The patient was a 61-year-old Japanese woman with a history of allergic rhinitis. She had purpura, blood blisters, and erythema with edema on both lower thighs, and associated numbness. Laboratory studies revealed elevation of the peripheral blood eosinophil count, and MPO-ANCA was positive. The skin biopsy specimen showed necrotizing vasculitis and a high-density, eosinophilic leukocytic infiltrate. She was therefore diagnosed as having Churg-Strauss syndrome. Combination therapy with corticosteroid and cyclophosphamide was started in the early stage; however, severe peripheral neuropathies involving multiple mononeuritis with predominantly sensory symptoms continued even though the eruptions disappeared. Because steroid monotherapy may sometimes not achieve remission of clinical symptoms, combination therapy with corticosteroid and immunosuppressive agents should be immediately considered before vasculitic symptoms progress.

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A 32-year-old woman with a history of abortus habitualis started drug therapy of aspirin and heparin calcium in her fourth pregnancy. One month after starting the subcutaneous injection of heparin calcium, infiltrated erythematous plaques with skin necrosis developed on her abdomen and thighs. Using skin tests, we diagnosed a delayed-type hypersensitivity reaction to heparin calcium. Cross-reaction with other heparins was unclear. There are few case reports of heparin-induced delayed-type hypersensitivity skin reactions in Japan. We considered the mechanism and the choice of alternatives.

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A 26-year-old man visited our hospital because of erythema on his face, which is resistant to any treatments. Histopathological examination revealed that hair follicles and sebaceous glands are dilated and vacuolated. Deposits in the follicles stained light blue by Alcian blue staining. Therefore, we diagnosed this case as follicular mucinosis. After skin biopsy, his erythema disappeared in 10 days without any treatments. For these 23 years, 43 cases of idiopathic follicular mucinosis have been reported in Japan. We examined the effect of each treatment in these cases including our case.

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A 63-year-old man had first noticed a dark nodular growth on his left leg about 10 years previously, but reported that it seemed to have grown rapidly over the past few years. He consulted our clinic on June 9, 2008, and was diagnosed as having basal cell carcinoma, solid type, forming a polypoid nodular lesion based on skin biopsy findings. The lesion was resected with a 5mm margin. A lesion with a polypoid or pedunculated clinical appearance, pathologically demonstrating basal cell carcinoma, nodular-ulcerated type, has recently been proposed as a clinicopathological variant, polypoid BCC, reported first by Megahed. Polypoid BCCs have been reported to arise in more unusual non-sun-exposed locations, and develop more frequently in females than common BCC. There is no clear etiology despite various theories, for example, a response to external stimulus etc. on the mechanism underlying polypoid BCC.

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We report a case of congenital self-healing reticulohistiocytosis (CSHRH) in a premature baby girl. She was born generally healthy by cesarean section at 32 weeks' gestation with a weight of 1,248g. She presented with 3 to 5mm diameter, red-brown ulcerated and crusted papules scattered on her face, limbs, and buttocks since birth. She had neither organomegaly nor lymphadenopathy. Blood and X-ray examinations showed normal findings.

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A 58-year-old man had an egg-sized subcutaneous nodule which had developed on the right thigh 17 years previously. The nodule volume enlarged in summer but reduced in winter. We performed ultrasonography of the nodule before total resection. Histopathological examination revealed a parasitic body in the adipose tissue, which had several characteristic features of plerocercoid and granulomatous changes with infiltration of eosinophils around parasites. From these findings, a diagnosis of Sparganosis mansoni was made. The serum titer against plerocercoid, as measured by ELISA, was high in the serum 14 days after total resection, and decreased 6 months after resection. From these results, the plerocercoid was estimated to have lived in his body for 17 years.

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The efficacy of cetirizine hydrochloride dry syrup and patients' satisfaction with the drug were investigated in 77 adult patients with urticaria, eczema and so on using a questionnaire on adherence. Overall, 67% of patients reported that the dry syrup was easy to take, and 83% took it regularly. Efficacy of the treatment was evident in 83% of patients, and 89% did not feel somnolent. Only 40% of patients hoped to be prescribed tablets instead of the dry syrup formulation. These results suggest that cetirizine hydrochloride dry syrup is a highly useful medication for patients.

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