Many investigators have performed oral food challenges with major allergenic foods (eggs, milk, etc.) in patients with atopic dermatitis (AD), and found that these foods could provoke aggravation of eczema in a limited number (less than 10%) of patients. It has thus been widely assumed that foods do not play an important role in the aggravation of AD. To supplement the previous studies, we recently performed oral food challenge tests with all foods consumed by patients with AD, and found that foods other than the major allergenic types (especially tree nut-related foods and fermented foods) provoked aggravation of eczema in approximately 44% of adults and 75% of children who showed unpredictable aggravation of AD, and 73% of breast-fed infants suffering from AD. Thus, it seems that foods (especially tree nut-related foods and fermented foods) play an important role in the aggravation of AD.Skin Research, 13: 65-75, 2014

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An 82-year-old female presented with erythema at staple insertion sites on the day following removal of staples, which had been conducted 2 weeks after left total hip replacement. Two weeks later, she presented with many small erosions at the same sites. We diagnosed this case as contact dermatitis from nickel and chromium based on the results of patch tests and after checking the composition of the stapler. Inflammation was observed at the staple insertion sites. Therefore, we inferred that metals eluting from this surgical instrument had caused epidermal and dermal contact dermatitis. Only 2 cases of contact dermatitis caused by a medical stapler have been reported in Japan, and there is a possibility that the same kind of dermatitis has been underdiagnosed or misdiagnosed as contact dermatitis caused by antiseptic solutions.Skin Research, 13: 76-78, 2014

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Erythematous macules developed over the whole body of a 57-year-old male 7 weeks after the start of combination therapy with peginterferon α-2b, ribavirin, and telaprevir for chronic hepatitis C. Histopathology of the skin lesions was comparable with erythema exudativum multiforme. The eruption was successfully treated with withdrawal of those drugs and systemic corticosteroid. Both patch test and drug-induced lymphocyte stimulation test were negative for ribavirin, telaprevir, and oxypurinol (a metabolite of allopurinol). Combination therapy only with peginterferon α-2b and ribavirin, without telaprevir, induced slight erythema on his trunk, but topical steroid was effective against the rash. Hence, telaprevir might have contributed to the aggravation of drug eruption in this case.Skin Research, 13: 79-83, 2014

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We report a 48-year-old female presenting with a subcutaneous induration of about 10×20mm in size on her abdominal wall for a month. She had undergone mastectomy for breast cancer on the right side half a year before. Histopathological examination of the abdominal induration revealed fat necrosis and a dense granulomatous reaction consisting of histiocytes, eosinophils, lymphoid cells, and a few giant cells occupying the upper fatty layer. Leuprorelin acetate injections had been administered at her abdominal wall 4 times in total for her postoperative treatment. The clinical onset and pathological findings helped to diagnose her skin lesion as a granuloma with subcutaneous fat necrosis caused by leuprorelin acetate injection. A total of 50 such cases have been reported in Japan, and the number of granuloma cases caused by leuprorelin is increasing. Therefore, we dermatologists need to recognize that LH-RH agonist injection can cause granuloma.Skin Research, 13: 84-88, 2014

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A 56-year-old male with a history of follicular lymphoma presented with the complaint of a few papules on the left trunk that had first appeared 23 days earlier. The lymphoma, which had occurred three years previously, had gone into remission following chemotherapy. Four days after first examination, small blisters and pustules erupted all over the body. Tzanck test revealed multinucleated giant cells in the blisters, and a biopsy specimen from a red papule demonstrated giant cells with an inclusion body in the nucleus. Blood tests showed increases of anti-VZV IgM and IgG. On the basis of these clinical and histological findings, we made a diagnosis of chickenpox in the patient with a history of lymphoma. This patient exhibited a long delay from the onset of rash to whole-body scattering, without any other systemic complaints.Skin Research, 13: 89-92, 2014

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Case 1: A 73-year-old man noted painful erythema and vesicles on the buttock several days prior to the initial medical examination. As the rash spread systemically, he complained of difficulty urinating and defecating. The patient was diagnosed with generalized herpes zoster with dysfunction of bladder and rectum, and was hospitalized for treatment by intravenous drip injection of acyclovir at 750mg/day for 7 days. The constipation was improved by oral laxative. Urination was managed with oral distigmine bromide at 15mg/day and urethral balloon catheter. The patient was discharged from hospital when most of the rash had healed, although intermittent self-catheterization was required for one more month. Case 2: A 75-year-old woman observed painful erythema and vesicles on the buttock several days prior to the initial medical examination. She also noticed difficulty urinating. Under the diagnosis of herpes zoster with bladder dysfunction, she consulted urologists and was diagnosed with cystitis, presumably secondary to dysfunctional urination. The patient was hospitalized for treatment by intravenous injection of acyclovir at 750mg/day for 7 days, and oral cefcapene pivoxil hydrochloride hydrate at 300mg/day and distigmine bromide at 15mg/day for 7 days. She was discharged after 1 week when the rash had healed and the bladder function had recovered. To summarize, we have experienced two cases of herpes zoster with dysfunction of bladder and rectum, both of which recovered without systemic administration of corticosteroids. In contrast to the treatment of herpes zoster oticus (Ramsay-Hunt syndrome), the benefits of corticosteroids for anogenital shingles affecting urination and defecation have not yet been established.Skin Research, 13: 93-96, 2014

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A 70-year-old man presented at our hospital for the treatment of elevated skin lesions on his face. They had been enlarging for 20 years. At the first medical examination, a dark-red pedunculated tumor of 26×12mm in diameter on his left nasolabial sulcus and a dark-red nodule of 10mm in diameter were observed. Skin-colored or black papules or nodules of less than 10mm in diameter were also noted on the left and right outer dorsum of the nose, and around wings of the nose and of the cheek, some of which were conjoined. We diagnosed the nodule on the left nasolabial sulcus as basal cell carcinoma (BCC) and multiple papules/nodules around the biggest tumor as multiple trichoblastoma by histopathological and immunohistochemical analyses. All of the skin lesions were surgically removed. Both trichoblastoma and BCC are considered to be tumors derived from hair germ. We speculated that these two disorders were closely related and occurred by transition or transformation under a common genetic background, rather than as an incidental complication.Skin Research, 13: 97-102, 2014

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A 14-year-old girl presented at the Department of Dermatology with a 9-year history of an erythematous plaque. Physical examination revealed a dark reddish or cyanotic plaque on the flexor aspect of the lower left thigh. Although angioma was suspected on the basis of the morphology, histopathological findings demonstrated band-like infiltration of lymphoid cells including atypical lymphocytes on the upper and middle dermis. Mild exocytosis and microabscess on the corneal layer were noted. The phenotype of these cells was LCA+, CD3+, CD56-, CD30-, cyclin D1-, CD10-, and bcl-2-. The number of CD4+ cells was equal to that of CD8+ and monoclonality was not noted by PCR analysis. On the basis of these findings, we ruled out acral pseudolymphomatous angiokeratoma of children and pagetoid reticulosis, and made a diagnosis of pseudolymphoma. The patient was started on topical corticosteroid therapy and PUVA (topical methoxypsoralen and ultraviolet) therapy. We considered that long-term observation is necessary in this case.Skin Research, 13: 103-107, 2014

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A 5-month-old male infant was brought to a local clinic because of a 3-day history of a persistent high-grade fever. The high-grade fever was suspected to be a manifestation of Kawasaki disease, and the infant was thus transferred to the Department of Pediatrics. He was diagnosed with Kawasaki disease a day after admission because his symptoms met the diagnostic criteria, and was subsequently given aspirin and immunoglobulin. The infant was later referred to the Department of Dermatology because orange-brown discoloration and pincer nail deformity affecting all fingernails and toenails were noted 7 days after the onset of high-grade fever. He was diagnosed with chromonychia and pincer nail deformity that developed after Kawasaki disease. Deterioration of microcirculation of the nail bed in the early phase of Kawasaki disease has been reported and biopsy specimens from nail fold have revealed edema, vascular dilatation, and inflammatory cell infiltration. Chromonychia and pincer nail deformity observed in the present case seemed to be associated with abnormality of microcirculation and pathological changes. Normalization of nail abnormality, such as chromonychia and pincer nail deformity, over time was reported. When the infant was brought to the pediatric outpatient clinic 2 months later, all fingernails were normal; however, chromonychia and pincer nail deformity still affected 4 of 10 toenails. We suspect that the faster growth of the fingernails compared with the toenails might have resulted in the unresolved nail disease of the toes.Skin Research, 13: 108-111, 2014

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How to treat metal allergy patients who play brass instruments is not well known among dermatologists, despite being relatively common. In this article, we describe how such treatment should be performed. Specifically, there are three approaches to avoid contact of metal to the lips: 1) change the mouthpiece to one made of wood, plastic, or titanium; 2) make a two-piece mouthpiece with a titanium or acetal upper part (rim); and 3) plate the mouthpiece with titanium or nitriding titanium ion. We also present 2 typical cases of metal allergy in brass players.Skin Research, 13: 112-117, 2014

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