To clarify the characteristics of elderly skin, the skin condition of the head, neck, trunk, and limbs was evaluated by instrumental measurements, and compared between young and elderly healthy female volunteers. The water content of the stratum corneum and transepidermal water loss were lower in many elderly volunteers than in young volunteers. The secretion levels of skin surface lipids were also lower in the elderly volunteers. In particular, they were hardly detected below the neck. The surface pH of elderly skin was also slightly lower. Taken together, elderly skin is generally dry, and the trunk and limbs are particularly prone to dry skin. It is important to inform elderly persons of their skin dryness below the neck and to recommend the use of moisturizers. Skin Research, 20 : 174-178, 2021

A 78-year-old man underwent chemotherapy for non-small-cell lung cancer, resulting in tumor progression. Atezolizumab, a PD-L1 antibody, was started as second-line anti-cancer therapy. After the seventh administration, itchy edematous erythema developed mainly on the trunk. Although topical steroid therapy was applied, edematous erythema developed on both eyelids and dark-red erythema developed on the dorsal hand. Moreover, increased blood myogenic enzyme,muscle weakness with a proximal predominance, and antiTIF1-γ antibody positivity were noted,leading to a diagnosis of dermatomyositis. We discontinued atezolizumab and started systemic steroids, and symptoms went into remission. Later, the cutaneous and muscular symptoms recurred with the progression of lung cancer. The patient passed away from the progression of lung cancer due to the poor effects of docetaxel chemotherapy. In recent years, immune-related adverse events have become more important with the increasing use of immune checkpoint inhibitors. There are few reports of dermatomyositis as an immune-related adverse event, but we suspected our case to be similar. However, it is difficult to exclude paraneoplastic dermatomyositis. Further accumulation of cases is necessary to clarify the pathological mechanisms. Skin Research, 20 : 179-186, 2021

A 27-year-old female was admitted to our hospital because of fever and painful erythema on the extremities. She was diagnosed with Sjögren syndrome when she was 15years old, but she discontinued visiting a clinic. Ten days before the hospitalization, she developed fever and visited her family doctor. Based on the presence of pyuria, infection of the urinary tract was considered and she was administered antibiotics. However, her fever remained. She was consulted our dermatology department for edema and painful erythema on the extremities. Based on ophthalmological findings and laboratory data, we rediagnosed her with Sjögren syndrome and started the administration of 30 mg/day of prednisolone, which alleviated the symptoms. Patients with Sjögren syndrome present with different cutaneous symptoms during the clinical course, and among them, erythema nodosum is a rare cutaneous manifestation and few cases have been reported. Our case was notable because of prominent edema on the extremities with erythema nodusum ; therefore,we reviewed and discussed previous reports of Sjögren syndrome with erythema nodusum. Skin Research, 20 : 187-191, 2021

A 33-year-old man presented to our hospital with a 4-month history of small, whitish scar-like lesions on his arms. All lesions were several millimeters in diameter, and the surface was atrophic and wrinkled. Preceding infections or skin lesions were not observed. Skin biopsy revealed a focal loss of elastic tissue in the superficial to mid-dermis, which was surrounded by irregular or twisted collagen fibers. No inflammatory cell infiltration was observed. Based on these clinical and histopathological findings, we diagnosed this patient with primary Schweninger-Buzzi type anetoderma. Primary anetoderma can be a precursor of autoimmune disorders and prothrombotic conditions such as anti-phospholipid syndrome. It is important to perform long-term monitoring to identify the development of further autoimmune symptoms associated with anetoderma. Skin Research, 20 : 192-196, 2021

A 91-year-old man presented with a 4-month history of edema on both eyelids. Although exacerbation of heart failure or circulatory disorder was suspected at the cardiology department of our hospital, no abnormality was found. To distinguish drug-induced angioedema, oral medications were discontinued. However, the edema spread to his entire face and he was referred to our department. At the time of consultation, in addition to facial edema, a tumor on the left side of the frontal region was observed under hair. Histologically, atypical cells proliferated throughout the dermis and formation of the luminal structure was hardly observed. Immunohistochemical staining, which revealed that the tumor cells were positive for CD31, D2-40 and factor VIII, confirmed the diagnosis of angiosarcoma. In this case, an accurate diagnosis was difficult because purpura, which is the most common characteristic of angiosarcoma, was not observed during the clinical course and facial edema was the major complaint. Therefore, we report this rare example of angiosarcoma presenting as facial edema with a literature review. Skin Research, 20 : 197-202, 2021

An 89-year-old man noticed a tumor on the right lower abdomen approximately 20 years ago and it gradually increased in size. Physical examination revealed a 35×26×8mm nodule composed of red to reddish brown areas and dark brown areas, and its surface was focally erosive and papillated. It was pedunculated without surrounding macules. On dermoscopy, most of the tumor was consistent with seborrheic keratosis, but milky red areas of malignant melanoma were observed. Biopsy of the milky red areas led to the diagnosis of malignant melanoma and wide local excision was performed. On histological assessment of the surgical specimen, seborrheic keratosis and malignant melanoma were adjacent and mixed at the boundary. We diagnosed the patient with a collision tumor of seborrheic keratosis and malignant melanoma. It is important to perform biopsy when a tumor exhibits worrisome dermoscopic features even focally. Skin Research, 20 : 203-207, 2021

A 17-year-old woman, who was an active member of a cheerleading club since last year, developed edema and erythema on both lower legs accompanied by a burning sensation, which worsened during exercise such as club activities. At the first visit, poorly demarcated diffuse erythema was found symmetrically on both lower legs. We diagnosed her with cutaneous erythromelalgia based on the clinical course and skin findings. Neither acetaminophen nor aspirin was effective, but her symptoms and pain improved after taking pregabalin even during club activities. She still felt pain after a bath, which disappeared by increasing the dose of pregabalin. She is now able to live a normal daily life. Exercise and thermal stimulation were considered the inducing factors in this case, and pregabalin was effective in suppressing the symptoms while continuing club activities. Although there is no established treatment for cutaneous erythromelalgia, pregabalin was reported to be beneficial in previous cases and may be considered as a treatment option. Skin Research, 20 : 208-211, 2021

A 65-year-old male with an intellectual disability developed an approximately 1-2 cm tumor on the occipital region 2 years ago. The patient noticed bleeding but did not seek treatment. The tumor gradually increased in size, and the patient noticed purulent exudate and was referred to this hospital. At the initial examination, a foul-smelling 4×6cm hemorrhagic tumor was observed and biopsy led to a diagnosis of basal cell carcinoma. Based on the size of the tumor and the patient’s condition,surgical excision was deemed difficult, and 69 Gy radiation therapy was performed on an outpatient basis. The tumor gradually decreased in size and was reduced further by the application of liquid nitrogen. Biopsy performed on the scar tissue demonstrated no remnant of basal cell carcinoma. For giant basal cell carcinoma that it is difficult to excise surgically, radiation therapy may be a therapeutic option. Skin Research, 20 : 212-215, 2021

A 33-year-old-man noticed warts on his penis from childhood, which gradually spread to the whole head of the penis. He developed phimosis and became unable to urinate due to balanoposthitis. Circumcision was performed more than ten years prior. The physical examination at our department revealed papillary nodules on the glans penis and foreskin. The foreskin was hard and attached to the coronal margin. We diagnosed him with common warts histopathologically. As this case had a wide range, was deep, and caused strong pain, cryotherapy was considered difficult, and imiquimod was administered. Imiquimod was self-applied by the patient to the warts three times per week and left in place overnight. When there was redness, erosion, swelling, or pain, imiquimod was temporarily discontinued, and betamethasone valerate, gentamicin sulfate ointment, or white petrolatum was applied until the symptoms disappeared. At 7 months, although there was some residual, the warts improved and the foreskin was able to retract. However, squamous cell carcinoma (SCC) was observed on the foreskin. No causal relationship between topical imiquimod treatment and the appearance of SCC has been found. There are three case reports of SCC during or after imiquimod treatment for solar keratosis, but no case reports of common warts. In this case,it is highly possible that SCC was lying underneath the warts. Common warts are often difficult to eradicate by current therapies and imiquimod is considered to be an effective treatment. It is important to observe carefully during or after imiquimod treatment, and to perform early skin biopsy if malignancy is suspected. Skin Research, 20 : 216-224, 2021

We report a case of tinea faciei caused by Nannizzia gypsea around the philtrum of an 82-year-old woman. She noticed erythema on the philtrum 1 month before her first visit to our hospital. The lesion was previously treated by topical corticosteroid but did not improve. Clinical examination revealed scaly annular erythema surrounded by pustules around the philtrum and both nostrils. Based on examination under a microscope, DNA sequencing, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), she was diagnosed with tinea faciei caused by Nannizzia gypsea. The lesion gradually disappeared after taking oral terbinafine at 125 mg/day for 1 month. Nannizzia gypsea, previously known as Microsporum gypseum, is a geophilic dermatophyte that is distributed globally. Nannizzia gypsea can cause tinea corporis, tinea capitis,kerion celsi, and tinea barbae, but rarely tinea faciei. Lesions caused by Nannizzia gypsea are often accompanied by severe inflammation mimicking other inflammatory dermatitis. Dermatologists should take this feature into consideration to avoid misdiagnosis and incorrect application of topical corticosteroids. Skin Research, 20 : 225-229, 2021

A 52-year-old female was referred to our department with a 20-year history of repeated violaceous rashes on the extremities that spontaneously resolved within several months. At the initial visit,multiple violaceous to erythematous scaly papules aggregated on her thigh, trunk, and upper extremities. Histopathological examination of a skin biopsy specimen revealed dense perivascular infiltrates of atypical lymphocytes and the destruction of vessels with extravasation. Immunohistochemical examination demonstrated that atypical lymphocytes ware positive for CD30 and CD4. Monoclonal TCR-β gene rearrangement was positive. The lesions regressed spontaneously within one month and we diagnosed this patient with lymphomatoid papulosis (LyP) type E. Among the 5 histological types of LyP thus identified, type E is a rare variant proposed in 2013 characterized by angiocentric and angiodestructive infiltration of atypical lymphocytes. Based on limited past case reports, this subtype clinically presents as few papular lesions that rapidly develop into necrotic eschar-like ulcers, which is different from the present case and few previous cases, suggesting the diversity of clinical expression in LyP type E. Further case analysis is needed to elucidate the characteristics and long-term prognosis of this new and rare subtype of LyP. Skin Research, 20 :230-234, 2021

A 41-year-old Japanese man presented with multiple erythema nodosum-like lesions over the lower legs and arthralgia of his ankle. The patient complained of swelling with tenseness on one side, extending from the thigh to the lower leg. It was diagnosed as deep vein thrombosis by an echo test. At disease onset, the D-dimer test was normal. A biopsy specimen of the macules exhibited vasculitis of a medium-sized vessel and thrombi with mild to moderate inflammatory cell infiltration in the septa and lobules of the subcutaneous adipose tissue. There was an inner elastic lamina, confirming the blood vessel to be a vein. The patient was diagnosed with superficial vein thrombophlebitis. Superficial vein thrombophlebitis is a common vascular symptom of Behcet’s disease and is characterized by erythema nodosum-like eruptions. Behcet’sdiseaseisamultisystem inflammatory disorder characterized by recurrent oral aphthous ulcers, uveitis, skin lesions,and genital ulcers. In this case, only neutrophilic panniculitis, superficial vein thrombophlebitis, and deep vein thrombophlebitis were present. Patients with deep vein thrombosis are most commonly treated using anticoagulants. After the treatment, deep vein thrombosis and superficial vein thrombophlebitis improved, but superficial vein thrombophlebitis recurred. Skin Research, 20 : 235-241, 2021

A 48-year-old man presented with non-healing right great and fifth finger ulceration. He smoked two packs of cigarettes a day for 20 years. Arteriography demonstrated occlusion of the tibial popliteal and anterior tibial arteries. The collateral arteries and a so-called corkscrew appearance were also observed, leading us a diagnosis of Buerger’s disease. Anticardiolipin autoantibodies were also detected, but no thrombosis was observed aside from in an artery of the lower limb. The ulcers healed after multidisciplinary treatment including smoking cessation, antiplatelet therapy,prostaglandin analogue, and percutaneous transluminal angioplasty. Skin Research, 20 : 242-246, 2021

A two-week-oldJapanese male infant deliveredvaginally at full-term pregnancy of 40 weeks and1 day was transferredto us because of esophageal achalasia andneonatal systemic herpes simplex infection that was resistant to prolongedsystemic antiviral agents. During the treatment for herpes simplex virus type 2 infection, pneumocystis pneumonia developed. Gene analysis for JAK3 disclosed a heterozygous missense mutation that was not definitive for the diagnosis of severe combinedimmunodeficiency disorder, and further mutation analysis is underway. At the age of one month, hyperpigmentation on the distal part of the fingers andtoes was noted. The acral pigmentation almost disappeared at the age of 2 without treatment. To investigate whether such acral pigmentation is common or rare in healthy infants, we carefully screenedall 90 healthy fullterm babies born at our hospital during a periodof two months, andfoundtwo with such pigmentation on the distal part of the fingers. However, the pigmentation was much fainter than that in the above patient. Inflammatory cytokines andbyproducts during the perinatal andpostnatal periodmay have alteredthe pigmentation in this patient. Skin Research, 20 : 247-250, 2021