The innate immune system provides the first line of host defense against invading microorganisms. The innate immune responses are initiated by the pattern recognition receptors (PRRs), which detect conserved structures found in microorganisms. Among them, Toll-like receptors (TLRs), which locate on the cell surface or in the endosomal compartments are capable of sensing organisms ranging from bacteria to fungi, protozoa and viruses and play a major role in innate immunity. On the other hand, cytoplasmic PRRs such as NOD-like receptors (NLRs) and RIG-like receptors (RLRs) detect bacteria and viruses that have invaded cytosols. This review summarizes the function and signaling pathways of PRRs .

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Imiquimod is an immune response modifier for topical administration. It has a molecular formula of C₁₄H₁₅N₄ and a molecular weight of 240.3. FDA approved for perianal warts in 1997, for actinic keratosis and superficial basal cell carcinoma in 2004. The major biologic effects of imiquimod are mediated through agonistic activity towards toll-like receptor7 and/or 8. This activity induced pro-inflammatory cytokines and activation against virus. Two cases of perianal warts, one case of actinic keratosis and two cases of plantar warts were treated with topical imiquimod cream which was imported from USA personally. These 5 cases were cured completely. General fatigue, fever was found in a case and erosion was seen in a case as adverse reactions.

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A 51-year-old man, who had rapid weight loss, general fatigue, and pigmentation of the face, tongue and arm, was diagnosed with Addison’s disease due to adrenal tuberculosis. After a two month treatment of hydrocoritison, isoniazid, rifampicin and ethambutol, the degree of pigmentation significantly increased along with itching. We diagnosed these cutaneous symptoms as lichenoid drug eruption. These cutaneous symptoms have gradually improved after discontinuation of the antitubercular agents.

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An 85-year-old woman with a 2-month history of painful eruptions was admitted to our hospital. She had been treated with systemic steroid (prednisolone, 30 mg/day);however, this treatment was less effective. On physical examination, we detected painful erythematous nodules, 3 cm in size, over her thighs, shins, buttock, and upper extremities. She also complained of abdominal pain. CT scan revealed a mass of the pancreatic head and multiple liver masses. Histological examination of the nodule revealed subcutaneous fat necrosis with the so-called ghost-like cells. The serum level of lipase was high. Subcutaneous fat necrosis with pancreatic head carcinoma was confirmed as the diagnosis.

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A 37-year-old man developed swelling and pain in the left axilla and fever on June, 2007. On the next day, in addition to the above symptoms a pale flare associated with severe pain spread to the left chest and the patient visited the dermatology department of our hospital. During the initial examination, flare and swelling were found in the area from the left axilla to the left chest and swelling and pain were also observed in the left axillary lymph nodes. As before his lymph nodes were swollen sometimes. The laboratory test results showed marked increases in WBC, CRP and CK. Therefore, the patient was diagnosed with necrotizing fasciitis and underwent surgical debridement and suture under general anesthesia at midnight of the same day. After operation, we transported the patient to the University Hospital Kyoto Prefectural University of Medicine by helicopter. The patient recovered by additional debridement.

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A 14-year-old Japanese female with painful infiltrated erythema on her right lower leg was brought to our hospital on March 25, 2006. Histopathologically, granuloma was observed in the dermis. Acid fast bacillus was cultured from the pus and was proved to be Mycobacterium abscessus by DNA-DNA hyblidization technique. She was treated with oral Minocycline, but this agent could not be continued due to side effects. Thereafter, we performed surgical excision. We reviewed 20 cases previously reported in Japan.

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We studied the use of narrowband UVB therapy for 124 patients with atopic dermatitis. Because atopic dermatitis patients have sensitive skin to ultraviolet, some patients with atopic dermatitis will have more sunturn reactions than if you use narrowband UVB therapy as well as using for psoriasis vulgaris and vitiligo vulgaris. We used 25%-16.6% MED the first time, and then we increased the irradiation 10-15% depending on the case.
66% of patients had effective results. The frequency irradiation was every two weeks, and many cases of these patients had better effects than the patients using other frequencies of irradiation. In the more effective cases, we could reduce or stop using steroid oral medicines. We could also decrease frequency of applying external some steroids. Our results are that narrowband UVB therapy is a good therapy for untreatable atopic dermatitis in addition to using conventional therapies.

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We carried out a four-week study in patients with sensitive skin in order to assess the safety of new cosmetics for sensitive skin, consisting of cleansing oil, mask, and whitening essence in the “d Program^®” series developed by Shiseido Co., Ltd.. The subjects were patients with a history of contact dermatitis and/or slight to moderate atopic dermatitis. A total of 128 subjects completed the study. About 87% of the subjects considered themselves to have sensitive skin.
We found adverse skin reaction in 1.7% of the subjects who used the cleansing oil, in 1.8% of the subjects who used the mask, and in 5.1% of the subjects who used the whitening essence. On the basis of these findings, it was concluded that these new cosmetics for sensitive skin can be used safely by the great majority of patients having sensitive skin.

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