We evaluated the clinical course, laboratory results and treatment of 22 cases of viper bites that were treated at our hospital over a 7-year period. In six of eight cases that demonstrated an increase in creatine phosphokinase (CPK) levels, it was difficult to predict the severity or prognosis from the value of CPK at the first visit because it peaked 24 hours after the bite. Although freeze-dried Mamushi Anti-venom (Equine) is considered effective in reducing the severity of the effects of viper venom, anaphylactic shock and serum sickness after its administration are problems. We pre-administered steroid drugs and used freeze-dried Mamushi Anti-venom (Equine) in 21 of the 22 cases. There were no side effects in any of them. Delay in the administration of freeze-dried Mamushi Anti-venom (Equine) reduces its efficacy against the venom; hence, the anti-venom should be given as early as possible after the bite to minimize the effects of the venom.Skin Research, 16: 113-119, 2017

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A 77-year-old man presented with a reddish-brown pedunculated tumor 16mm in diameter on the nose. The tumor had been growing slowly for 8 years. Histopathological examination of the resected tumor revealed epithelial cell proliferation with ductal and cyst-like structures in the background of mucinous stroma. The ducts and cyst-like structures were composed of myoepithelial cells. Numerous apocrine snouts were observed on the luminal side of these ductal and cystic structures. Cellular atypia and abnormal mitoses were not evident. We therefore diagnosed this tumor as hanging mixed tumor of the skin. To our knowledge, very few cases of this type of tumor with a hanging appearance have been reported.Skin Research, 16: 120-124, 2017

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A 65-year-old woman was referred to us from the Ophthalmology Department of our university with suspected sarcoidosis. Laboratory testing was positive for elevated serum levels of angiotensin converting enzyme and soluble IL-2 receptor. A chest CT scan showed mediastinal lymphadenopathy and multiple nodules in the right lower lobe of the lung. Histological evaluation of a small erythematous lesion on the left knee demonstrated non-caseous epithelioid cell granulomas with multinucleated giant cells, including foreign bodies. Her elder brother had pulmonary sarcoidosis that required inpatient treatment with corticosteroids, and her elder sister was diagnosed with sarcoidosis of the lip; both siblings were diagnosed in their 20s. Her younger sister and brother have not been diagnosed with sarcoidosis. Familial sarcoidosis has been reported to occur frequently in siblings. Interestingly, the age at the time of diagnosis is similar among affected family members. The current case is rare given the significant age difference at the time of diagnosis between the patient and her affected siblings.Skin Research, 16: 125-128, 2017

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A 45-year-old man, who had taken carbamazepine for a month to treat glossopharyngeal neuralgia, presented with fever and itchy eruption. At his first visit, he had generalized erythema with periocular sparing, swelling of cervical lymph nodes and liver dysfunction. Histopathology of the skin lesion revealed epidermal spongiosis, liquefaction degeneration of the basal layer and edema and inflammatory infiltrates in the dermis, which are seen in erythema exsudativum multiforme. Carbamazepine was discontinued, and he was treated with 30mg/day of prednisolone. As skin rash and liver dysfunction were improved, prednisolone dose was tapered slowly and 80 days after, treatment was completed. Patch testing for carbamazepine was positive, but a drug-induced lymphocyte stimulation test for the drug was negative. Reactivation of human herpesvirus 6, 7, cytomegalovirus or Epstein-Barr virus was not detected during the course of his disease. Based on these findings, atypical type of drug-induced hypersensitivity syndrome (DIHS) due to carbamazepine was diagnosed. After improvement of DIHS, he had depressive and suicidal thoughts. He consulted a psychiatrist and depressive state was diagnosed. Antidepressants relieved his symptoms in three months. We should be aware of psychiatric symptoms associated with DIHS, even after improvement of skin conditions, although our case may be rare.Skin Research, 16: 129-132, 2017

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A 17-year-old female with pollinosis developed wheals over her entire body and dyspnea after eating chocolate, lemon juice, and home-made sweet potato cake made of bean-curd refuse, sweet potatoes and low calorie granular sweetener. She had a past history of similar symptoms after ingesting grape-flavored jelly and pear juice, and thought she had a fruit allergy. Skin prick/scratch tests were positive for low calorie granular sweetener, the grape-flavored jelly and pear juice. The common ingredient in these three products was erythritol, and the prick test with erythritol was positive at concentrations of more than 10mg/ml. At the oral challenge test, 500mg of erythritol induced wheals, leading us to diagnose an immediate allergy to erythritol complicated by oral allergy syndrome, as suggested by the results of the skin and challenge tests. The two products that caused the symptoms contained approximately 5g of erythritol, which is enough to induce anaphylactic shock. Erythritol is widely used as a zero-calorie sweetener, and occurs naturally at extremely low levels as opposed to its concentration when used as an artificial sweetener. Although erythritol allergy is rare, this condition may be masked by a fruit allergy. Consequently, we should increase our awareness of this potential diagnosis.Skin Research, 16: 133-138, 2017

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Negative pressure wound therapy (NPWT) is now widely used for treating skin ulcers. However, it should not be applied to ulcers with apparent bacterial infections. In addition, application for more than four weeks is prohibited. In this study, we treated four patients with severe ulcers complicated by bacterial infections with IW-CONPIT (intra-wound continuous negative pressure and irrigation treatment); a combination therapy of NPWT and continuous irrigation. IW-COMPIT successfully treated decubitus and diabetic ulcers. Moreover, it greatly improved subcutaneous pockets and bacterial infections. IW-CONPIT seems to be an effective therapeutic option for treatment-resistant ulcers with subcutaneous pockets and infections.Skin Research, 16: 139-145, 2017

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A woman in her 60s had nausea, wobbling and tachycardia during dental treatment under local anesthesia with lidocaine hydrochloride approximately 20 years ago. She recovered from her symptoms by resting. Half a year ago, while undergoing tympanotomy under local anesthesia with lidocaine hydrochloride at otolaryngology, similar symptoms appeared. She visited our clinic for the purpose of resecting an epidermal cyst on the left elbow at this time. We suspected that she had a type I allergy to lidocaine hydrochloride, and therefore conducted a skin test for amide-type local anesthetics and ester-type local anesthetics. Positive reactions were observed for lidocaine hydrochloride, dibucaine hydrochloride and bupivacaine hydrochloride, which are all amide-type local anesthetics. Allergy to amide-type local anesthetics is very rare, but cross reaction between amide types may be relatively frequent. As for this case, cross reaction was suggested.Skin Research, 16: 146-149, 2017

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A 71-year-old woman was admitted to the department of internal medicine with chief complaints of hematochezia, abdominal pain and fever, with a body temperature of approximately 39°C. A diagnosis of left-sided ulcerative colitis was made using colonoscopy. Thereafter, a pustule appeared on the right gluteal region and formed a painful ulcer. Based on the histopathological findings and clinical symptoms, we diagnosed the ulcer as a complication of pyoderma gangrenosum. Treatment of the ulcerative colitis with steroid administration elicited no improvement, and the pyoderma gangrenosum proved to be refractory. Thus, we performed a granulocyte apheresis procedure, after which both conditions improved quickly. We believe that leukocytapheresis is a valuable treatment when performed aggressively in cases of steroid-resistant pyoderma gangrenosum or to quickly taper steroid dosage. At present, leukocytapheresis for isolated pyoderma gangrenosum is not covered by insurance, but we hope that coverage will be expanded to include the treatment hereafter.Skin Research, 16: 150-154, 2017

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