A 19-year-old Japanese woman visited Higashi Dermatology Clinic on March 25th, 2015 exhibiting numerous verrucous crusts on her face. At the Y dermatology clinic, the lesions were treated topically by 2% ketoconazole cream over the next 2 months considering them to have a fungal etiology. Direct microscopic examination of the crust of her right cheek revealed numerous spherical spores with chlorazol fungal staining. On histopathology of the crust, numerous periodic acid-Schiff (PAS)-positive spherical spores were observed in the keratinous layers. Based on these findings, the lesion was diagnosed as Malassezia sp. infection. After removing the verrucous crusts mechanically, her lesions were treated with oral itraconazole at 100mg/day and topical betamethasone cream. The lesions markedly cleared after 1 week of treatment and were appropriately cured 40 days later. Subsequently, the lesions were treated with topical 1% isoconazole sulfate cream. The lesions disappeared completely by August.Skin Research, 17: 1-4, 2018

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　Case 1: A 27-year-old woman presented with multiple alopecia patches on her scalp, arthralgia, and erythema on her cheek, nose, and dorsum of the hands. At the first visit, multiple alopecia patches with erythema were noted. A biopsy specimen taken from the alopecia lesion demonstrated vacuolar change along the follicular basement membrane zone, and lymphocytic infiltration around the follicles and sweat glands. Direct immunofluorescence study of the specimen revealed a positive lupus band. She was diagnosed with alopecia due to discoid lupus erythematosus (DLE) complicated by systemic lupus erythematosus (SLE). Hair regrowth was observed following intralesional triamcinolone acetonide injections. Case 2: A 26-year-old woman presented with multiple alopecia patches on her scalp and arthralgia. On her first visit, multiple alopecia lesions with erythema were observed. Based on the blood test results and histopathology, she was diagnosed with alopecia due to DLE complicated by SLE. Hair regrowth was observed following intralesional steroid injections alone, as in Case 1. Chronic cutaneous lupus erythematosus, including DLE which causes alopecia on the scalp, resulting in cicatricial alopecia, is sometimes complicated by SLE. We report two cases of SLE with multiple alopecia patches on the scalp, and marked hair regrowth following intralesional triamcinolone acetonide injections.Skin Research, 17: 5-10, 2018

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　A 21-year-old man was referred to us for evaluation of a small eruption on his right cheek that he had noticed more than one year before. On examination, a skin ulcer measuring 4.5×2.8mm was observed on his right cheek, and dermoscopy revealed smooth branching vessels around the ulcer, suggesting basal cell carcinoma (BCC). Excisional biopsy confirmed the diagnosis of non-pigmented BCC, and the tumor was excised with a normal skin margin of 2mm. In patients under the age of 20 without a background of genetic disorders, such as basal cell nevus syndrome or xeroderma pigmentosum, BCC is rare. This is the first report of non-pigmented BCC occurring before the patient was 20 years of age. In the present patient, the BCC developed on the embryonic closure line of the right cheek. In the five reported Japanese patients under the age of 20 with facial BCCs, all carcinomas developed on the embryonic closure lines.Skin Research, 17: 11-15, 2018

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　A 41-year-old male patient was admitted to our out-patient clinic for painful swelling in his back and general poor physical condition. From a few years ago, a skin tumor diagnosed as atheroma developed on his back, but it appeared to be infected and worsening from three weeks ago. Physical examination revealed severe infection and bacteremia with sepsis. Basketball-sized swelling with redness, purpura, tenderness and snow-ball crepitation was observed the right side of his back. Blood examination revealed severe diabetes and inflammatory response. A large abscess with gas in his swollen back was noted on computed tomography. Urgent exploratory incision confirmed extensive necrosis and pus in the lesional soft tissue, which was diagnosed as necrotizing soft tissue infection. Peptoniphilus sp. was detected from the bacteriological culture. Extensive debridement was performed and negative pressure closing therapy was started from the fourth day after debridement. Wound closure was accomplished with partial stitching and split skin grafting. Gram-positive anaerobic cocci groups, such as Peptoniphilus sp., are generally considered to be hypo-virulent, slow growing, well-responsive to antimicrobial therapy, and difficult to identify. In NSTI, they are often detected in mixed infections; however, they are relatively rare in single infection. In recent years, re-examination of the phylogenetic classification has progressed, and further information as well as understanding of the pathological significance are needed.Skin Research, 17: 16-20, 2018

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　Pellagra is caused by niacin deficiency, which develops due to a wide variety of clinical conditions. Several drugs can also cause niacin deficiency by inhibiting the conversion of tryptophan to niacin. However, although 5-fluorouracil is a known causative drug, there have been few case reports. A 63-year-old man who had underwent sigmoidectomy due to sigmoid colon cancer 3 years ago relapsed, and developed metastases in the lung and para-aortic lymph nodes. Prior to his visit to our department, he had taken mFOLFOX6 plus bevacizumab therapy and FOLFIRI plus panitumumab therapy for 8 months. During these therapies, he gradually lost his appetite, often had diarrhea, developed a pigmented rash on his face, and had frequent stomatitis. At the first visit, the patient had scaly edematous erythema, pigmentation, and dermatrophia on the exposed skin of the face and neck. He was slow to respond when spoken to. We found low blood levels of nicotinic acid and tryptophan, and diagnosed him with pellagra. His symptoms ameliorated after improvement of his diet, infusion containing amino acids, and oral administration of nicotinamide. We consider the 5-fluorouracil therapy combined with poor nutritional intake to have led to the development of pellagra.Skin Research, 17: 21-24, 2018

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　A 56-year-old woman presented with a 2-year history of small reddish papules with spontaneous regression and recurrence on her extremities. The patient had previously undergone skin biopsies three times and was diagnosed with lymphomatoid papulosis (LyP). These lesions ulcerated and spread over the entire body one month before her first visit to our hospital. Skin biopsy of an ulcerated nodule revealed pleomorphic large cells throughout the dermis without epidermotropic infiltration. CD30 was expressed by 80% of the tumor cells. Based on these findings, we diagnosed this patient with LyP that had progressed to primary cutaneous anaplastic large cell lymphoma. LyP is a recurrent papulonodular skin eruption with malignant histopathological features, but it often follows a benign and indolent clinical course. LyP has been reported to be associated with other malignant lymphomas such as mycosis fungoides, C-ALCL, or Hodgkin disease. Long-term follow-up is required for early detection of secondary malignancies in patients with LyP.Skin Research, 17: 25-29, 2018

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