Hideyuki Kosumi

Dermoscopic features of tungiasis

Tungiasis is a parasitic infection caused by the sand flea Tunga penetrans. Tungiasis is prevalent in rural Central and South America, the Caribbean and sub-Saharan Africa.1 In some endemic areas, the overall infestation prevalence exceeds 50 percent, and it remains an important public health problem for poor communities.1,2 In some cases, the eruptions can mimic viral warts, furuncles, abscesses and paronychia.1 Dermoscopy is reported to be a useful tool for differentiating between these and tungiasis lesions.3,4 Moreover, the majority of cases have multiple lesions, with the ectoparasites causing more than 50 lesions in a single individual in some cases,5 and dermoscopy can help find the lesions. Despite the clinical utility of dermoscopy, no reports have assessed the significance of each dermoscopic finding in tungiasis. Here we report a case of tungiasis and we review the dermoscopic findings of 11 lesions of the patient to reveal the characteristic findings. This article is protected by copyright. All rights reserved.

Unusual post‐patch testing erythema: a late, granulomatous, non‐eczematous reaction to gold sodium thiosulphate

In patch testing, delayed reactions at day 7 or later are regarded as “late reactions”.1 Neomycin, corticosteroids, paraphenylendiamin and gold are well-known allergens of late reactions.1,2 Of these, reactions to gold sodium thiosulfate (GSTS) can be significantly delayed, and some cases have been reported to be accompanied with granulomatous changes.3,4 Clinical reports of this reaction to GSTS are very limited. Here, we report a case of granulomatous reaction to GSTS, and we review the literature to reveal the features of this phenomenon. This article is protected by copyright. All rights reserved.

Bullous pemphigoid with the deposition of IgG2 but not IgG1, IgG3 nor IgG4 autoantibodies at the basement membrane zone

Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering skin disease, characterized by tense bullae and urticarial erythema with a generalized distribution. BP is induced by autoantibodies to structural proteins of the basement membrane zone (BMZ) such as BP180 and BP2301 . Because the majority of BP skin shows complement deposition2 , complement activation is considered to be important for blister formation. Among IgG subclasses, IgG1 have a high ability to activate complements, whereas IgG2 and IgG4 have a low and no ability, respectively. This article is protected by copyright. All rights reserved.

Diagnosis at a Glance: Acquired Perforating Dermatosis

A 70-year-old man receiving maintenance hemodialysis presented to the dermatology department with pruritic eruptions on the trunk and limbs. The lesions first appeared 30 months before his referral and had been gradually enlarging in size and increasing in number. His chronic kidney disease due to nephrosclerosis had been first diagnosed 20 years before his visit, and he had been receiving hemodialysis for 3 years. …

Diagnostic features of acquired dermal melanocytosis of the face and extremities

Acquired dermal melanocytosis of the face and extremities (ADMFE) is an unusual form of acquired dermal melanocytosis (ADM). In this paper, we report a case of ADMFE and review the published literature. Our review highlights several clinical differences between ADMFE and ADM: (i) more frequent involvement of the nasal alae in ADMFE than in ADM, (ii) less frequent involvement of the cheeks in ADMFE than in ADM, (iii) limbs affected in all cases of ADMFE but in few cases of ADM, and (iv) frequent involvement of conjunctiva and/or gingiva in ADMFE but very rare involvement in ADM. These findings strongly support the hypothesis that ADMFE is clinically distinct from the classic form of ADM, and gaining an understanding of its phenotype will enable accurate diagnosis and early intervention by Q‐switched laser therapy, which should benefit those patients with disease‐related cosmetic issues.

Generalized Pustular Psoriasis

A 6-year-old boy presented to our department with a 1-week history of generalized pustules with a high fever. It was suspected that he had pustular psoriasis when he was 8 months old. He had been treated with a topical dry distillation tar of delipidated soybean. The lesions were recurrent but had been under recent control. He had no recent history of infection or any new medication. Physical examination revealed multiple coalescing creamy-white pustules on a background of erythema over the whole body (Figure 1). Bacterial and fungal cultures of the pus were negative. Histologically, the erythematous pustules on the abdomen showed marked aggregates of neutrophils between degenerated keratinocytes in the uppermost portion of the spinous layer (spongiform pustule of Kogoj, Figure 2; available at www.jpeds.com). Based on these findings, the diagnosis of generalized pustular psoriasis was made. Topical corticosteroids and systemic cyclosporine (5 mg/kg/day) resolved the lesions and fever within 4 weeks. Generalized pustular psoriasis is an uncommon subtype of psoriasis that manifests as acute or subacute generalized sterile pustules appearing on erythema. Generalized pustular psoriasis is observed most frequently in middle-aged adults; however, it can also occur in children. Differential diagnoses include acute generalized exanthematous pustulosis, severe impetigo, and extensive tinea corporis. Drug history, bacterial and fungal tests on the pustules, and histologic findings are valuable diagnostic tools for ruling them out. Complications of childhood generalized pustular psoriasis include hepatic and renal failure, cholestasis, and severe infections, and these occasionally lead to a fatal outcome. Therefore, early systemic therapies, such as cyclosporine or methotrexate, are often required. Pediatricians should be aware of this potentially fatal disease, which necessitates prompt, appropriate management. ■

Hair colour shampoo dermatitis: HAIR COLOUR SHAMPOO DERMATITIS

Conflicts of interest: None of the authors has any conflict of interest, and there was no financial support or other benefits from commercial sources for this work. Hair colour shampoos, also called hair dye shampoos, are intended to preserve the colour of dyed hair, and some contain hair dye compounds. C12–14 hydroxyalkyl hydroxyethyl sarcosine (C12–14 HHS) (CAS no. 941296-64-6) is an ampholytic surfactant used in daily products such as soaps and shampoos (1). We herein report a case of allergic contact dermatitis caused by hair colour shampoo containing C12–14 HHS as a novel allergen.