Impaired wound healing is a common and costly problem in diabetes. Infection and bacterial colonization delay wound healing, and peripheral vascular disease results in recalcitrant diabetic ulcers. In the past decade, a revival has been seen concerning interest in the use of maggots, which are believed to produce factors that promote wound healing, in the treatment of diabetic wounds. A 44-year-old male with a 20-year history of untreated diabetes mellitus was referred to our dermatology outpatient clinic with a right lower leg ulcer. Amputation of his lower leg was being considered as a last option. Maggot therapy was started to debride the wound. Magnetic resonance angiography (MRA) revealed possible occlusion of the right popliteal artery and the measured skin perfusion pressure (SPP) of the right plantar was 75mmHg. The angiography of his lower leg revealed no significant stenosis of the popliteal artery. Results of the angiography and SPP suggested that the healing of the right foot ulcer removed the need for vascular surgery. The patient underwent amputation of the second to fifth toes to remove sequestrum and necrotic ligaments, and his right foot ulcer was healed using vacuum-assisted closure. Maggot therapy is an effective therapy for the debridement of diabetic ulcers. Careful evaluation of blood flow, including measurement of the SPP, is important in the treatment of diabetic ulcers.Skin Research, 12: 275-279, 2013

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We report a 47-year-old male with myelodysplastic syndrome who developed multiple indurated erythema on his lower extremities. During follow-up observation, the erythema extended to the upper extremities and became painful, and high fever also occurred. Oral administration of NSAIDs and potassium iodide did not improve the symptoms, and a biopsy specimen from the erythema demonstrated dense and lobular neutrophilic infiltration without adiponecrosis or angiitis. On the basis of the clinical and histological findings, we made a diagnosis of neutrophilic panniculitis. He had been treated with granulocyte colony-stimulating factor (G-CSF) several days before the onset of the skin lesions, and we suspected that this G-CSF injection had induced neutrophilic panniculitis in our patient with myelodysplastic syndrome.Skin Research, 12: 280-284, 2013

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We report three patients with dermatomyositis who visited our department during the year 2012. They had typical skin lesions such as heliotrope rash, Gottron's sign, periungual erythema and nailfold punctate hemorrhage, diagnostic signs of dermatomyositis. Muscle involvements were observed in two patients but none of the patients had interstitial pneumonia. Anti-TIF1 antibodies, specific for dermatomyositis, were detected by immunoprecipitation in all patients. Although anti-TIF1 antibody has been reported to be strongly associated with internal malignancy, only one patient developed cancer (esophageal cancer). Patients with dermatomyositis and anti-TIF1 antibodies over the age of 40 were strongly associated with malignancy. We reported two patients with no malignancy, but we should identify whether the 68-year-old patient among these two has malignancy in the future.Skin Research, 12: 285-291, 2013

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Sister Mary Joseph nodule (SMJN) is a sign of metastatic cancer from the viscera in the abdomen or pelvis. A 71-year-old male presented to the surgical outpatient clinic with a painful umbilical nodule and was later referred to the Department of Dermatology due to suspected omphalitis. Physical examination revealed a tender, subcutaneous, periumbilical nodule approximately 5mm in diameter. SMJN was suspected, and the patient underwent a biopsy and a contrast-enhanced computed tomographic (CT) scan of the abdomen and pelvis. Hematoxylin-eosin staining of the biopsy specimen confirmed small nests of enlarged atypical cells and a lumen structure in the dermis, and immunohistochemical staining was positive for carbohydrate antigen 19-9 (CA 19-9). CT scan of the abdomen showed a 3cm cystic lesion in the body of the pancreas and dilatation of the main pancreatic duct. Peritoneal dissemination of the tumor was strongly suspected due to the presence of fluid in the rectovesical pouch. The suspected presence of peritoneal dissemination made surgery inappropriate, and thus chemotherapy was recommended as a first-line treatment. He was subsequently referred for a second opinion. Histopathological examination of the umbilical tumor cannot always identify a primary lesion; therefore, systemic screening of malignancy using CT or magnetic resonance imaging should be considered. Some conditions, including omphalitis, mimic SMJN and have thus been reported as pseudo-Sister Mary Joseph nodule; therefore, SMJN should be distinguished from other conditions by meticulous examination of the periumbilical tumor. The importance of both timely biopsy of the periumbilical tumor and systemic screening using imaging modalities was highlighted by a report of the long survival of a patient with SMJN treated successfully by chemotherapy.Skin Research, 12: 292-295, 2013

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In 2009, a 53-year-old woman developed a nodule with a central depression on her right thigh at a site she had injured by nail scratching and at which scar formation had subsequently occurred. Dermoscopy revealed a delicate peripheral pigmented network and a central white network. Histopathologically, the reticular dermis of the lesion showed thinning accompanied by the loss of elastic fibers and a focal increase of collagen fibers, and proliferation of fibroblast-like cells that were positive for factor XIIIa. The epidermis showed acanthosis with hyperpigmentation in the basal layer and deeply elongated rete ridges showed folliculo-sebaceous induction with ductal structures. Atrophic dermatofibroma is a specific type of dermatofibroma, and it often has epidermal hyperplasia with adnexal induction.Skin Research, 12: 296-300, 2013

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Background Infliximab is a monoclonal antibody for the treatment of moderate to severe psoriasis including psoriasis arthropica and erythroderma psoriaticum. Objectives To evaluate the effectiveness of infliximab in the treatment of severe psoriasis. Methods Presence of joint pain and Psoriasis Area and Severity Index (PASI) 90 response rate were set as the primary endpoints. Infliximab was administered to 11 patients as a 5mg/kg intravenous injection at the interval indicated in the official pharmaceutical reference. Results Initial PASI score was 23.0±17.1 (range 3.6-58.8). PASI score was significantly improved within two weeks (t=2.76, p=0.02). PASI 90 response was achieved in 64% of all cases. Joint pain was also improved soon after the first administration of infliximab. Conclusions Infliximab was revealed to be effective for the treatment of severe psoriasis including psoriasis arthropica and erythroderma psoriaticum.Skin Research, 12: 301-305, 2013

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