Akiko Kishioka

Effects of alpha-hydroxy acids on the human skin of Japanese subjects: The rationale for chemical peeling

Alpha‐hydroxy acid (AHA) agents, such as glycolic acid and lactic acid, have been used as therapeutic agents for more than a quarter of a century. Recently, they have been used as agents to rejuvenate photo‐aged skin. It is believed that these AHA agents induce the epidermis to remodel and accelerate desquamation, thus exerting their therapeutic effects. In this study, we investigated the histological differences in skin treated with glycolic, lactic, citric and acetic acids once daily for 6 weeks. The melanin pigments in the basal layer were less prominent in the glycolic and lactic acid‐treated skin than in the citric and acetic acid‐treated skin. The melanin deposits in the horny layers were equal for all AHA. However, the melanin deposits in the squamous layers were less prominent in the glycolic and lactic acid‐treated skins than in the citric and acetic acid‐treated skins; this was analogous to observations of the basal layers. Collagen I and procollagen I were increased after treatment with glycolic, lactic and citric acid in the upper dermis, but were not increased with acetic acid treatment. However, the staining of the epidermis and dermis for matrix metalloproteinase‐1 (MMP‐1) after treatment was not significantly different among the agents. Our data suggest that longer treatment intervals with glycolic and lactic acid can cause improvements in both the epidermal and dermal components and support the usefulness of AHA for rejuvenating photo‐damaged skin.

Phenol peels as a novel therapeutic approach for actinic keratosis and Bowen disease: Prospective pilot trial with assessment of clinical, histologic, and immunohistochemical correlations

BACKGROUND Although chemical peels may be used for precancerous lesions, no histologic or immunohistochemical studies have been performed to validate clinical impressions and/or outcome. OBJECTIVE Our purpose was to investigate the efficacy and prognostic relevance of phenol peels in Japanese patients with actinic keratosis and Bowen disease using clinical and histologic criteria. METHODS A total of 46 patients were treated with phenol peels, and followed up for at least 1 year after treatment. Biopsy specimens were taken before and after treatment. Cases of complete response were classified by the number of treatment sessions. We evaluated parameters for epidermal thickness, proliferation, dysplasia, and apoptosis, and clinical characteristics to correlate phenol peels with assessments of efficacy, patient-selection criteria, and risk for transformation to cutaneous squamous cell carcinoma. RESULTS There were 39 (84.8%) patients with a complete response after one to 8 treatment sessions. Statistically, differences in clinical improvement with peels and the number of treatment sessions correlated with histology, personal history of skin cancer, tumor thickness, and cyclin A expression. LIMITATIONS This study was a prospective pilot trial. Blinded, placebo-controlled, randomized studies would be ideal. CONCLUSION We conclude that phenol peels are very effective for treating precancerous lesions of actinic keratosis and Bowen disease. In addition, our study clearly demonstrates that tumor thickness and cyclin A could be specific and useful markers as adjunctive diagnostic tools to predict the efficacy of phenol treatment of these lesions.

Effective treatment of intractable skin ulcers using allogeneic cultured dermal substitutes in patients with systemic lupus erythematosus

Skin ulcers in systemic lupus erythematosus (SLE) patients are non-healing or intractable, because various factors or complications, including vasculitis and immunosuppressants, impair wound healing. In the present study, we applied cultured dermal substitutes (CDSs) to 3 cases of SLE skin ulcers because various systemic or topical therapies were ineffective. CDSs are prepared by culturing human fibroblasts on two-layered spongy matrices of hyaluronic acid and atelo-collagen, and they effectively promote the healing of severe skin defects. After using CDSs in the 3 cases, healthy granulation tissues formed within 6 weeks, and skin grafts were successfully performed. These results indicate that allogeneic CDSs provide new therapeutic alternatives as topical therapies for intractable skin ulcers in SLE.

Successful treatment with trichloroacetic acid peeling for inflammatory linear verrucous epidermal nevus

Figure 1. Histology showing hyperkeratosis of orthotype and parakeratosis (hematoxylin–eosin, original magnification ·100). Dear Editor, Inflammatory linear verrucous epidermal nevus (ILVEN) was originally reported by Altman and Mehregan in 1971. The following criteria seem to be valid: (i) early age of onset; (ii) pruritic erythematous, slightly verrucous scaling papules, which coalesce into linear plaques; (iii) histological features resembling those of psoriasis; and (iv) persistent lesions markedly refractory to treatment. The criterion of ‘‘resistance to therapy’’ is a generally accepted feature of this nevus. Here, we report a patient whose lesions responded effectively to trichloroacetic acid (TCA) peeling treatment. Our patient was a 5-year-old girl. At the age of 1 year, her mother noticed verrucous scaling papules, which coalesced into linear plaques on her right armpit, right pubic region, left breast and left lower leg. These lesions spread gradually, and topical corticosteroids were ineffective. Histological findings from the lesion on the left lower leg showed acanthosis, with elongation of the rete ridges. There were areas with hyperkeratosis of the orthotype, and areas with parakeratosis. The upper dermis showed a mild and predominantly mononuclear infiltrate. Polymorphonuclear leukocytes were sparse, and no exocytosis of these cells into the epidermis was seen (Fig. 1). Initial treatment was topical corticosteroids, vitamin D3 and liquid nitrogen, but they were not effective; therefore, these skin lesions fulfilled the criteria for a diagnosis of ILVEN. After several treatments, we started to treat the lesions with TCA peeling (Fig. 2a). First, we carefully cleaned the skin using 70% ethanol and acetone-soaked gauze to remove any sebum from the application sites. Second, 70% glycolic acid was applied to the site with intensive hyperkeratosis. Next, we applied 60% TCA (w ⁄v) (Wako Pure Chemical Industries, Osaka, Japan) in distilled water to the region using cotton-tipped applicators until white

A rare case of mucinous carcinoma of the skin with multiple organ metastases

Mucinous carcinoma of the skin (MCS), which was first reported by Lennox [1], is an adnexal neoplasm considered to originate from the secretory coil of eccrine sweat glands [2]. It is a rare skin malignancy as only approximately 200 cases have so far been reported [3]. Its most common location is the head and neck [4]. Although local recurrences are frequent, only a few cases of distant metastases have been so far reported [5, 6]. We present herein an extremely rare case of MCS metastasizing to [...]