The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 77, Issue 6
Displaying 1-17 of 17 articles from this issue
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Clinical Case Reports
  • A Case of Herpes Gestationis Developed in the Puerperal Period
    Masami KOIKE, Shujiro HAYASHI , Yokurei OTANI, Sachiko ODA, Yoichiro H ...
    2015 Volume 77 Issue 6 Pages 548-551
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.548
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    A 30-year-old Japanese woman who gave birth to her first child at 41 weeks of pregnancy by normal delivery was referred to our department in July 2012 due to erythematous macules and tense blisters on her arms and legs developing since two days after delivery. The child was healthy. Histopathological examination showed subepidermal blisters containing fibrin depositions. The results of direct immunofluorescence analysis showed linear depositions of C3 and IgG along the epidermal basement membrane. The index value of anti-BP180 NC16a antibody in the serum, as measured by ELISA, was elevated to 280. A diagnosis of herpes gestationis was made based on these findings. The patient was treated with 50 mg of oral prednisolone per day initially and then the dose of prednisolone was gradually reduced to 5 mg per day without any exacerbation of her symptoms. To date, 9 cases of herpes gestationis developing in the puerperal period have been reported in Japan. The index values of anti-BP180 NC16a antibody in these cases were lower than those measured in cases of herpes gestationis arising before delivery.
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  • A Case Report of Cholesterol Granuloma of the Nasal Root
    Maki KUWASHIRO, Hiromi KIMURA, Takuya INOUE, Noriyuki MISAGO, Yutaka N ...
    2015 Volume 77 Issue 6 Pages 552-555
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.552
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    A 39-year-old female patient noticed a small subcutaneous nodule on her left nasal root a month ago. The tumor was 10 ×8 mm in diameter, elastically hard, and could be removed easily from underlying tissue. She had no history of trauma or operation on the nose. We suspected mixed tumor of the skin or a benign soft tissue tumor. The tumor was surgically excised. Histopathological findings revealed a granuloma lesion in the dermis with many spindle clefts, some of which were in the cytoplasm of multinucleated giant cells. We made a diagnosis of cholesterol granuloma of the skin. There were no keratin masses, epithelial elements, infiltration of neutrophils, or lymphocytes, so we ruled out postinflammatory granuloma due to a ruptured epidermal cyst. There have been several reports of cholesterol granulomas arising at various sites, but cholesterol granuloma of the skin is extremely rare. We herein report a rare case of cholesterol granuloma of the skin and review related literatures.
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  • Eosinophilic Pustular Folliculitis with Elevation of Serum IgE in an Elderly Patient
    Daisuke UEO, Tomiko YAMAGUCHI, Mitsuru MASUDA , Yutaka HATANO, Sakuhei ...
    2015 Volume 77 Issue 6 Pages 556-560
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.556
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    We report on an 82-year-old man who had pneumoconiosis. He presented with a 1-year history of pruritic indurated erythematous plaques studded with pustules on the face, which extended thereafter to the trunk at the age of 80. This is the most elderly patient ever reported to show these symptoms. A histological examination revealed eosinophilic infiltration around the hair follicles and sebaceous glands. Thus, the diagnosis of eosinophilic pustular folliculitis (EPF) was made. Oral indomethacin at a dose of 50 mg per day relieved his skin lesions, but the lesions relapsed after reduction of the dose to 25 mg per day. Oral minocycline at a dose of 200 mg per day was not effective. Serum IgE was elevated markedly after development of the skin lesions, suggesting that severe EPF maintained for a long period might cause a raised level of IgE. We considered that an adverse drug reaction might have induced EPF in this case, due to the sudden onset of the eruptions and the blood hypereosinophilia.
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  • A Case of Acquired Zinc Deficiency in a Very Low Birth Weight Infant Caused by a Low Zinc Concentration in Breast Milk
    Ayami MAEDA, Kotaro ITO, Shinichi IMAFUKU, Masutaka FURUE
    2015 Volume 77 Issue 6 Pages 561-564
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.561
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    We report a breast-fed very low birth weight infant with zinc deficiency because of a low zinc concentration in his mother's breast milk. He was born at 29 weeks of gestation weighing 1245 g. From the age of 2 months, scaly erythematous plaques appeared on his face and external genital region. Topical corticosteroids and antibiotics were prescribed but the symptoms did not improve. Alopecia and diarrhea were not observed. He had been fed only breast milk before being examined. Examination showed a low serum zinc level of 17 μg/dL (65∼110 μg/dL). His mother's serum zinc level was normal at 93 μg/dL (65∼110 μg/dL), but the zinc level in her breast milk was low at 32 μg/dl (110∼270 μg/dL). Based on these findings, this case was diagnosed as having acquired zinc deficiency due to a low maternal breast milk zinc concentration. In general, the treatment for zinc deficiency is supplemented with zinc sulfate. In this case, however, weaning the infant from his mother's milk onto mixed nutrition was sufficient to improve the dermatitis. No recurrence has been observed.
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  • A Case of Fibroadenoma Arising in the Right Axillary Accessory Mammary Gland
    Kotaro NAGASE, Reiko SHIRAI, Shinichi KOBA, Noriyuki MISAGO, Yutaka NA ...
    2015 Volume 77 Issue 6 Pages 565-569
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.565
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    A 41-year-old woman presented with a 9-month history of subcutaneous mass in the right axilla. The mass gradually increased in size over time. Dermatological examination found a mobile, elastic-soft, well-demarcated subcutaneous mass measuring 3 cm in diameter in the right axilla. The lesion was excised. Histologic examination showed proliferation of connective tissue with an adenoma component of glandular ducts and surrounding accessory breast tissue, yielding a diagnosis of fibroadenoma arising in the axillary accessory mammary gland. Fibroadenoma arising in an axillary accessory mammary gland should be included in the differential diagnosis when an axillary tumor is found, even though it is a rare clinical entity.
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  • A Case of Multiple Pseudolymphoma Occurring on the Face and Trunk
    Masayoshi NAKAO , Nahoko IWASAKI, Syuchi AZUMA, Daisuke MATSUMOTO , Ju ...
    2015 Volume 77 Issue 6 Pages 570-574
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.570
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    A 62-year-old man developed a large red nodule on his right lower jaw 6 months before visiting our clinic, followed by multiple nodules and erythema soccurring on his head and trunk. He visited the department of plastic surgery of Hamanomachi Hospital and had the large nodule removed surgically. A histopathological examination revealed dense mononuclear cell infiltration in the dermis without apparent nuclear atypia or conspicuous mitosis. Infiltrating cells were a mixture of numerous B and T cells as assessed immunohistochemically. Sections from the other nodules and the erythema were histologically very similar and no gene expression of immunoglobulin heavy chain or T-cell receptor β and γ chains was detected in these additional specimens. Cervical to inguinal computed tomography scanning and blood examination showed no evidences of malignant lymphoma. The diagnosis of pseudolymphoma was made from the above findings. The nodules and erythema disappeared after local injection of triamcinolone acetonide, but some eruptions flared and others newly appeared, necessitating monthly treatments. Careful follow-up is needed since cases of malignant lymphoma occurring from pre-existing pseudolymphoma have been reported.
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  • A Case of Squamous Cell Carcinoma Arising from Hypertrophic Lichen Planus
    Ryo UTSUNOMIYA, Hidenori OKAZAKI, Saori MIYAWAKI, Hideki MORI , Shinji ...
    2015 Volume 77 Issue 6 Pages 575-578
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.575
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    A 64-year-old woman developed plaques on her trunk and extremities that began developing at the age of 54 years. She consulted a dermatologist and was treated by topical steroid ointment on the diagnosis of discoid lupus erythematosus. An ulcerated tumor had developed on a previously existing plaque on the right lower leg and was first noticed 2 months before we saw her. The tumor was diagnosed as a squamous cell carcinoma (SCC) by biopsy. The tumor was removed with a surgical margin of 1-2 cm. Histopathology of the plaque showed remarkable hyperkeratosis and papillomatosis with band-like lymphocytic infiltration, which was diagnosed as hypertrophic lichen planus (HLP). Although it is a rare disease, we should carefully follow up patients with HLP because SCC can develop on the lesion.
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Clinical and Investigative Report
  • Evaluation of Patch Test with Thiodiglycolic Acid in Fixed Drug Eruption Induced by S-Carboxymethyl-L-Cysteine
    Reiko TOBITA, Yuko CHINUKI, Kyoko NOGAMI, Eishin MORITA
    2015 Volume 77 Issue 6 Pages 579-583
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.579
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    A 36-year-old female noticed pigmented patches on her back, neck, and buttock after a few days of oral administration of S-carboxymethyl-L-cysteine (SCMC) and dimemorfan phosphate. We presumed fixed drug eruption (FDE) induced by SCMC and therefore performed a lymphocyte stimulation test for SCMC. However, the result was negative. The result of patch test with SCMC was also negative, but that with its night-time intermediate metabolite thiodiglycolic acid (TDA) was positive. We definitely diagnosed the patient with SCMC-induced FDE because her skin eruptions were induced on the third day after consecutive ingestions of SCMC during the oral challenge test. It has been suggested that TDA could possibly be the causative allergen of SCMC-induced FDE. Several studies have reported that performing a patch test with TDA was useful for the diagnosis of SCMC-induced FDE. In our case, the result of the patch test with TDA was also positive. However,patch testing with TDA showed similar positive responses on healthy volunteers, so we carried out further research. To evaluate the usefulness of patch test with TDA in the diagnosis of SCMC-induced FDE, we performed patch tests with different concentrations of TDA on our patient and five healthy volunteers, and then assessed the response. The reaction occurred in a concentration-dependent fashion. We therefore measured the acidity of an aqueous solution of TDA and found that it was a strong acid. Infiltrative erythema on the patch test with TDA is possibly an irritation response, so physicians should be cautious when interpreting the results of patch testing with TDA in the diagnosis of SCMC-induced FDE.
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Statistics
  • Clinical Study of 81 Cases of “Mamushi” Viper Bite during the Past 11 Years
    Nanae KIMURA, Noriko OKABE, Rieko FUTAMURA-NAKAGAWA, Futoshi KODA, Aki ...
    2015 Volume 77 Issue 6 Pages 584-588
    Published: December 01, 2015
    Released on J-STAGE: March 15, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.77.584
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    We reviewed a total of 81 Mamushi viper (Gloydius blomhoffii) bite patients (51 males and 30 females) who required hospitalization from 2004 to 2014. Their average age was 57.3 years and 21 patients were in their sixties, which was the largest age group by decade. The most prevalent season for bites was between July and October. The onset time showed twin peaks, 46 cases were bitten between 4 p.m. to 12 a.m. hours and 16 cases were bitten between 8 a.m. to 12 p.m. hours. Mamushi bites occurred most frequently at farms (21 cases), followed by urban neighborhoods (14 cases). The main site of injury was the fingers (43 cases), followed by the foot or heel (16 cases). As many as 74 cases arrived at the hospital within 6 hours after onset. On their first visit, the severity tended to be mild (Grade Ⅰ ; 19 cases, Grade Ⅱ ; 38 cases). However, the peak severity became gradually higher (Grade Ⅲ ; 27 cases, Grade Ⅳ ; 25 cases). Patients with the more severe grades of injury tended to manifest higher serum levels of creatine kinase and longer hospitalization periods. None of the cases resulted in death or disseminated intravascular coagulation, however, 1 case developed renal failure and 6 cases developed diplopia. Seventy of the 81 cases were treated with Cepharanthine® and 45 with systemic corticosteroid. Antivenom was injected in 52 cases by intravenous administration. In addition, 78 cases were treated with antibiotics to prevent secondary infection. Prevention therapy for tetanus was carried out in 56 cases.
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Apologies and Corrections
Dermatologists around the World
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