A 29-year-old female took Niflec^®, an oral electrolyte lavage solution, before surgery to remove angiomyolipoma on the right kidney. Thirty minutes later, erythematous macules and heat sensation developed over her whole body, followed by facial swelling and dyspnea. Her symptoms were resolved by fluid replacement and intravenous corticosteroid. Prick tests showed positive reactions to Niflec^® and macrogol 4000, a constituent of Niflec^®, as well as macrogol 400, 1500 and 6000. Based on these results, we diagnosed this case as having an anaphylactic response to macrogol 4000 contained in Niflec^®.Skin Research, 10: 199-202, 2011

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Since May 2009, a 45-year-old woman repeatedly developed swelling around her eyes during postprandial walks. She particularly noticed swelling of her face while walking after eating Tempura in April 2010 and developed anaphylaxis while walking after eating a muffin in July 2010. IgE-RAST was positive for wheat, gluten and ω5-gliadin. Provocation tests demonstrated that anaphylaxis developed when she took both aspirin and wheat together. She had begun using a soap containing hydrolyzed wheat protein two years earlier. Both a prick test and a patch test to a hydrolyzed wheat protein showed positive responses, suggesting that this patient had both an immediate-type and a delayed-type hypersensitivity reaction to hydrolyzed wheat protein. We assume that intake of wheat followed by exercise or aspirin intake provoked the wheat-dependent induced anaphylactic episodes via percutaneous sensitization to a hydrolyzed wheat protein.Skin Research, 10: 203-208, 2011

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A woman in her sixties with a 20-year history of psoriasis vulgaris, which had been occasionally treated with OTC cream, was transported to our hospital by ambulance. She had widespread erythema, edema, and exfoliation, which had suddenly developed following cold symptoms 10 days previously. Due to severe cutaneous pain, she was unable to move and had difficulty eating. On admission, her Psoriasis Area and Severity index (PASI) score was 58.8 and her CRP levels had increased to 7.5mg/dl. After excluding severe bacterial infection and the past history of tuberculosis, infliximab was administered. One week after commencement of therapy, she showed rapid improvement of the symptoms including clearing of erythema and cutaneous pain, and became able to eat by herself. Treatment guidelines for psoriatic erythroderma in the United States recommend infliximab or cyclosporine as the first-line treatment. Since our patient showed marked hypertension, infliximab was selected instead of cyclosporine. Our case demonstrated that infliximab is useful for emergency cases demonstrating severe and rapidly aggravating psoriatic erythroderma.Skin Research, 10: 209-213, 2011

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A 41-year-old female initially presented with edematous erythema of the upper eyelids, and then erythema gradually appeared in hands, cheeks and trunk. Skin symptoms such as heliotrope rash and erythema as well as the findings on skin biopsy were consistent with dermatomyositis. However, there were no apparent muscle symptoms. The level of myogenic enzymes was within the normal range and anti-Jo-1 antibodies were negative on blood exam. Therefore, we considered that the patient had clinically amyopathic dermatomyositis (CADM). Thereafter, she complained of enhanced itching and presented skin ulcers and mild interstitial pneumonia (IP). In addition, the levels of myogenic enzymes increased. Anti-CADM-140 antibodies were detected. Skin eruptions and IP were resolved and the levels of myogenic enzymes were improved by combined administration of corticosteroids, cyclosporine and cyclophosphamide hydrate.Skin Research, 10: 214-219, 2011

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We report 6 patients (4 males and 2 females) with erythropoietic protoporphyria (EPP) treated at our hospital. In all cases including 4 intrafamilial cases, the symptoms initially developed in childhood. We diagnosed these patients as having EPP based on the high level of blood protoporphyrin together with the medical history, familial history and clinical features. In one case, genetic analysis was performed, detecting T to C transition in FECH cDNA changing from Ile to Thr at amino acid position 186. Single nucleotide polymorphism in intron 3 that affected the enzyme activity of FECH was also detected. There was no apparent seasonal change in blood porphyrin level in our cases.Skin Research, 10: 220-223, 2011

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Case 1 was a 43-year-old woman with a history of gastric cancer, who had been undergoing chemotherapy since February 2007. She had noticed a mass in the umbilical region in September 2008, which tended to enlarge, and consulted our department for the evaluation of the lesion in January 2009. On the initial examination, papules measuring 2 to 5mm as well as nodules were present in and around the umbilicus area. Skin biopsy yielded a diagnosis of umbilical metastasis of gastric cancer. Case 2 was a 77-year-old woman who noticed nodules in the umbilical region several weeks before the visit to our department. Physical examination showed a little-finger-tip-sized (it is better to indicate size as mm or cm) erosive nodules with exudates in the umbilical region. General examination demonstrated the existence of pancreatic cancer and multiple liver metastases. Clinical and histopathological findings led to diagnoses of Sister Mary Joseph nodule in both cases. Umbilical metastasis from visceral malignant tumors is known as Sister Mary Joseph nodule. To our knowledge, 191 cases of umbilical metastasis from visceral malignancy have been reported in Japan. To date, the primary tumor was located most frequently in the stomach (61 cases), followed by the pancreas (40 cases) and the ovary (30 cases).Skin Research, 10: 224-227, 2011

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We encountered two patients with Ramsay Hunt syndrome. The first case was a 70-year-old male who developed vestibulocochlear dysfunction and facial nerve palsy while undergoing antiviral treatment for herpes zoster of the right postauricular area and oral mucosa. Methylprednisolone succinate, initially 200mg/day with gradual tapering, was administered and facial nerve palsy was completely resolved. The second case was a 50-year-old male who consulted our clinic with otalgia and facial nerve palsy. The patient did not, however, have any apparent herpetic eruption (zoster-sine herpete). He was treated with an antiviral agent and methylprednisolone succinate 200mg/day with gradual tapering and his facial nerve palsy completely resolved. Thus, early administration of antiviral agents in combination with methylprednisolone can be useful for facial nerve palsy in cases of Ramsay Hunt syndrome.Skin Research, 10: 228-233, 2011

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