A 69-year-old woman with hyperthyroidism had a systemic sarcoidosis, which initially became evident with eruptions on the bilateral knee areas. A skin biopsy of the erythema showed epithelioid granulomas. Biopsies of lung and liver, ophthalmologic examinations and the ACE serum level determinations confirmed the diagnosis of systemic sarcoidosis. Oral corticosteroid therapy improved the symptoms of fever and general fatigue and decreased the serum ACE levels. The possible pathogenetic relationship between hyperthyroidism and systemic sarcoidosis is discussed.

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A 53 year-old Japanese man with generalized vitiligo and acral keratotic papulonodular lesions had a large nodule located around his right fourth toe, of three years’ duration. Close inspection revealed two other lesions near the right heel and a moist eroded lesion on the first intertoe space. He also had right inguinal lymphadenopathy. The large nodule was diagnosed histologically as a malignant proliferating trichilemmal cyst and the other lesions showed the histologic pictures of Bowen’s disease and squamous cell carcinoma. Despite amputation of the right leg and chemotherapy, distant metastases were evident 18 months after his first visit. He had severe pain, cystoparalysis and constipation and he died of malabsorption and cachexia. He had consumed arsenite for several years hence became susceptible to skin cancers.

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Cold urticaria in a 27 year old man was investigated. At temperature of 0∼27°C skin wheal was produced and the suppressive effect on urticaria was most effective when cimetidine and cyproheptadine were concomitantly applied. Cold tolerance increased the effect of the antihistaminics. In a 66 year old woman, a wheal was induced with temperature range of 0∼10°C. In both patiens, the minimum time required to produce the wheal parallel the temperature. Thus pathogenesis probably differed in those patients.

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We treated an 82 year old man with typical PSS. According to the literature, this patient may be the oldest person with an initial onset of PSS in Japan. The prognosis of the old aged with PSS is discussed.

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Ten autopsy cases of metastatic skin cancer, including 8 of lung cancer, one of uterus corpus cancer, and one of adrenocortical cancer, are reported. These 10 cases are discussed, according to: (1) relationship between skin metastic site and primary site, (2) tumor embolism and metastatic organ, (3) histopathological differences between primary cancer and metastatic skin cancer, (4) pattern of metastatic spread, and (5) prognosis of the metastatic skin cancer.

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A 53-year-old man and a 60-year-old woman with nodular lesions due to acupunctural therapy were treated. In the former, several soybean-sized nodules with seropapules were present on the dorsum, corresponding to several acupoints made of the time of acupuncture. Histopathologically, vesicle formation with spongiosis was seen in the epidermis and moderate cell infiltrations of the mononuclear cells were present perivascularly, in the entire dermis. In the latter cases, small finger-sized indurations on the leg were seen, corresponding to acupoints made at the time of acupuncture. Histopathologically, aggregation of histiocytes and mononuclear cells was seen in the deep dermis, some of which resembled a germinal center-like structure of the lymph node. Skin reactions caused by acupuncuture are rare, as we had not seen similar cases among 10,000 patients in total with progressive systemic sclerosis, seen from 1975∼1985.

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We treated a man with cutaneous T cell lymphoma (CTCL). This 61-year-old man had recurrent, multiple subcutaneous nodules on the trunk and the extremities for 13 months before the first examination. Biopsied specimens taken on several occasions revealed non-specific granulomatous inflammatory panniculitis, and a tentative diagnosis of Weber-Christian’s disease was made. Eight months after the first examination, CTCL was detected in a biopsied specimen obtained from one of the recalcitrant nodules. Two months after, he died of brain hemorrhage. Autopsy revealed a prominent erythrophagocytosis by benign histiocytes proliferating in the bone marrow, spleen, liver and lymph nodes. We speculate that the patient may have had CTCL since development of the multiple panniculitis, and that possible lymphokines produced by CTCL caused the panniculitis during the early stage, and the reactive histiocytosis with a prominent erythrophagocytosis at the end stage.

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A 45-year-old man with a previous history of liver dysfunction had erythema multiforme lesions over almost the entire body shortly after oral ingestion of a drug for upper respiratory tract infection. The clinical findings and examinations showed evidence of liver dysfunction and interstitial pneumonia. Since immunological examinations revealed little evidence of an allergic pathogenesis for these disorders, a non-allergic pathogenesis was considered. An unususal metabolite synthesized from the drug in the presence of liver dysfunction may have been related to the lesions.

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A 16-year-old boy was seen because of a rapidly growing tumor in the lumbar region. The CT scanning investigation revealed another large tumor in the retroperitoneal cavity. Physical examination showed numerous café-au-lait spots and soft tumors on the whole body, pachydermatocele in the left thigh, and thoracic scoliosis. His mother had signs of von Recklinghausen’s disease. Both tumors were surgically removed and were not associated with peripheral nerves. Histologically, they were diagnosed as malignant schwannoma, grade I, because of the high cellularity, moderate atypicality and some mitosis. The majority of tumor cells and fibers were S100 protein positive. In addition, he had anomalies of Marfan’s syndrome such as excessive length of extremities, particularly the fingers, and excessive mobility of the joints.

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The case 1 patient was a 27-year-old Filipino woman. At age 14, she was diagnosed as having tuberculoid leprosy. At age 25, she noticed numerous poorly defined light-brown plaques and nodules on the side of her neck, trunk and upper and lower extremities. Annular plaques with punch out centers and satellite lesions were present on her back and left elbow. Sensation to heat and pain was diminished in some of the lesions. A lepromin test was negative and an FLA-ABS test was positive. Histology of the upper dermis showed an infiltration consisting of histiocytes and foam cells. Periodic acid-carbol pararosanilin stain revealed numerous lepra bacilli in the foam cells. With Ziehl-Neelsen stain, numerous lepra bacilli were also observed in the skin slit-smear from lesions and the bacterial index was 4+ to 5+. The case 2 patient was a 41 year old man from Ibaragi Prefecture, about 18 months ago he noticed an abnormal sensation in the fingers of both hands and 6 months ago, three erythematous plaques appeared on the left flexural aspect of his forearm, upper arm and left elbow. The lesion on the flexural aspect of the forearm was annular and some portions were poorly defined. The sensation to pain was diminished in the lesions. In addition, the normal skin in both palms and soles, as well as the left groin, showed a decreased sensation to pain. Both ulnar nerves were swollen. The lepromin test and the FLA-ABS test were positive. Histology showed cell infiltration composed of lymphocytes and epitheloid cells surrounding the nerve, but lepra bacilli were not stained. Lepra bacilli were also not detected in the skin slit-smear. Case 1 was diagnosed as the BL type, and Case 2 as BT type of leprosy. The differential diagnosis of both types is discussed, based on the clinical and laboratory findings.

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Seventeen patients with titers of RNP antibody over 1:10,000 seen at our clinic from 1981 to 1986 were investigated.
(1) Five had systemic lupus erythematosus (SLE), 3 progressive systemic sclerosis (PSS), 7 mixed connective tissue disease (MCTD) and 2 unclassified connective tissue disease (UCTD).
(2) Six of 7 with MCTD, both of 2 patients with UCTD and 1 of 3 with PSS had high titers of RNP antibody alone.
(3) All 5 patients with SLE and 2 of 3 patients with PSS had both antiDNA antibody and antiSm antibody.
(4) Raynaud’s phenomenon was present in 12, but serious renal disease was not evident in any patient. The response to corticosteroid was positive in all patients.

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Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are autoimmune related blister diseases in which antibodies react on the cell surface of epidermal cells. The antigens reacting with antibodies in these patients have not been elucidated. We attempted to determine the epidermal cell surface antigens which reacted with antibodies in the sera of Japanese patients with PV and PF, using immunoblot analysis of extracts of the normal human epidermis. Proteins in these extracts were separated by SDS-PAGE and electrophoretically transferred to nitrocellulose sheets. The sheets were then incubated with sera, followed by immunoperoxidase staining, using goat anti-human IgG. Sera from six patients with PV and six patients with PF were examined One serum sample in case of PV and another in case of PF reacted with a protein band with a molecular weight of 160 kd. These data suggested that among the Japanese with PV or PF, there are patients whose sera react with the same molecules of 160 kd reported by Stanley et al. in 1984.

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Dermatitis of the hands is an occupational hazard of surgeons and nurses. Surgical rubber gloves and antiseptics are common causes of this allergic contact dermatitis. Closed patch tests of surgical rubber gloves (6 kinds), glove powder (Medic Powder), antiseptics (6 kinds) and antioxidants of rubber gioves (IPPD, BHT, MBMBP) were performed on 78 surgeons and nursing staffs of our hospital. To investigate the antioxidants of the surgical rubber gloves, thin-layer-chromatography (TLC) was performed. The reaction was judged as positive in 15 cases of patch tested surgical rubber gloves, and differences in the positive reactions varied considerably. Patch test of antiseptics at the concentration in practical use showed irritating reactions in more than 90%. Allergic reactions of IPPD were observed in 4 of 12 antioxidants patch tests. In an analysis of the surgical rubber gloves by TLC, only the same spot with MBMBP was observed, and IPPD and BHT were not detected. To prevent hand dermatitis in surgeons and nurses, both allergic and irritating reactions must be taken into consideration, and the method of scrubbing method and the surgical rubber gloves should be given consideration.

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Peripheral blood lymphocytes from 59 patients with atopic dermatitis were evaluated using monoclonal antibodies OKT3, OKT4 and OKT8. In contrast to the healthy controls, patients with atopic dermatitis had a increased percentage of OKT8-positive cells (p<0.05) and a reduced ratio of OKT4-positive cells over OKT8-positive cells (p<0.05), There were no significant differences in the these results, in the presence or absence of respiratory atopic disease. The ratio of OKT4-positive cells over OKT8-positive cells showed no significant relationships with the severity of the eczema or serum IgE levels.

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Transcutaneous Po₂ (tcPo₂), sensor temperature at 44°C, was investigated in case of sclerotic lesions in patients with progressive systemic sclerosis, morphea and hypertrophic scar. Simultaneously, the increase in cutaneous blood flow caused by local heating was measured with a laser Doppler flowmeter. The mean tcPo₂ levels and the mean blood flow levels in case of heat-induced hyperemia were significantly lower than in the normal skin. These results indicate that the reduced tcPo₂ on the sclerotic lesions is partially due to insufficient heat-induced hyperremia or so called “arterialization” in capillaries. In addition, the reduced diffusibility of oxygen through the altered capillary walls and surrounding sclerotic tissue may relate to the decrease in tcPo₂. tcPo₂ values seem to be a good parameter indicating the severity of sclerotic changes of the skin.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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