We reported a case of smoldering adult T-cell luekemia (ATL) in association with HTLV-I associated myelopathy (HAM). A 75-year-old male patient was seen because of generalized erythroderma and ichthyosiform scaling. A skin biopsy showed diffuse lymphocytic infiltration on the upper dermis, in which some cells demonstrated nuclear atypia. The infiltrating lymphocytes showed epidermotropism and formed microabscesses in the epidermis. A small number (1∼2%) of atypical lymphocytes were consistently observed in the peripheral blood. He had been suffering from the spastic paraparesis of his both legs, dysuria, and generalized pruritus for 2 and a half years. The antibody titers to HTLV-I were remarkably high both in the serum and in the cerebrospinal fluid. His HLA haplotype showed the one which is dominant in patients with HAM. The above mentioned findings support the diagnosis of the coexistence of smoldering ATL and HAM. The generalized erythroderma was responsive to the application of corticosteroid ointments, leaving only a mild erythema and purpura on the face and a slight scaling on the trunk one month later. Neurological abnormalities were improved by the administration of systemic glucocorticosteroid. The relation of smoldering ATL and HAM was also discussed.

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A 37-year-old man was suffering from an ulcerated tumor which had developed in burn scar on his head. He had been burnt by an “irori”, a Japanese hearth sunk in the floor, at the age of one. The tumor invaded the bone and dura. Squamous cell carcinoma-related antigen was slightly elevated. Seventy-three cases of burn scar squamous cell carcinoma reported in Japan from 1966 to 1988 were surveyed. The mean age at the onset of carcinoma was 54.8-year-old. The mean interval to the onset was 41.6 years. The sex ratio was male 2.4: female 1. We subdivided the cases into two groups, i.e. the cases who had been burnt under the age of 10 (group A), and the cases who had been burnt over the age of 20 (group B). The mean interval to the onset was 51.7 years in group A, and 22.4 years in group B. The most common area involved was the head in group A, and the lower extremities in group B. As to the cause of burn, “irori” was most frequent in group A, and the causes were various in group B. Loss of consciousness at burn was often observed in group B. The relationship between the age at burn and the interval to the onset of carcinoma is discussed.

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A 79-year-old man first noticed the appearance of a nodule on his left thigh about the size of a little finger’s head about 10 years ago, which slowly increased in size to finally form a horn-like tumor with a red halo. The horn was gray or yellowish gray in color, measuring 4 cm in length and 1 cm in diameter. Histologically, there was a mass of keratotic horny cells with trichilemmal keratinization at the base. The histopathologic features support a diagnosis of trichilemmal horn which was first identified by Brownstein in 1979.

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We report three cases of pitted keratolysis occuring in a 46-year-old man, a 20-year-old man and a 13-year-old girl. The authors state the clinical and histopathological findings, causative organisms, differential diagnosis and treatment of pitted keratolysis. In Japan, only 10 cases have been reported thus far, however we presume that pitted keratolysis is not rare and has merely been overlooked.

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A case of cutaneous myxoma in a 67-year-old male on the left arm was reported. A microscopic examination of skin tumors showed a thin epidermis, edematous dermis, a full of mucinous matrix in the dermis and either stellate cells or ovale cells in the dermis. An ultrastructual examination disclosed predominantly fibroblast-like cells with a prominent rough endplasmic reticulum, microfilamentous material, and pynocytotic vesicles, together with a mixture of amorphous and granular material and collagen fibers in the extracellular spaces. Histochemical techniques yieled the following results: a positive dialyzed iron reaction, however with either a complete or almost complete removal of this positive reaction by prior digestion with storeptmyces hyaluronidase; a positive toluisin blue staning at pH 3.5, yet a negative periodic acid-Schiff reaction. These results indicate the presence of a large amount of hyaluronic acid in the mucinous matrix. A biochemical study also supported these results.

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A 76-year-old Japanese woman, suffering from diabetes mellitus had been treated with 250 mg/day of acetohexamide for the last three years. This patient presented with geographic erythematous macules and plaques on both the trunk and extremities, which were first noticed by the ophthalmologist who took care of her diabetic cataracta, in March 1989. Individual lesions were characterized by marginal tiny pustules and branny scales associateel with a tendency to fuse to each other, particularly in the axillae, inguinal folds and submammary areas. A biopsy specimen revealed a subcorneal pustule formation together with mild hyperkeratosis and parakeratosis. The skin lesions had spontaneusly diminished after the acetohexamide administration was discontinued. The diabetes mellitus of this patient was therefore eventually treated with insulin injections because the alternative medicines for diabetes, such as gliclazide, also caused similar skin eruptions.

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An 82-year-old woman with slight dementia suffered a 3rd-degree flame burn on her left foot and was left untreated for 3 days. After being hospitalized in a clinic of internal medicine on day 4 post-burn, she was treated with antibiotics along with the application of some disinfectants. She was late hospitalized on day 7 post-burn at the Department of Dermatology, Miyazaki Medical College, with nonclostridial gas gangrene. No underlying diseases such as diabetes were found. On day 14 post-burn, the amputation of the left leg below the knee was undertaken. Tetanus developed on day 3 post-surgery (on day 17 post-burn). Convulsions could be controlled with daily doses of 40 mg of diazepam, divided into 8 doses, through the gastric tube. It took about 3 months for her to recover from muscle rigidity, and she was discharged 5 months post-burn.

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We reported a 48-year-old man with contact hypersensitivity to several topical corticosteroids and a cream vehicle. He had a past history of delayed healing for burn on his left forearm, despite intensive treatment with various topical agents including corticosteroids. Over the past 10 years he had experienced some episodes of exacerbation into eczematous lesions after he applied topical corticosteroids. Patch tests suggested that he had a contact sensitivity to several corticosteroids and/or some application vehicles. Further examinations revealed he has a positive patch test reactions against difulcortolone-21-valerate, betamethasone, betamethasone-17-valerate, diflorasone-17,21-diacetate, fluocinonide and a topical cream vehicle, while oral administration of prednisolone and betamethasone showed no adverse reaction in this patient.

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In the process of reviewing a large number of drug eruptions reported in Japan during the last six years, from 1984 to 1989, we have identified a hitherto unrecognized subset related to prodrugs, in whose subset the patients with eruptions related to prodrugs developed a positive reaction to a patch test (PT) and/or lymphocyte stimulating test (LST) for the prodrugs being taken as well as for the active final products of the prodrugs. Six reported patients with bacampicillin (BAPC) related drug eruptions in which PT and/or LST were done as a diagnostic aid, developed a positive reaction not only for BAPC itself but also for ampicillin (ABPC), and tarampicillin (TAPC) as well. While these findings were reported as a cross reaction among these antibiotics, from the point of view that both BAPC and TAPC are the prodrugs of ABPC, it seems conceivable that BAPC is much less responsible for the eruptions than ABPC, which is produced from these prodrugs during the absorption process into the digestive tract and thus is present in the blood stream in vivo.

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We report twelve cases receiving on oral therapy of DDS. 9 patients with pemphigus and pemphigoid, which were resistant to systemic corticosteroid therapy and reduction of corticosteroid therapy, were treated orally with DDS (50∼75 mg/day). No side effects were found in the safety assessment except for case No. 5 due to misuse (150 mg/day) for a week. The rate of improvement in this study was 75% (9/12).

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The population doubling time (D-time) of the fifth subcultured fibroblasts from various skin diseases was investigated by two different methods. The first method is a way to determine the D-time of the cultured fibroblasts by autoradiography after labelling the fibroblasts by ³H-thymidine. The other method is to calculate it by using a microcomputer from the exponential regression curve of the growing fibroblasts after counting their number four times every 24 hours. The D-time calculated by these two different methods showed almost the same results. The method of calculating the D-time by microcomputer was as useful as accurate as the method currently in use.

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The shape and function of the cultured fibroblasts derived from burn scar and normal human unexposed skin was compared and examined. The population doubling time of the cultured fibroblasts from normal skin was 67.6±36.4 hours, which was significantly shorter than that from burn scar (90.8±64.3). The population doubling time of the cultured fibroblast from large and fresh burn scar was longer than that from small and mature burn scar. The amount of collagen from fresh burn scar into the medium increased more significantly than that from mature burn scar and normal human skin. The cultured fibroblasts of burn scar were generally larger and more irregular in shape than those of normal human skin fibroblasts.

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TA-4 is one of the squamous cell carcinoma (SCC)-related antigens which was extracted from the SCC of uterine cervix and purified by Kato. This antigen is widely used as a tumor marker in order to make both a diagnosis and prognosis of SCC of the uterine cervix. To confirm the utilization of TA-4 for SCC of the skin as a tumor marker, TA-4 in SCC was immunohistochemically studied. 25 patients with SCC were examined by the biotin-strept avidin method using two kinds of anti TA-4 monoclonal antibodies: MoAb-27 which reacts with both acidic and neutral TA-4, and MoAb-317 which is specific to acidic TA-4.
1) in the normal skin
The MoAb-27 showed a positive reaction diffused in the granular to prickle cell layer and in the prickle cell layer, and a negative reaction in the corneum and the basal cell layers. The MoAb-317 showed no reaction to any of the layers. From these findings, it is suggested that the TA-4 in the normal skin is neutral.
2) in the nest of SCC
In SCC of Broders grades I and II, MoAb-27 revealed positive cells in the cancer nest, while it showed a negative reaction in the basaloid cells and the horney materials. In SCC of Broders grades III and IV, MoAb-27 were negative in all cancer cells. In Broders grades I and II cancer, MoAb-317 were positive only in the cells at the peripheral parts adjacent to the surrounding stromal tissue. The above findings imply that MoAb-27 is useful in differentiating between SCC of Broders grade II and that of Broders grade III, and also suggest that the cancer cells produce acidic TA-4. Acidic TA-4 is, therefore available as a tumor marker for SCC of the skin as well as of the uterine cervix.

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Pityriasis rosea, first described in 1860 by Gibert, is a common acute inflamatory disorder. Both its etiology and pathomechanism still remain unclear. Some confusion still persists over atypical cases and differential diagnoses of other familiar skin disorders such as acute guttate psoriasis, seborrheic dermatitis and parapsoriasis with generalized eruption. So far, histologic findings have not been helpful for making an accurate diagnosis because of their close resemblance to other dermatitis-eczema groups. The plasminogen activator, which converts plasminogen into plasmin, has been detected in the psoriatic epidermis. It may thus possibly be involved in one of the pathomechanisms of psoriasis. Plasminogen activator activity in the epidermis of the present 6 cases of pityiasis rosea was detected using a film of fibrin, i. e., Todd’s method, however this activity was not detected in the epidermis of seborrheic dermatitis and eczema groups. The striking histologic features in all the 6 cases were the absence of a granular layer. However, the epidermis of skin biopsy specimens of the 9 cases initially diagnosed as pityriasis rosea, in which epidermal plasminogen activator activity was not detected, showed a remaining granular layer. Whether the difference between the present two groups of pityriasis rosea is either a stage or an activity of the disease remains to be fully elucidated. Further studies should be conducted to clarify all the pathomechanisms involved in pityriasis rosea.

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To attain anesthesia of the skin without needle puncture, we developed a gel form mixture of lidocaine dissolved in propylene glycol and ethanol with glycyrrhetinic acid 3-0 hemiphtalate disodium salt as an absorption promoter along with an acid thikener and neutralizer. From the results of a patch test, slight was appeared in one person but did not cause any discomfort and clinically insignificant. The absorption was followed by measuring the concentrations of lidocaine in the general circulation at different time intevarls after application. When applied to normal skin, the serum concentrations of lidocaine were lower than those associated with toxicity. Cryotherapy of dermal melanocytosis by liquid N₂ was performed in one patient under a topical anesthesia with this gel. The analgesia was sufficient and the patient rated the pain as slight. When this gel was applied on repetively freezed skin by cryotherapy, the drug were 30 times higher than those applied to normal skin. These results suggest that this gel would provide an effective local anesthesia for cryotherapy, currettage of molluscs, cutting of split skin grafts as well as for a number of other skin surgical procedures.

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[in Japanese]

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A statistical survey of 1,002 patients with herpes zoster was carried out at the clinics of dermatology and anesthesiology in Ube city and Onoda city from January, 1988 to December, 1988, with the following results:
1) A larger number of patients were seen in the summer and spring as compared to other seasons.
2) The sex ratio was 1.0 (male):1.4 (female). The incidences showed two peaks at the age from 50 years to 79 years and from 10 years to 19 years.
3) The dermatomes of the thorax and the upper extremities were the most frequently involved areas of the body.
4) 7.9% of the patients (0∼9 years), 5.6% (10∼19 years), 35.4% (50∼59 years) and 53.3% (70∼79 years) had underlying disorders.
5) Recurrent attacks occured in 7 cases.
6) Neuralgia persisted over 1 month in 5.2% of patients (52 cases). The highest peak was noted in the seventies age group (20 cases).
7) In 30 cases, a generalized herpes zoster developed and the age groups of sixties and seventies were most frequently affected.
8) Ramsay-Hunt Syndrome occured in 7 cases.
9) Herpes zoster ophthamicus occured in 5 cases.
10) Herpes zoster duplex occured in 3 cases.
11) Malignant tumors were found in 16 cases (1.6%).

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The excision of benign or malignant tumors from the nose is often accompanied by full-thickness defects. This report details the experiences of three patients over a 6-month period, who had undergone partial nasal reconstruction using a local flap, 1) nasolabial flap, 2) median forehead flap and 3) scalping forehead flap. The technical considerations necessary to achieve good results are emphasized. This procedure provides a solution to a major problem of partial full-thickness defects of the nose.

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