During the last years, itch research has made much progress as well as pain research. Although the sensations of itch and pain, that share many common features, are necessary for us as nocifensive systems, pathological and chronic pain and itch are intolerable. Nociceptive and pruriceptive C-fibers express various kinds of receptors that are responsive to heat, mechanical and chemical stimuli. Most classical inflammatory mediators have been shown to sensitize both nociceptors and pruriceptors. Much effort has been made to identify itch-specific C-fibers and central transmission system, especially for histamine-mediated itch, while those for atopic dermatitis-induced itch are still obscure. Since there is emerging evidence that similar patterns of peripheral and central sensitization due to plastic neuronal changes occur in persistent pain and itchy conditions, it is most important to relieve patients from pain and itch symptoms as early as possible

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A 21-year-old woman saw us in June 2006, complaining diffuse erythemas on her whole body surface. Until then, atopic dermatitis had been diagnosed in the patient because of itchy erythemas on her neck and cubital fossa, which were well-controlled with topical corticosteroids. In May 2006, she used some of over-the-counter ointments such as bufexamac (anti-inflammatory drug), shiun-ko (traditional anti-inflammatory drug) and tetracyclin (antibiotic) for the eruptions of her neck and upper extremities. However, the skin lesions did not improve. She used another bufexamac ointment prescribed by a dermatologist, but her skin lesions got worse and resulted in erythroderma. We treated her with systemic and topical corticosteroids. Patch testing showed positive responses to both bufexamac and shiun-ko, by which we gave a diagnosis of erythroderma developed from contact dermatitis due to bufexamac.

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A 46 year-old-nurse with chronic hand eczema was diagnosed as having delayed-type hypersensitivity to alcohol with patch test 3 years ago. Within minutes after she prepared streptomycin instillment, angioedema of hands with severe itching developed, subsequently followed by abdominal pain. An open patch test showed an immediate positive reaction to streptomycin but not to other aminoglycoside drugs. In the present case, it is possible that streptomycin was absorbed through the damaged skin and penetrated into the systemic circulation to induce immediate type of allergic reactions not only on the contacted skin but also in the distant areas.

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A 35-year-old female, when she was 17 weeks pregnant, developed purpuric macules with a slightly itchy sensation on her lower legs. This condition gradually exacerbated on her extremities and back. She visited our clinic when she was 28 weeks into her pregnancy. At the first visit, reddish and brownish macules around 1 cm in diameter with punctuate purpura were disseminated on her extremities and back. There were no abnormalities in the laboratory data. Histologically, perivascular infiltrates of lymphocytes with extravasation of red blood cells were found in the upper dermis. Based on these findings, Schamberg’s disease was diagnosed in our patient. The treatment with topical corticosteroid was slightly effective, but the skin lesions did not disappear during her pregnancy. The eruptions completely disappeared 1 month after childbirth. This timing may indicate that in our patient’s case the eruptions develop as a dermadrome in association with the pregnancy.

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We report a case of onycholysis (the separation of the distal nail plate from the nail bed) associated with Basedow’s disease. A 30-year-old Japanese woman visited us with onycholysis of the fourth fingernail of the left hand. On examination, we diagnosed as oncycholysis associated with Basedow’s disease. The condition improved with treatment of the hyperthyroidism. Onycholysis occurs in some hyperthyroid patients and is often referred to as “Plummer’s nails.” It occurs most frequently in the fourth finger. As the changes progress, they extend to involve the fifth finger, and later the remaining fingers and the thumb. We should consider the possibility of the disorders of the thyroid gland when patients exhibit onycholysis.

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A 72-years old man visited our department with the chief complaint of a subcutaneous tumor in the left first interdigital area that was growing relatively rapidly. The fluctuating subcutaneous tumor measured 3cm, and an induration 2cm in size was palpated in the lower layer. When the subcutaneous tumor was incised, bloody pus was discharged. Histopathologically, the induration in the lower layer was a granuloma. In the granuloma, structures assumed to be the fungal hyphae that stained black with Grocott staining were presented. Trichophyton rubrum was isolated from the samples of both the pus and granuloma, and we confirmed the diagnosis of trichophytic granuloma. He has diabetes, but has no previous treatment with systemic immunosuppressive agents or topical use of steroids. Tinea unguium was noted in the feet, but no tinea superficialis was evident in the hands.

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A 62-year-old man has had a walnut-sized, asymptomatic, subcutaneous tumor on the left thigh for longer than 1 year without remarkable change. The tumor did not migrate from the primary site, but the tumor volume reduced to fingertip-size during the course of 3 months. Total resection was performed under a possible diagnosis of epidermal cyst. A histopathological examination revealed parasite bodies in adipose tissue, which had several characteristic features for plerocercoid and granulomatous change with infiltrarion of lymphocytes and eosinophils around parasites. From these findings, a diagnosis of Sparganosis mansoni was made. Although the ingestion of uncooked flesh or untreated water usually causes Sparganosis, the infection route in the present case was not defined. The specific anti-plerocercoid antibody with multiple-dot ELISA method was strongly positive 3 months after surgical removal of the lesion, and decreased but still positive 3 months later. Then praziquantel was orally administered without recurrence for almost 1 year after resection.

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Atorrege AD+^®, a series of skin care products with low irritability, was tested in 31 women complaining of hypersensitive skin and presenting with symptoms of skin dryness. When safety was evaluated by checking for adverse events and adverse reactions, a series of the test products was rated as safe in 93.5% of subjects. On the basis of a general assessment of improvement in skin and safety, the series of the products was found useful in 93.1% of subjects. Adverse events were noted in 2 cases. A questionnaire survey of the subjects revealed a high degree of satisfaction with both the comfort when used and the efficacy of the test products. These findings suggest that this series of products provides a safe and effective means of caring for hypersensitive skin presenting with symptoms of dryness when there is an absence of inflammation.

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BACKGROUND and OBJECTIVE: A variety of dermoscopes have been available on a commercial basis, and they are generally expensive but have no flexibility in lighting and the imaging unit cannot be replaced. We report (1) evaluation of a novel dermoscope and (2) method of fabrication. Features of this dermoscope are (1) use of a commercially available digital video camera, (2) use of an acrylic tube for a “spacer”, and (3) usage under room lighting or a surgical light.
RESULT: This novel devise provided a field of view, ranging from φ3mm to φ20mm, and satisfactory images under room lightning or a surgical light.
CONCLUSION: This novel handy dermoscope was outstanding in image quality, flexibility in lighting, and manufacture ability at low cost.

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