A case of a 48 year-old female patient with eosinophilic fasciitis was reported. Eosinophilic fasciitis is characterized by firm skin bound to underlying structures with histological thickening of the fascia particularly on the extremities, circulating eosinophilia and hypergammaglobulinemia. Further, our case showed Raynaud’s phenomenon as the initial sign. Thirty-eight cases reported hitherto were reviewed with reference to clinical and histological features.

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Five cases of bullosis diabeticorum were reported. The location of bullae; subepidermal in one case, intraepidermal in two cases, subcorneal in one case and sub- and intraepidermal in one case; was not pathognomonic of bullosis diabeticorum. Pathoanatomical changes may participate in the production of bullosis diabeticorum. Bullae appeared on dorsa of feet in one case and on the toes in four cases. The peripheral nerve conduction velocity decreased markedly in the five cases. Microangiopathy, neuropathy and pathoanatomical changes may be considered as major factors in the production of bullosis diabeticorum.

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The use of Limberg flap and analogous flap showed satisfactory results in the field of skin surgery. As Limberg flap is simple in design and in technics, it is available for many skin diseases.

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A 29-year-old female visited Nagasaki University Hospital Dermatology Clinic because of discoloration of her right thumb nail. The distal part of the nail plate was slightly thickened and onycholytic with dark-brown pigmentation. There was no paronychia. Removal of the onycholytic nail plate revealed brittle subungual hyperkeratosis. Round fungus spores or pseudomycelia compatible with parasitic form of yeasts were seen by KOH-preparation and also by Gomori’s methenamine silver stain, and Candida parapsilosis was isolated. The patient was treated with topical use of 5% glutaraldehyde solution but the course was not continued.

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Seven cases of acquired zinc deficiency with cutaneous manifestation were reported, with special reference to biochemical, histologic and electron microscopic studies. Histologic examination of 7 erythematous regions showed hyperkeratosis, parakeratosis, acanthosis, elongated rete ridges and chronic inflammatory infiltrate of the dermis. Six bullous regions showed spongiosis, intraepidermal bulla or pustule, edema of the dermal papillae and acute inflammatory reaction of the dermis. Munro microabscess and acantholytic cells were occasionally observed. By means of electron microscope, oval materials with low electron density were found in the Langerhans cell and keratinocytes, where they were numerous especially in the horny layer. The blistered area showed dissociation of the desmosomes and involution of the tonofilaments. The zinc content of the epidermis determined in two cases was as low as 127.0μg/g and 101.6μg/g, respectively. Decrease of serum linoreic acid and myristic acid levels was observed, while increase of lipoperoxide was not demonstrated. Diminution of the serum zinc content may not only be related to development of metabolic disorders but also gives rise to decrease of the zinc concentration in the local cutaneous tissue, which in turn may result in a variety of cutaneous disorders.

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A case of scleredema which appeared in a 48 year-old male with unstable diabetes mellitus was reported. The diagnosis was confiirmed by clinical and histological findings. The number of the cases reported in Japan is twenty-five including our case.

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Serum IgE levels were measured in patients with chronic eczematous dermatitis without any previous or family history of bronchial asthma and/or allergic rhinitis, or any parasite infections. The aged males accounted for a greater number of patients studied. The degree of dermatitis was classified into two groups according to the distribution and severity of skin involvement; the diffuse type and the localized type. The former has a wide region of lichenification over most of the cutaneous surface, while the latter has a small extent of lichenification on the localized area. High IgE levels (≥700IU/ml) were demonstrated in 27 of 57 patients with diffuse type and in 5 of 43 cases with localized type. It is, however, noteworthy that 95% of patients showed serum IgE levels below 3000IU/ml. There was no correlation between serum IgE levels and other immunoglobulin (IgG, IgM and IgA) levels and blood eosinophil counts. Investigation of specific antigens with RAST showed only 3 cases to be positive with dermatophagoides and other allergens. These findings suggest that the mechanism of IgE production in chronic eczematous dermatitis is different from that in atopic dermatitis.

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Three cases of genital Paget’s disease were observed by electron microscopy. In two cases, Paget’s cells included the presence of secretory granules or glycogen granules and formed lumens and intercellular canaliculi. Desmosomes were small and poorly developed. These findings were suggested as an eccrine sweat gland origin or differentiation toward eccrine apparatus. In the other case, pleomorphic mitochondria, ribosomes and vacuoles were prominent in the cytoplasma of Paget’s cells. Desmosomes were poorly developed and tonofilaments or glycogen granules were difficult to detect in the cytoplasma of Paget’s cells. Thus, we could not determine the origin of Paget’s cell in this case.

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Serum samples were collected from 30 patients with Behçet’s disease and 100 healthy volunteers between October, 1972 and October, 1977 and were examined for the precipitation reaction to physiological saline containing 0.5, 0.7, 1.0 or 1.3% of phenol (so-called carbol reaction). This examination was repeated, a total of 552 times for the patients’ samples and 670 times for the volunteers’ samples. The results are as follows:
1) In the healthy volunteers, all serum samples gave a negative reaction to 0.5 or 0.7% of phenol and some samples gave a positive reaction to the higher two concentrations as 1% and 1.3%.
2) It was proved that this reaction was well correlated with clinical severity, erythrocyte sedimentation rate, CRP and A/G of Behçet’s disease.
3) This reaction, though its mechanism is still a matter of conjecture, may be of aid in recognizing the condition of the disease.

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