During April - July, 2007, 79 cases of skin damage accompanied by leakage from a gastrostomy catheter were examined in our department. Of these, we performed a long term study of 6 cases in which leakage was highly apparent. We fixed the gastrostomy catheter in a vertical position. We anticipated that the damaged skin would improve with reduction in the pressure caused by the gastrostomy catheter tube on the skin. We think that this position reduced leakage from the gastrostomy catheter . Of the 6 cases, skin damage improved in 5 without using steroid ointment; the only case in which there was no improvement had a button-type gastric tube.

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Persistent serpentine supravenous hyperpigmented eruption (PSSHE) is the term to describe this peculiar eruption caused by intravenous cytotoxic drug without any evidence of superficial phlebitis or extravasation of drug. We experienced 2 cases of PSSHE which could be caused by infusion of docetaxel. In the first case, skin biopsy specimen demonstrated the deposit of melanin on basal layer, incontinence of pigment and infiltration of lymphocytes in upper dermis. Direct cytotoxity for endothelial cells of blood vessels is the most likely pathogenetic mechanism. With wide-spread use of these drugs in treatment of malignancies, the number of this disease could be increased. The accumulation of cases is needed to elucidate the mechanism.

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We report a case of Hailey-Hailey disease characterized by a granular appearance. A 70-year-old man had erythema and erosion in the groin. He was diagnosed as Hailey-Hailey disease based on clinical and histopathological findings. About five years after the first examination, the numerous papules appeared bilaterally in the groins, leading to the granular appearance. Histological findings of the swelling portion of a papule revealed irregular epidermal thickening without acantholysis. Two-months’ treatment with maxacalcitol ointment cleared the skin lesion.

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Juvenile generalized pustular psoriasis (GPP) is a rare, sometimes recurrent and fatal skin disease. An acute, severe form of juvenile GPP would require systemic therapy utilizing etretinate, cyclosporin, and glucocorticoid. However, long term use of those therapetic agents cause adverse side effects.
We report a case of 2 year old boy who had developed GPP. He was treated topically with low dose active vitamin D₃, tacalcitol ointment for his pustular eruptions. Two weeks later, pustules cleared and erythema subsided.
Unfortunately, safety therapeutic guidelines for children suffering from GPP have not been well-established. Active vitamin D₃ ointment is reported, a choice for the treatment of childhood GPP. Its use for the treatment wider leisions might cause hypercalcemia. We think that active vitamin D₃ is useful for the limited leisions of childhood GPP.

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A 23 year-old woman presented with a slowly growing nodule on her right chest. In the physical examination, we found a tan nodule measuring 15×11mm on her right chest. Histopathologically, a well-circumscribed lobular tumor with solid and cystic structures was present in the dermis. Majority of the tumor cells were clear cells and epidermoid cells. In addition, occasional ductal and cystic structures were present, and they were lined by mucinous cells. We diagnosed the tumor as a clear cell hidradenoma with mucinous cells.

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A 37-year-old woman had noticed a nodule 15 years previously on the scalp. She presented with a tumor of 10cm in diameter together with multiple cutaneous or subcutaneous tumors around it. Magnetic resonance imaging showed no invasion of tumors into the cranial skull. A surgical excision and free skin graft under general anesthesia was performed. Histological examination revealed the nest of spindle cells with no atypia arranged in a storiform pattern in the dermis to subcutaneous tissue. The tumor cells were CD34 positive, so we diagnosed it dermatofibrosarcoma protuberans (DFSP). Scalp is very uncommon lesion for DFSP.

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A 33-year-old black male from Africa consulted our department, complaining of exanthema with pruritus and pain involving the occipital and nuchal regions, which had persisted for a few years. On the initial consultation, uloid papules and nodules were observed in the occipital and nuchal skin regions. The enlargement of these papules resulted in the formation of flat and uloid plaques. Histopathological findings of biopsied specimen from a papule showed the growth of collagen fibers arranged in parallel to the skin surface in all layers of the corium. The clinical symptoms and histopathological findings suggested acne keloidalis. Five months of oral roxithromycin administration along with five intraregional injections of triamcinolone acetonide resulted in flattening of the skin lesions and disappearance of subjective symptoms. This is a typical case of acne keloidalis, which occurs most often in young African men. The likelihood of encountering such cases in Japan may be increased due to the recent internationalization.

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Twenty-seven patients consulted the Higashi Dermatology Clinic for treatment of dermatophytosis caused by Trichophyton tonsurans from April 2002 to March 2007. Two of the 27 patients were re-infected the next year, making the total number of 29. Twenty-three patients were in the second decade of life. The oldest patient was 64 years of age, and the youngest 12 years of age. Twenty-five patients were Judo players. The other two patients were a badminton player and soccer player. Durations of disease were as follows: more than six months in 5 patients, 4 months in one patient, 3 months in 3 patients, and less than one month in 20 patients.The patients treated with topical antimycotic cream exhibited large-spored endothrix infection of vellus hair on direct scraping. It apeared that oral administration of antimycotics was required for treatment of dermatophytosis caused by Trichophyton tonsurans. Treatment was therefore carried out with antimycotics orally and topically.

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We report a case of leprosy. A 35-year-old Filipina presented with a painless leg ulcer. Physical examination showed hypoesthesia of right upper and lower extremities, and many hypopigmented spots on the back. A histological examination of the hypopigmented spots showed infiltration of inflammatory cells around neural tissue, sweat glands and hair follicles. Fite stain revealed acid fast bacilli and PCR method showed a 157bp band which was specific of Mycobacterium leprae. A diagnosis of BL-type leprosy was made and multi-drug therapy according to WHO guideline was started. With attention to leprae reactions and adverse effects of the medicine, she is followed up once per month as an outpatient.

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To evaluate the effects of the herbal mix Kamishoyosan-goshimotsuto KGS1 on facial peripheral blood flow and skin conditions, a clinical study was conducted for 12 weeks in 11 women having skin troubles (poor complexion, spots, dryness, etc.) and signs of Ketsuo or Ketsukyo (concepts of traditional Chinese medicine).
One woman dropped out of the study due to private reason. In the remaining 10 women, blood flow increased significantly following treatment with the herbal mix, and significant alleviation of coarse skin (horny layer moisture, percutaneous moisture evaporation and skin texture score) and improvement in spot brightness and skin elasticity were observed.
These results suggest that Kamishoyosan-goshimotsuto KGS1 may improve skin conditions, possibly by its increased peripheral blood flow.

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We evaluated the effect, safety and texture of stabilized-hydroquinone preparation in this study. Macroscopic evaluation by volunteers and dermatologists showed bioengineering attenuation of pigmentation concomitant with improvement of value L∗ and color at pigmented sites. On the other hand, the preparation evoked slight or moderate, not persistent, irritation such as erythema and discomfort in some cases at the beginning of the examination. The volunteers were satisfied with the texture of the preparation as a cosmetic product. Taken together, these results indicated that the preparation has efficacy, relative safety and good texture.

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