[in Japanese]

View full abstract

A 19-year-old man visited our hospital with erythematous eruptions on his face, upper arms, and trunk, and with alopecia on his scalp. Histologically, the skin lesions showed features of SLE and large amounts of mucin deposition which led to the separation of the collagen bundles. A direct immunofluorescene test revealed deposits of IgG, C₃ along the basement membrane zone. We diagnosed SLE accompanied with subclinical Sjögren’s syndrome based on the presence of a malar rash, as well as on photosensitivity, leukocytopenia, high titers of anti-nuclear antibody, anti-Sm antibody, abnormal findings of sialography and cell infiltration around salivary ducts in a lip biopsy, while, on the other hand, no sicca syndrome was clearly observed.

View full abstract

A case of scleroderma renal crisis (SRC) is reported. A 59-year-old woman who had been suffering from systemic sclerosis (SSc) for about 13 years developed extremely high blood pressure (230/140 mmHg). Fundoscopy revealed Grade III KW retinopathy. The plasma renin activity level was markedly elevated. The blood pressure could not be sufficiently controlled by the administration of either captopril, furosemide or nifedipine and as a result the renal function progressively deteriorated. The patient eventually died of pneumonia and intracranial hemorrhage. An autopsy revealed typical histological findings of scleroderma in the skin, right lung, esophagus, stomach and the kidneys. The renal arteries did not show any fibrinoid necrosis which was often observed in SRC. When treating SSc, physicians should make their best efforts to provide suitable treatment as soon as possible after confirming the diagnosis of SRC.

View full abstract

A case of systemic scleroderma in which the symptoms became prominent after undergoing radiation therapy for breast cancer is reported. A 68-year-old woman, who had undergone a radical mastectomy for breast carcinoma at the age of 63 and thereafter received radiotherapy at 65, 66 and 67 years of age, visited our clinic complaining of skin sclerosis and Raynaud’s phenomenon which she had noticed since the age of 65. The physical examination revealed not only postirradiation fibrosis and pigmentation, but also edematous sclerosis and the pigmentation of her extremities, as well as short frenulum of the tongue and digital pitting scars. She demonstrated serum anti topoisomerase I antibodies, esophageal dysfunction and lung fibrosis. The histopathology of the forearm skin showed edema of the upper dermis as well as increased and homogenized collagen bundles in the middle and lower dermis. Since similar cases have been reported, it is considerable that radiation therapy may have thus worsened the lesions of scleroderma in this patient as well.

View full abstract

We describe two patients with relapsing polychondritis in whom circulating antibodies to type II collagen were detected. Chondritis of both auricles, a saddle-nose deformity and chondritis of the respiratory tract were observed in a 54-year-old woman. These symptoms thereafter improved by treatment with corticosteroids and cyclosporin A. After a five-month following-up, however, she experienced an episode of episcleritis. The other case was a 68-year-old woman who first visited our department complaining of chondritis of the right auricle. The patient developed swelling of the left auricle and episcleritis of both eyes in spite of being treated with corticosteroids. In both cases, circulating type II collagen antibodies were detected in acute symptoms of the disease. The antibodies in the 54-year-old woman were reactive with the CB10 fragment of type II collagen.

View full abstract

A 59-year-old Japanese male who had been on ticlopidine-HCl, pentoxyfylline, and lisuride maleate because of a cerebral infarction for two years developed flaccid bullae on an erythematous base over the upper half of the body. He was given corticosteroid ointment with some effect. Thereafter, the pentoxyfylline and lisuride maleate were withdrawn, and resulted in an improvement of the lesions. Ticlopidine-HCl was not withdrawn at the request of the doctor in charge. The readministration of lisuride maleate produced a reappearance of vesicles while simultaneously treated with ticlopidine-HCl. It was assumed that the original bullae had been produced either by the lisuride maleate or by a combination of the ticlopidine-HCl and lisuride maleate. The sulfur residue such as that contained in ticlopidine-HCl easily combines with proteins to form antigenetic compounds, which may thus explain the occurrence of bullae in this patient.

View full abstract

A case of a delayed type adverse skin reaction due to non-ionic contrast media, Omnipaque^® (iohexal) is reported. A 59-year-old female developed multiple erythema over her entire body five days after undergoing a cardiac catherterization for the examination of WPW syndrome. The patient had no known allergic history. Non-ionic contrast media, iohexol was used twice for the examination. The white blood cell count was 4,900/mm³, with 2% of peripheral eosinophiles, LDH 325 IU/L, IgE (RIST) 2 IU/ml and a negative drug-lymphote stimulation test. The skin test for Iohexol and Iopamidol (as is) was positive after 48 and 72 hours, respectively. Patch tests using 10% iohexol and iopamidol were positive after 48 and 72 hours according to the ICDRG classification.

View full abstract

A 41-year-old man had been suffering from psoriasis vulgaris for about ten years. The psoriatic lesions abruptly began to spread widely over his entire body surface. One month later, miliary pustules appeared on the dorsa of both his hands together with a high fever and a painful swelling of both sterno-costo-clavicular joints. The skin lesions and joint symptoms improved after undergoing a combination therapy of PUVA along with etretinate and AMPC. Sterno-costo-clavicular arthritis has been reported to be accompanied with palmoplantar pustulosis, acute generalized pustular bacterid and pustular psoriasis or sometimes even with psoriasis vulgaris. One of the most common histological findings among these diseases is the presence of intraepidermal infiltration of neutrophils or pustule formation in the epidermis. The intraepidermal infiltration of neutrophils and sterno-costo-clavicular arthritis might thus be caused by the similar pathogenetic mechanisms observed in these diseases.

View full abstract

A case of eruptive xanthoma which developed in a patient with hyperlipidemia and diabetes mellitus was reported. The patient was a 25-year-old Japanese obese male. Laboratory examinations revealed hyperlipidemia and hyperglycemia, diabetes mellitus and proteinuria. The skin rash consisted of numerous red to yellowish papules with a erythematous halo. The histological examination revealed an admixture of foamy cells, lymphoid cells, histiocytes and neutrophils. The foamy cells stained red with oil red O or yellowish red with Sudan III. Systemic treatment with anti-hyperlipidemia and anti-diabetes mellitus agents rapidly improved his hyperlipidemia and hyperglycemia. Thereafter, the skin rash began to flatten as soon as the laboratory data normalized. After 5 months of treatment, all the papules disappeared while only some pigmentation remained.

View full abstract

Four cases of pseudoxanthoma elasticum (PXE) with and without complications are reported. Case 1, a 56-year-old male, showed hypertension (HT), diabetes mellitus (DM), angioid streaks (AS), a diminution in the palpation of the pulse in the left radial artery and cerebral infarction. Case 2, a 45-year-old female, showed HT and AS. Case 3, a 32-year-old female, showed only AS. Case 4, a 34-year-old female, showed AS and a diminution in the palpation of the pulse in the left radial artery. In order to characterize the clinical features for the specific type of PXE with severe complications, 233 cases (male: 84 cases, female: 149 cases) were collected from previous reports in Japanese literatures including our 4 cases. They were divided into 4 groups consisting of patients with: central nervous system (CNS) disorders (male: 17, female: 16), heart disease (male: 4, female: 19), gastrointestinal (GI) bleeding (male: 9, female: 6), and no major complications (male: 61, female: 114). The symptoms of CNS disorders appeared most frequently in the third and fourth decades of life in patients with PXE. When the ratio of HT and DM were compared between the groups of patients with CNS disorders and those without any complications, they were significantly high (HT: 42% vs 7%, P=0.0001. DM: 26% vs 2%, P=0.0001). However, the ratio of a family history (FH) of PXE was considerably low in patients with CNS disorders (19% vs 38%, P<0.05). Heart disease associated with PXE mostly consisted of ischemic heart disease (21 in 23 cases) and occurred mostly in young female patients including some children with PXE. In this group of patients with heart disease compared with the group of patients without complications, the ratios of HT and DM were significantly high (HT: 57% vs 7%, P=0.0001. DM: 9% vs 2%, P<0.05), whereas FH was significantly low (FH: 13% vs 38%, P=0.0001). On the other hand, in the group of patients with GI bleeding hemorrhaging was observed from the wall of the stomach after vascular damage mostly in young male patients. In this group, the ratio of a family history of consanguineous marriage (CM) was significantly high compared with those without complications (43% vs 15%, P=0.0001). In conclusion, the following clinical features were indicated as risk factors for showing severe complications in patients with PXE: HT and DM without FH for CNS disorders; female sex, HT and DM without FH for heart disease; and finally, male sex and CM for GI bleeding in patients with PXE.

View full abstract

We present the case of an eighty-five-year-old man with Meibomian gland carcinoma on the left upper eyelid. He first noted the tumor in December 1991, which had grown gradually. The tumor was 38×23×17 mm in size at the time of our first examination on September, 1992. Histopathologically, nests of atypical basophilic tumor cells proliferated anastomosing in a strand-like and band-like pattern in the dermis. Lipid droplets were observed with oil red O stain. Some lipids were also seen in the cytoplasm ultrastructually. Both the mitochondria and rough endoplasmic reticulum were well developed, but desmosomes were scanty.

View full abstract

Epithelioid leiomyomas are uncommon tumors which are found almost exclusively in the gastrointestinal tract or the uterus. We report a case of epithelioid leiomyoma found in the muscles of the neck (m. sternocleido-mastoideus) in a sixteen-year-old boy. Histologically, the tumor cells were composed of round cells (epithelioid cells) and plump-spindle cells forming fascicles. The epithelioid cell showed eosinophilic cytoplasm and vesicular nuclei. The ultrastructural findings revealed the characteristics of smooth muscle cells, such as subplasmalemmal dense patch, cytoplasmic dense bodies, cytoplasmic microfilaments, pinocytotic vesicles, and basal lamina.

View full abstract

Two cases of eccrine hidrocystoma are reported. Case 1: A 69-year-old woman had been suffering from symptom free, multiple papules for the past four or five years, demonstrating a normal to brownish color. approximately the size of half a grain of rice on the periocular area, forehead, cheeks and upper perioral area. They had enlarged in summer or when she perspired, and almost completely disappeared in the winter. Case 2: A 48-year-old woman suffered from the same papules as in case 1 for five or six years on the periocular area and forehead. She felt slight itching when she perspired. An ultrasound examination demonstrated the relatively well demarcated cystic structures with an internal hypoecho in both cases, and an acoustic shadow in case 2. The histological examination showed the round to oval shaped cystic structures in the dermis, the walls of which consisted of one or two layers of flat epithelial cells. In addition, slightly dilated eccrine sweat apparatuses were found around them. We also reviewed the previously reported cases of eccrine hidrocystoma.

View full abstract

A 57-year-old woman presented with multiple subcutaneous nodules was diagnosed at first as lipogranulomatosis subcutanea (Rothmann-Makai syndrome), since the nodules showed histologically lipogranulomas and infiltration of neutrophils, lymphocytes, giant cells and foam cells, while the patient also had no systemic symptoms. Although the nodules spontaneously subsided after the diagnosis, six months later she developed multiple, large and deep skin ulcers associated with exudative erythemas. A biopsy specimen of the exudative erythema showed medium-sized atypical lymphoid cells in the dermis and the subcutaneous tissue. The diagnosis of T cell lymphoma was made since the cells were positive for MT1 and UCHL-1 staining, but negative for L26 staining. Biopsies specimens of the other tissue revealed the involvement of the nasal mucous tissue and right inguinal lymph nodes. A cytologic examination of the aqueous humor showed Pap. class III. Diagnostic imaging indicated the involvement of lymphoma cells in the pancreas and the kidney. She was treated by chemotherapy, but eventually died one and a half years after the first diagnosis.

View full abstract

Two cases of varicella-zoster-virus (VZV) meningitis are reported. The first case was a 61-year-old female who complained of painful small vesicles on her right leg. She was diagnosed as having herpes zoster and was intravenously given acyclovir 250mg three times a day. After 4 days of therapy, she complained of severe headache and nausea with a high fever and vomiting. The anti-VZV antibody titer of the cerebrospinal fluid was high and the other findings suggested viral meningitis. The second case was a 62-year-old male. He experienced painful, erythema and small vesicles on his right head and neck. He was diagnosed as having herpes zoster and was intravenously given acyclovir 750mg a day. After 5 days, he complained of severe headache and nausea. The findings of his cerebro-spinal fluid including anti-VZV titer showed viral meningitis. Each case was treated with acyclovir 1500mg in a day. Thereafter, a rapid improvement was obtained both clinically and immunologically.

View full abstract

We report the findings of a 3-year-old and a 12-year-old girls with tinea nigra. Both had asymptomatic brown macule on their palms which had been slowly enlarging over several months. A light microscopic examination of the scales from the lesion showed brown branching hyphae. In a culture, black colonies were observed to be formed which were identified to be Hortaea werneckii. Tinea nigra hase been previously reported 17 cases in Japan and these are the first cases reported in Saga prefecture.

View full abstract

Crude extracts made by homogenizing the neurofibromas in patients with von Recklinghausen’s disease were applied to heparin-sepharose chromatograghy. Two heparin-binding proteins showing activities to proliferate NIH3T3 cells in vitro were eluted with 1.0 M and 1.4 M NaCl. The elution profile was quite similar to that reported by Ratner et al, and the latter fraction was suspected to be basic fibroblast growth factor (bFGF). This fraction was found to activate c-fos in both NIH3T3 cells and cultured neurofibroma cells by immunofluorescent staining. The commercial bovine bFGF also activated the c-fos expression in these cells and the activation of c-fos oncoprotein by bFGF in cultured neurofibroma cells was found to be prolonged for up to 3 hr as compared to that in NIH3T3 cells which were only prolonged for 1 hr. In addition, the NF cells were found to express c-fos oncoprotein constitutively by a Western blot analysis. These results indicated that the bFGF existing in neurofibromas may thus act as an important growth factor through the mechanism of the activation of protooncogenes such as c-fos.

View full abstract

Using immunohistochemical staining for Langerhans cells (LC), we counted the number of epidermal LC in variable skin lesions of the patients with atopic dermatitis (AD) who developed a positive patch test (PT) reaction for dust mite antigens. The number of LC increased in the skin specimens obtained from the positive PT areas in patients with AD as well as those from allergic contact dermatitis. In patients with AD, a smaller number of LC were found in erythematous and lichenoid skin lesions, however, an increased number of LC were found in prurigo-like nodular lesions. These results suggested that in AD patients with a positive PT reaction for mite antigens, delayed type hypersensitivity (DTH) reaction for antigens might play a key role in the developement of prurigo-like skin lesions like those found in allergic contact dermatitis, while it might not be involved in other types of AD skin lesions.

View full abstract

The sun protection factor (SPF) of a new foundation product, 2 WAY Foundation TD, was evaluated according to our laboratory and the Japan Cosmetic Industry Association (JCIA). The geometric mean SPF was 14.7 with a standard deviation of 1.0. The SPF determined according to the JCIA’s guidelines was 15.5. This product, thus proved to belong to the ‘Very High Sun Protection Product’ class and thus seems to be appropriate for use by normal and photosensitive subjects.

View full abstract

Hyogo Society of Clinical Dermatologists reported the statistics of chickenpox and adult chickenpox on the basis of the skin disease surveillance data, which had been collected since March 1986. It was observed that the incidence of chickenpox tended to be the lowest in October and there after in creased from the winter to early summer. Further more, the incidence of adult chickenpox completely changed in parallel with that of chickenpox. Thus, the proportion of the cases of adult chickenpox to the cases of all chickenpox always remained fixed (11% to 12%). Over a period of 6 years (1987 to 1992), the reported 4,592 cases of chickenpox (including 569 cases of adult chickenpox) were evaluated according to sex and age. The entire proportion of males to females was found to be a ratio of 1:1.1. In the cases of adult chickenpox alone, the proportion was 1:1.6, without indicating any remarkable significant difference between female and male. Especially in regard to female in their twenties, the cases of adult chickenpox were 2 times those of male in their twenties. The results are ascribable to the fact that there are many chances to become infected from childhood. In regard to the patients above thirty, the proportion of male to female was reversed. In other words, the number of male cases tended to be higher than the female cases. The incidence of herpes zoster was found to be almost the opposite of chickenpox in view of the monthly and yearly changes. In brief, the incidence of one disease in creased while the incidence of the other disease decreased. It is unknown why there is an inverse relation between the two types of incidence for those two diseases which are caused by the same virus.

View full abstract

A statistical analysis of the clinical features observed in the patients demonstrating positive anticentromere antibody was studied over a 3 year period since 1990 to 1992. Total of 55 patients (male 3 cases; female 52 cases) were detected. Mean age was 56.9±13.8 years old. The clinical diagnoses were as follows, systemic scleroderma; 45 cases (82.0%). SLE; 1 case, DLE; 1 case, morphea; 1 case, psoriasis vulgaris; 2 cases, atopic dermatitis; 1 case, Darier disease; 1 case, polymorphous light eruption; 1 case, prurigo chronica multiformis; 1 case and macular amyloidosis; 1 case, respectively. The serum A/G ratio, pulmonary involvement, esophageal involvement, cardiac involvement and renal involvement were then compared between the Barnett I group and Barnett II/III groups in systemic scleroderma patients. There was no statistical significance in these investigations between the Barnett I group and Barnett II/III groups except for the % DLco in the pulmonary function test (p<0.01).

View full abstract

A statistical investigation on the recent increase of skin malignancies in association with the patients’ exposure to ultraviolet light was carried out at the dermatological clinic of Kyushu University Hospital as a member of the skin carcinogenesis study group, which was organized by the Environmental Agency of Japan. In addition, a questionnaire was made on the past history of patients with squamous cell carcinoma regarding their exposure to the ultraviolet light while simultaneous also giving the same questionnaire to other age-matched control persons. The patients with malignant melanoma were found to be fairly young in age, and the number of the patients of both male and female has been clearly increasing over the last 10 years. The distribution of the sites of malignant skin tumors, including basal cell carcinoma, squamous cell carcinoma, malignant melanoma and actinic keratosis, is suspected to be associated with exposure to sunlight. Although it was obscure in the case of malignant melanoma, there was a definite positive association of a history of exposure to sunlight after adolescence with the occurrence of squamous cell carcinoma, based on the results of the questionnaire.

View full abstract

We concomitantly administered ursodeoxycholic acid (UDCA, Ursosan), a secondary bile acid, orally to patients with psoriasis vulgaris who had received etretinate, at a small maintenance dose, over a long term with little effects. We measured the serum levels of its main metabolites before and after the administration of UDCA, and then investigated the clinical effects of the combination therapy. The subjects consisted of 12 patients with psoriasis vulgaris, including 10 males and 2 females, ranged from 33 to 61 years old. They had all been treated as outpatients with an external steroid ointment combined with a maintenance dose of etretinate (10mg or 20mg/day) orally but with little effects. We measured the serum levels of its metabolites 4 hours after the administration of etretinate alone. Then, UDCA was combined orally at a dose of 4 tablets (200mg), and then the serum levels of substance were again measured to evaluate the effect of the combination therapy. The results revealed that 10 (83%) of the 12 patients showed increases after the combined administration of the two drugs. Among them, 4 of 8 patients given 10mg of etretinate and all 6 given 20mg showed increases in the combinations of the metabolites. In addition, the clinical symptoms improved in 8 (66%) of the 12 total patients treated by the combination therapy. Among the above patients, 3 (50%) of 6 given 10mg of etretinate and 5 (83%) of 6 given 20mg demonstrated clinical improvements.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract