The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 68, Issue 6
Displaying 1-20 of 20 articles from this issue
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Color Atlas
Mini Review
Clinical Case Reports
  • Two Cases of Anaphylactoid Purpura that Led to the Diagnosis of Malignancy
    Asako ICHIHARA, Jun AOI, Shoji WAKASUGI, Toshiro KAGESHITA, Hironobu I ...
    2006 Volume 68 Issue 6 Pages 618-622
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.618
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    Two cases of anaphylactoid purpura (AP) were reported. The first case was a 57-year-old male with palpable purpura on the lower legs and arthralgia. Examinations revealed malignant lesions in the lungs, lymph nodes, liver and other organs. He was diagnosed as having hepatocellular carcinoma. The second case was a 63-year-old male with palpable purpura on the lower legs. He was found to have pancytopenia and was diagnosed with myelodysplastic syndrome. Biopsy specimens of both cases showed leukocytoclastic vasculitis in the upper dermis. Both cases had advanced-stage malignancy. AP in the elderly should be recognized as a dermadrome of malignancy.
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  • A Case of Bullous Rheumatoid Neutrophilic Dermatosis
    Nobuhiko UEDA, Takahiro SATOH, Hiroo YOKOZEKI
    2006 Volume 68 Issue 6 Pages 623-625
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.623
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    A 76-year-old woman presented with a 4-day history of itchy small vesicles on her trunk and extremities. She had had rheumatoid arthritis for 3 years and had been administered PSL and MTX. Physical examination revealed multiple tense vesicles and pustules surrounded by erythema. Results of laboratory examination showed increased inflammatory reaction and monoclonal IgA gammopathy. Subepidermal bullae filled with neutrophils and a dense infiltrate of neutrophils in the upper dermis were found on skin biopsy. The patient was diagnosed as having bullous rheumatoid neutrophilic dermatosis and was successfully treated with DDS 150 mg/day.
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  • A Case of Primary Sjögren's Syndrome with Cutaneous Vasculopathy Presenting as Leg Ulcers
    Akihiro SOTOME, Youichiro HAMASAKI, Yohei KITAMURA, Yumi KAWAHARA, Sit ...
    2006 Volume 68 Issue 6 Pages 626-629
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.626
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    A 70-year-old woman presented with a 9-month history of skin ulcers on the lower legs. Because the lesions evolved into some painful ulcers, she was admitted to our hospital in May 2004. Histological examination of the skin lesion revealed mononuclear cell infiltrations and obstructive changes of subcutaneous small vessels. Clinical and laboratory evaluation showed subjective sicca symptoms, decreased salivary secretion, and positive anti-Ro/SS-A antibodies. These findings fulfilled the diagnostic criteria of Sjögren's syndrome. We suggest that clinical and laboratory evaluations are necessary in patients with leg ulcers to rule out the coexistence of primary Sjögren's syndrome.
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  • A Case of Cutaneous Focal Mucinosis Associated with Rheumatoid Arthritis
    Harumi SHINAGAWA, Yukinori OHTA, Kenichi IWASHITA, Yoshinori UMEZAWA, ...
    2006 Volume 68 Issue 6 Pages 630-632
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.630
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    We report a patient with cutaneous focal mucinosis on the right elbow associated with rheumatoid arthritis. This 57-year-old female had been hospitalized due to rheumatoid arthritis and had been treated with predonisolone 5 mg/day. She presented with dome-shaped, translucent nodules about 3∼8 mm in size. Histopathological examination demonstrated a focal area in the dermis where most of the collagen bundles had been replaced by a myxomatous matrix. Scattered fibroblasts ware also observed. The mucinous material was alcian blue-positive, with metachromasia shown by toluidine blue staining. Taken together,these findings supported the diagnosis of cutaneous focal mucinosis (CFM). Thyroid disease or other internal diseases were not observed in our case. Previously we summarized complications of CFM in 53 reported cases from Japan.
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  • A Case of Chemical Burn due to Hydrofluoric Acid
    Akiko KAWAHARA, Taiyo ONO, Kazutoshi KAWAHARA, Masatoshi ITOH, Masami ...
    2006 Volume 68 Issue 6 Pages 633-635
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.633
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    We report a case of hydrofluoric acid burn. The right hand of a 33-year-old man who was at work in a glass bottle frosting factory came into contact with 65% hydrofluoric acid. Although he washed his hand for about half hour after returning home, swelling and severe pain developed. Immediately after presenting at our hospital, we treated the injury with a local injection of calcium gluconate. Because an elongated QT pulse was shown on an electrocardiogram at the time of this consultation, we suspected induction of ventricular fibrillation. He was urgently hospitalized in the ICU to monitor his condition and managed by intravenous injections of 2% calcium chloride. No other circulatory or respiratory symptoms appeared. Six days after the treatment, his hand had healed. We consider that it was important to apply rapid care and to determine quickly what kind of chemicals he had been exposed to in the factory.
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  • A Case of Adult T Cell Lymphoma (ATL) Associated with Granuloma Annulare-like Lesions
    Hiroko ICHIMIYA, Kazushi ISHIKAWA, Yuichiro OTANI, Yoshitaka KAI, Yuta ...
    2006 Volume 68 Issue 6 Pages 636-639
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.636
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    Approximately 6 months ago, a 66-year-old Japanese female had noticed painful papules with erythema on her hands, after which she visited a dermatologist. She was diagnosed as having verruca planae and was treated with ointment and medicine. After one remission, the eruption on her hands recurred, and she was referred to our hospital. She had miliary-sized papules over her entire body except for her face and lumbar central back. A few painful ring-shaped plaques resembling granuloma annulare (GA) were found on her fingers and palms. Blood examination revealed 11% abnormal lymphocytes and positivity for HTLV-1 antibody. Southern blot analysis of DNA obtained from a palmer lesion showed a clonal band of HTLV-1. A biopsy specimen taken from the palmer lesion revealed that atypical lymphocytes had densely infiltrated the upper dermis and had partially infiltrated the epidermis and that degenerative collagen fibers were surrounded by histiocytes and foreign body giant cells. The patient was given the diagnosis of ATL accompanied by GA-like lesions, which occurred presumably due to the pathological reaction of ATL cells. Pulmonary shadows on chest X ray film were evident 3 times during the clinical course. These were thought to be caused by infiltration of ATL cells into the lungs because chemotherapy consisting of the combination of pirarubicin hydrochloride, cyclophosphamide, vincristine and prednisolone was effective for the pulmonary lesions. Interestingly, when her pulmonary shadows increased, skin eruptions were decreased. We consider that the GA-like lesion might be a favorable predictive sign with regard to the severity of ATL.
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  • A Case of Mucoepidermoid Carcinoma
    Rie WATANABE, Takao UCHIDA, Masaki AKIYAMA, Hirohiko SUEKI, Masafumi I ...
    2006 Volume 68 Issue 6 Pages 640-643
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.640
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    The patient was a 37-year-old man. A nodule appeared on his upper lip 15 years ago. It had enlarged in recent 2 years. The nodule was suspected of being squamous cell carcinoma and biopsy was performed. As histological examination suggested mucoepidermoid carcinoma, the patient was referred to our department. In the center of the upper lip, there was a well-demarcated 16 mm in diameter, flatly elevated nodule. The center of the nodule was eroded, had a yellow crust, and had a bone-like hardness on palpation. Histologically, solid tumor foci and structures of various sizes resembling a glandular cavity were scattered. Tumor cells were composed of cells resembling epithelial cells with an eosinophilic cytoplasm, mucin-producing cells with an eccentrically located nucleus and a light cytoplasm, and intermediate-type cells. Inside the structures resembling a glandular cavity, there were cells containing an amorphous substance that was lightly stained with eosin. Some of the cells resembling epithelial cells had dyskaryosis or karyokinesis. Mucin-producing cells and the inside of the glandular cavity were stained positive with alcian-blue, and PAS which was diastase-resistant. Based on these findings, we diagnosed the tumor as mucoepidermoid carcinoma and the patient was underwent extensive resection of the lesion (tissue was resected 15 mm away from the tumor margin) and received an Abbe flap from the lower lip. There has been no overt recurrence or metastasis to date, 2 years after operation.
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  • Three Cases of Perianal Streptococcal Dermatitis
    Taizo TAKESHITA, Hisaki GONDO, Gaku TSUJI, Masutaka FURUE
    2006 Volume 68 Issue 6 Pages 644-647
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.644
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    We report 3 cases of perianal streptococcal dermatitis. Case 1 was a 2-year-old girl who had a 2-week history of perianal erythema and erosion. Case 2 was a 6-month-old boy who had erythema and erosion in the perianal and neck regions for a week. In these patients, cultures from swabs of each affected area yielded group A β-streptococcus. In Case 3, a 36-year-old man, perianal tenderness, erythema and erosion had been present for several days. A culture of the perianal erosion revealed group A β-streptococcus and group G β-streptococcus. Treatment with orally administered antibiotics led to rapid resolution of the condition in all three cases.
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  • Rugby Players Infected with Tricophyton tonsurans: A Case Study
    —With a Discussion of the Results of a Group Examination Performed at a High School Rugby Club—
    Hidekazu SHINODA, Hanako SEKIYAMA
    2006 Volume 68 Issue 6 Pages 648-651
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.648
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    We isolated Trichophyton tonsurans (T. tonsurans) fungus from a culture obtained from a 17-year-old boy who was a member of a high school rugby club and who had a 1.7 × 1.0 cm elevated, marginated erythema with scales on his left upper arm. Upon medical examination of all 39 members of the club to which the proband belonged, we found no tinea capitis. However, we found 2 cases of tinea corporis (face and left side of the neck), one of which was shown to be positive by the hairbrush (HB) method. One of the tinea corporis patients had belonged to a judo club in junior high school and had joined the rugby club after entering high school. Colonies of T. tonsurans were detected on all spikes on the brush used for the HB method. We concluded that this patient was the source from which the infection had spread. This is the first report of infection with T. tonsurans among rugby club members. As the rugby code contains playing techniques like ruck, maul, tackle, or scrum that require direct contact between players, we assume that group infection with T. tonsurans will become more common in rugby in the future and suggest that this sport receive as much attention with regard to this issue as judo and wrestling.
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  • A Case of Onychomycosis Caused by Fusarium oxysporum Infection
    Manabu MAEDA, Takashi MOCHIZUKI
    2006 Volume 68 Issue 6 Pages 652-655
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.652
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    A 54-year-old female visited our department in January 2003 with the complaint of a pigmented lesion of the right 1st toenail of a 2-year duration. In December 2002 in a private clinic, she had undergone skin biopsy because of suspicion of malignant melanoma, which was denied histopathologically. Histopathological examination of a punch biopsy from the lesion on the nail (diameter, 2.5 mm) revealed fungal elements with positive PAS stains. The sequence of ITS regions on ribosomal DNA of the isolate cultured from the biopsy specimen showed 99.6% homology with Fusarium oxysporum. Clinical and histopathologic features indicated a diagnosis of non-dermatophytic onychomycosis due to F. oxysporum infection. The lesion healed naturally in several months and there has been no recurrence.
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Review
Therapy
  • Effect of 0.1% Tacrolimus Ointment in the Treatment of Adult Patients with Atopic Dermatitis on the Trunk and Limbs
    Hiroshi MACHINO, Koji HASHIMOTO
    2006 Volume 68 Issue 6 Pages 671-676
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.671
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    The potential efficacy and safety of 0.1% tacrolimus ointment for the treatment of atopic dermatitis on the trunk and limbs were evaluated in a 24-week, open-label, non-comparative study that included 104 adult patients. Investigated scores for erythema and papule were significantly decreased during the first 2 weeks of therapy and continuous improvement was observed throughout the study. The pruritus score was also decreased significantly at 2 weeks and the improvement was continued throughout the study. Prurigo and lichenification scores were significantly decreased at 24 weeks, although the decrease was gradual. As to adverse events, transient skin burning was observed in 20% of patients during the study period. Three patients were removed from the study because of skin infection (2 cases) and skin burning (1 case). These results suggest that 0.1% tacrolimus ointment is safe and effective as long-term treatment of adult patients with atopic dermatitis on the trunk and limbs.
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  • Impact of 0.1% Tacrolimus Ointment in the Treatment of Reticulate Pigmentation of the Neck in Adult Patients with Atopic Dermatitis
    Hiroshi MACHINO, Koji HASHIMOTO
    2006 Volume 68 Issue 6 Pages 677-682
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.677
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    Reticulate pigmentation of the neck is a hyperchromatic disorder that affects the anterior neck in adults with atopic dermatitis (AD). We examined the potential efficacy of 0.1% tacrolimus ointment in the treatment of pigmented lesions on the neck in 54 adult patients by using a 10-point color scale (1-10). The pigmentation gradually improved during the therapy, and the mean score was significantly reduced from 5.4 to 3.9 (p<0.001) after 24 weeks. Marked improvement was observed in 14.8% and moderate improvement in 38.9% of patients after completing the therapy. These results suggest that tacrolimus ointment is effective for the treatment of reticulate pigmentation of the neck in patients with AD.
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  • Anti-pruritic Effect of Loratadine, a Long-acting Selective Histamine H1-receptor Antagonist, on Asteatotic Eczema Including Xeroderma
    Shinsuke TAJIRI, Juichiro NAKAYAMA, Nanakuma Research Group
    2006 Volume 68 Issue 6 Pages 683-690
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.683
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    The clinical effect of loratadine, a second generation antihistamine with weak sedation, was examined in 38 patients with asteatotic eczema, including xeroderma, who were not responding adequately to treatment with moisturizing agents. Patients achieving less than 50% improvement from baseline by the Visual Analogue Scale (VAS) of “daytime itching” and “nighttime itching” after one week of treatment with a moisturizing agent were considered to have inadequate response and received loratadine additionally. Of 66 patients examined, inadequate response was observed in 38 patients; 8 of these patients also received topical steroids at the physician's discretion. Anti-pruritic effect was examined based on the VAS score separately for the 30 patients with inadequate response and for the 8 who additionally received topical steroids. The VAS score for “daytime itching” of the 30 subjects not receiving a topical steroid was significantly reduced from 35.6±25.8 (mean±SD) before the addition of loratadine to 17.2±18.1, 15.7±20.1, 13.7±17.8, and 12.5±16.5 after 1, 2, 3, and 7 weeks, respectively. The VAS score for “nighttime itching” was also significantly reduced with the addition of loratadine from 45.0±24.2 to 24.3±18.3, 20.7±21.7, 19.2±19.7, and 15.1±16.3 after 1, 2, 3 and 7 weeks, respectively. The VAS score of the 8 patients likewise decreased over time, with the decrease being significant at all time points except for daytime itching after one week. In addition, the clinical efficacy of loratadine was evaluated in the 30 patients not receiving topical steroids, and marked or moderate efficacy was observed in 80% (24 patients) of the subjects. As an adverse reaction, mild sleepiness was observed in 2 patients (5.3%). These results suggested that loratadine, having weak sedation and confirmed antipruritic effect, is useful for the treatment of asteatotic eczema, including xeroderma.
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  • Effect of Hydorogell Dressing (VIEWGELL®) in the Treatment of Venous Leg Ulcer
    Naoaki RIKIHISA
    2006 Volume 68 Issue 6 Pages 691-695
    Published: 2006
    Released on J-STAGE: January 15, 2007
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.691
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    In this case report hydorogell dressing (VIEWGELL®)was used for venous leg ulcer. Compression therapy with this dressing was very useful and effective in management of venous leg ulcer that was superimposed on extensive stasis dermatitis, especially effective in analgesia with occlusive dressing, preservation of regenerated skin, and enhancement of autolytic debridment.
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