Connective tissue diseases are common in adult females, but pediatric cases are rare. Dermatologists have few chances to treat pediatric patients; however, cutaneous manifestations are important as a clue for diagnosis, especially in the early or preliminary stages of pediatric connective tissue diseases. Juvenile cases of systemic lupus erythematosus, systemic sclerosis, dermatomyositis, Sjögren's syndrome, Behçet's disease, and sarcoidosis were reviewed, and an overview of current knowledge is provided.
This study investigated the prevalence of cosmetic dermatitis, and identified cosmetic allergens and the responsible cosmetics in 2015. We performed a 48-hour closed test on the backs of patients who consulted our department for suspected cosmetic dermatitis in 2015. Patch testing was performed using each patient's cosmetics, the Japanese standard allergens, and cosmetically relevant allergens that were possibly related to their dermatitis. Results were assessed according to the International Contact Dermatitis Research Group recommendations. A reaction stronger than or equal to (+) was regarded as positive. We patch tested a total of 69 patients with suspected cosmetic dermatitis. Among them, 9 patients demonstrated positive reactions to their own cosmetic products, whereas 5 with negative reactions to their own cosmetic products or no patch testing for their own cosmetic products reacted positively to cosmetically relevant allergens. The cosmetics most frequently responsible were hair color products. We reported a total of 14 patients with allergic contact dermatitis caused by cosmetics. No new cosmetic allergens were found in this study.
In this study, we analyzed drugs that induced erythema multiforme and maculopapular and unclassified rash using unpublished data from the Pharmaceuticals and Medical Devices Agency (PMDA) . Analysis of data from 2,227 cases over a 10-year period from April 2009 to March 2019 revealed that these drug-induced reactions were most commonly caused by 8 drugs (amoxicillin hydrate, lamotrigine, carbamazepine, celecoxib, loxoprofen sodium hydrate, clarithromycin, acetaminophen, and carbocisteine) . Slightly higher numbers of cases of erythema multiforme were caused by celecoxib, the combination of lansoprazole-amoxicillin hydrate and clarithromycin for eradicating Helicobacter pylori, and lansoprazole, than those of maculopapular rash caused by the same drugs.
These results will be useful in preventing these types of drug-induced dermatological serious adverse events in routine medical care.
This is a single-center case-series study to investigate the clinicopathological characteristics of 30 patients with cutaneous mastocytosis between 1995 and 2019. Twenty-seven cases (90%) were childhood-onset mastocytosis, occurring before the age of 15 years, with the remaining three cases (10%) being adult-onset. Their cutaneous findings included maculopapular cutaneous mastocytosis (81%) and mastocytoma (19%) in the childhood-onset cases, and maculopapular cutaneous mastocytosis (100%) in the adult-onset cases. One patient with childhood-onset had acute gastric ulcer. We did not perform histological examination from the gastrointestinal tract ; however, previous reports also demonstrated that refractory cases with childhood-onset, adult-onset cases and diffuse cutaneous mastocytosis were likely to have lesions other than skin lesions. Therefore, when we treat such cases, we should perform thorough medical checkups, including histological examination, with careful follow-up.
A 41-year-old man developed urticaria, diarrhea, and hypotension following dental treatment for root-canal disinfection. The medications used included formaldehyde paste. He also developed urticaria after dental treatment 2 months prior. His symptoms improved after intramuscular injection of adrenaline, and intravenous injection of steroids and antihistamine. Based on his history of symptoms after dental treatment using formaldehyde paste and positivity to a specific immunoglobulin E against formalin, we diagnosed him with a type I allergy to formaldehyde. Many cases of immediate allergic reactions to formaldehyde have been reported. As the allergic symptoms to formaldehyde-containing medicaments have a delayed onset, clinicians may miss the cause if they do not take a full patient history.
A 62-year-old woman took moxifloxacin hydrochloride, carbocysteine, and toloxipide for 4 days and β-methadone and d-chlorpheniramine Maleate for 2 days for sinusitis. One month later, she developed wheals and erythema on her entire body (except the face) about 2 hours after taking moxifloxacin hydrochloride, carbocysteine, and mequitazine once. The rash disappeared about 3 hours after the administration of olopatadine hydrochloride. Suspecting drug eruption, we performed a prick test and a scratch test for each drug (moxifloxacin hydrochloride, carbocysteine, toloxipide, and mequitazine) . A positive reaction was seen only at the site where the moxifloxacin hydrochloride scratch test was performed. It is known that moxifloxacin hydrochloride can cause an urticarial-type drug eruption on the first dose, but in this case, sensitization was achieved on the first dose, and it was suggested that an immediate response was obtained on the second dose, one month later.
A 62-year-old woman with urethral cancer was treated by the application of 1% chlorhexidine digluconate (CHG) to the skin around the stoma of a bladder fistula while admitted as a temporary inpatient. She developed an anaphylactic reaction characterized by dyspnea, paresthesia of the hands, pruritic erythema over the entire body, and erythematous swelling on the face. Skin prick tests using 0.02% and 1% CHG and a scratch test using 1% CHG elicited positive reactions. Based on these findings, she was diagnosed as having anaphylaxis caused by CHG. She usually used over-the-counter ointment containing CHG for her hands and feet. CHG is an antiseptic used widely in health care settings, and has been reported to induce anaphylaxis in several countries including Japan. As CHG is included in a number of over-the-counter drugs and cosmetics such as ointments, mouthwashes, toothpaste, eye cream, and hair care products, the risk of sensitization is increasing. It is necessary to raise public awareness regarding the proper use of CHG, including compliance with appropriate usage in terms of application site and drug concentration.
Soy protein causes few cases of allergy at present even though several cases of soy milk allergy have been reported in Japan. However, with the spread of soy protein-containing foods, an increase in cases is expected. Here, we describe the case of a 44-year-old man showing anaphylactic symptoms including, facial edema, nasal obstruction, and dyspnea after his first intake of a soy protein drink. The patient had previously shown nasal obstruction after intake of soymilk and he had history of spring pollinosis. The skin prick test was positive for soy protein beverage and defatted soybean protein. The level of Gly m 4 specific IgE (CAP-FEIA) was 12.0 UA/ml. Based on the above results, we considered that Gly m 4 related Bet v 1 in the soy protein drink was the main antigen. Patients with pollinosis should be checked for specific IgE on birch and alder, and in the case of Gly m 4 positivity, the intake of soy protein-containing foods should be evaluated. Manufacturers should also alert the presence of soy protein for pollinosis patients.
A 42-year-old man presented with a 7-month history of generalized urticaria and anaphylaxis characterized by loss of consciousness, dyspnea and nausea. He was a fisherman living in Sanriku, Japan, and had been treated for erako dermatitis for 2 years. Erako (Pseudoptamilla occelata) belonging to the phylum Annelida, lives in gaps between rocks, at the bottom of ropes for aquaculture, and is used as fishing bait. After the patient's first medical consultation, he ate natto, and eleven hours later developed dyspnea, abdominal pain, and generalized urticaria. Skin prick tests using 1 mg /ml, 10μg /ml, and 1μg /ml poly γ-glutamic acid (PGA) , the viscous component of natto and the tip of the erako tube elicited positive reactions. The patient was then diagnosed as having late-onset anaphylaxis due to natto in association with erako dermatitis. Erako dermatitis is caused by PGA produced by Proboscidactyla flavicirrata, the polyp of a jellyfish that has a symbiotic relationship with its host, erako. As PGA is included in a number of foods, cosmetics, and medicines, the risk of sensitization is increasing. Therefore, patients with late-onset anaphylaxis due to natto PGA and erako dermatitis should avoid not only natto but also other materials containing PGA.
We report two cases of widespread contact dermatitis caused by over-the-counter (OTC) medicaments. Case 1 : A male in his 50s developed itching on the legs and feet one month prior to presentation. Although he applied an antipruritic OTC medicament, MUHI®S2a, for 2 weeks and MUHIα®EX for the following 2 weeks, lesions enlarged and increased in number on the face and trunk. Physical examination revealed edematous erythema and papules on the face, scattered papules on the trunk and extremities, and erythematous lesions on the lower thighs and dorsum feet. Patch testing resulted in a positive reaction to MUHIα®EX. This patient was diagnosed with contact dermatitis syndrome (stage 3A of allergic contact dermatitis syndrome) caused by MUHIα® S2a and MUHIα®EX. Case 2 : A female in her 30s applied Anmeltz® YOKOYOKO, a topical anti-inflammatory and analgesic OTC for stiff shoulders and back pain 6 days prior to presentation. She developed pruritic rash on the neck, left shoulder, and back. Physical examination revealed oval-shaped erythematous lesions on the neck and left shoulder, and brownish patches on the back. As she was patch test-positive to Anmeltz® YOKOYOKO, we diagnosed her with widespread contact dermatitis caused by this medicament. Although OTC medicaments are convenient, patients have to quit using them and consult doctors or pharmacists immediately when they are not effective.
A 20-year-old man developed anaphylactic symptoms after peanut ingestion several times since he was 2 years of age. At 20 years of age, the patient developed anaphylactic symptoms after ingesting sesame with broccoli and ingesting a rice cake with walnuts. Based on the clinical course and specific immunoglobulin E (IgE) , prick test results or peanut, sesame, and walnut, he was diagnosed with peanut, sesame and walnut allergy. There are many patients who can consume sesame even though they are positive for sesame-specific IgE; therefore, specific IgE positivity may not reflect sesame allergy, as in our case. In addition, as several papers discussing the cross-reactivity among peanut, walnut, and sesame have been published, we examined this in our case, but we were unable to demonstrate such cross-reactivity. Therefore, whether sesame-specific IgE positivity is clinically significant and whether there is cross-reactivity among sesame, peanut, and walnut are key questions to consider in the future.