We investigated the number of patients with caterpillar dermatitis in Itami City Hospital from 1993 to 2003. The result showed that the largest number of patients (95) sought medical advice in 2003, 46 patients in 1993, 34 patients in 1994 and under 25 patients in the other years. The analysis of patients in 2003 showed that the male-female ratio was 49 : 46 and that children under 9 years old and middle-aged to older patients over 50 years old were relatively numerous in the age distribution. The most affected site in those patients was the upper extremities.
Many patients came to the hospital in June, and August to September. This indicates that the cause of caterpillar dermatitis may be possibly Euproctis pseudoconspersa because that caterpillar appears twice in a year, from May to June and August to September. The data of mean temperature and precipitation reported at a weather station near Itami (in Kobe) showed cold and rainy summers in 1993 and 2003.
These results suggest that weather conditions may affect the outbreak of caterpillars and the number of patients with caterpillar dermatitis.

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A 66-year-old man developed a skin ulcer after receiving intravenous drip infusions of gabexate mesilate to treat disseminated intravascular coagulation. Gabexate mesilate had been given at a dose of 2.5% continuously for 7 days from a vein of his left dorsal hand. Although the drug did not extravasate, erythema with edema appeared around the affected vein, and an undermining ulcer was formed along the erythema 4 days later. Intradermal testing showed positive reaction to gabexate mesilate (0.1% aq) at 24 hrs. Skin biopsy of the erythema with edema on his left dorsal hand showed phlebitis and panniculitis. The skin ulcer became smaller after topical injection of 0.4% dexamethasone sodium phosphate and 1% lidocaine, 4ml/day around the erythema for 20 days. About 80 days after the first treatment, the skin ulcer was completely epithelized.

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A 22-year old female developed wheal on her whole body and slight dyspnea 5 minutes after an injection of sulpyrine (Metilon^®). The symptoms disappeared by an infusion of corticosteroid. An intracutaneous test showed an immediate reaction with sulpyrine, indicating that she had anaphylaxis caused by sulpyrine.
Pyrazolone drugs were widely used since the middle of twentieth century because of their strong antipyretic effect. Many cases of fatal anaphylaxis caused by pyrazolones had been reported in the nineteen sixties, therefore pyrazolones became unfamiliar drug in recent years. However, we should recognize that anaphylaxis caused by pyrazolone is still possible.

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A 35 year-old female patient suffered from several subcutaneous nodules over both legs, right forearm and hip for three months. Skin biopsy shows multiple epithelioid cell nodules located in the deep dermis and subcutis. Chest CT reveals bilateral hilar lymphadenopathy. She had not diabetes history, but impaired glucose tolerance was found during OGTT.

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A forty six year-old woman presented solitary tumor on the abdominal skin, which had gradually expanded from 3 months ago. At the first visit, solitary, approximately thumb-tip big-sized tumor with dome-like protrusion was present on the abdominal skin. Histopathological examinations revealed a variably sized multi-lobular tumor in the dermis, which was composed of squamous epithelium showing palisading basal layers. The squamous epithelium showed trichilemmal keratinization. Characteristically, in the keratinized mass or in the stroma of the tumor, needle-like choresterol clefts were observed together with foreign body granuloma and calcium deposits. Finally, we diagnosed this case to be a proliferating trichilemmal cyst with cholesterotic deposits.

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The patient was an 85-year-old man who developed itchy erythema in the left temporal region in September 2001. Since part of the erythema showed the development of erosion and crust, the patient initially consulted our department on October 26, 2002. The initial examination revealed erythema measuring 6.7×4.2 cm with crust in the left temporal region. Based on the results of biopsy, the patient was diagnosed as having solar keratosis. Considering the advanced age, a history of myocardial infarction, and other risk factors such as complications of heart failure, electron beam therapy was selected to avoid the risk of surgery. The total irradiation dose was 45 Gy (3.0 Gy × 15 times), and the tumor disappeared without showing any severe side effect. Currently, 19 months after the treatment, and there is no tumor recurrence.

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We report a case of multiple Bowen’s disease due to arsenic intake. The patient was a 81-year-old female. She had had arsenic intake for a skin lightening beauty treatment for 1 year in 1944. The number of erythematous plaques had increased since about 1990, when she recognized the painful erythematous plaque on the light of her flank. She visited our hospital complaining of the plaques on August 1, 2001. We surgically resected her 30 plaques. The histopathological examination of plaques showed Bowen’s disease. Of 13 cases reviewed, the latent interval is 39 years, on the average, from the taking of arsenic chemical to the evidence of multiple Bowen’s disease.

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A 65-year-old man had developed an erythematous lesion on the right inguinal region 14 years ago. A tumor appeared in this area 2 years ago and rapidly enlarged. At the first visit to our clinic in December 2000, a reddish, erosive tumor of 8 cm in diameter was found in an irregularly raised, dark brownish plaque. Surgery and lymphadnectomy were performed. Histologically, squamoid tumor cells infiltrated from the epidermis into the subcutaneous tissue. In the plaque area, characteristic features of Bowen’s disease were noted in the epidermis. Based on these findings, the diagnosis of Bowen carcinoma developed from Bowen’s disease was made. Before and after the operation, the patient received one and two courses of chemotherapy, respectively. Nineteen months after the operation, the multiple lesions of Bowen’s disease had newly appeared on the body, which were surgically removed

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A case of primary adenoid cystic carcinoma of the skin is reported. A 66-year-old man presented with an asymptomatic tumor in his lower jaw. Histopathologically, the tumor masses showed cribriform, tubular patterns mixed with less than 30% of solid areas. Perineural invasion was observed. The results of immunohistochemical examination were as follows : S-100 protein (-), CEA (+). Systemic examinations did not reveal any metastatic tumor. On the basis of these results, the tumor was diagnosed as a primary adenoid cystic carcinoma of the skin.
To our knowledge, this is the 13th reported case of primary adenoid cystic carcinoma in Japan.
Primary adenoid cystic carcinoma of the skin is less aggressive than similar neoplasms of salivary glands ; early metastasis of adenoid cystic carcinoma of the salivary gland is a common occurrence, but there have been only two reported cases of metastasizing primary adenoid cystic carcinoma of the skin. However, extensive resection is recommended for treatment of primary adenoid cystic carcinoma of the skin because recurrence is frequently observed

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A 76-year-old man was referred to our clinic because of a painful nodule located on the left supraclavicular area of the trunk. The nodule was smooth and soft, blue-red colored, and 10×5 mm in size. Microscopically, the tumor was composed of numerous dilated, cavernous-like, thin-walled vascular spaces surrounded by one or a few layers of round-shaped cells. These round-shaped cells presented positive staining for vimentin and α-smooth muscle actin, but negative for keratin, CEA, desmin, and S-100 protein. Based on these histological findings, we diagnosed the tumor as glomangioma. Glomangiomas rarely occur solitary on the trunk.

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Sporotrix schenckii was isolated from a skin nodule on the right hand of a 68-year-old female patient. The patient’;s rash appeared to subside with the oral itraconazole but did not resolve. After oral administration of potassium iodide instead, the rash healed with scar formation. Another 85-year-old woman had been receiving treatment for a rash on her right forearm from some doctors for two years without complete resolution. On her first visit to the our hospital, although sporotrichosis was suspected, a biopsy and culture of the lesion did not reveal any fungal element. Three months later, the rash expanded and the formation of a subcutaneous nodule was observed in the medial forearm, the culture of which isolated Sporothrix schenckii. The rash resolved with oral potassium iodide. While potassium iodide has some side effects such as gastrointestinal disturbances and allergic reactions, the author believes that it is the drug of choice for the elderly.

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Neurofibromatosis 1 manifests in various organs to various degrees and continues to grow. A study concerning the quality of life (QOL) of the patients reported that 9% have difficulty in maintaining on ordinary social life. The delay in treating the disease leads to a high possibility of such difficulty. Therefore, earler treatment might have improved their QOL. Conserning skin, we consider that earlier and more definitive treatments should be made. We examined 17 treated patients for tumor size, age, and specific problems. We found a tendency for patients never to seek treatment for the tumor until it becomes large, except in cases in which the tumor grows in a conspicuous area. We speculated that there is a tendency for patients for whom the first resection is not successful to neglect their tumor and seek treatment only when some physical disability occurrs. From these observations, we recognized the importance of the education of patients and the medical staff who treat this disease.

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A four-week use study of new makeup cosmetics was carried out on the patients with sensitive skin. The new make up cosmetics are composed of emulsion/powdery foundation, eye shadow, blusher, lipstick and lip treatment. These make up cosmetics are the products nominated in “d Program ^®” series designed for sensitive skin. The subjects were patients with past histories of contact dermatitis (CD) and patients with slight to moderate atopic dermatitis (AD). The objective of this study was to confirm the skin safety of these products. Of the 196 patients assigned to the safety assessment, 50% had CD, 38% had AD and 12% had both CD and AD. 93% of the subjects considered themselves to have sensitive skin. The incidence of the patients who had to discontinue the use of any test products due to an adverse reaction was relatively high at 5.2% in the case of the lipstick, whereas none had to discontinue the use of the emulsion foundation. The discontinuation rates for the other products were about 2~3%. Moreover, there was no occurrence of new significant or worsening symptoms such as erythema. These adverse reactions were limited to be very slight or slight. On the basis of these findings, it was concluded that these new makeup cosmetics could be safely used by the patients having sensitive skin after subsidence of contact dermatitis or atopic dermatitis with negligible symptoms.

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We report clinical assessment of the efficacy and safety of long-term treatment with tacrolimus ointment in adult atopic dermatitis. First, tacrolimus ointment was applied on the face and/or neck of the outpatients at 14 clinics in Gunma for 1 year. Next, the effectiveness of tacrolimus and betamethasone valerate on the affected areas of the extremities and/or trunk was compared for 4 weeks. Erythema/papules, scaliness and itching on the face and/or neck were markedly improved within 2 weeks. Local irritation was observed in 79% of the patients. In most cases, however, it gradually diminished in parallel with clinical improvement. The effectiveness of tacrolimus and betamethasone valerate on the extremities and/or trunk regions was comparable.

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This paper reviews several recent treatments for acne vulgaris and presents the preliminar on chemical peeling.
A few years ago, topical clindamycin gel became available as a new antimicrobial medicine for acne vulgaris. The last clinical trial of a novel synthetic retinoid, adapalens is currently on going. If adapalene is approved,it will be the first retinoid to become avairable for acne treatment in Japan.
Chemical peeling is receiving considerable attention as a new physical treatmet for acne, but the mechanism is not yet clear. Therefore, we studied the antimicrobial effect against P.acnes as well as changes in pH, volumes of water and lipids both in vivo and in vitro pre and post chemical peeling. The antimicrobial effect of glycolic acid against P.acnes was very strong, but its effect was temporary. The pH was decreased immediately after peeling only. We could find no changes in the volumes of water or lipids.

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The therapeutic management of hypertrophic scars and keloids can be difficult for physicians and patients, and remains challenging as yet. Treatment options for improving their clinical appearance include compression therapy, corticosteroid injections, steroid occlusive dressings, radiation therapy, following the surgery. But these modalities are often invasive, painful, inconvenient, and intolerant especially for children who are main population of all ages in keloid patients.
Silicone gel sheeting (SGS) was first reported to be an effective treatment for burn scars. Recent reports indicate that SGS improved flesh hypertrophic scars and keloids and was responsible for the prevention of the development of these scars. With the application of SGS, younger patients had much faster and more responsive results than did adults, and their flesh scars were more responsive than long-lasting scars. Although several factors including pressure, oxygen tension, temperature, circulation, hydration, silicone oil leakage, and so on have been investigated, the exact mechanisms of action of SGS are still unknown.
In this literature, the recent therapeutic management of hypertrophic scars and keloids is discussed.

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Different modalities for facial rejuvenation should be utilized depending on the individual patients’ needs. To provide every patient the highest quality of treatment appropriate for them I use a systematic approach for evaluating each patient and planning their treatments. Here I will present the essence of my approach for facial rejuvenation, including proposal of “Medical Aesthetics”, construction of systematic treatment for pigmented lesions, prescription of skincare products, development of skincare devices including iontophoresis machines, pioneering the use of chemical peeling, botulinum toxin injections, fillers, phosphatidylcholine injections for fat removal and thread lifts in Japan, and modifying the use of lasers and IPLs for Asians. I will also discuss some tips of my surgery.

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