The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 75, Issue 5
Displaying 1-14 of 14 articles from this issue
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Color Atlas
Mini Review
Clinical Case Reports
  • A Case of Rice Body Formation in Dorsum Manus Mass Associated with Rheumatoid Arthritis
    Kazuhiko YAMAMURA, Kana KOZONO, Masutaka FURUE, Takuya SAWABE, Toshihi ...
    2013 Volume 75 Issue 5 Pages 406-408
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.406
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    An 85-year-old woman was referred to our hospital with fever and polyarthralgia and was diagnosed as rheumatoid arthritis. She also complained of a subcutaneous mass on the dorsum of the left hand. The fever and the polyarthralgia were improved byoral administration of prednisolone and salazosulfapyridine, but the mass on the hand dorsum remained. When we performed a skin incision on the mass, a large number of rice bodies were found inside the tendon sheath. A histopathological analysis revealed a fibrotic fibrinoid structure in the center of the rice body, which was closely surrounded by histiocytic cells. Formation of rice bodies in the dorsum manus has rarely been reported in the literature.
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  • Serial Measurement of Anti-type VII Collagen Antibodyis Useful in Treatment of Epidermolysis Bullosa Acquisita
    Haruna SAWAKI, Amiko HAKUTA, Miwa KANAOKA, Kazuko NAKAMURA, Takashi HA ...
    2013 Volume 75 Issue 5 Pages 409-414
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.409
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    A 49-year-old Japanese female noticed multiple bullae and erosions in the oral cavity, which subsequently spread to the face and neck. A perilesional skin biopsywas performed and histologic examination revealed subepidermal blister formation. Direct immunofluorescence of the tissue showed linear deposition of IgG and C3c at the dermoepidermal junction. Indirect immunofluorescence with the patient's serum on salt-split skin revealed dermal binding of circulating antibodies. On immunoblotting of the normal human dermal extracts, IgG antibodies recognized a 290 kDa band corresponding to collagen VII. On the basis of these findings, a diagnosis of epidermolysis bullosa acquisita (EBA) was made. The lesions did not respond to oral prednisolone (PSL) 30 mg daily. Therefore, dosage was increased to 50 mg and concomitant cyclophosphamide pulse therapy (IVCY) and double filtration plasmapheresis started. The lesions disappeared soon after these therapies, but relapsed after PSL tapered and IVCY stopped. The relapse was accompanied bynew lesions, which were uncontrollable even with increase of PSL to 15 mg and a second round of IVCY. Remarkably, oral administration of colchicines rapidly diminished the disease, which was accompanied bya simultaneous decrease in the anti-type VII collagen antibodytiter byenzy me-linked immunosurbent assay (ELISA). The clinical disease course correlated well to anti-type VII collagen antibody ELISA titer. We suggest that serial measurement of anti-type VII collagen antibodycan provide information useful for assessment of disease severityand for treatment selection for EBA patients.
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  • Autoimmune Blistering Disease with Concurrent IgG Antibodies to Desmoglein 1 and BP180 : Two Cases
    Miki ICHIKAWA, Maya TANAKA, Kazunori URABE, Masutaka FURUE
    2013 Volume 75 Issue 5 Pages 415-418
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.415
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    We report two cases with concurrent detection of antibodies to Desmoglein 1 and BP180. In Case 1, a 78-year-old man was diagnosed with bullous pemphigoid and had been treated with oral prednisolone for 2 years. He developed crusted erythema on his face and trunk despite the well-controlled state of his bullous pemphigoid. Direct immunofluorescence detected intracellular deposition of IgG in the epidermis, and anti-BP180 and anti-Dsg 1 antibodies were detected by enzymelinked immunosorbent assay. In Case 2, a 91-year-old woman had had pruritic erythema with crusting on her thighs, axillae, face, and back for 2 months. Treatment with topical steroids was ineffective, and edematous erythema and tense bullae developed on her lower limbs. Direct immunofluorescence detected linear deposition of IgG and C3 along the basement membrane zone. Anti-BP180 and anti-Dsg 1 antibodies were also detected by enzyme-linked immunosorbent assay.
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  • Three Cases of Spindle Cell Lipoma, Myxoid Variant
    Ayako IJICHI, Tomoko SAITO, Kyoko KUDO, Junichi HACHISUKA, Takeshi NAK ...
    2013 Volume 75 Issue 5 Pages 419-424
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.419
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    Here we report 3 cases of spindle cell lipoma (SCL) that developed in relatively rare physical regions. Case1 : A 57-year-old woman had a 2 cm subcutaneous mass in her right buttock. A T1 weighted MRI image showed high and low mixing areas. The T1 low area was intensivelyenhanced, and the T1 high area was suppressed bya T2 weighted gadoliniumenhanced fat-suppressed image. The resected tumor was whitish yellow with glutinous secretion on the surface. Case2 : A 67-year-old man had a 9 × 8 × 5 cm pedunculated mass on his left lower leg. MRI showed somewhat similar findings to those of Case1. The split surface of the resected tumor was yellow, and the tumor had a jelly-like texture. Case3 : An 81-year-old man had a 2.5 cm dome-shaped elevated subcutaneous mass in the center of his forehead. An ultrasonic examination showed a mass that had an intensityequal to that of the surrounding adipose tissue. The resected tumor was yellow and contained a mucus-like viscous liquid. Pathological examinations revealed that these tumors were composed of a mixture of fat tissue, spindle cells, and collagen fibers with a mucinous matrix. Spindle-shaped tumor cells were positive for CD34, and the mucinous matrix was positive for Alcian-blue. SCL, myxoid variant were diagnosed in all of the 3 cases based on these findings. It seems that SCL should be suspected in spite of the location of the subcutaneous tumor, if the tumor shows atypical radiologic findings. Histologically, SCL is characterized by proliferation of mature adipocytes, collagen fibers, and spindle cells showing stronglypositive reaction for CD34. Moreover, the findings of the Alcian-blue positive mucin, spreading through the tumor, would enable the definitive diagnosis of the mixoid variant of SCL.
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  • A Case of Multiple PrimaryMelanoma
    Reiko ITO-MIYAZAKI, Hiroshi UCHI, Yoichi MOROI, Masutaka FURUE
    2013 Volume 75 Issue 5 Pages 425-428
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.425
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    A 44-year-old woman developed a malignant melanoma on the parietal region (pT4aN0M0, stage IIB). Two years later, another malignant melanoma had developed on her back (pT3bN1aM0, stage IIIB). Clinically, the second melanoma was a black hyperkeratotic nodule with crust formation, 16 × 12 mm in size, and did not fulfill the diagnostic criteria for epidermotropic metastatic malignant melanoma. Thus the second melanoma was also diagnosed as a primarylesion. Since the epidemiologyof multiple primarymelanoma in Japan has not been well evaluated due to its rarity, a careful follow-up is needed.
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  • A Case of Vibrio alginolyticus Infection Caused by Puncture with the Dorsal Fin of a Horse Mackerel
    Hidekazu SHINODA, Katsutaro NISHIMOTO
    2013 Volume 75 Issue 5 Pages 429-431
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.429
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    A 63-year-old man, currently treated for diabetes mellitus, accidently punctured his right thumb with the dorsal fin of a horse mackerel during a fishing trip in Tsushima Offing, Nagasaki Prefecture, Japan, in early July, 2012. The patient visited our clinic after the wound had developed a painful blood blister. Besides diabetes, he presented in good general condition. The serous bloody liquid aspirated from the blister was cultured on blood agar at 37C°, where it developed swarming grayish colonies containing peroxidase test-positive Gram-negative rods. The bacteria grew in 3%, 7%, and 10% saline media and presented yellow colonies on a TCBS medium. The microorganism was identified as Vibrio alginolyticus by a Viteck II analyzer with 99% reliability, so we concluded that the lesion was a case of V. alginolyticus infection and prescribed a treatment with 200 mg minocycline for five days, at the end of which the skin lesion had improved. In Japanese dermatologic literature, no reports were found of V. alginolyticus infection through wounding. International papers have described cases of necrotizing fasciitis that had developed from wound infections. Therefore, we consider it necessaryto identify the pathogen and take into account the possibility of further complications in compromised hosts presenting with infected wounds.
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  • A Case of Sporotrichosis (Fixed Type) on the Left Cheek Treated with Local Hyperthermia
    Yasuko KON, Utako KIMURA, Kaori TAKEUCHI, Ayako KINOSHITA, Midori HIRU ...
    2013 Volume 75 Issue 5 Pages 432-437
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.432
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    A 68-year-old female farmer presented with crusted infiltrative erythema on the left cheek that had started 5 months prior to the initial examination. The histological findings of a skin biopsy specimen showed granulomatous reaction involving the superficial to middle layers of the dermis with positive periodic acid-Schiff staining for yeast-like fungal elements. The patient had a positive sporotrichin test. Grayish-white, moist colonies with wrinkles formed at the center of fungal cultures. Slide cultures revealed nearly colorless, round or elliptical conidia ; some directly originating from the side of the mycelium and others with a petal shape showing colonization on the tip of the conidiophore of the mycelium. Molecular biological examinations showed the base sequence to have homology with known ribosomal RNA genes in the internal transcribed spacer region. Therefore, Sporothrix schenckii was identified as the causative organism. Treatment consisted only of local hyperthermia with a chemical body warmer, which resulted in healing approximately 3 months after the initial presentation, although scarring persisted. We report on sporotrichosis cases seen in our clinic with a review of Japanese case reports published over the past 9 years. In recent years, the number of reports has decreased, and sporotrichosis is becoming a rare disease. Sporotrichosis should be considered as a differential diagnosis for non-healing ulcer, erythematous plaque, or nodule.
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  • Photosensitive Drug Eruption due to Preminent®
    Daisuke UEO, Takashi SAKAI, Yutaka HATANO, Sakuhei FUJIWARA
    2013 Volume 75 Issue 5 Pages 438-443
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.438
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    We experienced three cases of photosensitive drug eruption due to Preminent® (losartan potassium/hydrochlorothiazide). All three cases were elderlypatients who developed eruption on sun-exposed areas after being treated with Preminent® Cases 1 and 2 were 72-year-old Japanese men. Case 3 was an 86-year-old woman. Photopatch tests were positive in both cases 1 and 2. MRD with UVA and MED with UVB were decreased in case 3. Renal dysfunction, which might be a risk factor of photosensitivity due to increased level of hydrochlorothiazide in plasma, was observed in case 2.
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  • A Case of Purpuric Drug Eruption Induced by Acetaminophen
    Ayuko HIRANO, Takaya FUKUMOTO, Hidetaka FUJII, Akihiro FUJISAWA, Hideo ...
    2013 Volume 75 Issue 5 Pages 444-447
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.444
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    A 15-year-old female with symptoms of a common cold and high fever developed generalized purpuric eruptions, 72 hours after internal use of several drugs in October and January, 2012-2013. A histological examination showed leukocytoclastic vasculitis. An oral challenge test with 100 mg of the suspected allergen, acetaminophen, provoked a flare up of the purpuric eruptions on the face, trunk and extremities. A drug-induced lymphocyte stimulation test (DLST) with acetaminophen was negative. We diagnosed her illness as purpuric drug eruption induced by acetaminophen.
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Review
Therapy
  • Efficacyof IKD-382 Cream for Tinea Pedis with Hyperkeratotic Lesions
    Takashi MOCHIZUKI, Shinya ABE, Hiroshi TANABE, Tsuyoshi USHIGAMI, Kiyo ...
    2013 Volume 75 Issue 5 Pages 454-459
    Published: October 01, 2013
    Released on J-STAGE: November 30, 2013
    DOIhttps://doi.org/10.2336/nishinihonhifu.75.454
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    Clinical trials of topical therapeutics targeted on tinea pedis with hyperkeratotic lesions, which is assumed to resist to topical therapies, are lacking. In this study, we assessed the effectiveness and safety of IKD-382 cream, which consists of 1.0% terbinafine hydrochloride, for eight weeks against tinea pedis with hyperkeratotic lesions. The study was made by objective examination of skin lesions by specialists of dermatology, subjective findings, mycological tests and safety. Of the 36 cases registered, 29 cases were evaluated for analysis of effectiveness. As a result, 100% of the patients scored improvement above moderate for general improvement, 79.3% showed negative studyfor mycological tests, and 79.3% scored more than effective in overall effectiveness. In addition, no side effects were observed in all 36 cases. The improvement effect on scale and hyperkeratosis was particularly remarkable in clinical manifestations, and improvements more than two steps were recognized in 18 cases of 29. The IKD-382 cream was proved to show constant effectiveness and safety, and it was shown as an effective device for tinea pedis with hyperkeratotic lesions.
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