We report two female cases of adrenergic urticaria. Both cases showed either urticarial papules or erythema puncutata, which were surrounded by a white halo of blanched vasoconstricted skin, which disappear within few hours. Such lesions can be elicited by the intradermal injection of noradrenalin. The beta-adrenergic receptor blocker, propranolol, has proven to be successful treatment for adrenergic urticaria. Finally, it is important to distinguish adrenergic urticaria from Higuchi’s erythema punctata.

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An 81-year old man with carcinoma of the descending colon repeatedly developed spreading annular erythematous eruptions on his lower extremities over a two-year period. After undergoing a resection of carcinoma of the descending colon, the eruptions rapidly disappeared and never reappeared. Spreading annular erythemas are usually called erythema annulare centrifugum. We considered such persistent and spreading annular erythemas to be similar to erythema annulare centrifugum of Darier, and they might therefore be closely associated with malignant disease. We discuss the relationship between malignant disease and atypical annular erythema differs in some aspects from Darier’s erythema annulare centrifugum. We also reviewed the previously reported cases and made a review of the literature regarding erythema annulare centrifugum associated with malignant disease.

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A 75-year-old man had suffered from psoriasis vulgaris for several years. His eruptions responded well to topical treatment. In the last few months, he had no-psoriatic lesions over his entire body. Three weeks before presentation he developed erythemas with blister lesions and was diagnosed to have bullous pemphigoid. He was treated with the oral administration of corticosteroids and minocycline. As the dose of corticosteroids was reduced, he developed a high fever and a decreased arterial oxygen pressure. Minocycline-induced pulmonary disease was thus suspected. The use of minocycline was thus stopped and steroid pulse therapy was started. After the use of minocycline was halted, his condition improved. This is a case of interstitial pneumonia associated with bullous pemphigoid caused by the administration of minocycline, which presented as an apparently curable state of psoriasis vulgaris.

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We report two cases of neutropenia which developed after minocycline (MINO) and famotidine (H₂-blocker) therapy for bullous pemphigoid (BP). Both a 38-year-old female (case 1) and a 59-year-old female (case 2) were diagnosed to have BP based on the findings of direct and indirect immunofluorescence studies and immunoblotting methods. As it was difficult to control both patients with systemic prednisolone alone, and thus we added MINO and niacinamide. Bulla formation decreased significantly and both patients also showed a marked improvement. They were treated with famotidine from the start of therapy for BP. In case 1, neutropenia appeared 21 days after MINO and 46 days after famotidine was started, and the patient recovered 3 days after the administration of MINO and famotidine was stopped. In case 2, neutropenia appeared 45 days after MINO and 49 days after famotidine was started, and she recovered 7 days after MINO and 3 days after famotidine was stopped. H₂-blocker appears to enhance the sensitization to these drugs, which are given together. These findings support the assumption that MINO and famotidine are causative drugs of neutropenia. We therefore should look out for to this side effect, even though it is very rare.

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A four month-old baby developed erythema on her lower limbs 3 days after receiving a BCG vaccination. Physical examination revealed infiltrated erythema and small vesicles on the trunk and limbs at the first visit. The lesions later developed into large and tense bullae. Direct immunofluorescence revealed a linear deposition of IgG and C3 at the basement membrane zone. The indirect immunofluorescence of normal human skin section showed IgG anti-basement membrane zone circulating antibodies at a titer of 1: 320, which were found to react with an epidermal side of 1M NaCl split skin. We made a diagnosis of juvenile bullous pemphigoid. The lesions disappeared after the administration of topical steroids.

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A 58-year-old woman, who was being treated for hyperlipemia, was found to have an erythema on her left abdomen in February 1997. She did not feel any pain or any itching at presentation. The eruption continued to gradually increase in size, and appeared on the opposite side and at other places in the form of erythema annulare. Shc visited our division in August 1997. No fungus was observed. Although steroid ointment was applied, this erythema did not improve. A microscopic examination showed us necrobiosis of collagen fiber in the dermis and palisading histiocytes. Histiologically, it was diagnosed to be granuloma annulare. Granuloma annulare in the form of erythema annulare is rare. Generalized granuloma annulare occurs with various diseases. In our case it was determined to be hyperlipemia and potential diabetes mellitus. We are presently treating the granuloma annulare and observing the patient for any complications.

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We report a case of porokeratosis in a 10-year-old Japanese boy with acute myelo-monocytic leukemia (AMMoL) The patient was diagnosed to have AMMoL at 1 year of age and was treated by radiation and chemotherapy. Anti cancer drugs were continuously administered until our examination. A skin lesion was observed on his right buttock measuring 20×30mm in size, which showed scaly plaque with an atrophic center and an irregularly shaped hyperkeratotic edge. Biopsy specimens showed typical cornoid lamella and atypical epidermal cells, thus suggesting the presence of porokeratosis with malignant change.

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Two cases of generalized eruptions associated with recurrent circinate erythematous psoriasis (RCEP) are reported. Case 1. A 48-year-old woman had been treated with ointment for a ring-form eruption at another clinic. The histologic findings showed psoriatic change and she was diagnosed to have RCEP. Case 2. A 78-year-old woman had been treated for seborrheic eczema on her face. The seborrheic eruptions contained annular erythema with scales and pustules, and eventually spread to her trunk and extremities. Both cases were successfully treated using oral etretinate and PUVA therapy.

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We herein report a 13-year-old woman with nevoid basal cell carcinoma syndrome, who demonstrated all the major criteria for this disease, including a basal cell carcinoma on her back, polyostotic bone cysts, palmo-plantar pits, an ectopic calcification, however, there was no family history. In a chromosome examination, no abnormality was identified.

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Extramammary Paget’s disease usually occurs in the genital region, but sometimes occurs simultaneously in the axillary or some other areas. Some authors have classified such cases as double, triple or multiple Paget’s disease. Some of these cases have subclinical Paget’s condition in which Paget’s cells were recognized histologically in the clinically normal skin. We treated a 66-year-old man with multiple extramammary Paget’s disease involving the genital and bilateral axillary regions. Although all three lesions showed the histological features of extramammary Paget’s disease, no apparent eruption was seen in the left axillary region. No abnormal laboratory data was observed and there was no evidence of metastasis to any other organs. We excised the lesions in all three regions and half-thickness skin grafting was also performed. Multiple extramammary Paget’s disease appears to be less progressive than solitary extramammary Paget’s disease according to our review of the literature but some cases do have metastasis to the regional lymph nodes. We believe that a radical excision is the best therapy when possible.

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A rare case of multiple pilomatricomas with a probable family history is presented. One of the tumors showed a giant pedunculated mass. A 32-year-old man noticed a small nodule on his right upper arm about 5 years previously. The nodule gradually enlarged and began to protrude. On his first visit to our hospital, a large pedunculated mass measured 7×5×2 cm was recognized on his right upper arm. Histologically, the tumor showed the features of pilomatricoma including basophilic cells and shadow cells associated with severe inflammation. He also had two other nodules on his chest and occipital scalp. A histological examination revealed the chest nodule to also be pilomatricoma.

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A 69-year-old man presented with malignant melanoma on his right thumb. It was treated by amputation and chemotherapy. Dyspnea developed 20 months after surgery. A chest X-ray showed a mass in his left lower lung field and it was considered to be a metastatic tumor. It was resected but he was found to also have multiple metastasis in his stomach, bone, brain and lung after surgery. He died due to brain metastasis 32 months after the first operation of the primary focus and 9 months after resecting the metastatic lung tumor.

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The simple removal of a lesion of granuloma telangiectaticum (GT) was followed by the appearance of three satellite lesions 5 months thereafter. Angiography revealed incoming vessels branching from A. temporalis superior (ATS) into the three lesions. At surgery, the ATS was ligated and removed, followed by the removal of the hemangioma and irradiation of the lesion with 18 Gy. electron beam therapy. At 1 year after the surgery, a half-rice-corn sized hemangioma was found corresponding to the ligated site of ATS. The hemangioma disappeared with the use of a corticosteroid ointment without any further flare-up. Regarding terminology, we favor the diagnosis of lobular capillary hemangioma (LCH) rather than GT. We reviewed 22 Japanese cases and studied both the abnormal microcirculation of these cases and the optimal methods of treatment.

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We report the case of a 28-year-old woman with Ramsay Hunt syndrome in her sixteenth week of pregnancy. She complained of strong pain due to skin eruptions on her left cheek and auricle. We diagnosed herpes zoster in the left trigeminal nerve area. Though we treated her with immunogloblin and stellate ganglion block, her facial palsy again appeared later. We repeated treating the patient with stellate ganglion block, without any antiviral agents such as acyclovir, and her facial palsy thereafter gradually recovered. Very few reports concening Ramsay Hunt syndrome in pregnancy have previously been reported.

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We report a case of secondary stage of syphilis occurring in a 42-year-old male patient. He first noticed 2 asymptomatic papules appearing on the foreskin and subsequent swelling of both inguinal lymphnodes, the latter showed no subjective complaints including pain. Because he was afraid of malignant tumors associated with lymphnode metastasis, he visited a local surgeon. As the histopathological examination from right inguinal lymphnode failed to reveal any evidence of malignancy, he was then referred to us for further examination. Skin eruptions of the face and genitalia, a histopathological study from the papule of the foreskin, and serological studies suggested a diagnosis of syphilis. The clinical manifestations, however, were a mixuture of the primary and secondary stages, which strongly suggested a latent clinical course between these two stages. Treatment was carried out with a per os administration of penicillin for 4 weeks. The eruptions were almost completely improved after 2 months of chemotherapy. As recent reports have demonstrated, the incidence of syphilis in the younger population is incresing along with the atypical clinical manifestations. Therefore, a close clinical inspection and serological studies as well as a histopathological examination should be performed, whenever cases of sexually transmitted diseases are suspected.

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Case 1: A 31-year-old man presented with a 4-month history of two nodules on his left hand. Case 2: A 16-year-old woman presented with 6-month history of the multiple nodules on her right hand and wrist. Epithelioid cell granulomas were noted histologically and mycobacterial colonies grew in a mycobacterium culture medium. These mycobacteria were identified as Micobacterium marinum (case 1) and Micobacterium gordonae (case 2), respectively. Case 1: Two nodules disappeared after the oral administration of minocycline, 200mg per day, for 3 months. Case 2: Multiple nodules disappered after the oral administration of rifampicin, 300mg per day and isoniazid, 300mg per day, for a month.

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A 9-month-old boy was given a BCG vaccination at 7 months after birth. About 1 month following the vaccination, he exhibited pyrexia. Two weeks later, his mother noticed small papules on his trunk. These skin-colored or slightly red, pinhead-sized papules later spread to his limbs and face. Laboratory findings were negative for HCV Ab. HBS Ag, and EBV Ab. A biopsy specimen taken from the nodule showed a small granulomatous lesion in the dermis, that was negative for Ziehl-Neelsen stain. His tuberculin test was positive. The chest X-ray findings were otherwise normal. We thus diagnosed the boy to have lichen scrofulosorum following BCG. Without any specific therapy, these eruptions disappeared, and his fever completely disappeared. Over the next 7 months, he showed no recurrence.

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We report two cases of toxic shock-like syndrome. Case 1: A 43-year-old healthy woman developed a painful swelling on the right leg, right foot, and then both hands a few days after contusion of her right ankle, which evolved into necrosis of skin which reached the deep fascia. Shock ensued, and laboratory examinations showed leukocytosis, increased serum levels of anti-streptolysin O, C-reactive protein (CRP), creatine phosphokinase (CK) and myoglobin, and both liver and kidney dysfunction. A culture of a skin lesion yielded group A β-hemolytic streptococci. Antibiotics and dopamine therapy in combination with continuous hemodiafiltration were effective. Case 2: A 67-year-old woman receiving corticosteroid therapy for dermatomyositis developed a painful swelling on her right knee after twisting it. Two days later, shock abruptly occurred, and laboratory examinations showed increased serum levels of CRP and CK and renal dysfunction. A culture of aspirate from the right knee joint yielded group A β-hemolytic streptococi. She died on the same day. An early diagnosis and prompt treatment of toxic shock-like syndrome are essential for improving the outcome. Dermatologists should keep in mind that a common skin manifestation of this syndrome is necrotizing fasciitis.

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A 21-year-old Japanese female, housewife, presented with a flat papule on her left sole of three year’s duration, which had gradually increased in size. A single hyperkeratotic slightly elevated round nodule showed a normal color on the plantar arch and had no symptoms. This papule had a normal ridge pattern of the surface of the sole. The papule was excised under local anesthesia. The microscopic examination for hematoxylin-eosin-stained section showed a slight degree of acanthosis and papillomatosis. The characteristic histological features included the presence of vacuoles in the horny layer and eosinophilic intracytoplasmic inclusion bodies in the granular layer. An immunohistochemically stained section by ABC method using anti-bovine papillomavirus polyclonal antibody showed positive granules at the vacuoles and nuclei of cells with inclusion bodies. In situ hybridization was performed with the biotinated HPV, type 60 DNA probe and showed positive deposits in the vacuoles of the horny layer and the nuclei of the upper squamous cell layer. We diagnosed the wart to be a human papillomavirus type 60 infection of the sole.

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A 74-year-old man first noticed a tumor on his right hand 5 years previously. On physical examination, a red, hemispherical tumor measuring about 13×9 mm in size was found on the back of his right hand. A histopathological examination showed a large cyst in the dermis. Within the cyst wall, small solid components consisting of poroid cells were observed. The tumor was diagnosed to be poroid hidradenoma, which was a new variant of poroma first described by Abenoza and Ackerman in 1990. An immunohistochemical examination using monoclonal antikeratin antibodies revealed the poroid cells to differentiate toward the eccrine dermal ducts, whereas the luminal cells differentiated toward the dermal ducts to the secretory regions.

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We herein report a 51-year old man in whom tinea corporis developed within a radiation field while he was receiving X-ray radiation therapy for the squamous cell carcinoma of hypopharynx. At a dose of 23 Gy approximately 10 days after starting radiotherapy, the patient began to complain of a pruritic eruption on the irradiated skin. A physical examination revealed diffuse erythema, and red papules on both sides of the neck. A fungal culture grew Tricophyton rubrum (T. rubrum). The eruption completely resolved after 3 weeks of topical treatment with 1% clotrimazole cream. We next investigated the effect of X-rays on the growth of T. rubrum and the number of Langerhans cells in the epidermis. One hundred Gy of X-rays did not cause any inhibition of growth of T. rubrum. On the other hand, 25 Gy of X-rays markedly reduced the number of epidermal Langerhans cells. These results show that dermatophytes are resistant to X-rays, while epidermal Langerhans cells, which play a crucial role in the skin immune system, are sensitive to it. These are some of the reasons why tinea corporis developed in the above case entirely within the radiation field duriug X-ray therapy.

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We report the case of a 23-year-old woman with generalized urticarial eruptions following the intravenous administration of methylprednisolone sodium succinate (Solu-Medrol^®). Skin tests with Solu-Medrol^®, hydrocortisone sodium succinate (Solu-Cortef^®) and prednisolone sodium succinate (Predonine^®) resulted in wheal-and-flare reactions. However, sodium succinate, methylprednisolone and chloramphenicol succinate caused no skin reactions, thus suggesting the importance of an ester-structure in the corticosteroid-succinates. Histamine release was induced by the incubation of Solu-Medrol^® with either the blood of patient (whole blood and basophil leukocytes) or basophil leukocytes from a healthy volunteer, passively sensitized with serum from the patient. These results suggest that the patient developed a reaction of type I hypersensitivity to succinate esters of corticosteroids.

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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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