A 13-year-old girl presented an indurated linear erythema on the mid-forehead with a 3-month history. Based on the clinical and histological findings, she was diagnosed as having scleroderma en coup de sabre. Since no efficacy of treatment with a glucocorticoid ointment and ultraviolet therapy had been observed, systemic glucocorticoid and methotrexate were administered. Her erythema disappeared after 4 weeks, and she was able to stop taking any medication 2 years later without any symptoms. No adverse events were observed. To date, there have been few case reports of scleroderma en coup de sabre treated with systemic glucocorticoids and methotrexate in Japan. This combination therapy is efficacious and comparatively safe. Thus, it should be considered as one of the treatment options for scleroderma en coup de sabre.
A 47-year-old Australian man who had a history of basal cell carcinoma (BCC) on the head and back in addition to an actinic keratosis on the cheek visited the Department of Dermatology of Fukuoka University Hospital with the complaint of a pinkish nodule with a fistula in the posterior region of the right auricle in July 2016. No familial history of nevoid basal cell syndrome was confirmed. An incisional skin biopsy led us the diagnosis of infiltrative-type BCC. Because the imaging examination revealed the infiltration of cartilage, we recommended an enlarged resection with removal of the auricle. Since he did not agree with the plan, a marginal resection to preserve the auricle was chosen. Residual tumoral cells in the deep part were confirmed by post-operative histopathological examination. Therefore, electron beam therapy at the dose of 60 Gy/30 Fr was administered after surgery. No recurrence has been observed for 1 year. According to the Japanese guidelines, surgical intervention is the primary choice for the treatment of BCC. However, we considered that radiotherapy is also an effective therapeutic option for BCC if surgical treatment could not be chosen for any reason.
A 74-year-old woman presented with a multilocular tumorous lesion on the right side of scalp. Pathological examination of the biopsy specimen revealed dense infiltration of tumor cells with eosinophilic cytoplasm in the dermis. Definite histological diagnosis could not be obtained from hematoxylin and eosin staining or immunohistochemical analysis. At the time of total resection, two similar, small tumors were found in the left contralateral side of her scalp. Histopathological findings of both lesions revealed densely proliferative atypical endothelial cells and tumor cells that had formed an irregularly shaped luminal structure through the dermal layer. Immunohistochemical staining showed that the tumor cells were positive for CD31, D2-40 and vimentin. She was diagnosed with angiosarcoma. No metastatic lesion was found on positron emission tomography-computed tomography, and post-surgical treatment was not performed on the family's wishes. Ten months after the surgical excision, the tumor had metastasized to the lung and liver, and she was treated with two courses of weekly docetaxel therapy. The patient developed interstitial pneumonia, and, in spite of corticosteroid pulse therapy, she died without improvement. In this case, the presence of purpura, which is the usual characteristic of angiosarcoma, was not observed during the patient's clinical course. Therefore, we could not make a clinical diagnosis of angiosarcoma until complete resection. Taxane-based anticancer agents are frequently used as the first-line treatment for angiosarcoma of the scalp. Close attention needs to be paid to avoid the development of interstitial pneumonia.
A 75-year-old woman underwent breast-conserving surgery with radiation therapy for left breast cancer in 2009. She had been treated with hormone therapy and had not experienced a recurrence of the breast cancer. The emergence of a red plaque and purpura on the left breast led her to visit our hospital. A partial incisional biopsy, in addition to her medical history, established the diagnosis of radiation-induced angiosarcoma. After total mastectomy and reconstruction by split-thickness skin grafting followed by weekly paclitaxel therapy (6 cycles), she has been tumor-free for 18 months. Due to breast cancer screening, breast cancers have increasingly been detected at an early stage. Thus, cases who underwent breast-conserving surgery and radiation therapy after surgery are increasing. Angiosarcoma has a very poor prognosis. Therefore, if dermatologists see purpura or nodules on the skin of patients who have a history of radiation treatment, we should always consider radiation-induced angiosarcoma as a differential diagnosis.
A 33-year-old female with systemic lupus erythematosus and antiphospholipid antibody syndrome visited our department due to having disseminated purpuric vesicles of a few-day history. She had been treated with a combination of immunosuppressive drugs ; prednisolone 25 mg/day, mycophenolate mofetil 1500 mg/day, and tacrolimus 1. 5 mg/day. Histological examination of a vesicle suggested a herpetic infection. Laboratory examination showed high titers of IgG antibodies against herpes simplex virus (HSV) and varicella zoster virus (VZV) on the first day, neglecting primary herpetic infections. The oral administration of valaciclovir 1000 mg 3 times a day for a week was successful and all her vesicles crusted and healed. No significant changes were seen in the antibody titers of HSV and VZV at 3 and 11 weeks after the onset, and the VZV-IgM and HSV-IgM antibodies were not detected throughout the clinical course. However, the VZV antigen was positively stained in the nuclei of affected keratinocytes by immunohistological examination, leading to a final diagnosis of recurrent varicella. The reactivation of VZV usually causes herpes zoster, while it may directly induce recurrent varicella without any association with a localized zosteriform eruption, especially in elderly or immunocompromised patients.
An 85-year-old man with no underlying disease or prior trauma had suffered from red nodules on the back of his hand for 2 months. Culture of a skin biopsy specimen from the nodules yielded white colonies on Sabouraud's medium but not on Ogawa's medium. DNA-DNA hybridization revealed that the colonies were Mycobacterium chelonae (M. chelonae). The patient was treated with clarithromycin and levofloxacin. The erythema and nodules improved in 4 weeks and the treatment was stopped after 16 weeks. M. chelonae is a rare, rapidly-growing mycobacterium. Although most of the patients infected with this mycobacterium have prior trauma or underlying disease, its occurrence in healthy individuals has also been reported. The diagnosis of M. chelonae infection is often difficult because of the low positive rate of culture. M. chelonae colonies are most often seen on Sabouraud's medium or blood culture medium. Thus, for diagnosis, it is important to culture the samples in various media repeatedly. Currently, there is no standardized treatment regimen for M. chelonae infection. We summarized the procedure for treating cutaneous M. chelonae infection with antibiotics.
We examined 30 cases (15 males and 15 females aged between 1-88 years) affected by tick bites who were treated at Okayama Medical Center in the fiscal year 2014. We removed ticks in 17 cases, and in the other 13 cases the ticks were removed by the patients themselves. We tried to remove ticks using a tick removal tool (Tick Twister®) as much as possible. However, we removed ticks along with the affected skin by excision in cases where a tick could not be removed using the tick remover. We attempted to remove ticks using the tick remover in 14 patients and we successfully removed the ticks in 12 patients. All the ticks removed using the tick remover preserved their mouth-parts without any damage. One of the two cases in which we could not remove the tick using the tick remover was affected by Ixodes ovatus. In the other case, more than 3 days had passed since the tick bite occurred. The species could be identified for each of the 21 ticks that we submitted for species identification and comprised Amblyomma testudinarium (13 ticks), Haemaphysalis longicornis (7 ticks), and Ixodes ovatus (1 tick). Some cases developed indurations on the affected site. One case developed erythema migrans and was diagnosed as having tick-associated rash illness. No systemic complications or tick-borne infectious diseases were experienced. We thought that the tick remover was useful for treating tick bites because it could remove the ticks easily and safely without major complications.
A milky lotion containing camellia oil was administered to 46 patients with drying dermatoses including atopic dermatitis, asteatotic eczema, xeroderma, and senile pruritus for 4 weeks to examine its safety. The subjects were patients who regularly visited the Department of Dermatology at Tokyo Medical University Hospital, Ageo Central General Hospital, Todachuo General Hospital, or Niizashiki Central General Hospital during a 5-month period from November 2016 to March 2017. The results confirmed that the lotion was safe to use, since no side effects were observed. Evaluation of skin symptoms through observation by a physician indicated significant improvements in the scores of dryness and scratch marks between before and after the test (p < 0.01). In addition, the patient's subjective ratings of the moisture and itchiness of the skin were evaluated using a visual analogue scale. A significant increase in the moisture of the skin (p < 0.01) and a significant decrease in itchiness (p < 0.01) were observed between before and after the test. The subjects reported that the formulation spreads well without stickiness and has a good feeling upon use. Based on these results, we considered that this milky lotion containing camellia oil acts as a moisturizer that can be expected to reduce drying and itching and can be used safely for the daily skin care of patients with drying dermatoses.
Andrew Blauvelt, M.D., M.B.A., is President and Owner of Oregon Medical Research Center, a private business dedicated to performing high quality clinical research studies in dermatology. Dr. Blauvelt received his undergraduate degree in electrical engineering at Purdue University in 1984 and his medical degree at Michigan State University in 1988. He then completed his dermatology training at the University of Miami and basic immunology training at the National Institutes of Health (NIH) in the laboratory of Dr. Steve Katz. In 2010, he returned to the classroom and received a Healthcare M.B.A. from a joint program at Oregon Health & Science University (OHSU) and Portland State University.