The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 78, Issue 3
Displaying 1-15 of 15 articles from this issue
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Clinical Case Reports
  • A Case of Glaucoma in Severe Atopic Dermatitis
    Tetsuko KIMURA, Takenobu YAMAMOTO, Fusako OKAZAKI, Yoshiaki IEKI, Wata ...
    2016 Volume 78 Issue 3 Pages 229-233
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.229
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    Therapeutic use of corticosteroids can lead to ocular hypertension and iatrogenic open-angle glaucoma in susceptible individuals, namely, “steroid responders”. Only a few cases of glaucoma induced by topical use of corticosteroids have been reported in patients with atopic dermatitis (AD) in Japan and other countries. A 29-year-old man with severe AD presented with glaucoma. Besides daily use of topical corticosteroids, he had temporarily taken oral corticosteroids when the cutaneous symptoms worsened. It was assumed that the patient was a “steroid responder” and that this trait was closely associated with the development of glaucoma in a setting of therapy with topical corticosteroids to the eyelids. As we cannot identify “steroid responders” in advance, it is important to check ophthalmological examinations periodically when AD patients are required to use topical corticosteroids on the eyelids.
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  • Anti-TIF1 Antibody Positive Dermatomyositis Case That Sequentially Evolved from Rashes to Double Gastric Cancer and Dysphagia : A Follow-up after Five Years of Treatment
    Aki TOKUZUMI, Masayoshi JOHNO, Keishi MARUO, Shinjiro TOMIYASU, Tsuyos ...
    2016 Volume 78 Issue 3 Pages 234-238
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.234
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    We report a 77-year-old male patient who presented at his initial visit with scaly erythematous patches on the face and head. The symptoms were refractory when treated as seborrheic dermatitis and were followed by severe itching of the sun-exposed area. When the symptoms evolved to erythema keratodes and erythema of the nail folds, several blood tests were performed, leading to the diagnosis of dermatomyositis (DM). Subsequent diagnostic imaging and histopathological examination identified two poorly differentiated adenocarcinomas in the stomach. After a total gastrectomy, there was a fast improvement of DM symptoms. Two months after the surgery, however, an acute manifestation of skin and muscle symptoms, including dysphagia and a walking impairment, led to the prescription of 60 mg per day of prednisolone. After the corticosteroid therapy, his skin condition, walking impairment, and high myogenic enzymes values quickly recovered and returned to normal, but his dysphagia took 95 days to ameliorate. This patient was positive for anti-TIF1 antibody. This case and the related literature made us acutely aware that whenever DM is complicated with malignant tumor, after the resection, one should not hesitate to administer corticosteroid therapy. The recovery of dysphagia is generally difficult, so feeding by tube and training in swallowing should be started from an early stage of treatment. In the present case, for four years from remission, exacerbations of skin symptoms, gastric cancer, and muscle symptoms including dysphagia have not arisen.
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  • A Case of High IgG4 Serum Level with Dacryoadenitis
    Saori MASAKI, Ryoko TATSUKAWA, Eiichi UCHIO, Shinichi IMAFUKU
    2016 Volume 78 Issue 3 Pages 239-242
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.239
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    A 66-year-old man noticed bilateral swelling of the upper eyelids 4 months prior to his initial visit to our department. Sjögren's syndrome was suspected, but his serum titers of antinuclear, anti-SS-A, and anti-SS-B antibodies were each within the normal range. His serum IgG4 level was elevated (325 mg/dl; normal range 4-108 mg/dl); therefore, IgG4-related dacryoadenitis was suspected, and a biopsy was taken from the lacrimal gland. Infiltrated plasma cells were observed in the lacrimal gland tissue, and by immunohistochemistry, 30% of IgG-positive plasma cells showed IgG4 positivity. On this basis, we suspected him as having IgG4-related dacryoadenitis. Prednisolone (PSL), 60 mg/day, soon relieved the swelling of eyelids, and the serum IgG4 level decreased to the normal range. However, eyelid swelling recurred when PSL was gradually tapered. Introduction of methotrexate, 6 mg/week, did not relieve the symptom. Therefore, the PSL dose was increased again, and the swelling of eyelids was relieved. Elevated serum IgG4, bilateral dacryoadenitis, and response to PSL suggested that he had IgG4-related disease. It is necessary for us to consider IgG4-related disease as a differential diagnosis when we encounter bilateral lacrimal gland swelling.
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  • A Case of Subcorneal Pustular Dermatosis in a Patient with Essential Thrombocythemia Accompanied by a High Plasma Level of TNF-alpha
    Chiaki KIYONAGA, Mitsuhiro MATSUDA, Kazuhiro YOSHIMURA, Chika OHATA, M ...
    2016 Volume 78 Issue 3 Pages 243-247
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.243
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    A 77-year-old woman who had been treated for essential thrombocythemia (ET) presented with generalized pustules, red patches, and scales that appeared one week earlier. A skin biopsy was consistent with subcorneal pustular dermatosis, demonstrating epidermal subcorneal neutrophilic pustules. She showed a high plasma level of TNF-α. Busulfan was added to hydroxycarbamide to treat the exacerbation of ET. After treatment, the platelet count and plasma level of TNF-α decreased and the rash disappeared. Subcorneal pustular dermatosis, Sweet syndrome, and pyoderma gangrenosum are neutrophilic dermatoses. TNF-α may be involved in the pathogenesis of neutrophilic dermatoses. ET is a chronic myeloproliferative neoplasm. Mutations in JAK2 and MPL that alter the activity of proteins that control signaling pathways are associated with ET. TNF-α is elevated in patients with ET. Subcorneal pustular dermatosis in a patient with ET is rare. This report suggests that TNF-α may be implicated in the pathogenesis of subcorneal pustular dermatosis.
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  • A Case of Erythrodermic Bullous Pemphigoid
    Yuka MORIOKA, Gaku TSUJI, Saho KAWAHARA, Yukihiro MIZOTE, Takeshi NAKA ...
    2016 Volume 78 Issue 3 Pages 248-251
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.248
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    A 73-year-old man visited our clinic with complaints of erythroderma and multiple erosion on his entire body. Physical examination and histopathology of the skin lesions suggested a diagnosis of erythroderma caused by chronic eczema or drug eruption. Numerous eosinophils were observed in the upper dermis ; therefore, we checked the serum anti-BP180 antibody level and found it to be elevated. Direct immunofluorescence staining revealed linear depositions of IgG and C3 along the basement membrane zone. A final diagnosis of erythrodermic bullous pemphigoid was made on the basis of these findings. Oral prednisolone (0.5 mg/kg/day) successfully controlled the erythrodermic condition.
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  • A Case of Acquired Trichorrhexis Nodosa in a Middle-aged Woman
    Ryo YASUMURA, Yuko OKUBO, Yuka KAWABATA, Daisuke UTSUMI, Sayaka YAMAG ...
    2016 Volume 78 Issue 3 Pages 252-256
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.252
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    We report a 50-year-old Japanese woman who had been aware of short hair growth on the parietal scalp region for 2 years before her first visit to our hospital. The symptoms could not be improved by topical steroids, which were prescribed by the previous dermatologist. When she visited our department, there were plenty of short hairs on her parietal scalp. Her short hairs had multiple punctate white nodules, and were easily cut off at nodules. However, her hairs could not be easily pulled out. There were no other abnormal findings. The patient had scratched her scalp and had her hair straight-permed at regular intervals. From her personal history, clinical symptoms, and microscopic findings, we diagnosed her as acquired trichorrhexis nodosa caused by a mechanical stress. Oral fexofenadine hydrochloride was given and the regular straight-perm treatment was stopped. Six months later, her hair symptoms have improved and there has been no recurrence.
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  • Squamous Cell Carcinoma Arising within Lichen Planus of the Vulva
    Miyuki KANNO, Yukiyo NARITA, Kosuke MOCHIDA, Masahiro AMANO
    2016 Volume 78 Issue 3 Pages 257-261
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.257
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    We reported a case of squamous cell carcinoma (SCC) arising within lichen planus (LP) of the vulva. A 51-year-old woman had suffered from vulval pruritus for 10 years, and an erosion appeared at the same site 2 years ago. At the first medical examination, white spots and erosions were observed on the bilateral labium minus. Histopathological examination showed LP on the left labium minus. Vulval LP had been intractable, and ulcers appeared within the erosive areas. Oral prednisolone (5 mg/day) for vulval LP failed to heal the ulcers. Three years later, biopsy of the ulcer within LP revealed a SCC. Resection with a 6 mm surgical margin from the LP and biopsy of sentinel lymph nodes were performed. Histopathology of the excised tumor revealed atypical keratinocytes that had invaded into the dermis, and vascular invasion was also identified. The bilateral inguinal sentinel lymph nodes were free of tumor cells. At 1 year after the operation, neither recurrence nor metastasis has been observed. LP-associated SCC has a poor prognosis, with high rates of regional lymph node metastases, recurrence, and disease-related death. An adequate treatment for LP lesions is important for preventing the development of SCC.
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  • A Case of Myeloid Sarcoma Presenting as Brown Nodule in a Young Woman
    Etsuko TOMIDA, Aya TAKEUCHI, Mai INDEN, Toshiyuki OHNO, Orie KAYO, Mak ...
    2016 Volume 78 Issue 3 Pages 262-265
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.262
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    We report a case of myeloid sarcoma on the nipple. The patient was a 31-year-old Japanese woman without blood disease. Eight months before her first visit to our clinic, she was operated on for a breast tumor, which she was aware of for 3 months beforehand. Five months after the operation, a brown nodule appeared on the scar. At her first visit to us, she presented with the chief complaints of the brown nodule on her nipple and a subcutaneous nodule in her breast. Hematoxylin-eosin staining revealed atypical enlarged cells with a high nuclear/cytoplasmic ratio densely infiltrating the dermis. Immunohistochemical staining was positive for CD68 and CD117, and negative for CD3, CD4, CD10, CD20, CD34, and CD56. Biopsy specimens from bone marrow showed no abnormal cells. From these findings, we diagnosed myeloid sarcoma. Two months later, she was administered chemotherapy with intravenous idarubicin hydrochloride and cytarabine at another hospital. After two courses of chemotherapy, she was not in clinical remission. At her own decision, she stopped receiving treatment for 5 months. Then, she visited the hematology department at our hospital and was diagnosed with leukemia. She was treated with mitoxantrone and cytarabine, and will undergo bone marrow transplantation.
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  • A Case of Mucoepidermoid Carcinoma
    Haruna OTUKA, Toshifumi ABE, Shinichirou YASUMOTO, Takashi HASHIMOTO, ...
    2016 Volume 78 Issue 3 Pages 266-269
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.266
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    A 71-year-old woman presented with a 10-year history of a brown papule on her lip that had gradually enlarged. Physical examination revealed a 15 × 7 mm, brown, wart-like nodular lesion with a crust of yellow scale. Histologically, multiple glandular cavities of varying size and scattered solid nests of abnormal cells that were positive for periodic Acid-Schiff and Alcian blue stains were observed throughout the mucinous stroma. The tumor comprised epithelial-like cells with an eosinophilic cytoplasm, mucin-producing cells, and intermediate-type cells. Based on these findings, mucoepidermoid carcinoma was diagnosed. The tumor was reconstructed using an Abbe flap. At 5 years after the initial surgery, no local recurrence or metastasis has been observed.
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Therapy
  • A Study on the Therapeutic Effect of Jumihaidokuto in Patients with Acne Vulgaris with Inflammatory Lesions
    Kenji MAKINO
    2016 Volume 78 Issue 3 Pages 270-273
    Published: June 01, 2016
    Released on J-STAGE: September 01, 2016
    DOIhttps://doi.org/10.2336/nishinihonhifu.78.270
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    Jumihaidokuto is a medicinal herbal formulation that is widely used for the treatment of skin diseases such as suppurative skin diseases, eczema/dermatitis, and urticaria. We administered Jumihaidokuto in combination with external medicine to patients with acne vulgaris with inflammatory lesions (83 sites in 42 patients) for 4 weeks or longer. Two weeks after the start of the medication, the rash severity score began to show significant improvement. When examined by site (forehead, cheeks, perioral region, jaw and neck region, chest region, dorsal region, and trunk), the rash severity score of the forehead and cheeks had significantly improved at 2 weeks after administration, and that of the chest and dorsal regions showed a trend towards improvement. Based on the above results, it was concluded that Jumihaidokuto contributes to an improvement in patients' quality of life, since it alleviates acne vulgaris with inflammatory lesions (not only on the face but also on the trunk) from an early stage, when used in combination with other medications.
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