A sixty-seven-year old, male presented with nummular eczema-like eruptions of one year’s duration on his lower legs. Thereafter, erythroderma gradually developed. Esophageal small cell carcinoma was observed on the upper gastrointestinal tract examinations. A tumor resection was not indicated because of the presence of liver multifocused metastasis, however, chemotherapy and radiation therapy were performed. A considerable improvement of the eruptions was noted after the treatment, but the patient died of ileus with the disseminated intravascular coagulation two and a half years after the initial presentation.

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Pityriasis lichenoides et varioliformis acuta occurring in a 9-year-old girl and an 8-year-old girl is reported. Case 1 was treated with systemic antibiotics and topical corticosteroids for 11 weeks, and Case 2 was treated with UVB radiation and topical corticosteroids for 7 weeks. Neither case showed any signs of improvement. They both had a history of repeated tonsillitis. Four weeks after performing the tonsillectomy, the lesions disappeared leaving either pigmentation or depigmentation. To date, in Case 1, 20 months after the tonsillectomy, a few new lesions have occurred, while in Case 2, 6 months after the tonsillectomy, there has been no recurrence of lesions.

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We report two cases of cholesterol crystal embolization. In both cases they noticed painful purpura on their soles and toes after undergoing coronary angiography. Histopathologically, needleshaped cholesterol clefts were found within the lumina of the small vessels which were located in the deep dermis and the subcutaneous fat. In one case, the same histological findings were observed in the kidney. Cholesterol crystal embolization is a disease with atherosclerosis. Atheromatous materials are detached by invasive procedures, such as during vascular surgery and arterial catheterization, or after the administration of anticoagulant drugs. These materials cause microemboli at the peripheral small vessels. The common skin lesions are painful purpura, ulcerations on the soles and toes, and livedo reticularis on the legs. A skin biopsy is effective for making an accurate diagnosis of cholesterol crystal embolization.

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A 35-year-old woman presented with malcirculation and Raynaud’s sign on her fingers at her first visit to our clinic in Okinawa in March 1998. The laboratory findings were positive for anti-RNP antibody, leukocytopenia, and thrombocytopenia. The tentative diagnosis of mixed connective tissue disease (MCTD) was made. Further examinations revealed pulmonary hypertension (PH), but no other background diseases were found which might cause PH. As a result, the final diagnosis was MCTD associated with PH. Previously, low dose oral corticosteroid administration was believed to be effective for the treatment of MCTD, but currently, MCTD patients are given a variety dose of corticosteroids to also help maintain their overall condition. Especially, MCTD patients with PH need a much higher dose of corticosteroids (over 60mg/day) than those without PH, and the prognosis of the former is also usually worse than the latter. The average survival period of MCTD patients with PH is 4.2 years after diagnosis. When dermatologists examine MCTD patients, it is therefore important to pay attention to further complications which may lead to a worse prognosis.

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A 46-year-old man noted erythema multiforme-like erythematous plaques on his trunk and extremities 13 days before the initial presentation. A tentative diagnosis of erythema exsudativum multiforme bullosum was made by a primary dermatologist, because they were associated with iris lesions. Prednisolone (PSL: 60-110 mg/day) was administered for 13 days, however, erythema and bullae spread over the entire body as was also associated by a continuous fever. The patient was then moved to our hospital. A physical examination revealed generalized erythema and multiple tense bullae. The eosinophil count was 14,500/μl. We diagnosed bullous pemphigoid (BP) based on the histological, immunohistological (direct immunofluorescence) and immunoblot analysis findings. Because PSL (1mg/kg/day) alone was not sufficiently effective in this case, we used azathioprine or cyclosporin A together with PSL and later tapered the dosage of PSL. This case is thus considered to meet the criteria of erythrodermic BP, which is an unusual variant of BP.

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We report a case of drug eruption (erythema multiforme type) due to etizolam which occurred in a 48-year-old Japanese female. After taking etizolam orally for 49 days, she noticed reddish non-itchy eruptions on her lower legs and forearms. The purple-reddish concentric circles or circinate eruptions were bean to swallow-egg sized. A skin biopsy demonstrated perivascular lymphocyte infiltration and exocytosis. We advised her to stop taking the etizolam and administered anti-allergic drugs. Soon after the eruptions began to decrease in size and number. A challange test with etizolam was positive.

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We describe a case of D-penicillamine-induced elastosis perforans serpiginosa (EPS) in a 37-year-old woman with systemic sclerosis. The lesions, which consisted of papules distributed in characteristic arcuate patterns, were located on her neck. Histopathologically, the phenomenon of transepidermal elimination by degenerative elastic fibers was observed. These findings led us to make a diagnosis of EPS. Although there have been reported cases of EPS in Japan, many of them were accompanied with pseudoxanthoma elasticum. This case is unusual because it is a case of systemic sclerosis that induced EPS with D-Penicillamine administration.

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A 59-year-old male showed diffuse whole body skin pigmentation and body weight loss (10 kg/6 months). His serum ACTH level was elevated (103.6 pg/ml) (normal 7.5∼51.9 pg/ml). In addition, his urinary free cortisol level, serum androstendion, serum DHEA-S and urinary17-KS were all slightly below normal, i. e., 21.2 μg/day (normal 30∼100 μg/day), 0.5 ng/ml (normal 1.0∼2.5 ng/ml), 286 ng/ml (normal 620∼2820 ng/ml) and 1.9 mg/day (normal 4.6∼18.0 mg/DAY), respectively. The patient was thus diagnosed to suffer from partial Addison’s disease.

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A man who developed prurigo associated with hepatitis C virus-induced mixed cryoglobulinemia is reported. Cryoglobulinemia has been reported to develop various cutaneous features. Our patient suffered from livedo racemosa and uncurable prurigo. Laboratory evaluations revealed a positive rheumatoid factor, a low CH50, a mixed cryoglobulinemia, and positive hepatitis C antibodies. The cryoglobulinemia was type II, which was composed of one monoclonal (IgMκ) and polyclonal immunoglobulin (IgG). Direct immunofluorcscence of a prurigo indicated IgG and IgM deposition in the upper dermis. These results suggest that cryoglobulinemia associated with hepatitis C virus infection may play a role in the development of prurigo in this case.

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A rare case of cutaneous metastasis from colon signet ring cell carcinoma is reported. A 58-year-old man presented with a tumor on his left upper arm. Histopathologically, the tumor was found to be mucinous carcinoma with an abundant amount of signet ring cells. A careful examinations revealed cancer of the descending colon, which had almost the same histopathological findings as those for a cutaneous tumor. Finally, the cutaneous tumor was diaguosed to be metastasis from the signet ring cell carcinoma of the colon.

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We report a case of malignant melanoma which showed a spontaneous and complete regression of the primary urigin within a very short period. A 64-year-old woman noticed a subcutaneous tumour in her right inguinal region a month earlier. Although a histological examination of the tumour showed lymph node metastasis of malignant melanoma, an extensive examination of the whole body did not reveal a primary lesion or any other metastasis except for a fingernail sized pigmented freckle on the abdominal site of the right big toe. This pigmented freckle showed an interesting course since it had been unnoticed by the patient until we pointed it out, and it disappeared 2 months later. A histological study of this pigmented freckle revealed the typical findings of a spontaneous regression of the primary lesion of malignant melanoma. A a result, the diagnosis was malignant melanoma, pT0N1M0, stage III. The previous studies have reported malignant melanoma with an unknown primary origin has a relatively good prognosis, but that with a spontaneous and complete regression of primary origin has a poor prognosis.

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We report a fibrous papule, which developed on the nose of a 35-year-old Japanese female. A histopathological analysis of the lesion revealed the lesion to be compsed of a prominent vascular component and both a superficial and deep dermal component of CD34-reactive stellate or spindle-shaped cells.

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We report an 81-year-old woman of trichilemmal carcinoma with lung metastasis. She noticed a dome-shaped hard tumor on her left axilla measuring 8∼10 cm in diameter. A tumor in her left hand had been resected two years previously. On admission, a chest X-ray showed a coin lesion measuring 2 cm in diameter in her left lung. All these tumors were treated surgically. The histopathology of the original tumor in her left hand showed the tumor mass to be lobular and infiltrating into the deeper dermis. The periphery of the tumor lobules presented with basaloid cells, and these cells became more cuboid in shape and clearer in color toward the center of lobules. Similar histopathological characteristics were observed in tumors of the left axilla and the lung. Based on these findings, trichilemmal carcinoma appears to metastasize easily to regional lymph nodes and lung.

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An 83-year-old Japanese female, who had undergone a colon cancer operation twenty months previously, visited our clinic with a nodule on the left side of her parietal scalp. Just before her visit, colon cancer metastasis was found in her lung. The histology of the nodule after a total excision showed the nodule to be composed of colon cancer tissue. This case was interesting because the colon cancer had metastasized via the lung.

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A 35-year-old woman developed a well defined, pigeon egg-sized, asymptomatic, subcutaneous soft tumor on her left vulva. The tumor showed hypointensity on the T1-weighted MR images and hyperintensity on the T2-weighted images. Eight to ten minutes after Gd-DTPA injection, the tumor slowly showed a slight enhancement. Histopathologically, the tumor existed in the dermis and subcutis, had a thin capsule, and contained a mucinous component showing a mixed appearance of hyper-and hypocellular areas. The tumor cells were either spindle, oval, or stellate shaped. They were immunohistochemically positive for vimentin and desmin, but negative for α-smooth muscle actin. 22 months after resection, no recurrence has been observed.

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Two patients with acquired digital fibrokeratoma are reported. Case 1: A 69-year-old man presented with a 5-year history of a small papule on his right thumb. Case 2: A 52-year-old woman with a 2-year history of a small papule under the nail of her right ring finger visited our dermatological division to undergo an examination and have the papule removed. The papule had caused dystrophic changes in the nail. The histopathological examination of both cases showed hyperkeratosis, acanthosis and an elongation of rete ridges in the epidermis and an increase in the collagen bundles and dilated capillaries in the dermis.

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We report a case of subcutaneous lipoma of the right index digit in a 21-year-old woman. Histopathologically, the mass was circumscribed and mainly showed a proliferation of mature adipocytes with intervening fibrous tissue. Degenerated adipocytes were also observed which were associated with occasional foamy histiocytes and multinucleated giant cells. Lipoma of the digit is very rare but should be considered in the differential diagnosis for a nodule in the finger.

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We report a 72-year-old man with pericostal tuberculosis who had a past history of pleuritis tuberculosa at 20 years of age. When he was referred to our hospital, a hen’s egg sized subcutaneous nodule had developed on his right chest, and a chest CT revealed a pericostal abscess in his right anterior chest wall. He was diagnosed to have pericostal tuberculosis (TAKEUCHI’s TYPE II) after the confirmation of acid-fast bacilli in the needle aspiration material of the abscess, and chemotherapy with INH, RFP, and EB was thus started. About 6 months after the administration of chemotherapy, the abscess had shrunken remarkably and no recurrence has been observed to date. Scrofuloderma on the thorax, tuberculous and/or a cold abscess in the chest wall, are quite similar to pericostal tuberculosis. These diseases may thus be considered to be identical.

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A 47-year-old man, who kept tropical fish in his home, visited our hospital on January 1998, because of multiple subcutaneous nodular lesions with tenderness that had developed on his left hand and forearm following an injury to his left little fingertip. A skin biopsy from a nodule of his left forearm revealed a granulomatous inflammation consisting mainly of epithelioid cells and lymphocytes with abscess formation in the mid dermis and the subcutaneous tissue. Although a direct acid-fast smear showed no pathogens, an acid-fast photochromogen was isolated from Kudo medium incubated at 28 °C for two weeks. The isolate was identified as Mycobacterium marinum according to both DNA-DNA hybridization and various bacteriological identification tests for atypical mycobacteriosis. After treatment with oral minocycline (200mg/day) for 9 weeks followed by sparfloxacin (200mg/day) for 5 weeks, the nodular lesions cured with atrophic scars.

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We report an infant who presented with sporotrichosis. A 6-month-old Japanese girl consulted our department due to nodules which had developed on her right cheek. These nodules first developed when she was 3-month-old. Sporothrix schenckii was isolated from a biopsy specimen from her cheek and we therefore diagnosed her to have sporotrichosis and she was successfully treated with topical heat therapy. Ordinally the incidense of infant sporotrichosis is very low, because infants do not often come in contact with soil or plant materials outdoors. The earliest reported case of sporotorichosis was in a 3-month-old infant, however, the symptoms also developed in our case at 3 months of age.

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