Human papillomavirus (HPV) is an important etiological agent in different kinds of malignant and benign skin tumor, including squamous cell carcinoma and Bowen's disease. We report a case of multifocal vulvar Bowen's disease of human papillomavirus (HPV) type 16. A 62-year-old man presented with hypopigmentation with erythema and black to brown papules involving the perianal to right genitocrural region. In 2006, the patient had been diagnosed with Bowen's disease and subsequently undergone 3 surgical treatments without histopathological complete resection. Therefore, he had been introduced to our hospital and received a curative extensive resection of the skin and anorectal mucosa in 2011. The diagnosis was confirmed as multiple Bowen's disease. To check for HPV infection, PCR amplification and DNA sequencing were performed on extracted tissue DNA using GP5/GP6 primers, resulting in the detection of type 16 DNA among malignant types of HPV. Sequentially, amplification of papillomavirus oncogene transcript (APOT) assay showed only episome-derived HPV16 transcripts without integration into tumor DNA. Since previous reports showed that genome integration of malignant-type HPV such as type 16 was associated with the development of SCC, APOT assay may be valuable to discriminate SCC from non-invasive Bowen's disease.Skin Research, 13: 263-268, 2014

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A 69-year-old woman visited our division with severe eczema of both feet after the topical application of anti-fungal ointment. Ten years previously, she had also experienced contact dermatitis due to another anti-fungal topical medicament containing diethyl sebacate. We performed 48-hour closed patch testing for the clotrimazole ointment (as is) and each of its ingredients. The results revealed that both the product (as is) and diethyl sebacate (5% pet) elicited positive reactions ++ (D2) and ++ (D3). Therefore, we diagnosed this case as contact dermatitis caused by diethyl sebacate. Although ingredient-based patch testing had not been performed ten years previously, we considered that the cause at that time had also been diethyl sebacate and that the present episode could have been avoided if ingredient-based patch testing had been performed.Skin Research, 13: 269-272, 2014

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We treated 16 patients with angiosarcoma at Nara Medical University Hospital between 2000 and 2012. We divided the patients into 3 groups according to their own characteristics and their treatment, and compared clinical outcomes. The first group (4 patients) received surgery for a small-sized tumor. The second group (4 patients) had a past history of radiation therapy or chronic lymphedema (underlying disease group). The third group (8 patients) had a large tumor located on the scalp (scalp group). The patients in the scalp group were elderly and took more time than the other groups to consult a doctor after becoming aware of their condition. For these elderly patients, education is needed for early detection. The scalp group was treated with radiation and/or chemotherapy without surgery, which were effective for the improvement of prognosis. Although the patients in the underlying disease group consulted us early, their sarcomas were too large for radiation or chemotherapy to be effective. Only the patients in the first group with small-sized sarcomas received surgery followed by radiation and chemotherapy. These patients had no recurrence or metastasis. Thus, surgery is only appropriate for patients with small sarcomas.Skin Research, 13: 273-277, 2014

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We report three cases of immediate hypersensitivity to quinolones. We divided quinolones into two groups: those consisting of a bicyclic or a tricyclic ring structure. The sensitizing and cross-reactivity drugs were as follows: ciprofloxacin and moxifloxacin with a bicyclic ring structure (Case 1), levofloxacin and pazufloxacin with a tricyclic ring structure (Case 2), and levofloxacin and ofloxacin containing its optical isomer (Case 3). It is likely that antigenic determinants are a cyclopropyl group in position 1 of a bicyclic ring structure and a pyridobenzoxazine ring of a tricyclic ring structure. Our data indicate that cross-reactivity of quinolones tends to occur within groups and may not occur between different groups.Skin Research, 13: 278-284, 2014

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Pilonidal sinus is an acquired condition commonly present in the sacral region in young male adults with obesity and hirsutism. Here, we report a 29-year-old Japanese male patient with recurrent pilonidal sinus. The affected lesion was evaluated by computed tomography and magnetic resonance imaging before surgical removal. CT detected a high concentration in the subcutaneous fat of the left sacral area. MRI identified a lesion like a cyst with high intensity in the subcutaneous fat of the left sacral area. No invasion toward muscle and bone was found. The fistula and granulation tissue were completely excised with staining of the lumen of the fistula with crystal violet. Histopathological findings showed a hair-containing fistula surrounded by granulation tissue with infiltration of neutrophils, lymphocytes and plasma cells. He was instructed after excision to improve his lifestyle, including activity and diet. We believe that anatomical evaluation before removal, complete excision, and improvement of patient's lifestyle are indispensable for reduction of the rate of recurrence in pilonidal sinus.Skin Research, 13: 285-289, 2014

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