We conducted skin care education training and a questionnaire survey before and after the training for nursing and care staff of facilities for the elderly. The purpose of this study was to examine whether these staff members can change their awareness of and actions for an inhabitant’sskin condition by learning correct knowledge about asteatosis and its treatment methods. A total of 11 nursing staff and 58 care staff members completed the questionnaire. The results of the survey revealed that the care staff improved their understanding of moisturizer application methods and increased the amount of the moisturizer applied to the inhabitant. In addition, they newly observed the inhabitant’s skin condition, and examined the degree of dryness and itching more frequently. The nursing staff also improved their understanding of moisturizer application methods. Furthermore, almost half of the nursing staff felt increased interest in the care of the inhabitant’s skin, and improved their cooperation with the doctors and care staff. These results demonstrated that providing education training on skin care to staff of facilities for the elderly can improve their awareness and actions. Skin Research, 18 : 1-14, 2019

A woman in her 60s developed systemic diffuse erythema, swelling of the eyelids, bulbar conjunctival congestion, and erosion of the lips. These symptoms developed 3 days after she took a general cold medicine (Benza^○R Block^○R L ; Takeda Pharmaceutical Company, Osaka, Japan) while infected with inuenza type A. Although her clinical manifestations resembled those of StevensJohnson syndrome, histopathological examination of her skin did not indicate epidermal necrosis. She was diagnosed with erythema multiforme and treated using an oral steroid. After the symptoms had resolved, we performed a patch test for Benza^○R Block^○R L, which was positive. We also performed a patch test for the components of Benza^○R Block^○R L and found that her erythema multiforme-type drug eruption was induced by pseudoephedrine. The drug lymphocyte stimulation test of Benza^○R Block^○R L was negative. Many general cold medicines and Chinese herbs include pseudoephedrine. When patients develop severe drug eruptions, as in the present case, it is important that we identify the components of the causal drugs to ensure that patients select appropriate drugs in the future. Skin Research, 18 : 15-21, 2019

An 82-year-old woman was referred to our hospital with pruritic rash and mucocutaneous erosions. She had rheumatoid arthritis (RA), hypertension, and diabetes. She had taken 10 mg/week methotrexate (MTX) and 5 mg/week folic acid for the treatment of RA for 3 years. Four days before admission, she noted a pruritic rash on her trunk and limbs. Two days later, she developed dysphagia due to severe oral pain. On admission, physical examination revealed inltrating erythema of the left shoulder, back and lower limbs, and oral erosions on the lips and in the oral cavity. Blood tests demonstrated pancytopenia, anemia, inammation, and mild renal dysfunction. Based on histopathological ndings from the erythema on the left shoulder, vacuolar dermatitis and perivascular inammatory inltration of lymphocytes and eosinophils were conrmed. No apoptotic keratinocytes were detected in the epidermis. The patient was therefore diagnosed with acute MTX toxicity. We stopped MTX administration and performed‘leucovorin rescue’. The cause of the acute MTX toxicity in this case may have been the complex state of renal dysfunction, multipledrug usage, and old age. There was no history of inadvertent use of MTX or folic acid. Mucocutaneous erosions due to MTX may precociously indicate the development of other severe organ damage such as bone marrow suppression. Physicians should be aware of MTX-induced skin lesions to enable appropriate therapeutic action at an early stage and prevent the development of further complications. Skin Research, 18 : 22-26, 2019

A 68-year-old woman presented with a black tumor on her right sole for 11 years, and it had gradually increased in size from 3 years ago. We performed skin biopsy and PET-CT, and diagnosed her with malignant melanoma (c Stage IV). We also diagnosed her with a BRAF^V600E mutation via BRAF gene mutation analysis of her tumor tissue, and treatment with dabrafenib at 300 mg PO plus trametinib at 2mg PO daily was initiated. The combination of dabrafenib and trametinib led to a good response, but the metastatic lesion on the left gastrocnemius muscle slightly increased in size. BRAF immunohistochemical staining demonstrated a difference in the intensity of staining between the responsive region and non-responsive region. Thus, BRAF immunohistochemical staining is a useful method for evaluating BRAF-mutant malignant melanoma patients. Skin Research, 18 : 27-32, 2019

A 40-year-old woman developed itching within the pharynx 20 minutes after taking a Precol^○R longacting capsule. Subsequently, itching edematous erythema spread throughout her body. The symptom disappeared in 1.5 hours without medical treatment. The scratch tests for the Precol^○R long-acting capsule(1% aq. and 10% aq.) and isopropylantipyrine(1% aq. and 10% aq.) werepositive. Isopropylantipyrineis oneof theconstituents of thePrecol^○R long-acting capsule. Oral provocation tests for ve drugs, including each constituent of the Precol ^○R long-acting capsule, except for isopropylantipyrine, were all negative. We diagnosed the patient with urticaria-type drug eruption and immediate allergy caused by isopropylantipyrine. Care must be taken when prescribing drugs and general pharmaceuticals that contain isopropylantipyrine. Skin Research, 18 : 33-37, 2019

A woman in her twenties with erythema on her bilateral upper and lower eyelids visited our hospital. The patient used mascara on a daily basis. Patch testing was performed with her own cosmetics, ointments, eyedrops, and Japanese standard allergens. Positive reactions were observed for the mascaras she used, fradiomycin sulfate, Balsam of Peru, rosin, and fragrance mix. On further patch testing for the mascara components, carnauba wax was positive. Carnauba wax is used in cosmetics and many wax products, and as an additive in foods and medicines. Contact dermatitis from carnauba wax is markedly rare. We considered the possibility of developing allergic contact dermatitis to cinnamic acid, which is commonly contained in carnauba wax, Balsam of Peru, and fragrance mix. The patient also had allergic contact dermatitis to fradiomycin sulfate. In addition,positive reactions to rosin, Balsam of Peru, and fragrance mix on patch testing suggested that she had fragrance allergy. Skin Research, 18 : 38-41, 2019

A 45-year-old Japanese woman developed bilateral postauricular lymphadenopathy 12 years ago,characterized by gradually enlarging and contracting lymph nodes. She was prescribed 10 mg of oral prednisolone (PSL) by her primary dermatologist ; however, the therapy was discontinued because of the development of moon face. The left postauricular mass enlarged 4 years ago, and skin biopsy results led to a diagnosis of Kimura’s disease. Subsequently, the patient stopped attending followup sessions ; however, she requested to be treated at our department and was thus referred to our institution. At the initial visit, several elastic and soft subcutaneous masses, up to 10 cm in size,accompanied by pruritus were observed in the periphery of both ears and around the chin. Hematological tests revealed abnormally elevated eosinophil, IgE, and TARC levels. PSL (30 mg) was initially administered, which decreased the large subcutaneous masses temporarily. However,the results of treatment with PSL alone were poor. Thus, radiotherapy (30 Gy/15 Fr) in combination with local injection of steroids was administered to the large masses in the left postauricular region. In addition, 200 mg of oral cyclosporine was administered because the multiple other masses did not disappear. Currently, her subcutaneous masses have markedly shrunken, and the dose of oral medication has been reduced. As Kimura’s disease can easily recur after monotherapy, many patients requiring multiple treatments have been reported. However,patients such as ours, to whom oral steroids, local injections, radiation therapy, and oral cyclosporine were administered, are rare. Skin Research, 18 : 42-47, 2019