We retrospectively investigated 10 patients with early syphilis at Kansai Medical University Medical Center between January 2014 and June 2018. The number of patients with syphilis has increased around this area, and male patients were predominant (Male ; 6, Female ; 4). Young or middle-aged men paying frequent visits to sex establishments were a major population, similar to the national trend. There were neither homosexual males nor HIV patients. We noted many clinical variations such as 3 cases of hard chancre, 2 cases of papular syphilis, 1 case of syphilitic psoriasis, 1 case of pustular syphilis, 1 case of condylomata lata, and 3 cases of syphilitic roseola. In general, oral amoxicillin is administered, resulting in rapid clinical cure. The titers on serological testing for syphilis (STS) rapidly decreased in almost all cases. It is an important responsibility of dermatologists to understand the many clinical variations and complicated movement of serum reactions in syphilis, and to play a leading role in the treatment of syphilis in hospitals. Skin Research, 18 : 139-143, 2019

A 43-year-old man was referred to our hospital because of the pain in the left shoulder that had appeared 10 days ago. Vesicles and pustules with erythema on the left arm developed 7 days ago. He had taken famciclovir orally for 7 days for herpes zoster. However, he felt weakness in his left upper limbs and disseminated vesicles on the trunk developed. Manual muscle test of the upper limbs demonstrated reduced power in the left deltoid muscle and biceps brachii muscle. T2- weighted magnetic resonance imaging study revealed swelling and high signal intensity of the C5/C6 nerve root. We diagnosed the patient with herpes zoster associated with segmental zoster paresis. He was administered a course of intravenous acyclovir (750 mg/day for 7 days followed by 1,500 mg/day for 7 days) and 3 sessions of steroid pulse therapy. After his rush resolved, weakness in the left upper limbs remained. He underwent rehabilitation therapy and pain management. When dermatologists see a patient with herpes zoster who exhibits muscle weakness, we should consider segmental zoster paresis. Skin Research, 18 : 144-150, 2019

A 39-year-old woman was referred for asymptomatic papules on the neck, bilateral axilla, and the inguinal region for a period of 30 years. In 1999, the eruptions were interpreted as pseudoxanthoma elasticum based on biopsy of the left axilla. In 2007, the patient was referred again to us for evaluation of the increase of asymptomatic multiple papules on the face, neck, back, and inguinal region. Skin biopsy from the left axilla suggested pseudoxanthoma elasticum. She had no ocular complications. In February 2017, she was referred to us because the multiple papules further increased in number on the face, axillae, and trunk. Skin biopsy of papules from the trunk and the lower eyelid indicated eruptive syringoma. This sample did not have the abnormalities of elastic bers found in the pseudoxanthoma elasticum. As she had mild scoliosis and umbilical hernia, the possibility of Ehlers-Danlos syndrome or Marfan syndrome was considered, but she did not meet the diagnostic criteria for either. In this case, the syringoma was dense and widespread, mimicking pseudoxanthoma elasticum. Therefore, eruptive syringoma can be listed as a differential diagnosis for PXE. Skin Research, 18 : 151-156, 2019

A woman in her 60s with type 1 neurobromatosis had a diffuse plexiform neurobroma in her left upper limb. Bruisingdeveloped, followed by swellingand pain in her left limb, and she was taken to the emergency room. She arrived in a state of shock, and emergency angiography of the left brachial artery revealed a pseudoaneurysm with jet extravasation. We successfully performed transcatheter arterial embolization (TAE). However, the patient subsequently had several rebleedingepisodes from ruptured pseudoaneurysms that may have been fatal. We chose to amputate her left upper limb to reduce the risk of death. To prevent hemorrhage, we performed preoperative TAE of the vessels feedingthe tumor. Our case demonstrates that patients with type 1 neurobromatosis have weak vessels that may cause massive life-threateninghemorrhage. Thus, we should perform preoperative radiological imaging, such as computed tomography, angiography, or magnetic resonance imaging, to prevent hemorrhage. Skin Research, 18 : 157-162, 2019

Case 1 was a 66- year-old man. After he used the disinfectant“Skin Aid^○R ”on a right lower leg bruise, erythema with itching developed on the same region. Patch testing was performed with the ingredients of“Skin Aid”. A positive reaction was noted for dibucaine hydrochloride. Case 2 was a 9-year-old male. After he used the disinfectant“MEMO-A^○R ”fora left knee abrasion, small blisters developed on the same region. Patch testing was performed with the ingredients of “MEMO-A ^○R ”. A positive reaction was noted for dibucaine hydrochloride. Both cases were diagnosed as contact dermatitis to dibucaine hydrochloride. Dibucaine hydrochloride is an amidetype quinoline derivative, and cross-reactions with other local anesthetics do not occur. However,as there was a report of positive reactions with multiple systems of local anesthesia on patch testing,we need to use local anesthetics carefully. Skin Research, 18 : 163-167, 2019

We report a case of extramammary Paget’s disease that developed on the breast. A 70-year-old woman presented with a brown macule, which was rst noted on the left breast more than 20 years ago and had slowly increased in size to become an irregular reddish brown macule that was elevated and accompanied by erosion. The tumor was diagnosed as extramammary Paget’s disease based on clinical evidence and histopathological ndings of the skin biopsy. No metastases were noted. The tumor was resected under general anesthesia. She has not had recurrence or metastasis. Extramammary Paget’s disease rarely occurs on the breast. As its clinical presentation is similar to that of mammary Paget’sdisease,itisdifcult to differentiate between the two diseases. Skin Research, 18 : 168-173, 2019

The clinical utility of bilastine for cutaneous diseases causing itching was evaluated by investigating the itching visual analogue scale (VAS) scores, Dermatology Life Quality Index (DLQI) scores, Skindex-16 scores, and patient satisfaction of 48 patients treated at the Dermatology Department of Aichi Medical University Hospital. Daytime and nighttime itching VAS scores signicantly decreased at both 2 and 4 weeks after the treatment compared with baseline. Stratied analyses taking into account previous treatment and age (≥70 years and ＜70 years) also revealed signicant decreases in both daytime and nighttime itching VAS scores. The total DLQI score signicantly decreased at both 2 and 4 weeks after the treatment compared with baseline. Skindex 16 scores for the symptom, emotional, and functional categories signicantly decreased at both 2 and 4 weeks after the treatment compared with baseline. Approximately 70% of the patients were highly satised with bilastine 4 weeks after the treatment. No severe side effects occurred in this study, even among elderly patients. Bilastine may be safely used by elderly patients with cutaneous diseases causing itching. Skin Research, 18: 174-181, 2019