A Japanese woman in her fifties had noticed general fatigue, Gottron's signs on the dorsum of her hands, and palmar papules about six months previously. She was diagnosed with clinically amyopathic dermatomyositis (CADM). We did not initiate systemic treatment because of mild interstitial lung disease and the absence of muscle weakness. An ulcerative eruption developed at the metacarpophalangeal joint on Gottron's signs six months after the first visit. Thoracic CT images revealed the spreading of ground-glass pulmonary nodules on the inferior lobes of both of her lungs, and laboratory examination showed the elevation of serum ferritin levels. Since anti-MDA5 autoantibody was detected, combination treatment with prednisolone at 1mg/kg/day and cyclosporine at 100mg/day was initiated. The laboratory findings shifted to within normal limits and interstitial lung disease improved. We think that cutaneous findings and serum ferritin levels may be useful in determining the time of systemic treatment for CADM.Skin Research, 13: 359-364, 2014

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A 34-year-old woman noticed parietal round patches of hair loss and visited our hospital. She had no history of allergic or endocrine diseases. Diffuse hair loss extended rapidly to the whole scalp in 4 months. Biopsy specimens showed that mononuclear cells and eosinophils had infiltrated around the hair follicles. Dermoscopy (using Dermalite^® II PRO, which does not need gel) revealed yellow dots, black dots, and exclamation mark hairs. She was treated with steroid pulse therapy and topical application of squaric acid dibutylester 4 months after the onset. Hair regrowth was observed 7 months after the onset. The scalp had completely recovered with regrowth hairs 10 months after the onset. We diagnosed acute diffuse and total alopecia of the female scalp (ADTAFS), based on the clinical and histopathological findings. ADTAFS takes a characteristic clinical course, and a large number of eosinophils often infiltrate compared with the levels in other types of alopecia areata. However, a large number of eosinophils may not necessarily be present.Skin Research, 13: 365-369, 2014

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A 61-year-old female, having been under treatment for blastic plasmacytoid dendritic cell neoplasm in the Hematology Unit of Takeda General Hospital, noticed several painful nodules on her limbs. Hematoxylin-eosin staining of a skin biopsy specimen showed massive intradermal pus formation. After the detection of Fusarium spp. from a culture of peripheral blood, we re-examined the former specimen and identified numerous PAS-positive yeast-like microorganisms having a tendency to form hyphae. We made a diagnosis of disseminated Fusarium spp. infection and started intravenous injection of voriconazole and liposomal amphotericin B, which was effective in this case. Disseminated Fusarium spp. infection is a rare disease with a poor prognosis. However, the number of cases in individuals with an immune-deficient state, particularly those with neutropenia, is increasing. In any cases suggestive of Fusarium spp. infection, careful examination including culture and PAS staining of the biopsied skin is encouraged.Skin Research, 13: 370-374, 2014

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We experienced a case of severe acne conglobata under an immunosuppressed condition. A 52-year-old male had been treated with systemic cyclosporine for long-lasting aplastic anemia. In January 2013, he noticed painful cutaneous nodules with purulent discharge on the lip followed by their rapid increase and expansion to the whole body along with fever and multiple nodular shadows in bilateral lung. We diagnosed those skin nodules as acne conglobata, a variant of chronic pyoderma. Whereas the skin lesions and heightened fever were not improved by antibiotic drugs, oral administration of steroid was successful for not only the cutaneous but also the lung lesions. In addition to repetitive bacterial infection, immune imbalance in neutrophil function and proinflammatory cytokine production may be involved in disease onset and its increase in severity.Skin Research, 13: 375-381, 2014

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A 65-year-old man visited our dermatology clinic. He had a past history of a habit of drinking alcohol for more than 45 years. Approximately 6 months before the first visit, vesicles appeared on the back of the hands. The family history was negative for consanguinity or photosensitivity. The patient manifested vesicles and pigmentation on the back of both hands, erosions on the nose, and erythema on the neck. Histopathologically, subepidermal bulla was seen. PAS staining demonstrated deposition of PAS-positive material in the vessel wall of the upper and middle dermis. Laboratory examinations showed a marked increase in urinary uroporphyrin and mild liver dysfunction. HCV antibody, HBs antigen, and HBs antibody were all negative. DNA analysis from the patient's peripheral blood cells revealed no mutation of the uroporphyrinogen decarboxylase gene or the hemochromatosis gene. We made a diagnosis of porphyria cutanea tarda based on clinical, histopathological, and laboratory findings. Photoprotection using a novel foundation preparation made for the absorption of light ranging from 405nm to 450nm prevented the induction of vesicles.Skin Research, 13: 382-386, 2014

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In order to evaluate the effectiveness of the Tick Twister^®, I selected 15 tick bite cases where removal was performed with the Tick Twister^® (O'Tom) between March 2013 and June 2014. In addition, 2 successful cases are shown and the treatment method is explained. Amblyomma testudinarium was observed in all cases. The success rate was 80%. The average estimated time from tick infestation to completion of successful treatment was 2.1±0.9 days, while the treatment time for the failures was 5±2 days. The average estimated number of days for successful treatment was significantly shorter than for failures (p<0.01, ANOVA followed by Scheffe's post hoc multiple comparison tests). The handle of the Tick Twister^® was held in the fingers and the fork end slid toward the tick until it was caught. The tick was removed by gentle double rotation of the handle. This method is fast, minimally invasive, and non-surgical. Use of the Tick Twister^® is an effective method for early-phase removal of an Amblyomma testudinarium tick.Skin Research, 13: 387-394, 2014

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