A case of acropathies ulcéro-mutilantes pseudo-syringomyéliques non familiales des membres inférieurs in a 56-year-old public official was reported. The patient was admitted with a marked swelling and deformity of the right big toe and recurrent ulcer surrounded by tylosis-like keratosis on the sole. Within the following years the patient was hospitalized 3 times, the ulcer was removed and covered with a full thickness skin graft several times. The graft was always not stable in consequence of a recurrent ulceration. At the last admission the big toe was amputated because of a macrodactylia-like deformity with ulcer. This disease is characterized by chronic ulceration as a result of slight injury, neurogenic acro-osteolysis, sensory disturbance of the extremities and is of a non-familial incidence. This disease usually begins in middle aged men who are undernourished as the result of chronic alcohol ingestion. Such cases have been reported in France, but this is the first typical case to be documented in Japan.

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Majocchi’s disease on the lower extremities of a 52-year-old man took the form of numerous red puncta without itchness and pain for the previous 3 months. The red puncta were arranged in groups, and partially in annular form. Pathological findings showed capillary dilatation in the papillae, and swelling of endothelium of small blood vessels and lymphocytic infiltration, extravasation of erythrocytes and deposition of hemosiderin around the vessels in the upper dermis. In laboratory examinations, only the RA test was positive. Observation without treatment was decided on. After 4 months the RA test became negative, and at the same time, the red puncta disappeared spontaneously. Majocchi’s disease is considered to occur by transient hypersensitivity or allergic reaction in the upper dermis. Biologically active substances probably released by the reaction might reach the papillae, after which the capillary loops become dilated by these substances.

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A 67-year-old woman with a cutaneous metastasis of renal cell carcinoma on the scalp was treated in our clinic. Histologically, two types of tumor cells were evident: one was a clear cell type and the other a granular cell type. Both contained abundant PAS positive, diastase digestive materials and the stroma showed vascular structures. Electron microscopic examination revealed that the tumor cells had brush border-like structures in some areas, thereby suggesting that renal cell carcinoma originates from proximal tubule cells.

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A 68-year-old man with multiple ulcers and gangrene of the extremities and face was reported. Clinical studies revealed evidence of arteriosclerosis, diabetes mellitus, and rheumatoid arthritis. Two months after admission, he became leukemia and the abnormal cells formed E-rosetts.

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A 3-month-old girl with a localized hypertrichosis on the right thigh was reported. Histologically, the dermis and subcutis contained a large number of smooth muscle fibers, some of which appeared to connect with the hair follicles. The diagnosis of nevus leiomyomatosus was made on the basis of clinical and histological data. Difference from leiomyoma and relation to Becker’s nevus was discussed.

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The present work is part of a correlative study of the fine morphology and etiology of the vascular spider, and is an extension of earlier investigation of the dermal microcirculation (S. Imayama et al.^1)∼4)). In the subcutaneous tissue, the beginning of the central ascending vessel is marked by dilatation of the vascular lumen and considerable thickening of the muscular coat and involves disappearance of the elastica interna of the arterioles which empty into this segment. The muscular coat is composed of an inner layer of longitudinally arranged immature smooth muscle cells and an outer layer of circularly arranged mature smooth muscle cells. These findings are similar to those seen in the arteriovenous anastomosis (AVA). In the dermis, however, the wall of the ascending vessel shows a close resemblance to that of venules and post capillary venules; an attenuated endothelium and few layers of flattened smooth muscle cells. In the subepidermal layer, dilated vessels running parallel to the skin surface are essentially a thin endothelial tube with few pericytes. Based on these observations, it would appear that the distended AVA allows blood to rush constantly through AVA and flow backward to the descending and postcapillary venules and finally the subepidermal capillary network, to form a spider.

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From 1963-1978, the Kveim Test was performed by single section examination on 22 patients at Tokushima University Hospital. Recently, by making serial sections from the reserved paraffin-blocks, a positive rate of this test was markedly increased (14.3% to 50%). The Kveim nodule was small (0.23 to 0.35mm in diameter) and was generally included alone in the block. Therefore, the serial sections which were made in this study had a greater possibility of including such small Kveim nodules. It has been emphasized that serial sections should be made when performing the Kveim Test.

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We devised a slide culture making use of rice grains as a means to obtain macroconidium of Microsporum. canis. This is a simple method which comprises merely making use of rice grains for slide culture. Macroconidium obtained by this method was large in number and very clear in shape. This method was considered useful as a convenient means to identify M. canis.

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Since 1953, 26 topical corticosteroids have been permitted for clinical use in Japan. The first topical corticosteroids used clinically in Japan were rather mild, for example, hydrocortisone. However, in recent years, the new corticosteroids are much more potent. This is undoutedly due to the fact that the more effective the agent is, the less time is required for treatment, and the more resistant lesions become to a cure. Untoward reactions such as suppression of the adrenal cortex function and local skin side effects seen with these potent, topical corticosteroids present a problem for clinician. Skin atrophy, redness, and telangiectasia are sometimes observed after a long duration of use of such corticosteroids. Rosacea-like dermatitis, so-termed by Steigleder (1968) and which usually occurs on the face of women, is sometimes seen in patients with a history of long term application of corticosteroids. Although these types of local side effects subside with time, long term application of such corticosteroids should be avoided. From above mentioned facts, development of an effective but mild topical corticosteroid has long been awaited. It is difficult for the physician to assess untoward reaction potential, because the patient might be using more than one corticosteroid during the course of treatment. Therefore, a method for prediction of untoward reaction potential has to be designed. Some workers have described the methodology of measurement of skin atrophy due to various corticosteroids. The data from animal experiments do not necessarily allow for a sufficient prediction of reactions in humans. This report is concerned with the assessment of local side effects such as skin atrophy, redness, telangiectasia on human skin. The test was performed on 16 healthy male volunteers. Two areas on the flexor aspect of each forearm were used as the test site for randomly allocated four test samples, namely; 0.3% prednisolone 17-valerate 21-acetate (PVA) ointment, its vehicle, 0.1% hydrocortisone 17-butyrate (HB) ointment and its vehicle. HB ointment was selected as the reference drug because; (1) it was reported that the adrenal cortex suppression due to HB was significantly weaker than that of betamethasone 17-valerate, in a double blind study conducted in Japan, and (2) the test drug, PVA, is a nonhalogenated corticosteroid, as is HB. The test samples were applied daily for six weeks every morning and evening, and an occlusive dressing was applied overnight. The thickness of skin at the test areas was measured prior to and each week during the test using a Harpenden skinfold caliper. Also, ocular inspection for the occurrence and the degree of redness, and telangiectasia and palpation for skin atrophy was made. The following results were obtained:
(1) Measurement of skin atrophy; the average skin thickness on the test area prior to application of test samples was 2.2mm. A decrease in skin thickness on the PVA and HB applied site was observed one week after the initiation of application and the degree of skin atrophy increased weekly. Two weeks after the initiation of application, the degree of skin atrophy due to HB was significantly higher than PVA. Four weeks after the discontinuation of application, the skin atrophy due to both corticosteroids returned to the initial value.
(2) Observation of redness, telangiectasia, and skin atrophy; four weeks after the initiation of application, redness was observed at HB and PVA applied sites in 6/16 volunteers. Six weeks after the initiation of application, redness was observed in 12/16 at the HB applied site and in 11/16 at the PVA applied site. A significantly higher degree of redness was evident at the HB applied site. Telangiectasia was observed in 8/16 at the HB applied site and in 7/16 at the PVA applied site. Skin atrophy was evident on palpation in 11/16 at the HB applied site and in 10/16 at the PVA applied site. (to be continued)

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A statistical survey of tinea was carried out in the dermatological clinic of Shimane Prefectural Central Hospital from 1976-1979. The proportion of tinea pedis and tinea unguium of the toes has increased in adults but not children since 1976.

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