Case of a 17-year-old high school student. She developed atopic dermatitis in her childhood and which worsened from time to time. On several occasions she had physical education (PE) after lunch and she developed urticaria. Later her dermatitis became more severe. Through blood test and provocation tests, we determined that her condition was food-dependent exercise-induced anaphylaxis (FDEIA) caused by the batter used for the fried chicken she ate lunch. We advised her not to do exercise for two hours after eating the fried chicken. As a result, her dermatitis improved to our satisfaction. After cooking she had developed dermatitis on her hands and her atopic dermatitis worsened. We determined her rash was caused by latex delayed-hypersensitivity from patch tests. We advised her not to use latex gloves while cooking. Since then her condition has improved.

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We report two child cases of pityriasis lichenoides, one a 1 year old girl, and the other a 3 month old baby. They both presented with numerous red papules on the trunk and extremities,some of which were topped with crusts. They were diagnosed based on their clinical manifestations and histological findings of skin biopsy. Topical steroid was ineffective in both cases. (Because they were otherwise clinically healthy), we decided to observe the natural course without treatment. The girl′s eruption eventually disappeared (leaving a slight scar and pigmentation) in approximately 16 months, and the boy′s eruption took nearly 50 days to be healed. Both cases had histological features of Pityriasis lichenoides et varioliformis acuta as well as Pityriasis lichenoides chronica.

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A 72 year-old Japanese woman was admitted to our department with punctuate purpura that suddenly affected her lower limbs, after being diagnosed as a pulmonary adenocarcinoma 1 year prior, for which she began receiving chemotherapy with 250mg/day of Gefitinib 7 months prior to admittance. Purpura ranging in size from a grain of rice to a small bean had developed throughout her entire lower limbs, some of which had formed pustules at the center. However, no abnormalities were found in medical examinations, and neither arthritic nor abdominal pain was complained by the patient. Histopathologically, subcorneal pustular dermatosis accompanied by acantholysis and neutrophilic angitis in the upper dermis were observed. Further, the pustules extended continuously to the eccrine duct, and neutrophil infiltration was observed around dermal sweat duct. In the pustules, acantholytic cells were present. The eruption disappeared within a few days after internal use of Gefitinib was suspended, but returned when administration was resumed for the purpose of treating the pulmonary adenocarcinoma. Clinically, Gefitinib-induced eruptions in which purpura and pustules are formed along with acantholysis in the pustules extending to the eccrine duct has been scarcely reported

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Alacepril is a widely used angiotensin converting enzyme inhibitor and we report here the first case of Stevens-Johnson Syndrome associated with alacepril treatment.
A 57-year-old woman with hypertension and hyperuricacidemia was treated with alacepril. On the 21th day of treatment she noticed fever, painful erythema over her whole body. Dermatological examination revealed multiple generalized atypical targetoid macules on her face, trunk and extremities (‹10%body surface area), with erosions of the buccal mucosa and external genitalia as well as those with crusts of the lips and conjunctival erythema. A punch biopsy specimen from an atypical targetoid macule on the abdomen showed epidermal necrosis.
Alacepril showed positive in the skin patch test and the drug lymphocyte stimulation test. On the basis of these findings, we established the diagnosis of alacepril-induced Stevens-Johnson Syndrome. Stevens-Johnson Syndrome can be life-threatening, and may be induced by alacepril.

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A 65-year-old woman was diagnosed with polycythemia vera in February 1994, and treatment with hydroxyurea(HU)was started in 1996. She noticed an ulcer on the left lateral aspect of the ankle about 1 month before the initial examination. She treated the ulcer herself, but the ulcer became worse and she visited our department. In the initial examination, a painful cutaneous ulcer of 35×13mm in size was found on the left lateral aspect of the ankle. She had a past history of cutaneous ulcer on the right lateral aspect of the ankle that had occurred twice. It was diagnosed as HU-induced cutaneous ulcer from clinical findings, past histories and clinical course. Discontinuation of HU therapy and external application resulted in complete epithelization of the ulcer in about three months.

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The patient was a 32-year-old female who had been diagnosed with impetigo herpetiformis at a nearby hospital at the time she gave birth to her second baby, 1 year and 8 months before her first visit to our hospital. She began to develop erythema and pustules on her trunk and four extremities about the time she was 8 months pregnant with her third baby. She was diagnosed with redeveloping impetigo herpetiformis and treated with activated vitamin D3 ointment and an external steroid preparation. The rash improved after childbirth and systemic symptoms such as fever were not observed.

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We report a case of 74-year-old woman who developed leukoderma of the vulva for a half year. There was no history of similar skin lesions in her family members. She was treated with topical steroid ointment but did not get well. On physical examination she had keratinized leukoderma on the clitoris and the labia minora. The histopathological examination showed acantholysis, dyskeratosis and clefting in epidermis similar to that seen in Hailey-Hailey disease and also showed epidermolytic hyperkeratosis.
This case was thought to be a case of acantholytic dermatosis localized to the vulvocrural area reported by Cooper and Chorzelski with epidermolytic hyperkeratosis.
The erupution cleared almost 1 month after the initiation of treatment with systemic etretinate and topical steroid ointment.

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A 71-year old Japanese man visited us with pruritic erythema on the whole body. The patient was diagnosed as having psoriatic erythroderma based on histopathological findings. The eruption was initially improved with topical betamethasone butyrate propionate for 3 weeks. NB-UVB irradiation(600mJ/cm², 5times per week)was performed for the treatment of residual erythema. However, pustules on erythema developed on the abdomen after the NB-UVB irradiation and rapidly enlarged with low-grade fever and malaise. The patient was diagnosed as generalized pustular psoriasis based on pathological evaluation. We postulated NB-UVB therapy might have induced pustular psoriasis. We should keep in mind the possibility that NB-UVB irradiation to patients with psoriasis is carefully applied not to elicite pustular psoriasis.

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A 74-year-old man presented with erosions and ulcers on the lips and the oral mucosa. Erythemas and flaccid blisters appeared one week before the consultation. Histopathological examination showed liquefaction degeneration in the basal cell layer with Civatte bodies and subepidermal blister. Indirect immunofluorescence using 1M NaCl split skin detected IgG antibody reacting with the epidermal side of the split. Immunoblotting using epidermal extract failed to detect the IgG antibodies against BP230, BP180, desmoglein 1, desmoglein 3, envoplakin or periplakin. The patient was treated with an oral administration of prednisolone (60 mg/day), which improved the skin eruptions. However, the erythemas changed to dark purple or purplish-red bumps. The diagnosis of lichen planus pemphigoides was made. We considered several differential diagnoses on this case.

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A 73-year-old Japanese female presented with keratotic blackish nodule observed on the lateral side of the right foot. She had a 20-year history of type 2 diabetes mellitus with triopathy. A cutaneous ulcer spread to the right 5th metatarsal bone could be found after mechanical removal of keratotic material. It surrounded verrucous surface with macerated horny material, and healed within three months by repeated shaving horny material and controlled diabetes mellitus. We diagnosed as verrucous skin lesions on the feet in diabetic neuropathy.

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A 76-year-old woman noticed her tumor in the right subscapular region three years ago. It was painless. Magnetic resonance imaging (MRI) of the lesion confirmed the presence of a right infrascapular soft-tissue mass of 10×17×4cm in diameter with signal intensity similar to that of skeletal muscle interlaced with strands of fat. Histological examination revealed the presence of collagenous and fatty connective tissue where eosinophilic fibers and globular masses positively stained by elastica van Gieson staining were interspersed.
Imaging studies could provide the definite diagnosis in most cases. MRI is particularly effective, as it visualizes the layered pattern of fatty tissue and fibrous tissue. Elastofibromas are benign soft tissue tumors and when a tumor would be diagnosed as an elastofibroma by MRI, we can avoid unnecessary surgical excision.

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A 66-year-old woman presented for pale-red infiltrated plaques in dorsum of hands, which gradually extended to forehead, bilateral cheeks and upper eye lid during one year. She accompanied with arthritis and eye incompatibility and laboratory data showed high titer of anti nuclear antibody. she came to our hospital to examine the collagen disease. Skin specimens from hand and forehead showed noncaseating granuloma, which was an evidence of sarcoidosis of the skin. She was diagnosed as sarcoidosis because of her bilateral hyper lymphadenopathy (BHL), and small nodules in the lung. Her type of skin sarcoidosis was lupus pernio, which was popular in Europe, but rarely in Japan. She was diagnosed as complicated with sjögren syndrome due to some clinical findings. It is recently said that sarcoidosis and collagen disease such as sjögren syndrome or scleroderma sometimes occurred together, and two diseases shared several common features in the etiology and clinical symptom.

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A 85-year-old man with prostate cancer had been receiving subcutaneous injections of Leuprolin acetate depot 3.75mg (for one month use) on his upper arms since May 2000. He noticed subcutaneous nodules on the injection sites after he changed the depot to 11.25mg (for three month use) in November 2002. The subcutaneous nodules were resected and histopathological examination showed foreign body granuloma. We diagnosed these nodules as foreign body granuloma caused by subcutaneous injections of Leuprorelin acetate.

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Sebaceous nevus is usually located on the scalp, the face or the neck as a single lesion. A 32-year-old man having multiple extensive lesions found on the arm and the trunk visited our hospital. At birth, he presented linear or band-like lesions on the back, the breast and the upper arm, which is normal skin or light brown color plaque partially with a paving stones-like surface. He was diagnosed sebaceous nevus at 5 years old and had underdone laser treatment on the left shoulder lesions. He showed the recurrence on the laser-treated lesion and developed many black nodules on the plaque. The secondary tumors were pathologically diagnosed as trichoblastoma. Surgical resection is considered to be a preferable treatment for sebaceous nevus. However, it was difficult to determine how to cure the case because of the widespread lesions. We reviewed the treatment of sebaceous nevus based on the previous literatures.

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A 35-year- old man presented with multiple papules on his face and neck, which have gradually developed after 20 years of age. On examination, there were skin-colored to light-brown, smooth and solid,1-to 3-mm papules on his face and neck. There were acrochordons on his neck, too. Histopathological findings were fibrofolliculoma and trichodiscoma. Thoracic CT revealed pulmonaly cysts. We diagnosed him with Birt-Hogg-Dubé syndrome. Birt-Hogg-Dubé syndrome was described as the grouping of 3 skin tumors : the fibrofolliculoma, trichodiscoma, and acrocordon - in family members with an autosomal dominant inheritance association with this. The patient will need regular check. up.

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We report two patients with Muir-Torre syndrome. The first case was a 72-year-old woman, who had past histories of uterine body cancer, colon cancer, ureteral cancer and basal cell carcinoma. She was noticed a nodular lesion on her back, which was histologically diagnosed as sebaceous carcinoma. In addition, she had multiple sebaceous adenomas on the trunk and forehead. The second patient was a 63-year-old man who had been followed up for an advanced stage of esophageal cancer. He developed a papule on his nose, which was progressively enlarged. Histologically, the tumor exhibited typical characteristics of sebaceous carcinoma. Because of having visceral malignancies and sebaceous carcinoma in combination, the two cases were diagnosed as Muir-Torre syndrome. In addition, our survey of the records of the past patients in our department revealed that 2 of 4 patients with sebaceous carcinoma had visceral malignancies, indicative of Muir-Torre syndrome.

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A 70-year-old man showed recurrent bilateral flaring subcutaneous induration around the ears since Feb, 2006. A CT scan showed the bilateral parotid glands swelling, laboratory data revealed high levels of sIL-2 receptor and salivary amylase. A skin biopsied specimen from the induration lesion showed noncaseating granuloma throughout the dermis to fat tissue. Aangiotensin converting enzyme (ACE) was normal range and other symptoms associated with lung, heart, eyes were not shown. We diagnosed this case as Mikulicz disease with sarcoid reaction. Subcutaneous induration spontaneously regressed without medication. In some diseases showed bilateral salivary gland swelling, Mikulicz disease and Mikulicz syndrome were very rare cases. We briefly discussed histories of Mikulicz syndrome and Mikulicz disease and new finding about Mikulicz disease.

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Two cases of cutaneous endometriosis are presented. A 31-year-old woman visited our hospital because of a painful mass on the left inguinal region. Surgical resection of the tumor was carried out. Histological examination revealed glandular structures and stroma resembling the true endmetrium.
After the surgical removal, the tumor did not reccur.
The second case was a 48-year-old woman who had noticed a guradually enlarging mass
with pain at menstruation for two years on the umbilical region.
Histological examination of the nodule revealed the findings of cutaneous endometriosis. The MR imaging analysis showed adenomyosis uteri. Although no treatments had been done by the patiet’s request, the tumor mass showed no changes.

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We report a case where chronic arsenic poisoning was suspected. The patient was a 77-year-old male. He had surgical treatment for multiple Bowen’s disease on his abdomen at the age of 58. At the age of 72, he had new lesions of Bowen’s disease on his abdomen and both lower legs. Pulmonary carcinoma was diagnosed at age 75. When he presented at our hospital, extramammary Paget’s disease on the perianal region and keratosis on the palms and soles were discovered. He had no obvious history of arsenic ingestion, but we suspected that he was exposed to arsenic from well water for 22 years when he lived in Hiroshima.

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A 48-year-old woman noticed a red-brown nodule (2cm in diameter) on her right chest wall about six months before seeking medical attention. Histopathologically, the nodule consisted of adenoid proliferation of atypical cells. Metastatic cancer was considered, but examinations did not detect other primary tumors, and the nodule was surgically removed with a 1cm wide margin. Because fragments of normal appearing mammary gland were detected under the tumor nest in the resected specimen, a diagnosis of breast cancer arising from an accessory mammary gland was made. Immunohistochemical examination demonstrated that the tumor cells were positive for estrogen receptor, progesterone receptor, and HER 2 (human EGFR related protein 2). Sentinel lymph node biopsy performed during subsequent extended surgery demonstrated metastasis in a lymph node, and total lymph node resection was performed. The patient underwent radiotherapy and chemotherapy, and no local recurrence has been observed to date. When nodules or tumors are observed on the skin along the milk line, the possibility of cancer arising from accessory mammary gland should be considered

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The patient was a 69-year-old male who had underwent right nephrectomy for right renal cell carcinoma at 61 years of age. A mass was detected in the anterior mediastinal region by CT after 7years of follow-up, and tumorectomy was performed. Based on the excised tissue findings, thymic cancer was diagnosed. Multiple shadows were noted in the lung one month after the diagnosis, suggesting lung metastasis. At the same time, a mass was detected in the right neck, and the patient was referred to our department. The mass was 15mm in diameter, elastic, hard, and had an embankment-like surrounding and ulcer in the center. On histology, atypical cells containing large nucleoli and bright nuclei formed a solid alveolar lesion, showing squamous cell carcinoma. Since it was very similar to the primary lesion, it was diagnosed as skin metastasis from squamous cell carcinoma of the thymus origin.

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A 50-year-old woman was refered to our out-patientclinic for the evaluation of a ten-year history of subcutaneous tumor in her abdomen. On CT examination, she had a subcutaneous tumor measuring cal 7cm in diameter and the thick rectus abdominal muscle. Histopathologic examination of the biopsy specimen demonstrated granular cell tumor. At surgery, we noted peritoneal infiltration, but there was no infiltration of the internal organs in the abdominal cavity. Therefore, we removed the tumor with peritoneum, but without internal organs. The lesion was excised under general anesthesia and the peritoneal defect was reconstructed with fascia lata. The vertical margin was positive on histpathologic examination for infiltration of the peritoneum. We noted recurrence ten months postoperatively. Although the lesion was a histopathological variant, it was diagnosed as malignant based on the clinical course.

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We report a case of metastatic malignant melanoma to the urinary bladder.
A 52-year-old woman had undergone a resection of malignant melanoma in the left side of the temple (Breslow tumor thickness 4mm, Clark level V). Histological examination showed a micrometastasis in one of 49 lymphonodes excised from the neck. After five courses of DAV-feron therapy, interferon alfa was subcutaneously injected over 36 months. Fifty-one months after the operation, the patient showed skin metastasis. Sixty-six months after the operation the patient visited the urological clinic because of macroscopic hematuria. Endscopy and CT scan revealed a 3cm-mass in the bladder, which had histological findings of metastatic malignant melanoma. Although an immuno-therapy and a Dac-Tam therapy were performed, metastases were detected in the bones and brain. The patient died 78 months after the first visit to our clinic. Rare metastatic malignant melanoma to the urinary bladder was herein discussed.

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We describe a 35-year-old man with a metastasized malignant melanoma with the markedly elevated serum level of Granulocyte Colony-Stimulating Factor(G-CSF)and paraneoplastic leukemoid reaction. The patient suffered from a metastasised melanoma to the liver on two years after the total removal of primary lesion on his back. The patient’s white blood cell count exceeded 110,000/μl and the serum level of G-CSF was elevated up to 710pg/μl. The bone marrow infiltration contained markedly atypical cells, having clear cytoplasm and demonstrating positivity to anti-G-CSF antibody on immunohistochemical examination.

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A 71-year-old man consulted our hospital because he noticed small black patch on his nose several month ago. Excisional biopsy was done and he was diagnosed as having malignant melanoma. Extended excision and sentinel lymph node biopsy, which was negative, were performed as additional treatment. In this case, 3D-CT lymphography which was taken after injection of Iopamiron370 around the primary legion was useful to detect the position of the sentinel lymph node.

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A 48-year-old Japanese male has been aware of a brownish black hyper-pigmented oral lesion in his lower lip about 1 month before administration to our hospital. The biopsy specimen showed intraepithelial dendritic melanin-laden mylanocytes and acanthotic epidermis with spongiosis. Immuno-histochemically, these melanocytes were positive for HMB-45, but negative for MIB-1. We diagnosed this lesion as oral melanoacanthoma. The lesion has been showing a tendency of spontaneous-resolution during 9-months follow-up.

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A 50-year-old woman complained of a sudden headache,high fever and eruption, 8 days after traveling around Ise City, Mie Prefecture, Japan. Her extremities and trunk not including palms or soles were covered with erythematous exanthemata, parts of which were petechial. An eschar was observed on her right upper arm. Lymphadenopathy was not noted. Because of rickettsial diseases were considered possibilities, she was given drip infusion of minocycline 200 mg per day, which was dramatically effective ; the fever decreased to 37°C during the first drip infusion. These eruptions were disappeared in 3 days. Elevation of immunoglobulin G(IgG)and IgM antibodies to Rickettsia japonica supported our diagnosis of JSF. And we use immunohistochemical examination, staining for IgM monoclonal antibodies. The number of cases of JSF and its endemic area are gradually increasing. 26cases of JSF were reported in Hyogo Prefecture, Mie Prefecture and Wakayama Prefecture, in Kinki District,f rom 2001 to 2005.

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A 69-year-old female, who returned from Costa Rica in February 2007, visited our hospital for an abdominal erythematous nodule. It appeared in her left abdomen after she returned to Japan, and it had been gradually increasing in its size. She visited a clinic and received the incision under the diagnosis of infected epidermal cyst. One day after incision, a fly larva came out from the nodule, which was classified to be a Dermatobia hominis. When an erythematous nodule like an infected epidermal cyst was found in the skin of the patient who came from central to south America, myiasis has to be included in the differential diagnosis.

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The patient is 48-year-old Japanese woman who lives in Wakayama prefecture of Japan. While lying on the floor in her house in the afternoon on July, she felt slight pain on the flexural area of her left upper arm and noticed nearby a brown spider. About 4 hours later she had suffered by pain and swelling on the left upper arm. In spite of the treatment of a local physician which included administration of steroid and antibiotics, her symptoms did not subside and enforced her to visit our hospital on the 6th day. Our first examination revealed hemorrhagic plaque with induration and tenderness on her left upper arm surrounded by widespread edematous erythema on the left arm. The plaque became necrotic gradually, leaving well-circumscribed black necrotic lesion of 7×4cm size on the 20th day. It needed debridement and skin graft for healing. Because Loxosceles rufescens is confirmed to live in Wakayama prefecture and clinical course of the patient was supposed to be typical for necrotic cutaneous loxoscelism and there were no other plausible causes inducing such a skin lesion, we concluded that the patient was bitten by L.rufescens. This is the first reported case of loxoscelism in Japan.

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Atheroma is a benign tumor of the skin that emits strong unpleasant odor during treatment. Therefore, we analyzed the contents of the tumor and investigated the possibility of reducing the odor using commercial deodorizers(A-C). As a result, the main characteristic odor components were lower fatty acids(FAs), mercaptan and indole. On chemical deodorizing tests of these odor components, deodorizer B, which contained green tea extract and amphoteric detergent, showed very high effects on FAs, but limited effect on mercaptan. However, on sensory test using a model of atheroma odor(a mixture of FAs, mercaptan and indole), deodorizer B had an excellent effect. Therefore, it was suggested that the effect of deodorizer B was due to 1) chemical deodorizing effect for FAs, and 2) significant sensory deodorizing effect for mercaptan.

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We carried out a four-week study in patients with a history of contact dermatitis and/or atopic dermatitis in order to assess the safety of new sensitive-skin cosmetics containing hyaluronic acid. We found adverse skin reactions in 9.6% of the subjects who used the lotion (enriched type), in 6.7% of the subjects who used the lotion (light type), in 8.2% of the subjects who used the emulsion, and in 6.5% of the subjects who used the cream. These adverse skin reactions were slight or moderate, and there was no severe reaction. All subjects presented with dryness of the face at week 0 on clinical examination. More than 85% of the subjects exhibited improvement of facial skin dryness at 4 weeks. The satisfaction index for skin condition, obtained by using a visual analog scale, showed a notable improvement after the study. The results indicate that these skin care cosmetics are safe and useful for patients with contact dermatitis and/or atopic dermatitis.

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