after injection of contrast medium, F: rubella suspected patients. The highest percentage of toxic eruption was seen in group B at 50%, followed by group A and C at about 15% each. Total percentage of these three groups accounted for more than 80% of whole toxic eruption patients. Oral lesions were frequently observed in group B patients (hairy tongue: 81%, tonsillar redness and swelling: 90%) in contrast to the control group (25%, 50% respectively), suggesting possible relations between oral lesion and the development of toxic eruption. To find some facile laboratory data which might prospect worsening case of toxic eruption, we compered CRP (C-reactive protein) and LDH (Lactate dehydrogenase) levels of mild case including groups B and C with those of sever cases, such as SJS (Stevens-Johnson syndrome), TEN (Toxic epidermal necrolysis) or DIHS (Drug-induced hypersensitivity syndrome) from reported articles. In severe cases, the positivity rate of CRP and LDH were both high (90%, 71% respectively), compared to our mild cases (11% and 21%). Considering the facts that CRP levels are closely related the amount of IL-6 and that IL-6 exacerbates local underlying inflammation through promoting cytokine storm, the increase of serum CRP levels may be used as a predicting marker for severe toxic eruption.

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A 83-year-old Japanese female presented with a skin lesion on her right fifth finger, which had developed after she had pricked her finger on a Sudachi thorn 2 months earlier. A physical examination revealed a light brown, slightly papillomatotic plaque on the right fifth finger. A histopathological examination of a biopsy specimen demonstrated numerous dilated vessels in the dermis, and some of them showed the internal aggregation of mononuclear cells. These cells were positive for CD68, and the surrounding vessels expressed D2-40. A tissue culture of the skin showed no fungal growth. Based on these findings, we diagnosed her with intralymphatic histiocytosis (IH). The patient was monitored without any specific treatment. At 7 months after her initial visit, there were no significant changes, but her right fifth finger exhibited lymphedema. It is well known that IH is associated with chronic rheumatoid arthritis, but other conditions, such as artificial joint replacement, infection, malignancy, and trauma, have also been reported to be associated with IH. In our case, the prick of a Sudachi thorn may have triggered the IH, but there have been no reports of similar cases.

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Second-generation antihistamines play an important role in treatment for pruritus. However, there are no clinical data on the efficacy of combinations of second-generation antihistamines. Although the importance of shared decision making (SDM) has been recognized in recent years, there are also no data on choices of antihistamines/antihistamine combinations arrived at through SDM. In this study, we examined chronic urticaria patients treated with combinations of second-generation antihistamines using SDM in the choices for treatment. We report on the selected combinations in terms of efficacy and safety.

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In 2007, with the aim of ascertaining the percentage of latent patients in Japan with conditions that arise on the foot, especially tinea pedis and tinea unguium, the Japan Organization of Clinical Dermatologists conducted a “large-scale epidemiological survey on the actual situation and latent morbidity of tinea pedis and tinea unguium (Foot Check 2007).” In the 16 years since that survey, new topical antifungal agents for tinea unguium and an oral antifungal agent have been approved, and activities to increase awareness of tinea pedis and tinea unguium have also been conducted. Nonetheless, since then, no large-scale epidemiological survey on the latent morbidity of tinea pedis and tinea unguium has been conducted, and the actual situation had not been fully elucidated. Therefore, to obtain the latest information on the percentage of patients with latent tinea pedis and tinea unguium, the Japan Organization of Clinical Dermatologists planned and conducted a national epidemiological survey on tinea pedis and tinea unguium (Foot Check 2023). Participants were patients who visited an outpatient dermatology department of one of the 211 Japanese institutions affiliated with members of the Japan Organization of Clinical Dermatologists from April 2023 to May 2023, and were asked to participate in a “health check of the foot (Foot Check 2023).” Of the responses obtained from 23,087 patients, 2,116 patients who visited the institution for “a consultation on fungal infection of the foot and/or nail” were excluded, and 14,588 patients who consented to participate in a health check of the foot (Foot Check) were included. The physicians checked the patients for foot and nail disease and symptoms, and a definitive diagnosis of tinea was made when tinea pedis/tinea unguium was suspected. The results revealed that, in Japan, 13.7% of patients (18.9% men, 9.6% women) had tinea pedis, 7.9% (11.6% men, 5.8% women) had tinea unguium, and 16.6% (22.3% men, 12.2% women) either had latent tinea pedis or tinea unguium, revealing that 1 in 6 Japanese people have tinea on their foot. As a role of dermatologists, proactive treatment intervention against tinea pedis and tinea unguium as well as initiatives to increase awareness of the conditions, including preventive measures for latent patients, continue to be important.

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