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Mariko TAMAI, Yuko HIGASHI, Hidemichi KUBO, Takuro KANEKURA, Hirofumi ...
2009 Volume 71 Issue 2 Pages
128-130
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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A 71-year-old Japanese man was referred to our clinic in July 2007 for the evaluation of itchy erythema on his abdomen, which appeared about 12 hours after abdominal ultrasonography using Ultrasonic gel for assessment of prostate cancer metastasis. Physical examination revealed well-defined edematous erythema at the site of the gel application. A patch test with ultrasonic gel showed a positive reaction. He was subsequently patch-tested using the ingredients of the gel. Readings at 48h and 72h gave a positive reaction to methylparaben. Based on these results, a diagnosis of contact dermatitis due to methylparaben, an ingredient of ultrasonic gel, was made. The eruption immediately subsided following topical application of corticosteroid ointment that does not contain methylparaben.
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Naoko TAKEO, Misuzu AKAMINE, Kazumoto KATAGIRI, Sakuhei FUJIWARA, Seii ...
2009 Volume 71 Issue 2 Pages
131-136
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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We report here 3 cases of digital ulcers in women accompanied by collagen diseases. The first case consisted of a 76-year-old woman presented with skin ulcer on her right fifth toe. She had been treated for rheumatoid arthritis but the disease activity was low, according to the level of CRP and erythrocyte sedimentation rate. Angiography of the right foot revealed peripheral arterial occlusion of right tibia and fibula, and low bloodstream in the peripheral artery of dorsum and sole of foot. Amputation of her fifth toe was performed at the metatarsophalangeal joint, but subsequently, she repeatedly developed new ulcers around her toenail. Case 2 was a 64-year-old woman who presented with skin ulcer on her right first toe. She had been diagnosed with systemic sclerosis and interstitial pneumonia, but no therapy was needed. Angiography of the right foot revealed occlusion of the periphery of the anterior and posterior tibial arteries. Amputation of her first toe was performed at the metatarsophalangeal joint following right posterior tibial artery bypass graft. Case 3 was a 40-year-old woman who presented with gangrene on her right second fingertip. She had been treated with oral prednisolone (5 mg daily) for mixed connective tissue disease. Angiography of the hand revealed occlusion of the right and left ulnar artery at the wrist. Further, at the periphery of her first, second and third fingers, the proper palmer digital arteies on both sides were occluded. The progression of fingertip gangrene was stopped by increasing the dose of oral prednisolone (up to 20 mg daily) and administration of warfarin potassium. In all 3 cases, high titers of anti-centromere antibodies were found. The evaluation of the activity of systemic rheumatic disease, especially in cases with high titers of anti-centromere antibodies, is very important for the treatment of digital ulcers.
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Norio OHASHI, Hiromi KANTO, Chikako IWABUCHI, Yuki HASHIMOTO, Nanae IW ...
2009 Volume 71 Issue 2 Pages
137-140
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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Case 1: The patient was a 38-year-old male who developed a swollen lower lip after treatment for a decayed tooth. Histological examination revealed epithelioid cell granuloma, and he was diagnosed with cheilitis granulomatosa. Result of a patch test for urushiol was positive. Treatment with fexofenadine hydrochloride (120 mg/day) was initiated, and 10 months later, the lesion had improved. Case 2: The patient was a 31-year-old male who had experienced a swollen upper lip for two months. He underwent treatment for pyorrhea before he visited our hospital, but the lesion had not improved. Histological examination revealed epithelioid cell granuloma, and the patient was diagnosed as having cheilitis granulomatosa. He had many metal dental fillings and six post crowns. Results of patch tests for nickel sulfate and para-phenylendiamine were positive. Predonisolone (5 mg/day) and olopatadine hydrochloride (10 mg/day) were administered, and the lesion had improved one month after the start of this treatment. However, the metal dental workcould not be removed. It has been proposed that cheilitis granulomatosa is an incomplete form of Melkersson-Rosenthal syndrome. Based on previous case reports, we compared these two diseases and found that cheilitis granulomatosa is frequently associated with dental diseases or allergies to dental metals and responds better to therapy than does Melkersson-Rosenthal syndrome.
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Kei NEMOTO, Yoshitaka NAKAMURA, Hirotaka DEGUCHI, Masahiko MUTO, Junji ...
2009 Volume 71 Issue 2 Pages
141-143
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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A 37-year-old Japanese woman, who had first noticed asymptomatic eruptions on her trunk 4 years earlier, presented with scattered soft nodules that had a white to normal skin color. A biopsy specimen revealed increased amounts of collagen in the dermis. Collagen bundles were thickened and irregularly arranged. Elastic fibers were scanty and partially fragmented. She was otherwise in good health and there was no family history. These findings led us to make a diagnosis of eruptive collagenoma, a type of connective tissue nevus, according to the classification of Uitto. The patient was under control without any treatment, because there were many lesions.
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Shinsuke YASUKAWA, Taizo TAKESHITA, Takao MAE, Daisuke MORI, Masutaka ...
2009 Volume 71 Issue 2 Pages
144-146
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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A 61-year-old man presented with a subcutaneous tender cyst in the ischial region. We performed partial excision of the cyst, and the pathological findings showed fibrin deposits on the wall covered with several layers of synovial cells. The cyst was diagnosed as synovial bursitis. No recurrence has been observed nine months after the operation. Due to the rare occurrence of synovial bursitis and thus limited opportunity for dermatologists to encounter, it is important for dermatologists to be aware of the characteristic clinical and pathological features of synovial bursitis for appropriate diagnosis.
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Ryutaro ICHIKAWA, Miki ICHIKAWA, Masutaka FURUE, Hiromaro KIRYU
2009 Volume 71 Issue 2 Pages
147-149
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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A papule with no subjective symptoms had been present for several years on the left side of the lower jaw in a 66-year-old woman. Histopathological examination revealed a nodular structure in the dermis with a cleft between surrounding tissue, and the nodular structure was composed of nerve bundle-like multiple nodular structure of bundled proliferation of mainly spindle cells. Some of the nuclei of the spindle cells were in palisades and most of them were positive for S-100 protein. Moreover, axons were stained with Bodian stain. Based on these findings, a diagnosis of palisaded encapsulated neuroma was made. Since there have been few reports of this type of neuroma in Japan, the clinical and histopathological characteristics of this neuroma are described with some discussion of the literature.
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Yohei KUDO, Ryuhei OKUYAMA, Setsuya AIBA, Muneo TANITA
2009 Volume 71 Issue 2 Pages
150-152
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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A 78-year-old man had noted red eruption 2 year before in his penis shaft. The skin eruption was diagnosed with herpes simplex and candidiasis. He was treated topically, but his eruption was not improved. He was then referred to us in early April, 2007. Examination showed well-defined erythema with erosion on the inferior surface of the penis shaft. Skin biopsy showed atypical cells with an abundant, pale-staining cytoplasm and round nucleus within the epidermis. Based on positive staining with cytokeratin 7 (CK-7) in the neoplastic cells, we suspected the erythema of extramammary Paget's disease. However, we could not neglect the possibility of pagetoid Bowen's disease, since the neoplastic cells were negative for PAS, and CEA. The total absence of p63 ruled out the possibility of pagetoid Bowen's disease. We surgically removed the skin change under local anesthesia. There was no evidence of tumor recurrence or metastasis almost 1 year later.
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Masayuki SUGAWARA, Takahiro HAGA, Katsuko KIKUCHI, Setsuya AIBA
2009 Volume 71 Issue 2 Pages
153-155
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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A 80-year-old man had noticed a tumor with bleeding in the anal region during evacuation. Physical examination revealed a 10 × 20 mm erythematous tumor accompanied by an ulcer on its surface at the 3 o'clock position of his anus. Additionally, there were blackdots in a part of the tumor. We excised the tumor surgically under local anesthesia, and we diagnosed it as basal cell carcinoma based on the histological findings and positive immunohistochemical staining for Ber-EP4. Perianal basal cell carcinoma is comparatively rare, and it presents a histopathological image similar to that of anal canal basaloid carcinoma. Anal canal basaloid carcinoma has the possibility of distant metastasis, thus we should be careful to differentiate perianal basal cell carcinoma from anal canal basaloid carcinoma.
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Makiko WATANABE, Hiroshi MIZUNO, Masao HIRASHIMA
2009 Volume 71 Issue 2 Pages
156-159
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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We introduce the representative case of Tsutsugamushi disease that we recently experienced and report the characteristics of clinical symptoms and clinical findings of 62 cases experienced in 10 years (from 1998 to 2007), in Hiroshima City Asa Hospital. Mean age was 52.2 years (range4-84), and 34 were males and 28 were females. 58 patients (93.5%) were infected during October to December. 51 (82.3%) patients lived in Asakita-ku in Hiroshima city. 49 cases (79.0%), patients first visited department of internal medicine. Fever was observed in all cases, and eruption was observed in 61 cases (98.4%). Eschars were determined in 53 cases (85.5%), and swelling of lymph nodes were observed in 41 cases (66.1%). Fever came before eruption in most of the cases including 50 (88%) out of 57 cases. The time during fever and eruption was an average 3.5 days. As the abnormalities in laboratory values, of the 59 cases examined on peripheral blood smear, atypical lymphocytes were detected in 48 cases (81.4%). Liver dysfunction (high values of GOT or GTP) was observed with high rate in 57 cases (91.9%). On the other hand, decrease of platelets was observed only in 10 cases (16.1%) and no case developed disseminated intravascular coagulation. All cases quickly alleviate fever after the appropriate treatment, and an average from treatment to alleviate fever was 1.5 days. These findings may be helpful for next medical treatment.
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Eri ASAKAWA, Machiko FUJIHIRO, Takashi MOCHIZUKI
2009 Volume 71 Issue 2 Pages
160-163
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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We report here a case of a healthy 91-year-old woman who presented with papules and erythema accompanied by itching on the face, which began six months ago. We treated her as contact dermatitis, but she stopped consultation. Upon reexamination two months later, several nodules and subcutaneous tumors were present on her forehead, nose and mandible. Several pustules were also on the top of her head. A biopsy specimen showed an infectious granuloma. Hyphae could be seen within the dermis when stained with Grocott's methenamine silver and periodic acid Schiff (PAS) stains. Trichophyton rubrum was identified by the culture of mandible skin. The hyphae could also be seen in the abscess of the head. Tinea was noted in the toenails and fingernails, but the Trichophyton reaction was negative. The patient improved quickly with oral intake of the antimycotic medicine, griseofulvin. The cause of the disease was supposed to be the application of a very strong class steroid ointment for about 2 months which was prescribed by her physician.
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Motoi TAKENAKA, Shinichi SATO
2009 Volume 71 Issue 2 Pages
186-191
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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Urticaria is believed to decrease QOL in patients due to the repeated occurrence of wheal and itch. However, there have been a limited number of reported studies investigating interventions that improve QOL as well as reduce symptoms. We studied the effect of cetirizine hydrochloride on QOL of 26 patients with urticaria who had not previously received oral/injectable steroids within 2 weeks before study commencement. Cetirizine 10 mg was administered orally once daily for 4 weeks, and skin symptoms, itch (by visual analog scale [VAS]), severity of sleepiness, and QOL (by Dermatology Life Quality Index; [DLQI]) were evaluated. Five patients dropped out, and 21 patients were availabe for analysis (M/F, 9/12; mean age, 52.6 ± 13.5 years). At the end of the study, VAS significantly improved from 64.0 at baseline to 13.7. Both skin symptoms and itch resolved in 8 patients (38.1%). Regarditching sleepiness as a side effect, 19.2% of 26 patients had severe sleepiness; however, all patients with improved urticaria symptoms were nonetheless satisfied with the treatment. On the other hand, all three patients in whom there was no improvement of symptoms were dissatisfied with the treatment, regardless of sleepiness (sleepiness, n = 1; no sleepiness, n = 2). The total QOL score at baseline was 4.8; subscale scores were 2.7 for "symptoms and feelings," 1.2 for "daily living," and 0.7 for "workand school." At the end of the study, the total score was 1.3, showing a significant improvement (P<0.01), and other QOL subscales also showed significant improvements (all P<0.01). Taken together, improvements were observed not only in the assessments by physicians but also in the patient self-assessments (VAS and DLQI). Thus cetirizine seems very useful for the treatment of urticaria and thereby improves QOL of patients with this disease.
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Junna OBA-OKADA, Noriko FUKIWAKE, Masutaka FURUE
2009 Volume 71 Issue 2 Pages
192-200
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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Phototherapy has become a widely used treatment for a variety of skin diseases. In particular, 311-nm narrowband ultraviolet B (nb-UVB) is commonly used and quite effective in the treatment of psoriasis, atopic dermatitis, prurigo, mycosis fungoides and many other dermatoses. However, the use of this modality is limited because it irradiates uninvolved surrounding skin in addition to the affected area and is thought to increase the risk of long-term adverse effects such as photoaging and photocarcinogenesis. Shielding of the surrounding normal area is time-consuming, and therefore, patients with mild localized lesions tend to be excluded from phototherapy. The development of 308-nm xenon-chloride (XeCl) lasers and lamps as targeted nb-UVB treatment devices has provided a new and promising therapeutic option for these patients. These devices deliver high-intensity light selectively to individual lesions, thus limiting the exposure of normal, unaffected skin to unnecessary radiation. Therefore, higher doses of irradiation can be used during a single treatment, resulting in faster clearing and fewer exposures, as compared to conventional nb-UVB. Several reports have demonstrated the effectiveness of the XeCl excimer laser and lamp in the treatment of psoriasis, vitiligo and other skin diseases. Here, we examine the clinical efficacy of a monochromatic 308-nm excimer lamp for the treatment of various skin diseases, including psoriasis, vitiligo, localized scleroderma, nail lichen planus, multiple lymphocytomas/ plasmacytoma, alopecia, systemic sclerosis and complex regional pain syndrome. Our results indicate that this excimer lamp method is effective in the treatment of many dermatoses.
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Minako YASUMOTO, Takako SHIMODA, Rieko TSUBOUCHI, Seiji KAWANA
2009 Volume 71 Issue 2 Pages
201-205
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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We assessed the efficacy of the topical ALA-photodynamic therapy for actinic keratosis and basal cell carcinoma. Seven cases of actinic keratoses, including two with large lesions, one with multiple lesions, two who were not responsive to cryotherapy, and two who requested cosmetic therapy, and one case of basal cell carcinoma who could not undergo operation because of anti-coagulant therapy received the treatment. Consequently, tumor lesions were clinically absent in five cases following three to eight doses of treatment and diminished in two cases. Topical ALA-PDT has the advantage of being cosmetic-friendly, since no scars or high pigmentation are observed after treatment. On the other hand, there is room for improvement especially with regard to the procedure time, since it requires four hours from application of the ALA onto the lesion to exposure of the light.
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Eiichiro TANAKA, Masaaki ITO
2009 Volume 71 Issue 2 Pages
206-208
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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Effects against tinea unguium were evaluated on a preparation composed of a combination of liranaftate cream (anti-fungal cream for topical use) and urea ointment (possessing horny layer-softening activity). [Subjects] The study involved patients satisfying all of the following requirements: (1) diagnosed as having tinea unguium or tinea pedis on the basis of positive findings from direct microscopy and (2) patients not indicated for oral anti-fungal drug therapy or (3) patients desiring topical anti-fungal drug therapy. [Methods] At bedtime, a 1 : 1 mixture of liranaftate cream and urea ointment was simply applied to the test site of each subject. [Results] In 16 of the 22 patients, opacity alleviated following treatment, and it disappeared completely in one patient. "Prominent" or better improvement was seen in 4.5% of all cases, "moderate" or better improvement seen in 13.6% and "slight" or better improvement in 59.1%. Thus, the responses to this therapy were comparable to those previously reported for topical anti-fungal drug therapy. Since patients with tinea unguium are often unable to take oral anti-fungal drugs because these drugs are listed as requiring particular care or drugs that are concomitantly contraindicated for these patients, we strongly believe that liranaftate cream should be considered as an alternative for treatment of tinea unguium.
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Fukumi FURUKAWA, Takaharu IKEDA, Shinichi SATO, Masahiro TAKIGAWA
2009 Volume 71 Issue 2 Pages
209-215
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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In 2002, we reported the results of a questionnaire study on prescription of glucocorticoid by dermatologists and preventive therapy for glucocorticoid-induced osteoporosis. In the report, several points were found: 1) more than 90% of dermatologists prescribed oral corticosteroids for treatment of dermatological disorders, 2) the mean monthly numbers of patients treated with corticosteroids were 48.3 by dermatological general practioners and 14.9 by hospital dermatologists, 3) periodic checks for glucocorticoid-induced osteoporosis were done by 5.2% of general practitioners and 29.6% of hospital dermatologists, 4) preventive therapy for glucocorticoid-induced osteoporosis was administered by 38.5% of general practitioners and 50.6% of hospital dermatologists, and 5) there were no standards in their criteria for initiation of the preventive therapy. After the 1st report, the guidelines for preventive therapy for glucocorticoid-induced osteoporosis were established. Thus, a second questionnaire study was performed to understand the change in glucocorticoid use by dermatologists and preventive therapy for glucocorticoid-induced osteoporosis. The interesting points from this study are as follows: 1) the mean monthly numbers of patients treated with corticosteroids were 16.1 by general practioners and 13.5 by hospital dermatologists, 2) periodic checks for glucocorticoid-induced osteoporosis were done by 10.7% of general practitioners and 36.7% of hospital dermatologists, 3) preventive therapy for glucocorticoid-induced osteoporosis was administered by 24.0% of general practitioners and 84.4% of hospital dermatologists, and 4) bisphosphonates were the primary agent for initiation of the preventive therapy in 46.5%, which was a marked change from the first questionnaire study (12.5%). The establishment of the guidelines for preventive therapy for glucocorticoid-induced osteoporosis has changed the therapy administration for this disease in the dermatological field. Further, the bisphosphonates are less frequently administered by general practioners than by hospital dermatologists.
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Hideko HATTORI, Mina YAMADA, Yasuko INABA, Kayoko MATSUNAGA, Mie SUZUK ...
2009 Volume 71 Issue 2 Pages
216-223
Published: April 01, 2009
Released on J-STAGE: May 30, 2009
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The purpose of washing the face is not only to clean it, but also to maintain the skin physiology in a healthy state. In particular, patients with atopic dermatitis and xerosis require a low-stimulus hypoallergenic formula with good lubrication and moisture-retention properties to prevent irritation of their sensitive skin. A new facial wash, consisting of a self-foaming gentle cleanser in a pump dispenser, was examined over 4 weeks to evaluate its safety and effectiveness in patients with dry skin, such as atopic dermatitis and xerosis. No side effect was reported during the study in 41 subjects. Skin physiology was evaluated in 21 of these subjects. The skin surface moisture level was significantly increased after 4 weeks of use, and transepidermal water loss was improved. Most of the subjects evaluated the new facial wash as an easy-to-use, effective facial cleanser and moisturizer. The results of this examination show that the new self-foaming gentle cleanser is safe, with effective skin-moisturizing action, and could be used by patients with dry skin, such as atopic dermatitis and xerosis, with a high degree of satisfaction.
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