Arata Hakamada

Cytokeratin and filaggrin expression in nevus comedonicus.

Abstract:  To elucidate the pathogenesis of abnormal keratinization in nevus comedonicus, we performed an immunohistochemical study using antikeratin and antifilaggrin (filament‐aggregating protein) antibodies. There were no significant differences between nevus comedonicus and normal skin in cytokeratin expression. Although filaggrin was only detected in the granular layer in open comedones, filaggrin was detected in both superficial cells and also intermediate cells in closed comedones, suggesting that filaggrin is involved in the formation of closed comedones. The disorder of terminal differentiation related to filaggrin may play a role in the pathogenesis of abnormal keratinization in nevus comedonicus.

Keratin and filaggrin expression in keratoacanthoma

To clarify the histogenesis of keratoacanthoma, we studied keratin (K) expression in keratoacanthoma (KA) using 10 different anti‐keratin antibodies against K1, K7, K8, K10, K14, K15, K16, K17, K18 and K19 and anti‐filaggrin (filament aggregating protein) antibody. In the centre of KA, K1 and K10 expressions were declined, and K14 and K16 were detected in the tumour cells, suggesting differentiation towards the outer root sheath beneath the orifice of the sebaceous duct. These results suggest that KA differentiates towards the outer root sheath beneath the opening of the sebaceous duct.

Drug Eruption Caused by Azathioprine: Value of Using the Drug‐Induced Lymphocytes Stimulation Test for Diagnosis

Azathioprine (AZA) is an immunosuppressant commonly used for organ transplantation and autoimmune diseases. Allergic side effects of AZA are rare, and reported allergic skin eruptions from AZA are very limited in Japan. We report AZA‐induced drug eruption that developed in two cases of systemic scleroderma with polymyositis. One case presented with Stevens‐Johnson syndrome, and the other had systemic papular erythema. The stimulation indices of the drug‐induced lymphocyte stimulation test (DLST) for AZA in these two patients were as high as 2,180% and 430%, respectively, but those of healthy volunteers were under 120% without nonspecific suppression of lymphocyte proliferation. Other drugs used simultaneously were ruled out by patch and challenge tests. The challenge test for Stevens‐Johnson syndrome type drug allergy is very risky. DLST is a good diagnostic tool for AZA allergy, especially for severe drug allergy cases.

Pilonidal sinus of the supra-auricle area

JEADV 2007, 21, 247–289

Relapse of Dermatomyositis after 10 Years in Remission Following Curative Surgical Treatment of Lung Cancer

A 55‐year‐old woman with dermatomyositis and small cell lung cancer was successfully treated with surgery followed by combination chemotherapy in 1987. She had been in remission without further immunosuppressive therapy for 10 years. However, myositis with cutaneous manifestations specific for dermatomyositis relapsed when the patient was 69 years old. Intensive examinations revealed no neoplasm, and she responded to a moderate dose of systemic corticosteroids. This case suggests a long‐lasting autoimmune abnormality in dermatomyositis and that a neoplasm is an important factor in eliciting an occult dermatomyositis.

Rippled‐pattern sebaceoma with an immunohistochemical study of cytokeratins

JEADV 2007, 21, 104–143

Filaggrin expression and the pathogenesis of epidermal cysts

associated with autoimmune diseases, especially thyroiditis. Moreover, there is already one report of a correlation between HLA-DR4 and better prognosis in melanoma. We also found a high frequency of HLA-A2: six of 10 LS, whereas the frequency of HLA-A2 is 17–30% in the Western European population (HLA Workshop, 1996). HLA-A2 is associated with a better outcome in some immunotherapy trials. Altough statistical analyses are impossible in our comparison because of the small number of patients, these observations highlight links between antitumour control and autoimmunity, even in patients without previous immunotherapy. Based on these data, we hypothesize that, spontaneously or during immunotherapy, some people have the predisposition to overcome self-immune tolerance, a prerequisite for obtaining effective antitumoral immunity.

Primary cutaneous follicle center cell lymphoma of the scalp successfully treated with anti CD20 monoclonal antibody and CHOP combination therapy with no subsequent permanent loss of hair

We present a primary cutaneous follicle center cell lymphoma (PCFCCL) patient who was successfully treated with Rituximab, a new anti‐CD20 monoclonal antibody. A thirty‐two‐year‐old male developed two asymptomatic tumors on the scalp. Histopathologically, the tumors were composed of diffuse and nodular infiltration of centrocytes and centroblasts. Immunohistopathologically, the tumor cells stained positively with anti‐CD20 antibody and anti‐kappa antibody, but not with anti‐CD5, anti‐CD10, or anti‐Bcl‐2 antibody. Radiation therapy is effective in treating PCFCCL; however, it usually results in the permanent loss of hair. This patient was treated with Rituximab and CHOP, and achieved a complete remission. He has had no recurrence in more than 12 months and no permanent loss of hair on the scalp.

Magnetic resonance (MR) imaging‐induced deep second‐degree burns of lower extremities by conducting loop

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Necrobiotic xanthogranuloma with paraproteinemia; an atypical case.

Necrobiotic xanthogranuloma (NXG) is a rare marker for paraproteinemia. An 86‐year‐old woman had a one year history of large red‐yellow to brown annular plaques involving all limbs. Biopsies showed a non‐palisading granuloma with numerous multinucleated giant cells showing prominent elastophagocytosis and extensive areas of necrobiosis throughout the entire dermis. Complete loss of elastic fibers was observed in the central atrophic area of an annular plaque. Small vascular thromboses were also present. Laboratory findings revealed paraproteinemia of IgG‐lambda type. Immunohistochemical staining detected the presence of roughly equal numbers of IgG‐lambda‐and IgG‐kappa‐staining plasma cells in the dermis. We diagnosed NXG with paraproteinemia with monoclonal gammopathy (IgG‐lambda type) of unknown significance.