Autoimmune bullous diseases often manifest as symptoms in the oral cavity. Particularly in pemphigus vulgaris, erosion can occur widely in the oral cavity, and oral hygiene can become extremely poor due to contact pain and bleeding. In addition, severe periodontal disease, dental caries, and incompatible dentures may lead to the onset of acute inflammation, erosion, and irritation ulcer during treatment. With the onset of steroid therapy, preventing the occurrence of oral candidiasis, toothache- like hypersensitivity, and bisphosphonate-related bone necrosis of the jaw is important, and professional oral management is essential for maintaining patient quality of life (QOL). A 70-year-old man who complained of erosion of the oral mucosa was admitted to our hospital. Based on a diagnosis of pemphigus vulgaris, steroid treatment was scheduled, but severe periodontal disease was confirmed. After instruction in oral cleaning was given, 5 teeth were extracted. We continued oral care even during treatment and improved masticatory function by providing dentures at an early stage after improving erosions. In the treatment of autoimmune bullous disease, good cooperation between dermatologists and dentists is necessary to provide higher-quality treatment with
consideration for patient QOL. Dermatologists should make use of special technical support and oral care systems in dentistry.
Objective: To understand the degree of recognition of hidradenitis suppurativa (HS) among physicians in Japan and the treatment in situation current clinical practice. Methods: Online questionnaire survey was conducted among physicians in medical departments related to HS treatment, and their responses were compiled and analyzed. Results and discussion: Responses were obtained from 517 physicians. The disease name HS was widely known among dermatologists. The lesions in the armpit were often considered as HS. The lesions on the buttock were often considered as chronic pyoderma. If the lesions in the armpit were severe, they tended to be considered as chronic pyoderma. However, among general practitioners of internal medicine, many physicians did not know HS; therefore, it was considered that if a patient visits a medical department other than the department of dermatology, it is highly likely that accurate diagnosis will not be made. In recent years, it has been considered that bacterial infection is not the main cause of HS but that HS is an autoimmune disease caused by abnormality in the natural immunity in hair follicles. Even among dermatologists, ≤50% responded that the etiology of HS was abnormality in the immune system. This suggested that most of the physicians may widely use antibiotics in HS patients as a treatment for general infections. In the future, raising awareness about the diagnosis and treatment of HS is desired not only among dermatologists but also among physicians who possibly treat patients with HS.
The patient is a 66-year-old woman who experienced skin eruption and associated itching on the left side of the umbilicus 5 months before the initial visit. In the following month, the patient presented to a nearby clinic, and an antibacterial drug was administered; however, no improvement was observed, and she visited our hospital with a referral. A tense blister and associated itching were observed on the left side of the umbilicus. Although the patient did not have relevant history and was not previously administered PRN drugs, nutritional supplements, or dipeptidyl peptidase-4 -4 inhibitors, fixed drug eruption was suspected on the basis of the clinical findings. Laboratory examination indicated increased eosinophil levels and positivity for anti-BP180 antibodies. Histological findings indicated the formation of a subepidermal blister and infiltration of eosinophils into the blister and the dermis. Application of the direct immunofluorescence technique revealed linear deposition of IgG and C3 in the epidermal basement membrane. These results led to a diagnosis of localized pemphigoid at the umbilical region. The patient was treated with topical application of a steroid ointment as well as oral administration of tetracycline and nicotinic-acid amide and is recovering. In many cases, dyshidrosiform pemphigoid that is localized in the palm of the hand or on the sole of the foot spreads to the entire body. Although, according to reports, localized pemphigoid developed at other sites mostly remains localized, a careful follow-up of the patient is being performed.
We treated 187 patients with onychomycosis of the great toenail using LUCONAC® Solution5% over a 17-month period. Of the 187 patients treated, 48 discontinued treatment and 26 were followed-up beyond 48 weeks. We observed similar results to those noted in the phase III trial; 11.5% of patients showed a marked improvement, 23.1% showed improvement, 23.1% showed marginal improvement, 26.9% showed no change, and 15.4% showed exacerbation. Therefore, approximately 42% of patients had no change or an exacerbation of the disease condition. Our results suggest that the type and severity of onychomycosis needs to be considered in each patient before establishing the treatment option for better management of the disease.