For the diagnosis of photosensitivity diseases, experimental induction of an eruption is of the most importance. Fluorescent lamps, such as black lights and sunlamps, have been used as light sources for phototesting. At the present time, however, both lamps are not commercially available because of the usage of mercury in the tubes. Recently, LED Wood’s lamp has been developed for examination of skin disorders including bacterial infection, fungal infection, porphyria, and pigment disorders. The LED Wood’s lamp emits UVA similarly to that of a fluorescent black light. Based on this characteristic, we used LED Wood’s lamp and also a targeted narrow-band UVB lamp as UVA and UVB light sources, respectively, for phototesting. Phototoxicity of 8-methoxypsoralen was induced in a normal subject using a LED Wood’s lamp, and polymorphous light eruption was produced in a photosensitive patient by exposure to LED Wood’s lamp and targeted narrow-band UVB. These mercury-free devices are much more convenient than conventional apparatuses because of their compact size and inexpensiveness. Skin Research, 20 : 1-5, 2021

A 78-year-old Japanese woman was diagnosed with anaphylactic shock due to loss of consciousness, hypotension, and generalized edematous erythema. She was referred to our hospital after treatment for the shock. She was febrile, and edematous erythemas were widely distributed on her trunk and extremities. Blood examination revealed a slightly elevated white blood cell count and C-reactive protein. The plasma D-dimer level was significantly elevated (30.6 μg/mL ; normal range ＜0.9 μg/mL). Histological examination showed superficial dermal edema and perivascular infiltration, mainly composed of lymphocytes, neutrophils, and eosinophils around the dermal blood vessels. Leukocytoclastic vasculitis was not observed. Antihistaminic treatment was unsuccessful. Antibiotic treatment was empirically started without an obvious focus of infection as the proposed diagnostic criterion of acute infectious urticaria was met, after which her fever and eruption were resolved. The plasma D-dimer level was also almost normalized. Systemic workup failed to identify other potential causes of the anaphylactic shock and elevated plasma D-dimer level. Thus,we diagnosed the case as acute infectious urticaria complicated with anaphylactic shock. Some reports, including ours, showed that acute infectious urticaria may cause anaphylaxis. We also speculated that the elevation of the plasma D-dimer level was related to urticaria. Considering recent studies on the relationship between urticaria and the coagulation system, the plasma D-dimer level may be significantly elevated in acute infectious urticaria. Skin Research, 20 : 6-10, 2021

Extramammary Paget’s disease (EMPD) is usually resected with adequate margins. Artificial anus or urinary tract change may be required in addition to the removal of the anus or urethra, which significantly reduces the patient’s quality of life. Although unresectable EMPD is sometimes treated with radiotherapy, there are few reports on it. Accordingly, the significance of radical radiotherapy has not been established. In the present report, we describe 6 cases of EMPD treated with radiotherapy. Although all the patients were proposed for total resection, they chose radiotherapy due to their own wishes or dementia. The mean age was 78.3 years old and the ratio of male to female was 1 : 5. The average duration of observation was 32.7 months. The average radiation dose was 51 grays. In all cases, the involved lesions grossly resolved six months later. Adverse effects included erosions in 2 cases and candidiasis in 1 case. During the course, there were 2 cases of recurrence with an average of 13 months. One case has not been recurred repeatedly by a local excision and the other case has died from concomitant peritonitis after cystourethrectomy for urethral invasion. In order to maintain the quality of life, radiotherapy is considered to be beneficial for patients with EMPD who do not hope to undergo aggressive surgery. Since the recurrence rate may be high, careful observation is needed after radiotherapy. Skin Research, 20 : 11-17, 2021

This report presents a 29-year-old man who had a fever 4days before the first visit. After taking acetaminopen for several days, a generalized rash appeared 1 day before the first visit. On the first visit, the body temperature was 39.5°C and red bean-sized erythema diffusely occurred on the trunk and extremities. The histopathologic examinations demonstrated individual cell necrosis of epidermal keratinocytes and vacuolar degeneration. The skin rash improved after treatment with topical steroids, but fever and high inflammatory reaction persisted. No viral infection could be proved from the serum virus antibody titer. He developed hyponatremia, myocarditis, and ileus. He was diagnosed with adult-onset Still’s disease due to fever of 39 degrees or higher that lasts for 1 week or longer, swollen lymph nodes, sore throat, and marked increase of serum ferritin. Systemic administration of steroids improved all of his symptoms. The skin eruption in our case was considered to be similar to drug eruption, but the skin histopathology was consistent with adult-onset Still’s disease. We considered the possibility that adult-onset Still’s disease and drug eruption were combined, and that the symptoms of adult-onset Still’s disease were enhanced by the drug. Skin Research, 20 : 18-23, 2021

A 77-year-oldfemale presentedwith multiple subcutaneous nodules on the abdomen for a month. Computedtomography of the chest andabdomen demonstratedmultiple tumors in the lung andliver. A clinical investigation revealed25 mm-sizedsubcutaneous nodules respectively on the epigastric region andthe right lower abdomen, accompaniedby multiple, small, fingertip-sizedsubcutaneous nodules on the chest and abdomen. A biopsied specimen demonstrated a relatively welldemarcated, irregularly-shaped basophilic nodule in the subcutaneous tissue. Tumor cells had roundto oval, hyperchromatic, atypical nuclei, anda faint cytoplasm with high nucleo-cytoplasmic ratio. A lot of mitoses could be detected. Indian filing could be seen partially. Immunohistochemically, tumor cells were positive for CK7, CD56, synaptophysin, chromogranin A, andthyroid transcription factor-1 (TTF-1), andwere negative for CK20. Positron emission tomography/computedtomography (PET/CT) demonstratedan abnormal uptake of FDG in the subcutaneous tissue, the liver, the upper lobe andhilum of the left lung, mediastinal andbilateral axillary lymph nodes, and adrenal gland. Metastatic carcinoma of the skin from lung small cell carcinoma could be diagnosed definitely. Several transcription factors have been reportedto be useful as specific markers in a variety of internal carcinomas. In the present case, the expression of TTF-1 enabled the diagnosis of lung small cell carcinoma. A skin biopsy is a useful tool in investigating the origin of metastatic carcinomas of the skin, leading to the choice of appropriate treatment. Skin Research, 20 : 24-29, 2021

A 67-year-oldman became aware of erythema andswelling of both lower legs from 5 months before andvisitedour department. Three months after the first visit, harderythema with gloss spreadto the trunk andupper andlower extremities. A skin biopsy was performedandhistopathological examination of the erythema of the abdomen showed thickening of the dermis due to collagen fiber growth andswelling. From bloodandimaging tests, we diagnosedthis patient with generalized localizedscleroderma. In this case, he was a carpenter andhada history of contact with epoxy resin for over 40 years, so it was considered that exposure to organic solvents may have been a factor in the onset. Although there are some reports of generalizedmorphea-like systemic sclerosis (GM-like SSc) causedby epoxy resin, there is no report of GM occurrence as in this case, andfuture accumulation of cases is desired. Skin Research, 20 : 30-34, 2021

An 84-year-oldfemale hadundergone left hemithyroidectomy for left papillary thyroidcancer 6 years before. She presentedwith a nodule on the right clavicle for 2 months. A clinical investigation revealeda 9×7 mm-sized, light-red, dome-shaped nodule on the right clavicle. Dermoscopy demonstratedarborizing vessels. A biopsiedspecimen demonstrateda well-demarcatedbasophilic nodule in the dermis and deeper. There were atypical columnar cells with oval, hyperchromatic nuclei andample cytoplasm, arrangedin a papillary or tubular fashion. Immunohistochemically,tumor cells were positive for cytokeratin 7, thyroidtranscription factor-1 (TTF-1), andPAX8, and were negative for CEA andGCDFP-15. The present case was diagnosedas metastatic carcinoma of the skin from papillary thyroidcancer. Several transcription factors have been reportedto be useful as specific markers in a variety of internal carcinomas. In the present case, the co-expression of TTF-1 andPAX8 enabledthe diagnosis of papillary thyroidcancer. A skin biopsy is a useful tool in investigating the origin of metastatic carcinomas of the skin, leading to the choice of appropriate treatment. Skin Research, 20 :35-40, 2021

A 79-year-old man complained that erosions appeared and disappeared repeatedly on the penis for about 10 years before the first visit. One month before, he noticed bleeding from the penis and a painful sensation. On the first visit, approximately 2/3 of the entire penis and foreskin were covered with elastic, soft, mildly-protruding, easily hemorrhagic changes. On the left side of the penis was a red bean-sized soft protruding lesion. Mild redness, erosion, and irritative pain were noted on the dorsal side of the glans. Histopathologically, epidermal defect was observed, and numerous plasma cells, hemosiderin deposits, and inflammatory granulation tissue were observed in the dermis. Thus, plasmocytosis cirumorifialis was diagnosed. Looking at even protruding changes in the penis,a histopathological approach should be positively considered to distinguish from plasmacytosis circumorificialis. Skin Research, 20 : 41-45, 2021