A 64-year-old woman had been suffering from a ten-month history of erythemas and papules with waxing and waning on the face, lateral thoracic regions and upper arms. A biopsy specimen revealed infiltration of atypical lymphocytes in the dermis, which were positive for CD30 and CLA, and negative for ALK and EMA. No findings observed on physical and radiologic examination or blood tests suggested extracutaneous disease. Thus, we diagnosed her with lymphomatoid papulosis (LyP). After a year, some lesions on the face persisted without spontaneous regression. Oral methotrexate was applied for 7 months, resulting in poor response. Two months later, these lesions showed self-healing. Four months later, papules relapsed and rapidly worsened to enlarge on lateral thoracic regions and lower extremities, and lymphadenopathy and left iliac neoplasm developed. Biopsy specimens of both skin and bone revealed infiltration of atypical lymphocytes, which were positive for CD30 and CLA, and negative for ALK and EMA. We therefore diagnosed her with primary cutaneous anaplastic large cell lymphoma with subsequent lymph node and bone involvement.Skin Research, 13: 1-7, 2014

View full abstract

An 11-month-old male infant presented with small, erythematous macules, papules, nodules, vesicles, and pustules. The distribution of the lesions involved the trunk, palms, soles, and back. We suggested hand-foot-mouth disease or pompholyx. Histopathological examination of the left upper back found appendages and perivascular infiltration, and infiltrating cells were mainly composed of a small number of lymphocytes. After follow-up, multiple skin lesions spread and looked like mite burrows. We examined his skin scraping microscopically, and identified an adult scabies mite and some eggs. Therefore, we diagnosed him with scabies. First, we chose 10% crotamiton cream for treatment. However, the skin lesions did not resolve, so we used 5% permethrin cream. One month later, there was complete remission of the disease. We should remember the possibility of scabies, which involves obstinate dermatitis with vesicles on the hands and feet. In this case, permethrin treatment contributed to quality of life in the family.Skin Research, 13: 8-12, 2014

View full abstract

A 60-year-old Japanese woman was referred to our division for treatment of subcutaneous abscess on the left back at the site of herpes zoster. Because of severe skin lesions and high levels of blood glucose, the abscess was treated with systemic antibiotics as well as topical medications, and her blood glucose levels were managed in an inpatient setting. The lesions healed on day 61 after hospitalization. There have been 3 patients with secondary bacterial infection occurring at a site of herpes zoster during the last 10 years in the Japanese literature. In 2 of these 3 patients, the underlying disease was diabetes mellitus. Given the results, diabetes mellitus-induced immunosuppression may cause secondary bacterial infection at the site of herpes zoster. The present case illustrates the importance of medical practitioners paying attention to diabetes mellitus and blood glucose control.Skin Research, 13: 13-15, 2014

View full abstract

A 61-year-old woman had received chemotherapy for the treatment of follicular lymphoma over the past 5 years. She visited our hospital because of multiple papules that began to appear on her face and limbs since November 2011. The patient had no history of insect bite; however, her clinical and histological findings closely resembled insect bite. We diagnosed an insect bite-like reaction associated with follicular lymphoma. We treated the eruption with oral prednisolone at 10mg/day and observed an improvement in the condition. A lower dose of oral steroids showed improvement in our case compared with previous cases of insect bite-like reactions.Skin Research, 13: 16-19, 2014

View full abstract

In 2013, many patients with tick bite visited dermatology clinics because of severe fever with thrombocytopenia syndrome (SFTS), so tick-borne viral emerging infectious disease became a major topic in Japan. We collected 47 cases of human infestation with hard ticks from medical institutions in Honshu, the main island of Japan, and reported 33 cases (17 males, 16 females) of tick bites in Hyogo Prefecture in 2013. The causative tick species were Amblyomma testudinarium (32 cases) and Haemaphysalis longicornis (1 case). The age of the patients ranged from 5 to 89 years and those over 60 years of age accounted for 67% of the total. All of the tick infestations were acquired in mountainous areas or fields. The period in which all patients were infested by ticks was from March to August, and the highest incidence was in May. The most commonly (64%) affected site was the lower half of the body. Most patients had no eruption or erythematous macules of less than 2cm around the biting site, but three patients showed erythema of over 5 cm in diameter. We diagnosed these cases as tick-associated rash illness.Skin Research, 13: 20-25, 2014

View full abstract

A 7-year-old boy presented with a 10-day history of papules on the trunk. Physical examination revealed numerous tiny white papules, 1-2mm in diameter, with an erythematous halo, mainly grouping on the right shoulder and left lower waist. Histologically, the papules consisted of subepidermal calcium deposits and localized acanthosis, where dilatated acrosyringium contained the accumulation of a keratinized mass and calcium. Laboratory data suggested the absence of calcium metabolism abnormality. On the basis of these findings, the skin lesions were diagnosed as milium-like idiopathic calcinosis cutis. An analysis of 29 previous cases and this one suggested that this skin disorder results from the temporary deposition of calcium in the acrosyringium due to disturbed sweat secretion, and that a part of the calcium deposits accumulates in the dermis and a part is eliminated from the skin. This skin disorder is more frequently seen on the hands and feet of children with Down's syndrome, the reason for which is unclear.Skin Research, 13: 26-34, 2014

View full abstract

A 73-year-old Japanese male had a shiny erythematous and slightly infiltrated plaque on his glans. Skin biopsy of the lesion showed acanthosis with atypical keratinocytes at all levels of epidermis with scattered mitoses. Human papillomavirus was detected in the lesion. On the basis of these findings, a diagnosis of erythroplasia of Queyrat (EQ) was made. The patient refused a surgical resection and topical imiquimod therapy (3 times/week) was started. The lesion still remained clinically and histopathologically 16 weeks after the therapy, and the erythema finally disappeared 29 weeks after the treatment clinically; a rebiopsy specimen showed no residual atypical keratinocytes. The patient was free from recurrence 11 months after cessation of the therapy. An external preparation of imiquimod therapy may be one of the most useful remedies for the treatment of EQ.Skin Research, 13: 35-39, 2014

View full abstract

A woman in her sixties had had a pigmented macule on her right sole for 10 years. At the initial examination, a pigmented macule with ulceration was found in her right sole. Dermoscopic examination showed irregular dots/globules in most parts. A diagnosis of malignant melanoma was established with histological examination of an excisional biopsy. Breslow's tumor thickness was 1mm. A sentinel node biopsy was performed with a positive result. Therefore, we performed right inguinal lymph node dissection. The histological specimen showed three micrometastases in the lymph nodes. In general, early palmoplantar melanomas exhibit parallel ridge patterns on dermoscopy, but some cases show irregular dots/globules in most parts of the lesion. In addition, we should consider the possibility of lymph metastasis in cases of thin palmoplantar melanoma.Skin Research, 13: 40-43, 2014

View full abstract