Fournier gangrene (FG) is defined as necrotizing fasciitis that progresses rapidly, mainly in the genital, perineum, and perianal areas, and has a high mortality rate. Therefore, it is important to immediately assess the disease severity and initiate appropriate treatment. We report a case of FG in which indices, such as the Uludag FG severity index (UFGSI) and simplified FGSI (SFGSI), were low. Appropriate treatment was administered, and the patient did not develop severe disease. The patient was a 59-year-old man who has been suffering from buttock pain for eight days. Oral antibiotic treatment was initiated at a local hospital; however, there was no improvement. He had difficulty walking; therefore, he was referred to our department. Erythema and fluctuating motions were observed on the right scrotum and left buttock, and a snow-grabbing sensation was palpable in the right scrotum. Contrast-enhanced computed tomography revealed gas and liquid accumulation with a clear border around the perineum; hence, FG was diagnosed. The LRINEC score was 8, and necrotizing fasciitis was considered; however, the UFGSI was 7 and SFGSI was 0, indicating a low-risk assessment. Streptococcus constellatus and Prevotella bivia were detected in the necrotic tissue cultures. Incision, drainage, and debridement were performed, and the affected area and overall condition rapidly improved. FGSI and UFGSI are useful for assessing the risk of FG. As these scores are difficult to calculate, a simplified version of the SFGSI has been devised and reported to be a useful index. Early diagnosis and treatment of FG are extremely important. We believe that indices that predict disease progression, such as the UFGSI and SFGSI, are useful.

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Objective: New options for treating psoriasis vulgaris have become increasingly available. Given this context, the present study (DEFENDER) aimed to study future options for topical therapy by investigating how psoriasis vulgaris is treated in real clinical practice in Japan. Methods: We obtained data on patients diagnosed with psoriasis vulgaris who had been treated with topical therapy, systemic therapy, and phototherapy from a real-world medical information database that mainly targets general practitioners throughout Japan. Treatment details were examined by practice specialty (all clinical departments, dermatology, and non-dermatology) by reviewing the data from June 1, 2021, and from December 1, 2023. We also evaluated changes over the course of the two-and-a-half-year period. Results: The study included 10,687 cases from June 1, 2021, and 25,140 cases from December 1, 2023. Approximately 10% of these cases involved treatment of psoriasis vulgaris in non-dermatology practices. The results showed that psoriasis vulgaris was mainly treated by topical therapy, with steroids being the most commonly prescribed. In addition to steroid monotherapy and multiple steroid therapy, it was revealed that, as of December 2023, a combination with active vitamin D₃ was widely prescribed. Prescriptions of topical fixed-dose combination drugs, the second most commonly prescribed treatments, increased over the two-and-a-half-year period. Regarding dosage form, ointments were a popular choice; however, a new topical foam formulation developed for topical fixed-dose combination drugs was also increasingly prescribed. Compared with non-dermatology practices, dermatology practices used a higher proportion of combination therapy comprising topical fixed-dose combination drugs in addition to conventionally co-administered steroids and active vitamin D₃. Conclusion: The results of the present study revealed that in the topical treatment of psoriasis vulgaris in real clinical practice in Japan, it was considered problematic that steroids and active vitamin D₃ are still commonly prescribed as monotherapy or combination therapy. A problem with steroids is the risk of adverse drug reactions, and active vitamin D₃ has problems such as insufficient efficacy due to lower treatment adherence. On the other hand, topical fixed-dose combination drugs, which are recommended as first-line topical therapy, may overcome these problems, and new dosage forms have become available. Consequently, dermatology practices can now select the dosage form according to each patient's lesion and lifestyle. Therefore, based on a recent treatment trend, in future topical therapy, it is considered desirable to choose the more optimal medication and dosage form, focusing on topical fixed-dose combination drugs such as Cal/BDP, in which three different dosage forms are available, aiming to maintain good treatment adherence for each patient.

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The Japan Organization of Clinical Dermatologists conducted an epidemiological survey on the prevalence and potential morbidity of tinea pedis and tinea unguium as part of the Foot Check 2023 project. Of the 14,588 individuals examined, 8,164 (56.0%) presented with some kind of foot or nail disease or symptom. Symptoms of tinea pedis (18.1%) was the most common foot condition, and symptoms of tinea unguium (10.5%) was the most prevalent nail disorder. This report focuses on the analysis of other foot and nail diseases observed in the survey. Beyond tinea pedis, 4,956 participants (33.4%) exhibited other foot symptoms. In descending order of frequency, these included: corns and calluses (13.2%), verruca (5.0%), keratosis (4.7%), eczema (3.3%), lentigo (3.1%), and palmoplantar pustulosis (0.7%). Furthermore, 1,736 participants (11.9%) presented with nail symptoms other than tinea unguium. Incurved nail or ingrown nail (4.8%) and pachyonychia (3.4%) were the most common, followed by onychogryphosis (1.5%) and nail psoriasis (0.4%). This survey reveals that approximately half of the Japanese population suffers from some form of foot or nail disorder. Abnormalities in these often-overlooked areas can go unnoticed unless accompanied by pain or itching. Even when recognized, individuals may delay seeking treatment. Dermatologists should proactively engage in educational activities that encompass preventative measures and treatment interventions for a wide range of foot and nail conditions, including both tinea unguium and tinea pedis.

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