A 24-year-old Japanese man, who was a cook and had been working in a buckwheat noodle shop for the previous 8 months, developed contact dermatitis caused by buckwheat. Two months after he started this work he noticed eruptions on his palms. He consulted several dermatologists and was treated with oral antihistamines and topical corticosteroids. However, his symptoms continued. He came to our clinic with the chief complaint of pruritic erythema with scales and vesicles on his palms and rhagades on his fingers. He could not use his hands because of pain. Results of closed patch testing with buckwheat noodles and flour were positive. The same test was negative in 6 healthy controls. Serum total IgE and RAST level of specific IgE for buckwheat were within normal range. Therefore, we made a diagnosis of allergic contact dermatitis in response to buckwheat. We told the patient to avoid contact with buckwheat, and thereafter he has had no trouble with his hands. Immediate hypersensitivity to buckwheat has been reported in many publications ; however, to our knowledge, this is the only report of a delayed reaction. Furthermore, we conclude that it may be of significance from the viewpoint of occupational dermatosis. We describe herein a patient with contact dermatitis from buckwheat.

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A 31-year-old woman presented with erythematous macules after she applied betamethasone butyrate propionate 0.05% ointment and alclometasone dipropionate 0.1% ointment for blepharitis. Previously, she had experienced contact dermatitis, probably due to bethamethasone valerate 0.12% ointment/cream that was effectively treated with oral betamethasone and topical betamethasone butyrate propionate 0. 05% ointment. Patch testing revealed positive reactions to alclometasone dipropionate, bethamethasone valerate, dexamethasone valerate and hydrocortisone butyrate on days 3 and 7, suggesting cross-reaction with members of groups D1 and D2, according to the classification of Coopman and Goossens. However, results of the patch test with betamethasone butyrate propionate was negative, although its product, Antebate^®, produced a clearly positive reaction.

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We report a 35-year-old female patient with diffuse cutaneous systemic sclerosis (SSc) accompanied by generalized morphea-like eruption. In 2002, Raynaud's phenomenon and skin sclerosis from fingers to chest had appeared. Because no favorable effect had been observed by the oral administration of steroid, D-penicillamine, salazosulfapyridine, and cyclosporine and PUVA therapy at the former clinic, she visited our hospital for further investigation in August, 2005. Severe skin sclerosis and gastroesophageal reflux disease were observed. Skin sclerosis gradually improved by daily oral administrarion of predonisolone (PSL ; 30 mg). The daily dosage of PSL had been gradually decreased to 7 mg. However, systemic itching appeared in September, 2007 and erythematous patchy sclerotic changes appeared on her dorsum of hands, back, and legs in December. The skin biopsy indicated the diagnosis of diffuse cutaneous SSc with generalized morphea-like eruption. Although the oral administration of PSL had not been effective for her morphea-like eruption, skin sclerosis and itching improved by topical tacrolimus ointment and oral administration of cyclosporine. In conclusion, topical tacrolimus treatment and oral cyclosporine administration would be good candidates for treatment to morphea-like lesions in SSc, when they are refractory to oral and topical corticosteroid treatment.

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We here describe 2 pediatric cases of cutaneous mastocytosis in which mutations of the c-kit gene were analyzed. Case 1 is a 3-month-old Japanese girl with brownish spots and bullae that emerged beginning a few days after birth on the back and the right leg. Case 2 is a 21-month-old Japanese boy who presented 2 months previously with small, thumb-sized, brownish spots arising on his abdomen. The number of eruptions has gradually increased in this patient. In both cases, mastocytosis was diagnosed by the clinical presentation and plane histology and toluidine blue staining of a lesional skin biopsy specimen. In Case 2, c-kit analysis using polymerase chain reaction and direct sequencing identified a heterozygous missense mutation located in exon 17 (A>T substitution that changed an aspartate (GAC) to a valine (GTC), Asp816Val).

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A 21-year-old woman presented at our clinic with a skin nodule on her back. The nodule was asymptomatic but growing slowly. Histological evaluation with various histochemical and immunohistochemical studies disclosed that the nodule was a nerve sheath myxoma, comprised of immature epithelioid cells and mature spindle-shaped cells with mucin-rich stroma. The tumor was resected. Of interest was intensive infiltration of eosinophils in the tumor stroma, which has not been cited in previous reports. Nerve sheath myoma is rarely reported, with only about 40 cases in the literature. This is a benign neoplasm and there have been no reports of metastasis. No recurrence is expected after careful excision.

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A 33-year-old woman presented with a 5×8 mm hard brownish papule, which was suspected to be a dermatofibroma. Results of pathology showed basal cell carcinoma-like epidermal changes in addition to the common pathological features of dermatofibroma. Immunohistological examination led to a diagnosis of dermatofibroma accompanied by basaloid epidermal hyperplasia.

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A 41-year-old man with herpes zoster on his forehead, the area of the first branch of the trigeminal nerve, was hospitalized and treated with 750 mg/day acyclovir. On the 2nd day of hospitalization, high fever, headache, vertigo, nausea and nystagmus developed. Lymphocyte count was markedly increased and VZV-DNA was detected by PCR in his cerebrospinal fluid. Based on these cerebrospinal fluid findings and manifestations, the diagnosis of VZV-associated meningoencephalitis was made. The dose of acyclovir was tripled (2250 mg/day), and steroid pulse therapy with 500 mg methylprednisolone was added. His cutaneous and central nervous system symptoms disappeared in 2 days, and no relapse occurred thereafter. Our experience suggests that dermatologists should consider central nervous system complications in patients with herpes zoster, even in young patients without underlying disorders.

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We report 2 cases of toxic epidermal necrolysis (TEN). Both patients were treated with corticosteroid pulse therapy and intravenous immunoglobulin (IVIG) administration. Steroid pulse therapy is usually selected as the initial therapy for TEN patients. However, it remains unclear whether we should select IVIG or plasmapheresis for subsequent treatment. Plasma exchange, which requires a large access vessel in the extremities, presents a high risk of infection, as the skin of TEN patients is erosive. In contrast, IVIG, which is administered through peripheral vessels, presents a low risk of infection. Furthermore, IVIG is effective for treatment of infection. As the primary disease process of TEN is skin erosion on the entire body following infection, IVIG, which is effective for severe infection, promotes epithelization of the skin. Hence, it is suggested that IVIG is recommended as therapy after steroid pulse administration.

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We report a 60-year-old woman with hand-foot reaction to sorafenib. She had scaly lesions on her palms and soles and yellowish and slightly elevated painful plaques on the plantar side of her bilateral big toes. Skin lesions appeared 5 days after the commencement of use of sorafenib at 800 mg daily, which was administered for treatment of lung metastasis of her renal cell carcinoma. Cessation of sorafenib resulted in amelioration of the skin lesions within 2 weeks. The same skin reaction reappeared when sorafenib was reintroduced because of multiple liver metastases. Because sorafenib has been approved by the Japan Ministry of Health, Labour and Welfare for the treatment of renal cell carcinoma in January 2008, its use can be expected to increase. We dermatologists should be aware of cutaneous adverse effects of sorafenib, including hand-foot skin reactions.

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[in Japanese]

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On 32 patients with atopic dermatitis and xerodermawe investigated the efficacy and safety of skin care products-HIBA Lotion^® and HIBA Cream^® each containing Aomori HIBA oil and Aomori HIBA distilled water-which are Thujopsis dolabrata var. hondae extracts. The natural plant extract is a cosmetic material obtained by steam distillation from the woody portion of Thujopsis dolabrata var. hondae. After 2 weeks of topical application, the products were found to be safe in all cases. The evaluation of the usefulness of the products was based on clinical findings, moisture level in the horny layer, and morphological observation of horny cells. The result of this study indicated that the two skin care products containing extracts of Thujopsis dolabrata var. hondae were quite safe in clinical application for cutaneous manifestations of dry skin and that they could improve skin symptoms.

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We investigated clinical effects of short-term (3-month) oral administration of Terbinafine at 125 mg/day in 88 patients with toenail tinea having a mean turbidity of 5.27. Sixty-three patients completed the 3-month treatment and 40 patients attended a 6-month visit. The mean turbidity decreased significantly over this time and the usefulness rate after 6 months was 81.1%. No severe adverse drug reactions were observed. Twenty of 28 patients with toenail turbidity less than 4 dropped out before 6 months. Meanwhile, 15 of 33 patients with turbidity between 4 and 7, and 11 of 27 patients with turbidity more than 7 dropped out during 6 months. It was noted that 11 of 28 patients with turbidity less than 4 did not visit clinics even within 3 months after the treatment. The reason for this low rate of completing treatment for 3 months was partly because of cure of toenail tinea, which was conveyed by telephone in some patients who had dropped. It was concluded that doctors should get strict agreement on compliance so that patients with rather mild nail tinea complete the short-term oral administration of Terbinafine for 3 months, because it may be an effective cure. More importantly, these results suggest that this short-term treatment was apparently effective even on the moderate to severe nail tinea patients, but that more than 6 months of administration of Terbinafine may be necessary for the purpose of cure in such patients.

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We studied the anti-itching and topical steroid sparing effects of olopatadine hydrochloride (olopatadine) in 99 patients with chronic eczema or chronic dermatitis. The 99 patients were randomized into two groups, one of which received olopatadine 5 mg orally twice daily. We assessed itching (by visual analog scale [VAS] and Shiratori's itching score), severity of skin eruptions (scoring of atopic dermatitis [SCORAD]) and quantity and rank of topical steroids used (topical steroid score) in the two groups over eight weeks. Itching, by both the VAS value and Shiratori's itching score and SCORAD decreased significantly after two-weeks, four-weeks, and eight weeks in the olopatadine group. In addition, topical steroid score significantly decreased in the olopatadine group. This randomized controlled study showed that administration of olopatadine improved the itching and severity of skin eruptions and decreased the topical steroid score.

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