A 55-year-old man visited a dermatologic clinic with a complaint of erythema with pain on both lower legs. The eruptions were not successfully treated with antibiotics. The patient was therefore referred to our hospital and was diagnosed with erythema nodosum based on the clinical features, blood biochemical findings, and results of histological examination. Treatment with oral prednisolone was started and the eruption disappeared promptly. A whole body examination was performed to investigate the background of the skin lesions. Colon cancer was found by colon fiberscopy. Lymph node swelling in the cervical and porta hepatic regions was also found by positron emission tomography, and a diagnosis of lymph node tuberculosis was made on the basis of the results of a cervical lymph node biopsy.

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We describe a 49-year-old woman with amicrobial pustulosis associated with autoimmune disease. She had noticed eruptions of the intertriginous folds and scalp beginning 7-8 years earlier. Six months before her admission, she was diagnosed as having systemic lupus erythematosus (SLE). She was admitted to our hospital because the eruption had spread,without any worsening of her SLE symptoms. The eruption, which involved the scalp, reticular folds, flexural and anogenital areas, and the trunk and buttocks, consisted of coalesced pustules forming large, crusting plaques. We started to treat the patient with cimetidine and ascorbic acid, and an improvement was obtained over the course of two weeks. The present case suggests the effectiveness of cimetidine and ascorbic acid treatment as a safe alternative to corticosteroids.

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We report an 80-year-old man of recurrent circinate erythematous psoriasis (RCEP) with dissemination after 5-year followup. At first visit, scaly erythema had been scattered mainly on the intertriginous areas, and histological findings had revealed subcorneal pustules and epidermal spongiosis. At that time, we could not make an exact diagnosis. Annular plaques with pustules appeared on the trunk and extremities after 5 years from onset. A biopsy specimen revealed neutrophilic spongiosis in the upper epidermis. The final diagnosis of recurrent circinate erythematous psoriasis (RCEP) was made. Oral intake of etretinate was very effective. On reviewing 72 Japanese cases, only 2 cases (including this case) of scaly erythema without annular erythema were disseminated after 5-year follow-up. The early stage of RCEP, which does not show the typical clinical and histological findings, should be included as a differential diagnosis.

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We report a case of dialysis-related amyloidosis presenting as large subcutaneous masses on the buttocks. A 53-year-old man had been on maintenance hemodialysis for 33 years due to chronic renal failure and had suffered partial paralysis due to human T-lymphotropic virus (HTLV)-1-associated myelopathy. During the next few decades, he recognized that sharplymarginated, hard masses had gradually protruded on his both buttocks. Histopathological examination of the indurated area showed massive eosinophilic amorphous deposits in subcutaneous tissue, which stained with Congo red. Immunohistochemistry showed positive staining with an antibody to β2-microgrobulin (β2M). Skin lesions have rarely been reported previously in β2M-associated amyloidosis and there have been many fewer literature reports of the mass-forming type.

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Methotrexate (MTX) has recently been employed in the treatment of rheumatoid arthritis (RA) and has shown good therapeutic effects, but we rarely experience the development of malignant lymphoma in RA patients treated with MTX. Here we report two cases of malignant lymphoma in RA patients who were treated with MTX. Although the generating mechanism of methotrexate-related lymphoproliferative disorder (MTX-LPD) is still not fully understood, it has been hypothesised that neither the clonal multiplication of B cells induced by infection with the Epstein-Barr virus nor the polyclonal multiplication of other lymphocytes can be adequately controlled in the state of the immune suppression induced by MTX treatment of patients with an autoimmune disease. If we see RA patients who are treated with MTX, we should keep in mind that there is a risk of them developing malignant lymphoma.

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Pagetoid reticulosis (PR) is a variant of mycosis fungoides (MF) with localized lesion. Previously, disseminated pagetoid reticulosis (DPR) was classified as a variant of PR, with multiple localized lesions. Although the original term PR remained in the 2008 World Health Organization classification, the definition of PR excluded DPR. According to a recent textbook, DPR should be reclassified to classical MF or another lymphoma group, such as aggressive epidermotropic CD8 positive cytotoxic T-cell lymphoma, γδ-T cell lymphoma, or extranodal NK/T cell lymphoma, nasal type. Herein,we report a clinical case of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) with multiple localized lesions and some histopathological similarity with MF. A 42-year-old man visited our department with an 8-month history of asymptomatic erythematous plaques, with one plaque on the left axilla and another on the right lower extremity. Swollen lymph nodes in the left axilla and right inguinal region were palpable at the initial visit. Histopathologically, specimens taken from these lesions revealed dense infiltrations of lymphoid mononuclear cells with atypical nuclei in the epidermis, and in the upper dermis and around the appendages. These findings were similar for MF, but the multiple localized lesions did not match typical MF. In the present case, we excluded the some differential diagnosis, and eventually diagnosed the patient with PTCL-NOS with characteristics of MF. We report the present case and discuss the clinical characteristics and diagnosis for similar cases such as DPR with localized multiple lesions of MF within the literature.

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A 72-year-old female patient was referred to us for a 2-month history of an asymptomatic erythematous nodule on her left chest, which had been suspected to be a malignant lymphoma due to the results of an aspiration biopsy. Physical examination revealed a well-circumscribed and dome-shaped nodule measuring 2 cm in diameter on her left chest. Histopathologic features included a diffuse dermal infiltrate with extension into the subcutis, composed predominantly of small to mediumsized atypical lymphocytes. Epidermotropism was rarely seen. Immunohistochemically, atypical lymphocytes were CD3 positive, CD4 positive, and CD30 negative, and were associated with reactive CD8 positive T cells and CD20 positive B cells. The TCR gene was clonally rearranged. Soluble interleukin (IL)-2 receptor was within the normal range, and human Tlymphotrophic virus (HTLV)-1 antibody was negative. We diagnosed the patient as having primary cutaneous CD4+ small/medium-sized pleomorphic T cell lymphoma. The lesion was completely excised and no relapse had occurred at 33 months follow-up.

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A 32-year-old woman visited us, complaining of a 10 cm mass on her right thigh. A biopsy specimen from the mass was consistent with undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma (UPS/MFH). Contrast-enhanced computerised tomography (CT) detected swelling of the right pelvic and inguinal lymph nodes, and positron emission tomography (PET)-CT also found integration of radio-isotope at those same lymph nodes. Histopathologically, the tumor consisted of spindle-shaped or typical round cells in a storiform pattern, with scattered bizarre tumor giant cells. Immunohistochemically, tumor cells were focally positive for E3 ubiquitin-protein ligase homolog (MDM2) and cyclindependent kinase (CDK)4. Histopathologically, the tumor was difficult to differentiate from dedifferentiated liposarcoma (DDLPS), but fluorescence in situ hybridization (FISH) showed no detection of MDM2/CEP12, hence DDLPS was deemed less likely. A diagnosis of UPS/MFH was established. Wide resection, lymphadenectomy and adjuvant radiotherapy were performed, and the patient has been free of disease for 1 year following the operation.

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We report a case of non-clostridial gas gangrene that developed from a decubitus ulcer overlying the left ischial tuberosity. A 47-year-old woman with paraplegia secondary to multiple sclerosis presented with fever associated with a sacral pressure ulcer of several weeks duration. The patient had been confined to a wheelchair for several years and did not seek medical attention when the pressure ulcer developed several weeks before. Tissue necrosis was observed at the ulcer site and computed tomography revealed gas in the left gluteal muscles and the lower left leg. A diagnosis of gas gangrene was made,and antibiotics were started. However, the fever continued and surgical debridement was performed. Bacterial cultures yielded Enterococcus avium and Lactobacillus sp. Multiple skin grafts and a gluteus maximus myocutaneous flap were needed to cover the skin defect. No recurrence of the ulcer has occurred.

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Here we report the case of a 3-month-old girl with tinea capitis. Her father was a judo expert. The girl developed scaly alopecia on her frontal scalp and visited our outpatient clinic. The girl was diagnosed with having tinea capitis caused by Trichophyton tonsurans from our observations of black dot ringworm, intra-follicular fungal elements and fungal culture. Her father was also found positive for T. tonsurans by hairbrush technique. The scalp lesion was improved after treatment with oral griseofulvin (10 mg/kg) and a shampoo containing ketoconazole for two months. Although many group infections of T. tonsurans have been reported among school children and adult martial artists, intrafamilial infection has been becoming more frequent among pre-school children in Japan, based on our review of the literature.

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Parental education on how to apply a topical corticosteroid and moisturizer is essential in managing childhood atopic dermatitis (AD). Twenty-one children with AD and their mothers or grandmothers received either video- or pamphlet-based instruction on how to apply a topical corticosteroid and moisturizer. Video-based instruction was performed with an iPad^® (at an outpatient clinic) and via YouTube^® (at home). We assessed AD disease severity using the AD severity classification of the Japanese Dermatological Association and the patient-oriented eczema measure (POEM) scale at time points before and after the 2-week intervention. User intelligibility of applying ointment was assessed by the visual analogue scale (VAS) after instruction. Home care and online video viewing status were checked after the 2-week intervention. At baseline, the videobased instruction group (Group V : n = 11) and the pamphlet-based instruction group (Group P : n = 10) had similar AD severity. After 2 weeks, AD severity significantly improved in both groups. User intelligibility of applying topical corticosteroid was far better in Group V than Group P (VAS score : 96.2±6.9 vs 81.7± 18.6, ρ = 0.046). All participants were able to complete the administration of topical medication at home (VAS score : 90.7±12.1 in Group V, 89.8±9.4 in Group P). No participants in group V watched the YouTube^® video. Due to the simplicity of our video (about 60 seconds), the participants completely understood the contents after a single viewing at our outpatient clinic. In conclusion, video instruction using an iPad^® on topical therapy for AD in children was an effective tool for improving clinical outcomes. Video instruction might improve intelligibility more than traditional pamphlet-based education.

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