The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 54, Issue 3
Displaying 1-27 of 27 articles from this issue
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Color Atlas
Clinical Case Reports
  • Kaposi’s Sarcoma Developing after Prolonged Treatment with Corticosteroid.
    Yumiko KUBOTA, Shuhei IMAYAMA, Kimihiko MIHARA, Shin-ichiro YASUMOTO, ...
    1992 Volume 54 Issue 3 Pages 429-433
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.429
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    We report a case of Kaposi’s sarcoma developing in an 84-year-old Japanese male, a native of Miyakojima, after prolonged treatment with corticosteroid for the control of bronchial asthma. The patient noticed a dark colored indurated plaque with several nodules on the left foot in March, 1989 while being given 5-20mg/day predonisolone for 4 years. Similar skin lesion developed on the proximal aspect of the same lower extremity for 2 years and eventually spread to the left upper extremity. Biopsy specimens from the nodular lesions showed histologic features characteristic of Kaposi’s sarcoma. During predonisolone therapy, most skin lesions had gradually increased in size and number, but the nodules on the left lower leg regressed spontaneously. Immunohistologically 30-50% of the spindle cells, characteristic of Kaposi’s sarcoma, were positive for factor XIIIa, which is expressed in dermal dendrocytes. The relationship of an immunosuppressive condition presumably resulting from corticosteroid treatment and the pathogenesis of Kaposi’s sarcoma is discussed.
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  • A Case of Syringoma with a Clinical Appearance of Pseudoxanthoma Elasticum
    Haruko TAMURA, Satoshi DEKIO
    1992 Volume 54 Issue 3 Pages 434-436
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.434
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    A 23-year-old man visited our clinic because of the appearance of numerous erythematous or yellowish papules on his foreneck. There was no similar eruption on any other regions. As some papules were yellowish and confluent to each other and were only limited to the foreneck, we suspected that this eruption was most probably a pseudoxanthoma elasticum. However, the histopathology demonstrated a typical syringoma. To the best of our knowledge, among all the cases of syringoma ever reported in our country, our patient was only the second case with such lesions restricted to the foreneck.
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  • Cytophagic Histiocytic Panniculitis
    Kenji TASHIRO, Shuhei IMAYAMA, Junko NODA, Yoshiaki HORI, Koichi OHSHI ...
    1992 Volume 54 Issue 3 Pages 437-442
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.437
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    Two cases with cytophagic histiocytic panniculitis, initially developed as subcutaneous nodules on the bilateral inguinal regions of a 36-year-old man and on the left thigh of a 17-year-old women are described. Histologically these skin lesions showed a panniculitis associated with dense cellular infiltrates composed mainly of small to medium-sized lymphoid cells, histiocytes, foamy macrophages, and some plasma cells. The lymphoid cells exhibited mild nuclear atypia. A few mitotic figures were encountered. However, it was always noted that the histiocytes demonstrated prominent erythrophagocytosis. An immunohistochemical examination revealed that the lymphoid cells were positive for UCHL-1 antibody, which mainly stains T cells, and the histiocytes were positive for lysozyme and α-1 anti-chymotrypsin by immunoalkaline phosphatase staining. These two cases were diagnosed as cytophagic histiocytic panniculitis based on the clinical and histological features and the absence of any gene rearrangement of the TCR β chain in the infiltrated lympoid cells which exhibited atypia to a certain level.
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  • A Case of Merkel Cell Carcinoma
    Yoshiko NODA, Kyoko SHIBATA, Mikio ICHIKI, Noritaka HAYASHI, Shoji TOS ...
    1992 Volume 54 Issue 3 Pages 443-447
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.443
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    A case of Merkel cell carcinoma occurring on the left upper arm of an 83-year-old male is reported. Histologically, the tumor cells were located in the dermis and showed a trabecular pattern. Immunohistochemically, NSE and EMA were positively stained within the tumor cells. Under electron microscopy, dense-core granules, 68 to 145 nm in diameter, were observed in the cytoplasm. No local recurrences or metastasis to the regional lymph nodes were observed within one year and a half after the surgical removement. 52 cases previously reported in Japan are reviewed in this report.
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  • A Case of Papulonecrotic Tuberculid and Erythema Induratum Occurring Together
    Hiromi SHIBUYA, Kazumoto KATAGIRI, Hiroshi SHINKAI, Susumu TAKAYASU
    1992 Volume 54 Issue 3 Pages 448-452
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.448
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    A 57-year-old woman presented with a nearly 8 year history of small papules on the upper extremities which resolved in winter leaving slightly depressed scars. In addition, she had noticed several firm lesions on her lower legs 4 months previously. A histological examination of one small papule revealed an area of necrosis throughout the whole dermis which was surrounded by epithelioid cells and lymphocytes. The histology of the firm lesions on her legs showed caseation necrosis in an interlobular septum. Histiocytes, lymphocytes, and a small number of giant cells were observed at the margin of the necrosis and between the fat cells. A chest X-ray showed an old scar in the right upper field which was suggestive of a tuberculous origin. A Mantoux test was strongly positive, followed by development of surrounding erythematous papules. After treatment with INH and EB for one month, these lesions almost disappeared. However, the eruptions exacerbated 7 months later, when she neglected to take the prescribed medication and caught a cold. This is only the tenth case in Japan of these two kinds of tuberculides occurring together in the past 20 years.
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  • Allergic Contact Dermatitis due to Topical Corticosteroids
    Shigeruko IIJIMA
    1992 Volume 54 Issue 3 Pages 453-457
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.453
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    A 32-year-old man with allergic contact dermatitis to topical corticosteroids of amcinonide, budesonide and betamethasone valerate is described. A cross-reaction to budesonide was considered to have occurred, followed by betamethasone valerate, after sensitization to amcinonide which was applied for 3 weeks. The cross-reaction between amcinonide and budesonide was considered to be due to almost the same stereotaxis occupied by the partial structure protecting 16α and 17α-cis diol at the D-ring. The cross-reaction between budesonide and betamethasone valerate was considered to be due to the structure of the valerate ester protecting the hydroxyl group of betamethasone valerate which was stereochemically similar to that of the butylidene residue of budesonide. The cross-reaction between budesonide and amcinonide as well as betamethasone valerate was considered due to the existence of stereoisomers of transoid and cisoid in butylidene. For contact sensitivity to a topical corticosteroid for the first time, it may be important that there are more than four carbons present as residues in the 17α position. Individuals once sensitized are likely to demonstrate one cross-reaction after another according to the stereostructure of the 17α position at the D-ring.
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  • Erythrokeratodermia Variabilis in a Girl Showing Variations of Eruptions with the Menstrual Cycle
    Masayori KAGOURA, Shozo TAKAHASHI, Masaaki MOROHASHI
    1992 Volume 54 Issue 3 Pages 458-462
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.458
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    We describe a 16-year-old girl diagnosed as a typical case of erythrokeratodermia variabilis. She had been suffering from this disease for twelve years. The oral administration of retinoid at 10 to 20gm/day was effective for the reddish, keratotic plaques but was ineffective for her variable erythema. It was highly interesting to note that, both the variable erythema and the reddish, keratotic plaques receded during her menstrual follicular phase but were aggravated during the luteal phase. Thus, we may speculate that sexual hormones, especially estrogen, may be related to these variations in eruptions.
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  • A Case of Psoriasis Vulgaris Associated with Primary Biliary Cirrhosis
    Toshiki ITOH, Yoshihiro MAEKAWA, Reiko NOGAMI
    1992 Volume 54 Issue 3 Pages 463-467
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.463
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    A case of a fifty five year-old-woman with psoriasis vulgaris (PV), who developed primary biliary cirrhosis (PBC) is reported. During the therapy with etretinate for psoriasis vulgaris, liver dysfunction was observed, in which serum alkaline phosphatase, leucine amino peptidase and gamma-glutamyl transpeptidase were all more elevated than transaminase. As anti-mitochondorial antibody was positive and a biopsy specimen of the liver showed chronic non-supprative destructive cholangitis, she was diagnosed as having PBC by the internal medicine department at our hospital. This coincidence of PV and PBC is the first case as far as we could determine in the literature.
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  • Congenital Acanthosis Nigricans Accompanied by Growth Hormone Neurosecretory Dysfunction (GHND)
    Shigeki HAGANE, Kensei KATSUOKA, Hiroo YOKOZEKI, Nozomi HOSODA, Yukifu ...
    1992 Volume 54 Issue 3 Pages 468-472
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.468
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    A case of dwarfism due to a growth hormone neurosecretory dysfunction(GHND) with acanthosis nigricans(A. n.) is reported. The patient was a 12-year-old boy with blackish brown and rough skin on the face, nape, axillae, buttocks, fingers and toes since birth. Signs of growth disturbance were first evident at the age of about 4 years. A diagnosis of growth disturbance due to GHND was made. GHND is a new concept in the pathology of continuously decreased secretion of growth hormones similar to a physiological condition during sleep with some ability to respond to secretory stimulation. The patient was concluded to have A. n. of a genodermatosis type associated with endocrinopathy.
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  • A Case of Menkes’ Disease
    Yasushi TOMITA, Tatsuo YOSHIMURA, Yoshiaki KONDO, Hiroshi IGARASHI, Sh ...
    1992 Volume 54 Issue 3 Pages 473-479
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.473
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    We report a case of Menkes’ disease which is known to be a copper deficiency condition demonstrating various clinicopathologic features. The patient was a 6-month-boy with low levels of serum copper and ceruloplasmin as well as typical symptoms such as poor feeding, impaired weight gain, and coarse stubby hair with abnormalities of the pili torti and white hair. The amount of eu- and pheo-melanin in his bright hair was about a half that found in normal Japanese hair, which suggests that the activity of tyrosinase, a copper enzyme, probably decreased due to a copper deficiency.
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  • Photosensitivity in Dermatomyositis and its Relation to Internal Malignancy
    Kiyohiro TSUTSUI, Satoru KIMURA, Kunio MURATA, Takae HIRONE
    1992 Volume 54 Issue 3 Pages 480-483
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.480
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    We herein present two cases of dermatomyositis with photosensitivity and internal malignancy. In addition, we also report on the relation of photosensitivity to internal malignancy as demonstrated in 22 cases of dermatomyositis observed at our university hospital from 1979 to 1990. Malignant tumors were detected in 5 of 10 cases with photosensitivity. The incidence of malignancy was therefore significantly higher in the photosensitivity-positive group than in the photosensitivity-negative group.
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  • A Case of Lipoma with a Satellite Nodule Mimicking Solitary Nevus Lipomatosus Cutaneous Superficialis
    Junichi HASEGAWA, Naonori MAEDA, Tamotsu KANZAKI
    1992 Volume 54 Issue 3 Pages 484-486
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.484
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    A 74-year-old woman developed a cutaneous nodule on a lipoma which she had noticed a year before. Histological findings of the nodule resembled that of a solitary nevus lipomatosus cutaneous superficialis (NLCS). In view of the patient’s age and clinical history, this NLCS-like lesion was considered more likely to be a focal proliferation of the adipose cells than a nevus.
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Clinical and Investigative Report
  • Laminin and Type VI Collagen in Dermatofibrosarcoma Protuberans
    Toshihiro SATO, Shuji TAKASAKI, Hiroto TERASHI, Soutaro KURATA, Tomohi ...
    1992 Volume 54 Issue 3 Pages 487-490
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.487
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    A 39-year-old man presented with several firm nodules of 6 months’ duration in the right inguinal region. This tumor could be diagnosed as dermatofibrosarcoma protuberans (DFSP) from the clinical and histopathological findings, however, the tumor cells did not stain for vimentin, which normally is strongly positive in most cases of DFSP, by the peroxidase-antiperoxidase technique. Next, we examined the distribution of laminin and type VI collagen in the present tumor as well as in four respective cases of DFSP and neurofibroma. All four cases of neurofibroma were positive for both laminin and type VI collagen. In all four cases of DFSP, the results showed a weak positivity for laminin, while they were negative for type VI collagen except for a single case. The present case was positive for type VI collagen and weakly positive for laminin. These immunohistological studies of the extracellular matrix thus seem to be useful in analyzing the histogenesis of soft tissue tumors.
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  • Clinicopathological Studies of Mixed Tumors of the Skin
    Shinichi ANSAI, Yutaka HOZUMI, Kazuo ASO
    1992 Volume 54 Issue 3 Pages 491-499
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.491
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    Clinical, histopathological and immunohistochemical studies were performed on 16 cases of mixed tumor of the skin (MTS). Histopathologically, those specimens could be separated into two different types—tubulocystic (TC) and syringomatous (SYR) type. Thirteen of the 16 specimens showed a TC type pattern, one a SYR type, and two showed a co-expression of TC and SYR type patterns. The TC type of MTS similarly showed “decapitation secretion” in the inner cells of the tubulo-cystic structures, kerationus cysts and the cells of sebaceous differentiation, while the SYR type did not. These findings indicate that the TC type of MTS is similar to the apocrine glands and SYR is similar to the eccrine glands. Chondroid stromal changes were seen only in ten specimens out of 16 (62.5%). In immunohistochemical studies using 17 antibodies, the inner cells of the tubulo-cystic structures in the TC type MTS showed similar findings to the secretory portion of the apocrine gland, while those in SYR showed similar findings to the secretory portion of the eccrine gland. The outer cells of tubulo-cystic or ductal structures, the stromal celles, the hyaline cells and chondrocyte like cells all showed the characteristics of epithelial, mesenchymal and neural cells with a hyperproliferative state.
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  • Changes of T Lymphocyte Subsets in the Peripheral Blood of Patients with Psoriasis with Aromatic Retinoid Administration.
    Juichiro NAKAYAMA, Yoshiaki HORI
    1992 Volume 54 Issue 3 Pages 500-506
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.500
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    The systemic administration of an aromatic retinoid, etretinate (Tigason®), in patients with psoriasis vulgaris was analyzed regarding what influence it had on the percentages of T lymphocyte subsets in the peripheral blood of patients using the FACS system with monoclonal antibodies (Leu-series). The percentage of Leu-3a+ cells in the psoriasis patients was significantly higher than that in the normal individuals, and the ratio of Leu-3a+cells/Leu-2a+cells increased during the 6 weeks of etretinate administration. This tendency was considered to be remarkable in the patients who responded well to etretinate. It is thus concluded that ebretinace treatment of psoriasis vulgaris also has an effect on immune cells such as T lymphocytes in the peripheral blood either directly or indirectly.
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  • Study of the Mechanism of Epidermoid Cyst Inflammation
    Eiji MIZUNO
    1992 Volume 54 Issue 3 Pages 507-512
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.507
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    In order to learn more about the mechanisms by which epidermoid cysts become inflamed, we conducted a study of the relation between the presence or absence of clinical inflammation and bacteria cultures. This study revealed no correlation, however. Thus, it does not seem to us that bacteria plays an important role in inflamed epidermoid cysts. Nextly we studied the possibility of a relation between keratin and the reaction that forms the foreign body granulomas. We used the PAP method with anti-keratin antibody to study the granuloma specimens histologically, and found large quantities of anti-keratin substances within the giant cells, which inferred the involvement of keratin in granuloma formation. For further investigation, we conducted an experiment on mice in an attempt to induce granuloma formation through the injection of autologous nails and epidermis. The results showed that foreign body granulomas formed after the injection of either a homogenized nail preparation or a keratin extract made from the nails, however, such injections of homogenized epidermis or epidermis extract yielded no such effect. Our results show that the anti-keratin reaction is considered to be especially important in the mechanism of inflammation.
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  • Possible Involvement of Allergy in Drug Eruptions Due to Gold Compound
    Tetsuya KOGA, Shuhei IMAYAMA, Tamiko HASHIZUME, Minao FURUMURA, Shinic ...
    1992 Volume 54 Issue 3 Pages 513-519
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.513
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    A 66-year-old Japanese woman with seborrhoic dermatitis-like skin eruptions following the treatment with 350mg of gold sodium thiomalate (GST) is presented. The patient developed a positive patch test reaction to GST, while the lymphocyte stimulation test with GST was negative. A histological examination of the skin lesion demonstrated a superficial perivascular infiltration of lymphocytes intermingled with eosinophils and focal spongiosis in the epidermis. Immunohistological studies revealed that most of the infiltrates were CD4-positive T cells, and that HLA-DR antigen was expressed focally by the epidermal keratinocytes. Both the histological and immunohistochemial features of the skin obtained from the positive patch test site were almost the same as those of the skin lesion. Peripheral blood mononuclear cells (PBMC) obtained from the patient were cultured for 72h with GST, and after incubation, a culture supernatant was taken. IFN-γ and eosinophil chemotactic activity were detected in the culture supernatant. These findings suggest that certain cytokines produced by GST-specific T cells may play an important role in the development of such skin eruptions.
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Review
Statistics
  • Bacteriological Evaluation of Severely Burned Patients
    Shinichiro NARAHARA, Motoki KUROKAWA, Shouhei INOUE
    1992 Volume 54 Issue 3 Pages 532-538
    Published: June 01, 1992
    Released on J-STAGE: September 29, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.54.532
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    The bacteria isolated from 39 severely burned patients, hospitalized at Miyazaki Medical College over the past 11 years, were studied. Among the Gram-positive bacilli, S. aureus and Enterococcus were the most frequent. As for the Gram-negative bacilli, P. aeruginoza, K. pneumoniae and Enterobacter were the most frequently encountered. There were no special tendencies from year to year. Identical species were generally grown both from the sputum and the wounds. From the urine, Gram-negative bacilli and fungi were most frequently detected, although there were considarable differences in the species. There were no significant tendencies toward a lessening of the sensitivity of the bacteria to antibiotics. S. aureus and P. aeruginosa tended to become resistant in the third post-burn week, compared with the bacteria detected earlier.
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Dermatologists around the World
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