We examined the effects of cutaneous itching on daily life through an Internet questionnaire. Overall, 29,497 adults and 9,423 guardians of children participated in the study ; 5,322 adults (21.4%) and 1,618 children (17.2%) had itching with skin eruptions. Adults (42.1%) and children (59.9%) had visited medical doctors, including dermatologists, respectively. On the other hand, adults (3.4%) and children (2.2%) had complained of itching without skin lesions. In their daily life, adults with itching confessed to being “irritated/impatient”(27%) and having “inefficient work or study”(18%). Children with itching had sleep disruption (27%). Dermatologists should realize that itching disturbs patients’ concentration.

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A 52-year-old Japanese man presented at our hospital with low-grade fever, swelling on the right side of the chin, and purpura with blood blisters on the four limbs and hip. Based on the high inflammatory reaction shown by laboratory data, he was diagnosed as having Henoch-Schönlein purpura caused by facial cellulitis, and the pathological examination demonstrated leukocytoclastic vasculitis. Antibiotics were effective for cellulitis, but new purpura developed ; therefore, we started prednisolone (20mg/day), which improved his skin condition. Thereafter, he complained of abdominal pain and hematochezia. Because factor XIII activity was 72%, we administered factor XIII concentrate and increased the prednisolone dose to 60mg/day. There was no obvious discharge, so we decreased prednisolone to 40mg/day. He suddenly developed a massive hemorrhage, causing hemorrhagic shock. Pulsed steroid therapy was not effective, but plasmapheresis markedly improved his abdominal condition. Plasmapheresis is a useful tool to treat severe gastrointestinal symptoms of a non-responder to steroid therapy.

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A case of regression of hobnail hemangioma after incisional biopsy is reported in a 31-year-old woman. She presented with an asymptomatic cutaneous lesion on the right temple which had been noticed for about two months without a preceding lesion or history of trauma. Physical examination revealed a 9×7mm violaceous nodule surrounded by ill-defined erythema. Incisional biopsy showed an increase of dilated capillaries with occasional papillary projections and prominent endothelial cells with a hobnail appearance in the superficial to mid-dermis. Slit-like vascular channels were also seen to dissect collagen bundles. Many red blood cells extravasated to the stroma and there were hemosiderin deposits in peripheral areas of the lesion. Although the nuclei were of various sizes, there were few mitoses. Immunohistochemically, the endothelial cells were positive for CD31 and CD34, but negative for Factor VIII-related antigen and D2-40. Six weeks after incisional biopsy, peripheral erythema disappeared and the nodule was less conspicuous. Histopathology of the resected nodule showed lympho-histiocytic infiltrate, the proliferation of dilated capillaries and fibrosis. Irregular vascular spaces were rarely found and no atypical cells were noted. The clinical course and histopathologic findings were considered to represent the regression of hobnail hemangioma after incisional biopsy.

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A 70-year-old man presented with an area of scarring alopecia measuring 5×8 cm with tufts of hair over the parietal to the right occipital region. At the age of 50, the patient had received a ventriculo-peritoneal shunt for hydrocephalus after an aneurysm of his right vertebral artery.
About one year after that operation, he developed a pustule-like eruption in the parietal area where a cerebral ventricle catheter had been placed. Since then he had undergone various kinds of treatment unsuccessfully.
Culture plates grew Staphylococcus aureus. The patient was successfully treated with topical clindamycin, butyric acid propionate betamethazone and oral roxithromycin and has improved.

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A case of necrotizing fasciitis caused by Aeromonas hydrophila is reported in a 54-year-old man who had been treated for hepatitis B virus-related liver cirrhosis. He developed fever and general fatigue three days after he ate sashimi (raw fish). The next day, at the first visit, there was painful swelling with faint and ill-defined erythema on the left leg and a fingertip-sized purpura on the posterior aspect of the leg. The day after the first visit, the eruption on his leg worsened markedly. There were multiple hemorrhagic bullae and purpura on the diffusely swollen leg. An emergency operation was performed because he was in shock. Aeromonas hydrophila was identified from blood and tissue culture. Intensive care with imipenem, pazufloxacin, polymyxin b-immobilized fiber hemoperfusion etc. recovered the endotoxin shock and infection; however, he died of hepatorenal syndrome 21 days after the first visit. Aeromonas hydrophila infection in patients with liver cirrhosis has a high mortality rate. It is therefore crucial to instruct these patients to avoid eating raw fish.

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Melasma is an irregular brown or grayish-brown facial hypermelanosis, often affecting women, and is difficult to treat and easy to relapse. We evaluated the effectiveness of a covering foundation “PERFECT COVER Foundation PS (PS)” (Shiseido Co., Ltd) for patients with melasma.
Twenty patients applied PS to cover facial melasma for two consecutive weeks. Skindex-16 was used to evaluate the extent of quality of life and patient satisfaction was assessed using the visual analogue scale (VAS).
The scores of Skindex-16 and VAS were significantly improved after two-week usage of PS (p=0.003 and p‹0.001, respectively). In Skindex-16, the emotion score was greatly decreased by using PS (p=0.002). No side effects were seen during this investigation.
In this study, it is concluded that the make-up effect using PS improved QOL in patients with melasma.

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