Although the phototherapy has a long history of thousands of years starting by the sun-worship, modern photo(chemo) therapies have been done based on scientific understandings only for a few decades. Owing to the development of useful artificial light sources, there are various modalities available of photo(chemo) therapies such as PUVA, broad- and narrow-band UVB, UVA-1, and photodynamic therapies. There are also diverse diseases which can be responsive to photo(chemo) therapies, including mainly vitiligo vulgaris, psoriasis, mycosis fungoides, atopic dermatitis, and so on. The immuno-suppressive effects of UV radiation may be involved in the mechanism of therapeutic actions. The carcinogenicity due to DNA damage must be taken into account as a chronic adverse effects after repeated exposures to photo(chemo) therapies.

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We examined whether avoidance of detergent would relieve winter deterioration of dry skin in atopic dermatitis patients. Twenty-six mild atopic dermatitis patients with winter deterioration of dry skin were instructed to avoid the use of laundry detergent by utilizing a Zero-Detergent Washing Machine, which does not require the use of soap. After 2 weeks, dryness of non-lesion skin was resolved in 24 cases (90%), and dry eczema was resolved in 16 (60%). Our results suggest that residual laundry detergent in clothes may play a role in winter deterioration of atopic dry skin on the trunk generally covered with clothes.

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Three patients with intractable prurigo were treated with roxithromycin (RXM), a 14-member macrolide, for intensely pruritic skin lesions. The pruritus had decreased promptly after initiation of therapy, followed by improvement of the eruptions. Although the mechanism of action of RXM in prurigo remains unclear, 14-member macrolides have been used for several pruritic skin diseases.
The improvement of pruritus may possibly be attributed to the numerous immunomodulatory and anti-inflammatory properties of 14-member macrolides. RXM and other 14-member macrolides can be useful in the treatment of prurigo and other pruritic skin diseases.

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A 44-year-old woman with systemic lupus erythematosus and diabetes mellitus had leg ulcers associated with large pockets underneath the surrounding skin.
They had been treated with a variety of ointments for the past 6 months without satisfactory effects.
Then, we performed patch grafting and negative pressure dressing. Grafted skins partially covered the surface and the size of pocket cavity was reduced. Next a catheter for the negative pressure treatment was inserted into the remaining pocket. This procedure induced a further improvement. Complete cure was obtained by additional topical treatments.
Negative pressure dressing is a useful modality for the treatment of ulcers associated with large pocket cavity.

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Here we report the case of chemical burns on the lower left abdomen and thigh of a 28 year-old man from nearly 100% cresol solution. Upon admission, he suffered from edematous erythema over approximately 5% of his body. After application of Dermovate-ointment^®, by the next day the erythema and pain had subsided, and healed completely after 3 weeks. During admission, gas chromatography analysis of serum and urine revealed levels of 0.31μg/ml and 0.97μg/ml, respectively, extremely low values likely attributable to early decontamination and treatment soon after the accident. Even in cases where the affected area is small, cresol poisoning a matter in which proper care should be taken.

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Gefitinib(Iressa^®) is a newly approved anticancer agent in Japan that acts by inhibiting epidermal growth factor receptor (EGFR) signal transduction.
Gefitinib(Iressa^®) was applied to total 32 cases at Department of Internal Medicine, Otemae Hospital. Among 32 cases, 17 cases developed an eruption consinting of acne like erupiton(13,40%), paronychia(7,22%), dry skin on the soles, palms(6,19%), and dry skin on the limbs,trunk(6,19%).

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A 59 year-old man with spinal cord injury had been treated with carbamazepine (Tegretol^®). One month later, high fever and disseminated eruption consist of disseminated erytematous macules with purpura developed. In the laboratory data, leukocytosis with eosinophilia and liver dysfunction were found. He got better with systemic steroid. The anti-HHV-6 IgG titer significantly increased during development of eruption. The results of patch test and drug-induced lymphocyte stimulation test for Tegretol^® were positive. In the cytokine assay, productions of IFN-γ and IL-5 in the culture supernatant significantly increased by the stimulation with Tegretol^®.

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A 52-year-old Japanese man visited our department, complaining of blackish discoloration and edema of lower legs. He had received oral minocycline therapy for more than 3 years prior to the visit. Histopathological examination of lower legs revealed increased melanin granules in the basal layer of the epidermis and extravasation of erythrocytes and the deposit of hemosiderin- like particles in the upper dermis. Electron microscopic studies revealed that electron dense materials were contained in the cytoplasms of dermal macrophages, partially were in the lysosomes. From these results, we diagnosed this case as hyperpigmentation caused by the administration of minocycline. The discolorations gradually improved by discontinuence of minocycline.

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We experienced an example of Hailey-Hailey disease that formed intractable verrucous hyperkeratotic plaque by repetition of aggravation and remission for many years. We performed skin cortex abrasion with a grinder and a razor, and a razor was useful in comparison with a grinder. In case of both, control by external preparation became easier just after epithelialization. Maxacalcitol was effective as postoperative external preparation. We present our case while adding consideration from literatures and consideration about operative procedure.

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A 43-year-old Japanese woman with systemic sclerosis visited our clinic with 10 year history of Raynaud’s phenomenon and telangiectasia on the face. At the age of 49, pulmonary hypertension developed, and treatment with ACE inhibitors did not reduce the right ventricular pressure. She suddenly died of respiratory failure at the age of 58. Histopathological examination did not show pulmonary fibrosis, angiitis, embolism, thromboembolism. Autopsy specimens from other organs did not show significant lesions related to sudden death, either. Therefore, we assumed that she might have died of pulmonary arterial spasms.

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A 48-year-old woman during renal dialysis presented pruritic papules with crust on the trunk and upper arms. Some papules are arranged in a linear fashon, suggesting a Koebner phenomenon. Histopathological examination of the crusted papule on the back revealed transepidermal elimination of collagen fibers. From these findings, we diagnosed this case as acquired reactive perforating collagenosis.

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Incontinentia pigmenti in female monozygotic twins are reported. They were born following cesarean section at 34 weeks of gestation. Case 1: the first baby showed edematous erythema with blisters and crusts on arms, legs and trunk after birth. Ophtalmological examination revealed retinal hemorrage. Case 2: the second baby were more severe eruption than the first baby. Because of typical eruption and course they were diagnosed as incontinentia pigmenti. This is the fourth twin-case described in Japan.

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A 14-year old girl presented with a rapidly enlarging nodule with a central keratotic plug arising within a nevus sebacous on her preauricular cheek. Histopathologically, keratinocytes with eosinophilic glassy cytoplasm proliferated around a central keratin crater. Some keratinocyts showed nuclear atypia and focal dyskeratotic cells were observed. The tumor was diagnosed as a keratoacanthoma arising within nevus sebaceous. We reviewed literatures and suggest that keratoacanthoma associated with nevus sebaceous preferably develops on the preauricular cheek in young-aged patients.

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We report a 71-year-old man with syringomatous carcinoma (SC) on the dorsal aspect of right hand. He noticed an asymptomatic papule for five years before his first visit of our hospital. And then, tumor size gradually increased and became dark-purplish erythematous, painful, ulcerated, hard plaque of 4×8cm in size. Although the clinical appearance resembled to squamous cell carcinoma, histopathological findings of tubules possessing comma-like extensions discerned it as SC. While the most frequent site of SC is face and head in western countries, it is at hand in Japan.

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A 77-year-old man noticed an asymptomatic nodule of 15 mm in diameter on his right upper arm three months ago. Histopathological findings revealed that large atypical lymphoid cells with large nucleus infiltrated throughout the entire dermis, and mitotic cells were scattered. The tumor cells were positive for CD30. Gene rearrangement was recognized in T cell receptor βchain. We diagnosed this case as anaplastic large cell lymphoma (ALCL) according to these findings. No abnormal accumulation in Gallium scintigram and no lymph node swelling in neck, chest and abdominal computer tomography were found. Although simple excision was performed on the tumor, a swollen lymph node was found on his right axilla one month later. CD30 positive tumor cells were found in this lymph node histopathologically, and we thought this case as systemic ALCL. He was given oral etoposide as therapy.

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The patient was a 71-year-old female. She was suffering from herpes zoster in C₃-Th2 dermatome in her left side during July 2002. In November 2003 she suffered from herpes zoster again in the same dermatome, C₃-Th2, on her right side. The very short inteval from the first herpes zoster and suggested existence of malignancy or immuno-deficiency. Internal malignancy is not detected by several examinations. Immunological findings showed hyper immunoglobulinemia, IgG and IgA and a decrease in CD4 positive cell and in the ratio of CD4/CD8. HIV antibody was detected by enzyme-linked immuno sorbent assay and Western blot analysis showing HIV-1type antibody. She was therefore diagnosed as HIV infection.

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Mass outbreaks of Trichophyton tonsurans (T. tonsurans) infection in high school boys belonging to judo clubs and in amateur wrestlers have occurred in various parts of Japan since 2001. We report cases of tinea corporis caused by infection with T. tonsurans in 19 boys aged 15-17 years as well as their 47-year-old coach who belonged to a judo club in a private high school in Kyoto. Erythema was found in various regions of the body, including the head and face and also on the trunk, a part of the body that is covered during judo practice. Fungus was detected in lesions of 10 patients by direct KOH examination and in lesions of 4 patients by fungal culture. Moreover, the same fungus (T. tonsurans) was detected from the culture of dust collected from the floor of the training room. The fungus was identified as T. tonsurans on the basis of conventional morphologic findings and results of PCR-RFLP. We also tried to establish a new rapid method for detecting T. tonsurans infection by using an original PCR procedure.

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We describe a 72-year-old famer male patient with a lesion on the forehead. The histologic finding showed granuloma formation with neutrophilic infiltrates in the dermis. The fungus cultured from a lesion was confirmed to be Sporothrix schenckii. The lesion of the patient cured after 3-months administration of oral itraconazole (100 mg/day). We diagnosed this patient to be sporotrichosis due to Sporothrix schenckii.

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A 51-year-old Japanese female had had a dystrophy of the left great toenail for 6 years. Examination revealed longitudinal stripes on the left great toenail. Initial culture grew Aspergillus sp. only on Sabouraud agar. Oral terbinafin treatment (125mg once daily for five months) was unsuccessful. Second and third culture on separate day grew Aspergillus terreus only on Sabouraud agar. Diagnosis of onychomycosis caused by A.terreus was made. Oral itraconazole treatment (100 mg once daily), topical 1% lanoconazole solution and removal of affected nailplate were successful.

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Clinical evaluation of a sunscreen cream (AK-UV^®) containing glycoceramide was performed in 36 patients with sensitive skin found in atopic dermatitis or contact dermatitis. The sunscreen has been developed as hypo-irritant and hypo-allergic for the sensitive skin such as atopic dermatitis. The products were evaluated for the safety and the usefulness on dry skin. Dryness of the skin and erythema at the end of 4 week’s application were observed. The results of the clinical trial of the products on the sun-exposed area for 4 weeks indicated that AK-UV^® improved dry skin and erythema with atopic dermatitis or contact dermatitis. No adverse effect was observed throughout the study. In conclusion, these results suggest that AK-UV^® is a safe and useful sunscreen for the patients with sensitive skin.

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