A 59-year-old male developed a skin ulcer 10cm× 5cm in size on the right leg (lateral malleolus). The patient's conditions were complicated with renal and heart failures. In practice, this patient had been managed by hemodyalysis machine 3 times weekly. Although the patient had received traditional topical treatment with various types of ointment for one month, wound conditions had not improved. The allogeneic cultured dermal substitute in conjunction with a wound dressing capable of releasing antimicrobial agent was used as a wound bed acceptable for autologous meshed split-thickness skin graft. The wound conditions improved significantly in 5 weeks, showing a highly vascularized granulation tissue. The wound closure was achieved in 3 weeks after meshed skin graft. The allogeneic cultured dermal substitute is able to release some kinds of cytokines including VEGF and IL-6 which are useful in promoting wound healing. The wound dressing is designed to release antimicrobial agent to suppress bacterial growth. This wound treatment using the allogeneic cultured dermal substitute and the wound dressing is proven effective in preparing excellent wound bed for skin graft.

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A 15-year-old male with linear lesions on the left lower leg is described. Each eruption appeared to be almost circular, violaceous and was accompanied by slight itching. Clinically we suspected of linear lichen planus or lichen striatus. Incisional biopsy was taken from the lesion on his ankle. Histology revealed a band-like inflammatory infiltrate of lymphocytes in the papillary dermis, vacuolar alteration of the basal layer, spongiosis and necrotic keratinocytes in the epidermis. In addition, we found the presence of inflammatory infiltrate in the reticular dermis around eccrine glands. With these findings, we diagnosed this case as lichen striatus. Skin Research, 1:97-101, 2002

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We measured the serum level of cytokines in an adult patient with Still's disease.
The IL-6 level elevated only in early stage, while the IL-18 level changed correlatively with the degree of joint pain. The G-CSF and M-CSF levels slightly increased during the course of the disease. Any serum cytokine did not change correlatively with the skin changes. It is possible that some cytokines are involeved in the divelopment of clinical symptoms of this disease. Skin Research, 1:102-106, 2002

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We describe a case of cutaneous polyarteritis nodosa with mutiple indurated erythema in a 55-year-old Japanese woman. She was referred to our hospital with fever up to 38°C, chill, systemic malaise and multiple indurated erythema on the trunk and limbs.
Biopsy of an erythema on the lower leg was performed. Histopathological examination showed infiltration of neutrophils, lymphocytes and histiocytes around the small arteries in the lower dermis and in the lobules of fat cells. We could also find fibrinoid degeneration and leukocytoclastic vasculitis of small arteries. Elastica-van Gieson staining revealed small arteries characterized by destruction of the internal elastic laminae and disappearance of external elastic laminae. Laboratory data revealed absence of MPO-ANCA and PR3-ANCA and positive occult blood in stool. Histopathologically we could not find vasculitis in the intestinal mucous membranes.
We made a diagnosis of cutaneous polyarteritis nodosa, according to histopathological examination and clinical findings.
We cannot, however, rule out that the present case may develop systemic PN. Close follow up is necessary.
We also discussed the relationship between necrotizing vasculitis and EBV infection.

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Puncture and surgical excision has been chosen for the treatment of ganglion and mucous cyst of the fingers and toes, but recurrence with ulceration has been often seen after these treatments. We performed acupuncture therapy for recurrent ulcer and lesions of 2 cases with ganglion and a case with mucous cyst. After 4 to 14 months of the treatment the lesions markedly improved. Therefore, it is suggested that the acupuncture therapy may be an optional modality for recurrent ulcer and lesions of ganglion and mucous cyst of the fingers and toes.

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A 70-year-old male patient developed erythema on the dorsum of his nose at the age of about 35 years. Then, similar erythema gradually appeared on the many sites of the body. The skin lesion was diagnosed as chronic discoid lupus erythematosus in another hospital. At the age of 43 years, a tumor developed on the erythema of the left upper limb. The tumor was resected and diagnosed as SCC. Later, squamous cell carcinoma and keratoacanthoma developed on the lower lip, neck and left upper limb and were resected. At the age of 51 years, a tumor appeared on te right side of his neck, and was histologically diagnosed as squamous cell carcinoma and malignant hemangioendothelioma. The patient underwent resection and treatment with DTIC (dimethyltriazenoimidazole carboxamide) was done. At the age of 65 years, squamous cell carcinoma developed on the left retroauricular region. Both tumors were resected in another hospital. On July 15, 1999, the patient was referred to our hospital because of the change of his residence. At the end of January, 2000, the patient exhibited a small nodule and shallow ulcer on the cicatricial lesion of DLE on the nape, and the nodule and ulcer were slowly enlarged. The lesion was histologically diagnosed as squamous cell carcinoma by skin biopsy. On July 11, 2000, resection of the tumor and skin grafting were performed. At present, about one year after the surgery, the patient has neither recurrence nor metastasis of SCC.

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An 86-year-old male noticed a purple macule on the left cheek after a shaver injury in Sep. 1999. Histological examination of the macule revealed a diffuse proliferation of anaplastic cells with large nuclei in the dermis and subcutaneous tissue. The tumor cells were positive for CD56 and TdT. EBER and TCR gene rearrangement were negative. Based on these findings, we diagnosed this case as blastic NK cell lymphoma. Radiation therapy was performed and the number of the tumor cells reduced remarkably histologically. However macule recurred on forehead and chest four months later.

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Streptococcus pyogenes causes a variety of infectious complications including toxic shock-like syndrome (TSLS), characterized by fever, necrotizing fasciitis, and hypotension that can lead to multiple organ failure and lethal shock.
This report presents a 35-year old woman with complaint of an 1-day history of a painful erythema and swelling on her left thigh, and a 65-year old man with a 3-day history of painful erythema with necrosis and blister on his right thigh. Both of two cases fulfilled the criteria for TSLS, rapidly developed destructive soft tissue infection, disturbed consciousness, and shock. In addition to conventional therapy, which consisted of operative debridement, antibiotics and intensive supporting care, we performed plasmapheresis, endotoxin-adsorbing therapy using polymyxin B, and intra-artery or local injection of antibiotics into the site of infection. As a result of our treatment, there was no further spread of the infection in both of two cases. The first case was eventually discharged home, but the second case died 15 days after admission despite intensive treatment.

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We report an adult case of molluscum contagiosum at the of a site finger ring. Asymptomatic reddish nodules developed on the left ring finger in a 38-year-old female from 2 months ago. Histologically, the biopsied specimen showed a typical finding of molluscum contagiosum. This is a rare case in which the lesion deveroped on unusual site and in adult woman without any immunodeficiency diseases.

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NOV ^® AC Series was applied to total 22 cases with acne vulgaris at Department of Dermatology, Kobe University School of Medicine (Kobe, Japan) during Oct.-Nov., 2000.
These products (Cleansing Gel, Washing Powder, Face Lotion and Moisturizing Gel) possess the ingredient of PIONIN as and bacterial for Propionibacterium acnes and further contains Dipotassium Glycyrrhizate which inhibits inflammation.
Among 22 cases, 21 used safely, and no side-effect was observed after 2-week application of these products. One case, however, complained of reddish itchy papules on the face after using Washing Powder for 3 days that disappeared after discontinuation.
These results indicate that NOV ^® AC Series is safe skin care product for patients with acne vulgaris

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