Hifu no kagaku
Online ISSN : 1883-9614
Print ISSN : 1347-1813
ISSN-L : 1347-1813
Volume 17 , Issue 6
Showing 1-9 articles out of 9 articles from the selected issue
Clinico-pathological notes by Dr.Murata
  • Yozo Murata
    2018 Volume 17 Issue 6 Pages 299-312
    Published: 2018
    Released: August 13, 2019
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    It is not usual to discuss clinical and pathological correlations in extramammary Paget’s disease. But by thinking about this relationship, you will have a deeper understanding of the clinical picture of extramammary Paget’s disease. In the lesional erythema,“boundary of clinical erythema”coincide precisely with“boundary of histologic inammation”. And, the latter also coincides with the“histologic tumor boundary”. As a result,“boundary of clinical erythema”and“histologic tumor boundary”coincide. The same syllogism can also be established for hypopigmentation of extramammary Paget’s disease. This simple fact is now out of sight. As a result, institutions that force patients to penetrate mapping biopsies are increasing in Japan. There will be described the multilayered relationship between erythema and hypopigmentation,the behavior of melanocyte in hypopigmentation, and the unique relationship between melanocytes and Paget’s cells in pigmented area. Finally, Paget cells, considered to be isolated, could be shown immunohistochemically to be connected by their cellular processes. Skin Research, 17 : 299-312, 2018

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CASE REPORT
  • Ayako Kojima, Kazuna Tatsumi, Masaru Natsuaki, Teruki Dainichi, Ken ...
    2018 Volume 17 Issue 6 Pages 313-316
    Published: 2018
    Released: August 13, 2019
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    A 17-year-old man with a furuncle-like lesion brought in a maggot, which had emerged from an eruption on his chest. The patient had previously visited Placencia in Belize, Central and South America and stayed there for about a month. Mosquitoes and other insects had often bitten the patient in the jungle or at the coast during his stay. He rst noticed an itchy exanthema on the left side of his chest four days before his return to Japan, and it persisted. Two weeks after the appearance of the skin eruption, he experienced severe pain at the eruption site for a few days, and a small stula appeared at the center of the lesion with some effusion. Five weeks after the appearance of the eruption, a maggot emerged from it when he pressed the surrounding area. It was identied as a second instar larva of Dermatobia hominis by its appearance and the body length, and we diagnosed this case as cutaneous myiasis. Dermatobia hominis only lives in Central and South America. The larva grows in the skin of mammalian hosts, emerges spontaneously and eventually the wound heals. Since it causes pain in the host, several treatment strategies have been suggested : expulsion, surgical removal or extraction of the lesion, and squeezing out the larva by blocking the larval air supply. The last approach has often been practiced by the local people in the endemic areas. It is predicted that both the opportunities for travel abroad and the diversity of destinations will continue to expand rapidly. When a refractory furuncle-like lesion is observed, the patient should be asked about their travel history and the possibility of cutaneous myiasis should be considered. Skin Research, 17 : 313-316, 2018

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  • Yoko Yamamoto, Yushiro Ohara, Erina Nishizaki, Takashi Hosomoto, Noz ...
    2018 Volume 17 Issue 6 Pages 317-323
    Published: 2018
    Released: August 13, 2019
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    This is a report on our experience of two cases diagnosed with erythema nodosum associated with granulomatous mastitis. Case 1 was a 39-year-old female. A painful subcutaneous induration appeared in her left breast and from the fourth day after onset, erythema accompanied by tenderness appeared on the extensor surfaces of her lower legs and elbows, so she was referred to our department. Skin histopathology based on her right lower leg erythema was found to be septal panniculitis in which lymphocyte/neutrophil inltration was observed around the dermal blood vessels and lymphocytes extended from the fat septum into the lobule. Regarding the histopathology based on the subcutaneous induration area on her left breast, a granuloma in which epithelial cells had mainly inltrated was observed, so she was diagnosed with erythema nodosum associated with granulomatous mastitis based on the clinical course. Case 2 was a 40-year-old female. Painful erythema and subcutaneous induration appeared in her left breast approximately two weeks prior to her initial visit to our department, and the day before her initial visit, erythema accompanied by pain appeared in the vicinity of the medial malleolus of her right foot. It has been reported that approximately 20% of granulomatous mastitis cases are complicated by erythema nodosum. Granulomatous mastitis should also be considered as a contributing factor to erythema nodosum. Skin Research, 17 : 317-323, 2018

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  • Nagisa Fujimori, Yuka Kobayashi, Akari Kaganoi, Kentaro Ozawa
    2018 Volume 17 Issue 6 Pages 324-327
    Published: 2018
    Released: August 13, 2019
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    An 81-year-old man presented with a light brown tumor on his right temple of two years’duration. The tumor had gradually enlarged and had recently been bleeding due to scratching. Clinically, the tumor was 17×10 mm and covered with a crust. Histologically, the lesion showed features of seborrheic keratosis at the periphery and Bowen’s disease in the rest. As seborrheic keratosis is benign in nature, it does not always require treatment. However, rare cases associated with malignant tumors have been reported. Especially, in cases with erosions or crusts, the possibility of a malignant tumor should be taken into account. Skin Research, 17 : 324-327, 2018

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  • Ayumi Horiguchi, Yoshihiro Yamamoto, Kensei Sakurai, Yoshiki Miyach ...
    2018 Volume 17 Issue 6 Pages 328-332
    Published: 2018
    Released: August 13, 2019
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    A female in her seventies who lived independently presented with a genital ulcer of about six months’duration. She had been suffering from urinary incontinence for a year, and used sanitary napkins instead of diapers. Although she received topical treatment at the rst clinic she visited,the ulcer did not diminish in size, but instead expanded, so she visited our hospital. We performed a patch test to rule out contact dermatitis. Epicutaneous patch tests on a diaper, sanitary napkin, zinc ointment and aztec ointment all showed negative reactions. Because the area of the ulcer matched that of the urine incontinence stains, we diagnosed this case as incontinence-associated dermatitis (IAD). Her genital ulcer improved following urinary catheterization, pelvic oor muscle exercises and topical application of a water-repellent cream. IAD is an inammation of the skin induced by urine or stool which comes into contact with perineal or perigenital skin usually after urine absorption in diapers, causing maceration. In our case, it was suspected that urine leaked because she used a sanitary napkin instead of a diaper, thus irritating her skin and causing an ulcer. We compared the water absorption of a sanitary napkin with a diaper and found that the napkin absorbed much less liquid than the diaper. It is important to consider IAD when elderly patients have urinary incontinence even if they have adequate physical function and live independently. Skin Research, 17 : 328-332, 2018

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  • Chigusa Yamashita, Aya Tanaka, Hirohiko Shirai, Syoko Sonobe
    2018 Volume 17 Issue 6 Pages 333-336
    Published: 2018
    Released: August 13, 2019
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    Ramucirumab is a fully human monoclonal antibody (IgG1) that selectively binds to the extracellular domain of vascular endothelial growth factor receptor 2 (VEGFR2). Common welldocumented side effects of ramucirumab include hypertension, diarrhea, stomach ache, anorexia and deep vein thrombosis. We experienced a rare case of multiple hemangiomas as a side effect possibly induced by ramucirumab. A 60-year-old Japanese woman was diagnosed with stage IV non-small cell lung cancer, with peritoneal dissemination. Docetaxel and ramucirumab therapy were started after two cycles of rst -line chemotherapy with carboplatin and pemetrexed. After the change in treatment, reddish nodules developed over her whole body. They gradually expanded and some of them bled easily with ulceration. A histopathological examination showed a well circumscribed proliferation of small capillaries in the dermis, similar to capillary hemangioma. We diagnosed them as pyogenic granuloma clinically. After cessation of ramucirumab therapy, the papules stopped expanding and no new lesions developed. It is reported that pyogenic granuloma can occur due to trauma, drug treatment, hormonal inuences and viral infection. Recently, it was reported that proliferative angioma in patients treated with ramucirumab can involve gene mutation. Further studies are needed to clarify the mechanism of ramucirumab-induced multiple hemangiomas. Skin Research, 17 : 333-336, 2018

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  • Mariko Hara, Yoichi Kato, Rika Ohashi, Kaoru Tsujioka, Fumio Yama ...
    2018 Volume 17 Issue 6 Pages 337-342
    Published: 2018
    Released: August 13, 2019
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    A 73-year-old man was favorably treated for 18 months with methotrexate (MTX) for rheumatoid arthritis. Four months prior to presentation, the patient developed multiple papules on his face that did not resolve with oral antibiotics. The diagnosis was molluscum contagiosum ; however,treatment with oral coix seeds, curettage, and cryotherapy was ineffective. MTX was discontinued 10 days before presentation. Physical examination revealed >100 itchy, erythematous papules that were 3-5 mm in diameter. They were widely distributed on the patient’s face and sparsely distributed on his neck and upper limbs. A biopsy revealed nodular and endophytic epidermal hyperplasia with enlarged keratinocytes containing eosinophilic intracytoplasmic inclusions and an intense inammatory reaction. Results of assays for HIV and HTLV-I/II antibodies were negative. Topical application of imiquimod 5% cream once daily, three times a week for four weeks resulted in almost complete disappearance of the lesions at eight weeks. There has been no subsequent recurrence. We concluded that these peculiar clinical features suggestive of sycosis vulgaris were caused by the inammatory nature of the eruptions with probable spreading due to shaving. Topical therapy with imiquimod cream may be an effective treatment for recalcitrant molluscum contagiosum in some patients undergoing treatment with immunosuppressive agents. Skin Research, 17 : 337-342, 2018

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  • Tomoko Matsuda, Naotomo Kambe, Kahori Nakatani, Haruka Goda, Yuki Nomu ...
    2018 Volume 17 Issue 6 Pages 343-346
    Published: 2018
    Released: August 13, 2019
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    A 35-year-old woman had often experienced acute edema of the extremities with spontaneous improvement after 3-4 days from around eight years of age. Laboratory ndings showed low levels of C4 and C1-INH activation, indicating hereditary angioedema (HAE). She had hesitated to be treated with human C1-INH concentrate and had been treated with corticosteroid injections when she complained abdominal symptoms. She was referred to our department after she moved for her baby’s delivery. Two weeks after delivery, she presented with severe abdominal pain along with nausea and vomiting and made an emergency visit to our hospital. Plain CT ndings of the abdomen showed ascites and marked intestinal edema. Her abdominal pain was intense. After obtaining informed consent, we administered human C1-INH concentrate, which dramatically improved her symptoms within about 30 minutes. As the patient had no family history of HAE, we performed genetic analysis and found a C1-INH gene point mutation (M470K). Since patients with HAE often visit hospitals complaining of acute abdominal pain, medical staff should share HAE information with each other to provide appropriate patient care. Skin Research, 17 :343-346, 2018

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CLINICAL EVALUATION
  • Aya Yokoi, Motomu Manabe, Mai Noto, Naoko Hasunuma, Kazumi Nozawa, Nao ...
    2018 Volume 17 Issue 6 Pages 347-353
    Published: 2018
    Released: August 13, 2019
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    We evaluated the efcacy and safety of an oil-in-water (O/W)-type emulsion containing partially myristoylated carboxymethyl-chitosan (PMCMC) in 19 patients with xerosis coexisting with itching following four weeks of application on dry skin and the itchy area. Dermatological ndings, water content of the stratum corneum, transepidermal water loss, and itching severity signicantly improved after four weeks of emulsion application. These results were consistent with those obtained using a heparinoid pharmaceutical water-in-oil (W/O)-type preparation. The patients lled in a questionnaire regarding self-reported results after using a product containing PMCMC ; they reported that their skin felt better after using a PMCMC emulsion (O/W) than after using a heparinoid pharmaceutical preparation (W/O). This study showed that an O/W type emulsion containing PMCMC could be useful to improve the condition of not only dry skin and itching, but also quality of life in patients with xerosis. Skin Research, 17 : 347-353, 2018

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