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Volume 71 (2009)
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Volume 71, Issue 6
Displaying 1-16 of 16 articles from this issue
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Color Atlas
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Chikage MITOMA, Tomomi UJINO, Satoshi TAKEUCHI, Masakazu TAKAHARA, Yoi ...2009 Volume 71 Issue 6 Pages 551-552
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSDownload PDF (923K)
Clinical Case Reports
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Ai IGUCHI, Sayoko KATO, Junko DAITO, Jun ASAI, Hideya TAKENAKA, Saburo ...2009 Volume 71 Issue 6 Pages 553-555
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSA 72-year-old woman presented with severe edema and bulla formation on the neck, left wrist, and right ankle following bloody stool and diarrhea. She had been diagnosed with pyoderma gangrenosum and treated with oral corticosteroids and skin grafting in our hospital between Sep 2006 and Nov 2006. After discharge from our hospital, she was followed up every month and the dosage of oral corticosteroids was tapered gradually. However, she also had enteritis, which was not clearly diagnosed. We diagnosed a recurrence of pyoderma gangrenosum associated with ulcerative colitis. Systemic mesalazine, which is the active component of sulfasalazine and a potent inhibitor of leucocyte motility and cytotoxicity, was then started and the skin lesions were rapidly resolved in conjunction with improvement of the enteritis without the use of oral corticosteroids. The present case suggested that mesalazine could be one of the effective therapies in pyoderma gangrenosum, especially in cases that occur in conjunction with inflammatory bowel disease.View full abstractDownload PDF (942K) -
Ai SAKAMOTO, Toshihide HARA, Fumihide OGAWA, Shinichi SATO, Kenzo KAJI ...2009 Volume 71 Issue 6 Pages 556-560
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSA 53-year-old female had received paclitaxel therapy for the treatment of endometrial cancer. Four months after paclitaxel administration, swollen fingers and skin sclerosis of the forearms appeared without Raynaud's phenomenon. Cutaneous biopsy from the skin lesion showed diffuse dermal fibrosis and perivascular infiltration of mononuclear cells in the dermis. An autoantibody against RNA polymerases was detected by immunoprecipitation. Other clinical and laboratory findings revealed no severe internal complications. Therefore, this patient was diagnosed as having systemic sclerosis. Daily oral administration of prednisolone 20 mg improved her skin sclerosis. It is suggested that paclitaxel therapy in this patient played a role in the induction of systemic sclerosis.View full abstractDownload PDF (1125K) -
Manami ISHIKAWA, Yuji SHIRAKATA, Shinji MURAKAMI, Mikiko TOHYAMA, Keik ...2009 Volume 71 Issue 6 Pages 561-565
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSWe report a case of a 46-year-old Japanese female with severe pemphigus vulgaris successfully treated with high-dose intravenous immunoglobulin. Oral high-dose corticosteroids and double-filtration plasmapheresis (DFPP) was unsuccessful in suppressing her disease activity. Addition of cyclosporine and DFPP, immediately followed by pulse therapy with intravenous (IV) methylprednisolone (1,000 mg/day for 3 days), was only partially successful. We decided to use intravenous immunoglobulin (IVIG ; 400 mg/kg/day for 5 days). After IVIG therapy, erosions began to heal rapidly, and the bullae completely disappeared, along with a decrease in anti-Dsg3 antibody titer.View full abstractDownload PDF (1166K) -
Shunsuke SASAOKA, Hironori MATSUURA, Wataru FUJIMOTO, Masami IKEDA2009 Volume 71 Issue 6 Pages 566-570
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSPemphigus foliaceus is an autoimmune blistering skin disease usually treated with systemic corticosteroids. Adjuvant therapy is commonly used for pemphigus to reduce the high morbidity associated with the use of corticosteroids and to improve disease control. We report a case of a 54-year-old woman with intractable pemphigus foliaceus complicated with diabetes mellitus. The patient presented with generalized erythroderma, and the ELISA index to anti-desmoglein 1 at baseline was 4,672. Treatment was comprised of 40 mg of oral prednisone together with 100 mg of oral cyclophosphamide, followed by a course of pulse intravenous cyclophosphamide 100 mg as adjuvant therapy. Control of disease activity was achieved in 2 months with a significant decline of the ELISA index for anti-desmoglein 1 antibodies, and a partial remission was achieved 11 months after the initiation of therapy. These results indicate that adjuvant therapy with oral and pulse intravenous cyclophosphamide in the early phase of treatment can be effective in the management of patients with intractable pemphigus foliaceus, especially those who cannot be treated with high-dose systemic steroids because of diabetes mellitus.View full abstractDownload PDF (1046K) -
Eri YOSHIMURA, Takahito CHIBA, Masakazu TAKAHARA, Shinji KOBAYASHI, Ke ...2009 Volume 71 Issue 6 Pages 571-574
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSA 63-year-old man visited a dermatology clinic in January 2008 for swelling of his left cheek, which started in September 2007. He was diagnosed as having erysipelas and administered antibiotic. As the symptoms did not improve, a biopsy was performed. Because angiosarcoma was suspected histologically, he was referred to our hospital. On physical examination, a diffuse swelling appeared over his left cheek, without obvious purpura. The biopsied specimen showed that atypical tumor cells formed pseudovascular-type structures without red blood cells. Immunohistochemically, these tumor cells were negative for CD34, but positive for CD31 and D2-40 staining. Based on these findings, we diagnosed this case as having lymphangiosarcoma. Treatment was innitiated with monthly paclitaxel (175 mg/m2)and radiation (total 70 Gy). The tumor decreased gradually in size and currently remains without metastasis.View full abstractDownload PDF (1044K) -
Michiyo NAKANO, Kazuhiro INAFUKU2009 Volume 71 Issue 6 Pages 575-579
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESS49-year-old male who lives in the southern area of Chiba prefecture was treated with medication because of a high fever over 38°Cand skin eruption over his entire body for seven days. He had cleaned a poultry farm ten days previously. He had no tick bite eschar, but the high fever and renal dysfunction continued, so we suspected rickettsia infection and administrated minocycline 200 mg/day. The fever in this case was reduced promptly after the treatment. An indirect immunofluorescence analysis revealed an increased level of anti-Rickettsia japonica IgM and an IgG antibody titer of more than 160 times. Because of this result, the patient was diagnosed as having Japanese spotted fever. Histopathology of erythema strongly showed leukocytoclastic vasculitis in the dermis. There are only two previous reports discussing the histopathology of Japanese spotted fever. We review the case reports and present a summary of the literature regarding Japanese spotted fever associated with leukocytoclastic vasculitis and renal dysfunction.View full abstractDownload PDF (1164K) -
Emiko KAMADA, Yohei SANO, Azusa HAYAKAWA, Yasuko YAMADA, Yoshihiro IKE ...2009 Volume 71 Issue 6 Pages 580-583
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSWe report a case of drug-induced hypersensitivity syndrome (DIHS) with transiently raised IgM antibody to parvovirus B19 (PB19). A 61-year-old man presented with generalized erythema, fever and elevated liver function tests. The patient had been undergoing treatment with carbamazepine (CBZ) for approximately one month for a headache. After the patient was clinically diagnosed with DIHS, we stopped the administration of CBZ and switched to prednisolone (PSL 30 mg/day) instead. On the 14th day, his clinical symptoms improved significantly, but blood tests indicated a reactivation of human herpes virus 6 (HHV-6) and an increase in PB19 IgM antibody. It is well known that there is a relationship between DIHS and reactivation of HHV-6. A correlation between reactivation of PB19 and DIHS has been also reported. In our case, we observed the PB19 IgM antibody levels were rising, but didn't realize that the PB19 IgG antibody levels were also rising and believe that the PB19 IgM antibody was a false-positive. This possibility should be considered when elevated antibodies for other viruses are detected.View full abstractDownload PDF (1047K) -
Kenji HIROSE, Yoshihiro MATSUDATE, Yasutoshi HIDA, Shin-ichi ANSAI, Yo ...2009 Volume 71 Issue 6 Pages 584-588
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSA 17-year-old man with epilepsy developed erythema over the whole body and erosion on the lip accompanied by high fever, leukocytosis, eosinophilia and severe liver dysfunction. He had been taking Zonisamide for 4 weeks, Carbamazepine for 4 days and Amoxicillin just once. Based on clinical observations, we initially diagnosed this case as drug-induced hypersensitivity syndrome (DIHS). We started systemic steroid therapy, but bullae and erosions appeared on the trunk, face and limbs. Because toxic epidermal necrolysis (TEN) was highly suspected, steroid pulse therapy (mPSL 1 g × 3 days) was done, but it was not effective. Intravenous immunoglobulin (IVIG) therapy (0.4 g/kg/day × 5 days) showed a good effect and both skin lesions and systemic symptoms were resolved gradually. HHV-6 DNA was detected in blood sample and HHV-6 IgG antibody titers increased from 1 : 80 on day 6 to 1 : 10240 on day 19. A marked rise in soluble Fas ligand (sFasL) level was also seen on day 2, 6 and 8. Both patch test and drug-induced lymphocyte stimulation test (DLST) were positive for Zonisamide, Carbamazepine and Amoxicillin. In Japan eight cases of SJS/TEN with HHV-6 reactivation have been reported. Six of eight cases can be diagnosed as DIHS with the features of SJS/TEN. DIHS as well as common drug eruption (non- DIHS) can be viewed as the disease, which has a variety of skin lesions from mild types to severe types. We finally considered our case as DIHS with the severest type of drug eruption, TEN. High sFasL level also indicated severe clinical manifestations of the case.View full abstractDownload PDF (1208K) -
Atsuko IBUSUKI, Yuko HIGASHI, Shigeto MATSUSHITA, Takuro KANEKURA, Tos ...2009 Volume 71 Issue 6 Pages 589-591
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSA 32-year-old man was referred to our department complaining of a red nodule with exudate on his umbilicus. He had lower abdominal pain and fever 3 weeks prior to his first visit. These symptoms had subsided subsequent to a purulent exudate that he noticed 2 days later. Physical examination revealed a red nodule, 1 cm in diameter, and a fistula. Computed tomography showed a cord-like structure that connected to the umbilicus extending under the rectus abdominis muscle close to the urinary bladder. A diagnosis of pyourachus was made. Surgical treatment was employed. We approached the anterior space of the urinary bladder by a transverse lower abdominal incision, a partial cystectomy was performed, and the whole lesion was removed en bloc. After the excision, an umbilicus was reconstructed by means of a simple surgical technique utilizing a triangle flap designed on the skin adjacent to the umbilicus. We describe this case in detail.View full abstractDownload PDF (1051K)
Review
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—Molecular Mechanism of Skin Fibrosis—Hironobu IHN2009 Volume 71 Issue 6 Pages 592-596
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESS
Statistics
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——Evaluation of Itchiness by Visual Analog Scale (VAS) and Health-related Quality of Life by DLQI-base Examination——Yuko MASUDA, Daisuke WATANABE, Shin TANAKA, Yasuhiko TAMADA, Yoshiya M ...2009 Volume 71 Issue 6 Pages 597-602
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSWe examined the effectiveness of co-therapy with oral cetirizine and topical ointment. Changes in disease severity, itchiness, and health-related quality of life (HRQoL) were assessed using the atopic dermatitis (AD) severity score, a visual analog scale (VAS), and the Dermatology Life Quality Index (DLQI)-base examination, respectively. Nineteen patients with AD treated topically were enrolled (seven male and 12 female patients, average 28.4 ± 13.6 years old). Oral cetirizine hydrochloride 10 mg/day was administered for 4 weeks in addition to topical treatment. Disease severity, itchiness, and HRQoL were evaluated before and 2 and 4 weeks after the start of cetirizine administration. The rate of improvement was slight, with more than 50% improved after 2 weeks treatment and 80% after 4 weeks treatment. Mean VAS scores on itchiness and DLQI-base examination also showed effective improvement by degrees. These results suggest that the combination of cetirizine hydrochloride with topical therapy improves HRQoL in AD patients through improvement of disease activity and symptoms.View full abstractDownload PDF (1474K)
Therapy
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Toshihiko TANAKA, Yukiko NABESHIMA, Michihiro HIDE, Kenichi MORIMOTO, ...2009 Volume 71 Issue 6 Pages 603-608
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSWe conducted itraconazol pulse therapy for 104 cases of tinea unguium, and evaluated its clinical efficacy over a year to determine a proper timing of additional treatments for cases that were not improved by this therapy. Seventy out of 104 patients (67.3%) completed three cycles of itraconazol pulse therapy, and the time course of nail opacity in 17 patients was followed for one year from the beginning of the therapy. Nine of 17 (67.3%) patients showed remarkable improvements of the nail opacity, which became one or less at one year after the beginning of the therapy, but that in two (11.8%) patients did not show substantially improvements. When the ratio of nail opacity at sixth month were compared with those before the treatment, eight patients showed five or more decrease and six of them (75.0%) eventually became one or less at one year. On the other hand, nine patients showed less than five decrease at sixth month and only three of them (33.0%) achieved the improvement to one or less ratio of the opacity at one year time. Time course study of the nail opacity of patients with tinea unguium may be useful to predict the final effect of itraconazol pulse therapy in individual patients and the necessity of additional treatments before the end of one year observation.View full abstractDownload PDF (1279K) -
——Evaluation of High-dose Administration——Fukumi FURUKAWA, Nobuo KANAZAWA, Takashi YOSHIMASU, Takeshi NISHIDE, M ...2009 Volume 71 Issue 6 Pages 609-615
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSTo assess the usefulness of a second-generation antihistamine, ebastine (EBASTEL®), for pruritic skin disease, we investigated the efficacy and safety of ebastine administration at 20 mg/day to patients who showed an insufficient response at 10 mg/day. A total of 115 patients with pruritic skin disease, including new patients and those with an insufficient response to other antihistamines, were treated with 10 mg/day of ebastine for two weeks. Those in whom the drug showed insufficient efficacy then received treatment at 20 mg/day for another two weeks. If the patient showed a good response at 20 mg/day, the dose was decreased to 10 mg/day again, while it was maintained at 20 mg/day if the response was inadequate, followed by a further two-week treatment period in both groups of patients. As a result, of 99 patients who completed the first two-week treatment period with 10 mg/day of ebastine, 61 showed a good response and 38 did not. Thirty-seven of the 38 patients with an inadequate response (except for 1 dropout), then received two weeks of treatment at 20 mg/day, after which 11 showed a good response. In these 11 patients, significant improvement of skin symptoms and improvement of itching (VAS) was maintained. High-dose administration of ebastine caused no new adverse events. The above findings indicate that ebastine is an effective drug for pruritic skin disease and that increasing the dose to 20 mg/day in patients with poor response to 10 mg/day can achieve a better effect.View full abstractDownload PDF (1186K) -
Efficacy and Compliance of Loratadine Dry Syrup 1 % in Pediatric Patients with Pruritic Skin DiseaseKeizo MATSUO, Juichiro NAKAYAMA, Nanakuma Loratadine Dermatology Study ...2009 Volume 71 Issue 6 Pages 616-623
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSClinical efficacy and preference for loratadine dry syrup 1%, a second generation antihistamine in the treatment of pruritic skin disease were evaluated in 91 pediatric patients. A significant improvement of the primary endpoint, the severity of pruritus and skin eruption, was observed at 1 week after the start of loratadine treatment, and the efficacy of improvement was maintained at 2 weeks after the start of treatment. A visual analogue scale (VAS) score of pruritus also showed similar clinical efficacy. The global improvement rate was scored as “improved” or better in 91.3% of the patients. As for the safety profile, only epistaxis was reported in 1 patient and loratadine was well tolerated. In addition, the survey of the patients' preference for loratadine conducted after treatment showed that more than 90% of the patients who responded to the questionnaire did not hesitate to swallow the drug, and 94% of the responders did not miss or hardly missed the doses of loratadine. After taking loratadine, the effect of the drug became apparent within a few hours in 81% of the responders, and 72% of the patients or their parents wished to continue treatment with loratadine while 5% did not. These results suggested that loratadine dry syrup 1% might be a highly beneficial medication for the treatment of pruritic skin disease in pediatric patients.View full abstractDownload PDF (1732K)
Dermatologists around the World
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Hajime KANANO2009 Volume 71 Issue 6 Pages 625-626
Published: December 01, 2009
Released on J-STAGE: January 29, 2010
JOURNAL RESTRICTED ACCESSDownload PDF (972K)
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