The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 73, Issue 1
Displaying 1-16 of 16 articles from this issue
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Clinical Case Reports
  • A Case of Adult Still's Disease in Which Examination of the Plasma Level of Interleukin-18 was Useful for Early Diagnosis
    Kazuo MIZUMOTO
    2011 Volume 73 Issue 1 Pages 8-12
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.8
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    A 74-year-old woman had high fever, over 39°C, and itchy constant dark violet eruptions on her left upper arm and back. Her plasma level of ferritin was high. After further examination, she was diagnosed with adult Still's disease because her plasma level of interleukin (IL)-18 was notably high, and she was administered prednisolone at a daily dose of 30 mg. During the course of the disease, high fever recurred and she was administered a daily dose of 40 mg of prednisolone, which rapidly reduced the fever. After that, the daily dose of prednisolone was gradually decreased to a daily dose of 5mg, and she have had no recurrence through the 70th day after her first visit. Although this case did not fulfill Yamaguchi's diagnostic criteria of the adult Still's disease, with recent knowledge we were able to treat it rapidly because of the examination of the plasma level of IL-18. We considered the examination of inflammatory cytokines, such as IL-18, useful for the diagnosis of adult Still's disease.
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  • Histological Findings in Pressure Ulcers : Four Case Reports
    Takahito CHIBA, Shuji FUKAGAWA, Akari TASHIRO, Ayako HAYASHI, Yoichi M ...
    2011 Volume 73 Issue 1 Pages 13-18
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.13
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    Although knowledge of tissue response to pressure is important for understanding the mechanism of the pressure ulcer development, few previous reports describe histopathological investigations on pressure ulcers. We performed skin biopsies from erythematous sites in four patients to exclude other diseases. Case 1 underwent a biopsy of an erythema of the buttocks caused by chronic pressure in the sitting position. The histopathological features were accompanied by vascular ectasia and diffuse hemorrhage, which showed the characteristics of both an erythema and a purpura. The skin biopsy of Case 2 was performed from an erythema with a bulla on the right thigh. It was caused by mechanical stimulation with the rehabilitation equipment. The histopathological observation showed extensive necrosis from the epidermis to the subcutaneous fat layer. We performed a biopsy on Case 3 of an erythema with an alopecic lesion in the left temporal area resulting from prolonged sleep on that side. Inflammatory cell infiltration and fibrosis were observed around hair follicles. The skin specimen in Case 4 was obtained from an erythema of a great trochanter lesion caused by chronic pressure in the sleeping position. The epidermis became increasingly thicker, and newly formed vessels were observed at the papillary dermis. In conclusion, although each erythema looks similar macroscopically, there are various histopathological changes in the microscopical analysis. In addition, we reviewed the previous reports on the histopathological analysis of pressure ulcers.
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  • A Case of Neonatal Lupus Erythematosus Associated with Prominent Skin Lesions
    Akiko TARA, Takeshi OKAWA, Takuya INOUE, Noriyuki MISAGO, Yutaka NARIS ...
    2011 Volume 73 Issue 1 Pages 19-22
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.19
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    A one-day-old boy presented with annular erythematous lesions on the face and chest. He was diagnosed with neonatal lupus erythematosus because of extremely high titers of his own and maternal antinuclear antibodies and autoantibodies to Ro/SSA and La/SSB. He did not develop congenital heart block. During the course of the disease, the erythematous lesions enlarged progressively and were beginning to become ulcerated. However the titers of the autoantibodies started to decrease at the age of 3 months and the erythematous lesions disappeared by 8 months of age.
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  • A Case of Dermatomyositis with Rapidly Progressing Small Cell Lung Cancer
    Hirotaka DEGUCHI, Mitsutaka NAKAMURA, Junji NAKANO
    2011 Volume 73 Issue 1 Pages 23-25
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.23
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    A 76-year-old woman presented with itchy erythema on the face, upper arms and trunk, muscle tenderness of the extremities and general fatigue. A diagnosis of dermatomyositis was made according to the clinical manifestations, a high level of serum CK, and a high erythrocyte sedimentation rate. No malignant tumor was found at the initial investigation. She was treated with oral prednisolone at 50 mg per day, and her symptoms were improved. However, her disease relapsed 3 months later, and a small cell lung cancer with multiple metastases was found. The tumors were treated with chemotherapy and regional radiotherapy ; nevertheless, she died 8 months after her first visit. We reviewed the clinical characteristics of dermatomyositis associated with malignant tumors.
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  • A Case of Harlequin Ichthyosis
    Yukako ITO, Mizuki GOTO, Yoshitaka KAI, Yutaka HATANO, Kazumoto KATAGI ...
    2011 Volume 73 Issue 1 Pages 26-30
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.26
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    We report on a female infant who was born at 38 weeks of gestation. Harlequin ichthyosis (HI) was suspected from her facial appearance by prenatal ultrasonography, and the baby was delivered by Caesarean section. At birth, she was generally covered by a plate-like stratum corneum. Marked ectropion of eyelids, eclabium and deformation of auricles were observed. She was diagnosed as having HI by her characteristic clinical features. A skin biopsy specimen revealed marked hyperkeratosis, and electron microscopic observation revealed many lipid droplets in the cytoplasm of corneocytes. Gene analysis of ABCA 12 revealed that the patient was a homozygote for two missense mutations located at exon 9 and exon 31. She was treated with oral etretinate and topical application of petrolatum ointment soon after birth. Hard, thick scales were removed, and the stratum corneum gradually became thinner. Ectropion of eyelids also improved. Now at the age of two years, she has no serious complication with oral intake of the same amount of etretinate as at birth.
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  • A Case of Primary Dermal Melanoma Appearing as a Subcutaneous Tumor on the Back
    Yuka KONDO, Yukari OKUBO, Atsuko KAWAGUCHI, Kae USUI, Ryokichi IRISAWA ...
    2011 Volume 73 Issue 1 Pages 31-34
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.31
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    A 70-year-old Japanese female noticed a nodule on her back about 6 months before her first visit to our department. Clinical examination revealed a 1cm-sized, dark red, movable nodule on her back. There was no evidence of inflammation orinfiltration around the nodule. The nodule was initially suspected of being an atheroma, and was excised entirely. Histopathological examination revealed that the tumor had been situated in the deeper dermis to subcutaneous tissue and wascomposed of spindle cells and mildly atypical round cells. There were no atypical melanocytes in the epidermis. The tumorcells were positive for S-100, c-kit, and vimentin, weakly positive for MELAN-A, and strongly positive for p53. The nodule wasprovisionally diagnosed as a metastatic malignant melanoma, and an expanded resection was performed. Detailed physicalexamination on the entire skin surface revealed no lesion that suggested a primary melanoma or a resolved melanotic lesion. CT and MRI examinations revealed no tumor lesions in the body. We finally diagnosed the lesion as primary dermalmelanoma. There has been no recurrence or metastasis for 18 months following the removal of the tumor.
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  • A Case of Sebaceous Tumor with a Whole Cystic Structure
    Yutaka MASUJI, Hisao EGAWA, Keita KOBAYASHI
    2011 Volume 73 Issue 1 Pages 35-39
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.35
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    A 45-year-old women had a 35×35×15mm dome-shaped, soft tumor on the back of the head. Histopathological findings revealed a well-circumscribed cystic lesion located in the dermis and subcutaneous tissue. In some areas of the cyst, there were papillary and multiple lobules mainly composed of mature sebocytes. In other areas, lobules were mainly composed of basaloid cells with some cytologic atypia and scattered mitoses. We considered this sebaceous tumor as a borderline case from benign to malignant. And it had many histopathological resemblance to cystic sebaceous tumors, specific marker lesions of Muir-Torre Syndrome. After excision, she has had no local reccurence and no history of internal malignancy for 3 years.
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  • A Case of Molluscum Contagiosum in a HIV Infected Patient Resolved Following Highly Active Anti-retroviral Therapy
    Kaori SUETSUGU, Masuyoshi SAITO, Ryoji TSUBOI
    2011 Volume 73 Issue 1 Pages 40-43
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.40
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    We report a case of a 43 year-old man who developed molluscum contagiosum while receiving Highly Active Anti-Retroviral Therapy (HAART) for the treatment of HIV. The patient began developing small nodules on his face from February, 2008, the number of nodules increasing rapidly. HAART was initiated in the beginning of October, 2008. One month later, about half of the nodules developed a red halo, and disappeared entirely without any further treatment. The number of CD4+ lymphocytes was 27/μl at the time of the onset of molluscum contagiosum, and 342/μl at the time of the complete remission of the symptoms. There were 6 cases of molluscum contagiosum among the HIV infected patients seen in our ward including the present case. It would appear that molluscum contagiosum tends to develop when the number of CD4+ lymphocytes is 100/μl or less, and to resolve when the number of CD4+ lymphocytes recovers as a result of HAART.
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  • Cycloserine-induced Lichenoid Drug Eruption
    Motoko MIYACHI, Ritsuko KUNITAKE, Nobuo HIROTA, Shinichi IMAFUKU, Juic ...
    2011 Volume 73 Issue 1 Pages 44-48
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.44
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    We report a case of cycloserine-induced lichenoid drug eruption in a 63-year-old man with multidrug resistant tuberculosis. He had been treated with cycloserine, levofloxacin, and streptomycin sulfate for 6 months. He suffered from pruritic violaceous plaques on the dorsum of the hands and pigmentation on his cheeks 10 days after addition of rifabutin. Histopathologic findings were consistent with lichenoid drug eruption. Patch tests with the drugs revealed a positive reaction only to cycloserine. Six months after completion of anti-tuberculous treatments, the skin lesions subsided. In this case, the patch test was useful to identify the causal agent.
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Review
Statistics
  • Clinical Survey of 272 Cases of Tinea Faciei
    — Diagnosed at a Japanese Dermatology Clinic during 1990-2009 —
    Hidekazu SHINODA, Hanako SEKIYAMA, Katsutaro NISHIMOTO
    2011 Volume 73 Issue 1 Pages 54-60
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.54
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    This paper analyzes 272 cases of tinea faciei that were diagnosed at our clinic between 1990 and 2009, with an average of 13.6 cases per year. The youngest patient was a 26-day-old boy, the oldest was a 89-year-old woman, and the male : female ratio was 129 : 143. Trichophyton rubrum in 156 cases (72 males, 84 females), Microsporum canis in 43 cases (8 males, 35 females), and Tricophyton tonsurans in 39 cases (37 males, 2 females) accounted for 88% of the pathogenic fungi. In younger patients (elementary through high school students), T. tonsurans and M. canis were identified as the pathogens, but in the adult age group (20 through 80-plus years of age) the main pathogen was T. rubrum. The patients presented with a typical rush (erythema annulare, tinea cruris) in 182 cases and with atypical rushes in 90 cases, the latter including discoid and desquamated erythema as well as steroid-modified tinea. Steroid-modified tinea was seen mainly in females, and the pathogen detected was T. rubrum in most cases. Typical rushes were caused mainly by T. rubrum and M. canis. T. tonsurans infections presented with a similar number of erythema annulare (17 cases) and discoid erythema (16 cases). Tinea faciei cases with multiple lesions had a 22% comorbidity with tinea capitis (including 9 cases with black dot ringworm), a percentage much higher than the 4% found in solitary lesion cases. Tinea at the ear was found in 42 cases (15%). A total of 100 cases had been previously diagnosed as eczema or dermatitis at a different medical institution, and 3 cases had been diagnosed as impetigo. From the latter 3 cases we isolated M. canis. The diversity of pathogens and clinical pictures of tinea faciei often leads to misdiagnosis. Therefore, we consider it necessary to promote ‘tinea faciei’ as an independent disease type in order to increase the awareness of clinicians towards this infection.
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Therapy
  • Research on Preferences and Satisfaction about Antihistamine of Patients with Itchy Allergic Skin Disease
    Ken MIYOSHI, Hideki NAKAJIMA, Shigetoshi SANO
    2011 Volume 73 Issue 1 Pages 61-68
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.61
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    Patients with allergic skin disease were asked about their preferences for a “more effective” antihistamine or a “less hypnotic” antihistamine on a questionnaire, and medical outcomes, safety and patient satisfaction were assessed for the treatment chosen on the questionnaire. Of 76% who preferred a “more effective” drug, 43% was “very satisfied” with the drug, 36% “somewhat satisfied” and 21% “neither satisfied nor dissatisfied”, while 22% preferred a “less hypnotic” drug, 29% of whom was “very satisfied”, 50%“somewhat satisfied”, 14% “neither satisfied nor dissatisfied” and 7% “very dissatisfied.” With regard to their preferences being considered in treatment decision making, 19 patients “felt safe and got a sense of satisfaction and contentment”, 47% of whom was “very satisfied” and 53% “somewhat satisfied” with their treatment. Of 36 patients “leaving treatment selection to their doctor because of lack of knowledge”, 36% felt “very satisfied”, 33% “somewhat satisfied”, 28% “neither satisfied nor dissatisfied” and 3% “very dissatisfied.” Nearly half of the patients who had been “bothered by sleepiness” after taking over-the-counter cold medicines had a preference for a “more effective” antihistamine. It is suggested that treatment selection depending on patient preferences results in bringing a feeling of safety and increasing patient satisfaction.
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  • Usefulness of Cetirizine Hydrochloride (Zyrtec®) for Senior with Pruritus or Asteatotic Eczema
    Masahisa SHINDO, Nanako YAMADA, Osamu YAMAMOTO
    2011 Volume 73 Issue 1 Pages 69-76
    Published: February 01, 2011
    Released on J-STAGE: June 09, 2011
    DOIhttps://doi.org/10.2336/nishinihonhifu.73.69
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    To assess the usefulness of cetirizine hydrochloride (Zyrtec®), for senior over 65years-old with pruritus or asteatotic eczema, we investigated the efficacy and safety of cetirizine administration. Significant improvement of itching and improvement of scratch was maintained for 2 weeks and 4 weeks after treatment with cetirizine. There are no adverse events. All cases were useful on general evaluation. Patients were treated with 10 mg/day of cetirizine hydrochloride for 2 weeks. Those in whom the drug showed insufficient efficacy then received treatment at 20 mg/day for another 2 weeks. As a result, increasing the dose of cetirizine maintained significant improvement of the symptom and general improvement. 76% of the patients reported that usual dose, 10 mg/day, of cetirizine for 2 weeks improved the symptom. Total 89% of the patients improved the symptom after increasing the dose of cetirizine on insufficient case. The cetirizine hydrochloride seems safe and useful drug without serious side effect.
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