We presented a 39-year-old female patient who had suffered from clinically typical erythema elevatum diutinum for two years. The erythematous plaques were distributed symmetrically on the extensor surface of all the interpharyngeal joints of her fingers. There were no systemic signs or symptoms. Laboratory studies were all within normal limits, as was the chest radiogram. Histologically, the epidermis was invaded by the infiltrate of neutrophils and showed acanthosis and hyperkeratosis. There were dense perivascular infiltrates of lymphocytes and histiocytes in the dermis. However, there were no obvious findings of leukocytoclastic vasculitis. The lesion was diagnosed as erythema elevatum diutinum in a chronic condition, and it was treated with dapsone (75 mg t. i. d.) resulting in an almost complete clearing of the eruptions within eight months.

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A 28-year-old woman, without skin involvement, was diagnosed as having SLE by fullfilling the ARA criteria. She had been treated with oral predonisolone administration, 60 mg per day. In the midsummer of 1984, after many hours of sun exposure, she suddenly devoloped widespread erythematous plaques with large blisters in the center leaving denuded areas. Oral mucosa was also affected, showing erosive lesions on the hard palate, but mucosal lesions were less intense than the skin lesions. Histopathology of the blister-forming lesions showed large subepidermal separation, severe hydropic degeneration of basal cells, and extensive epidermal necrolysis. There was only sparse infiltration of the inflammatory cells in the dermis, and there existed no neutrophilic invasion into the blisters which is a finding peculiar to vesiculobullous SLE. Direct immunofluorescence study of biopsied erythematous plaque adjacent to the blister showed linear IgG, Ig M, C1, C3, fibrinogen deposits on basement membrane zone. Under the diagnosis of acute onset of TEN type SLE caused by many hours of sun exposure, a trial of steroid pulse therapy (1,000 mg per day for three days) was performed, inducing resolution of both cutaneous lesions and laboratory data for SLE within two weeks. The patient remained in a well-controlled condition for both skin and SLE laboratory data until July 1987, when she noted a second outbreak of extensive skin rash and blisters after a very short term of sun exposure. Histological findings of the blisters were the same as that of the first episode. Once again pulse therapy induced remission for both skin manifestation and SLE, and she has remained in a good condition since then. We conclude that this case is TEN type SLE clinically and histologically, caused by sun exposure and based on photosensitivity of the patient. TEN type SLE is so rare that there have been only three cases reported worldwide, and this is the first reported case in Japan.

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A 30-year-old woman visited us with a large ulcer on the lower abdomen, which had appeared on the second day following a Caesarean operation. The ulcer was shallow, but exposed the subcutaneous fat tissue. The edge of the ulcer was edematous and was covered by necrotic tissue. Histopathological findings of specimens taken from the ulcer were non-specific. No pathogenic organisms were cultured from the materials of the ulcer. The ulcer epithelized in about 4 weeks with treatment. Though we could not obtain clear histopathological or bacteriological evidence, we concluded that the ulcer was a bacterial gangrene because of the numerous large gram-positive bacteria found in the histologic sections previously taken at Kyushu Kouseinenkin Hospital.

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A case of graft-versus-host disease following bone marrow transplantation was reported. The bone marrow transplantation from an HLA-matched brother was carried out on a 23-year-old Japanese man who was suffering from continuous infectious episodes because of dysfunction and immaturity of neutrophils. 12 days after transplantation, he noticed a widespread maculopapular rash on his shoulders and back. Histologically, intercellular edema, fissures and dyskeratotic cells in the squamous cell layer, liquefaction degeneration of basal cell layer and lymphoid cell infiltration in the dermis were observed. Diarrhea was observed at the same time although hyperbilirubinemia was not observed. This condition was diagnosed as grade 1 acute graft-versus-host disease. 75 days after transplantation, severe diarrhea and hyperbilirubinemia, over 19 mg/dl, were observed so that he was diagnosed as having grade 4 chronic graft-versus-host disease. At that moment he showed ichthyosiform highly scaly dry skin on almost the entire body, especially on the lower legs. The possibility of diagnosis of chronic skin graft-versus-host disease is discussed.

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A 28-year-old woman who had a history of recurrent abortion developed ulcers on the lower left leg. She showed a prolonged prothrombin time (PT) or activated partial thromboplastin time (APTT). The presence of lupus anticoagulant in this patient was suggested by the failure of PT or APTT to return to normal when the patient plasma was mixed 1:1 with normal plasma. A biopsy specimen taken from the ulcerated lesion showed the dilatation and proliferation of dermal capillaries and the extravasation of red blood cells. Histopathologic and immunofluorescence studies of biopsy specimens from the skin lesions failed to demonstrate any evidence of vasculitis. Venography demonstrated a deep venous thrombosis in the left calf and thigh. There were no clinical or laboratory findings suggesting the presence of systemic lupus erythematosus or other systemic diseases.

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In a 65-year-old man with stage IV malignant melanoma, metastatic skin lesions were treated with intralesional infusions of γ-interferon and interleukin-2. However, no response was seen. Chemotherapy for carcinomatous peritonitis with a combination of intraperitoneal injections of cisplatinum and intravenous injections of vinblastine and dacarbazine caused a reduction of ascites and in the size of metastatic skin lesions.

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A 60-year-old man developed symmetrical vitiligo and pernicious anemia. Laboratory studies revealed antibodies to intrinsic factor and gastric parietal cells in the patient’s serum. He also had achlorhydria. The serum of the patient was tested for antibodies to melanocytes and melanin by indirect immunofluorescence and immunofluorescent complement fixation tests. The results were negative. The occurrence of vitiligo and pernicious anemia in a patient is a very rare.

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A 47-year-old woman with progressive systemic sclerosis had bilateral carpal tunnel syndrome. Local corticosteroid injections were not effective. Surgical intervention improved the symptoms of carpal tunnel syndrome. Histological examination of the thick transverse carpal ligament showed thick bundles of collagen, replacement of surrounding fatty tissue by collagen, and slight mononuclear cell infiltration. We thought that the thick transverse carpal ligament in this case was a result of subcutaneous involvement of progressive systemic sclerosis. Cases with progressive systemic sclerosis and other collagen diseases coexistent with carpal tunnel syndrome discussed in previous publications were reviewed.

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A 45-year-old woman who had been treated for five years under the diagnosis of aortitis syndrome, had fever and raised, red, tender nodules and plaques on the right cheek. Neutrophilia, elevated ESR, and positive CRP were evident. The histological findings of the red nodules were compatible with the diagnosis of Sweet’s syndrome. The eruption cleared without scarring with daily oral administration of 50 mg prednisolone, but acne-like eruptions appeared on the face when the dose of prodenisolone was reduced. The eruption finally faded with daily oral aciministration of 7.5mg prednisolone for about one and a half years after it first appeared. This case is the first report of Sweet’s syndrome associatied with aortitis syndrome and we discussed the relationship between Sweet’s syndrome and pyoderma gangrenosum.

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A 73-year-old Japanese woman suffered from an elevated lesion, clinically diagnosed as cornu cutaneum, on the face. Light microscopically, there were numerous epidermal cells which included eosinophilic amorphous substances; electron microscopically, they were aggregates of tonofibrils. Immunohistochemically, there were granules, positive for papilloma antigen by the ABC method, in the horny layer. Based on these findings, a diagnosis of viral wart was made. There were many giant cells with polymorphous nuclei and some dyskeratotic cells in the center of the lesion, suggesting a transformation into Bowen’s disease. Electron microscopically, however, viral particles were not detected. Carcinogenesis, virus, and sunlight were discussed.

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Three patients with eosinophilic pustular folliculitis were treated with oral indomethacin (50 mg/day). This therapy resulted in complete healing in a week. However, the lesions reappeared in two patients when the therapeutic dose was gradually reduced Oral and topical administration of indomethacin was effective for these patients. The mechanism of these therapeutic effects may be to inhibit the synthesis of LCF (lipid chemotactic factor), HHT (12-L-hydroxy-5,8,10, heptadecatrienoic acid) and PG (prostaglandin), which influence eosinophils.

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A case of lichen planus with mild porphyrinuria is reported. A 53-year-old male had a history of excessive alcohol intake for 30 years. The patient’s symptoms were initially thought to be porphyria cutanea tarda (PCT). However, the urinary porphyrin pattern revealed a predominance of coproporphyrin while fecal porphyrins showed a normal pattern. Histopathological findings coincided with lichen planus, but a deposition of IgG was seen around small blood vessels in the upper dermis by the direct immunofluorescence technique. From these results, a diagnosis of lichen planus with mild poprhyrinuria was made. Caution should be exercised in cases of this sort concerning the differentiation between porphyrinuria and porphyria.

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A 78-year-old man had pruritic brown hyperkeratotic papules on the extensor surfaces of both upper and lower extremities, and the lumbosacral area for 5 years. Laboratory studies disclosed increased levels of IgG (3,335 mg/dl) and IgA (697 mg/dl), and IgG kappa-type and IgA kappa-type of M-protein. Atypical plasma cells were not found in the bone marrow aspirate. Bence-Jones protein was negative. Histologically, the papillary dermis contained faintly eosinophilic amorphous masses, which were positively stained with cotton dye. These amyloid deposits proved to contain S-S bond by DACM staining. They were partly positive with keratin staining by polyclonal antibodies labeled with immunoperoxidase. A biopsy specimen of the rectum was negative by cotton dye staining. These results suggest that amyloid deposits are derived from epidermal keratin rather than from a systemic amyloidosis associated with monoclonal hypergammaglobulinemia. As topical application of corticosteroids was not effective, these papules were surgically excised.

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The responsiveness of psoriatic epidermal cells to 1α,25-dihydroxyvitamin D₃ (1α,25(OH)₂D₃) was examined in explant-outgrowth cultures of involved and uninvolved skin of five patients with psoriasis vulgaris. A feeder layer was required for outgrowth of psoriatic epidermal cells of involved skin but not for that of cells of uninvolved skin. Normal epidermal cells were sensitive to inhibition by 1α,25(OH)₂D₃ and the number of DNA synthesizing cells, determined by autoradiographs, was reduced to about 15% of that of the controls by 1 nM 1α,25(OH)₂D₃. Psoriatic epidermal cells isolated from both involved and uninvolved skin were more resistant, and 1α,25(OH)₂D₃ at two orders of magnitude with higher concentrations was required to inhibit their DNA synthesis.

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We cultured non-epithelial cells derived from an extra-abdominal desmoid tumor (17-year-old male), and studied the characteristics of the cells, comparing them with normal skin fibroblasts (12-year-old male). (1) Desmoid cells could be subcultured for only about one year, which was shorter than in normal fibroblasts. (2) The shape of cells was the same as that of fibroblasts, but the rate of proliferation was lower than that of the control. (3) The rate of collagen synthesis of desmoid cells was the same as in the control. (4) Fc receptors, the staining of acid phosphatase and esterase, and immunophagocytosis were all negative in desmoid cells. Therefore, the nature of desmoid cells was similar to fibroblasts, and not to “facultative fibroblasts”.

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The role of IgG subclass antibodies of bullous diseases was studied, using the organ culture system. Normal human skins were cultured by means of the organ culture system for 5 days and were then incubated with sera, IgG3 and IgG1. 2. 4. fractions purified from the sera of patients with pemphigus, bullous pemphigoid or herpes gestationis for 48 hours, with or without complement. The histological and immunohistological examinations of the cultured skins were performed at 1, 24 and 48 hours after the incubation. Acantholysis was observed in the tissues incubated with sera, IgG3 and IgG1. 2. 4 fractions from patients with pemphigus. Dermo-epidermal separation (DES) was observed in the tissues incubated with the sera from patients with bullous pemphigoid, but was not observed in the tissues incubated with the IgG3 and IgG1. 2. 4. fractions from patients with bullous pemphigoid. DES was observed in the tissues incubated with sera and IgG3 fractions from patients with herpes gestationis, but was not observed in the tissues incubated with the IgG1. 2. 4. fractions from patients with herpes gestationis. These findings suggest that each subclass of IgG may play a different role in the mechanism of blister formation in pemphigus, bullous pemphigoid and herpes gestationis.

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Danthron (1,8,-dihydroxyanthraquinone) ointment was prepared at concentrations of 1% and 10% by mixing the drug into petrolatum. Twenty-one patients with psoriasis were treated with this ointment every day by ODT (occlusive dressing technique) or just simple topical application. Clinical effects of this treatment were assessed four weeks after starting the therapy. Excellent improvement was noted in 5 cases, good improvement in 9 cases, moderate improvement in 3 cases and no effect in 4 cases with 1% or 10% danthron ointment. Clearance of erythema and decrease in skin thickness were observed in the effective cases. On the other hand, no side effects including either skin atrophy, redness, itching, irritation, or folliculitis appeared in 20 cases, whereas redness and irritation were seen in one case. Thus, topical treatment with 1% or 10% danthron ointment seems to be effective in bringing psoriatic lesions under control.

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Studies were performed on the monocyte modulating activities of the serum of patients with granuloma annulare associated with progressive systemic sclerosis. As indicators of monocyte modulation, spreading and aggregation were used. As control sera, normal human sera and the sera of patients with granuloma annulare alone were prepared. Normal human monocytes were incubated with either test serum or control sera. The percentage of spread cells was estimated at 6 hr of incubation and that of aggregated cells was estimated at 24 hr of incubation. The sera of patients with granuloma annulare alone showed significantly higher monocyte-spreading activity and monocyte-aggregating activity than normal human sera. However, the monocyte-spreading activity of the serum of this patient was significantly lower than that of the sera of patients with granuloma annulare alone and there was no significant difference between the monocyte-spreading activity of the serum of this patient and that of normal human sera. In contrast, the monocyte-aggregating activity of the serum of this patient was significantly higher than that of the sera of patients with granuloma annulare alone.

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A statistical survey of 114 cases of Microsporum canis infection in Nagasaki prefecture from 1977 to 1986 was reported. A higher incidence was noted among patients under the age of 10. Sex ratio was 52 (male) : 62 (female). An increasing tendency of M. canis infection has been noted during the last 10 years. There has been no seasonal deviation in occurrence. Tinea corporis was seen in 51 cases (43.2%), followed by tinea capitis in 45 cases (38.1%), kerion Celsi in 19 cases (16.1%), tinea unguium in 2 cases, and tinea pedis in one case. Familial infection was seen in 16 family groups with a total of 35 cases. The infection source was most often considered to be cats. Twelve strains of (-) mating type Nannizzia otae, teleomorph of M. canis, were confirmed after confrontation with N. otae tester strains, VUT77054 and VUT77055 on niger seed agar.

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Chitin non-woven fabric comes from wet spinning of amino sugar purified from shells of the Japanese crab. Clinical tests using the fabric as a dressing for donor sites were made at Japanese medical schools and major hospitals. The total number of halfside tests, which were used to compare the chitin dressing with porcine skin or collagen fabric (control) were 104 cases. In a general comparison with LPS, chitin was judged to give excellent results in about 90% of the total cases. The advantages were suppression of superficial pain and induction, hemostat effect and rapid epithelization. The period of wound healing using chitin was significantly shorter than that of LPS according to statistical analysis. Results confirm the usefulness of chitin dressings for various kinds and degrees of wounds.

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This paper reports a case of extensive burns in a female infant aged 1 year and 10 months who fell into a bathtub. The patient was treated with a combination ointment of Netilyn and Elase as a topical therapy. As this therapy brought satisfactory results, I present the case here. Netilyn (netilmicin sulfate) shows a broad-spectrum antibiotic action against both Gram-positive and negative organisms. It has less adverse reactions, such as hypacusia, than other aminoglycoside antibiotics. From my experience, a combination ointment which is prepared from this antibiotic agent plus Elase ointment is stable in formula, and proves to be useful for the treatment of burns and bed sores.

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Two cases of a 58-year-old man and a 73-year-old man developing eczematous lesions contaminated with fungi on the entire surface of their bodies are reported. They had mild serum hyper IgE. The spread of their skin lesions was cured with glyteer (soybean tar) ointment containing 0.1% dexamethasone. The relationship between senile erythroderma with serum hyper IgE, atopic dermatitis and this disorder remains to be fully understood.

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[in Japanese]

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Five normal subjects were intracutaneously injected with Su-DP in the forearm. Their cutaneous reaction reached a peak after 48 hours and the mean diameters of erythemas were 13.40±8.60 mm. Histopathologically, mainly lymphocytic infiltrations were observed in the perivascular areas. Ultrastructurally, some lymphocytes possessed clustered dense bodies, well developed Golgi apparatus and numerous ribosomes. Clinical side effects were not observed. Taken together, these results indicate that Su-DP skin tests are delayed type skin reactions and very useful for evaluating the cell-mediated immunological state.

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