Hifu no kagaku
Online ISSN : 1883-9614
Print ISSN : 1347-1813
ISSN-L : 1347-1813
Volume 11, Issue Suppl.18
Displaying 1-17 of 17 articles from this issue
  • Masayuki Amagai
    2012 Volume 11 Issue Suppl.18 Pages 1
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Skin Research, Suppl. 18: 1, 2012
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  • -Which medicament? What amount? To where? How long?-
    Yoko Kataoka
    2012 Volume 11 Issue Suppl.18 Pages 2-8
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Although atopic dermatitis is a chronic skin disease, complete remission is also expected when well controlled status is maintained. Therefore treatment goal is to keep no or minimal skin lesion with little medication. To achieve the goal, it is important to control cutaneous inflammation appropriately by reliable treatment for which topical corticosteroids play the major role. In Japan, disease activity of atopic dermatitis has been able to be measured by serum TARC that is a highly sensitive biomarker under health insurance support since 2008. After reviewing the previous topical corticosteroid application methods of severe intractable cases with their serum TARC, it is identified that considerable numbers of patients have been suffered with severe prolonged inflammation as a result of insufficient application of topical corticosteroid. Conventionally topical corticosteroid application method has depended on the art or the sense of individual dermatologist, however it should be reconsider precisely and scientifically.
    Several clinical evidences and practical benefit reveal that the concept of treatment strategy should be “tight control” which achieved early complete remission and long-term maintenance of no inflammation even subclinically. Advantage of proactive treatment, prolonged high serum TARC level which suggest persistent enhancement of inflammation by positive feedback, difference value of serum IgE elevation with eczema controlled status in severe atopic dermatitis infants, easily understandable finish line for both patients and physicians, best quality of life without any symptoms for patients, these are the reasons.
    Additionally practical procedures of adequate topical corticosteroid application to accomplish the treatment goal were proposed precisely about following questions. Which medicament? What amount? To where? How long?Skin Research, Suppl. 18: 2-8, 2012
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  • Hidehisa SAEKI
    2012 Volume 11 Issue Suppl.18 Pages 9-12
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Calcineurin inhibitors used for the treatment of atopic dermatitis contain tacrolimus ointment and cyclosporine. Guidelines in the USA and Europe recommend the use of tacrolimus ointment as maintenance therapy as well as induction therapy. Recent studies reported the effectiveness of intermittent therapy for flare prevention with two- or three-times weekly applications of tacrolimus in stabilized atopic dermatitis. Cyclosporine for the treatment of atopic dermatitis has been covered by health insurance since October 2008 in Japan. Cyclosporine can be administered p.o. to adult patients with severe and recalcitrant atopic dermatitis. According to the guidance, the use of cyclosporine can be repeated intermittently; however, it is necessary to discontinue it within the first 3 months of initial use (or resuming use).Skin Research, Suppl. 18: 9-12, 2012
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  • Atsuko Kamo, Mitsutoshi Tominaga, Kenji Takamori
    2012 Volume 11 Issue Suppl.18 Pages 13-16
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Exacerbation of dermatitis associated with erythema is caused by intractable itch-evoked scratching. It is wellknown that phototherapy improves dermatitis following pruritus. We previously demonstrated that psoralen ultraviolet A (PUVA) therapy normalizes the density of intraepidermal nerve fibers and epidermal expression of opioid systems, and improves pruritus in atopic dermatitis (AD). However, the effect of phototherapy on erythema in AD are unclear. Erythema is caused by neovascularization and vasodilation, and nerve fibers and infiltrated cells are related to its development. Phototherapy might be effective in reducing redness associated with anti-intraepidermal nerve fiber density and induction of apoptosis in infiltrated cells.Skin Research, Suppl. 18: 13-16, 2012
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  • Yozo Ishiuji
    2012 Volume 11 Issue Suppl.18 Pages 17-19
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Hypersensitivity of pruritus is the main features of atopic dermatitis. The lower threshold of itch is called “sensitization” under this condition. It has been suggested that both peripheral and central sensitization are involved in itch of atopic dermatitis. Recent neuroimaging studies are focused on brain imaging of histamineinduced itch in humans. In healthy humans, acute histamine-induced itch coactivates the anterior cingulate cortex (ACC), the insular and primary somatosensory cortices, premotor and supplementary motor areas, the prefrontal cortex and thalamus. In contrast, the patients with atopic dermatitis exhibited more broad areas of brain than healthy subjects. These results may suggest the strong itch intensity of atopic dermatitis patients.Skin Research, Suppl. 18: 17-19, 2012
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  • Masahiko Toyoda
    2012 Volume 11 Issue Suppl.18 Pages 20
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Skin Research, Suppl. 18: 20, 2012
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  • Shigetoshi Kobayashi
    2012 Volume 11 Issue Suppl.18 Pages 21-25
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    [Background] Good sleep is essential for the growth and the development of children. However, sleep is often impaired by the night scratching in patients with atopic dermatitis (AD). It is important to assess the sleep quality and the night scratching in pediatric AD patients. For that purpose, we utilized actigraphy as an objective method for the assessment of sleep quality and upper limb movement.
    [Methods] 30 childhood patients with AD and 14 non-allergic volunteers were recruited. Actiwatch® (AW-64) was attached to each subject's wrist for 11 days at maximum. Sleep parameters were calculated with Actiware® and compared among various patient groups. We also compared the activity count (AC) that represented the upper limb movements. 6 patients with severe or very severe AD patients were also recruited for the analysis of long term changes in the sleep parameter and the night scratching during the treatment.
    [Results] Results demonstrate that sleep was significantly compromised in patients with AD, according to the severity. Upper limb movements in AD patients remarkably increased, according to the severity. Subjective scoring of the sleep quality by parents showed limited correlation with actigraphy. Sleep quality of AD patients has improved quickly during treatment. However, scratch movement remained even after three-month treatment.
    [Conclusion] Actigraphy is an objective and unobtrusive method to measure the sleep quality and the night scratching in childhood AD patients and can provide useful outcome in clinical trial.Skin Research, Suppl. 18: 21-25, 2012
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  • -on the Experiences of Inpatient Morita Therapy-
    Rieko Shioji
    2012 Volume 11 Issue Suppl.18 Pages 26-30
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    In this article, basic concepts of Morita therapy are outlined, and through the investigation of a case of inpatient Morita therapy introduced after the dermatological inpatient treatment, an application of Morita therapy to treatment of atopic dermatitis is illustrated. In inpatient Morita therapy, a patient leads a healthy life characterized by light work while dermatological treatment is continued. After therapist sufficiently listened to patient's complaints about dermatological symptoms, therapist treated his anxiety as something natural and encouraged him to step into actions while coping with anxiety. Attention on daily life itself has an effect of shifting a focus from his obsession with physical status and of regaining a natural state of physical and psychological being, which leads to the interaction with self as “arugamama.” The experience of Morita therapy as such is considered to have the potential to sustain remission of atopic dermatitis.Skin Research, Suppl. 18: 26-30, 2012
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  • Ritsuko HOSOYA
    2012 Volume 11 Issue Suppl.18 Pages 31-35
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Various stressors including dermatitis itself are expressed as physical symptoms such as itching, and are sometimes dispersed by actions such as scratching, tapping, and rubbing. Continuation of these behaviors, that could be stress-coping, leads them to habitual behavior. These behaviors become the vicious itch-scratch-cycle that makes it much harder for the patients to stop scratching, and leads to the advance of dermatitis and cause a chronic and intractable state. Most of the patients who have reached that state are obsessed by scratching, sensations of itching, or atopic dermatitis, and some of them develop an addiction to scratching.
    In order to develop a psychological treatment, we must try, first of all, to improve dermatitis by medication, and to search and remove antigens, because it's necessary to remove patients' physical pain caused by skin symptoms as much as possible. Then we can try to prevent and treat patients scratching becoming habitual. If the patients already have strong psychological dependency on scratching, it is better to give them psychological guidance for the purpose of changing their ways of life or thinking rather than to tell them not to scratch.
    It's well known that maintaining skin barrier function and giving the patients appropriate skincare at an early stage is very important to prevent skin conditions from getting worse in the future. Similarly, in my opinion, it is just as important to help the patients develop psychological barrier functions, and we need to give patients' mothers advice how to help them to do that.Skin Research, Suppl. 18: 31-35, 2012
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  • Eiichiro Ueda
    2012 Volume 11 Issue Suppl.18 Pages 36-38
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    It has been well known for many years that psychosocial stress often plays an important role in the clinical course of atopic dermatitis (AD), and recognized the importance of stress management on the healing process to those patients. However, little has been known about how trauma care is applied in patients with AD. In this article, trauma and the response to the traumatic event, and the efficacy of those therapies will be discussed.Skin Research, Suppl. 18: 36-38, 2012
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  • Sonomi Nakajima, Hiroshi Nishino, Hiroko Kishida, Nanase Maeda, Eriko ...
    2012 Volume 11 Issue Suppl.18 Pages 39-42
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    We perform stress management in a hospital-based educational program as a psychological treatment for patients with severe adult atopic dermatitis (AD). Many patients with AD have a poor understanding and awareness of stress and mind-body interaction. Such patients cannot effectively deal with stress, which greatly affects the exacerbation of AD symptoms. We assume that “experiential understanding” is more effective than “educational understanding” to perceive stress and mind-body interaction. Thus, we believe that “experiential stress management,” which encourages a patient to gain insight into stress by means of objectification through psychological tests, communication to elicit questions about stress, and the patient's considering stress and experiencing relaxation, would be useful.Skin Research, Suppl. 18: 39-42, 2012
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  • Hideki MUKAI, Hidetsugu FUKUDA, Taku SUZUKI, Atsuko SAOTOME, Eri SOUDE
    2012 Volume 11 Issue Suppl.18 Pages 43-47
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    The responses to the questionnaire, obtained from 66 subjects aged over 20 years, were analyzed to evaluate the usefulness of inpatient care. The subjects included 40 men and 26 women, and the mean duration of hospital stay was 12.6 days.
    Preadmission analysis of skin and mental symptoms showed that “intense itching sensation” was the most commonly reported symptom (87.9%). Other common symptoms included symptoms related to impaired performance (eg, “difficulty in job or learning” and “loss of concentration”), sleep disorders (eg, “difficulty falling asleep” and “unable to sleep”), and problems related to one's external appearance (eg, “difficulty going out” and “nervous with surrounding people”).
    An analysis at the time of discharge from the hospital showed that the alleviation rate for skin and mental symptoms was high (92% and 79%, respectively). In summary, the favorable effects of hospitalization included direct advantages of inpatient care (eg, “alleviation of skin symptoms, letting the patient feel easier and comfortable,” and “release from itching sensation”) and improvement in compliance and adherence to treatment (eg, “understanding the necessity of oral medication” and “understanding the using method and necessity of topical drug preparations”). After discharge from the hospital, 76% of the patients have remained free of skin symptoms.
    The results indicate that short-term intensive inpatient care is very useful and markedly improves the quality of life of patients with severe atopic dermatitis.Skin Research, Suppl. 18: 43-47, 2012
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  • ∼a narrative approach for atopic dermatitis∼
    Ryosuke Shimizu
    2012 Volume 11 Issue Suppl.18 Pages 48-52
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Interventions, mainly by telephone and facsimile, in the psychosocial aspect of a female patient of age 40 years with atopic dermatitis, with which favorable results were obtained, are reported. The variety of anxieties concerning atopic dermatitis was externalized as “The Scream by Munch”, and the patient was asked to restate as “Sunflowers by van Gogh” the dominant story concerning the atopic dermatitis which was clarified by relative influence questioning, as well as her resources for taking a stand against it. Although significant improvement was seen psychologically, it was considered that for the stabilization of the skin manifestations it is necessary to rewrite the problem-free alternative story to be more thick and heavy using techniques such as re-membering conversations and definitional ceremonies.Skin Research, Suppl. 18: 48-52, 2012
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  • Naoka UMEMOTO, Eri IIDA, Rieko TSUKAHARA, Toshinobu NAKAMURA, Masumi M ...
    2012 Volume 11 Issue Suppl.18 Pages 53-56
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    A 32-year-old man visited us because of intractable, sever adult atopic dermatitis (AD). He was treated with systemic cyclosporine therapy, resulting in poor control. The patient was innately introverted and expressed few complaints, so the medical staff was not aware of his living environment. One and half year after the first visit, the patient's father came together and told us that his son was social withdrawal. Then he was admitted to our hospital and administered with a short-term systemic steroid therapy. His symptoms improved promptly, and now he remains stable condition with topical steroids and tacrolimus therapy more than one year after discharge from our hospital. The effects of the same treatment considerably improved by listening to the patient's complaints attentively, understanding his psychosocial stressors, and leading to the far better improvement of drug compliance and treatment effect. We came to reaffirm the significance of seeing not only the skin symptoms but also the personality.Skin Research, Suppl. 18: 53-56, 2012
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  • Eriko Yoshioka, Nanase Maeda, Hiroko Kishida, Hiroshi Nishino, Yoko Ka ...
    2012 Volume 11 Issue Suppl.18 Pages 57-60
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Parents of children with atopic dermatitis (AD) are very anxious about eczema itself and also treatment method. We are performing group educational programs for the parents, “atopic dermatitis school for infants”, consisted of 4-week-completed weekly group sessions.
    They are constituted of ‘etiology and course of atopic dermatitis’ ‘topical corticosteroids therapy’ ‘skin care’ ‘food allergy’. Quality of life of the parents by ‘questionnaire measuring quality of in primary caregivers of children with atopic dermatitis (QPCAD)’ were assessed before and after the education. Cutaneous inflammation activity is also tracked by peripheral eosinophil count and serum TARC of infants. The quality of life of the parents and clinical data were improved significantly by our group education programs. We are convinced that decrease of anxiety in the parents achieves favorable result in both disease outcome of the infants and their parents quality of life.Skin Research, Suppl. 18: 57-60, 2012
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  • -Shifting from trichotillomania to scratched alopecia-
    Naoyuki HIGASHI
    2012 Volume 11 Issue Suppl.18 Pages 61-64
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    A nine-year-old boy who had been receiving treatment for mild atopic dermatitis at his local clinic was referred to our department because of alopecia on the left side of the head, which had developed one month before the initial visit to our department. Because his band-like alopecia was not accompanied by itching and had residual ruptured short hair, with the patient unconsciously pulling out his hair, a diagnosis of trichotillomania was made. A detailed examination by interview showed that he was under stress due to being forced to keep goal during soccer practice in after-school care for children. His parent consulted a person in charge of afterschool care for children, and three months later his condition nearly recovered. After that, the atopic dermatitis worsened due to sweating, and itching of the frontal region and both sides of the head caused scratched alopecia. Although the patient underwent topical steroid treatment, the symptom was refractory to the treatment. Thus, a photographic record of the alopecia on both sides of the head was made to have him see the affected parts objectively at every visit. As a result, he was cured of the disease in approximately eight months.Skin Research, Suppl. 18: 61-64, 2012
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  • Mizuho Nagao, Yumi Machino, Mayumi Sugimoto, Koa Hosoki, Takao Fujisaw ...
    2012 Volume 11 Issue Suppl.18 Pages 65-69
    Published: 2012
    Released on J-STAGE: November 28, 2013
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    Burden of atopic dermatitis, such as chronically progressing rash, strong itching, sleep disorder or mental restlessness by itch, a matter of physical appearance due to rashes, and troublesome of topical treatment, etc., on overall life is not small. Atopic dermatitis causes electrolyte imbalance and poor weight gain in infants, and sometimes it is closely involved in growth and development of infants. Especially among pediatric patients, burden affects tremendously not only children themselves but also their parents. Therefore, it is very important to assess objectively not only rash but also itching and its impact on sense of burden upon medical treatment. The improvement of QOL was observed when children with atopic dermatitis suffering from remained itch were administered with levocetirizine, and subsequently assessed by using the Japanese QOL questionnaire for childhood dermatosis. Therefore it is also desirable to take QOL of children into account in their medical treatment.Skin Research, Suppl. 18: 65-69, 2012
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