I reviewed several new treatments for acne vulgaris and its problems. Last year topical clindamycin gel became available as a new antibacterial medicine for acne vulgaris. The clinical trial of a novel synthetic retinoid, adapalene is currently on going. If adapalene is approved, it will be the first retinoid to become available for acne treatment in Japan.
Chemical peeling may receive considerable attention as new physical treatment for acne, therefore several associated ploblems must be resolved.

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Atopic dermatitis is a chronic inflammatory skin disease frequently seen in individuals with a genetic predisposition to increased IgE synthesis and IgE-mediated allergic reactions. However, the role of IgE in the pathomechanisms of atopic dermatitis remains unclear. The high affinity IgE receptor (FcεRI) is expressed on two distinct groups of cells: effector cells of anaphylaxis, i.e., mast cells, basophils; and antigen presenting cells such as Langerhans cells and monocytes/macrophages. FcεRI enables them to efficiently present antigen in IgE-mediated delayed-type hypersensitivity. In addition, FcεRI mediates various, unexpected activating signals in these cells which contribute to inflammatory reactions and chronicity of atopic dermatitis. Modulation of FcεRI-mediated signals may be a promising strategy for treating atopic disease.

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Ketonemia may be one of the etiologic factors of prurigo pigmentosa. We present an 18-year-old, non-diabetic female patient with prurigo pigmentosa that was preceded by loss of weight. Ketone bodies in blood were higher than normal, whereas urine ketone body was negative. After four-weeks treatment of oral minocycline (200 mg/day) skin lesions disappeared and normalization of blood ketone bodies followed. Our case suggested that ketonemia might be involved in the pathogenesis of prurigo pigmentosa.

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We witnessed anaphylactoid purpura associated with myelodysplastic syndrome in a 60 year-old male patient. The patient first felt general fatigue at June, 2001. He was pointed out anemia and abnormal hemocyte. As the result of a careful examination, the hematologist diagnosed him as myelodysplastic syndrome(MDS) at September, 2001. While his treatmet with oral steroids and transfusion, asymptomatic purpura appeared on his lower legs at November, 2001. The eruptions enlarged to his abdomen and arms. There were no abnormal findings on the platelet count and coagulation system. The histological examinations of his leg resulted in a diagnosis of anaphylactoid purpura. We discuss as skin eruptions associated with MDS, MDS presenting as anaphylactoid purpura, associations between anaphylactoid purpura and malignancy, vasculitis associated with malignancy.

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A 59-year-old woman who had often taken senna tea for the treatment of constipation developed erythematous macular eruption on the almost entire body surface. Senna is widely used as the aperient and the main ingredient is included in the aloe, too, in sennosid. With discontinuation of senna tea and the treatement with topical steroid, her symptoms alleviated in approximately. However, when she took senna tea and aloe arborescens for constipation, skin lesions reccurred. Therefore, it concluded that the eruption in this case was a lichenoid drug eruption due to sennosid.

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We report two cases of hypersensitivity syndrome due to anticonvulsants. Case 1 : A 50-year-old male had been suffered from epilepsy for a long time. Two months after he began to take carbamazepine, high grade fever, edema of his limbs and erythema on the whole body were developed. Case 2 : A month after a 54-year-old female began to take zonisamide for brain infarction, diarrhea, edema of body systemic, fever and erythema of whole body were developed. She had shock and DIC. Both cases got better with systemic steroid, but the erythema redeveloped during tapering. Both cases needed 2 and 5 months till they were free from steroid. The serum IgG titer of HHV-6 indicated high on both cases.

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We report a 18-year old woman with rupioid psoriasis. One month before initial consultation, the patient was diagnosed as omphalitis, and administration of antibiotics was initiated. During the initial consultation, erythematous lesions covered with layers of silvery scales on the back, and around the umbilicus was seen. After three months, we finally diagnosed rupioid psoriasis, based on limpet-like, cone-shaped clinical features and pathological findings. This patient had been treated with topical steroids and oral administration of cyclosporin(3mg/kg). All nodules flattened and there is no recurrence of those clinical features during the follow-up period of 2 years.

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A 71-year old woman presented our outpatient department with the history of multiple erythema on the face and upper extremities for two years. She already consulted a few dermatologists, but she could not obtain successful treatment. On the initial examination, elliptical, ring-shaped, scarlet and slightly atrophic erythema were obserbed on the face and upper extremities. The size of the leision was about 1cm in diameter. Histological examination showed non-caseous epitheloid cell granuloma at the entire layers of the dermis. From the clinical and histological fidings, the patient was diagnosed as beeing with plaque type skin sarcoid. We tried oral steroids, oral minocycline and topical steroids for the treatment of the patient. The treatment with oral steroids and oral minocycline was slightly effective. The skin lesions were refractly by discontineuing the medication. We also discussed about the treatment of cutaneous sarcoidosis with reviewing the relevant literature.

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We experienced two cases of nodular hidradenoma, which showed distinct differentiation patterns; poroid hidradenoma and apocrine hidradenoma. Case 1 was a 1.5cm-sized nodule without itch or pain appeared on the back of a 81-year-old man. We diagnosed the tumor as an apocrine hidradenoma because there were many clear cells intermingled with epidermoid cells which showed decapitation secretion. Case 2 was a 3cm-sized nodule on the back of a 48-year-old man. This case was a poroid hidradenoma showing eccrine differentiation because most of the composing cells were poroid cells and cuticular cells. However, there were also many mucinous cells and clear cells, which indicated apocrine differentiation. Our cases suggested that, in nodular hidradenoma, not only apocrine hidradenoma, but also poroid hidradenoma could show some features toward apocrine differentiation.

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Invasive squamous cell carcinoma (SCC), once becoming resistant to chemotherapy or radiation therapy, is quite difficult to treat. In this context, recall of anti-cancer immunity is one of last therapeutic possibilities. Hence, we treated a case invasive SCC with intralesional injection of interleukin (IL)-2. A 75 year-old Japanese woman with multiple SCC on her right lower leg was intralesionally injected with IL-2 twice daily for 10 days. To monitor the effect, immunostaining was conducted using a panel of antibodies, and in situ TUNEL staining was performed to examine apoptotic death of tumor cells upon the IL-2 injection. The intralesional administration of IL-2 led to the marked reduction of the tumor size. Furthermore, immunostaining revealed the marked increase in the number of CD1a positive Langerhans cells surrounded by CD4+ and CD8+ T lymphocytes. in situ TUNEL staining demonstrated apoptosis of the tumor cells upon intralesional injection of IL-2. Collectively, we propose that intralesional injection of IL-2 is worthy of consideration for treatment of SCC, when it becomes resistant to conventional therapies.

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A 91-year-old woman presenting with cutaneous metastases from breast cancer is reported. The primary lesion had been excised 13 years previously, and histopathologically showed mucinous carcinoma. Nine years after the operation, she noticed a left subclavicular dome-shaped tumor, and visited our hospital. Histopathologically, the tumor showed typical feature of mucinous carcinoma. The primary lesion and the tumor were immunohistochemically positive for BRST-2, EMA, ER and negative for CEA. The occurrence of delayed cutaneous metastases in the literatures was also discussed.

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We reported a case of skin metastasis of prostatic carcinoma in a 73-year-old Japanese man. At first visit, he had presented five red-purple-colored firm skin nodules on his anterior chest, which had gradually increased in size for the last one year. Histopathological studies showed dermal nests consisted of atypical cells of non-cutaneous origin, which arranged in a glandular pattern. Immunohistochemical staining of those cells for prostatic specific antigen were positive. Prostatic carcinoma rarely metastasizes to the skin, and only about 40 cases have been reported so far in Japan.

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A 30-year-old woman was diagnosed systemic lupus erythematosus at the age of 14 years and treated with oral prednisolone. About 9 years later, 32 firm, slightly elevated, 3 to 20 mm in diameter, brown nodules were developed on the extremities, trunk and hip. Four of these lesions were excised. Histologic examination confirmed the diagnosis of dermatofibroma. Mucin deposited were found in the region between the fibrous lesion and the overlying epidermis. It was suggested that altered immune states in patients with autoimmune disorders could lead an outbreak of multiple dermatofibromas and the depositon of mucin.

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In general, the diagnosis of dermatofibrosarcoma protuberans is not difficult because of its characteristic clinical appearance. We report an unusual variant of dermatofibrosarcoma protuberans in a 19-year-old female. The lesion was a non-elevated and blue-colored subcutaneous tumor on the right upper arm. Histological examination showed the typical appearance of dermatofibrosarcoma protuberans. Tumor cells proliferated in the lower dermis and invaded into the subcutaneous tissue. They were composed of spindle-shaped tumor cells arranged in a storiform pattern HMB-45 positive and pigmented dendritic cells. Spindle-shaped tumor cells were positive for vimentin and CD34 and negative for factor XIIIa. The tumor was diagnosised as Non-protuberans Pigmented Dermatofibrosarcoma Protuberans (Bednar Tumor). These stainings were helpful in the diagnosis of this unusual variant of dermatofibrosarcoma protuberans. Dermatologists should recognize uncommon clinical appearance of dermatofibrosarcoma protuberans.

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A 39-year-old man had noticed multiple asymptomatic eruptions on the trunk from March, 2001. At the first visit, the skin symptom was consisted of multiple yellowish or pinky soft papules, which were as big as 2-3-mm in diameter. Those papules were not seen on eyelids, tendons or palms. Histopathological examinations with hematoxyllin-eosine-stained biopsy specimens revealed relatively small formy cells admixed with lymphocytes and histiocytes from upper to middle dermis and occasional occurrence of Touton’s giant cells. Based on these findings, we finally gave a diagnosis on this case to be adult multiple xanthogranuloma.

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57-year-old female patient revealed erythema and muscle pain with a history of tick bite at her left abdominal wall on 26th July in 1999 at Oze in Gunma. The erythema developed rapidly and formed erythema chronicum migrans on the most of her left trunk. Tick’s mouthpart was removed by surgically with a subsequent oral administration of benzyl-penicillin benzathine and minocycline hydrochloride for 28 days. By serological finding, The Lyme anyibody were positive on ELISA, WB and FA.

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