The term acne inversa has been introduced to cover acne conglobata, hidradenitis suppurativa, and perifolliculitis capitis abscedens et suffodiens, comprehensively. A study of 32 Japanese patients with acne inversa yielded the following observations: 1) the male to female ratio was 25: 7, 2) the mean onset of the disease was estimated to be at 26 years old, 3) positive family history was observed in 5 patients, 4) the affected areas were buttocks and the perineal area in 72%, head and neck in 65%, torso in 41%, and axilla in 28% of cases, 5) multiple areas were affected in 50% of cases, 6) double comedones was noted in 72%, 7) cutaneous squamous cell carcinomas had occurred in 3 patients on the skin sites affected by acne inversa, 8) 4 patients had concurrent internal malignancy such as lung cancer, renal cell carcinoma, unspecified sarcoma, and acute lymphocytic leukemia, and 9) unroofing operation was a useful method for sparing normal skin.Skin Research, 12: 3-11, 2013

View full abstract

From surveillance by Wakayama Dermatologic Association between 2005 and 2011, (1) hand-foot-mouth disease was found to be most prevalent in Wakayama prefecture in 2011 within this period. In addition, in 2011, (2) we had many cases with remarkable skin lesions and/or subsequent nail change. (3) The proportion of patients aged 20 and over was higher in 2011 than in other years. By weekly reports from the National Institute of Infectious Disease of Japan, hand-foot-mouth disease was shown to be most prevalent in 2011 within the period between 2002 and 2011, and Coxsackievirus A6 was most frequently detected in this epidemic. There are papers about cases of hand-foot-mouth disease by Coxsackievirus A6 with remarkable skin lesions or subsequent nail lesions. It is suggested that many adults were infected with Coxsackievirus A6 and this may be one of the reasons for the hand-foot-mouth disease epidemic in 2011.Skin Research, 12: 12-17, 2013

View full abstract

A 50-year-old man with type 2 diabetes mellitus and hypertension had been undergoing hemodialysis from the age of 41 due to diabetic renal failure. He also suffered from peripheral arterial disease, which was managed by endovascular therapy in an internal medicine department. One year before his first visit to our department, an ulcer had appeared on the middle toe of his right foot. Regardless of other endovascular therapy, the ulcer expanded and he consulted our department, but infection of the ulcer worsened his general condition. Modified transmetatarsal amputation of his right foot and a superficial femoral-dorsal pedis artery bypass were performed, but the ulcer expanded to the heel. Topical, less invasive treatment seemed hopeless, and the ulcer was treated with a rectus abdominis muscle flap and free skin graft to enable the patient to walk by himself. Six months later, an ulcer on the middle toe of his left foot following a small injury developed and rapidly enlarged, but was finally improved by Lisfranc's joint disarticulation leaving the left heel. In such cases, limb revascularization may take a long time, but it enables us to salvage critical limb ischemia.Skin Research, 12: 18-25, 2013

View full abstract

A 34-year-old woman experienced swelling of her lips after administration of an analgesic for headache. Several months later, blistering on her upper and lower lips and the dorsum of her right hand and erythema on her left index finger developed after administration of another analgesic, and pigmented lesions were observed. Since both drugs contained allylisopropylacetylurea, ibuprofen, and anhydrous caffeine as active ingredients, a fixed drug eruption caused by any of these ingredients was suspected. However, a closed patch test was negative for all three ingredients on nonlesional skin. Therefore, an open patch test with simple application was performed on the lesional skin. After Vaseline containing allylisopropylacetylurea or ibuprofen (20% w/w) was applied onto the pigmented lesions on her lower or upper lip, erythema appeared within 5 minutes on both lesions. On the other hand, no such reactions were observed after applying allylisopropylacetylurea onto the pigmented lesion on the back of her hand, or after applying anhydrous caffeine onto the pigmented lesion on her lip. The open patch test on the lesion was considered a rapid, safe, and highly useful method for the diagnosis of fixed drug eruptions on transitional areas between the skin and mucosa.Skin Research, 12: 26-30, 2013

View full abstract

A 56-year-old Japanese woman presented with a 7-year history of reddish-brown linear atrophic plaques and non-healing ulcerations with moth-eaten appearance on the bilateral pretibial lower extremities that had been worsening for the previous 1-year. A punch biopsy specimen demonstrated non-necrotizing epithelioid granulomas in the deep dermis and subcutaneous tissue. These histological findings were those of cutaneous sarcoidosis. Computed tomography scans showed bronchial wall thickening, and transthoracic echocardiogram showed the thinning of the basal portion of the ventricular septum, which were suspicious for systemic sarcoidosis. One of the clinical differential diagnoses of atrophic plaques with ulceration is ulcerative sarcoidosis, and in patients with non-necrotizing epithelioid granulomas in the skin, we should consider possible systemic sarcoidosis. A long-term follow-up is necessary if sarcoidosis cannot be definitely differentiated.Skin Research, 12: 31-34, 2013

View full abstract

A 61-year-old female developed a subungual tumor on the big toe of her right foot in 2007. The tumor was treated with liquid nitrogen under a diagnosis of granuloma pyogenicum by a doctor. The tumor did not change after the treatment, and she had not received any treatment since then. In autumn 2010, she noticed the formation of exudate on the surface of the tumor after injuring it. She visited our outpatient clinic in February 2011. At her first visit, a light red-colored subungual nodule was observed, and the nail had not been destroyed. A biopsy specimen showed eccrine poroma. The tumor was excised and grafted with her skin. The course after the excision was good. Subungual eccrine poroma is very rare. In this case, the tumor did not occur in the nail bed but in the hyponychium.Skin Research, 12: 35-38, 2013

View full abstract

A 75-year-old man was served several raw eggs of the soft-shelled turtle at a hotel in Wakayama City ten weeks before the first consultation. He felt a slight itching of the skin on the right side of the abdomen about 8 weeks later, and noticed a tiny red nodule there. The first examination of the right side of the abdomen showed a dome-shaped, soft, red nodule, with a diameter of fifteen millimeters, elevating on the erythema that spread backward like the tail of a comet associated with subcutaneous infiltration. A three-millimeter punch biopsy revealed that the nodule contained a thin, white, string-like parasite, and it was removed as much as possible. The parasite was identified as a plerocercoid larva of Spirometra erinaceieuropaei based on the findings of the surface and anterior end of the body, and the presence of calcareous corpuscles in histological examination. Dot-ELISA analysis demonstrated an elevated titer of anti-Spirometra erinaceieuropaei antibodies in the patient's serum. No nodule recurrence was noted after removing the larva at biopsy, and the titer of the antibodies diminished after three months. We diagnosed this case as an early stage of sparganosis mansoni caused by the intake of raw eggs of the soft-shelled turtle. Examination of the reported parasitic cases in the Japanese literature disclosed only a few previous cases of sparganosis mansoni and creeping disease, possibly due to the consumption of raw soft-shelled turtles. Therefore, eating the eggs of this turtle raw involves a slight risk of parasitic disease.Skin Research, 12: 39-43, 2013

View full abstract