The effectiveness, safety, and patients’satisfaction of sofpironium bromide treatment was investigated in 46 patients with primary axillary hyperhidrosis with a baseline hyperhidrosis disease severity scale (HDSS) score of 3 or 4. The placebo consisted of a phase 3 confirmatory study of sofpironium bromide. We obtained HDSS score, visual analogue scale (VAS) for sweating, and dermatology life quality index (DLQI), and performed a patient questionnaire survey for evaluating patients’satisfaction before treatment and at 4 weeks of treatment. The proportion of patients who achieved an HDSS score of 1or 2 at 4 weeks of treatment was 82.6% (38/46 patients), which was significantly higher than 41.2% (56/136 patients) in the placebo group. Mean VAS for sweating (± standard deviation) was 7.3±1.7 before the treatment versus 4.2±2.5 at 4 weeks of the treatment,and mean DLQI total score was 6.5±5.4 before the treatment versus 2.3±2.9 at 4 weeks of the treatment, showing significant improvement for both scores. A total of 95.7% of patients (44/46 patients) continued topical therapy of sofpironium bromide. The questionnaire survey for evaluating patients’satisfaction revealed that 58.7% (27/46 patients) reported being“very satisfied”and “moderately satisfied”. As for the timing of effectiveness onset, 67.4% (31/46 patients) reported that sofpironium bromide was effective within 1week of the initiating treatment. As for benefits of this therapy, 60.9% (28/46) of the patients reported that treatment could be administered simply by topical application. The rapid resolution of hyperhidrosis and the convenience of the treatment may have contributed to the high patients’satisfaction. Skin Research, 21 :79-85, 2022

A 75-year-old female presented with an erythema on the right waist since about a year before. The first skin biopsy revealed pale cells in the upper layers of the thickened epidermis. There was slight parakeratosis. Extramammary Paget’s disease was suspected by her previous doctor. A rebiopsied specimen revealed atypical keratinocytes and scattered dyskeratotic cells with a loss of polarity throughout the thickened epidermis. There were atypical pagetoid cells with pale cytoplasm in the middle to upper epidermis. Histochemically and immunohistochemically, tumor cells showed PAS (＋) (diastase-labile), Alcian blue (−), CK5/6 (＋), CAM5.2 (−), CEA (−),GCDFP15 (−), and S-100 protein (−). We diagnosed the present case as pagetoid Bowen’s disease. Histochemical and immunohistochemical approaches were efficacious for the definitive diagnosis of pagetoid Bowen’s disease. Skin Research, 21 : 86-90, 2022

A 13-year-old Japanese boy had white comedones and red papules on both cheeks since January, X. In March, he visited a dermatology clinic. He was treated with oral and topical antibiotics, and topical adapalene gel, but the pustular nodules on the forehead and both cheeks expanded and worsened rapidly. He was referred to our department in May. At the time of the first visit to our department, pustular nodules were fused on the forehead, cheeks, and nose, and red papules were seen around the mouth. No skin rash was seen on the trunk. Based on the clinical findings, we diagnosed cystic acne. In addition to oral and topical antibiotics, we administered cyclosporine,Japanese-Chinese herbal medicine (Sai-rei-To and Haino-sankyu-To), pus drainage, and local injection of triamcinolone acetonide into the cyst, which suppressed the appearance of neoplastic pustules and flattened most of the pustular nodules. Cystic acne is a severe form of acne vulgaris and is considered to be a deep inflammatory rash with intense inflammation that is often difficult to treat with conventional acne therapy. In our case, immunosuppressive drugs and aggressive drainage of the deep inflammatory rash that showed strong inflammation reduced the inflammatory response. The addition of Chinese medicine inhibited the growth of new acne ; thus, it was effective in reducing the dose of immunosuppressive agents. Skin Research, 21: 91-97, 2022

A 63-year-old man complained of a tumor on the left back that had been slowly enlarging for 10 years. The tumor was subcutaneous beneath an elastic and hard lesion. Tumor with a welldefined margin was removed under local anesthesia. The histological findings included atypical spindle cells, adipocytes, lipoblast, and pleomorphic cells in variable amounts of collagenous and myxoid extracellular matrix. Immunohistochemically, the tumor cells expressed CDK4. None of the tumor cells showed expression of MDM2 and RB1. We diagnosed this tumor as an atypical spindle cell/pleomorphic lipomatous tumor. This tumor is rare and represents a new concept as a benign adipocytic tumor. Further studies are needed to clarify this tumor concept. Skin Research, 21 : 98-102, 2022

A-71-year-old Japanese man was referred to our department because of slightly pruritic eruptions on the face for 2 months. Clinically, scaly erythematous macules and vesicles were scattered on the face, trunk, and extremities. We diagnosed as pityriasis rubra pilaris type 1 based on histopathological examination and clinical findings. The eruptions persisted despite topical application of corticosteroids and vitamin D3 analogues ; however, additional oral administration of etretinate and cyclosporine improved his symptoms. Recurrent lesions developed after stopping administration of etretinate and cyclosporine. The lesions improved after oral administration of apremilast, a phosphodiesterase 4 inhibitor, with topical corticosteroids and vitamin D3 analogues for 5 weeks. Apremilast may be an effective drug for pityriasis rubra pilaris type 1 via antiinflammatory reaction, even though the possibility of spontaneous disappearance may remain. More accumulated case series are needed to confirm the efficacy of phosphodiesterase inhibitors for pityriasis rubra pilaris type 1. Skin Research, 21 : 103-107, 2022

A 52-year-old man had undergone medications of oral prednisolone and cyclosporine for pemphigus vulgaris for 7 years. Mucocutaneous bulla and erosions recurred gradually, Pemphigus Disease Area Index (PDAI) was moderate with 10 points on the skin and two points on the mucous membrane, but it was intractable. After hospitalization, sore throat and dyspnea required endoscopy. It revealed mucosal erosions, ulcers, and lacerations over the entire length of the esophagus with Dsg1 and Dsg3 antibodies elevated to 630 units and 2,540 units, respectively. The esophageal lesions were coincident with mucosal pemphigus vulgaris. Oral corticosteroids and azathioprine, plasmapheresis, and high-dose intravenous immunoglobulin reduced mucosal lesions 41 days later. Our case emphasizes the necessity of performing endoscopy to examine esophageal involvement in cases of severe mucosal pemphigus vulgaris. Moreover, aggressive initial treatment is important in severe cases. Skin Research, 21 : 108-113, 2022

A 74-year-old man presented with a painful nodule on the pad of the left first toe that had been present for 6 years. On examination, a reddish, elastic hard, mildly tender, mobile nodule (6×5 mm) was observed. Ultrasonography showed a hypoechoic mass without blood flow signal. These findings led to the suspicion of glomus tumor and the nodule was resected. Histopathological examination showed a well-defined nodular lesion that was composed of a sheet-like proliferation of round, eosinophilic cells with marked hyperchromatibility and variability in size and shape of nuclei. There was no increase in mitotic activities or atypical mitotic figures. In some cells, typical features of glomus tumor without nuclear atypia were observed. Immunohistochemistry revealed diffuse αSMA positivity and Ki-67 (mib-1)-positive cells were less than 1%. The tumor was diagnosed as symplastic glomus tumor, a variant of glomus tumor. Although it shows marked nuclear atypia and cellular variability, symplastic glomus tumor is a benign tumor that is clinically sharply marginated,superficially located, and small in size and histologically does not show increased mitotic activities or atypical mitotic figures. It is important to recognize this rare tumor and differentiate it properly from malignant tumor. Skin Research, 21 : 114-118, 2022

A 72-year-old man was referred to our department with a chief complaint of swelling of the right forearm that had persisted for two months. MRI revealed diffuse changes in the muscles with high signal on STIR images, and the patient was referred to the orthopedic department. At the time of muscle biopsy, skin tumor with redness and tenderness appeared on his left side of abdomen. Its diameter was 3 cm, height was 1.5 cm. The lesion had gently elevated margins and smooth surface. Palpation of the mass revealed elastic hard subcutaneous tumor, which adhered to epidermis but not to fascia. Biopsy was performed from the skintumor inadditionto the muscle. Histological examination of muscle and skin revealed a metastasis of poorly differentiated adenocarcinoma. Endoscopic examination of the upper gastrointestinal tract revealed intramuscular metastasis of gastric cancer. Skeletal muscular metastasis of malignant tumors is rare, and previous studies reported that the primary tumors are usually located in the lung and mammary gland. Skeletal muscular metastasis of gastric cancer is more common in male patients. The metastatic sites tend to be in the trunk, especially in the paraspinal muscles. Metastatic lesions are typically mass lesions ; however, in the present case, the changes were diffuse ; thus, it was necessary to include non-neoplastic lesions in the differential diagnosis. Skin Research, 21 : 119-125, 2022

A 77-year-oldman was referredto us because of a one-week history of erosions on the lips, oral cavity, andpenis, andnumerous erythemas andblisters on the trunk andextremities. Chemiluminescent enzyme immunoassays did not detect anti-BP180-NC16A domain autoantibodies or anti-desmoglein 1 and 3 autoantibodies. Histopathological examination showed subepidermal bullae with infiltration of eosinophils andneutrophils. Direct immunofluorescence detected linear deposition of C3 at the basement membrane zone (BMZ). Indirect immunofluorescence using normal skin as substrate showed IgG anti-BMZ antibodies, which reacted with the dermal side of 1M NaCl-split skin. Immunoblotting with normal human dermal extract detected 200 kDa laminin γ1 (p200), andimmunoblotting with laminin 332 recombinant proteins detected165kDa laminin α3. We made a diagnosis of coexistence of anti-laminin γ1 pemphigoidandanti-laminin 332 mucous membrane pemphigoid. Intravenous administration of prednisolone led to quick improvement of the mucocutaneous lesions. Our findings suggest the need to establish more convenient strategies for the diagnosis of both anti-laminin γ1 pemphigoidanti-laminin 332 mucous membrane pemphigoidfor differential diagnosis and appropriate treatments for these diseases. Skin Research, 21 : 126-132, 2022

A 48-year-old man noticed multiple reddish-brown infiltrated nodules located mainly on his trunk since his thirties. He had atopic dermatitis as a child, after which his symptoms were stable. He was referred to our hospital and considered as atopic dermatitis. He had been treated with topical corticosteroid with temporal improvement and recurrence of symptoms for 13 years. For histopathological diagnosis, we performed a punch biopsy from a reddish-brownish papule at his back. The specimen showed lymphocytes, eosinophils, and plasma cells in the superficial dermis. No storiform fibrosis and obliterative phlebitis were observed. Light chain restriction was not found in the tissue. M proteins and Bence Jones protein were negative. We considered cutaneous plasmacytosis, pseudolymphoma, and IgG4-related disease. Recent studies reported the association amongcutaneous plasmacytosis, pseudolymphoma, and IgG4-related disease. Our patient showed high serum IgG4. The biopsy material revealed IgG4 positivity in 40-60% of IgG positive plasma cells. The absolute IgG4 counts were 40/hpf. Our patient did not fulfill the criteria of the International Consensus Statement in 2011 ; however, he had features of IgG4-related disease. This suggests an oversight in the International Consensus Statement and that the diagnosis of IgG4- related skin disease is still controversial. Skin Research, 21 : 133-137, 2022

A 73-year-old male presented with a 7 mm-sized pink nodule on the left upper lip. Dermoscopy demonstrated arborizing vessels. Atypical, spindle, or epithelioid cells were intermingled with fibrosis. Signet-ring cells were scattered. There was dPAS and Alcian blue-positive sialomucin in cytoplasm. Immunohistochemically, tumor cells were positive for CK7, CK20, and CDX2, and negative for TTF-1 and napsin A. The present case was diagnosed as metastatic carcinoma of the skin from gastric tube cancer. Endoscopy did not demonstrate gastrointestinal carcinomas. PETCT detected a tumor in the bottom of the right lung. He had undergone esophagectomy with gastric tube reconstruction for esophageal cancer at the age of 63, and had received gastric tube resection with jejunal interposition for gastric tube cancer at the age of 67. The gastric tube was elevated to the right thoracic cavity, and the final pathological diagnosis was poorly differentiated adenocarcinoma with serosal infiltration. We concluded that the gastric tube cancer had spread to the right lung directly, resulting in a hematogenous skin metastasis. Skin Research, 21 : 138-143, 2022