We report the case of 6-year-old girl with multiple juvenile xanthogranulomas. Yellowish papulonodular lesions were distributed on her face, trunk and extremities. However, no extracutaneus lesions or hyperlipidemia was observed. A skin biopsy showed the infiltration of histiocytes and lymphocytes in the upper dermis. Seven years after onset, the lesions spontaneously involuted. In general, juvenile xanthogranulomas develop within the first year of life and thereafter the lesions spontaneously involute within 6 months to 3 years. Our case was considered to be interesting in that she was considerably older than typical cases of juvenile xanthogranuloma and the clinical course was also longer than usual.

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An 87-year-old man was referred to our clinic with one month history of pruritic eruptions mainly on his back. A group of vesicles, pustules, erosions, and crusts was found in the middle of his back surrounded by irregularly shaped edematous erythema. The extensor surface of the extremities and the shoulders were also affected as well. Papillary micro-abscesses were histologically observed that were composed of neutrophils, and resulted in subepidermal bullae. Direct immunofluorescence testing showed fibriller deposits, partially granular deposits of IgA in the dermal papillae. He was diagnosed as having dermatitis herpetiformis Duhring, and was successfully treated with oral diaphenylsulfone (DDS). Further study revealed HLA B8, DR3, DQw2 to be negative on HLA typing, while, in addition, the serum anti-gliadin IgG and IgA antibodies, anti-reticulin IgA antibody, and anti-endomysium IgA antibody were all negative. Immunohistochemically, anti-kalinin antibody was expressed on both the roof and floor of the bullae.

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A 48-year-old Japanese male and his daughter, a 17-year-old female patient presented with intensely pruritic small nodules, milia, and irregular scarring, mainly on the extensor and peripheral aspects of their extremities, and nail dystrophy. In addition, albopapuloid skin lesions were also observed on the trunk of the latter case. Histological observations revealed a cleft formation below the epidermis in both cases and electron microscopic observations demonstrated the focal disappearance of anchoring fibrils of the epidermal basal lamina in the lesional skin. We report these two cases as a familial case of epidermolysis bullosa pruriginosa, but not as the pretibial type (father) and Pasini type (daughter) of epidermolysis bullosa. The different clinical manifestations found in these two cases may represent a phenotypic variation.

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We describe a case of palmoplantar pustulosis and severe arthro-osteopathy in a 32-year-old man. Since the arthralgia was not sufficiently controlled by either oral steroids or etretinate, the patient was treated with oral cyclosporine at an initial dosage of 3mg/kg/day. A remarkable reduction in the arthralgia was observed after only a few days of treatment, while the pustules and nail deformity persisted. The patient showed a positive reaction to several kinds of metal by patch testing. He also had a previous history of dental caries being treated with metal fillings and an aggravation of skin lesions after pharyngotonsillitis. Therefore, all metal dental fillings were removed and alternative treatments for dental caries and periodontitis were performed. A tonsillectomy was also performed. Thereafter, a remission of the skin lesions was observed and the patient was eventually able to withdraw from cyclosporine. In conclusion, cyclosporine was found to be very useful in treating palmoplantar pustulosis, and especially for ameliorating the symptoms of associated severe arthro-osteopathy. Based on our findings, patients with such symptoms should thus be examined for metal allergies or an infectious focus, and the treatment of these disorders should be continued even after the administration of cyclosporine.

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We report a case of eccrine porocarcinoma occurring in an 82-year-old woman who presented with papular and vesicular lesions with irregularly shaped punctate ulcers on her left sole. Such a clinical appearance resembled tinea vesicular but the histopathological findings of her ulcerative lesions showed a proliferation of basaloid cells with an atypical nucleus infiltrating into the epidermis. An electron microscopic examination revealed intracellular ductal formation with microvilli. We thus diagnosed this case as eccrine porocarcinoma. Papular lesions around the ulcer histopathologically revealed metastatic tumor nests in the dermal lymphovessels. Interestingly, these tumor cell nests were distributed throughout the upper dermis and spread into the epidermis or sweat ducts until finally being eliminated from the overlying epidermis. Moreover numerous S-100, CD-1 and CD-4 positive Langerhans cells were also observed in the tumor cell nests. These findings thus suggested the possibility of a relationship between transepithelial elimination and Langerhans cells.

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We report a case of pilonidal sinus. The patient was a 24-year-old man, who developed a painful nodule from which a purulent material had occasionally drained, in the coccygeal region after he had sat for many hours in his junior high school days. A physician had failed to obtain an improvement in the lesion with the treatment of antibiotics, and the lesion instead worsened while extending upward to the sacral region. On our initial examination, a tender nodule was observed in the sacral region with a fistulous orifice, from which hairs were eliminated on compression, in the coccygeal region. Palpation revealed subcutaneous induration and infiltration, both of which probably connected the above-mentioned nodule with the fistula, respectively. The lesion was clinically diagnosed to be pilonidal sinus, and a wide resection of the entire lesion was thus performed. At the time of operation, it was confirmed that the fistula of the coccygeal region was in continuity with the nodule of the sacral region. The histopathological findings revealed that the fistula containing hairs was present in the subcutaneous tissue, and that its wall was composed of a stratified squamous epithelium. Some of the hairs had also spread into the surrounding subcutaneous tissue at the tip of the fistula, while other hairs had penetrated the epithelial fistulous wall, thus resulting in the infiltration of the inflammatory cells. These findings are thus considered to support the acquired theory in the pathogenesis of pilonidal sinus.

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We report four cases of lime burn who were injured after spraying lime for the prevention of Imoti disease of rice. The patients were 71, 65 and 53-year-old males and one 68-year-old fermale. All patients developed characteristic eruptions located in both femurs in all four patients and both knees in three. The mechanism of the eruption was probably caused either by heat or by alkaline due to contact with wet lime.

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We report 2 cases of stonefish sting. Case 1: A 28-year-old male who was stung by a captured stonefish. Case 2: A 31-year-old female who was stung while swimming. Both cases were immediately diagnosed as having stonefish sting and came to our hospital after receiving primary treatment. The clinical symptoms were very severe and one of these cases needed surgical debridement. Since the frequency of these cases seems to be increasing due to the growing popularity of marine sports, it is considered important to be informed about the toxin of these creatures.

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We report a 26-year-old man presenting with condyloma acuminatum on the urethral meatus. He first noticed a tumor on the urethral meatus about three weeks earlier. A macroscopic examination revealed a papillomatous tumor on the urethral meatus. The tumor was reddish in color. There were no other tumors on foreskin or glans. The tumor was thus resected. The histopathological findings of the resected specimen were compatible with that of condyloma acuminatum. About two months after operation, a similar tumor recurred on the urethral meatus. We thus performed liquid nitrogen therapy at the outpatient clinic twenty times. The tumor remnants were also treated with electron coagulation. In the cystourethroscope findings after treatment, no tumors were found elsewhere. At six months after treatment, no recurrence has been seen.

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We histologically examined 178 cases of nevocellular nevi for fat cell infiltration. In 44 cases of nevi (24.7%), large fat cells were found. The frequency and extent of fat cell infiltration in the nevi rose in proportion with the increasing age of the patients. Out of 44 nevi containing large fat cells, 39 were resected from the scalp, face or neck. Most of the nevi with fat cell infiltration were intradermal nevi. In addition, the fat cells were mainly observed in the nevi showing type-c structures that were rich for stroma, and in type-c structures in the nevi, thus indicating fat cells to be associated with the stromal tissue. The fat cells in the nevi were morphologically uniform and were thus indistinguishable from typical adipocytes in fat tissue. These results suggest that fat cells in nevi originate from stroma cells and not from degenerated nevus cells.

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To investigate the role of HLA-C molecules in the pathogenesis of psoriasis vulgaris, we analyzed 58 psoriasis vulgaris patients for aspartic acid at position 9 (Asp-9) in their HLA-C molecules, which is common to HLA-CW6 and HLA-Cw7. Among the patients with psoriasis vulgaris, 23 out of 58 were found to be positive for Asp-9, while, in contrast, 15 out of 49 were positive in healthy subjects. The difference was not statistically significant. In addition, no significant difference was observed between the patient group with Asp-9 and that without Asp-9 regarding clinical severity, age at onset, or heritability. These findings thus support the idea that the HLA-C gene is linked to some unknown susceptibility gene for psoriasis.

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Statistical surveys on 156 cases of calcifying epithelioma in our clinic conducted from 1979 to 1995 provided the following results. 1) The male: female sex ratio was 1:2. 2) The tumors were mostly located in the exposed areas, in particular on the face. 3) 58% of the tumors were found in the under 20 age group. 4) In the under 20 age group, the tumors mostly developed on the face and arms. 5) Clinically calcifying epitheliomas were sometimes misdiagnosed to be either atheroma or dermatofibroma. 6) Three of 156 cases had two tumors per person. One case consisting of two sisters was also observed. In addition, 2 individual cases were also reported; case 1 was clinically diagnosed to be angiosarcoma, while case 2 demonstrated a tumor with a bullous appearance.

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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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