Hansen’s disease, leprosy, is one of infectious diseases caused by Mycobacterium leprae. Infection occurs in young age when M. leprae is inhaled through the respiratory tract upon exposure to leprosy patients discharging a large number of bacilli.
Recently, there are about 10 new patients per year, and non-Japanese patients (imported cases) have been on the increase since roughly 1991, counting about 8~10 patients per year. It is, therefore, anticipated that there will be no leprosy patients among Japanese in near future. Non-Japanese patients, however, appear among a large number of employees.
The multidrug therapy (MDT) has been recommended by WHO. In Japan, MDT has been modified by adding other drugs or prolonging the medication period.
Leprosy patients used to develop deformities of appearances and extremities, and thereby suffered from prejudice and discrimination. Even nowadays, this line of hostility can still be seen.

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It is well known that tranexamic acid (TA) and sodium L-ascorbyl phosphate (APS) are used as medicines for pigment spots. Since their pharmacological mechanisms are different, the concomitant use of these medicines was expected to be more effective. Because anodal and cathodal iontophoresis were effective for TA and APS, respectively, the sequential effect of iontophoresis was investigated. When the anodal iontophoresis for TA was performed after the cathodal iontophoresis for APS, the APS concentration in epidermis decreased remarkably. When the sequence of iontophoresis was reversed, no remarkable change of TA or APS was found. The results suggested that the sequence of applied electric field can affect the permeation rate of medicine into the skin.

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On the third day after completion of 15-day oral administration of minocycline hydrochloric acid (Minomycin^®), edematous erythema over the entire body accompanying breathing difficulty developed in a 39-year-old woman. She was admitted to hospital and treatment with prednisolone (Prednine^®) at 40 mg/day was started. A diagnosis of urticaria type drug eruption caused by minocycline hydrochloric acid was made on the basis of results of pathological histology and reoral tests. To the best of our knowledge, there has been no report on urticaria type drug eruption 3 days after oral administration of minocycline hydrochloric acid. It was thought that characteristic pharmacokinetics of minocycline hydrochloric acid were involved.

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We report a case of pyoderma gangrenosum which developed extensively on the hip and thigh of an 52-year-old male without any systemic associated disease. The lesions were responsive to conventional treatment with systemic corticosteroid. The patient must be carefully observed for the development of systemic complications.

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We report a case of nodular scleroderma in a 58-year-old woman with Overlap syndrome (polymyositis + systemic scleroderma + Sjögren syndrome). At the age of 53, eight months after diagnosis, asymptomatic nodules appeared on her back and gradually increased in number for five years. Multiple normal skin colored or pigmented firm elevated nodules of 2cm in diameter scattered on her shoulders and back. Histopathological findings showed increase of fibroblasts, and whorl-like collagen nest through the dermis. We diagnosed this case as a nodular scleroderma with Overlap syndrome. Along with oral steroid and ciclosporin for Overlap syndrome, topical injection of steroid and oral tranilast were given, but the size and number of these nodules were unchanged. Nodular scleroderma is a rare and refractory disorder, and the mechanism remains still unclear.

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Topical 0.1% tacrolimus ointment was used for treatment of necrobiosis lipoidica that occurred on a lower leg of a patient with diabetes mellitus. The patient was a 53-year-old woman who had been receiving medication for diabetes mellitus type 2. In January 2004, she noticed erythema with palpable induration on the anterior aspect of her right lower leg but left it untreated because the symptoms were not severe. The eruption gradually spread medially and the degree of induration increased, and she visited our department on September 18, 2007. A scaly purplish-red plaque area with board-like induration measuring 90×80 mm with a relatively clear border was seen on the anterior aspect of the right lower leg. A diagnosis of NL was made from biopsy results, and treatment with topical butyric propionic acid betametazon ointment was started. However, there was no change in the degree or area of inflammation and hardening, and the treatment was changed to topical 0.1% tacrolimus ointment treatment. An obvious reduction in the degree of induration was seen 4 weeks after the change in treatment, and the degree of inflammation had decreased at 8 weeks. At 16 weeks after the change in treatment, the erythema had almost completely subsided with only pigmentation remaining.

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A 66-year-old man who had been diagnosed HTLV-1 carrier presented two subcutaneous hard nodules on his centriciput and tempus. Histopathology of the lesion showed dermal dense infiltration of atypical lymphoid cells composed of centroblasts and centrocytes. The tumor demonstrated a clonal rearrangement of immunoglobulin JH gene, but not T cell receptor gene. IgG antibody to the Epstein-barr virus-viral capsid antigen was 5120 times. He was diagnosed as primary cutaneous follicular center lymphoma with HTLV-1 carrier. We suggested that HTLV-1 infection may cause the dysfunction of cytotoxic T cells and may be related with the occurrence of B cell lymphoma.

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Three cases of onchomycosis due to Aspergillus niger are reported. The three patients were females, 68, 72 and 56 years of age, and not immunocompromised host. The lesions were in the thumb nail in all three cases. Clinical findings in two cases showed black discoloration at the tip of the finger beneath the nail plate and distal area of the nail plate. In the other patient at first visit, the nail plate was broken by her doctor artificially. In the course of illness, onycholysis and paronychia of the thumb nail had developed in all three cases. After partial removal of the nail plate using nail-scissors in the three cases, microscopic examination of scrapings from the nail bed revealed large numbers of broard filaments terminating in spherical vesicles from which sterigmata and conidiospores extended. The conidiospores were dark brown. Materials from the nail bed in the three cases were inoculated on Sabouraud’s media. Aspergillus niger was cultured in all three cases. In one of the three cases, histological study of the removed nail revealed fungal elements in the subungual keratin layers, but none in the nail plate.

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A 71-year-old male had suffered from painful dark red nodules on his right leg for three months. He had chronic hypersensitivity pneumonitis treated with prednisolone(10mg/day) and diabetes mellitus caused by steroids. He sometimes cultivated the land on the hill for fun. Culture of a skin biopsy specimen from the nodule yielded white colonies after five days, and DNA -DNA hybridization revealed that these were Mycobacterium chelonae. The patient was treated with levofloxacin 300mg/day and clarithromycin 400mg/day, which successfully improved his conditions. Recently, clarithromycin has become recognized as an effective agent in the treatment of cutaneous M. chelonae, and it was also effective in our case. Further discussions are needed to decide when to stop medication without recurrence.

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We investigated efficacy and safety of “BU MOISTURIZING CREAM” on the dry skin in 46 patients with atopic dermatitis and xerosis. After 4-week use of this cream, The dry skin conditions were improved in 80% of patients examined. Side effect was observed in only 2 cases. These results suggest that “BU MOISTURIZING CREAM” is a beneficial moisturizing cream in the treatment of dry skin found in atopic dermatitis and xerosis.

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We compared the effects of underwear made from ethylene-vinyl alcohol copolymer fiber (MEDIELE^®) with those made from cotton on skin condition of atopic dermatitis patients in winter season. This was a randomized, single-blind, crossover study in which the subjects consecutively wore MEDIELE^® and cotton underwear for 4 weeks each. Local SCORAD, skin conductance and transepidermal water loss (TEWL) were measured on the scapular region. There was no difference in local SCORAD and the skin conductance values. An increase of the TEWL value was observed at the endpoint of wearing cotton underwear. On the other hand, the TEWL value was maintained at the same level during the period of wearing MEDIELE^® underwear. Therefore, we concluded the underwear made from MEDIELE^® was useful in maintaining skin barrier function of atopic dermatitis patients in winter season.

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We evaluated the efficacy and safety of Besoften^® Lotion (heparinoid preparation) in 17 patients with atopic dermatitis after 8 weeks of application on their dry skin. The amount of water content of stratum corneum showed a tendency to increase, but this tendency was not significant statistically. The transepidermal water loss decreased significantly 8 weeks after the beginning of the treatment. The scores on dermatological findings of dryness, itching, erythema, desquamation, and scratch marks all improved significantly after 8 weeks of application. Evaluation by VAS (visual analog scale), assessed by the patients, revealed that a moisture condition determined by visual inspection, softness judged by touch, severity of itching, and skin color had a significant improvement after 8 weeks of application. These results suggest that the continuous application of Besoften^® Lotion has a beneficial therapeutic effect in the treatment for dry skin, and provides a high level of satisfaction to patients with atopic dermatitis.

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An evaluation of the usefulness of a body moisturizing gel (CDJ) containing ceramides, amino acids and other sebum-like components was conducted in a four-week usage test divided in two periods. During the first period, in 19 subjects using dry areas of the skin, improvement of clinical symptoms, increases in water content of the stratum corneum and decreases in transepidermal water loss were observed, suggesting improvement of the barrier function and moisture retention function of skin. During the second period in 10 cases focusing primarily on mild inflammatory symptoms of atopic dermatitis, in addition to significant improvements in the aforementioned parameters, reductions in nucleated cells as well as improving trends in other stratum corneum examinations were observed in some cases. These results indicate that the gel used in this study is very useful to improve overall stratum corneum function through continued use, and it is expected to demonstrate effects leading to recovery to normal skin.

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