Three cases of acute GVHD were reported. Case 1. 32-year-old woman with acute myelogenous leukemia. Maculopapular erythemas occurred on the cheeks, arms and chest 43 days after bone marrow transplantation. Case 2. 28-year-old man with aplastic anemia. Erythematous vesicles on the extremities and trunk and linear white macula on the oral mucosa were evident 85 days after bone marrow transplantation. Case 3. 27-year-old woman with aplastic anemia. Erythemas occurred over the whole body 25 days after bone marrow transplantationer. Gastrointestinal and liver disorders ensued and she died 3 months after the transplantation. Histlogical examinations revealed typical findings of acute GVHD, including the presence of vacuolated, dyskeratotic kerationcytes in the basal layer, upper dermal perivascular infiltrate and lymphoid exocytosis into the epidermis.

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A 54-year-old Japanese woman who developed acanthosis nigricans in the course of pemphigus erythematosus was reported. Two years prior to the first dermatologic consultation at Sagamihara Kyodo Hospital, she noticed bullae and erosions on the face, neck, chest and back following a seborrheic dermatitis-like eruption on the scalp and face. The diagnosis of pemphigus erythematosus was made on the basis of clinical features, histopathological appearance and immunofluolescence findings. Subsequently, she was treated with endoxan and external application of corticosteroid ointment. About nine months later, a papillomatosus brownish eruption occurred in the perioral and periorbital regions, the neck, axillae, wrists and inguinal regions, areas not coinciding with the distribution of pemphigus. Biopsy specimen of the pigmented lesion Showed features of acanthosis nigricans. Despite repeated examinations, no clinical evidence of malignant tumor and endogenous disease was obtained. Acanthosis nigricans associated with pemphigus has been reported very rarely. This may be the first report of acanthosis nigricans in the same patient with pemphigus erythematosus.

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A 51-year-old man had a pigeon egg-size blue macula on the right lower eyelid. The patient noticed the blue macula, which had been present for two years, was partly elevated as a nodule and he visited Saga Medical College hospital in November 1985. Histological examination of the nodule revealed solid basal cell epithelioma and a number of pigment containing cells in the stroma. The pigment containing cells were morphologically like dermal melanocytes. The blue macula was considered to be an acquired dermal melanocytosis associated with basal cell epithelioma.

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Blue rubber bleb nevus syndrome was diagnosed in a 50-year-old man. Multiple hemangiomas had developed over the body surface and in the oral cavity since he was a junior high school student. A protuberant, reddish-purple rubbery soft tumor was present on the left shoulder, two semipedunclated, bluish-purple nodules in the oral cavity and six subcutaneous nodules on the face, trunk and extremities. Histopathological studies of a rubbery soft tumor on the shoulder revealed numerous large irregular vascular cavities lined with a single layer of endothelial cells. Parts of the walls of some cavities, especially in the subcutaneous tissue, were made up of thick fibrous tissue intermingled with elastic fibers and smooth muscle cells. As both thin and thick walls were found in the same cavities, they were considered to transit each other. A normal vein was also observed to communicate with the dilated cavities, but no arteriovenous communications were observed. In ultrastructural studies, a single layer of flattened endothelial cells and rich smooth muscle cells were found in the vessel walls. The hemangiomas observed in this case were considered to be a venous angioma.

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We report a case of multiple subcutaneous abscesses caused by Nocardia brasiliensis occurring in 49-year-old diabetic man maintained on therapy with prednisolone and cyclophosphamide for chronic T lymphocytic leukemia. He suffered an abrasion wound adjacent to the right knee while he was working outdoors about two weeks before his first visit at the Dermatology Clinic of Nagasaki University. Despite the administration of sulfamethoxazole-trimethoprim and minocycline he died of bacterial septicemia, other than Nocardia species. A short review is made of 11 previously reported cases of cutaneous infection caused by Nocardia brasiliensis in Japan.

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A well-demarcated reddish brown elevated plaque appeared on the light pretibial region of a 89-year-old Japanese man. Histologic examinations revealed multiple intraepidermal epitheliomas which could be clearly distinguished from the surrounding keratinocytes. A low power view showed a close resemblance to that of hidroacanthoma simplex. Tumor cells showed a prominent nuclear atypia, and clumping. Individually keratinized cells were also seen in some parts of the tumor nests. Most of the tumor cells were PAS negative. Electron microscopically, the tumor cells showed findings of abnormal keratinization associated with relatively abundant tonofibrils but there were no definite findings indicative of an intraepidermal sweat duct origin.

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A 33-year-old Japanese woman had a sharply defined black macule on the right middle finger. Histologically, the lesion consisted of nests of pigmented spindle-shaped melanocytes affecting the epidermodermal junction, and were diagnosed as pigmented spindle cell nevus (PSCN). These cells are characterized by nuclear uniformity, showing neither pleomorphism nor mitosis. The presence of pigmented keratinocytes in the epidermis and of melanophages in the upper dermis is worthy of mention. Although PSCN may have been assigned to the place of nevus of large spindle and/or epithelioid cells (Spitz nevus), these two should be divided, because the latter is characterized by the composition of large cells with an abundant basophilic cyotplasm (epithelioid cells) and the pigmentation is sparse.

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A Japanese male infant with congenital generalized fibromatosis (CGF) involving subcutaneous tissue, diaphragma and myocardium, died of disseminated intravascular coagulation (DIC) at 25 days of age. Ultrastructural studies revealed the constituent cells to be myofitroblasts with a deeply indented nucleus and intracytoplasmic microfilament bundles located just beneath the plasma membrane. The extracellular matrix showed a network consisting of proteoglycan particles and fine filaments with intermingling of thin collagen fibrils, without distinct cross striations. In primary tissue culture, the tumor cells proliferated well, and were elongated and spindled in shape, similar to fibroblasts. They failed to attach to a glass surface after treatment with pronase for subculture and extinction of the viable cells followed. This finding may correlate with the fact that most tumor cells of this disease regress spontaneously.

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A 15-year-girl with an erythematous, indurated plaque on a portion of her right eyebrow was presented. Histological examination revealed characteristic features of follicular mucinosis. Dense inflammatory infiltrates were seen around hair follicles which showed reticular degeneration. The severely affected hair follicles had a cystic appearance, and the cystic spaces contained an Alcian blue-positive amorphous substance. As an uncommon feature, mitotic figures were occasionally seen among the dermal infiltrates. Electron microscopy revealed lymphocytes and stimulated macrophages, both in and outside of the hair follicles. Some lymphocytes had deeply indented nuclei. Immunohistochemical studies showed that most of the infiltrates were T cells, and that the ratio of OKT4/KOKT8 was approximately 4:1. In addition, the expression of Tac antigen was seen on some lymphoid cells. These findings strongly suggest that cell-mediated immunity, probably elicited against antigenically altered follicular cells, may play an important role in the pathogenesis of follicular mucinosis.

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Eighty two cases of various dermatoses, including 11 bullous diseases, 24 collagen diseases, 25 vasculitis and 22 other dermatoses were studied using immunofluorescence staining. In almost all cases. the findings obtained were in accord with those reported in the literature. In a few cases, the following interesting findings were seen. In one case of localized bullous pemphigoid, circulating anti-basement membrane zone antibody of IgA class was present in the serum. In one case of morphea, IgM antibody was present at the basement membrane zone. In one case of purpura pigmentosa chronica, IgM antibody was deposited on the wall of dermal blood vessels.

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Thirty-one diabetic patients with ulcerative lesions on the extremities were divided into two groups and examined; Group (+) had normal peripheral pulsation, and Group (-) reduced or no peripheral pulsation. These groups were compared with Group ASO, that is those with non-diabetic gangrene or severe cyanosis due to arteriosclerosis obliterans. In Group (+), compared with Group (-), the duration of diabetes at the onset of gangrene was shorter. The prevalence of neuropathy and retinopathy was higher and the severity of retinopathy was greater. FBS and HbA₁ showed no statistical significance between 2 groups. Thus, factors other than FBS or HbA₁ may be involved. The levels of FBS and HbA₁ were abnormally high in both groups. Group (-) had no male predominance, as seen in Group ASO, and the onset age of gangrene was higher than Group (+) and lower than Group ASO. Thus, Group (-) also had characteristics of diabetes and arteriosclerotic changes related to the diabetes were accelerated.

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Cranial computed tomography (Cranial CT) was performed on ten out of sixty-two patients with von Recklinghausen’s disease and the significance was discussed. Intracranial tumor was found at high incidence (two out of ten cases, 20%). Therefore, cranial CT was considered to be useful examination for von Recklinghausen’s disease which frequently accompanied intracranial tumor. Moreover, we attempted to find specific skin manifestation for the presence of intracranial tumor. Two cases with intracranial tumors were included in four cases with pacydermatocele on the head and face. We suggest that cranial CT is necessary for detection of intracranial tumor in patients with pachydermatocele on the head and face.

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A statistical survey of seven hundred arid seventeen Japanese patients with herpes zoster was carried out at the Dermatological Clinic of Sapporo City General Hospital from January, 1980 to December, 1985.
1) The number of patients with herpes zoster showed a tendency to increase from 1980 to 1985.
2) Larger number of patients were seen in spring or summer as compared to other seasons.
3) Sex ratio was 1:1.5 (male:female).
4) The age group of fifties was most frequently afflicted. The relative frequency of herpes zoster in all out-patients increased in the geriatric age group.
5) The thoratic (25.5%), cervical (13.7%) and trigeminal (21.3%) dermatomes were most commonly involved in all ages, and in those over 50, trigeminal (including ophthalmic) herpes zoster increased.
6) Two hundred and sixty-one cases (36.4%) had underlying disorders such as hypertension, malignant tumor and diabetes mellitus.
7) Recurrent attacks occurred in eight cases.
8) In 66.9% of patients, the neuralgia recovered with in one month after healing of the eruptions, but in 16.4%, over six months was required. In aged group and in those with generalized herpes zoster, neuralgia persisted for longer periods.
9) In thirty-three, cases generalized herpes zoster developed and the age group of seventies were most frequently affected. Trigeminal and ophthalmic dermatomes were most frequently involved as a primary location.

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Herpes zoster (HZ) was diagnosed in 531 patients (2%) out of 26,032 seen at the Department of Dermatology, St. Marianna University Hospital, between January of 1980 and December of 1986. The male to female ratio was equal. HZ had a peak incidence during the fifth decade in females, while HZ had the highest incidence in males during the second decade. No seasonal trend was observed. The highest incidence was in July. HZ most frequently (39.7%) involved the thoracic area and arm. Other sites of involvement and frequency were as follows: Head and neck, 26.5%; abdomen and lumbar area, 19.7%; nates and legs, 13.9%. The HZ lesions were unilateral and the right and left sides of the body were equally affected. Underlying diseases such as carcinomas, diabetes mellitus and collagen diseases were present in 95 patients and included carcinomas 16, diabetes mellitus 16, collagen diseases 8, leukemias 3 and others 52. The most common complication resulted from ocular involvement. Keratitis and iritis were present in 19 patients. Methods of treatment which were used included administration of γ-globulin, acyclovir and epidural block (nerve block). In 50 patients, postherpetic neuralgia occurred.

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Statistical survey on 68 patients with pustulosis palmaris et plantaris (PPP) seen in the dermatological clinic of Shimane Medical University Hospital from 1979 to 1984 revealed the following:
1) The patients with PPP comprised 0.7% of all outpatients seen at our clinic, the male/female ratio being 9:5.
2) The most frequent onset of PPP occurred in the fifth decade. The onset of PPP in women tended to be later than in men.
3) In most PPP patients, eruptions developed on either bilateral palms or bilateral soles at the onset. Later, the eruptions appeared over both palms and soles.
4) Extra-palmoplantar eruptions included nail lesions, pustular or vesicular erythematous desquamous lesions of the dorsa of hands and feet, and erythematous desquamous lesions on the scalp, elbows and knees.
5) There were many patients with not only pustular eruptions on the palms and soles, but also extra-palmoplantar eruptions. In this group, also affected nails were in most cases.
6) Main factors which worsened the eruptions of PPP included menopause, high temperature, excessive sweating and dental diseases.
7) Patients with abnormal peripheral white blood cell counts, erythrocyte sedimentation rate, ASO, ASK and CRP were few. These laboratory data are not always specific for PPP.

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[in Japanese]

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[in Japanese]

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