At present, there is great expectation placed on regeneration therapy by utilizing stem cells. In the dermatological field, much progress has been made in research on hair follicle stem cells recently. The technologies to separate hair follicle stem cells from mouse and human skin have been developed. Furthermore, roles of hair follicle stem cells on maintenance of skin epithelium and wound repair have been clarified. We discuss the potential for utilizing hair follicle stem cells for generating hair follicles.

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A 51-year-old male patient presented with erythema, edema, swelling and blister on the left leg that had developed 20 days previously. He had developed bronchial asthma one year ago, which was under medical treatment. The patient subsequently exhibited various cutaneous symptoms, including purpura and small papules on bilateral legs and abdomen, with an onset of fever later. Peripheral eosinophils and serum IgE levels were increased. Endoscopic biopsy from the lower gastrointestinal tract revealed features of extravascular granuloma. We finally diagnosed our case as allergic granulomatous angiitis with polymorphic cutaneous symptoms.

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We report two cases of epidermolysis bullosa acquisita.
Case 1, a 72-year-old man, visited us with blisters on the extremities. Physical examination revealed large bullae on the hands, lower legs and feet. Case 2, a 40-year old man, visited us with blisters and erosion on the whole body. Physical examination revealed large bullae and eryhema on the trunk and extremities. The oral mucosa was involved in the both cases. Hisitopathological examination disclosed subepidermal blister. Direct immunofluorescence showed deposits of IgG and C3 at the cutaneous basement membrane zone. Indirect immunofluorescence on salt-split skin demonstrated that the patient’s IgG antibodies reacted with the dermal side of the split. Immunoblotting showed that the patient’s serum reacted with 290-kDa epidermolysis bullosa acquisita antigen,and these cases were diagnosed as epidermolysis bullosa acquisita.
Case 1 was treated with the systemic predonisolone and colchicine, but colchicine caused agranulocytosis. Therefore he was treated with the systemic predonisolone and dapsone. Case 2 responded well to the systemic prednisolone and dapsone.

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We report a case of pyoderma gangrenosum(PG) with aseptic cervical and mediastinal abscesses, an unusual complication of PG. A 52-yaer-old Japanese woman with myelodysplastic syndrome (MDS) and Tolosa-Hunt syndrome, treated with prednisolone, developed a cervical abscess followed by a mediastinal abscess. After the drainage by thoracotomy, she developed necrotic skin lesion on her chest. The biopsy revealed massive infiltration of neutrophils in the whole dermis. The lesion turned to be sterile. We diagnosed the chest lesion was PG and presumed that cervical and mediastinal lesions were related to PG. These lesions were aggravated by G-CSF for the treatment of MDS but pulsed administration of methylprednisolone followed by oral prednisolone improved all these lesions. We summarized reports of PG cases with aseptic abscess in visceral organs.

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Hyperkeratosis lenticularis perstans(HLP) is a rare disorder of keratinization , which is characterized by asymptomatic hyperkeratotic papules predominantly located on the lower extremities. The lesions are usually resistant to any treatment. In this paper, we report the effect of topical calcipotriol ointment on a case of HLP.
A 78 year-old man presented multiple, solitary, reddish-brown, hyperkeratotic papules on his dorsa of the feet and lower parts of the legs. The palms and soles were not involved. The lesions had persisted for 45 years and were almost asymptomatic. After removal of the hyperkeratotic papule, a pinpoint bleeding was observed. The patient did not report the occurrence of similar skin lesions in his family members. Data of laboratory examination were within normal limits.
Histologically, the epidermis at the center of the lesion was coverd with a focally hyperkeratotic horny layer. A dense, bandlike lymphocytic infiltrate was observed below the epidermis. Small number of extravasated erythrocytes were seen in the papillary dermis.
The patient was treated with twice daily application of topical calcipotriol ointment. The lesions gradually disappered after 3 months of treatment. The histopathological findings were normalized after the treatment of topical calcipotriol ointment.

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A 34-year-old Japanese woman was suffering from scleroderma with contracture of the interphalangeal joints, which was resistant to treatment with prednisolone and cyclosporine A or PUVA-bath therapy. Her hands exhibited extreme “finger-in-palm” deformities, including metacarpophalangeal joint extension and interphalangeal joint contractures. Function was severely limited, and she was unable to grasp so much as a teacup. She underwent the operation designed to correct the balance of the tension between extensor and flexor of her left fingers. She also underwent excision method of fibrosing peritenon of extensor digitorum longus muscles. The patient satisfied with the functional outcome of the surgery, as her finger position was significantly improved, and she was able to place her fingertips on objects. Hand surgery for severe scleroderma is reliable when significant deformity and functional limitations are present.

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We presented two cases of diffuse cutaneous type of systemic sclerosis with multiple ulcers and gangrenous lesions on the feet and toes. The first case, a 46-year-old woman, presented with ulcers and purpura on her foot. When her ulcers worsened, elevated MPO-ANCA levels were noted. As renal dysfunction developed after her admission, predonisolone (PSL), 40mg/day, was orally administered under the diagnosis of ANCA-related nephritis. Although her renal function improved with the treatment, all her digits turned to be gangrenous. The second case, a 44-year-old woman, presented ulcers and gangrenous lesions on her feet and toes. Elevated MPO-ANCA levels were also noted. The treatment with oral PSL, 30mg/day, was started for deteriorating interstitial pneumonia. Arteriographic examination of the lower extremities showed stenosis and occlusion of plantar digital arteries, plantar artery and posterior tibial artery. In both patients, functional loss was minimized with conservative treatments.

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A 48-year old female patient with butterfly rash like eruption having a history of Basedow’s disease visited our hospital. We diagnosed this case as Sjögren syndrome based on the findings of a salivary gland biopsy, Schirmer test, Rose-Bengal test, and positive anti-SS-B antibody. The butterfly rash like eruption disappeared after the systemic administration of 10mg/day of predonisolone. We present our case since a case of Sjögren syndrome with butterfly rash like eruption and/or Basedow’s disease is rare.

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We report two cases, 42-year-old and 48-year-old healthy women, of acral persistent papular mucinosis. In both cases, there have taken asymptomatic whitish~yellow-whitish papules with 2~3 mm in diameter on the back of hands and on the extensor surface of forearms for several years. These were gradually increased in the number. Histological examination showed the deposition of hyaluronic acid in the upper reticular dermis. By these findings and the absence of associated systemic diseases, the patients were diagnosed as acral persistent papular mucionosis.

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65-year-old woman presented with a 10-year history of a round dark-red tumor on an anterior side of her leg. The tumor increased in size and became 1.3 cm in diameter and a surface of it is a little bit uneven. We excised the tumor and examined histopathologically. A resected specimen showed marked acanthosis of epidermis with hyperkeratosis. In epidermis there were tumor cells with no atypia which had a large clear cytoplasm with PAS-positive, diastase-digested granules. There was a clear division between the area of tumor cells and that of normal epidermis. So we diagnosed this patient as having clear cell acanthoma.

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We reported two cases of sebaceous carcinoma of eyelid that probably arose from the glands of Zeis and undetermined origins.
Case 1 : A 64-year-old woman presented a yellow small nodule on the inside of her left eyelid two years ago. The nodule was excised including outside normal eyelid. On the histopathological examination, the tumor was composed of many lobules of varying sizes in the dermis, and a part was connected with the sebaceous glands of the eyelashes. There were basaloid features and peripheral basophilic cells with hyperchromatic nuclei and scanty cytoplasm. Lipid stains of tumor cells were positive.
Case 2 : A 83-year-old man was presented a red small nodule on the outside of his right eyelid. On the histopathological examination, the tumor shows similar histological pattern to the tumor of Case 1. However, the cells were connected with neither sebaceous gland of the eyelashes nor meibomian gland.

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A 69-year-old man was presented to our hospital for the complaint of a facial skin nodule that had been present for approximately six months. On his right temple, a highly mobile 10×10×2mm facial skin nodule was recognized. We suspected that the nodule was a skin appendage tumor and treated the patient by local excision under local anesthesia.
Histopathological examination revealed that the tumor showed no continuity with the epidermis, but rather formed lobulated cell nests that propagated into the dermis.
The tumor cells had cytological atypia, and immunohistochemistry showed that the tumor cells were positive for cytokeratin 7, CEA, and EMA stain, while negative for S-100 and cytokeratin 20. No atypical lymphocyte infiltration was seen around the tumor nest. Head CT and nasopharynx fiberscopy showed no abnormalities. The patient was diagnosed with lymphoepithelioma-like carcinoma of the skin.

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A 31 year-old-woman, who was born with spina bifida, club foot, hemiagenesis, and dysfunction of urinary bladder and rectum. She found the subcutaneous tumor of left inguinal region about 6 months before her visit. The tumor had enlarged rapidly, and become painful, then she visited the orthopedics. Since needle biopsy suggested a metastasis of melanoma, she was introduced to our hospital. At this time, ulcerative and erosive red huge tumor (8cm across and 4cm high) with subcutaneous induration beneath the tumor was found at left inguinal region. A small verrucus tumor was found in the strongly keratinized callus on the left sole. The biopsied specimens from the tumor showed the findings of amelanotic melanoma.
This case suggests that chronic trauma is one of the causative factors of acral lentiginous melanoma.

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A 32-year old woman has been noticing a progressing keloid like reddish lesion in her right shoulder for three years. There are no history of injury in her shoulder. Histopathogically, relatively uniform spindle cells are proliferating, and arrenged parallel to the epidermal surface. There cells show neither atypicality nor mitosis. Immunohistochemically, spindle cells were positively stained by vimentine and α-SMA, while they were negative of neither CD34 nor Factor XIII features are diagnosis of Dermatomyofibroma. The patient was diagnosis as having dermotomyofibroma, which is rare benign dermal proliferation of fibroblasts and myofibroblasts.

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A 63-year-old female presented with one-month history of a nodule on her dorsum of the left foot. It grew gradually. There was no history of trauma. Physical examination revealed an oval, light brown, 12×9mm in size, elastic hard nodule. The nodule was biopsied under the clinical diagnosis of dermatofibroma. Histologically, multilobluar nests were observed around the blood vessel, nerve and eccrine gland apparatus. The tumor was composed of the spindle-shaped stromal cells and histiocytic cells without nuclear atypia and mitoic figures. These cells expressed CD34, but not factor XIII a and keratin. The tumor nests contained a number of capillaries, abundant mucin and the network of reticulum fibers. Based on these findings, the diagnosis of fibromyxoma was made.

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We reported a 54-year-old woman with epidermodysplasia verruciformis(EV). The relationship of her parents is cousinage. Multiple erythematous or brown scaling macules and plaques were scattered over her body since her childhood. She was operated for squamous cell carcinoma on left auricle in 1995. Since then, she had had operation for skin tumors 15 times until July 2001. Histopathologically, those tumors were diagnosed as basal cell carcinoma, squamous cell carcinoma, Bowen’s disease, and seborrheic keratosis respectively, and those were supposed to have supervened on EV.
She visited our hospital again in August 2004, because of a recurrence of Bowen’s disease on her left forearm, an appearance of a plaque with hyperkeratosis on her left cheek, and multiple black nodules on her trunk. Histopathologically, they were diagnosed with Bowen’s disease, actinic keratosis and basal cell carcinoma, respectively. HPV type 15 was detected in Bowen’s disease and actinic keratosis.

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Once daily ebastine (5-10mg/day for 4 weeks) was administered to 116 patients with dermatological diseases who complained of pruritus. The usefulness of ebastine was evaluated with respect to skin symptoms and improvement in QOL using a QOL questionnaire specific to skin diseases, Skindex-16. Both the itching sensation and traces of skin scratching were significantly alleviated after 4 weeks of treatments. VAS scores also decreased significantly after 4 weeks of treatments, indicating alleviation of pruritus. When assessing QOL, the symptom score, emotional score and the overall score, excluding the functional score, decreased significantly after 4 weeks of treatments, indicating improvement in QOL. When analyzed by disease, the overall score for the atopic dermatitis group and the eczema group showed a significant reduction after 4 weeks of treatments, indicating improved QOL. In summary, the treatment with ebastine was found to alleviate skin symptoms and improve the QOL of patients with dermatological diseases.

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