Skin Research, 15: 147-148, 2016

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A 50-year-old Japanese female complained of painful paronychia and opaqueness of her right thumbnail. Direct microscopy of the nail debris showed the presence of branching hyphae and conidia. A culture on Sabouraud's dextrose agar without cycloheximide showed crescent to banana-shaped conidia. The patient was diagnosed with onychomycosis due to Fusarium sp. The paronychia affecting her right thumbnail was successfully treated with oral itraconazole (100mg/day), but the opaque area of the nail plate increased in size. The nail plate was removed and was studied histologically. Fungal elements with a broad and septate structure were found in the nail plate. Ten months later, oral itraconazole therapy was stopped, and oral fluconazole therapy (100mg/day) was started. The opaqueness of the nail plate persisted; therefore, the oral fluconazole therapy was stopped 5 months later. Subsequently, oral voriconazole (200mg/day) was started, and the opaque area of the right thumbnail gradually cleared. Thus, oral voriconazole is useful for treating nail plate infections with Fusarium sp.Skin Research, 15: 250-253, 2016

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Here, we report the first case of eosinophilic pustular folliculitis (EPF) after cord blood transplantation for acute myeloid leukemia. An 18-year-old male who had been diagnosed with acute myeloid leukemia underwent a cord blood transplantation. Sixty-nine days after the transplantation, he presented with intensely pruritic papulopustular eruptions on his cheeks and neck. Blood analysis detected marked hypereosinophilia (white blood cell count: 14,100/ml, eosinophils: 53.0%, 7,420/ml), and a skin biopsy showed the intense infiltration of inflammatory cells, predominantly eosinophils, within and around hair follicles. Bacterial cultures derived from the pustule were negative. We diagnosed the patient with EPF, and he was successfully treated with oral and topical indomethacin. To the best of our knowledge, no cases of post-cord blood transplantation EPF have been reported in the literature. This report highlights EPF as an important differential diagnosis to consider in patients who have undergone cord blood transplantation and subsequently develop intense pruritic papulopustules on their face.Skin Research, 15: 254-258, 2016

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We report a case of thymoma-associated graft-versus-host like disease. A 78-year-old female who had suffered with erythema for four months was referred to our department in Oct. 2013. She had been diagnosed with thymoma (MASAOKA III) one year earlier. Diffuse erythematous plaques with scaling were seen on the patient's face, trunk, and extremities. A skin biopsy showed a graft-versus-host-like reaction, involving necrotic keratinocytes in the epidermis together with some lymphocytic infiltration, and basal liquefaction degeneration. She also exhibited abnormal liver function. We diagnosed the patient with graft-versus-host-like disease associated with thymoma. She died of pneumonia one month later. Erythema is one of the symptoms of graft-versus-host-like disease in thymoma, and generalized erythroderma is associated with a poor prognosis in such cases.Skin Research, 15: 259-264, 2016

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A 41-year-old male presented at our hospital with a 1-month history of two erythematous nodules on his chest and back, and a 1-week history of bilateral parotid swelling. A histopathological examination resulted in both lesions being diagnosed as non-caseating epithelioid granulomas. Magnetic resonance imaging showed swelling of the orbital part of the lacrimal glands and the parotid glands. Therefore, he was diagnosed with sarcoidosis, and the chest lesions were treated with topical corticosteroids. Three weeks after his first visit, right cheek dysesthesia appeared. We started administering oral corticosteroids (30mg/day prednisolone) and minocycline (100mg/day). At 1 week after the start of this treatment, the patient's parotid gland swelling had improved, and his dysesthesia improved over the next 2 weeks. Several mechanisms are known to cause neurological complications in sarcoidosis. In this case, the swelling of the lacrimal gland might have caused an increase in intraorbital pressure, leading to trigeminal nerve symptoms. This case demonstrates the importance of being aware of the clinical signs and symptoms of sarcoidosis, including parotid gland swelling and neurological manifestations, because it often requires oral corticosteroid treatment.Skin Research, 15: 265-269, 2016

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An 85-year-old male presented at the Department of Dermatology of our institution with an erythematous plaque. He had been inoculated with pneumococcal vaccine (Pneumovax^® NP) three days earlier. The next day, he developed pain followed by redness at the vaccination site. A physical examination revealed dark reddish edematous erythema together with purpura on the lateral aspect of the left upper arm. He noted mild tenderness on pressure. The patient's white blood cell (WBC) count and differential WBC count demonstrated mild neutrophilia (WBC: 9,000/μl, neutrophils: 75.7%). Although a blood biochemistry panel, which included markers of renal and liver function, produced normal results, he exhibited an elevated C-reactive protein level of 4.51mg/dl. The erythema and pain disappeared three days after the topical application of betamethasone valerate + gentamicin sulfate (Rinderon^® VG) ointment. However, the patient subsequently developed a cutaneous ulcer at the injection site. The ulcerative lesion subsided, leaving a scar, after 4 months' sulfadiazine silver (Geben^®) cream. On the basis of the patient's morphological findings, we speculated that the pathogenesis of this case involved inflammation of the dermis and subcutaneous tissue. Phlegmon might be caused by a different mechanism because it exhibits a different clinical course to that seen in the present case. Clinicians should be aware of such adverse effects of pneumococcal vaccinations, the use of which is increasing in Japan.Skin Research, 15: 270-273, 2016

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We report three cases of cat bites. Case 1: A 47-year-old female had her hand bitten by her cat 6 days before visiting our institution. Subsequently, she developed redness and swelling on her left hand. Although she was treated with cephem antibiotics, the lesion did not improve. A physical examination revealed edematous swelling and redness together with punctate ulcers on the dorsal aspect of his left hand. Pasteurella sp. and Bacillus cereus were detected in bacterial culture samples collected from the ulcer. Although oral levofloxacin (500mg per day) produced a temporary improvement in the patient's symptoms, the swelling recurred two weeks after her initial visit. Magnetic resonance imaging demonstrated purulent arthritis and acute osteomyelitis. She underwent debridement and external skeletal fixation by orthopedists. Case 2: A 70-year-old female had her right index finger bitten by a stray cat 8 days before visiting our institution. Faropenem was administered at a clinic, but it was not effective. Her index finger displayed edematous swelling and redness. The administration of amoxicillin (300mg per day) for 11 days led to an improvement in the lesion. Case 3: A 43-year-old woman had her left hand bitten by her cat one day before visiting our institution. Erythematous swelling was seen on her left index finger and wrist. Her symptoms improved after 7 days' treatment with 300mg per day of amoxicillin. In Japan, 10.8% of families keep cats, and the total number of cats in Japan is estimated to be 9,740,000. As a result, cat bites are a common problem. Since cats' teeth are thin, cat bite wounds close easily. As this can lead to the proliferation of anaerobic bacteria like Pasteurella, clinicians should carefully observe patients with cat bite for signs of deep infection.Skin Research, 15: 274-277, 2016

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Objective: This study was conducted in Japanese patients with acne vulgaris to assess the efficacy of the fixed dose combination gel of adapalene 0.1% and benzoyl peroxide 2.5% in comparison with each monad gel as well as the safety and tolerability profile of this fixed dose combination gel in a 12-week treatment.
Methods: This was a multicenter, randomized, double-blinded, active-controlled, parallel group phase 3 study. The study drugs were applied once daily for 12 weeks to the entire face of a total of 417 subjects. The primary efficacy endpoint was the percent reduction in total lesion counts at the last visit. The safety and tolerability profile was assessed with various parameters such as adverse events and skin irritation scores.
Results: A high efficacy of the fixed dose combination gel on total lesion count (median percent reduction: 82.7%) was demonstrated with a statistically significant (p<0.001) superiority over adapalene 0.1% gel (68.6%), but not over benzoyl peroxide 2.5% gel (81.6%). No severe or serious adverse events were reported in this study. Although a higher percentage of subjects experienced signs/symptoms of skin irritation with the fixed dose combination gel as compared to adapalene 0.1% gel and benzoyl peroxide 2.5% gel, the severity of signs/symptoms was mostly mild and moderate in any arms.
Conclusion: This study demonstrated a high efficacy and a good safety/tolerability profile of this fixed dose combination gel in Japanese patients with acne vulgagris, which is consistent with foreign data and supports the good risk/benefit ratio of this product in the treatment of acne vulgaris.Skin Research, 15: 278-293, 2016

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Objective: This study was conducted to assess the safety and efficacy of the fixed dose combination gel of adapalene 0.1% and benzoyl peroxide (BPO) 2.5% in Japanese subjects with acne vulgaris in a 12-month long term treatment.
Methods: This was a multicenter, open-label, non-comparative, long-term phase 3 study. The study drug was applied once daily for 12 months to the entire face of a total of 436 subjects. The safety profile was assessed with various parameters such as adverse events and skin irritation scores. The efficacy was assessed with the percent reduction at month 12 in lesion counts.
Results: A total of 47 adverse events (AEs) related to the study drug were reported in 43 (9.9%) subjects,leading to discontinuation of 9 subjects from the study. The incidence of AEs related to the study drug was highest in the first period (i.e. first 90 days). The majority of related AEs were dermatological in nature, in which skin irritation was the most frequent. The incidence of skin irritation was 5.5% in the first period. The severity of local tolerability signs/symptoms was mostly mild or moderate with very few subjects experiencing severe signs/symptoms. As for the efficacy, the median percent reduction from baseline in total lesion counts, in inflammatory and non-inflammatory lesion counts was greater than 85.0% at Month 12.
Conclusion: This study demonstrated a good safety/efficacy profile of the fixed dose combination gel of adapalene 0.1% and BPO 2.5% in a long term treatment in Japanese patients with acne vulgaris.Skin Research, 15: 294-307, 2016

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