Emiko Ishikawa

Scedosporium apiospermum skin infection mimicking tuberous xanthoma

underlying fibroblasts. To date, 35 cases have been reported in the English published work, and their clinical characteristics are summarized in Table 1. Characteristically, the ages of the patients ranged 35–81 years (mean 64.0 years). CHP occurs mainly in middle-aged or elderly women, with a predilection for the thenar palm. Only three of the reported cases of CPH developed on the sole, and the other 36 cases affected the palm. Twenty-three lesions occurred on the thenar eminence, eight on the hypothenar eminence, one case on the palmar aspect of the index finger and ring finger, and two cases on the thumb. Four cases involved multiple lesions. The duration of the lesions, when noted, ranged 2–40 years. All except one of the reported CPH cases were manifested clinically as an erythematous lesion. Several hypothetical pathogeneses have been proposed, such as a primary keratinizing disorder of the granular and horny layers, trauma, human papilloma virus type 4 infection, or clonal epidermal malformation. The most common clinical differential diagnosis at presentation was Bowen’s disease. In an immunohistochemical study of CPH, Ishiko et al. reported that overexpression of antipankeratin antibody (AE1 + AE3) and K16, and decreased expression of K2e were evident in the lesional skin. In addition, Tanioka et al. noted complete disappearance of the expression of palmand sole-specific K9 in the hypokeratotic lesional epidermis. Although published reports of CPH have been increasing recently, its pathogenesis is still unclear. The diagnosis of CPH is based on its clinical manifestation, anatomical site and immunohistochemical characteristics (loss of K9 and K2e and overexpression of AE1 + AE3). The presented two cases demonstrated no changes of proliferative epidermal tumor or cornoid lamella, however, the CPH lesions must be distinguished clinically from Bowen’s disease, arsenic keratosis or palmoplantar porokeratosis.

Effects of Topical N-Acetylcysteine on Skin Hydration/Transepidermal Water Loss in Healthy Volunteers and Atopic Dermatitis Patients.

Dear Editor: Atopic dermatitis (AD) is a relapsing chronic inflammatory pruritic skin disorder that has been partially attributed to skin barrier dysfunction. Skin barrier function was previously estimated by measuring skin hydration and transepidermal water loss (TEWL), and low levels of skin hydration along with high levels of TEWL were reported in AD patients1,2. N-acetylcysteine (NAC) is a thiol derivative that stimulates the synthesis of glutathione, an internal antioxidant. NAC has been clinically used as a mucolytic agent as well as an antidote for acetaminophen toxicity. NAC was previously reported to be useful in the treatment of skin diseases including toxic epidermal necrolysis and lamellar ichthyosis3,4. NAC may exert beneficial effects in skin diseases by: (1) reacting with oxidative intermediates and replenishing intracellular cysteine levels; (2) inhibiting the production of proinflammatory cytokines and factors; and (3) regulating epidermal proliferation. In the present study, we assessed the clinical effects of topical NAC on skin hydration and TEWL in healthy volunteers and AD patients. We enrolled 10 healthy volunteers (6 males and 4 females, age range: 28 to 76 years) and 11 AD patients (6 males and 5 females, age range: 31 to 73 years). AD patients had been receiving topical treatments including corticosteroids and tacrolimus ointment. Patients were not receiving cyclosporine or methotrexate. Patients with severe co-existing conditions as well as those with a heavy smoking status and/or high alcohol consumption were excluded. Informed consent was obtained from all patients. This study was approved by the Ethics Committee of the Faculty of Medicine, Kagawa University (No. 20-14). A NAC solution (20 w/v%; Senju Pharmaceutical Co., Ltd., Osaka, Japan) or its control vehicle was applied to the forearm skin twice a day for 4 weeks. Forearm skin hydration and TEWL were measured before and after the topical NAC application. Skin hydration and TEWL were measured using a Corneometer and Tewameter (Courage+Khazaka Electronic GmbH, Cologne, Germany). The topical application of NAC for 4 weeks increased skin hydration in 9/10 healthy volunteers (Fig. 1A, increase from 36.2±9.9 to 48.8±15.7 arbitrary units, p=0.001) and decreased TEWL in 8/10 healthy volunteers (Fig. 1B, decrease from 13.5±8.9 to 10.1±6.1 g/hm2, p= 0.0341). Topical application of the control vehicle for 4 weeks decreased skin hydration in 8/11 AD patients (Fig. 1C, decrease from 39.3±15.1 to 33.3±11.6 arbitrary units, p=0.0409). The topical application of NAC increased skin hydration in 9/11 AD patients (Fig. 1C, increase from 35.6±12.0 to 44.7±13.9 arbitrary units, p=0.0262) and decreased TEWL in 9 AD patients (Fig. 1D, decrease from 18.1±15.1 to 10.8±11.2 g/hm2, p=0.0409). Fig. 1 (A, B) Effects of the topical application of N-acetylcysteine (NAC) (for 4 weeks) on skin hydration and transepidermal water loss (TEWL) in healthy volunteers. (C, D) Effects of the topical application of NAC on skin hydration and TEWL in atopic dermatitis ... In a mouse model of AD, NAC was reported to restore the expression of some cell adhesion molecules that contribute to skin barrier formation by reducing oxidative stress5. Therefore, the topical application of NAC may increase skin hydration and decrease TEWL by strengthening the function of this barrier. Lamellar ichthyosis exhibits abnormal keratinization due to TGM1 gene mutations and a differential pattern of filaggrin expression, which implies that the success of NAC treatment in lamellar ichthyosis may be attributed to NAC-induced amelioration of abnormal keratinization and improvements in skin barrier function. Our results also support the possibility of skin barrier function restoration by NAC. Although AD patients generally have low levels of skin hydration and high levels of TEWL1,2, we could not obtain consistent results. Some AD patients have been shown to have normal skin barrier function6, and these values can be affected by various factors such as seasonality, exercise, and lifestyle. Thus, future studies involving a larger number of patients and excluding skin barrier-deteriorating factors are required to accurately assess the effects of NAC on AD.

Two cases of nevus sebaceous accompanying secondary tumors with βKlotho expression.

Dear Editor, Nevus sebaceous (NS) has a well-documented potential to develop into a wide variety of neoplasms of both epidermal and adnexal origins in the late stage. bKlotho is a member of the Klotho family which regulates the function of fibroblast growth factor (FGF). Herein, we demonstrate reduced bKlotho expression in secondary tumors of NS. Case 1 was a 56-year-old Japanese woman who reported a 2-year history of rapid growth and bleeding in a previously asymptomatic plaque on her scalp present since birth. A physi-

βKlotho expression is reduced in human non‐melanoma skin cancer

technique. Because of these limitations, we cannot rule out that the infection was caused by R. sibirica mongolotimonae, a rickettsia that has been diagnosed in Portugal, France, and Spain, which has been associated with the occurrence of lymphangitis contiguous with the bite point. In addition, the R. sibirica-related disease is characterized by the existence of more than one black spot and can be associated with a headache and a rash that typically affects the palms and soles. R. conorii, R. sibirica, and R. africae species are similar in proteins and lipopolysaccharides of the membrane and therefore may result in cross-reactive serologic studies. R. africae can be epidemiologically ruled out in this case, as the patient and her dog did not leave Spain. This case shows characteristics of infection due to rickettsias not common in our country such as lymphangitis, which could be caused by R. conorii, and not yet reported in the literature. Lymphangitis was probably caused by the entry of rickettsia into the lymphatic system. Lymphangitis caused a delay in the diagnosis and treatment of the patient. We recall the need to be alert in cases of lymphangitis due to the possibility that rickettsia could cause it, and the need, if more cases occur, to send samples to a reference center for definitive characterization of the agent and its eco-epidemiology in our country.

Primary cutaneous cryptococcosis in a patient with CREST syndrome

ejd.2012.1684 Auteur(s) : Emiko Ishikawa emiko-i@med.kagawa-u.ac.jp, Kozo Yoneda, Kozo Nakai, Junko Moriue, Ikumi Yokoi, Asuka Munehiro, Yasuo Kubota Department of Dermatology, Kagawa University, 1750-1 Ikenobe Kitagun Mikicho, 761-0793 Kagawa, Japan Cryptococcus neoformans is an encapsulated yeast. In these days of globalization, the vast majority of patients with cryptococcosis have an underlying immunocompromised condition, with prolonged corticosteroid treatments. Cutaneous involvement is reported [...]