Recently, the necessity of disinfection before and after surgery in various fields has become controversial. There is no report to which EBM is satisfied in the dermatology field. In this study, we investigated whether the intraoperative use of a non-sterilized gloves and the presence or absence of postoperative disinfection/antibiotic therapy influence postoperative infection over a 1-year period. As a result, Of the 240 patients, 189 could be treated according to the protocol, excluding 51 who dropped out. Of the 189 patients, postoperative infection was suspected in only 1 during the study period. Thus, postoperative infection did not occur regardless of gender, age, site, season, or surgery with non-sterilized gloves. There was no marked difference in its incidence between the two groups, suggesting that there is no influence of the presence or absence of disinfection after minor surgery at the outpatient clinic of the Department of Dermatology(restrict to biopunch^® use of 5mm or less), postoperative antibiotic therapy, nor the intraoperative use of non-sterilized gloves on the incidence of postoperative infection.

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Here we show a case of Sweet’s disease combined with essential thrombocythemia, that is one of myeloproliferative disorders(MPD).
A 76-year-old man, having endured persistent severe thrombocythemia without any essential disease for two years, came to us because of a fever and an ache in the nape of neck accompanied by the skin eruption on the face. Blood tests revealed that the number of neutrophils and platelets remarkably increased and c-reactive protein elevated. His skin lesions were a few raised dull-red-colored painful plaques on the face. A skin biopsy showed a dense infiltrate of neutrophils in the dermis. The bone marrow profile was well-matched to essential thrombocythemia. According to these results, his disorder was diagnosed as Sweet’s disease combined with essential thrombocythemia. With a combination of predonisolone, hydroxyurea and antibiotics, the skin eruption disappeared immediately but never recurred although the effect was unreliable on his hematological disorder and c-reactive protein.
We think that in our case Sweet’s disease was onset by an infection to the patient having been carrying essential thrombocythemia.

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Case 1: A 64-year-old woman, with a history of advanced gastric cancer and post-operative pleural effusion treated by antibiotics presented with the sudden onset of progressive palpable purpura on her lower extremities.
Case 2: A 78-year-old woman who had artificial dialysis due to chronic renal failure and had antibiotics for unknown fever and elevated C-reactive protein, presented with the sudden onset of progressive palpable purpura on her bilateral legs and feet. Laboratory data revealed some elevated tumor makers. Aspergillosis antigen was positive. CT of the chest showed mediastinal lymph node swelling.
Histopathologically, the findings of leukocytoclastic vasculitis were observed in skin biopsy specimens of two patients, and direct immunofluorescence studies showed depositions of IgA and complement 3 in superficial dermal blood vessels.
Triggers of anaphylactoid purpura may be some of malignancy, surgery, infection, chronic renal failure. Importantly, we should consider anaphylactoid purpura in elderly patients to be one of the dermadromes of internal malignancy.

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The appearance of a discoid lupus erythematosus-like eruption induced by TS-1^® is reported. A 72-years old man with pancreatic cancer was treated by TS-1^® 120mg per day. Twelve weeks after administration of TS-1^®, the eruption developed on the face. A skin biopsy specimen taken from the cheek site showed hyperkeratosis, follicular plugging, vacuolar degeneration of basal layer, and an infiltration composed mainly of lymphocytes around the vessels and follicles of the dermis. IgA, IgG, IgM, and C3 were deposited on the basement membrane by direct immunofluorescence test. A patch test of TS-1^®, tegafur, gimeracil, and oteracil potassium was negative. The lymphocyte stimulation test was also negative. After discontinuation of the TS-1^®, the eruption was improved within about 2 weeks.

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A 50-year-old man was referred for further treatment of refractory pressure pain and papules on the glans penis. The lesion onset was 18 months earlier. From the clinical features and the positive result of the tuberculin test, we suspected penis tuberculid. However, tubercle bacillus was not detected in cultivated effusion and urine samples, and its DNA was not detected by PCR using effusion and tissue samples. Pathological examination of tissue demonstrated an epithelioid cell granuloma without caseation necrosis. A oral combination of isoniazid, rifampicin and ethambutol for 4 months was given, with scar formation. Orally administered antituberculous were continued for 6 months. A nodular lesion appeared at the base of penis the 14 months after therapy commenced. The lesion was diagnosed as induratio peins plastica.

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Metals, especially nickel, have been commonest contact sensitizers from various daily necessities and accessories today. Patients suffering from contact dermatitis are so many that prevention of the dermatitis is necessary. Ion plating is a new industrial technique to seal metal ions in the metal goods, and it was successful to prevent wristwatch dermatitis with metal hypersensitive patients in 1992. This is the second report on the effect of ion plating on the necklaces as prevention for contact dermatitis due to metals. 23 metal hypersensitive patients, among which 22 were sensitized by nickel, agreed to use IP-treated necklace everyday for a month, without using other necklaces. Results: nobody produced dermatitis around the necklace area, when the skin was examined a month later. It is concluded that ion plating is recommendable as a prevention of metal allergies hereafter.

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The insurance claim for house call by a dermatologist is reported. Though it is very complicated and elusive, I explain the insurance claim briefly. Additionally, I report the practical calculation examples and a long-term care insurance.

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Hino clinic is a general out-patient clinic of internal medicine, orthopedics, dermatology, allergology, ophthalmology, urology, rehabilitation, artificial dialysis and plasma exchange. I can concentrate consultations by aids of a nurse and a driver during home visits. Between Jan 2006 and Aug 2007, we visited 10 patients at home and 47 patients at nursing home average monthly. Eczema, dermatitis and tinea were commonest diseases.

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A lot of various problems would happen when you visit nursing home, hospital, or personal home. There are many people, kakaritsuke-doctor, visiting nurse, care worker, engage in home care. They are concerned with home care both medical treatment and care. You must be concerned with not only the patient and there family but also all of them.

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Facial aging is perceived by some to be an inevitable outward sign of the aging process. Treatments may offer social, personal and professional advantages. Over the last decade numerous new treatment modalities have emerged which allow the use of minimally invasive and often non-surgical approaches to rejuvenate the aging face. The development of different novel types of lasers leading to non-ablative and resurfacing laser skin rejuvenation, often in combination with vascular and pigment specific lasers, enable the skilled practitioner to offer realistic non-surgical techniques to rejuvenate the face.
There are numerous benign pigmentation disorders that can lead to the appearance of increased facial aging. These include solar lentigo, pigmented seborrheic keratoses, melasma and facial melanosis from other causes. Laser therapy may be used to treat most facial pigmented lesions, but may prove disappointing for diseases such as melasma. Even now, topical hydroquinone application is the gold standard therapy for melasma. Therefore, accurate diagnosis is the key to success in the laser treatment of freckles.
There are many resurfacing techniques available, including lasers, chemical peeling, and topical retinoids. These techniques are useful for reduction of wrinkles. However, injection therapies with collagen, hyaluronic acid, and botulinum toxin are more effective and safer for wrinkle reduction, although they do not have any long-lasting effect.

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