We report an autopsy case of Paget's Carcinoma with brain metastases. A 72-year-old man presented with irregular erythema consisting of hyper- and hypo-pigmented macule and ulcerated red nodule on the left inguinal region. He was diagnosed with Paget's carcinoma by skin biopsy. The biopsy specimen showed numerous lymphatic ducts fulfilled with Paget cells in the dermis. ¹⁸F-FDG-PET-CT examination demonstrated multiple metastases to lymph nodes and bones superior to the inguinal region. Initially, multiple metastatic lesions seemed to disappear after several courses of chemotherapy. However, the tumors recurred and metastasis spread to the brain within 1 year after initiating comprehensive treatment. An autopsy was performed with written informed consent from the family and these findings suggest how Paget cells metastasized especially to the lung and brain in this patient.Skin Research, 9: 229-236, 2010

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A 54-year-old Japanese male patient with thymoma had been treated with prednisolone and tacrolimus (Prograf^®) since 2004 for symptoms of myasthenia gravis. He eventually showed weakness in his cervical muscles as well as dyspnea, and was hospitalized in the Neurology ward in 2006. One month later, an eruption consisting of small erythema multiforme-like lesions appeared on his trunk, with swelling and fiushing of the face. He was referred to the Dermatology department where he was diagnosed as having a drug eruption. All medications other than prednisolone and tacrolimus were discontinued, yet the eruption spread accompanied by oral and conjunctival involvements, developing into Stevens-Johnson syndrome (SJS). Steroid pulse therapy and high dose immunoglobulin therapy was administered without response. However, the eruption quickly faded after discontinuing tacrolimus. We concluded that SJS was induced by tacrolimus (Prograf^®) in a patient with immunoabnormality due to thymoma.

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A 63-year-old woman who had noticed occasional melana over 5 months demonstrated a black-brown colored and irregular macule on the perianal region that was initially detected by another hospital. She was referred to our department for further examination under a suspicion of melanoma in situ. In addition to perianal irregular pigmentation, a colonoscopic examination showed an irregular-shaped red-to-brownish nodule with white moss on the surface and irregular pigmentation of the bottom over the dentate line. The lesion was 18mm in diameter and histologically diagnosed as the mucosal type of malignant melanoma based on concurrent mucosal biopsy. Since ¹⁸F-FDG PET CT scan suggested metastases to the right obturator lymph nodes but not to distant organs, rectal amputation with extensive lymph node dissection was performed. Tumor thickness of the resected melanoma was 16mm and the post-surgical stage was pT4bN3aM0, Stage IIIA, according to AJCC 2002. Sequentially, the patient received adjuvant chemotherapy with DTIC, CDDP, with the addition of oral Tamoxifen, which is an antagonist of estrogen receptor. Recent reports show that estrogen receptor is expressed in melanoma and its signaling may be associated with the growth of melanoma cells. Because 10-20% of tumor cells in the present case were positive for estrogen receptor, an antagonist of estrogen receptor was diurnally administered. We present a case of advanced melanoma arising in both the anal and rectal regions and discuss the clinical effect of hormone receptor antagonist on malignant melanoma with estrogen receptor expression.Skin Research, 9: 244-249, 2010

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We report a case of folliculitis decalvans. A 59-year-old woman presented with erythema and hair loss on her parietal scalp, which had initially appeared 5 months earlier. The first medical examination showed 4cm, erythema and hair loss on her parietal scalp. Several hairs existed in a single hair follicle (tufted hair). Histopathological examination showed perifollicular infiltration of inflammatory cells and destruction of the follicular wall. We diagnosed this patient as having follicular decalvans with tufted hair.Skin Research, 9: 250-253, 2010

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An 83-year-old Japanese female developed three erythematous nodules with pus discharge on her right forearm. The sporotrichin test was positive. Histological examination of a biopsy specimen showed granuloma with dense mixed cellular infiltrate containing Langerhans giant cell, asteroid body of the dermis and subcutaneous tissue. Periodic acid-Schiff (PAS) reaction demonstrated PAS-positive fungal elements. She was treated with oral potassium iodide (300-900mg/day) and topical hyperthermia for 3 months and the lesion was resolved, although it left a scar. In this case, Sporothrix schenckii in the lesion was confirmed by direct PCR. A PCR-based method is useful for the early diagnosis of sporotrichosis.Skin Research, 9: 254-259, 2010

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Using an Internet questionnaire, we investigated the effects of medical consultation for pruritus and the degree of patient satisfaction with physicians' explanations. Among adults and children with pruritus, 42% (2,242pts/5,322pts) and 60% (969pts/1,618pts) consulted medical doctors, respectively. Among patients seeking medical consultation, 56% of adults and 44% of children chose a general practitioner specializing in Dermatology. Fifty-five percent of adults and 62% of children did not change their initial doctor, whereas the other patients did consult more than 3 doctors on average. Regarding physicians' explanations, 66% of adult patients were satisfied with explanations from a general practitioner specializing in Dermatology. Patients required doctors to provide tips for preventing or ceasing itch in daily life and an appropriate explanation may improve patient satisfaction.

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Using an Internet questionnaire, we compared degrees of satisfaction and outcomes between patients consulting doctors for pruritus and patients purchasing over the counter (OTC) drugs. Doctors prescribed oral drugs for pruritus to 60% of patients with itching. Among these, 60% expressed satisfaction with the oral drugs and recognized effects obtained from these agents. Eighty-five percent of patients with urticaria indicated that topical drugs are effective and 70% expressed satisfaction with these agents. We considered that topical drugs exhibited high psychological and physical effects on itching, in addition to their pharmacological effects. When patients with itching purchase oral or topical drugs OTC, only 25% of adults and 12% of children received an explanation from the pharmacist. Adults purchasing OTC drugs expressed the same degrees of satisfaction as those receiving prescribed drugs. Compliance of adult patients with prescribed and OTC oral drugs was as high as 60%. However, the compliance for prescribed and OTC topical drugs was as low as 39% and 26% in adults, respectively. Patients showed a tendency to use topical drugs when they felt an itching sensation. Topical drugs for urticaria may provide satisfaction for patients with pruritus, in addition to their pharmacological effects. Skin Research, 9: 271-281, 2010

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Using an Internet questionnaire, we examined the effects of oral drugs for itching on daily life and clarified the factors related to antipruritic medication that satisfy patient expectations. Among adults receiving prescribed oral drugs, 32% complained of sleepiness and half of these patients indicated that sleepiness decreased their efficiency at work or caused unconsciousness. Patients with itching desired an antipruritic that could be taken once a day, had a low manifestation of sleepiness, strong anti-itch effect and was easy-to-take in daily life. However, our survey indicated that over 80% of both adults and children with pruritus did not know of any antipruritics with a low frequency of causing sleepiness. Moreover, approximately 40% of patients wanted a tablet that could be taken without water (for example, Reditabs), if such a tablet existed. Dermatologists should be aware these patient expectations regarding antipruritics and prescribe drugs to each patient according to the needs of their life style.Skin Research, 9: 282-290, 2010

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