The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 59, Issue 6
Displaying 1-22 of 22 articles from this issue
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Color Atlas
Clinical Case Reports
  • Artificial Carbon Dioxide Balneotherapy for Treatment of Diabetic Foot Ulcer
    Masami TERAUCHI
    1997 Volume 59 Issue 6 Pages 811-815
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.811
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    Artificial carbon dioxide balneotherapy using a bath aid was used with favorable results in the treatment of diabetic foot ulcers which have been increasing in recent years. The efficacy of balneotherapy has long been known, but along with the progress in topical agents for the ulcers, this therapy is often taken lightly. However, this therapy is worth considering even today, when used in carefully selected cases. Carbonate is liposoluble, and absorbed percutaneously to increase the capillary bed and dilate capillaries, and thereby helps to improve blood circulation. Not only does the absorbed CO2 increase PtCO2 but a hot bath also raises the local temperature. Both of these effects shift the oxygen dissociation curve rightward, thus reducing the oxygen saturation of haemoglobin. These factors, when combined, raise the partial pressure of oxygen in local tissue and thus improve diabetic foot ulcers derived from damage of the major blood vessels and microvessels. Artificial carbon dioxide balneotherapy using a bath aid should thus be one of the therapies of choice in treating diabetic foot ulcers.
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  • A Case of Systemic Vasculitis Associated with Wide-spread Gangrene of the Extremities
    Hiroki ONOUCHI, Kazumitsu SUGIURA, Yukiko OGIYAMA, Yoshinari MATSUMOTO ...
    1997 Volume 59 Issue 6 Pages 816-819
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.816
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    A 52-year-old man with wide-spread gangrene of the extremities who was diagnosed to have systemic vasculitis is reported. He was admitted to Nagoya University Hospital due to the development of pleuritis and was later referred to the Department of Dermatology because of wide-spread gangrene of the extremities. We confirmed some extensive necrotizing vasculitis involving the small arteries and veins in biopsy specimens. His clinical symptoms indicated polyarteritis nodosa, however, his histopathologic findings tended to indicate Wegener’s granulomatosis with necrotizing vasculitis.
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  • Two Cases of Generalized Morphea in Children
    Yumiko KUBOTA, Tetsuya KOGA, Shoji TOSHITANI
    1997 Volume 59 Issue 6 Pages 820-825
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.820
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    We report two cases of generalized morphea (GM) in children. Case 1: A 6-year-old girl developed numerous sclerosed brown-colored plaques and atrophic hyperpigmented areas on her face, back and lower limbs over a two-year period. Sclerotic plaques progressively involved the left limb with hemidystrophy. A skin biopsy of the left sclerosed thigh demonstrated thick collagen bundles all over the dermis. The antinuclear antibody (ANA) level, rheumatoid factor and anti-single-stranded (ss) DNA antibody level were all high. We thus diagnosed GM with possible severe deformities and functional disabilities, and the systemic administration of corticosteroids thereafter proved to be effective on the sclerosis. Case 2: A 6-year-old boy developed three alopecia areas and atrophic sclerosed plaques on his left upper eyelid to the temple region. The ANA and anti-ss DNA antibody were negative. We diagnosed GM with a good prognosis, and topical corticosteroids proved to be effective. In selecting the appropriate treatment for both cases, the measurement of the serum anti-ss DNA antibody level was found to be very useful.
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  • SLE with Poikiloderma Atrophicans Showing Leukocytoclastic Vasculitis
    Yoko HIROTA, Masahiko MUTO, Akiko OOMURA, Toru HIROTA, Chidori ASAGAMI
    1997 Volume 59 Issue 6 Pages 826-828
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.826
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    A case of SLE with eruptions similar to those of dermatomyositis is reported. A 42-year-old female noticed reddish eruptions on her back, buttocks, and bilateral arms and also felt pain in her showlder, elbow, and hand joints for two months prior to the first medical examination. The pain became more severe and she thus visited our hospital. We observed edematous erythema on her face, infiltrative erythemas and hypopigmented scars on her buttocks. She complained of general fatigue and muscle pain in her right upper arm. Histological examinations of infiltrative erythema on her lumbar region showed leukocytoclastic vasculitis while direct immunofluorescence showed IgG, IgM, C3, C4 depositions on the basement membrane zone and around the vessels of the dermis. No signs of myositis were detected in a muscle biopsy.
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  • A Case of Post-steroid Panniculitis
    Wataru RIKIHISA, Hiromaro KIRYU
    1997 Volume 59 Issue 6 Pages 829-831
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.829
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    A rare example of post-steroid panniculitis is reported. A 58-year-old woman experienced painful nodular lesions on her flanks during the course of a rapid withdrawal of high doses of orally-administered prednisolone for the treatment of polymyositis. A histopathological examination revealed patchy lobular panniculitis with a dense inflammatory infiltrate consisting mainly of lymphocytes and histiocytes. Characteristic needle-shaped clefts were found within the lipocytes and histiocytes. Based on the clinical features and histopathological findings, the diagnosis of post-steroid panniculitis was thus highly suggested.
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  • A Case of Lichen Striatus
    —A Histopathological Study—
    Takashi MIZUNO, Norihisa ISHII, Hiroshi NAKAJIMA
    1997 Volume 59 Issue 6 Pages 832-834
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.832
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    A 14-year-old male with linear and discrete eruptions on the left buttocks, the back of the left lower limb, and the second interdigit of the left foot is described. Each eruption appeared to be an almost circular scaly erythema measuring from 10∼30 mm in diameter and was accompanied by slight itching. Histopathologically, parakeratosis was observed with a loss of the granular layer, elongation of the papillary process, Munro’s microabscess in the horny layer, and patchy perivascular infiltration of inflammatory cells in the superficial dermis. We thus considered a possible diagnosis of linear psoriasis, lichen striatus, and linear lichen planus. However, the existence of linear psoriasis remains controversial and case reports of “true” linear psoriasis are extremely rare. In cases of “true” linear psoriasis, eruptions are scattered widely. In our case, the eruptions improved gradually by ointment therapy and there was no recurrence. We therefore ruled out the possibility of linear psoriasis. In addition, since the patient was a child, the infiltration pattern of inflammatory cells was perivascular, and lichen striatus is known to show various histopathological patterns and sometimes resembles psoriasis, we thus decided this case to be lichen striatus rather than linear lichen planus. Based on the above findings, we believe that a differential diagnosis of lichen striatus thus needs both clinical and histopathological evidence.
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  • A Case of Transient Acantholytic Dermatosis Localized in Genital Region after Child Delivery and Menstruation
    Shimako MIZOGUCHI, Mitsuru SETOYAMA, Tamotsu KANZAKI
    1997 Volume 59 Issue 6 Pages 835-837
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.835
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    We report a case of transient acantholytic dermatosis. A 27-year-old Bangladesh woman presented with reddish papules localized in the genital region with severe itching. The eruptions fluctuated after each delivery or menstruation. No one had ever demonstrated any similar problem in her family. Skin biopsy specimens showed intraepidermal acantholytic bulla. On an electron microscopic analysis, some keratinocytes revealed perinuclear aggregation of tonofilaments, and a few dyskeratotic cells were also present. An immunofluorescence study for pemphigus was negative. Topical corticosteroid application was not very effective and thus we administered oral etretinate (20 mg/day), which proved to be very effective and, as a result, the eruptions disappeared in six weeks.
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  • Two Cases of Incontinentia Pigmenti (Bloch-Sulzberger)
    Shin-ichi ANSAI
    1997 Volume 59 Issue 6 Pages 838-840
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.838
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    I herein report two female cases of incontinentia pigmenti. Patient 1 was considered to be a familial case, since her mother had anodontia and pigmented plaques on her inguinal region. Patient 2 was thought to be sporadic. Blisters, erosions, erythemas and reticular pigmentation were observed on the trunk and extremities, in both cases. Regarding dermatological observations, no major difference was found between these two cases. The cutaneous symptoms soon disappeared after topical corticosteroid administration except for some remaining reticular pigmentation in both cases.
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  • A Case of Neutrophilic Dermatosis Accompanied by Myelodysplastic Syndrome
    Yasushi SUGITA, Takahiko YANO, Fumio IMANAKA, Hajime SHINDO, Yuzo HAYA ...
    1997 Volume 59 Issue 6 Pages 841-846
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.841
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    We present a 51-year-old woman diaguosed to have MDS (refractory anemia type) who was hospitalized because of high fever and painful erythematous plaques on her right hand. In spite of administering antibiotics, the cutaneous ulcer rapidly expanded to the right forearm and became necrotic. The bacterial culture of the cutaneous lesion showed no growth. A skin biopsy showed a dense dermal infiltration of mature neutrophils and also revealed like pyoderma gangrenosum (PG). The cutaneous lesion on her right hand somewhat improved after the administration of corticosteroids, but thereafter the ulcer gradually spreaded to the bone. Moreover, the cutaneous erythema and nodules also repeatedly appeared at the other sites. A cutaneous lesion on her right arm resembled Sweet’s syndrome, but somewhat differed from typical cases based on the clinical and histopathological findings. Her lesion had the characteristics of both Sweet’s syndrome and PG, and thus she was diagnosed to have MDS developed neutrophilic dermatosis (ND). Generally, corticosteroids have been recognized to be very effective in treating these skin lesions, but this treatment was not effective in her case. Ten months after her first visit, she died of pneumonia and sepsis. The findings of this case suggest that the cutaneous lesions of MDS patients represent a severe condition which alterately change back and forth between Sweet’s syndrome and PG. After reviewing the pertinent literature, we found 34 previously reported cases of MDS with ND.
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  • A Case of Lepromatous Leprosy which Showed a Reversal Reaction Soon after Beginning Chemotherapy
    —The Clinical Course and the Pathogenesis of Scarring Lesions—
    Masako NAMISATO, Mie KAKUTA, Yusuke FUJITA, Akiko OBARA, Hideoki OGAWA
    1997 Volume 59 Issue 6 Pages 847-854
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.847
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    A 35-year-old male presented with multiple lepromata which contained abundant acid fast bacilli with a solid shape associated with many scarring lesions on his extremities. Chemotherapy with minocycline was administered for a week and then was followed by a multi-drug regimen of WHO-MDT. One month after the 1st visit, reactional skin lesions appeared accompanied with high fever and swelling of the inguinal lymph nodes. The symptoms did not subside after the administration of thalidomide but did dramatically responding to prednisolone. The clinico-pathological findings were closely compatible with that of a reversal reaction (type 1). Six months from the beginning of MDT, the inflammatory symptoms subsided. The Mycobucterium leprae specific and mycobacteria specific serum antibody titers decreased rapidly thereafter which thus indicated the chemotherapy to be successful. The pathological findings of the scarring lesions on the extremities suggested the intradermal lepromatous granulomata to have been traneferred through the epidermis, mainly through the hair follicles due to the phenomenon of transepidermal elimination.
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Clinical and Investigative Report
  • The Prurigo Type Atopic Dermatitis
    Masayoshi NISHIMOTO, Toshihiko NUMAHARA, Kuniyuki NAKASHIMA, Tomoko YO ...
    1997 Volume 59 Issue 6 Pages 855-858
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.855
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    In a study of 324 patients with atopic dermatitis, 40 prurigo type patients were selected. The prurigo type was divided into two subtypes consisting of 26 scratch type patients and 14 nodular type patients. The ages of the nodular type patients were higher than those of the scratch type. In the nodular type cases, 4 patients were hespitalized, while 10 were treated with phototherapy and 7 by cryotherapy. In the scratch type cases, only one patient had to be hespitalized and few were treated with either photo or cryotherapy. Forty-three percent of the nodular type cases and 77% of the scratch type cases were well controlled at the end of this study. It is thus important to prevent the development of nodular lesions since it is extremely difficult to control.
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  • IFN-γ Production in Peripheral Lymphocytes from Patients with Drug Eruptions in Response to Stimulation with a Causative Drug
    —A New in vitro Test for Determining the Causative Drug in Drug Eruptions—
    Yukiko NONAKA, Tetsuya KOGA, Shoji TOSHITANI
    1997 Volume 59 Issue 6 Pages 859-863
    Published: December 01, 1997
    Released on J-STAGE: January 14, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.59.859
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    In order to determine the causative drug, 20 patients who were clinically diagnosed to have drug eruptions but had no evidence for causative drug by the patch test, were thus studied both with the drug lymphocyte stimulation test (DLST) and the drug-stimulated IFN-γ production test (IFN-γ test). The IFN-γ test was carried out by measuring the IFN-γ activity in the culture supernatant obtained after the incubation of peripheral lymphocytes either with or without the causative drug. The IFN-γ test was considered to be positive when the stimulation index was over 180%. In this study, a positive IFN-γ test was more frequently observed than a positive DLST, although no statistical difference was observed between them. These results may thus suggest that the IFN-γ test is useful as a new in vitro test for determining the causative drug in drug eruptions.
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