A case of erythema nodosum leprosum (ENL) is presented. The patient was 48-year-old Japanese male. He had developed tender erythemas and nodules with fever, arthralgia and lymphadenopathy for six years. He had been wrongly diagnosed as having Sweet’s disease and had been treated with oral corticosteroid, potassium iodide or diamino-diphenyl sulfone. Biopsy specimen from infiltrated erythema showed histiocytic granuloma with polymorphonuclear cell infiltration. Cytoplasm of these histiocytes was foamy or vacuolar, and included many acid-fast bacilli. Biopsy specimen from apparently normal skin also showed dermal histiocytic granuloma with massive acid-fast bacilli. The patient did not show any eruptions characteristic of leprosy; peripheral nerve trunks were not thickened and peripheral nerve damage on hands and feet was minimal. He was diagnosed as suffering from lepromatous leprosy (LL) with ENL. Chemotherapy for his leprosy is continuing at our out-patient clinic. ENL is well controlled with thalidomide.

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A case of lichen purpuricus on the right thigh of a 10-year-old girl is reported. Her thigh had several plaques, in a linear pattern, varying from pea-size to thumb head-size, consisting of grouped papules of a dark red color. A skin biopsy specimen showed almost typical features except for slight epidermal exocytosis. The results of a Rumpel-Leede test were whithin the normal range. She had a habit of wearing bloomers for a long period everyday, and that might have caused venous hypertension of her thighs. Prior to the onset of the symptoms, she had been suffering from a decayed tooth, which eventually resulted in a dental fistula on her left cheek. The eruptions gradually improved following radical treatment for the dental fistula. From these findings, we speculated that the dental fistula, together with the localized venous hypertension, might have acted as a focus of the focal infection and might have aggravated the skin lesions.

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Nine cases of tinea barbae mycologically examined at Nagasaki Municipal Hospital and Nagasaki University Hospital are reported and summarized. Trichophyton rubrum was isolated from all cases and the lesions were on the upper lip in all but one case. All, excluding one that was not examined, had the preceding tinea lesions (tinea pedis and/or t. cruris) on other parts of the body, suggesting these played a role as infection sources of tinea barbae in the beard region.

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A 6-year follow-up of 5 cases including 3 cases within one family of nevoid basal cell carcinoma syndrome (NBCS) in which the main symptoms were NBCS tumors, multiple jaw cysts, palmoplantar pits, calcification of the dura and rib anomalies is reported. No aggressive malignancies of the NBCS tumors in these 5 cases have been observed for 6 years. Statistical analysis of 137 cases (69 male, 68 female, and 58 familial cases) in Japan showed that multiple jaw cysts are the most frequent symptom (83.2%) followed by palmo-plantar pits (50.4%), NBCS tumors (48.2%), calcification of the dura (48.2%), hypertelorism (46.7%) and rib anomalies (41.6%). Among 137 cases, there were 3 cases of mebuloblastoma in children and 3 cases of metastatic malignant NBCS tumors.

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Two cases with cutaneous metastatic lesions from carcinoma of the breast are presented. A 47-year-old woman suffered from dimpling of the skin and retraction of the nipple with an underlying saucer-like induration of the left breast of six months’ duration. Histopathologically, the lesion was diagnosed as infiltrating duct carcinoma of the breast, whereby the tumor cells infiltrated between the collagen bundles in the middle to deep dermis. In the upper dermis, there was a diffuse invasion of smaller groups of tumor cells arranged in poorly differentiated ductal and alveolar structures. The other case was an 80-year-old woman who had reddish nodular masses on the upper inner quadrant of the right breast. Histopathologic examinations revealed hyperchromatic tumor cells infiltrating the whole dermis, arranged in alveolar structures. The nuclei were uniform in size and shape and displayed only a small number of mitotic figures. This case was diagnosed as scirrhous carcinoma of the breast.

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The various stages of nevoid basal cell tumors (from lentiginous to basal cell carcinomatous tumors, 39 biopsied specimens from 4 patients) were studied histologically and campared to those of basal cell carcinomas (54 cases). The follicular differentiation of nevoid basal cell tumors such as 1) formation of melanin filled keratinous cysts and concentric whorls by parakeratotic cells, 2) budding of basaloid cells from hair follicles and sebaceous glands, and 3) the similarity of tumor structure to that of various pilar tumors including pilar basal cell carcinomas, strongly suggests that nevoid basal cell tumors are nevoid tumors with various follicular differentiations. In all the 6 tumors examined, hair sheath keratins (56 Kd, PI 7.8 48 Kd, PI 5.1, 46 Kd, PI 5.1) were identified by two dimensional gel electrophoresis in the tumors.

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Fourteen cases of lupus erythematosus (LE) including 8 cases of discoid lupus erythematosus (DLE), 4 cases of SLE, one case each of LE profundus (LEP) and nodular cutaneous lupus mucinosis (NCLM) were treated with DDS (dapsone). Five cases of DLE and one case each of LEP, NCLM and SLE were shown to respond effectively. Prompt improvements in cutaneous lesions were observed in some cases after the application of DDS. These data indicate that DDS should perhaps be the drug of first choice for DLE. In none of the cases which responded effectively were neutrophilic infiltrations detected in the skin lesions. Although the pharmacodynamic mechanism of DDS on the cutaneous LE remains unknown, DDS may operate on the lymphocytes, fibroblasts or histiocytes in the involved skin.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Seventy-one patients with various forms of dermatitis were treated with LOC-5 ointment and cream, by simply applying three times daily. The rate of improvement in this study was 80.3% (57/71). Of forty-two patients who were treated with the ointment, the improvement rate was 76.2% (32/42). Of twenty-nine patients who were treated with the cream, the improvement rate was 86.2% (25/29). The improvement rate for chilblains was 84.8% (28/33), showing a high efficacy. No side effects were found in the assessment of safety, and thus LOC-5 vehicles were considered to be safe. Both vehicles were also effective in the treatment of atopic dermatitis and senile cutaneous pruritus, although the number of patients was not enough for statistical assessment, as well as being effective for chilblains, senile asteatotic eczema and miliaria.

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I. Ten female patients with Raynaud’s phenomenon (eight, PSS; one, SLE, one suspected SLE) and ten healthy female controls were examined by thermography to evaluate the effects of nitroglycerin ointment (2%) on peripheral circulation. Before the local application and at 5, 10 and 20 minutes after the local application, thermograms of dorsal aspects of right hands were obtained. We then obtained the mean skin temperatures and histograms of the dorsal aspect of both the right hand and the middle finger. As for the results; 1) Skin temperatures elevated in the sequential thermograms in all twenty cases. 2) Mean skin temperatures after the application were significantly higher than those obtained before at all periods in hands and fingers of both groups. At ten minutes, the mean temperatures of the right middle fingers in the control group were significantly higher than in the patients group. 3) After the application, the histograms in patients tended to change from the type with two or more peaks to the type with one peak, which is commonly seen in a control group. II. Microulcers of the fingers and feet in six patients with Raynaud’s phenomenon (five, PSS; one, SLE) were treated with nitroglycerin ointment three times a day for about one month. The ulcers of four patients out of the six healed or became smaller. Experiments I and II revealed that nitroglycerin ointment has favorable effects for impaired peripheral circulation and may be suitable for various diseases based on peripheral circulatory disturbance.

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[in Japanese]

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[in Japanese]

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