Repetitive exposure of the skin to UVA radiation elicits sagging more frequently than wrinkling, which is mainly attributed to the biochemical mechanism involved in up-regulating the expression of matrix-metalloproteinase (MMP)-1 and skin fibroblast elastase (SFE), respectively. In this study, we used real-time RT-PCR, Western blotting and enzymatic activity assays to examine the effects of an antioxidant, flavin mononucleotide (FMN), on the induction of MMP-1 and SFE by exposure of cultured human dermal fibroblasts to UVA. UVA radiation elicited a significant increase in the gene expression of MMP-1 as well as SFE, which was followed by distinct increases in their protein and enzymatic activity levels. The addition of FMN at concentrations of 0.2-5μg/ml immediately after UVA exposure significantly attenuated the induction of MMP-1 and SFE expression elicited by UVA at the gene, protein and activity levels. These findings suggest that FMN would offer a significant benefit in protecting against UVA-induced skin photo-aging effects such as sagging and wrinkles.

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In this study, sixteen healthy male volunteers were enrolled in drug-induced lymphocyte stimulation test (DLST) for two kinds of Kampo medicines (Shosaikoto, Maobushisaishinto) and four medical herbs including, Saiko (Bupleurum root, Bupleuri radix), Ohgon (Scutellaria root, Scutellariae radix), Mao (Ephedra herb, Ephedrae herba), and Houbushi (Processed aconite root, Processi aconiti radix). As a result, stimulation index values over 181% were observed for Houbushi in 14 cases, for Saiko in 8 cases, and for Shosaikoto, Maobushisaishinto and Ohgon in 5 cases each. All patients showed a negative reaction to Mao. There was no relationship between history of medication for each Kampo medicine and the results on DLST. These findings indicate that DLST for Kampo medicines or medical herbs may show some false positive or negative reactions. Therefore, this possibility should be kept in mind when diagnosing a drug eruption thought to be due to Kampo medicine.

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A 62-year-old woman demonstrated infiltrated erythematous macules with itching on her back and upper extremities that had persisted for a few years. Histology of erythema on the back was compatible with erythema multiforme. She was treated with mometasone furoate, paramethasone, and loratadine, but the eruptions were not controlled. Because of recurrent herpes simplex on her buttock over the past several years, the diagnosis of herpes-associated erythema multiforme was made. Continuous suppressive therapy with valaciclovir effectively suppressed attacks of recurrent herpes simplex and erythema multiforme.

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At a gynecological clinic, a 64-year-old female was prescribed Holin^®-V vaginal tablet for atrophic colpitis. Within a few minutes after inserting the tablet into her vagina, she felt sick and erythematous macules developed over her whole body, and then angioedema of the throat, clouding of consciousness developed 30 minutes later. The symptoms disappeared immediately after washing of the vagina and injection of intravenous methylprednisolone. Prick testing for ingredients of Holin^®-V vaginal tablet showed a positive reaction for macrogol 6000 and negative reactions for estriol and stearic acid magnesium. Based on these results, we diagnosed this patient as having anaphylaxis due to macrogol 6000.

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A 76-year-old woman presented with a painful induration and swelling of her left nipple, which developed after receiving a hard blow on August 2009. There were no abnormalities on mammography performed at a local clinic in September. She was referred to our department after failing to respond to the treatment under a tentative diagnosis of hypertrophic scar. Examination demonstrated a dark brown induration on the left nipple. Neither erosion nor secretion was observed. Skin biopsy demonstrated adenocarcinoma. On ultrasound examination, an irregular shaped, hypoechoic lesion, 6×6×4mm in size, was detected directly beneath the nipple. Although an enhanced lesion at the same site was observed on CT, there were no other findings such as distant metastases. The patient was diagnosed as having primary breast cancer localized to the nipple, and underwent modified radical mastectomy. Pathological findings at mastectomy demonstrated infiltrating ductal carcinoma, specifically papillary ductal carcinoma. Ductal carcinoma originating in the nipple is rare, and only 19 cases have been reported in Japan to date.

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Two cases of systemic plasmacytosis are reported. Case 1: A man in his sixties consulted our hospital complaining of a two-year history of red-brown macules on his face and trunk. He had a swollen lymph node in the left groin. Skin and lymph node biopsy samples showed polyclonal plasma cell infiltration. The level of IgG was increased to 2,702mg/dl. He was followed without any treatment for the first two years but started on oral prednisolone 15mg/day two years after the initial examination. The patient had neither fever nor general fatigue during the course. The LDH levels have gradually decreased and the lowest level was 100IU/l. Case 2: A man in his fifties presented with a 4- to 5-year history of red-brown macules on his trunk, which had increased in size and number, and was accompanied by fever and general fatigue. Skin biopsy showed plasma cell infiltration in the dermis and the level of IgG was increased to 5,100mg/dl. Chest CT demonstrated ground-glass opacity in the right lung, which was compatible with lymphocytic interstitial pneumonia. He was started on oral prednisolone 15mg/day; fever and general fatigue disappeared but the skin eruptions did not respond to treatment. The lowest level of LDH was 102IU/l. According to previous reports, enzyme activity of LDH may be partly inhibited by overproduction of immunoglobulin via LDH-immunoglobulin complex. Therefore, LDH may be a marker that correlates with the disease activity of systemic plasmacytosis.

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We reported three cases of papular tuberculid after receiving Bacille Calmette-Guerin (BCG) vaccination. Case 1 was a 5-month-old girl who developed eruptions on her extremities five weeks after the BCG vaccination. Case 2 was a 6-month-old boy who developed eruptions on his extremities one month after the BCG vaccination. Case 3 was a 5-month-old boy who developed eruptions all over his body 6 weeks after BCG vaccination. Histopathologically, dermal perivascular lymphocytic inflammatory infiltrate and non-caseous epithelioid cell granulomas were observed in all cases. We diagnosed these cases as papular tuberculid resulting from BCG vaccination. All lesions resolved in three months without treatment. To establish the diagnosis when discrete eruptions are observed in a child under one year old, it is important to ask the guardians about the time of BCG vaccination.

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