Eri Hotta

Contact sensitivity in patients with recalcitrant atopic dermatitis

Patients with atopic dermatitis are usually responsive to conventional treatment such as topical steroids; however, they are sometimes refractory to the treatment. The influence of contact sensitivities on the course of patients with recalcitrant atopic dermatitis is not known. The aim of this study was to investigate whether contact sensitivities affect the course of patients with recalcitrant atopic dermatitis. We evaluated 45 patients with atopic dermatitis who had failed conventional therapy. Patch testing was performed with the Japanese standard series, metal series and/or suspected items. A total of 15 patients had a positive patch test reaction to at least one allergen. The most common allergens were nickel, topical drugs and rubber accelerators. Avoidance of products or food containing allergic substances greatly or partially improved skin symptoms in nine patients. These results suggest that contact allergens and metals may be critical factors causing eczematous lesions in patients with recalcitrant atopic dermatitis.

Delayed-type hypersensitivity to 6-methyl-prednisolone sodium succinate.

1 Lovell CR, ed. Plants and the Skin. Oxford: Blackwell, 1993; 86–92, 142–145. 2 Murdoch SR, Dempster J. Allergic contact dermatitis from carrot. Contact Dermatitis 2000; 42: 236. 3 Machado S, Silva E, Massa A. Occupational allergic contact dermatitis from falcarinol. Contact Dermatitis 2002; 47: 113–114. 4 Kanerva L, Estlander T, Jolanki R. Occupational allergic contact dermatitis from spices. Contact Dermatitis 1996; 35: 157–162. 5 Hausen BM, Br€ ohan J, K€ onig WA, Faasch H, Hahn H, Bruhn G. Allergic and irritant contact dermatitis from falcarinol and didehydrofalcarinol in common ivy (Hedera helix L.). Contact Dermatitis 1987; 17: 1–9.

Allergic contact dermatitis due to ginkgo tree fruit and leaf

The patient was a 66-year-old woman who had picked ginkgo tree fruit from among ginkgo leaves with a glove in a field and collected ginkgo nuts within the fruit. Five days later, she developed erythematous edematous plaques and papulovesicles accompanied by pruritus on her forearms (figure 1A), face and neck (figure 1B). Her medical history included allergic contact dermatitis with lacquer trees and mangos. A biopsy specimen from erythematous edematous plaques on her forearm showed spongiosis, exocytosis, [...]

Correlation between soluble interleukin-2 receptor levels and modified Rodnan total skin thickness scores in a patient with generalized morphea: a case report.

Generalized morphea is a rare condition in which idiopathic sclerosis of the skin occurs in a widespread manner. It usually starts on the trunk and is not associated with systemic disturbances.1 Interleukin-2 receptor (IL-2R ) is a membranous glycoprotein that forms the high-affinity IL-2 receptor. The soluble form (sIL-2R) is elevated in most proliferative disturbances of the hematopoietic system and in many solid tumors.2 Here, we describe in detail a correlation between soluble IL-2R levels and modified Rodnan total skin thickness scores (mRTSS) in a patient with generalized morphea treated with topical corticosteroids. A 79-year-old Japanese woman was referred to our department for diagnosis of sclerotic skin with erythema on the chest, abdomen, waist, and right lower leg (Fig. 1a). The sclerotic skin of the abdomen had a 5-month history and the symptoms gradually spread to the chest, waist, and right lower leg. She had no medical history of note. Her younger sister had died due to collagen disease, but the patient did not know the accurate diagnosis. Laboratory tests, including complete blood cell count, urinalysis, erythrocyte sedimentation rate, and liver and kidney functions were within normal limits. However, % eosinophils (12.0%; normal, 0-8%), lactate dehydrogenase (LDH) (288 IU l ; normal, 114-243 IU l), and serum sIL-2R (1690 U ml; normal, 145-519 U ml) were elevated. Immunoglobulin (Ig) A, IgM, IgG and complement component 3 (C3) levels were within normal limits, but C4 (38.6 mg dl; normal, 1235 mg dl) and total hemolytic complement (CH50) (63.0 U ml; normal, 34-49 U ml) levels were slightly elevated. Autoantibody screening was positive for Allergology International. 2013;62:391-393

Verrucous lesions arising in lymphedema and diabetic neuropathy: Elephantiasis nostras verrucosa or verrucous skin lesions on the feet of patients with diabetic neuropathy?

Verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) develop in areas with sensory loss in diabetic patients. Although various types of chronic stimulation, such as pressure or friction, are considered an important factor in the development of such lesions, the precise pathogenesis of VSLDN remains obscure, and there is currently no established treatment for this disease. Here, we present a case of VSLDN on the dorsum of the right foot. However, because lymphedema was also observed at the same site, this lesion could also be diagnosed as elephantiasis nostras verrucosa arising in diabetic neuropathy. The lesion was successfully treated with a combination of elastic stocking and mixed killed bacterial suspension and hydrocortisone ointment, which suggested that VSLDN might have been exacerbated by the pre‐existing lymphedema. Because various types of chronic stimulation can trigger VSLDN, treatment plans should be devised on a case‐by‐case basis. Therefore, it is important to investigate the presence of factors that can induce or exacerbate chronic inflammatory stimulation, such as lymphedema in our case, in each patient with VSLDN.