In order to understand pigmented lesions along the structure of nail organs, the textbook description is insufficient. Two-dimensionally, it is essential to understand the tandem arcade-like structure in the nail bed/distal nail matrix and the arborised structure in the proximal nail matrix. The more superficial nail plate isproduced by a more proximal nail matrix, and the deeper nail plate by a more distal nail matrix. Therefore, it is necessary to grasp three-dimensionally the nail lesions, especially the pigmented one. Furthermore, the continuous production of the nail plate allows a comprehensive observation of changes in units of several months. In other words, a fourdimensional understanding that takes the time axis into consideration is required. The tandem arcade-like structure of the nail bed / distal nail matrix is same to that of palmoplantar skin. For the histological evaluation of these structures, the cross section is preferable to the conventional longitudinal section. Embryologically, the development of the nail organ hasbeen conventionally described as “downward invagination of the proximal groove”. However,“stay-in theory”seems to be more explanatory than the“down-growth theory”from the view point of finger development. Skin Research, 19 : 65-89, 2020

Bilastine is a non-sedating H1-antihistamine taken once dailyunder fasting conditions ; it has been reported to be clinicallyuseful and highlyconvenient, and to not cause significant side effects. As there are few other medicines that are prescribed to be taken under fasting conditions, medication compliance bypatients is of concern. Therefore, we examined whether the timing of medication and compliance affect the effects of bilastine for itching associated with cutaneous diseases. Sixtyseven patients with itching associated with cutaneous diseases were enrolled in this study. We evaluated the itching intensityusing the visual analogue scale (VAS) and dermatologylife quality index (DLQI) before and 4 weeks after bilastine treatment, and analyzed significant differences in the effects of bilastine for itching based on the timing of medication or medication compliance status. The itching VAS demonstrated significant improvements in the group that took bilastine at bedtime and in that that took it at anyother time (Wilcoxon signed rank test). Both the compliance group (at least 1 hour before meals or at least 2 hours after meals) and the non-compliance group exhibited significant improvement in the itching VAS and DLQI (Wilcoxon signed rank test). In addition,there was no difference between the compliance group and non-compliance group in improvement of itching VAS and DLQI (Student’s t test). Pharmacokinetically, bilastine is considered appropriate for administration under fasting conditions rather than after meals. This studysuggests that regardless of pharmacokinetics, the interval between meals and medication is not important. Skin Research, 19 : 90-96, 2020

Bilastine is administered under fasting conditions, which is uncommon for antihistamines. In a previous trial, fasting was defined as an interval of 1 hour or longer before meals and 2 hours or longer after meals. In this study, we investigated the effectiveness of bilastine by focusing on food intake (defined as“overeating”,“sufficient”,“moderate”, and“small amount”in descending order of intake), and the time interval between meals and medication. Daytime and nighttime itching assessed by the visual analog scale (VAS) improved significantly with“sufficient”and“moderate”food intakes. With “overeating” and “small amount”, almost all patients demonstrated improvement in itching VAS scores. With“overeating”, the time interval between meals and medication was greater than 150 minutes for all patients. Patients often had longer intervals between meal intake and medication as the meal size increased. Patients may have taken bilastine correctly on an empty stomach according to their food intake, which may have led to an improvement in the itching VAS. With“sufficient”meals, itching VAS scores improved as the interval between the meal and medication increased. On the other hand, with“moderate”meals, itching VAS scores improved regardless of the time interval. Our study revealed that larger meal volumes influence bilastine effects ; therefore, patients should be educated about the appropriate interval between meals and medication. Even if bilastine intake is timed according to the feeling of hunger, satisfactory effects may be observed when the amount of food intake is low. To increase the effectiveness of bilastine, it is important to clarify the appropriate time interval between food intake and medication according to the amount of food intake. Skin Research, 19 : 97-105, 2020

We report the case of a 74-year-old man who presented with scaly erythema on his trunk caused by Epidermophyton floccosum. He was diagnosed with myasthenia gravis from age 50 and thymoma from age 68, and administered systemic cortico-steroids and immunosuppressants. Direct microscopic examination revealed mycelia on an erythematous lesion and fungal culture was positive. Biopsy confirmed the presence of fungal hyphae in the horny layer of the skin and neutrophilic pustules were observed. Based on giant colony culture and slide culture findings, the isolated fungus was identified as E. floccosum. E. floccosum is an anthropophilic dermatophyte present globally that causes scaly erythema on the trunk or groin. There have been reports of outbreaks of E. floccosum, but its incidence has decreased and is rarely reported nowadays. E. floccosum infections are of concern in immunosuppressed patients. This case was characterized by generalized superficial tinea corporis caused by E. floccosum in an immunosuppressed patient. Skin Research, 19 : 106-110, 2020

An 80-year-old woman without immune deficiency visited her local clinic for skin eruptions on her right upper limb and right back. The patient wasdiagnosed with herpeszoster and wastreated using famciclovir. However, she had anorexia and malaise 3 days after taking her medication. There was no fever or unconsciousness. Erythema and vesicles were scattered in the C4 and C5 areasfrom the right shoulder to the upper arm, and in the Th10 area of the right lumbar region. The patient wasdiagnosed with multidermatomal herpeszoster and intravenousacyclovir wasstarted on admission. Eruptions were crusted, but general malaise did not improve. Right hemiplegia and thermal pain sensation below C3 on both sides developed. The number of cells in the cerebrospinal fluid increased. Cervical spine enhanced MRI demonstrated a high-signal area extending from the brainstem medulla to the C3-4 level of her cervical spine. The patient was diagnosed with encephalomyelitis due to varicella-zoster virus, and was treated using a double dose of acyclovir for 7 days and 3 courses of steroid pulse therapy. Muscle weakness and thermal pain sensation improved. However, as enhanced MRI revealed enhancement of the lesion, a double dose of acyclovir was readministered with one course of steroid pulse therapy. The patient was transferred to rehabilitation after a total of 34 daysof acyclovir. Currently, rehabilitation for difficulty in raising her right upper limb and contracture of her right shoulder is continuing. Varicella-zoster virus myelitismay develop without an underlying disorder that causesimmune decline. Asmotor paresis due to myelitishasa poor neurological prognosis, a careful explanation of the condition isrequired. Skin Research, 19 : 111-116, 2020

A 76-year old man had supraglottic carcinoma (stage IV), and was treated by radiotherapy,chemotherapy, and lymph node dissection. Five months after the operation, blisters developed on his entire body and he was referred to our hospital. Skin biopsy revealed subepidermal blisters, and many neutrophils were noted in the blister and in the upper dermis. Direct immunofluorescence microscopy revealed the presence of linear deposits of immunoglobulin A and C3, resulting in the diagnosis of linear IgA bullous dermatosis. He was treated using prednisolone and diaminodiphenyl sulfone. Although his skin condition gradually recovered, he died of supraglottic carcinoma. Our case was characteristic in that additional DDS therapy was effective and the patient had accompanying malignant disease. Skin Research, 19 : 117-121, 2020

A 76-year-old man noticed a red papule at the right cheek region several months before the first visit. It gradually increased in size and he visited our hospital. At the first visit, a verrucous nodule was observed at the right cheek region. Histopathological examination revealed that the tumor nests in the upper dermis were connected to the epidermis. The tumor was composed of small tumor cells with little atypia. There were lumens in the tumor nest. We diagnosed him with Pinkus-type eccrine poroma. Only 41 cases of eccrine poroma on the face have been reported since 1968 in Japan. Although the frequency of eccrine poromas on the face is comparatively low, we should perform skin biopsy or excision when a red elevated lesion is found on the face. Skin Research, 19 : 122-126, 2020

Case 1: A 68-year-old woman presented with a one-month history of a scratched ulcer on her right lower leg. She was on dialysis for chronic kidney disease of unknown cause for 19 years. She received a topical ointment by the previous physician ; however, the ulcer did not improve. Examination on admission revealed a walnut-sized skin ulcer with a bloody clot on the right lower leg. She complained of severe pain. The number and size of the ulcers gradually increased. Histopathology by Kossa staining demonstrated ring-shaped calcification on the wall of the small and medium arteries. A diagnosis of calciphylaxis was made. Case 2 : A 48-year-old woman was diagnosed with calciphylaxis by skin biopsy 5 months ago, and she was referred to the nephrology department of our hospital from the dermatology department of another hospital. She was on dialysis for 18 years because of IgA nephropathy. Examination on admission revealed a fist-sized ulcer on both thighs and severe pain was present. In each case, adjustment of the calcium (Ca) and phosphorus (P) levels, administration of sodium thiosulfate, and topical treatment were performed. In case 2, artificial dermis was applied after debridement. Successful epithelization was observed in both cases. In both cases, adjustment of the serum Ca and P levels, and intravenous injection of sodium thiosulfate were effective. Case 2 was the proximal type, but the lesion was localized and improvement was observed because sufficient debridement was performed. We consider it important to perform both systemic and surgical management for calciphylaxis. Skin Research, 19 : 127-132, 2020

A 65-year old man developed acute myocardial infarction and underwent percutaneous coronary intervention (PCI) followed by two coronary angiography examinations. He was exposed to a total of 28 Gy of radiation. After PCI, acute radiation dermatitis developed on the upper left back, which was treated by topical steroid therapy. Approximately 6 months before the first visit, erythema with mild pruritus developed at the same site, and it formed a palm-sized ulcer with yellow necrosis. After the diagnosis of chronic radiation dermatitis, he received topical treatment without improvement. We considered surgical treatment to be necessary, and performed debridement of the wound under general anesthesia and started negative-pressure wound therapy. When the wound was well granulated, we performed stratified skin grafting. The explant was successfully implanted and epithelialized. There was no recurrence or deterioration thereafter. We consider negative-pressure wound therapy to be an effective method of treatment for chronic radiation dermatitis and ulcers, and combining it with reconstructive surgery like skin grafting is useful to improve the treatment results. Skin Research, 19 : 133-137, 2020

Daily skin care with moisturizers is necessary for infants who have immature barrier function and are more likely to have dry skin than adults. We evaluated the moisturizing effects of an oil-inwater (O/W)-type emulsion containing partially myristoylated carboxymethyl-chitosan (PMCMC) on 28 Japanese infants for 4 weeks. Dermatological findings (dry skin score) and water content of the stratum corneum significantly improved after 4 weeks of emulsion application compared with before the test. These results were equivalent to or better than those of the W/O-type emulsion preparation containing heparinoid used as a control. In a questionnaire survey of the parents, the evaluation of moisturizing-related items in both groups was high. On the other hand, the PMCMC emulsion was rated higher than the heparinoid preparation for items related to the feeling of use. This study suggests that the PMCMC emulsion has high moisturizing effects and excellent feeling of use, and is useful as a moisturizer for long-term skin care of infants. Skin Research, 19 : 138-143, 2020