Hayao Miyoshi

Efficacy of topical tacrolimus for treating the malar rash of systemic lupus erythematosus

Summary The rash of systemic lupus erythematosus (SLE) is usually treated with topical corticosteroids, but prolonged use causes adverse cutaneous side‐effects. We assessed the efficacy of topical tacrolimus for treating the skin lesions of SLE. Three patients with SLE affecting their facial skin applied 0·1% tacrolimus ointment on one side of their face twice daily for 3 weeks, in conjunction with a sunscreen cream. After 3 weeks, erythema on the treated side was ameliorated in all three patients compared with the untreated side. Although the study is preliminary, the results demonstrate that topical tacrolimus may be useful for treating the malar rash of SLE.

Evaluation of a newly‐developed immunochromatography strip test for diagnosing dermatophytosis

Background  Traditionally, dermatophytosis, a common disease affecting millions of people world‐wide, has been diagnosed by direct microscopy and fungal culture. The immunochromatography (ICG) strip test was recently developed.

Beneficial effects of tissue inhibitor of metalloproteinases-2 (TIMP-2) on chronic dermatitis.

Chronic dermatitis, such as contact dermatitis (CD) or atopic dermatitis (AD), is a long‐standing inflammatory skin disease with cutaneous damage such as erosion, ulceration, and lichenification due to itch‐induced scratching. The resultant lesion can be considered to be a kind of wound. The tissue inhibitor metalloproteases‐2 (TIMP‐2) accelerates wound healing by enhancing the proliferation and migration of epidermal keratinocytes and dermal fibroblasts; it is also a physiologic inhibitor of matrix metalloproteinases. The aim of this study was to test the effect of TIMP‐2 on chronic dermatitis. NC/Kuj mice were sensitized with Dermatophagoides farinae (Df) extract. Eczema was induced by repeated applications of this mite allergen to the skin of 20 sensitized mice that were maintained under specific pathogen‐free conditions. One group of 10 mice was then treated with topical TIMP‐2 solution (0.1 ml, 0.5%) for 28 days, and the other with vehicle alone and the effects of TIMP‐2 were evaluated macro‐ and microscopically. The effect on skin barrier function was estimated by measuring transepidermal water loss (TEWL). Scoring of gross skin findings showed that TIMP‐2 significantly reduced the severity of eczema (P <0.05) on days 12–28. Histological examination revealed that TIMP‐2 treated mice manifested lower degrees of hyperkeratosis, acanthosis, and spongiosis in the epidermis and fewer inflammatory cells in the dermis than vehicle‐treated mice. There were significant reductions in the epidermal thickness and dermal inflammatory cells in the TIMP‐2 treated animals (P <0.01); their TEWL was significantly decreased on day 28 (P <0.05). Our results suggest that NC/Kuj mice with Df extract‐induced chronic eczema may be a useful model for investigating chronic dermatitis, and that TIMP‐2 may be a good agent for treating chronic dermatitis as well as chronic ulcers.

A Case of Factitious Skin Disease

To the Editor: Psychological conditions may play roles as triggers or deterioration factors in dermatological disorders such as atopic dermatitis, urticaria, and psoriasis (1). Therefore, the psychological conditions of patients should be evaluated by dermatologists. Psychiatric disorders also can lead to self-induced paradoxical skin conditions (1, 2). Such histories sometimes confuse dermatologists. We experienced a case of skin disease which had a unique appearance and history. Case Report: A 20-year-old Japanese woman with a five month history of eruptions on her ckeeks visited our hospital on May 3, 2000. Coin-sized, hyperpigmented, erythematous macules with scales were noted on both of her cheeks (Fig. 1). She had an extroverted character by nature. She had won an award in a regional beauty contest in July of 1999. She became anxious about the relationships in her office and suffered from maladjustment to society and withdrawal symptoms. In October of 1999, she had aphthosis stomatitis. When she pushed her cheeks to relieve the pain of the aphthosis stomatitis, she felt relaxed and gradually recovered her confidence. She felt that she could not live without always pushing her cheeks. A diagnosis of dermatitis artefacta was made. Her blood cell counts, liver and renal function tests, urinalysis, and electrocardiogram were all within the normal ranges. An intelligence test revealed her intelligence quotient (IQ) as 66. A discrepancy was observed between her language IQ (77) and action IQ (62). A YG character test revealed indecisiveness and pessimism. She was admitted to the psychiatry ward with a diagnosis of maladjustment and was given psychotherapy and medication (Triazoram Letters to the Editor

DRUG ERUPTION (ERYTHEMA MULTIFORME TYPE) DUE TO A DIGESTIVE ENZYME DRUG

An 84‐year‐old Japanese male had pruritic indurated erythema on his upper limb and left lower abdomen, which had developed abruptly two months before visiting our hospital. Hematological examination showed eosinophilia, 550/mm3. Histopathological findings were suggestive of erythema multiforme in response to a drug. By means of patch tests and a p.o. challenge test, Aczym®, a digestive enzyme drug, was shown to be the cause of his condition. Further study revealed that the specific ingredients involved were pancreatin and Taka‐diastase. An eruption resulting from ingestion of a digestive enzyme drug has not previously been reported.

Subcorneal Pustular Dermatosis: A Follicular Variant

To the Editor: Subcorneal pustular dermatosis (SPD) is characterized by chronic, benign, recurring pustules which have a distinctive subcorneal histological appearance with a predilection for the abdomen, axillae, and inguinal folds. We observed a 28-year-old woman with subcorneal pustules limited to the hair follicles, as determined both clinically and histopathologically. A review of the literature failed to uncover any reports of a disor-