Emiko Akasaka

A new objective histological scale for studying human photoaged skin

A quantitative understanding of the histological alteration of the skin is important for assessing the severity of photoaging.

A novel case of nocardiosis with skin lesion due to Nocardia araoensis.

Nocardiosis is caused by Gram‐positive aerobic actinomycetes that live in soil and are known to be responsible for opportunistic infections. The condition mostly affects the lung, brain or skin. Here, we present a 24‐year‐old Japanese woman who had had systemic lupus erythematosus since the age of 20 years, and lupus nephritis since the age of 23 years. She developed cutaneous lymph duct‐type nocardiosis due to Nocardia araoensis while on immunosuppressant therapy. The patient had cutaneous findings from the right inguinal region to the right lower thigh and did not have lesions on the rest of the body. Minocycline and co‐trimoxazole were co‐administrated, and her condition improved. To our knowledge, this is the first case in which N. araoensis was detected by analysis on rRNA base sequence in skin lesions.

Seborrheic keratosis that follows Blaschko's lines

A 66‐year‐old Japanese man had skin lesions on the left side of his trunk and the left upper extremity for approximately 10 years. The skin lesions were asymptomatic but increased gradually, which brought the patient to our hospital. On the initial examination, we noticed 5 mm × 5 mm to 15 mm × 5 mm, round or oval, light to dark brown keratotic papules on the left side of chest and abdomen and the left upper extremity. The papules were aligned in an S‐shaped line on the trunk and in a straight line on the upper extremity. Clinical and histopathological findings led to a diagnosis of seborrheic keratosis that followed Blaschkos lines. To our knowledge, no such a case has been reported previously. Our case supports the hypothesis that seborrheic keratosis can be associated with genetic mosaicism.

A novel splicing variant of CADM2 as a protective transcript of psoriasis

CADM2, a candidate gene for psoriasis, was identified by a genome-wide association study using microsatellites in the Japanese population (561 cases and 561 controls). Moreover, haplotype analysis included an additional 68 SNPs and indicated that a 110-kb haplotype block was detected for the protective risk haplotype of psoriasis. We also identified an initial exon of novel splicing variants in this haplotype block. A functional analysis by qRT-PCR using RNAs from the blood of 56 cases and 64 controls significantly demonstrated an inverse correlation between expression frequencies in a novel splicing variant and the number of alleles associated with psoriasis. To confirm these results, we must perform replication studies using other ethnic groups and more functional analysis particularly for skin tissues.

A case of blastic NK-cell lymphoma.

© 2007 The International Society of Dermatology 722 The patient was a 64-year-old Japanese man. He first visited our department on April 23, 2004 with an eruption on his anterior chest of 2 months’ duration as the chief complaint. The visit was preceded by consultation with a local physician who took a skin biopsy when the eruption gradually increased in size. On the basis of the pathologic findings, the patient was diagnosed with cutaneous malignant lymphoma and, as a result, was referred to our department for further testing and treatment. The patient presented with a semicircular, purplish-red lesion measuring approximately 5 cm in diameter, with a clear border, on the anterior chest. Irregularities of up to several millimeters in size were observed on the surface of the lesion, which appeared mostly glossy (Fig. 1a). In addition, diffuse, partially fused, semicircular erythematous patches accompanied by reddish to reddish-brown discoloration were present on the face and extending to the upper body (Fig. 1b). The cervical and supraclavicular lymph nodes were swollen. Hematologic findings on admission (Table 1) revealed a differential peripheral white blood cell count of 1.0% lymphoma-like cells and slightly elevated lactate dehydrogenase (LDH) levels of 238 U/L. Levels of LDH2 and LDH3 were elevated at 41.0 and 28.0%, respectively. Furthermore, the level of interleukin-2R (IL-2R) was elevated at 610 U/mL. The patient had a history of Epstein–Barr (EB) virus infection. The results of various tests (Table 2) showed bilateral enlargement of the posterior cervical, supraclavicular, cervical, axillary, portal, and inguinal lymph nodes. No tumor was seen from the nose to the neck. Gallium scintigraphy showed no accumulation. A skin biopsy of the lesion on the anterior chest was performed, with histopathologic evidence indicating the existence of a tumor exhibiting a Grenz zone and infiltration into all dermis layers. The tumor consisted of large blastoid atypical lymphocytes (Fig. 2a,b). The results of a biopsy of a semicircular erythematous patch on the right upper arm were similar. Immunohistological staining with in situ hybridization showed that the tumor cells were CD4-positive, CD56-positive, CD34-negative, CD68-negative, myeloperoxidase (MPO)negative, terminal deoxynucleotidyl transferase (TdT)negative, and EB-negative. Rearrangement of the T-cell receptor (TCR) Cβ1 and IG(H)JH genes was not observed in dermal tissue. The cervical lymph nodes were biopsied and flow cytometry was conducted. Tumor cells in the lymph nodes were CD4positive and CD56-positive. Bone marrow biopsies confirmed the diagnosis: CD4-positive, CD56-positive, CD34-negative, and CD13-negative. On the basis of the aforementioned clinical and histopathologic findings, the patient was diagnosed with blastic natural killer (NK)-cell lymphoma. One week after hospitalization, the lesion on the anterior chest and the erythematous patches from the face to the chest exacerbated, and the patient was placed on a hyper-CVAD regimen (300 mg/m of cyclophosphamide, 2 mg of vincristine, 25 mg/m of doxorubicin, 40 mg of dexamethasone, 1000 mg/m of methotrexate, and 1000 mg/m of cytarabine), with the lesion and erythematous patches mostly disappearing after two cycles of the regimen (Fig. 3). Blackwell Publishing Ltd Oxford, UK IJD nternational Jour al of Dermatology 0011-9059 , 2006 45 Morphology

Long-term efficacy of psoriasis vulgaris treatments: Analysis of treatment with topical corticosteroid and/or vitamin D3 analog, oral cyclosporin, etretinate and phototherapy over a 35-year period, 1975–2010

Various therapies have been tried for psoriasis. In Japan, biologics began to be used for psoriasis treatment in January 2010. Their clinical efficacy is well known, but biologics cannot be used in all psoriasis patients for reasons such as side‐effects and cost. It is necessary to evaluate the effect of long‐term psoriasis treatment, but there have been no reports evaluating long‐term treatment. Therefore, the outcomes of patients who had been treated at the Tokai University Hospital for more than 5 years, before biological agents were released, were examined. Three categories, classified by initial severity, changes in severity by method of treatment and background characteristics, were investigated. In conclusion, cases of long‐term treatment with a combination of topical corticosteroid and topical vitamin D3 analog or oral cyclosporin were found to be effective therapies. Patients with a history of diabetes mellitus or cardiovascular disease of psoriasis were likely to be treatment resistant.

Development of psoriasis 10 years after allogeneic hematopoietic cell transplantation from non‐psoriatic donor: Further evidences for genetics and immunopathogenesis of psoriasis

Japan and only five instances from other countries. This scarcity of papers on adalimumab for GPP highlights the significance of our report. The case we experienced was rare in that GPP developed in a PsA patient, who refused infusion. Adalimumab elicited a favorable response to the concomitant GPP. No similar reports have been published except for a case reported by Zangrilli et al. More case records should be collected to establish evidence that adalimumab is a safe and effective treatment, even for GPP patients judged as having primary or secondary failure to infliximab therapy.

A case of implantation dermatosis that formed a tumor

A 51‐year‐old man visited our hospital complaining of a tumor located above his lip. He had been hit on his upper left lip by a chopstick holder 2 months previously. The lesion turned into a tumor and gradually enlarged. The tumor was well circumscribed, smooth and covered with reddish, partially milk‐white skin. During surgery to remove the tumor, a piece of a chopstick was found in the subcutaneous tissue, and a diagnosis of implantation dermatosis (ID) was made. On histology, the tumor appeared as an abscess that had increased fibroblasts, small vessels and a large number of neutrophils. In the Japanese published work, we found 86 cases of ID; three were similar to our case and had been clinically diagnosed as adnexal tumors. There were also six cases that showed abscess formation similar to our case on histology. In a survey of the published work from other countries, there were 44 ID cases. There were no common features found among the cases reported in the published work.