The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 68, Issue 5
Displaying 1-20 of 20 articles from this issue
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Color Atlas
Mini Review
Clinical Case Reports
  • Three Cases of Chronic Actinic Dermatitis
    Yumi KAWAMURA, Michio HASHIKABE, Akihiro SOTOME, Atsushi HATAMOCHI, So ...
    2006 Volume 68 Issue 5 Pages 487-490
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.487
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    Patient 1 was a 66-year-old man who 6 months previously had noticed erythema and papules on his face and lichenification on the back of his hands, which then spread over his entire body. He was treated for chronic eczema, but was examined in our department because it was intractable. Patient 2 was a 61-year-old man who 2 years previvusly had begun to notice erythema, papules, and lichenification, mainly on areas exposed to light. He was treated for chronic eczema, but because the rash on his face and the back of his hands worsened and spread over his entire body, he was examined in our department. Patient 3 was a 59-year-old man who 6 months previously had noticed erythema, papules, and lichenification, mainly in areas exposed to light. He was treated for chronic eczema, but was examined in our department because it was intractable. All 3 patients were UVA-and UVB-positive in photo-irradiation tests, and histopathological examinations revealed findings of chronic dermatitis. They were all treated by light shielding and topical steroid therapy, and slight relief was obtained. However, even greater improvement was noted when cases 1 and 3 were subsequently treated in combination with an oral preparation containing chlorpheniramine maleate and betamethasone (Celestamine®), and cases 1 and 2 with tacrolimus ointment (Protopic® ointment).
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  • A Patient with Livedo Reticularis with Summer Ulcerations Complicated by Mononeuritis Multiplex and Extensive Exanthema
    Kotaro NAGASE, Yasuyuki SUZUKI, Takuya INOUE, Noriyuki MISAGO, Yutaka ...
    2006 Volume 68 Issue 5 Pages 491-495
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.491
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    A 55-year-old female developed livedo reticularis with summer ulcerations. Irregular network-like brown erythema and pigmentation in the bilateral lower limbs and on the back of the bilateral hands were observed. In the regions, multiple small ulcers involving the anterior lower thigh and foot, white atrophic scars, and punctiform purpura were noted. In addition, this patient had mononeuritis multiplex. Histopathological diagnosis suggested thrombus formation in microvessels involving the middle/lower layers of the corium and the fat tissue. A nicotine preparation (nicotine patch) improved the dermal symptoms; however, the neurological symptoms persisted despite slight improvement. We reviewed case reports of this disorder in Japan. In patients with network-like exanthema not only in the lower limbs but also in the upper limbs, the incidence of peripheral nerve symptoms was higher than that in patients without it. When extensive network-like exanthema is observed, the presence or absence of mononeuritis multiplex should be examined.
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  • A Case Report of Cholesterol Crystal Embolization Developing without Clear Cause that Flared up Following Intraarterial Catheterization
    Yumi KAWAMURA, Youichiro HAMASAKI, Sityu HOU, Yohei KITAMURA, Atsushi ...
    2006 Volume 68 Issue 5 Pages 496-499
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.496
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    An 81-year-old woman who developed pain and ulceration in the right 5th toe in July 2004 visited our department in September, as the condition had proved to be refractory to treatment. Skin biopsy was conducted under the suspicion of squamous cell carcinoma; however, no evidence of malignancy was found. The patient was treated conservatively, and epithelialization of the ulcer was confirmed in early December. Later in December, however, the patient underwent intraarterial catheterization for treatment of acute myocardial infarction, followed by the initiation of oral anticoagulants. In January 2005, pain and cyanosis of the right 1st toe developed, which gradually spread to all toes of the right foot and also extended to the left foot. In February, she presented at our department with cyanosis, ulceration and gangrene of all toes on the right foot and of the 1st and 5th toes on the left foot. Pathological examination revealed cholesterol clefts in the blood vessels of the foot. Peripheral blood eosinophil count was elevated, and renal dysfunction was evident by results of hematologic studies. Cholesterol clefts in the lower layers of the dermis were shown by detailed pathological examination of tissue specimens collected at the initial examination. Based on these findings, the patient was diagnosed to have cholesterol crystal embolization of unclear causation, which flared up following arterial catheterization. Most previously reported cases of cholesterol crystal embolization of unclear causation were associated with aneurysm. It is suggested that aneurysm may be one cause of cholesterol crystal embolization.
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  • A Case of Infective Endocarditis Associated with Purpura on Ventral Toes as a Clue to the Diagnosis
    Miho UCHIHIRA, Yumiko TAKAHATA, Yoshiaki HAMAMOTO, Masahiko MUTO, Taka ...
    2006 Volume 68 Issue 5 Pages 500-503
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.500
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    A 29-year-old female had fever and headache since October 2003, and transient and tender purpura with regional edema also had been noted repeatedly since November 2003. She was examined for fever of unknown origin and anemia in the Internal Medicine Department at our hospital. On 5 December 2003, the patient was referred to us for further investigation of the eruption. Laboratory data were noncontributory except for inflammatory findings with neutrophilia. Since painful purpura was observed on the left ventral toes at presentation, we performed skin biopsy from the purpura to rule out embolism or vasculitis. Histopathological findings included cell infiltration predominantly composed of neutrophils accompanied by nuclear dust throughout the dermis and in subcutaneous tissue. Histology also revealed an embolus in a relatively large vessel. Echocardiogram 3 weeks later showed vegetation on the mitral valve. Blood cultures grew Streptococcus mitis. Based on these findings, we diagnosed this patient as having infective endocarditis. Dermatologists must be familiar with various eruptions associated with infective endocarditis, because such cutaneous manifestations are very useful in diagnosing the disease as described in this report.
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  • Generalized Granuloma Annulare in an Infant:
    a Case Report
    Hiroko KOIZUMI, Nobuko TABATA, Ryuhei OKUYAMA, Setsuya AIBA
    2006 Volume 68 Issue 5 Pages 504-507
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.504
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    A 7-month-old girl developed multiple nodules on her lower legs during the previous 1 month, and new lesions gradually appeared in her extremities. She presented with multiple nodules, several millimeters in diameter, chiefly located on the distal part of her extremities. Histopathological examination showed granulomas composed of epithelioid cells, multinucleated giant cells, and lymphocytes with mucin deposition between collagen fibers. From the clinicopathological findings, we diagnosed her as having generalized granuloma annulare. After a skin biopsy, the lesions began to resolve spontaneously. To our knowledge, she is the youngest case of generalized granuloma annulare in Japan.
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  • Long-term Observation of a Case of Bullous Congenital Ichthyosiform Erythroderma (BCIE)
    Mami TAKAGI, Keiko KOBAYASHI, Akimichi MORITA, Tokio NUMATA
    2006 Volume 68 Issue 5 Pages 508-511
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.508
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    We reported a 12-year-old girl with bullous congenital ichthyosiform erythroderma (BCIE). She had diffuse erythema with membranous scales and erosions 10 cm in diameter over her entire body. The lesions were observed at birth and were gradually desquamated. At the age of 3, washboard-shaped thick scales and bulla began to appear. At the age of 5, she started to take etretinate (0.2-0.5mg/kg/day). Histology at the age of 12 years showed hyperkeratosis and granular degeneration in the epidermis. From those findings, we assigned the diagnosis of BCIE. Etretinate was effective in reducing the thick scaly lesions. The symptoms of desquamated and keratotic plaques gradually decreased. Although her skin was tight, neither bulla nor severe erythema was observed on her body at the age of 20.
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  • Perianal Streptococcal Dermatitis in Father and Daughter
    Kazunari USUKI
    2006 Volume 68 Issue 5 Pages 512-514
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.512
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    We report 2 cases of perianal streptococcal dermatitis. A 5-year-old Japanese girl presented with erythema on the perianal region. Results of the group A streptococcal antigen-test were positive and the patient was diagnosed as having perianal streptococcal dermatitis (PSD). After 4 days, her father (44-year-old healthy Japanese) presented with the same symptom, and was also positive for group A streptococcal antigen and was diagnosed with PSD. Both were treated with oral and topical antibiotics. Including these 2 cases, as of January 31, 2006, we experienced 13 cases (9 males and 4 females) with PSD. The age of onset of symptoms in these patients varied from 11 months to 44 years. Ten of the 13 cases had PSD in winter. There were 3 cases of vulvovaginitis, 1 case of balanoposthitis and 1case of otitis media as the complication due to streptococci. Of the 13 cases, 5 had atopic dermatitis.
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  • Two Cases of Pseudomonas Toe Web Infection Effectivelly Treated and Prevented from Recurrence with a Footbath in 1% Acetic Acid
    Hiroaki HAYASHI, Makoto INAOKI, Wataru FUJIMOTO
    2006 Volume 68 Issue 5 Pages 515-518
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.515
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    We experienced two cases of Pseudomonas toe web infection. Successful therapies were achieved with surgical debridement of the “hyperkeratotic rim” and surface exudate, together with a footbath in 1% acetic acid. Wood's light examination was useful not only for a rapid diagnosis of the infection by green fluorescence but also for evaluating the efficacy of the treatment. Toe web infections easily recur due to the host's susceptibility and environmental factors. In the presented cases, topical management with a 1% acetic acid soak was useful in preventing recurrence as well.
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  • A Case of Drug Eruption due to Turmeric
    Eriko ITO, Ryutaro ICHIKAWA, Hiroshi TERAO, Hiromaro KIRYU
    2006 Volume 68 Issue 5 Pages 519-522
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.519
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    A 57-year-old man had suffered from itchy erythema and vesicle on his left side abdominal lesion. The eruption soon spread over his entire body. The histological study showed spongiosis in the epidermis, accompanied by eosinophilis in the upper dermis. IgG, IgA, IgM were not observed by a direct immunofluorescence technique. Oral steroid therapy was effective for skin lesion. He had taken turmeric for his health for about 2 years. The patch testing with turmeric showed positive reactions. We diagnosed our case to be a drug eruption due to turmeric.
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  • A Case of Erythema Multiforme-type Drug Eruption due to Loflazepate Ethyl (Meilax®)
    Kotaro ITO, Yumiko KUBOTA, Yuichi YOSHIDA, Juichiro NAKAYAMA
    2006 Volume 68 Issue 5 Pages 523-526
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.523
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    A 43-year-old female had been taking loflazepate ethyl (Meilax®) and sulpiride (Dogmatyl®) for one year and milnacipran (Toledomin®) for 6 months for depressive psychosis. Since these drugs were not very effective, Toledomin® was replaced by maprotiline (Ludiomil®). Two weeks later, at the beginning of October 2004, erythema developed on her dorsal hands. The following day, the erythema spread over her body, and facial edema appeared. She was referred to our hospital. At the first examination, we noted erythema multiforme over her entire body and conjunctival congestion of both eyes with facial edema. Examination of biopsy specimen taken from erythema of the left forearm showed dermal edema and infiltrates of lymphocytes and eosinophils around the vessels in the upper dermis. First, we assigned the diagnosis of drug eruption due to Ludiomil®. After admission, the eruption improved by systemic steroid therapy; however, upon gradual reduction of prednisolone, erythema recurred. The only positive results of the patch test and DLST were for Meilax®. Finally we diagnosed the patient as having drug eruption due to Meilax®, which she had been taking for one year.
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Review
Therapy
  • Sentinel Node Biopsy in Non-melanoma Skin Malignancies
    Masaki OTSUKA, Osamu YAMASAKI, Kenji ASAGOE, Keiji IWATSUKI, Yoshio KI ...
    2006 Volume 68 Issue 5 Pages 532-537
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.532
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    At the Department of Dermatology, Okayama University Graduate School of Medicine and Dentistry, 14 patients with non-melanoma skin malignancies underwent lymphatic mapping and sentinel node biopsy from July 2000 to March 2004. Primary diagnoses were 9 squamous cell carcinomas (SCCs), 2 Merkel cell carcinomas (MCCs), 1 extramammary Paget carcinoma, 1 accessory breast cancer and 1 leiomyosarcoma. Sentinel node biopsies were performed using preoperative lymphoscintigraphy and blue dye from July 2000 to October 2001 and using those strategies in addition to intraoperative radiolocalization from November 2001. We identified sentinel lymph nodes in all 14 patients. Four patients (3 SCCs, 1 extramammary Paget carcinoma) had tumor-positive sentinel lymph nodes. In these 4 patients, radical lymph node dissection was performed, revealing further metastases in 2 patients (1 SCC, 1 extramammary Paget carcinoma). One of the 2 patients (extramammary Paget carcinoma) died of metastatic disease. No patient with a negative sentinel lymph node had tumor dissemination at a median follow-up of 22.6 months. Sentinel node biopsy is a minimally invasive and highly sensitive staging tool for non-melanoma skin malignancies.
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  • Cyst Wall-preservation Method for Operation on Epidermal Cyst
    Keiko HANAOKA, Toshihiko TANAKA, Hajime SHINDO, Michihiro HIDE, Kiyosh ...
    2006 Volume 68 Issue 5 Pages 538-543
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.538
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    Epidermal cyst is a common skin tumor and is usually removed as a mass together with surrounding tissues. However, removal may not be easy because of the size and/or anatomical position of the tumor. In 4 patients, we removed the ceiling of an epidermal cyst that developed on the sole, preserving the rest of its wall and sewing its edge to the surrounding skin. The results were satisfactory both cosmetically and functionally. Since the wall of an epidermal cyst consists of epidermis, the removal of only its ceiling and the evacuation of the content avoids development of ulcer, pain or infection after the operation. Thus, this method may be useful for the treatment of epidermal cysts that are difficult to remove as a mass because of size and/or anatomical position.
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  • Immediate Clinical Effectiveness of Bepotastine Besilate for Patients with Urticaria
    Futoshi KOHDA, Masutaka FURUE, Shinichi IMAFUKU
    2006 Volume 68 Issue 5 Pages 544-547
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.544
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    A questionnaire survey concerning the immediate efficacy of bepotastine besilate (Talion®)was administered to 25 patients with urticaria. All 20 of the 20 patients (100%) who answered the question “When did you feel the effect of inhibition of itching?” reported noticing such an effect within 90 minutes after taking the medicine. Moreover, 92% expressed the opinion that they were conscious of the medication's effectiveness. As for duration of the effect, of 19 patients, 16% reported 4 hours, 32% reported 8 hours, and 47% reported 12 hours. Even though 33% of the patients reported drowsiness as a side effect, 84% wanted to continue using this medicine, proving its high efficacy.
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  • Experience Using Chemical Peeling with Glycolic Acid for 199 Acne Cases
    Yukie WATANABE, Akimichi MORITA
    2006 Volume 68 Issue 5 Pages 548-552
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.548
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    Under the “2001 Guidelines for Chemical Peeling of the Japanese Dermatological Association,” chemical peeling has become a popular dermatological treatment in university and general hospitals and in private clinics. I herein report a retrospective study of 199 acne patients who underwent chemical peeling at my clinic during the last 18 months. Twenty-seven cases were evaluated as excellent, and 105 cases were evaluated as good. Thus, a curative effect among the 176 who completed treatment was 75%. Side effects were observed in 7 cases, with the scab coming off in 2 of these cases. The remaining 5 cases complained of irritation and needed topical steroid. This treatment was proved to be a safe and efficient method for treatment of acne by a medical practitioner.
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  • Efficacy and Safety of Fexofenadine Hydrochloride in Pediatric Patients with Atopic Dermatitis in a Phase III, Randomized, Double-blind, Multi-center Comparative Study
    Hidemi NAKAGAWA, Makoto KAWASHIMA
    2006 Volume 68 Issue 5 Pages 553-565
    Published: 2006
    Released on J-STAGE: November 09, 2006
    DOIhttps://doi.org/10.2336/nishinihonhifu.68.553
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    The safety and efficacy of fexofenadine hydrochloride for the treatment of atopic dermatitis were evaluated in a 4-week, multi-center, randomized, double-blind study in patients aged 7 to 15 years. Patients received fexofenadine 30 mg bid (7 to 11 years), 60 mg bid (12 to 15 years) or ketotifen fumarate dry syrup 1 mg bid. The primary efficacy endpoint was the mean change in itching scores from baseline. Enrolled in the study were 190 patients. Safety was analyzed in 174 patients, and primary efficacy was evaluated in 162 of those patients. The mean changes in itching scores were -0.50 [95% CI, -0.61 to -0.38] in the fexofenadine group (n=77) and -0.58 [95% CI, -0.70 to -0.45] in the ketotifen group (n=85), confirming that fexofenadine was not inferior to ketotifen. There were no differences between the two groups in daily and weekly changes in itching scores, conditions of rashes or the patients' impressions. Adverse events were reported in 25 patients (30.1%) in the fexofenadine group and in 29 patients (31.9%) in the ketotifen group (n.s.). No serious adverse events were reported. This study showed that the efficacy and safety profiles of fexofenadine were comparable to those of ketotifen for relief of pruritus associated with atopic dermatitis in pediatric patients.
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