Ayaka Hirao

Clinical effectiveness of intense pulsed light therapy for solar lentigines of the hands

Intense pulsed light (IPL) treatment, as a nonablative phototherapy, is known to improve various signs of facial photoaging skin, e.g., solar lentigines, fine wrinkles, and telangiectasias. The purpose of the present study was to investigate the efficacy and tolerability of IPL with a 515‐nm filter in patients with solar lentigines on the back of hands. An open study was performed in 31 patients who were treated with a 1‐month interval up to five times. Sixty‐two percent of patients had more than 50% improvement and 23% had more than 75% improvement. No patients discontinued due to adverse effects, and no patients showed hyperpigmentation or scarring after the treatments. Phototherapy using this IPL source was effective and well tolerated in the patients, suggesting that this phototherapy may be an appropriate modality for the treatment of solar lentigines of the hands.

Efficacy and Safety of a Low-Energy Double-Pass 1450-nm Diode Laser for the Treatment of Acne Scars

OBJECTIVE The purpose of this study was to evaluate the efficacy and safety of a 1450-nm diode laser on acne scars in Asian patients. BACKGROUND DATA Acne and acne scars affect individuals during puberty and adolescence, and decrease their quality of life. METHODS An open study was performed on 24 Japanese patients (17 female and 7 male, aged 15-44 years) with acne scars on the face treated with five sessions of low-energy double-pass 1450-nm diode laser at 4-week intervals. The mean duration of the acne scars prior to receiving laser therapy was 4.8 years (range 1-9). Clinical evaluation by physicians and with photographs was conducted at baseline, 1 month after the final treatment, and at a 3-month follow-up visit. Topical therapies for acne vulgaris were permitted during the follow-up period. RESULTS All patients completed the five treatment sessions. Seventy-five percent of the subjects showed at least 30% improvement of acne scars. At the 3-month follow-up evaluation, 92.9% of the subjects with >30% improvement maintained the effectiveness. Vesicle formation and transient hyperpigmentation also occurred in one case. CONCLUSIONS The 1450-nm diode laser therapy was effective and well-tolerated in patients with acne scars, suggesting that this may be an appropriate modality for treating facial acne scars.

Allergic contact dermatitis from dibucaine hydrochloride, chlorpheniramine maleate, and naphazoline hydrochloride in an over‐the‐counter topical antiseptic

An 89-year-old male presented with pruritic lesions over his left knee. Several years previously, he had developed eczema following the repeateduse of an over-the-counter antiseptic, and there had been several further episodes after use of similar products. Twenty days before presentation tous, he hadvisited hospital with a wound on his left knee; this was treated with the daily applicationof povidone iodine 10%.Twodays before we saw him, he had applied another over-the-counter antiseptic, and pruritic erythematous papules and vesicles over the knee with linear extension down onto the lower leg appeared the next day. The antiseptic the patient used in the current history contained benzalkonium chloride, dibucaine hydrochloride, chlorpheniramine maleate, naphazoline hydrochloride, and a mixture of fragrance ingredients. The product was sold in pharmacies. The dermatitis was treated with topical steroids. Patch testing (InternationalContact Dermatitis Research Group criteria; Finn Chambers on Scanpor tape; Epitest Ltd, Tuusula, Finland) using the over-the-counter antiseptic produced a positive reaction to the product ‘as is’ at D2 (þþ) and D3 (þþ). A second patch test with the same method and reading was performed only with the ingredients of the antiseptic and a fragrance mix 8% pet. (Brial allergen GmbH, Greven, Germany) (Fig. 1). The manufacturer provided us with the ingredients. They did not know the precise components of the fragrance because they purchased it from another company. Twenty healthy volunteers showed negative reactions to naphazoline hydrochloride 1% pet. at D2, D3, and D7. We diagnosed the patient as having allergic contact dermatitis caused by dibucaine hydrochloride, chlorpheniramine maleate, and naphazoline hydrochloride in the overthe-counter antiseptic.

Occupational allergic contact dermatitis due to cashew nut oil

A 37-year-old Japanese male, working as a researcher in an industry producing phenol–formaldehyde resins, presented with painful, oedematous erythema with bullae on his right leg (Fig. 1). He had dropped pure cashew nut oil from a bottle onto his right thigh 14 D previously but had taken off his work clothes immediately and thoroughly washed the skin. However, an itchy erythema began to develop 10 D later. Because of the severe swelling, the patient was hospitalized. The dermatitis was treated with systemic and topical steroids and an oral antihistamine. Patch testing was performed with cashew nut oil 3% alcohol (alc.), 0.3% alc., 0.03% alc., urushiol 0.01% pet., ethanol ‘as is’, and pet. ‘as is’. Cashew nut oil was provided by his employer. Urushiol (diluted to 0.01% pet.) was purchased from Torii Pharmaceutical Co., Ltd. (Tokyo, Japan). Reactions were recorded as follows: pet. and ethanol were negative (Fig. 2).

Transient Effectiveness of an Oral 5-Fluorouracil Derivative, S-1, for Epirubicin, Cyclophosphamide and Paclitaxel Refractory Skin Metastases from Possible Occult Breast Cancer in a Male

Recent chemotherapies for skin metastases from breast cancer have shown to be effective for regression, disappearance, and favorable quality of life. We describe the case of a 76-year-old male showing transient effectiveness with an oral 5-fluorouracil derivative, S-1 (tegafur, 5-chloro-2,4-dihydroxypyridine and potassium oxonate), for epirubicin, cyclophosphamide and paclitaxel refractory skin metastases from possible occult breast cancer. The male patient was initially diagnosed as having lymph node metastases in the left axilla as possible occult breast cancer. The skin metastases developed after chemotherapy with a combination of epirubicin and cyclophosphamide, subsequent chemotherapy with paclitaxel, and radiotherapy. Chemotherapy with paclitaxel was resumed for skin metastases, but it was not effective. Alternative chemotherapy with the oral agent S-1 was administered. The skin metastases completely disappeared after the second course, but recurred at the end of the third course. This case suggests that S-1 may be a candidate for chemotherapy for skin metastases from occult breast cancer in males.

Allergic Contact Dermatitis with Diffuse Erythematous Reaction from Diisopropanolamine in a Compress

Compresses containing a nonsteroidal antiinflammatory drug (NSAID) are commonly used in Japan. However, this treatment may induce both allergic and photoallergic contact dermatitis from the NSAIDs and their ingredients. Here, we describe a case of allergic contact dermatitis with diffuse erythematous reaction due to diisopropanolamine in the applied compress. The absorption of diisopropanolamine might have been enhanced by the occlusive condition.

Cellulitis with Leukocytopenia as an Initial Sign of Acute Promyelocytic Leukemia

Patients with hematologic malignancies are immunosuppressive and may develop cutaneous or invasive infections as a primary sign of immune suppression. Acute promyelocytic leukemia (acute myeloid leukemia M3) is caused by translocation of reciprocal chromosomal rearrangement t(15;17), which produces an oncogenic protein. We herein describe a 71-year-old man having cellulitis with leukocytopenia as a first sign of acute promyelocytic leukemia. Dermatologists and hematologists should keep in mind that patients with a hematologic malignancy, such as acute promyelocytic leukemia, can develop cellulitis with leukocytopenia.

Therapeutic hotline. The effectiveness of intense pulsed light for possible Riehl's melanosis.

Riehl’s melanosis is characterized by facial hyperpigmentation (1,2). It has been associated mostly with pigmented allergic contact dermatitis from ingredients of cosmetics, brilliant lake red, sudan III, and other specific substances in cosmetics (1,2). Occurrences decreased dramatically after these components were eliminated from cosmetics (2). Recent cases have not been caused by exposure to chemicals (2–4). It is now believed that Riehl’s melanosis is a continuum of lichenoid immune reactions and may be caused by intrinsic as well as extrinsic factors (2–4). Here, we show a case of a facial melanosis with negative patch test reactions to the cosmetics used by the patient. Intense pulsed light (IPL) has the broad range of 500– 1200 nm. We applied IPL therapy to the patient because melanin granules are distributed in both epidermis and upper dermis. The affected lesions were noticeably improved by the treatment with IPL.dth_1362 561..563

Photoallergic Contact Dermatitis due to Ketoprofen and Hydrogenated Rosin Glycerol Ester

A topical application of a nonsteroidal anti-inflammatory drug (NSAID) may induct an adverse reaction of photoallergic contact dermatitis. The occlusive usage may provoke concomitant photoallergic sensitizations to an NSAID and other ingredients. We describe a 58-year-old woman with photoallergic contact dermatitis from ketoprofen and hydrogenated rosin glycerol ester in the applied compress. Our case indicates that photopatch testing with all ingredients is required to verify the actual photoallergen(s).

Aging rather than sun exposure is a major determining factor for the density of miR-125b-positive epidermal stem cells in human skin

Sunlight exposure and aging are two major factors in the deterioration of skin function. In the present study, we used eighty formalin‐fixed human skin samples from sun‐exposed and unexposed areas from old and young individuals to evaluate the presence of miR‐125b‐positive epidermal stem cells (ESCs) by in situ hybridization. miR‐125b‐positive ESCs were detected in the basal layer of the epidermis. The density of miR‐125b‐positive ESCs was significantly associated with age rather than sun exposure, whereas the density of miR‐125b‐positive ESCs tended to decrease in the sun‐exposed area. These data suggest the potential use of miR‐125b as a surrogate marker for the quality of epidermal cells.