Akira Fujioka

Elafin is induced in epidermis in skin disorders with dermal neutrophilic infiltration: interleukin-1β and tumour necrosis factor-α stimulate its secretion in vitro

Background Elafin, an elastase inhibitor produced by keratinocytes, is overexpressed in the subcorneal region of skin affected by psoriasis, a major feature of which is epidermal infiltration by neutrophil leucocytes. Objectives We studied the expression of elafin in the epidermis in other skin disorders characterized by dermal neutrophil infiltration and in skin disorders with dermal lymphocyte infiltration. Patients/methods We examined biopsies from the lesional skin of patients with Behçet’s syndrome, Sweet’s syndrome, pyoderma gangrenosum, cutaneous allergic vasculitis and acute bacterial infection (cellulitis), and from the skin of patients with chronic prurigo, discoid lupus erythematosus and psoriasis. We performed in vitro experiments using cultured keratinocytes treated with mediators such as interleukin (IL) ‐1β, tumour necrosis factor (TNF) ‐α, IL‐6, neutrophil elastase and interferon (IFN) ‐γ. Results Anti‐elafin antibody showed a strong reaction with the subcorneal region of the epidermis in patients with Behçet’s syndrome, Sweet’s syndrome, pyoderma gangrenosum, cutaneous allergic vasculitis and acute bacterial infection (cellulitis), but showed no reaction in skin from patients with dermal lymphocyte infiltration such as is seen in chronic prurigo and discoid lupus erythematosus. The in vitro experiments demonstrated that treatment with IL‐1β and TNF‐α resulted in 2·6‐fold and 4‐fold stimulation of elafin secretion, respectively, whereas IL‐6, neutrophil elastase and IFN‐γ caused no significant changes in elafin release. Conclusions These results suggest that inflammatory mediators such as IL‐1β or TNF‐α secreted by dermal neutrophils may be involved in overexpression of elafin in keratinocytes; this could protect the epidermis from degradation by dermal neutrophil infiltration.

A Pediatric Case of Atypical Mycobacterium avium Infection of the Skin

We report a case of cutaneous atypical mycobacteriosis in a 12‐year‐old healthy girl due to Mycobacterium avium. The cutaneous symptoms were three well‐defined subcutaneous nodules on both buttocks and on the posterior surface of the left thigh. One had a fistulous opening on the skin surface. Histopathological examination revealed epithelioid cell granulomas surrounded by dense lymphocytic infiltration and acid‐fast bacteria were seen with modified periodic acid‐carbol fuchsin staining. Using Ogawas medium at 37°C, acid‐fast bacteria were isolated from the biopsied specimen and identified by the DNA‐DNA hybridization method as Mycobacterium avium. In drug susceptibility test, these were resistant to all antituberculous drugs. Oral administration of minocycline 100 mg/day for two months had little effect on the two remaining lesions, which were therefore excised. Based upon reported cases of Mycobacterium avium complex, we considered that our pediatric patient with multiple intradermal or subcutaneous nodules on the buttocks and the thigh exhibited the characteristic symptoms of M. avium infection.

The Analysis of mRNA Expression of Cytokines from Skin Lesions in Churg-Strauss Syndrome

We report our recent clinical experience with a patient suffering from Churg‐Strauss syndrome and the results of our investigation into the mRNA expression of cytokines in the patients lesions as well as in the frozen sections from a previous patient. In both cases, blood IgG was at a high level.

Spitz Nevus on the Palmar Surface

Relatively little is known about the incidence of Spitz nevus on palmar surfaces. This report places a case study in the context of the Japanese literature regarding the occurrence of Spitz nevus on palmar surfaces. Although the proportion of palms and soles in relation to the body surface is about 5%, the incidence of the Spitz nevus was 2%. The mean age at onset was 17.8 years, and all 4 cases were women. The clinical features were a black macule or flatly elevated small modules. The size of the lesions was relatively small, extending from 3.5 mm to 8.0 mm. Although the backs of the hands and insteps have almost the same area as the palms and soles, the incidence of onset in these regions was 6.3% (13 cases). We thus concluded that Spitz nevus tends to be rare on palms and soles.

A Case of Cytophagic Histiocytic Panniculitis with Sicca Symptoms and Lupus Nephritis

A 48‐year‐old Japanese woman presented with many subcutaneous nodules. The skin was purplish in color and tender; the nodules were scattered over the entire surface. Histological findings of biopsy specimens from the nodules indicated septal panniculitis comprised of histiocyte and/or macrophage infiltrates, often with erythro‐ and/or leukophagocytosis. Phagocytic cells were OKM1 (CD11b), MT1 (CD43), LeuM3 (CD14), and histiocyte antigen positive, indicating the presence of histiocytes and/or macrophages. The patient had sicca symptoms, positive homogenous, speckled pattern ANA (×320), and diffuse proliferative lupus nephritis.

Contact dermatitis from neticonazole

A 62-year-old engineer, with a long history of hand dermatitis, was investigated in 1996 for a widespread pruritic dermatitis of the hands, legs, face, neck and back. Patch tests had been negative in 1976, and positive to epoxy resin, balsam of Peru and p-phenylenediamine in 1984. Examination revealed a patchy dermatitis with accentuation under coloured articles of clothing. Patch testing revealed positive reactions to PPD free base (0.5°/., pet.) ++, a range of azo disperse dyes (Disperse Red 17 (1% pet.) + + +, Disperse Black 1 (I% pet.) + +, Disperse Red 1 (1% pet.) + + +, Disperse Orange 3 ( 1% pet.)+++, and Disperse Blue 153 (1% pet.)++). Detailed questioning revealed that the patient had been a keen coarse fisherman, using red, yellow and bronze maggots for more than 30 years with many episodes of residual staining of his hands. There has been a marked improvement following treatment with topical corticosteroids and emollients, avoidance of coloured clothing items and cessation of the use of dyed maggots.

A case of dual ectopic thyroid accompanied by positive antithyroid antibodies

Ectopic thyroid tissue is an uncommon congenital aberration that is seldom present at two different sites simultaneously. The patient was a 32-year-old woman with dual ectopic thyroid accompanied by positive antithyroid antibodies. The simultaneous occurrence of dual ectopic thyroid and positive antithyroid antibodies has been documented in only two cases: the case discussed here and one previous case. The cervical ectopic thyroid was followed up by ultrasound, which showed an increase in the size of the lesion and an internal echo texture that became slightly heterogeneous after the patient had her second child. We speculated that these changes resulted from the changes in hormone demand brought on by pregnancy and parturition.

Nodular fascitis in the thigh followed up using ultrasonography.

A 41-year-old woman noticed a mass on the inside of her right thigh in April 2003. Ultrasound examination revealed a mass measuring 18 mm × 10 mm × 10 mm in the subcutaneous fatty tissues. Its boundary was relatively clear, with rough edges. The interior of the lesion was hyperechoic and contained an irregular hypoechoic area in its center; a color Doppler sonographic examination detected no blood flow signals. Incision biopsy examination seemed warranted. Pathologically, the specimen showed a proliferation of fibroblast-like spindle-shaped cells but no atypical cells. Immunologic staining revealed that sections were positive to vimentin; negative to CD34, CD68, α-smooth muscle actin (α-SMA), and S-100 protein; and mildly positive to HHF35. These results led to a diagnosis of nodular fascitis. Nodular fascitis is not common, and few studies have described its sonographic characteristics. We therefore used ultrasound to follow up the patient and found that the lesion was markedly smaller 3 months after the first examination, at which time it was hardly discernible as a mass. Here we compare the ultrasound and pathologic findings, and report the results of a bibliographic study.

Localization of Angiotensin Converting Enzyme (ACE) in Granulomas of Sarcoidosis Cutaneous Lesions

Using an immunofluorescent technique, the localization of angiotensin converting enzyme (ACE) was investigated in granuloma lesions from the skin of three sarcoidosis cases. Specific fluorescence was observed in epithelioid cells in the sarcoidosis granulomas examined. However, it was not found in any other granulomatous diseases observed as controls, which included granuloma annulare, foreign body granuloma and lupus miliaris disseminatus faciei. These results indicate that ACE is specifically localized in the epithelioid cells in cutaneous granuloma lesions of sarcoidosis; in one case, it was also observed in Langhans giant cells. Therefore, it is suggested that examination for ACE in cutaneous lesions using an immunofluorescent technique is very useful for the diagnosis of sarcoidosis in the skin. We suggest that epithelioid cells of granulomas in sarcoidosis cutaneous lesions may play an important role in the increase of serum ACE activity.