CD4⁺ effector T cells have been categorized into two subsets : T helper type 1 (Th1) and Th2. Recently, another distinct T cell subset which produces interleukin (IL)-17 has been identified and termed as Th17. IL-6 and transforming growth factor-β initiate differentiation of Th17 subset from naïve precursors and IL-23 serves to expand differentiated Th17 cells. Th17 cells can induce inflammation in various tissues including the skin via production of various cytokines such as IL-17A, IL-17F, and IL-22. Although the mechanism of the hyperplasia of the epidermis (acanthosis) in psoriasis remains unclear, recent studies clarified that Th17-derived IL-22 mediates IL-23-induced acanthosis through the activation of signal transduction and activators of transcription (STAT) 3. Thus, Th17-related cytokines are potential targets for skin inflammatory diseases such as psoriasis.

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The area of histamine-induced flare in ten healthy volunteers was measured by laser Doppler blood flow imaging. Wheal area and itch intensity were measured by traditional visual evaluation and self-assessment, respectively. Olopatadine hydrochloride, a histamine H₁ receptor antagonist, was applied once or twice and suppression of these reactions was investigated in a placebo controlled manner. As a result, all the reactions were suppressed significantly by application of olopatadine hydrochloride as compared with placebo. This study suggests that laser Doppler blood flow imaging enables precise measurements of flare, which is irregularly shaped and has no clear border, and is useful in assessments of antihistamine efficacy.

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A 38-year-old female with systemic lupus erythematosus (SLE) and secondary Sjögren’s syndrome(SjS) developed psoriasis vulgaris. She developed photosensitivity at approximately 15 years of age, and Raynaud’s phenomenon and arthralgia at the age of 35 years. Laboratory tests revealed leukopenia, thrombocytopenia and were positive anti-nuclear antibodies. She also complained of dry mouth. A gum test and sialography revealed that she had secondary SjS. Oral prednisolone was initiated against her symptoms of SLE. A scaly erythematous plaque appeared in the left temporal area. Similar eruptions also appeared with tapering prednisolone down on her trunk and extremities. The diagnosis of psoriasis vulgaris was made by a skin biopsy. She has been treated with ciclosporin A (150-200 mg/day) and her psoriatic eruptions are well controlled.

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We report the case of a 49-year-old woman with a 5-year history of alopecia on the scalp. She was treated with carpronium chloride by her family doctor, but the therapy had no effect. Dermatological examination revealed scaly, erythematous plaques with alopecia on the scalp. Skin biopsy demonstrated dermal fibrosis and a decrease in the number of hair follicles. Laboratory test results including those for antinuclear antibody were within normal limits. Based on these findings, the patient was diagnosed with discoid lupus erythematosus. Although hair growth was not expected based on the histological findings, betamethasone butyrate propionate lotion successfully induced hair growth in merely 2 months.

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A 64- year-old man with a red nodule on his top right oral angular visited our hospital. The nodule appeared in his cutaneous one month before his first visit. In that time the nodule had grown in size 10×10mm, and infiltration was recognized around it. Histopathologic and immunohistochemical findings in a biopsy specimen confirmed a clinical diagnosis of Merkel cell carcinoma. Involution of the tumor started 3 weeks after the biopsy and disappeared 3 months later.

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A 65-year-old male with a 15-year history of a black patch on the right heel consulted our hospital. The lesion measured 5×6 cm, and its tone was irregular (dark and light areas). A portion was swollen, comprising a node.
Preoperative echography revealed a metastatic bulbar lymph node in the popliteal fossa. Palpation did not show any abnormalities. Therefore, preoperative echography was useful for detecting the metastatic lesion.
For surgery, a mass was resected at an area 2-cm distant from the margin of the primary focus. Sentinel lymph node biopsy of the popliteal fossa was performed. A blue dye was injected into the periphery of the lesion, and a lymph node that became blue was extirpated. Histopathologically, the metastasis of malignant cells was suggested.
On extended resection, the primary focus measured 4.2 mm in thickness. As additional treatment, lymphadenectomy was performed in the popliteal and inguinal regions. The findings suggested a Pt4b/N2b/M0 stage IIIB acral lentiginous melanoma.
Foot melanomas mainly metastasize to the inguinal lymph nodes. However, some studies have reported popliteal lymph node metastasis from a primary melanoma in some regions such as the heel, as demonstrated in the present case, suggesting the necessity of sentinel lymph node biopsy of the popliteal fossa. For this procedure, preoperative echography is useful. With respect to this issue, we reviewed the literature.

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Angiosarcoma is a relatively rare, aggressive malignant disorder with a poor prognosis which occurs on the head of the elderly. And it causes pulmonary metastasis at a high rate. We report 4 cases of angiosarcoma treated at our department since 1996 to 2006.
Three cases of nodular type of angiosarcoma were treated with combination therapy such as surgical excision, localized or intravenous injection of rIL-2, electron beam, and taxoid anti-cancer drug. Two cases of nodular type of angiosarcoma treated with chemotherapy showed reduction of original tumor and lung metastasis. We suggest that chemotherapy will be useful for therapy of nodular type of angiosarcoma already operated cases and lung metastasis, and chemotherapy should tke precedence over other therapy such as rIL-2 and radiation. And chemotherapy may prolong the survival time. Injection therapy of rIL-2 was considered to be effective for macular type of angiosarcoma. However, we had to end rIL-2 therapy because general condition of the patient worsened. Thus we considered it was difficult to conclude rIL-2 was effective to macular type.

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A 9-month-old boy received BCG vaccination at the age of 4 months and a subcutaneous nodule appeared on his left subclavicular area 3 months after vaccination. During the period of observation, the skin over the nodule became ulcerated, and white mass was eliminated when pressed. Histopathologically, a biopsy specimen obtained from the white mass revealed epithelioid cell granuloma with caseation necrosis, so we suspected cutaneous tuberculosis. Polymerase chain reaction (PCR) was performed and was positive for Mycobacterium tuberculosis. As we could not find other systemic organ involvement, we diagnosed this case as true cutaneous tuberculosis after BCG vaccination. QuantiFERON^®TB-2G examination was also used as an adjunct to the diagnosis.

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Bier reported patients anemic macules in 1898. The macules are distinct pattern of vascular mottling composed of small, irregular spots, triggered by external compression of the limb. We present a case of a 28-year-old man with a 10-year history of Bier’s white spots. He had multiple asymptomatic anaemic macules on the limbs. He was treated with oral tofisopam, it didn’work. Bier’s white spots are not recognized frequently, but it probably might be more common.

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A randomized, multicenter, investigator-blinded, active- and vehicle-controlled study was conducted to evaluate the efficacy and safety of adapalene gel 0.1% compared to adapalene gel 0.03% and the corresponding gel vehicle in Japanese acne patients. Patients were randomly assigned to receive either adapalene gel 0.1%, adapalene gel 0.03%, or vehicle once-daily for 12 weeks. Primary efficacy assessment was the total acne lesion count at the end of treatment and secondary assessments included inflammatory and non-inflammatory lesion counts. Safety was assessed by evaluating adverse events and local tolerance. Routine laboratory parameters were also evaluated. A total of 238 patients with acne vulgaris were enrolled and 87% of patients completed the study. Both concentrations of adapalene gel were more effective than the gel vehicle and had comparable safety and tolerability. For the primary efficacy endpoint (total lesion counts), there was no statistical difference between adapalene 0.1% and 0.03% treatment groups (median total lesion count at week 12, LOCF: 19, 20, 33 for the 0.1%, 0.03%, and vehicle groups, respectively), but each concentration was significantly better than the vehicle (both P‹.01). However, adapalene 0.1% had an earlier onset of action (week 4) than adapalene 0.03% (week 6) and had better improvements in inflammatory lesion counts (median reductions at week 12, LOCF: 54%, 48%, 30% for the 0.1%, 0.03%, and vehicle groups, respectively). Both active treatments were well tolerated, with the incidence of adverse events and local tolerance comparable between the adapalene 0.1% and 0.03% gel treatment arms. The results of this study indicate that 0.1% is the optimal concentration of adapalene in a gel formulation for treating the 2 components of acne (inflammatory and non-inflammatory lesions) in the Japanese patient population.

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Acne vulgaris is a chronic disease that may require long-term therapy for many patients to achieve the desired effect as well as to increase the likelihood of maintaining short-term improvements. The aim of this study was to evaluate the long-term safety and efficacy profile of adapalene gel 0.1% in the treatment of Japanese patients with acne vulgaris when used once daily for up to 12 months. A total of 446 male or female patients were enrolled in the study, 404 (91%) patients completing 6 months or more and 357 (80%) of patients completing the 12-months. Treatment with adapalene was safe and well-tolerated when used for up to 12 months in Japanese patients with acne vulgaris. Adverse events were mostly mild or moderate and were transient in nature. The vast majority of adverse events occurred during the first two weeks of the study. Nine patients (2.0%) had 13 serious adverse events; none were considered to be related to the study drug. Eight patients (1.8%) had adverse events leading to discontinuation of the study drug that were characterized as related to study medication. The therapeutic benefit of adapalene gel 0.1%, expressed as median percent reduction from baseline for total, inflammatory and non-inflammatory lesions, consistently observed after 3 months of treatment continue to improve after 6 and up to 12 months thus demonstrating the interest for many patients to continue treatment after the recommended 3 months period. Patients also expressed high satisfaction about treatment outcomes at the end of the study. These high satisfaction rates did increase during the course of the study and up to 12 months. These findings strongly support the use of adapalene as a safe and effective treatment in the long term management (up to 12 months) of Japanese patients with acne vulgaris.

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Bepotastine besilate, a second-generation antihistamine, is characterized by its rapid absorption after oral administration and immediate clinical responses in patients with chronic urticaria. To confirm its effectiveness, 46 patients diagnosed with chronic urticaria were given bepotastine besilate, and questionnaires were filled out in interviews with doctors for evaluation of the patients’ state regarding the frequency of itching and time till clinical response on their first and second visits. Itching, sleepiness, and level of disability were evaluated using the visual analogue scale (VAS). Seventy percent of the patients experienced clinical efficacy of bepotastine besilate treatment within 1 hour of administration. In the VAS assessment, itching was significantly ameliorated and the level of disability significantly decreased by bepotastine besilate treatment. Sleepiness was comparable before and after the start of treatment. This report shows using VAS assessment that bepotastine besilate treatment improves the quality of life of patients with chronic urticaria. We concluded that bepotastine besilate is a useful drug for symptomatic and preventive treatment of chronic urticaria.

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