A 37-year-old female visited our clinic because of the development of pruritic, erythematous macules limited to the site of application of Norspan^® transdermal patches. She had been applying Norspan^® for the previous three weeks because of chronic pain caused by interstitial cystitis and endometriosis. Patch testing with Norspan^® showed a positive reaction, while testing with sample tape of Norspan^® containing the same constituents except for buprenorphine showed a negative result. From these results, we diagnosed this case as allergic contact dermatitis to buprenorphine. This is the first report of allergic contact dermatitis from Norspan^® in Japan; we should be aware of the possibility of similar cases.Skin Research, 12: 69-73, 2013

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We present a case of recurrent hydroxyurea-induced ulcers on the feet and toes, even after discontinuation of hydroxyurea therapy. A 72-year-old man with a history of polycythemia vera had received hydroxyurea for 1 year and 7 months, but he developed a painful skin ulcer over the right lateral malleolus. He discontinued the hydroxyurea; however, skin ulcers spread to the heels, which did not respond to conventional topical therapies. Peripheral artery diseases, venous insufficiency, diabetes, mycobacterial infection, and collagen diseases were ruled out; the direct cytotoxic effect of hydroxyurea may result in fragility of the skin, leading to multiple skin ulcers by minor trauma or pressure.Skin Research, 12: 74-78, 2013

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A 60-year-old woman suffering from left breast cancer was treated by chemotherapy with paclitaxel (Abraxane^®). The day after the initial treatment, erythematous macules and papules with severe itching developed on her trunk and extremities. On the fifth day of rash, maculopapular erythemas with scales and excoriations covered her whole body except her face. Oral bepotastine besilate and topical betamethasone butyrate propionate were effective and the eruptions resolved in one week. The treatment with Abraxane^® was restarted because she wanted to continue the chemotherapy. Although every treatment with Abraxane^® induced similar eruptions, the tumor gradually decreased in size. The result of drug-induced lymphocyte stimulation test for paclitaxel was negative. This case was given a diagnosis of a maculopapular-type drug eruption caused by Abraxane^® via a non-allergic mechanism. In a case of mild drug eruption with chemotherapy for cancer, continuation of medical treatment with the chemotherapy should be considered.Skin Research, 12: 79-82, 2013

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We report a 49-year-old woman who presented in 1999 with oral erosions and cutaneous erosions and was diagnosed with pemphigus vulgaris. The patient was treated with pulsed methylprednisolone, pulsed cyclophosphamide, plasma exchange therapy and azathioprine. She was then free from any lesion of pemphigus vulgaris with 5mg of prednisolone, and both Dsg1 and Dsg3 antibodies were below the threshold of detection. In June 2009, scattered scaly small erythematous lesions appeared on her face and lower limbs. A biopsy of a skin lesion showed intraepidermal blister that splits at the level just beneath the stratum granulosum and acantholysis, and only Dsg1 antibodies were detected at high levels. The transition from a pemphigus vulgaris phenotype to pemphigus foliaceus was mirrored in this case by striking changes in the Dsg1 and Dsg3 autoantibody levels.Skin Research, 12: 83-87, 2013

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A 65-year-old female patient had noticed an itchy mass in the vulva two months previously. We noted an elastic-hard, 1cm-diameter mass accompanied by superficial erosion on the clitoris, as well as shiny white spots on the inner side of the left and right labia majora. On the basis of biopsy findings, she was diagnosed with squamous cell carcinoma with lichen sclerosus et atrophicus. We performed resection 1cm distant from the affected site. Clinicopathologically, squamous cell carcinoma in the vulva is classified into three types: warty and basaloid types involving perimenopausal development through human papilloma virus infection, and the keratinizing type observed commonly in elderly people and suggested to originate from lichen sclerosus et atrophicus. Patients with the keratinizing type of this disease generally show a poor prognosis and may require careful follow-up.Skin Research, 12: 88-91, 2013

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Adapalene (Differine^®) gel is a topical retinoid originally approved for the treatment of acne vulgaris. It has been reported that adapalene is effective for painful periungual inflammation induced by molecular target drugs. We present three cases of painful periungual inflammation that were alleviated by adapalene application. Two of these three cases were periungual inflammation of the toes induced by gefitinib (Iressa^®) for lung cancer. The other was periungual inflammation of the fingers induced by cetuximab (Erbitux^®) for metastatic colorectal cancer. The patients did not respond to the treatment with topical corticosteroid preparation. After 4 weeks of adapalene application, periungual granulomatous inflammation and pain were alleviated in all three cases.Skin Research, 12: 92-96, 2013

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A 52-year-old man with untreated diabetes mellitus had a raised purple-red lesion on his right lower back. Blood examination showed remarkable elevation of C-reactive protein level. Emergent incision and drainage of the raised purple-red lesion, surgical debridement, and wound irrigation with a pulsed lavage system were performed under local anesthesia. We diagnosed him with necrotizing fasciitis on the basis of the necrosis of subcutaneous tissue extending to the middle layer of the muscle, as an operative finding. The causative agent was methicillin-sensitive Staphylococcus aureus. Infection control was carried out with a pulsed lavage system and the skin defect with deep pockets diminished using negative pressure wound therapy (NPWT); the wound subsequently healed without a skin graft. We diagnosed this case as a subcutaneous abscess from the clinical course because his skin did not necrotize. This case is rare because it involved a subcutaneous abscess that developed on the back of a patient with untreated diabetes. We had difficulty achieving infection control and wound healing, but pulsed lavage system and NPWT, respectively, were useful for these conditions.Skin Research, 12: 97-102, 2013

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We present a case of multiple cutaneous Mycobacterium abscessus infection. A 72-year-old woman presented with a 2-month history of multiple nodular lesions on the extremities. She had been diagnosed with pulmonary tuberculosis at 17 years of age and Sjögren's syndrome at 50 years of age. Physical examination revealed seven thumbnail-sized, dark-red nodules with a small central ulceration and serous pus discharge on bilateral extremities. Histopathologically, a skin biopsy showed a neutrophilic abscess in the dermis and an epithelioid cell granuloma containing foreign-body-type and Langerhans-type giant cells. A culture of a pus specimen on 1% Ogawa egg medium at 37°C showed smooth white colonies on day 5. Using PCR-restriction enzyme pattern analysis of the hsp65 gene, the mycobacterium was identified as M. abscessus. Although pulmonary mycobacteriosis was suspected based on the chest X-ray and computed tomography (CT), cultures of specimens obtained at bronchofiberscopy failed to demonstrate M. abscessus. Although initial monotherapy with 400mg/day oral clarithromycin was insufficient, the combination of clarithromycin and 300mg/day isoniazid therapy for 9 months cleared all of the cutaneous lesions. However, no improvement of the lung lesion was observed on chest X-ray.Skin Research, 12: 103-108, 2013

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An 85-year-old woman was referred to our department for a history of itching on her head and neck. Her skin lesions had been treated by topical corticosteroids with transient improvement under the diagnosis of seborrheic dermatitis by a dermatological practitioner, but the symptoms later recurred. Physical examination at the initial visit revealed hyperkeratotic erythema with pustules, crusts and sparse hairs on her head. We demonstrated Microsporum canis from the hairs by mycological examination, and made a diagnosis of kerion celsi by Microsporum canis. Oral administration of terbinafine alone was not effective. However, the addition of topical terbinafine showed significant improvement. A previous report indicated that topical application of antifungal is a contraindication for kerion celsi because of its exacerbatory effect. However, in our case, topical antifungal was effective, coordinated with oral administration.Skin Research, 12: 109-112, 2013

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A 73-year-old man, who had undergone chemotherapy for acute myeloid leukemia, had erosion around his urostomy. The erosion formed a deep ulcer, and rapidly developed gangrenous, black dome-shaped nodule. Histopathology of the necrotic tissue showed dermal and subcutaneous degeneration and necrosis with many hyphae. The hyphae were also observed in dermal artery as thrombi. We diagnosed him with mucormycosis by the morphology of the hyphae. Repeated debridement resolved the skin lesion without any antifungal agent after 6 months. Primary cutaneous mucormycosis is rare and often fatal. It is classified into superficial type and gangrenous type. The superficial type develops in healthy individuals and has a slow progression. On the other hand, the gangrenous type develops in debilitated patients with underlying diseases, and has a rapid progression. In this case, the pathological findings themselves suggested severe gangrenous type, which could be fatal; however, its clinical course was consistent with the superficial type. This discrepancy could be explained by the fact that the patient developed mucormycosis in a transient immunosuppressive period after chemotherapy. Subsequently, the cutaneous lesion naturally healed in accordance with the recovery of his immune system.Skin Research, 12: 113-116, 2013

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A 47-year-old man had erythema with swelling at sites of mosquito bites and high fever the day after receiving such bites on his legs. Three days after the bites, soya bean-sized blisters with hemorrhage, blackish crusts and purpura at the sites of the mosquito bites were observed in widespread edematous erythema. He also had fever and right inguinal lymphadenopathy. Anti-Epstein-Barr virus (EBV) viral capsid antigen (VCA) IgG and anti-EBV early antigen (EA) IgG levels were increased (×640 and ×20, respectively). EBV DNA copy number in the peripheral blood was 79 copies/μg DNA. Dense lymphocytic infiltrate with eosinophils was found in the dermis and subcutaneous adipose tissue. Infiltrating cells had no atypia and were barely positive for EBV-encoded small RNA (EBER)-1. We diagnosed him with adult-onset hypersensitivity to mosquito bites on the basis of characteristic cutaneous symptoms at the sites of the mosquito bites, fever, lymphadenopathy and laboratory data of EBV. We report this rare case of adult-onset hypersensitivity to mosquito bites.Skin Research, 12: 117-121, 2013

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A 42-year-old woman presented with a pruritus, linear rash over the the left abdomen. One month prior to the appearance of the skin lesions, the patient had eaten raw Salangichthys microdon from Aomori prefecture. Because of its prevalence in Aomori, creeping disease due to Gnathostoma nipponicum was suspected. She was treated with oral ivermectin, which relieved her symptoms. However, the eruption reappeared one month later and she received ivermectin again with a good therapeutic effect. Since measurement of antibody titer to Gnathostoma nipponicum is not available, we used antibody titer to Gnathostoma doloresi, which shares antigenicity with Gnathostoma nipponicum. During the course of treatment, the antibody titer to Gnathostoma doloresi decreased gradually. It is suggested that the cross-reactivity between the two species is useful for the monitoring of Gnathostoma nipponicum.Skin Research, 12: 122-125, 2013

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We report a 42-year-old woman who suffered from left eyelid, cheek and neck swelling after dental extraction of a lower left molar. Angioedema was suspected at the first examination because of marked swelling of her eyelid. However, a crackling and crepitant feeling in the left cheek was palpable, and radiography and computed tomography of her head and neck showed subcutaneous emphysema and pneumomediastinum. We diagnosed this case as subcutaneous emphysema and pneumomediastinum caused by the introduction of air into the soft tissue by an air turbine handpiece during molar extraction. Although cases of subcutaneous emphysema and pneumomediastinum after dental treatment have rarely been reported, the possibility of complications may be higher than expected when using higher-pneumatic-pressure air turbine and air syringe systems. Dermatologists should bear in mind this disease entity, which may occur after dental treatment.Skin Research, 12: 126-130, 2013

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We developed a combination test method for concomitant determination of both the MIC and the MFC of antifungal drugs against dermatophytes, in which the standardized broth microdilution method is combined with the use of a trans-well system and neutral red for the direct measurement of MFC. With this newly developed method, MIC and MFC values of five topical antifungal drugs commercially available in Japan against Trichophyton rubrum were determined. The geometric means of the MIC of luliconazole, lanoconazole, bifonazole, terbinafine and liranaftate were 0.00029, 0.00060, 0.032, 0.0064 and 0.0043μg/ml, respectively. These values are comparable to those from previous reports. The geometric means of the MFC of these drugs were 0.0035, 0.0058, >1, 0.034 and 0.047μg/ml, respectively. Among the five drugs tested, luliconazole and lanoconazole were found to be more potent in terms of both growth-inhibitory and fungicidal activities than the others. This new method is considered useful for evaluation of the in vitro activity of antifungal drugs against dermatophytes.Skin Research, 12: 131-137, 2013

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