A typical case of psoriasis arthropathica is described. The patient was a 61-year-old male. The psoriatic eruption was rupioid and exudative, and it was distributed not only on the trunk, arms, thighs and legs, but also on the external genitalia and axillae. The finger and toe nails were also involved. Arthropathy was seen on the knee and finger joints. However, the serum rheumatoid factor was negative. The severity of the arthropathy was correlated with that of the eruption.

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A 40-year-old woman was examined in August, 1984 with the symptoms of asymptomatic skin lesions, systemic superficial lymph nodes swelling with tenderness, and fever. She was diagnosed as suffering from histiocytic necrotizing lymphadenitis by the results of histological findings obtained from one of her enlarged cervical lymph nodes. We attempt to precisely describe the characteristics of the skin lesions as seen in this case of histiocytic necrotizing lymphadenitis.

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We report 4 cases of lymphocytic infiltration of the skin. One case was studied immunohistochemically with monoclonal antibodies. The majority of the infiltrating cells in the dermis were T lymphocytes, predominantly T helper/inducer cells and half the cells expressd HLA-DR antigen. These findings indicate that this condition, probably related neither to discoid lupus erythematosus nor to lymphadenosis benigna cutis, may be a separate entity.

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The case of a 68-year-old man with giant condyloma acuminatum in the inguinal region is reported. Histological studies of the surgical specimen showed the typical findings of giant condyloma acuminatum, but it was suspected to be partially malignant. Electron microscopically, virus-like particles were found in the nuclei of the keratinocytes. DNA of the human papillomavirus type 6 (HPV6) with a slightly smaller genome was detected by Southern blot hybridization analysis of the DNA extracted from the condyloma acuminatum.

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The case of a 63-year-old woman with dermal cylindroma in the parietal region is described. Histopathologically, the tumor was formed with compact nests in the dermis, but showed no evidence of duct-formation. The nests were surrounded by eosinophilic hyalinized fibrous connective tissue. The tumor cells consisted of 2 types of cells with small dark nuclei and large clear nuclei. Electron microscopically, large and small lipids were seen in the cytoplasm and tumor cells were adhered to adjacent cells by a few desmosomes. Amorphous material was recognized in the intercellular spaces.

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A 76-year-old man with a nodule on a right nasolabial fold visited us. The nodule consisted of two kinds of tumors of the epidermal appendages; one was solitary trichoepithelioma and the other was so-called mixed tumor of the skin (chondroid syringoma). The association of these two types of tumors is very rare. The part of the so-called mixed tumor of the skin showed differentiation toward the apocrine gland. Our case was considered to support the assumption that the two tumors have a common genesis from pluripotential cells, such as primary epithelial germ cells.

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Multiple basal cell carcinomas developed predominantly on the sun exposed areas in a 52-year-old Japanese man. He also had follicular atrophoderma on the extensor aspect of the extremities. Five other siblings were free from symptoms, but his mother suffered from follicular atrophoderma. These findings were consistent with the syndrome described by Bazex et al. However, because the patient lacked other cardinal skin synptoms such as abnormalities of scalp hair and sweating, a diagnosis of an abortive form of Bazex syndrome was made. Numerous basal cell carcinomas were also observed on the trunk, a non-exposed area, previously irradiated with X-rays. We would like to emphasize that radiation therapy should be avoided in patients with Bazex syndrome. Here we report the first case of this rare inherited syndrome in Japan.

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We report a case of small cell variant (6∼8 μm) of Sézary syndrome in a 79-year-old man from Kashima, Ibaragi who had suffered from generalized erythroderma for 2 years. A few circulating classical Sézary cells were evident. The neoplastic cells showed the strong helper T-cell subset marker (OKT4). Tests for antibodies to ATL-associated antigen (ATLA) were negative. Oral administration of etretinate, 50 mg/day had no effect. Geographical distribution of patients with Sézary syndrome in Japan is reviewed.

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An 89-year-old woman was seen because of a rapidly growing, egg-sized, gourd-shaped tumor of 2 months’ duration on her cheek. Metastasis to the right submandibular lymph node was detected. Histologically, the lower part of the tumor was composed of sheets of small atypical cells, reminiscent of those of Merkel cell carcinoma. Electron-dense granules were rarely observed in these tumor cells. Occasional immature, desmosome-like structures were also present. In the upper part of the tumor, three histologic components were present, namely, sarcoma-like spindle cells, moderately differentiated squamous cell carcinoma and small atypical cells. Gradual transitions were seen from these small atypical cells to the other two kinds of tumor cells. Sarcoma-like spindle cells were considered to be of mesenchymal origin, because they were positive for vimentin and α₁-antichymotrypin, and negative for keratin and neurofilament. We suggest that this was a rare case of true carcinosarcoma of the skin.

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The plasma concentrations of FVIII-RAg and β-thromboglobulin (β-TG) were measured in patients with collagen diseases (SLE; 32 cases, PSS; 20 cases) as well as in healthy controls (12 cases). The mean concentration of plasma FVIII-RAg in SLE was 193±94% (mean±SD), showing apparently elevated levels compared with healthy controls (P<0.05). There were no significant relations between the elevated levels of this antigen and abnormal data of ESR, CRP, complements and urinalysis. There were also no relations between plasma levels and clinical manifestations such as Raynaud’s phenomenon, livedo and acrocyanosis. Of the 32 SLE patients, however, 5 had clinical manifestations with acute, subacute or progressive blood vascular involvement; i. e., leukocyteclastic vasculitis, thrombophlebitis, livedo vasculitis, annular erythema, nodules with microthrombosis, and all these cases had plasma FVIII-RAg levels of more than 150%. We, therefore, concluded that increased FVIII-RAg levels can be an aid in confirming the acute or progressive phase of blood vascular damage in SLE patients. The mean concentration of plasma β-TG in PSS patients (15 samples) was 240±89ng/ml (mean±SD), a significantly high level compared with the controls (6 samples, 120±23ng/ml) (P<0.01), suggesting positive platelet activation occurring in PSS patients.

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The effects of an oral administration of etretinate on the function of the stratum corneum were studied on the uninvolved skin of patients. Oral administration of etretinate produced a significant increase in water content, hygroscopicity and transepidermal water loss compared with those found in normal individuals. These results suggest that an oral administration of etretinate increases the skin surface hydrate which induces smoothness and flexibility of the skin surface and decreases its barrier function.

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Eleven autopsied cases with burns were evaluated histopathologically. The average burn index was 48. The average survival period was 23 days after being burned. Histopathological findings of the organs (lungs, liver, kidneys and others) showed various severe changes respectively because of the complicated destructive effects of burns, such as circulatory disorders, malnutrition, infection and other anamneses. These findings suggest that many problems remain to be resolved in the treatment of patients with severe burns.

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Vidarabine (ara-A) ointment was used to suppress the development of skin lesions and reduce the death rate of mice which had been inoculated intradermally with herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). Depilated female BALB/c mice were inoculated intradermally at the midflank with HSV-1, Hayashida strain. Treatment with ara-A ointment initiated 3 h after inoculation was effective in increasing the survival rate. The treatment with ara-A ointment initiated 24 h after inoculation had no effect on the final mortality but it prolonged the survival time. The mortality of mice inoculated at the midflank with an acyclovir-resistant HSV-2 strain and treated with ara-A ointment was lower than that of the control mice. Topical treatment with ara-A ointment of mice which had been inoculated intradermally at the perineal skin prolonged the survival time but did not reduce the mortality. The protective effects of ara-A ointment were enhanced when it was used in combination with human anti-HSV-1 antibodies.

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We report two cases receiving a combined oral therapy of niacinamide and tetracycline. Two patients with bullous pemphigoid, which were resistant to systemic corticosteroid therapy, were treated orally with niacinamide (1500 mg/day) and tetracycline (100 mg/day). Both improved remarkably after receiving oral administration.

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A statistical study of 22 cases of cutaneous malignant lymphoma occurring between 1972 and 1988 was carried out on the basis of clinical, histopathological and immunohistochemical findings. The 22 cases comprised of 8 mycosis fungoides, one Sézary syndrome, 4 ATLL, 3B cell lymphomas, 2 true histiocytic lymphomas of the skin and 4 unclassified lymphomas. In accordance with the LSG classifications, the 20 cases, excluding the 2 true histiocytic lymphomas, were classified into three types; namely, 14 cases of diffuse pleomorphic, 4 of diffuse large cell and 2 of diffuse medium sized cell. The 12 cases examined on the lymphocyte subset identification were divided into 9 cases of T cell lymphoma and 3 cases of B cell lymphoma. The median survival period of the patients was estimated at 93 months for mycosis fungoides and Sézary syndrome, 15 months for ATLL, 6 months for B cell lymphoma and 34 months for the others. Autopsy revealed that the tumor cells of mycosis fungoides remained for a long period only in the cutaneous tissue, while those of B cell lymphoma and ATLL invaded into the distant organs a relatively short time after diagnosis was made. In general, the prognosis of all these cases was poor, but 3 patients who received adequate therapy at a very early stage have had satisfactory remissions.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The structure and function of a newly developed whole body UVA irradiating unit, Dermaray M-DMR-TS, is explained. Its clinical application for the treatment of some dermatoses is reported. Its characteristics are as follows: (1) Whole body surface is exposed at one time. (2) The irradiance on the body surface is much higher than with conventional Dermaray units. (3) The irradiance distribution is relatively uniform on the whole body surface. (4) Emission spectra range from 305 to 440 nm with a peak at 352 nm. (5) Temperature in the apparatus is considerably elevated by exposure. By using this irradiating unit, patients with psoriasis vulgaris were treated with topical PUVA or a combination of topical PUVA plus oral etretinate (Re-PUVA). Marked improvement or complete clearance was obtained within 30 exposures in 13/25 (56.5%) PUVA-treated patients and in 12/19 (63.2%) Re-PUVA-treated patients. In addition, patients with other skin disorders received topical PUVA. Marked improvement or complete clearance was observed within 15 exposures in 5/7 (71.4%) patients with atopic dermatitis, in 3/3 (100%) patients with parapsoriasis guttata and in 1/2 (50%) patients with parapsoriasis en plaque. In treating these patients, there were no side effects or accidents caused by the irradiating unit. These results demonstrate the clinical usefulness and safety of Dermaray M-DMR-TS.

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SBT/CPZ is a combined drug, consisting of cefoperazone and sulbactam. Cefoperazone is a cephem drug with a broad spectrum, and sulbactam is a β-lactamase inhibitor. In this paper, the clinical effects of SBT/CPZ on burn wound infections were examined. Two grams of SBT/CPZ were intravenously injected twice a day to 30 patients with burns. The clinical effects of SBT/CPZ were mainly judged by the inhibiton of infection in the skin grafted area. That is, when the skin graft took well, the clinical effects of SBT/CPZ were difined as excellent. When the skin graft took poorly, the effects were defined as poor. In this study the skin grafts took well in all the patients with burns who were examined. From this point of view, SBT/CPZ had a remarkable effect on burn wound infection. Side effects were not found in any of the patients who were studied.

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[in Japanese]

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The number of bacterial colony forming units (CFU) was counted on eczematous skin lesions during the treatment by topical corticosteroid with and without antibiotics, using Staphylococcus No. 110 medium combined with brush-sampling technique. The numbers of colonies formed in petri-dishes containing the media rapidly decreased with the initiation of the topical corticosteroid treatment. The decrease was positively correlated to the improvement of the clinical features of the lesions and the difference was not apparent between the lesions treated by corticosteroid whether with or without antibiotics, suggesting that the decrease of bacterial counts was influenced more by the corticosteroid ointment used for the treatment, than the antibiotics the ointment contained.

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[in Japanese]

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