The development of all skin appendages (hair follicles, sebaceous glands, sweat glands, nails) has been embryologically considered to be“down-growth from skin ectoderm”(down-growth theory). This may be true from the viewpoint of the xed position of the epidermis. However, it is possible to change the viewpoint and think that“the skin thickens while leaving the deepest part of each adnexa xed”(stay-in theory). Are these two ways of thinking merely“relative differences”that “look at one phenomenon from a different way”? These two perspectives were compared for following 10 items : consistency of direction, waste of energy, destruction of dermis, movement with the mesenchymal cell mass, relationship between cellular differentiation and proliferation, development of apocrine glands, development of sebaceous glands, development of arrector pili muscles, formation of perifollicular sheath, and the interface between dermis and subcutaneous adipose tissue. As a result, it seems that the“stay-in theory”can explain these 10 items better. Although it is not a concerning problem for daily medical practice, it may be not useless for dermatologists to consider the embryological development of skin appendages. Skin Research, 18 : 59-70, 2019
A 29-year-old man presented to our hospital with a 2-week history of painless swelling on his upper chest. Physical examination revealed a subcutaneous mass of 3 cm in diameter on the right sternoclavicular joint. Histologically, the cyst wall consisted of stratied squamous epithelium including some areas of pseudostratied ciliated columnar epithelium with goblet cells. No cartilage, smooth muscle, seromucous glands, or lymphoid follicles were found around the cyst. Based on his age, the location, clinical course, and histological ndings of the tumor, it was diagnosed as a cutaneous bronchogenic cyst. We reviewed the clinicopathological features in 108 previously reported cases of cutaneous bronchogenic cysts, and found that their histological features are similar to those of branchial cleft cysts in some cases. Thus, both clinical and histological ndings should be considered when diagnosing cutaneous bronchogenic cysts. Skin Research, 18 : 71-78, 2019
A 69-year-old man with head angiosarcoma started receiving electron beam radiation therapy and intravenous IL-2therapy. After completion of electron beam radiation therapy, he received weekly paclitaxel therapy. As numbness of the limbs exacerbated, the administration interval of paclitaxel was extended. However, purpura of the scalp and right posterior ear, and cervical lymph node metastases were detected. Paclitaxel was discontinued and pazopanib administration was started,but adverse reactions, such as hypertension, thrombopenia, and increases in the levels of liver enzymes, were observed in the early phase. Administration was discontinued 26 days after its start. CT 25 days after the start of pazopanib administration revealed a reduction in the right cervical lymph node. However, bilateral hemopneumothorax developed 2months after the discontinuation of administration, and pneumonia simultaneously developed, leading to death. In the present case,pazopanib was effective, although the administration period was limited. Skin Research, 18 : 79-84, 2019
We report two cases of gastroenteritis during the course of IgA vasculitis. Case 1: A 25-year-old woman developed purpura on both lower legs 4 days before her rst visit to our hospital. We diagnosed the purpura as IgA vasculitis by histopathology of the skin, and diamino-diphenyl sulfone (75 mg/day) was started. The purpura subsided once, but recurred on both lower legs. She exhibited abdominal pain, bloody stool, and vomiting. Abdominal computed tomography and colonoberscopy (CF) were performed, revealing enteritis in the small intestine, but the bleeding source was not found. Prednisolone improved the purpura and abdominal symptoms. Case 2 : A 60-year-old man had purpura and joint pain on both legs 3 days before his rst visit to our hospital. He was admitted to our hospital because the purpura spread, and he developed vomiting and diarrhea. We diagnosed the purpura as IgA vasculitis by histopathology of the skin, and diamino-diphenyl sulfone (75 mg/day) was started. After 5 days of hospitalization, he exhibited upper abdominal pain. Abdominal computed tomography, esophagogastroduodenoscopy, and CF were performed, and gastroenteritis was observed in the stomach, small intestine, and colon. Methylprednisolone pulse therapy improved the abdominal symptoms, and prednisolone improved the purpura. As we were able to observe gastrointestinal lesions associated with IgA vasculitis throughout the digestive tract,endoscopic examinations are useful for nding gastrointestinal lesions. Skin Research, 18 : 85-93, 2019
An 88-year-old man had an ostium on his left palm for approximately 20 years. Several months prior to his rst visit, the lesion began to grow quickly ; therefore, he visited our department. At the initial examination, he presented with a 15×12 mm red nodule with a well-dened margin and supercial erosion in the center of the left palm. Histopathology revealed tumor nests comprising basophilic tumor cells connected to the epidermis. No partial skin ulcer or differentiation to the lower part of the follicle was identied. These ndings were characteristic of basal cell carcinoma (BCC). Fissure formation, mucin, and deposition were not observed. The surrounding area was abundant in spindle cells. These ndings suggested benign trichoblastoma (TB). Immunohistochemical analysis revealed that the tumor cells expressed Ber-EP4 and were partially positive for PHLDA-1. Scattered androgen receptor-positive cells were observed, whereas no CK20-positive Merkel cells were found in the nests. These ndings were characteristic of BCC. Based on the comprehensive assessment of the above ndings, we diagnosed the tumor as nodular ulcerative BCC. Cases of BCC on the palm are rare. Skin Research, 18 : 94-98, 2019
A 58-year-old woman receiving hemodialysis due to diabetes-associated chronic renal failure was referred to us because of painful, swollen erythema on the face and neck. Partial necrosis of the upperlip and right neck developed 5 days afterthe rst admission. The lesions were diagnosed as cervical necrotizing fasciitis. Debridement was immediately performed. Subsequent debridement,topical application of 10% povidone-iodine gel and 0.9% iodine ointment, and administration of intravenous antibiotics resulted in a good prognosis. Prompt diagnosis and immediate treatment are essential for patients with cervical necrotizing fasciitis. Skin Research, 18 : 99-103, 2019
A Japanese male in his 60’s consulted our hospital for dark brownish lesions on both toes and heels. Purpura, erythema, livedo racemosa, and small ulcers were all observed in the lesions. His skin condition became aggravated in winter. Blood examination demonstrated increased cryoglobulin levels ; IgG-κ type I M protein, consistent with type I cryoglobulinemia. Histopathological ndings included many intravascular eosinophilic crystals. Immunohistological study demonstrated crystal-like bodies with positive expression of IgG and κ. We conrmed this case as cryocrystalglobulinemia in association with type I cryoglobulinemia. The skin lesions improved with rest and warmth, but later deteriorated. They later improved after prednisolone and cryoltration. As cryocrystalglobulinemia often becomes more severe than non-cryocrystalglobulinemia, treatment should be started immediately. Skin Research, 18 : 104-109, 2019
We report a 60-year-old man with a 2-month history of painful undermining genital ulcer on the glans. Histopathological examination demonstrated an ulcer and dense dermal inltrate composed mainly of plasma cells. He was diagnosed with plasmocytosis circumoricialis, and successfully treated using topical tacrolimus ointment. The pathogenesis of this disease is considered to be irritation due to the retention of urine, smegma, and scales induced by phimosis. This disease may also be due to immune response by T cells leading to activation of the humoral immune response mediated by B cells because there are several case reports successful treatment using calcinurin inhibitors. In our case, phimosis was not observed. However, the patient had polyarteritis nodosa,in which T cells and plasma cells are easily activated. The undermining genital ulcer was suspected to have been induced by activated T cells and plasma cells due to polyarteritis nodosa, and was healed following the suppression of T cells by tacrolimus. Skin Research, 18 : 110-115, 2019
Case1:A50-year-oldfemalenoteda at subcutaneous nodule of 3 cm in diameter with tenderness under the extensor side of the left forearm 5 days prior to presentation. The nodule was diagnosed as nodular fasciitis by sonography and MRI. After 4 weeks of follow-up with observation, the nodule regressed spontaneously. Case 2 : A 40-year-old female suddenly developed a tender nodule in the subcutaneous region of the extensor side of the right forearm 3 weeks prior to presentation. Under a tentative diagnosis of nodular fasciitis based on sonography and CT, the nodule was observed and it became very small after 11 days. Case 3 : A 33-year-old female noted a subcutaneous nodule on the extensor side of the right forearm the day before consultation. Under the diagnosis of nodular fasciitis based on sonographic examination, the nodule was observed and it disappeared after 3 months of follow-up. Case 4 : A 59-year-old female noted an asymptomatic subcutaneous nodule of 2 cm in diameter in the right temporal area 1 week prior to presentation. The nodule was diagnosed as typical nodular fasciitis based on sonography, but it disappeared after 3 weeks of observation. Case 5 : A 50-year-old female noted a subcutaneous 2 cm nodule that adhered to the underlying tissue and was movable under the skin. The nodule was diagnosed as nodular fasciitis and followed up with observation. It exhibited no change after 1 month of observation and regressed after 2 months. Case 6 : A 15-year-old male noted a subcutaneous nodule of less than 2 centimeters in diameter on the fascia of the right acromion. Sonographic examination strongly suggested nodular fasciitis. The 3-month follow-up with observation resulted in self-regression. Case 7 : A 14-year-old male noted a subcutaneous nodule with tenderness of 2 cm in diameter on the left side of the occipital area 2 weeks prior to consultation. The nodule was diagnosed as nodular fasciitis based on sonography and CT. After 4 weeks, it spontaneously regressed. Subcutaneous nodules that can be diagnosed as typical lesions of nodular fasciitis based on clinical symptoms and imaging examinations should be followed up without treatment for several weeks. Skin Research, 18 : 116-121, 2019