The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 60, Issue 4
Displaying 1-31 of 31 articles from this issue
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Color Atlas
Clinical Case Reports
  • A Case of Cold Urticaria
    Yumie HOSHIYAMA, Hiroshi UEZATO, Kayo SHINJYOU, Takeo AOKI, Shigeo NON ...
    1998 Volume 60 Issue 4 Pages 433-437
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.433
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    A 47-year-old woman developed cold urticaria. As a cold challenge test, we put an ice cube on the flexor-area of the patient’s forearm skin for 3 minutes. After 8 minutes, a wheal appeared on the side of the test area. A wheal was also induced by a cold stimulation test under 10°C. We observed changes in the skin temperature caused by the cold stimulation test using thermography. As a result, the patient skin temperature increased faster than the normal control. In Okinawa which is in the subtropical zone, cold urticaria cases are rare. From 1988 to 1997, at the dermatological clinic of Ryukyu University Hospital, only 10 of total 361 urticaria patients demonstrated cold urticaria. We believe that recent changes in the types of food consumed, such as the common use of frozen foods, may be the cause of cold urticaria in the subtropical zones.
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  • A Case of Erythroderma Associated with Early Gastric Cancer
    Mineko SHIMOHIRA, Yumiko GOTOH, Yutaka NARISAWA, Ichiro MAKINO, Tetsuy ...
    1998 Volume 60 Issue 4 Pages 438-441
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.438
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    We herein report the case of an 81-year-old male presenting with erythroderma associated with early gastric cancer. He developed pruritic erythrodermic lesions several months before presentation. Various examination confirmed early gastric cancer. After undergoing surgical treatment for the early gastric cancer, the erythroderma over the whole body completely disappeared. We discuss the relationship between erythroderma and solid cancer based on a review of the literature (46 cases).
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  • Three Cases of Skin Necrosis Caused by the Intravenous Administration of FOY®
    Yoshiyuki KATAGIRI, Shin-ichi ANSAI
    1998 Volume 60 Issue 4 Pages 442-444
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.442
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    Three cases of skin ulcers caused by the intravenous administration of gabexate mesilate (FOY®) are reported. All three cases showed skin ulcers after the peripheral venous administration of FOY® fluid which were caused not only by the extravasation of fluid, but also by the direct injury to the veins due to too high a concentration of FOY®. Many cases of iatrogenic skin ulcers caused by the extravasation of anti-cancer drugs have been recently reported. As a result care should be taken not to cause an extravasation or to use too high a concentration of FOY®. Based on these findings, when we encounter cases of skin ulcers on the extremities of an unknown origin a possibility like with FOY® administration should thus be considered.
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  • Effective Management by Immunoadsorption Plasmapheresis for Three Patients with Systemic Lupus Erythematosus
    Yoko SHIN, Yoshihiro MAEKAWA, Eiko MURAKAMI, Reiko NOGAMI, Atsushi NAK ...
    1998 Volume 60 Issue 4 Pages 445-449
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.445
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    Three women with systemic lupus erythematosus (SLE) who were successfully treated with immunoadsorption plasmapheresis (IAP) using polyvinyl alcohol phenylalanine column ligand are reported. The diaguosis of SLE was based on the criteria of ARA, and all cases had been treated with corticosteroids including pulse therapy and immunesuppressant drugs (methotrexate, cyclophosphamide). Since these 3 cases continued to show general fatigue, fever, alopecia, arthralgia associated with livedo reticularis, and ulcers of hands despite the therapies, they were thus referred to our clinic. All patients showed a good response after two or four administrations of IAP and their clinical symptoms and laboratory findings, such as anti-DNA antibody and immune-complex were improved. However, some side effects were observed to be associated with IAP.
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  • A Case of Bullous Pemphigoid Associated with Iatrogenic Interstitial Pneumonia
    Yoshinori UMEZAWA, Shinichi OYAKE, Tsunao OH-I, Michiyuki KOGA, Takash ...
    1998 Volume 60 Issue 4 Pages 450-453
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.450
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    A 72-year-old man was treated with steroids for bullous pemphigoid (BP), and sepsis with MRSA occurred. The blood culture became negative after the administration of antibiotics. Thereafter, the course of BP was smooth, but an irregular high fever and high CRP values continued. When steroid administration was discontinued, difficulty in breathing and coughing suddenly appeared. Interstitial pneumonia (IP) was diagnosed because of pervasive shadows in both lungs on the chest X-ray findings associated with low oxygen blood syndrome. The steroid pulse treatment was effective against IP. In this case, IP was considered to have developed due to the large amounts of antibiotics for MRSA that had been administered over a long term. This case, comparatively rare case of iatrogenic IP combined with BP, is discussed in detail.
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  • A Case of Epidermodysplasia Verruciformis
    Yoshiyuki MURAKAMI, Shonosuke NAGAE, Shinichi IMAFUKU, Masutaka FURUE, ...
    1998 Volume 60 Issue 4 Pages 454-458
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.454
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    A 40-year-old Japanese man visited our hospital complaining of small black nodules on the bilateral lower eyelids. He also had flat wart-like lesions and pityriasis versicolor-like plaques on his extremities and trunk. Based on the clinical and histopathological findings, he was diagnosed to have epidermodysplasia verruciformis. The black nodules of the lower evelids were treated with cryosurgery under a diagnosis of seborrheic keratosis. No skin lesions suspected to demonstrate either premalignancy and/or malignancy were obsereved. In addition, no immunological abnormalities were detected.
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  • A Case of Diabetic Scleredema
    Shoko MAEDA, Akito TOSHITANI
    1998 Volume 60 Issue 4 Pages 459-461
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.459
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    A case of typical diabetic scleredema appearing in a 60-year-old male is reported. He suffered from poorly controlled non-insulin dependent diabetes mellitus for the past 18 years which was associated with retinopathy and neuropathy. A well-circumscribed sclerotic skin lesion appeared on his posterior neck to upper back regions and rapidly enlarged over a 2 month period. In CT imaging, we found a marked thickening of the dermis and subcutaneous tissue. A histopathological examination of biopsied specimens revealed a profound accumulation of thick and swollen collagen bundles in the middle to lower dermis and also in the septum of the subcutaneous tissue. In addition, colloidal iron-stained sections disclosed deposits of acid mucopolysaccharides in the dermis and septum of the subcutaneous fat tissue.
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  • A Case of Porphyria Cutanea Tarda Treated by a Diet of Carrots and Green Vegetables
    Hideharu ISHIHARA, Toshio HAYASHIBARA
    1998 Volume 60 Issue 4 Pages 462-463
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.462
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    A 74-year-old man with porphyria cutanea tarda had previously been unsuccessfully treated with shading and topical corticoids. After being told to eat a lot of carrots and green vegetables, his cutaneous symptoms improved. As a result, β-carotene and other carotenoids contained in vegetables were thus considered to be effective in treating our case.
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  • A Case of Cartilaginous Rest (Accessory Tragi) of the Neck
    Tomohiro BANNO, Hisae SATOMI, Takeshi TATEISHI, Hiroshi FUJISAWA, Fuji ...
    1998 Volume 60 Issue 4 Pages 464-466
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.464
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    We herein report a 14-year-old Japanese male who presented with cartilaginous rest of the neck. The lesion was observed at birth and was located in the anterior portion of the left sternocleidomastoid muscle, just above the sternoclavicular joint. After being surgically removed, the lesion was found to have a firm consistency resembling cartilage and it also extended deeply into the adipose tissue. Histologically, numerous follicles with large sebaceous glands were observed. A single central core of cartilage containing capillary vessels existed in the connective tissue. The cartilage was rich in elastic fibers and was identified as elastic cartilage based on the findings of Elastica van Gieson staining. Pacinian corpuscles and nerve fibers were also observed around the cartilage. These histological findings mimic those of normal auricular cartilage which was thus suggested to be the origin of cartilaginous rest.
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  • A Case of Dermatofibrosarcoma Protuberans with Giant Dome-Shaped Appearance
    Shinichi ANSAI, Kuhihiko MAEDA, Mikio MATSUDA
    1998 Volume 60 Issue 4 Pages 467-470
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.467
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    A case of dermatofibrosarcoma protuberans (DFSP) occurring in a 64-year-old male is reported. He presented with the chief complaint of a rapidly growing tumor on his right anterior chest wall of two years duration. A 9×8×4cm, dome-shaped, skin-colored and smooth surface tumor with telangiectasia was observed on his right chest wall. Histopathologically, spindle-shaped tumor cells proliferated in a storiform pattern in most parts while myxoid changes of the stroma were also observed. Immunohistochemically, the tumor cells were CD34-positive and factor XIII-negative. These findings suggested this tumor to be DFSP. Cases of DFSP with such a unique clinical appearance are considered to be extremely rare.
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  • A Case of Primary Cutaneous B-cell Lymphoma
    Yoshiyuki MURAKAMI, Kazunori URABE, Masutaka FURUE, Koji IRIE
    1998 Volume 60 Issue 4 Pages 471-475
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.471
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    We herein report the case of a 75-year-old Japanese woman who presented with multiple cutaneous nodules on her trunk and left upper limb and thus was diagnosed to have primary cutaneous B-cell lymphoma (pCBCL). We could not detect any extra-cutaneous lesions in the patient. Histologically, the nodule showed nonepidermotropic diffuse dermal infiltrates, which mainly consisted of large abnormal lymphoid cells. Immunohistochemically, these neoplastic cells expressed CD19, CD20, κ type sIg. An immunoglobulin gene rearrangement of the neoplastic cells of the cutaneous nodule was shown by a Southern blot analysis. Based on these clinical and laboratory findings, she was diagnosed to have diffuse large cell type pCBCL. She was treated by THP-COP chemotherapy and 30 Gy of local radiotherapy with an electron beam. No relapse was noticed at 14 months after the initial treatment.
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  • Multiple Bowen’s Disease due to Occupational Arsenical Exposure
    Junichi KOBAYASHI, Shinichiro YASUMOTO, Hiromaro KIRYU, Masutaka FURUE
    1998 Volume 60 Issue 4 Pages 476-478
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.476
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    A 73-year-old Japanese man presented with multiple Bowen’s disease on his left upper arm, right chest, and abdomen. In addition, five arsenic keratoses were observed on the extremities. Diffuse bronze-like pigmentation with scattered hypopigmented macules was also noticed on his trunk and the extremities. According to his occupational history, we speculated that these lesions may have been provoked by occupational arsenical exposure 47 years earlier.
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  • A Case of Malignant Melanoma with a Satellite Lesion Showing a Tendency to Dissappear Spontaneously
    Katsushi YAMAMOTO, Kenshi YAMASAKI, Kazuo TAGAWA, Atsushi HATAMOCHI, H ...
    1998 Volume 60 Issue 4 Pages 479-482
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.479
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    A 70-year-old female first noticed a pigmentation and a black subcutaneous tumor on her right little finger. During the two year period before presentation at the hospital, the color of this subcutaneous tumor became vivid and there after tended to disappear spontaneously. We diagnosed this case to be acral lentiginous melanoma stage 3. She underwent a wide resection of the tumor and a dissection of her right axillary lymph nodes. The subcutaneous tumor in a satellite lesion was considered to be unique since it demonstrated a apparent spontaneous regression.
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  • A Case of Angioimmunoblastic T-cell Lymphoma (AILD) with Skin Eruptions as the First Sign of Disease
    Mamiko KAWAUCHI, Akihiko SHIMIZU, Tetsuya KOGA, Syoji TOSHITANI
    1998 Volume 60 Issue 4 Pages 483-486
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.483
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    We report a case of angioimmunoblastic T-cell lymphoma in a 59-year-old Japanese male. His erythematous skin eruptions preceded such other clinical symptoms as generalized lymphadenopathy, splenomegaly, and fever. A skin biopsy revealed perivascular polymorphous infiltrates containing atypical lymphocytes. A histological analysis of the lymph nodes confirmed the diagnosis. A T-cell receptor gene rearrangement analysis revealed a monoclonal pattern in the lymph nodes, but not in a skin specimen. The patient was treated with chemotherapy (adriamycin, cyclophosphamide, etoposide and prednisolone). He continues to show a good course at 1 year after the diagnosis.
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  • A Case of Drug Eruption due to Eviprostat
    Hanako KODERA, Yumiko GOTOU, Noriyuki MISAGO, Yutaka NARISAWA
    1998 Volume 60 Issue 4 Pages 487-490
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.487
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    We herein report a 69-year-old man who developed a drug eruption due to Eviprostat treatment. He showed symmetrical eczematous skin lesions. A skin biopsy specimen revealed an eczematous tissue reaction. The diagnosis was confirmed by the oral readministratian of Eviprostat, which clearly resulted in a reccurence of erythemas and itching. So far only a small number of cases demonstrating a drug eruption due to Eviprostat have been reported.
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  • A Case of Cutaneous Injury Induced by the Intraarterial Infusion of Doxorubicin Hydrochloride.
    Noriyuki HIRASHIMA, Mitsuharu KAYABA, Takuya INOUE, Yutaka NARISAWA, Y ...
    1998 Volume 60 Issue 4 Pages 491-493
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.491
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    An 63-year-old Japanese woman with breast cancer was intraarterially injected with doxorubicin hydrochloride (ADM) 3 times. After each treatment the patient developed extensive erythema all over her chest wall which was also associated with chest pain. A skin biopsy demonstrated characteristic vacuolar alterations of basal keratinocytes. We thus considered the couse of these symptoms to be due to toxic cutaneous injury following intraarterial ADM treatment.
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  • Lichenoid Drug Eruption
    Chihiro SHIMIZU, Hiroyoshi HANAKAWA, Norio OHTSUKI
    1998 Volume 60 Issue 4 Pages 494-497
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.494
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    Antihistamines and antiallergic agents are now widely prescribed in Japan. We herein report a case of lichenoid drug eruption induced by these agents. A 64-year-old man presented with pruritic erythematous, violaceous flat topped plaques on his trunk and extremities. He also demonstrated liver damage. He had a 1 month history of taking epinastine hydrochloride and homochlorcyclizine hydrochloride before developing these eruption. A month after the discontinuation of these two drugs, the pruritus diminished and the lesions subsided. Patch tests revealed positive reactions to both drugs. The former drug was positive for the drug lymphocyte stimulation test (DLST). The challenge tests also showed a positive reaction for both of them. We consider both of these drugs to thus be the cause of the observed drug eruption, and drug-induced liver damage.
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  • Systemic Contact Dermatitis due to Mercury
    Makoto ICHIMIYA, Toru HIROTA, Koichiro YAMAMOTO, Masahiko MUTO
    1998 Volume 60 Issue 4 Pages 498-500
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.498
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    A 19-year-old Japanese woman who developed systemic contact dermatitis after accidentally breaking a clinical thermometer is reported. She did not come in contact with the drops of mercury. Diffuse erythemas were noted on her thighs and trunk. She showed positive patch test for 0.05% mercuric chloride but a negative reaction for 0.1% thimerosal. The patch test with 0.05% mercuric chloride did not demonstrate a flare-up reaction. We therefore consider that the mercury exanthem seen in the present case might thus have been caused by the inhalation of mercury vapour.
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  • Endoscope-Assisted Surgery in Dermatology
    Yoshiyasu ITOH, Yasuhiro WATANABE, Takaaki OHKURA, Minoru CHISHIKI, Hi ...
    1998 Volume 60 Issue 4 Pages 501-505
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.501
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    We successfully performed endoscope-assisted surgery on 16 patients who are suffered eight subcutaneous lipomas, three epidermal cysts on the cheek, one osteoma, one enlarged lymph node and one gynecomastia, and who all underwent an insertion of a tissue expander and one subcutaneous dissection of a progressive hemifacial atrophy. The endoscope utilized was a 30-degree, 4mm diameter instrument which can be mounted on a retractor to maintain a cavity. From one or more orifices which were prepared on either the target region or a distantly concealed region, a subcutaneous dissection was carried out under endoscopic visualization. In all patients, no noticeable complications were observed. This method is thus thought to offer potential benefits for shorter incisions and also an ability to prevent scarring in conspicuous regions.
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Clinical and Investigative Report
  • The Involvement of HLA in Leprosy in Southern China
    Li-Man WANG, Jian-Zhong WANG, Su-Yu SU, Zhuo-Hao WANG, Pei-Hua LI, Man ...
    1998 Volume 60 Issue 4 Pages 506-509
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.506
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    On the basis of the World Health Organization-recommended multidrug therapy classification (WHO-MDT). we have carried out this study to investigate the involvement of human leukocyte antigens (HLA) in leprosy. The subjects consisted of 72 Southern Chinese leprosy patiens, including 51 with multibacillary leprosy (MBL), 21 with paucibacillary leprosy (PBL), while 267 healthy subjects also participated in this study as the control. HLA-A, -B and -Cw were serologically typed using the standard microcytotoxicity test, while HLA-DR2 was typed at the DNA level using the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) method. The frequencies of HLA-B54 and -B57 antigens significantly increased in the leprosy patients (17.6%, 31.9%, respectively) as compared with the control group (4.9%, 21.1%, respectively). In contrast, the frequencies of HLA-B46 antigen significantly decreased in the leprosy patients (4.1%), compared with the control group (25.8%). The frequency of HLA-DR2 antigen in the patients showed a higher tendency than that in the controls, but no significant difference was seen between them. In addition, the frequencies of HLA-DRB1*1501, *1502 and *1602 alleles were not significantly different between the patients and controls. As far as we know, there have so far been very few reports on the association of HLA class I with leprosy patients in the Southern Chinese population. This study shows that the leprosy in this district is associated with HLA-B54 and HLA-B46 antigens. These results thus suggest that HLA-B54, and not -DR2, may therefore be involved in the pathogenesis of leprosy in Southern China.
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  • Polymorphous Light Eruption
    —Histopathologic and Immunohistochemical Findings in Primary and Reproduced Lesions—
    Yasuhiro WATANABE, Minoru AKIYAMA, Kohkichi MORIMOTO, Mizuho KIMURA, M ...
    1998 Volume 60 Issue 4 Pages 510-513
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.510
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    The histopathologic and immunohistochemical findings were investigated in primary and reproduced lesions from 4 patients with polymorphous light eruption (PLE). The diagnosis of PLE was made based on the clinical features and the findings of provocative phototests. Two minimal erythema doses of UVB were irradiated daily for 3 consecutive days to reproduce PLE. In the primary and reproduced lesions, dermal perivascular lymphocytic infiltrates and hydropic degeneration of basal cells were most frequently observed. Dermal lymphocytes were almost only T cells, in which the CD4 subset was predominant over the CD8 subset in both lesions. ICAM-1 was positive in the endothelial cells of half the cases, and was also positively seen in the keratinocytes. These histopathological and immunohistochemical results suggests that the pathogenesis of PLE is thus due to a delayed type of hypersensitivity.
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Review
Statistics
  • Clinical Study of Confirmed Drug Eruptions over the Past Five and a Half Years
    Kazue NISHIOKA, Tokuji SEGUCHI, Masako MURATA, Takehito ISHIKAWA
    1998 Volume 60 Issue 4 Pages 520-523
    Published: August 01, 1998
    Released on J-STAGE: October 15, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.60.520
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    We examined 121 patients suspected of having drug eruptions from July 1991 through December 1996. The causative drugs were confirmed in 65 patients out of the 121 with at least one of provocation test, skin test and drug-induced lymphocyte stimulation test. Because two patients showed positive reactions to more than one drug, a total 68 cases were thus detected. The clinical characteristics of the eruptions were exanthematic type in 35 cases, urticarial type in 8, both erythroderma and fixed drug eruption type in 7, photosensitive type in 4 and other types in 5. The causative drugs were carbamazepine in 6 cases and 5 cases each for amoxicillin and allylisopropyl acetyl urea. Provocation tests were performed on 42 out of 68 cases and a positive reaction appeared in 34 out of 63 cases undergoing with skin tests.
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