Chizu Miyamoto

Allergic photocontact dermatitis due to suprofen : photopatch testing and cross-reaction study

We report 5 cases of Photocontact dermatitis due to suprofen, a nonsteroidal anti‐inflammatory drug introduced to the Japanese market in 1989, and available as a 1% ointment. The patients developed pruritic eczematous lesions after applying the ointment for from 2 weeks to 3 months. All 5 patients reacted positively to photopatch testing with ultraviolet A (UVA) and suprofen down to 0.1–0.01% pet., and 3 patients showed positive reactions with ultraviolet B (UVB)and suprofen down to 1.0–0.1% Moreover, all patients showed a cross‐reaction with tiaprofenic acid, which has a very similar chemical structure to suprofen. However, there was no cross‐reaction between suprofen and ketoprofen. Prescribers should be aware of the existence of photocontact sensitivity due to these drugs.

Photosensitivity in Atopic Dermatitis: Demonstration of Abnormal Response to UVB

It is a well‐known fact among clinicians that sunlight may exacerbate atopic dermatitis (AD), but little is known beyond that. In a preliminary study investigating this phenomenon, 19 patients with AD were selected for phototests. All of them had a normal minimal erythema dose (MED). However, 3 patients (15.7%) demonstrated abnormal cutaneous responses 24–72 h after provocation with ultraviolet light B (UVB). None of the patients had a positive response to pure ultraviolet light A (UVA) irradiation of up to 9 J/cm2. The photobiological results of this study confirm the existence of photosensitivity in AD and indicate that UVB wavelengths are responsible for it.

Case of tinea capitis caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae): Prevalence of a new zoonotic fungal infection in Japan

Dear Editor, We describe herein a case of tinea capitis caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae) and suggest that infection caused by A. benhamiae-related T. mentagrophytes has already spread widely in Japan. A 6-year-old girl, living in Tokyo, was referred to our clinic for evaluation of a scalp eruption that had appeared 1 month earlier. Despite treatment with systemic griseofulvin, the symptoms had worsened. On initial examination, we observed four nodules on the scalp, with hair loss. One nodule was on the parietal region, two were on the regio occipitalis capitis, and the fourth was on the regio temporalis capitis. One of the nodules, on the parietal region, was the size of a quail’s egg and showed pronounced swelling, with spongy and indurated areas exuding pus and with adherent crusts (Fig. 1). On the child’s face and trunk, there were many pruritic, erythematous, crusted lesions, which had been scratched. Examination of hair shafts by direct microscopy showed ectothrix tinea capitis spores outside the hair shaft. As no fungal element was observed on the face and trunk, the eruptions outside the scalp were considered dermatophytid. A colony cultured on Sabouraud dextrose agar from these lesions produced flat, milky-white, powdery colonies with ray-like margins. On slide culture of the isolates, numerous circular to tear-shaped microconidia, spirals and a few club-shaped macroconidia were observed. Based on macroscopic and microscopic characteristics (Fig. 2), we identified the isolate as T. mentagrophytes, a classification that includes multiple species, including three teleomorphs. The chitin synthase 1 (CHS1) sequence from the clinical isolate was investigated to determine its similarity to other dermatophyte sequences. Its sequence proved to have more than 85% similarity with sequence of the other dermatophytes examined. Moreover, the sequence similarity between the clinical isolate and known A. benhamiae isolates exceeded 99%. As the clinical isolates CHS1 sequence was essentially identical to that of A. benhamiae and distinct from those of Arthroderma simii, Arthroderma vanbreuseghemii and Trichophyton interdigitale, the isolate was highly suggested to be A. benhamiae by molecular analyses. Trichophytin skin test was not carried out. We diagnosed kerion celsi with dermatophytid and treated the patient with a combination of oral

Chronic Actinic Dermatitis: A Clinical and Photobiological Study in 6 Japanese Patients

Chronic actinic dermatitis (CAD) has distinct clinical features different from polymorphous light eruption (PLE). In order to clarify the difference between CAD and PLE, not only in clinical histories and findings but also in photobiological and histopathological reactions to phototests, we investigated 6 Japanese patients with CAD and performed provocative phototests which are our standardized methods in diagnosing PLE. On provocative phototests in CAD, pruritic papules were reproduced with smaller doses of UVB, at longer hours after irradiation (48-72 h) and they lasted for more days than in patients with PLE. Our study demonstrated that although milder cases of CAD and severe cases of PLE could not be distinguished clearly based on photobiological reactions alone, typical cases of CAD showed completely different provocative phototest results from those of PLE.