Skin Research, 12: 159-160, 2013

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We report a rare case of angioedema in a 39-year-old Japanese man presenting with edematous erythema with slight itch of upper limb and clusters of blisters on the flexor side of the right forearm. Since his twenties, after taking cold remedies, he had occasionally experienced non-itchy edematous erythema lesions on his limbs, which cleared up spontaneously within 4-5 days. Examination of a skin biopsy specimen of his recent blisters revealed severe edema of the papillary dermis, and infiltration of lymphocytes and eosinophils around the vessels and between collagen fibers. Laboratory findings showed low levels of serum C4 and both a low level and low activity of C1 esterase inhibitor (C1-INH). Analysis of SERPING1 gene coding the serping C1 inhibitor revealed a frameshift mutation in exon 3, c.106_107delAG or p.Ser14fs. Therefore, he was diagnosed with HAE type 1 despite having no family history of this disease. The symptoms have been well controlled by oral administration of tranexamic acid (500-750mg/day).Skin Research, 12: 190-194, 2013

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A 65-year-old man with high-risk myelodysplastic syndrome (MDS) presented with a fever and painful, violaceous, and indurated erythema on his face and extremities. For high-risk MDS, 5-azacytidine was administered intravenously at a dose of 130mg/day before the appearance of skin rash. Biopsy specimen revealed dense infiltration of neutrophils without vasculitis in the dermis, so a diagnosis of Sweet's syndrome (SS) was made. The eruption and fever recurred every time after the administration of 5-azacytidine, but responded to systemic corticosteroid therapy. To the best of our knowledge, this is the first case report in Japan that 5-azacytidine may be involved in the pathogenesis of SS. Further investigation of cytokine profiles in MDS patients should be necessary in order to clarify the mechanisms of SS.Skin Research, 12: 195-198, 2013

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A 69-year-old woman developed pruritic erythema on her face, ears and dorsal side of the hands 2 weeks after starting prochlorperazine. She showed positive photo tests to 2.5J/cm², 5J/cm² and 10J/cm² UVA but not to UVB up to 120mJ/cm². Photo patch tests revealed positive responses for 0.1% and 1% prochlorperazine with 2J/cm² UVA irradiation and 1% prochlorperazine with 80mJ/cm² UVB irradiation. No erythematous response was observed by patch tests with 0.01%, 0.1% and 1% prochlorperazine. She was diagnosed with photosensitivity due to prochlorperazine. The present case is the second case of photosensitivity due to prochlorperazine in Japan as far as we could tell from the literature.Skin Research, 12: 199-202, 2013

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A 72-year-old male patient presented with nodules and papules on the right anterior chest. The rash appeared during chemotherapy for right pulmonary adenocarcinoma and the patient was introduced to our department. A diagnosis of metastatic cutaneous tumor was made on the basis of skin biopsy. The tumor showed gradual yellow necrosis in the center, enlarged, and bled easily. We performed a procedure with Mohs paste with the cooperation of a palliative care team to fix the tumor and eliminate a bad odor caused by infection. After this procedure, the patient was able to enjoy going out and brief visits to his home without discomfort from the protruding tumor, exudate fluid, bleeding, and bad odor. Thus, the procedure improved the QOL of the patient, prior to his cancer-related death. This case shows that Mohs paste is useful to improve the QOL of patients with a metastatic unresectable cutaneous tumor, controlling bleeding, pain, exudate fluid, and bad odor.Skin Research, 12: 203-206, 2013

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A 57-year-old male had been burned on the left thigh approximately 20 years previously. After healing, the lesional skin was slightly elevated and then gradually depressed. First examination revealed a 15×13mm, well-circumscribed, reddish-brown atrophic lesion with a central crateriform depression. Histopathologically, proliferation of fibroblastic and histiocytic cells was seen in the thinned dermis. The cells were positive for factor VIIIa. On the basis of these findings, we diagnosed this lesion as atrophic dermatofibroma. Although the cause of atrophic dermatofibroma is unknown, pronounced loss of elastic fibers in the dermis and multiple hair follicle inductions in the overlying epidermis were demonstrated, as shown in recent case reports. These findings suggest that a specific micro-environment might be present in the dermis of atrophic dermatofibroma.Skin Research, 12: 207-211, 2013

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We report the case of a 44-year-old man who developed a visceral varicella zoster virus (VZV) infection accompanied by severe organ failure. He had a history of tumor resections of non-metastatic colorectal cancer and testicular carcinoma. This patient was hospitalized because of stoma closure with concomitant severe abdominal pain. This abdominal pain was refractory to treatment with NSAIDs and pentazocine. Morphine chloride was needed to control his pain. All routine physical, laboratory and ultrasonographic studies were performed, but no diagnosis was revealed. The following day, the characteristic skin rash of VZV infection appeared over his entire body. Tzanck testing demonstrated herpes virus infection giant cells in the vesicular fluid, and varicella zoster virus DNA was detected in peripheral blood on polymerase chain reaction (PCR) analysis. We diagnosed this case as disseminated VZV infection. Acyclovir was started immediately. Further blood tests taken the following day revealed that the patient also had acute hepatitis and disseminated intravascular clotting. Since he did not respond to intravenous acyclovir (750mg/day), we increased the dose of acyclovir to 1,500mg/day and added intravenous immunoglobulin (IVIG). Soon after this therapy was initiated, the abdominal pain and skin rash improved. Commonly, VZV infection occurs in immunocompromised subjects, such as recipients of bone marrow transplantation. Disseminated VZV infection can present with acute abdominal pain prior to skin eruptions and is dangerous and often fatal. Early acyclovir administration and detection of VZV using PCR with blood or biopsy samples are recommended.Skin Research, 12: 212-218, 2013

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Twenty-one cases (5 males, 16 females; mean age 46.2, range 11-78 yrs old) of Microsporum canis infection were encountered between 2005 and 2011 in a dermatology clinic located in the southern part of Kanazawa. During this period, 247 cases of tinea corporis and tinea capitis were encountered and the proportion of M. canis infection cases was 8.5%, with 10 of 21 cases being diagnosed between 2005 and 2006. All cases involved tinea corporis, two of which were combined with tinea capitis. Very different from previous reports, none of the patients was aged less than 10 years old, 12 of 21 had lesions on parts of the body usually covered by clothing, but 13 cases showed lesions on parts usually exposed. As the source of the fungus, 15 of 21 cases were suspected to be from cats, with 1 kept as an indoor pet, 12 having been found wandering outside, and 2 having been stray cats. From 2006 to 2011, detection and isolation of fungus from dogs and cats were performed at a veterinarian clinic located about 600m from the dermatology clinic. Fungal isolates from 30 feline and 6 canine animals suspected of dermatophytoses were found to be M. canis. The majority of the cats had been found wandering outside; these animals were speculated to have been contaminated with M. canis from infected stray cats. The purebred dogs and cats were mostly kept indoors as pets, and these were speculated to have been contaminated in animal breeder establishments or pet shops.Skin Research, 12: 219-223, 2013

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