A 92-year-old man presented with pruritic erythema, blisters and erosions on forearms and dorsum that had persisted for 1-month. Histology of the abdominal erythema showed a subepidermal blister and moderate infiltration of lymphocytes and eosinophils around the dermal blood vessels. Direct immunofluorescence and tests for circulating autoantibodies to pemphigus and pemphigoid were negative. As he had a nephrotic syndrome, a renal biopsy was performed, which disclosed renal and systemic amyloidosis. Direct fast scarlet staining revealed a small amount of amyloid deposit on the bottom of a blister. The amyloids were positive for anti-immunoglobulin λ chain antibody, and were negative for κ chain antibody, transthyretin and AA. A diagnosis of AL amyloidosis was established. He refused a bone marrow puncture, and serum and urine immunoelectrophoresis showed no M-protein and no Bence-Jones protein. Topical corticosteroid and oral antihistamines were not effective in preventing new skin lesions and pruritus. He refused a dialysis and died of renal failure 4 months after the first visit.

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A 12-year-old boy presented with a lesion on the upper lip that had been present for 2 years. First, the lesion was treated as molluscum pendulum by cryotherapy, but the lesion continued to grow. The size of the lesion was 7×7 mm, the surface was smooth with a dome-like shape and covered partly by a crust. Histopathologically, it was composed of numerous small basaloid cells, and had a syringoid epithelial structure within the reticular dermis. Tubular structures and cystic space contained PAS-positive, diastase-resistant, GCDFP-positive and CK-7-negative. We diagnosed the lesion as BCC with eccrine differentiation (BCCED). It was excised and skin grafted. We have reviewed the clinical characteristics of BCCED.

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A 10-month-old girl presented with an erythema on the left side of her face, present since 1 month of age. Despite previous treatments with dye laser surgery and intralesional injection of corticosteroids, the lesion had gradually protruded into an erythematous bulky mass with a deformity of the left auricle and difficulty in opening her left eyelid. She was diagnosed as infantile hemangioma (IH) and started on a treatment with propranolol. Propranolol was initiated at a dose of 0.25 mg/kg per day and titrated upward to 1.0 mg/kg per day. The hemangioma began to withdraw within a week, and afterward, the mass decreased without any side effects. A first line treatment of IH with a giant mass or functional disorder is currently the administration of oral or intralesional corticosteroids, but that may not be effective in some cases. Recently, the efficacy of propranolol for IH has been reported in many cases. Propranolol may be tried for the treatment of IH for extensive periods of time with an adequate monitoring of adverse effects.

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We have experienced two cases of angioimmunoblastic T-cell lymphoma (AITL) presenting with a skin eruption. Patient 1, an 80-year-old woman, had a generalized eruption with faint erythema and some induration. Histopathological examination of the indurated area showed atypical cell infiltration throughout the dermis. Patient 2, a 79-year-old woman, had purpura of the legs. Histopathological examination showed leukocytoclastic vasculitis without atypical cell infiltration. Histopathological examination of the lymph nodes revealed infiltration of atypical lymphocytes and widespread proliferation of the arborizing small vessels, which is a characteristic feature of AITL. About one-half of patients with AITL develop a skin eruption. However, the skin eruption and the histological picture of cutaneous lesions vary considerably. Further accumulation of relevant case studies is required.

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A 6-year-old girl was hospitalized in the pediatric ward due to painful erythema and fever, and was then referred to our department for evaluation of the eruptions. A biopsy from a painful erythema of the leg showed septal panniculitis and was diagnosed as erythema nodosum. The symptoms fulfilled the criterion for Kawasaki disease, and treatment with immunoglobulin and aspirin was started. The fever went down rapidly, and the eruptions improved. Her general condition has not worsened, and an echocardiogram showed no tendency to dilation of coronary arteries. She was discharged from the hospital on the 35th day. Aside from the symptoms simulating Kawasaki disease, the abdominal symptoms, erythema nodosum and a history of drinking well water suggested Yersinia infection. Although stool cultures were negative, antibody titers for Yersinia pseudotuberculosis 4b were elevated, and she was diagnosed as Y. pseudotuberculosis infection showing erythema nodosum and symptoms seen in Kawasaki disease.

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Cutaneous odontogenic abscesses are often first diagnosed by physicians other than odontologists because lesions outside of the mouth are more easily observed than those on the pathogenic teeth. Therefore, when refractory and suppurative lesions are found in a specific site, like the mandible it is necessary to consider a cutaneous odontogenic abscess as a differential diagnosis. To confirm the diagnosis, the existence of a radicular cyst is confirmed by orthopantomography. The funiculus is easily contacted near the pus discharge site. Here we report, and discuss the diagnosis, treatment, and common site of odontogenic abscess. 4 patients who visited the dermatology clinic in the last 3 years and 8 patients who visited a dental surgery clinic in the last 6 years.

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We report a case of black dot ringworm caused by Trichophyton rubrum. A 50-year-old man had suffered from erythema and scale on the head. He was first diagnosed with seborrheic dermatitis, and began receiving topical steroid. At the same time, he was also diagnosed with tinea pedis by direct microscopic examination of his feet, but they were left untreated. Four months later, several black dots were found on his scalp. After a potassium hydroxide (KOH) test of a sample, direct microscopic examination revealed endothrix arthroconidia in the hair shaft. Trichophyton rubrum was isolated from scales from his head on Sabouraud dextrose agar. A total of 17 cases of black dot ringworm caused by Trichophyton rubrum have been reported from 1978 to 2012. Most of these patients were elderly and had tinea pedis and had received topical steroid for lesions on the head.

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We report a case of a 53-year-old man who developed drug-induced hypersensitivity syndrome (DIHS) due to cyanamide. He had suffered from drinking too much alcohol and had liver dysfunction due to alcohol. He had taken cyanamide and diazepam for five weeks before his first visit. Because of fever, sore throat, and redness of tonsils, he was given antibiotics. The next day, although the fever was removed, he developed a rash on the whole body, multiple enanthemas of stomatitis, and acute laryngitis. On the day following the admission, he had a fever of 40°C, and developed a rash on the whole body. So other antibiotics were selected, and administration of cyanamide and diazepam was stopped. After that, his temperature decreased gradually. From day 13, he again had a fever over 39°C, edematous erythema on the face with erythroderma, increased numbers of white blood cells and eosinophils, liver dysfunction and swelling of lymph nodes. Before and after the second period of high fever, human herpes virus 6 (HHV-6) reactivation was observed. After he was administered an antiallergic drug, the fever was removed, erythroderma disappeared, and liver dysfunction improved. We performed a druginduced lymphocyte-stimulation test (DLST) on cyanamide and diazepam, which was negative. We then performed a patch test on cyanamide and diazepam, which produced a positive result for cyanamide, and a negative result for diazepam. We therefore diagnosed this case as a DIHS due to cyanamide.

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An 83-year-old woman had left hemiplegia caused by a thalamic hemorrhage in 2001, and from 2002 an edema developed gradually in the left lower extremity, which was diagnosed as chronic lymphedema of the left lower extremity in 2006. In March 2011, she developed a skin ulcer on the left leg. Because the lesion worsened, she was referred to our institution in May 2011. We found a lymphedema of the left lower extremity, a pigmented leg, and infectious, necrotic, bleeding skin ulcers on the leg that were between 5 cm and 13 cm in diameter. Computed tomography angiography revealed an obstruction and varication of the left femoral vein on the level of the inguinal ligament, and an obstruction in the left external iliac vein. Early perfusion of the veins of the left lower extremity suggested strongly that there was an arteriovenous fistula. Although the lesions were treated with topical conventional wound therapy, the lesions were not improved. Therefore, we performed a custom-made negative pressure wound therapy (NPWT) on the lesions, using the hospital's central vacuum system, and a good granulating bed was obtained. Because the granulating bed was large, we conducted a split-thickness skin graft (a patch graft ; the grafted skin was removed by the wheal shaving method) for the wound at the bedside, and NPWT was applied to the wound postoperatively. The patch graft with concurrent NPWT was performed every 2 weeks, for a total of 3 times, and the lesions were healed. The healing of skin ulcers from chronic lymphedema are markedly delayed. NPWT will be a significant therapeutic option for skin ulcers from chronic lymphedema. And then, when the obtained granulating bed is large, the patch graft (using the wheal shaving method) is simple and easy to use together with NPWT, which will contribute to the earlier healing of the wound bed.

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Since skin is the most superficial organ, skin aging is a complex process resulting from not only intrinsic factors (passage of time and genetic factors) but also extrinsic factors (UV irradiation and environmental pollutants). Important reasons for skin aging, such as wrinkling, sagging, and laxity, are a decreased number of fibroblasts and decreased synthesis of extracellular proteins in the dermis, as well as increased degradation of the collagenous matrix from UV irradiation and other environmental stresses. Fulvic acid is derived from humic substances, which are formed naturally during the decay of plant and animal residues. Fulvic acid has been shown to have chelating activity, to act as buffer solution, to have antimicrobial activity in vitro and to have an effect in treatment of eczema in vivo. We investigated the effect of fulvic acid on fibroblasts and matrix metalloproteinases (MMPs), which are responsible for degradation of collagen. Normal adult fibroblasts and calcein-AM were used in a cell viability study, and FITC-labeled collagen was used to evaluate MMP activity and inhibitory effect of fulvic acid. A concentration of 1% fulvic acid increased cell viability by 26.1% when compared with a control, and 5% fulvic acid did not show any cytotoxicity. In the presence of 0.25 units of MMP-8, the inhibition of collagen degradation was 47% in 1% fulvic acid (P < 0.01) and 61% in 5% fulvic acid (P < 0.01), and in the presence of 0.5 units of MMP-8, the inhibition of collagen degradation was 23% in 1% fulvic acid (P < 0.01) and 56% in 5% fulvic acid (P < 0.01). Our study suggests the possibility of an anti-aging effect of fulvic acid due to an increase in fibroblast viability and a prevention of collagen degradation.

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Two types of prescription topical emollients containing 0.3% heparinoid were used concurrently on either side of the body in 16 Japanese patients with atopic dermatitis (AD) treated with a standard topical administration of corticosteroids and calcineurin inhibitor. One of the prescription topical emollients, containing 0.3% heparinoid, is an aqueous type lotion (Besoften lotion^®), and the other one is a milky type lotion (Hirudoid lotion^®). The effects of the two types of skin emollients on the severity of the disease, the water content in the stratum corneum and the transepidermal water loss (TEWL) were studied by comparing the patients' right and left hemibody at the beginning of the study, at 4 weeks and at 8 weeks. The usability and patients' satisfaction or preference for one or the other of the skin emollients were also assessed by the subjects using VAS at the end of study. The results showed that both types of skin emollient improved clinical symptoms of AD. Although neither type of emollient caused a significant improvement in water content in the epidermal stratum corneum and TEWL during this study period, the patients judged that both skin smoothness and skin wetness were significantly improved with the use of either type of emollient throughout the study. Based on the feeling just after topical application of the emollient, the patients judged an aqueous type lotion as significantly superior to a milky type lotion, however, other factors -including the easiness of application, the odor when applied and whether they would want to continue to use the emollient -did not show any significant differences between these two types of emollient. These results suggest that dermatologists should select the more suitable emollient in combination with the standard topical treatment of AD, and that the suitability may vary depending on patients' preferences, seasonal difference and sweating.

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