Extramammary Paget's disease is an enigmatic disease with unknown cell origin and difficulty in making a surgical policy. Still, there are papers that are the core of the discussion in some points. These papers have been cited in textbooks and guidelines without being doubtful about the contents and continue to be the basis of the discussion. But if you read them with a critical mind, you will find that these papers are not to be actually accepted.
The first is a paper by Chanda, arguing for that “patients with extramammary Paget's disease have high rate of associated concurrent underlying internal malignancy”. However, when checking all 36 citation papers, 16 of them were reported as one single case, which proved to be inappropriate for examining the concurrence rate.
The second is a paper by Gunn, stating that “Four vulvectomy specimens from patients with vulvar Paget's disease were studied by means of sub-serial total sectioning. In each case, the extent of histologically demonstrable disease was far greater than that of the visible lesion.” However, if you carefully read the research method, it would turn out that what the authors see as a macroscopic boundary was just what they guessed on copy paper, which is quite different from the actual surgeon's grasp.
From these two papers, we could learn the necessity of critical reading of textbooks and core journals in the light of our own experience.Skin Research, 16: 241-247, 2017

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A 28-year-old man was referred to us with a 2-month history of swelling of the mid-forehead and eyebrow areas, which was suspected to be a foreign-body granuloma caused by the hyaluronic acid injected into the middle of his forehead 10 years ago. Physical examination revealed diffuse swelling of the mid-forehead, eyebrow areas, cheeks, and periocular regions without erythema. The first skin biopsy from the middle of his forehead was inconclusive. Three weeks later, several dark purple papules appeared on his face and clavicle, and facial edema worsened. He was a man who had sex with men, and blood tests for both the HIV antigen and the HIV antibody were positive. A second skin biopsy from the clavicle revealed nodular proliferation of spindle cells, and the presence of multiple, small, diffuse, and morphologically irregular vascular spaces in the dermis. Immunohistochemical staining for CD31, CD34, and HHV8 was positive. Thus, we diagnosed this patient with AIDS-related Kaposi's sarcoma (KS). The onset of KS following an external stimulus, including injection, trauma, and insect bites, has previously been reported as Koebner's phenomenon. Recently, the number of AIDS patients has been steadily increasing in Japan, and it is therefore important for dermatologists to be aware of such AIDS-related skin disorders, and diagnose these patients as early as possible. This case suggests that severe swelling or edema may possibly precede a typical KS eruption, and that Koebner's phenomenon is associated with the development of KS in HIV-positive patients.Skin Research, 16: 248-253, 2017

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We report a 65-year-old female patient with anti-BP180-type mucous membrane pemphigoid. Blisters appeared on her limbs, followed by erosion in the oral cavity. Histological examination of the blisters on her hand revealed spongiosis in the epidermis and subepidermal blisters. Direct immunofluorescence revealed linear IgG and IgA deposition in the epidermal basement membrane. Serological tests for anti-BP180, anti-BP230, anti-desmoglein (Dsg) 3, and anti-Dsg1 antibodies were all negative. Immunoblotting detected an IgG antibody against a recombinant BP180 C-terminal protein. Tests for epidermal extract, dermal extract, the BP180-NC16a recombinant protein, and laminin 332 recombinant protein were negative. Based on these results, the patient was diagnosed with anti-BP180 mucous membrane pemphigoid. Mucous membrane pemphigoid exhibits several clinical symptoms and varies in severity depending on the target antigen. When blisters are localized in the oral cavity or are widespread, many cases are often diagnosed and treated as other diseases. As it is important to identify mucous membrane pemphigoid, its method of diagnosis requires improvement.Skin Research, 16: 254-259, 2017

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A 49-year-old man presented at our hospital due to bulla formation on the left hand. As he had poorly controlled Parkinson's disease, his left hand to his forearm continued to be compressed during his sleep. Acute compartment syndrome was suspected due to elevation of creatine kinase and lactate dehydrogenase levels, and was confirmed with elevation of muscle compartment pressure. Due to rapid exacerbation of local pain, edema, and bulla number, we performed emergency decompressive fasciotomy on the 1st day of hospitalization. Severe edema from his left hand to forearm was relieved soon after skin incision. Thereafter, successful skin grafting was performed for the remaining partial ulcer. Bullae that occur on unconscious patients are generally referred to as coma blisters, and blister formation is known to be one characteristic feature of compartment syndrome. It is necessary to accurately differentiate coma blisters from decubitus.Skin Research, 16: 260-265, 2017

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Objective: We subjectively and objectively analyzed the clinical effects of underwear for xerotic skin diseases. Methods: We performed a clinical trial for 33 patients aged 20 years or older with xerotic skin diseases visiting the Dermatology Department at Osaka University and Osaka City University Hospital from December 2015 to June 2016 using completely seamless underwear (MediCure^®) distributed by Gunze Limited. We examined the skin manifestations (erythema, nodules, drying, lichenification, and scratching scars), transepidermal water loss (TEWL), and Visual Analogue Scale (VAS) as subjective symptoms of itching and pain, and the Dermatology Life Quality Index (DLQI) on days 0, 14, and 28 after the start of wearing the underwear. Statistical analysis was conducted using the multiple comparison test by Bonferroni and Dunn. Results: Thirty-three patients were registered, including 19 males and 14 females, with an average age of 56.2±18.9. Fifteen cases of atopic dermatitis, 9 cases of asteatotic eczema, 7 cases of psoriasis vulgaris, 6 cases of prurigo nodularis, 4 cases of pruritus, and 1 case of lichenoid amyloidosis were enrolled in this trial. The underlying diseases included 3 cases of renal dysfunction, 3 cases of diabetes, and 2 cases of mental disease. Erythema, xerosis, and scratching scars were significantly improved at day 14 and 28 compared with at day 0. Nodules and lichenification were significantly improved at day 28. TEWL, VAS for itching, and DLQI scores had significantly decreased at day 14 and day 28. No apparent adverse event was observed from the start to the end of the study. Discussion and Conclusion: In this study, all skin lesions were significantly improved, and TEWL, VAS, and DLQI scores significantly decreased. The underwear applied in this trial may improve skin barrier function and symptoms by reducing friction on the skin. Therefore, we suggest advising patients with excess alloknesis to try barrier free underwear for daily skin care.Skin Research, 16: 266-273, 2017

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