The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 74, Issue 3
Displaying 1-15 of 15 articles from this issue
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Color Atlas
Clinical Case Reports
  • A Case of Eosinophilic Pustular Folliculitis Successfully Treated with Tacrolimus Ointment
    Miki KOHNO, Mito TOYODA, Jyunichi KOBAYASHI, Masutaka FURUE
    2012 Volume 74 Issue 3 Pages 243-247
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.243
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    We report a case of eosinophilic pustular folliculitis (EPF) that was successfully treated with topical tacrolimus ointment. A 43-year-old Japanese woman presented with a 3-month history of a pruritic eruption on the left side of the face. She had been treated at a previous clinic with topical steroids and oral prednisolone (15 mg/day). The eruption responded to oral prednisolone, but she had moon face due to the side effect of steroid, so oral prednisolone was stopped. A histological examination of a skin lesion revealed infiltration of eosinophils in and around the hair follicles and sebaceous glands. White blood cell count was 5,200/μl (8.3% eosinophils). From the clinical examination and histological findings, we diagnosed the patient as EPF. The patient was treated with topical tacrolimus ointment. After 2 weeks, the eruption had improved markedly, and she is now free from symptoms. Tacrolimus ointment may become the treatment of choice for patients with EPF.
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  • A Case of Fabry's Disease Diagnosed in Adult
    Saori TATEMATSU, Shinichi IMAFUKU, Tatsuki MORI, Kotaro ITO, Monji KOG ...
    2012 Volume 74 Issue 3 Pages 248-251
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.248
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    A 33-year-old man was referred to our outpatient clinic because of proteinuria found by a regular medical checkup. He was further referred to our department of dermatology because multiple red papules were found on his thighs and trunk on a physical examination. A biopsy specimen of the papule showed dilated capillary dermis with elongated rete ridges, establishing the diagnosis of angiokeratoma. Electron microscopy revealed electron dense granules (Zebra body) in the endothelial cells of dermis and renal glomerular epithelial cells. Alpha galactosidase A activity was less than 1% of healthy control, and the patient was diagnosed as having Fabry's disease. Genetic analysis revealed a nonsense mutation in the 237 th codon of Exon 6 of the GLA gene. Despite the very low alpha galactosidase activity, the patient had minimal damage of the internal organs due to the precipitation of the globotriaosyl ceramide.
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  • A Case of Biotin Deficiency in Baby Fed Formula Milk
    Naoki SATO, Mikiko TOHYAMA, Shinji MURAKAMI, Koji HASHIMOTO, Koji SAYA ...
    2012 Volume 74 Issue 3 Pages 252-255
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.252
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    A 9-month-old baby who had been diagnosed as nonketotic hyperglycinemia neonatally was fed formula milk without glycine from 5 month after birth. Two months later, erythema appeared around his mouth, and then on the buttock, forearm and leg skin. Topical steroid therapy was not effective. Since the formula milk provides only 0.4 μg/day of biotin, biotin deficiency was suspected. Daily 0.1 mg of biotin administration by intramuscular injection resulted in rapid improvement of the skin eruption. Moreover, psychomotor development was also improved dramatically. When acrodermatitis is observed in an infant fed formula milk, biotin deficiency should be suspected in addition to zinc deficiency.
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  • Seven Cases of Blue Rubber Bleb Nevus Syndrome
    Reiko KAWASAKI, Kyoko KUDO, Chisato GONDO, Shiori KATO, Fumiko YASUKAW ...
    2012 Volume 74 Issue 3 Pages 256-264
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.256
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    Blue rubber bleb nevus syndrome is a rare disorder characterized by unique, multiple bluish, elastic hemangiomas of the entire body, mainly involving the skin and gastrointestinal tract. We have experienced seven patients with this syndrome and treated surgically those hemangiomas that resulted in serious dysfunction or disfigurement. Based on the follow up study (including a 62-year-old woman, who had been followed-up for more than 20 years), we propose prompt surgical treatment before hemangiomas grow incurable, particularly at the early phase of this syndrome. This disease could be suggested even at the onset of symptoms based on the unique hemangiomas, and some of them certainly show steady growth and thus are a burden physically, functionally and cosmetically.
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  • A Case of Extramammary Paget's Disease with Local Recurrence and Lymph Node Metastasis Following an Interval of 20 Years
    Rie MAEKUBO, Eiji MUROI, Yukichika ISHII, Kosuke MOCHIDA, Masahiro AMA ...
    2012 Volume 74 Issue 3 Pages 265-268
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.265
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    We report on an 89-year-old woman who presented a pruritic erythema on her vulva one year ago. She had been diagnosed as extramammary Paget's disease on her left labium majus, which was excised 20 years ago. We had followed her for five years and confirmed her disease free. A biopsy specimen showed Paget cells located in the epidermis and upper dermis. The diagnosis ofrecurrent extramammary Paget's disease was established. We surgically removed the lesion and carried out sentinel lymph node biopsy. The lymph node specimen showed invasion of Paget cells that were positive stained with CK-7 monoclonal antibody.
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  • Nerve Sheath Myxoma and Neurothekeoma
    Junko NISHIMOTO, Kosuke MOCHIDA, Hideki KOKETSU, Yujiro ODA, Masahiro ...
    2012 Volume 74 Issue 3 Pages 269-272
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.269
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    Nerve sheath myxoma and neurothekeoma are rare mesenchymal neoplasms of the skin presenting as solitary tumors composed of spindle cells and myxoid-rich matrix. They have previously been considered as related conditions of the peripheral nerve sheath based only on light microscopic similarities. Now, however, research based on immunohistochemical and microarray analyses has elucidated that neurothekeoma is a benign fibrohistiocytic tumor. We have reported one case each of nerve sheath myxoma and neurothekeoma that developed in a 50-year-old woman and a 55-year-old man, respectively. We discussed the differential diagnosis and reviewed the literature on these tumors.
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  • A Case of Multicentric Reticulohistiocytosis
    Mutsumi HIGUCHI, Masakazu TAKAHARA, Yoichi MOROI, Masutaka FURUE, Akar ...
    2012 Volume 74 Issue 3 Pages 273-277
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.273
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    A 47-year-old woman had noticed scattered erythema on the forehead about two years previously. These skin eruptions gradually extended to the whole face, neck and forearms with multiple nodules on her hands, accompanied by arthralgia. At her first visit to our hospital, a physical examination revealed aggregated red papules, 3-4 mm in size, on the face, auricles and neck, and small erythemal patches scattered on the forearms. Small brownish red nodules were present on the fingers with the joints swelling. Arthritis of both shoulders and hip joints were observed by computed tomography, and an X-ray roentgenogram showed arthritis of multiple finger joints. A histopathological examination of a skin nodule revealed a diffuse infiltration of histiocyte-like cells with eosinophilic and ground-glass like cytoplasm in the dermis. Multinucleated histiocytes were positive for CD68 and CD10. We diagnosed this case as multicentric reticulohistiocytosis based upon these findings. No evidence suggesting internal malignancy was observed. The patient was treated with oral prednisolone 20 mg/day in combination with oral methotrexate 6 mg/week, which stopped the progression of the arthritis and gradually improved the skin eruptions.
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  • A Case of Angiosarcoma on the Chest Wall
    Yosuke SHINODA, Noriyuki MISAGO, Shinichi KOBA, Yutaka NARISAWA
    2012 Volume 74 Issue 3 Pages 278-280
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.278
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    A 58-year-old man had noticed a subcutaneous mass on his chest wall 6 months before his first visit. Another doctor performed an excisional biopsy. A histological examination revealed angiosarcoma. Immunohistochemically, these tumor cells were positive for vimentin, CD31, CD34, and factor VIII-related antigen. Therefore, we diagnosed the mass as angiosarcoma and performed additional resection with a 3 cmmargin on the fascia. Radiation was administered as adjuvant therapy.
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  • One Case of Black Dot Ringworm Caused by Cervical Infection with Trichophyton tonsurans
    Hidekazu SHINODA, Katsutaro NISHIMOTO
    2012 Volume 74 Issue 3 Pages 281-283
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.281
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    A 16 year-old male, a high school student belonging to the Judo club, noticed an erythema on the right side of his neck four weeks before visiting our clinic. He received an antifungal unguent from a friend and applied it occasionally. After three weeks, the erythema had disappeared, but then he noticed a number of black dot-shaped hairs. At our clinic, the hairs were prevailed, fixed with KOH and noticed to be S-shaped with signs of endothrix parasitism when examined under the microscope. We isolated Trichophyton tonsurans from the Sabouraud agar inoculated with the black dot-shaped hairs and diagnosed the patient with black dot ringworm (BDR) caused by cervical T. tonsurans infection, based on our clinical and mycological findings. T. tonsurans is known for its strong affinity towards hair and there are cases of endothrix parasitism in the hairs inside a tinea corporis rash. Complete healing can be delayed iftreatment with topical antifungals is not accompanied by oral administration, which was the case in our patient. We concluded that, in this kind of situation, black dots can develop even in the hair of a tinea corporis rash. We are aware that BDR is usually used as a diagnostic name for one of the clinical subtypes of tinea capitis. However, we considered the ‘black dot’ as a symptom and, because we found the black dot-shaped hair in a tinea corporis rash, we decided to use BDR as a diagnostic name in this case.
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Review
Therapy
  • Treatment of Alopecia Areata with Excimer Lamp
    Aya TAKAHASHI, Maki YOKOGAWA, Masahito TARUTANI, Shigetoshi SANO
    2012 Volume 74 Issue 3 Pages 289-292
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.289
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    An excimer lamp used for light therapy emits ultraviolet rays of 308 nm wavelength from a xenon chlorine gas, and is effective in psoriasis vulgaris, pustulosis palmaris et plantaris and vitiligo vulgaris. In our institution, we treat various diseases with VTRAC (Photo MedexTM, America), which is a target type excimer lamp. We have examined the hair regrowth effect in 13 patients with alopecia treated with the target type excimer lamp once or twice a week, comprising 6 cases of solitary alopecia areata, 3 cases of alopecia areata multiplex and 4 cases of alopecia universalis. We determined the effect by three criteria, as reported by Zakaria et al. First, the number of treatments required to see hair regrowth ; second, judgment of the degree of hair regrowth on a 6-point scale (0 = no hair regrowth, 1 = 1%-24% hair regrowth, 2 = 25%-49% hair regrowth, 3 = 50%-74% hair regrowth, 4 = 75%-99% hair regrowth, and 5 = complete hair regrowth) ; and third, evaluation of patients. In 5 of 6 patients with solitary alopecia areata more than 75% hair regrowth was achieved, and 3 patients achieved complete response. Furthermore, even in the case that was refractory to conventional treatment, hair regrowth was recognized after 3-8 irradiation treatments. One patient with alopecia areata multiplex was cured after 18 irradiation treatments over a period of 4 months. Although regrowth of downy hair was seen in patients with alopecia universalis, they didn't show enough response. Compared with PUVA therapy, described in the treatment guidelines for alopecia areata in 2010, a target type excimer lamp emits radiation only in the lesion area, and thus avoids unnecessary irradiation. In conclusion, a target type excimer lamp can be a new standard therapeutic option in alopecia areata.
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  • Clinical Efficacy of Loratadine for Chronic Urticaria Refractory to Other Antihistamines
    Hitoshi TAKAHASHI, Sakae KANEKO, Yuko CHINUKI, Hiroyuki NIIHARA, Itaru ...
    2012 Volume 74 Issue 3 Pages 293-300
    Published: June 01, 2012
    Released on J-STAGE: September 26, 2012
    DOIhttps://doi.org/10.2336/nishinihonhifu.74.293
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    The efficacy of loratadine (Claritin®) was evaluated by using Urticaria Activity Score (UAS), Visual Analogue Scale (VAS), and Dermatology Life Quality Index (DLQI) in 18 adult patients with chronic urticaria who showed insufficient relief with other antihistamines. After taking loratadine 10 mg/day for 2 weeks, 12 patients who had a severity of urticaria under level 2 continued to take loratadine 10 mg/day for 2 weeks, and six patients who had a severity score over level 3 were treated with 20mg/day of loratadine for 2 weeks. UAS and VAS scores of the 18 patients were significantly decreased at the 4 weeks endpoint. The total DLQI score was significantly decreased at 4 weeks, indicating that the QOL of patients with chronic urticaria was improved by loratadine administration. No cases with itching lasting for more than 2 hours were observed after 4 weeks. It appears that loratadine administration is useful for patients with chronic urticaria who have shown insufficient reliefwith other antihistamines.
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Dermatologists around the World
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