Hideyuki Tada

Experience with surgical treatment of hidradenitis suppurativa.

The authors report their experience with 23 sites of hidradenitis suppurativa, including cases with musculocutaneous flap repair, and discuss the surgical methods applied. Twenty-three sites in 19 patients with chronic inflammatory skin lesions were reviewed. The lesions were divided into two groups: The limited group was comprised of mild lesions, which appear isolated and have limited abscesses without sinus tract formations. The severe group was compromised of severe lesions, which included diffuse, multiple abscesses with severe sinus tract formation and fibrosis. Nine sites were limited and 14 sites were severe. After resecting the lesion, the defect was covered with a split-thickness skin graft (four sites were limited, nine sites severe), a musculocutaneous flap (five sites severe), primary closure (four sites limited), and a local skin flap (one site limited). In six sites in 6 severe-group patients, local recurrence occurred. The local recurrence rate differed significantly between the limited and the severe groups. The reason for this may be because the lesions in the limited group could be resected completely, whereas the lesions in the severe group were diffuse and total resection was sometimes difficult for various reasons. The method of surgical repair did not affect the local recurrence rate. In recurrent cases, four sites treated with skin grafting required further surgical treatment, and two sites treated with musculocutaneous flaps were controlled with oral antibiotics. In conclusion, sufficient resection of the lesion is the most important issue in treating follicular occlusion triad disease. In lesions that can be resected completely, the surgical procedure to cover the lesions should be selected to suit the size and site of the defect. However, in cases that cannot be resected completely, a musculocutaneous flap is recommended instead of a skin graft for enhanced postoperative management of the recurring wound, and its contribution to aesthetic and functional improvement.

Expression of desmoglein I and plakoglobin in skin carcinomas

Reduction or absence of cell‐cell adhesion molecules has been reported in various carinomas and the abnormal expression of these molecules contributes to the invasive and metastatic behavior of malignant tumor cells. In epidermal keratinocytes, the main cell‐cell adhesion systems are adherens junctions and desmosomes. Previous studies have shown that, in skin carcinomas, the decreased expression of E‐cadherin, major constitutional glycoprotein of adherens junctions, is associated with the invasive and metastatic ability of the tumor cells. In the present study, we examined the expression of desmoglein I and plakoglobin, the constitutional components of desmosomes, in various skin carcinomas such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), extramammary Pagets disease and Bowens disease by an immunofluorescence method. In normal human skin, desmoglein I and plakoglobin were strongly expressed in the intercellular space of the epidermis except for the basal cell layer. In BCC and SCC, the expression of desmoglein I and plakoglobin was markedly reduced or absent in tumor cells. In carcinoma in situ of Pagets disease, compared with the normal epidermal cells surrounding tumor cell nests, the expression of these molecules was reduced in tumor cells. In Pagets disease with dermal infiltration of tumor cells, the expression of these molecules was almost absent throughout the epidermis. In Bowens disease, the expression of desmoglein I was reduced in the clumping cells and dyskeratotic cells. These results suggest that the expression of desmosomal cadherin is reduced or absent in human skin carcinomas, and that reduction of these molecules may also contribute to the invasiveness and metastasis of skin carcinomas.

8-Methoxypsoralen plus UVA induces the 72-kDa heat shock protein in organ-cultured normal human skin

Abstract The proteins induced by heat and other stressors, called heat shock proteins (HSP) or stress proteins, are considered to play a general role in protection from cellular injury. Exposure to UVA (320400 nm) following application of 8‐methoxypsoralen (8‐MOP), termed PUVA is commonly used in the field of dermatology. In order to understand the induction of HSP in PUVA‐treated human skin, indirect immunofluorescence using a monoclonal antibody specific for the 72 kDa HSP (HSP 72) was carried out in organ‐cultured normal human skin that was treated with PUVA. When the organ‐cultured skin was treated at 37°C for 1 h with 8‐MOP at a final concentration of 10 or 100 μg/mL and exposed to UVA (51.3 kJ/m2), nuclear immunofluorcscence of HSP 72 was detected in the epidermal cells 12 h after UVA irradiation. In contrast, the induction of HSP 72 was not detected either by UVA irradiation or 8‐MOP treatment. These results suggest that PUVA treatment is one of the stressors for human skin, and DNA damage caused by PUVA induces HSP 72.

Induction and repair of UVB-induced cyclobutane pyrimidine dimers and (6-4) photoproducts in organ-cultured normal human skin

SummaryTo examine the induction and repair of UV-induced DNA damage, indirect immunofluorescence was performed on UVB-irradiated organ-cultured normal human skin using monoclonal antibodies specific for either cyclobutane pyrimidine dimers or (6-4) photoproducts. Nuclear immunofluorescence of cyclobutane pyrimidine dimers and (6-4) photoproducts were observed in a dosedependent manner after UVB irradiation. The intensity of nuclear immunofluorescence of the upper epidermal layers was stronger and clearer than that of the lower epidermal layers. DNA repair time-course studies showed that both types of DNA damage could be repaired within 24 h after UVB irradiation.

Mortality and Recurrence Rate After Pressure Ulcer Operation for Elderly Long-term Bedridden Patients

We operated on 16 sacral pressure ulcers in elderly and long-term residential patients who were immobile as a result of cerebral vascular disease. The mean age of patients was 76 years. Eight ulcers were treated with local fascial flaps and 8 by simple closure. The follow-up period was from 1 to 4 years. Recurrence and mortality rates were examined retrospectively. In the 16 patients, recurrence occurred in 37.5%, and 43.8% died without recurrence. The recurrence rate was 37.5% for local fascial flaps and 37.5% for simple closure. Overall mortality was 68.8% in the follow-up period. Because postoperative death was common, we should not only focus on reducing local pressure but also pay attention to any underlying disease. Because of this high mortality rate, the least invasive procedure possible should be used. Because the recurrence rate of simple closure was the same as for local fascial flaps, simple closure should be considered as a reconstructive method.

Expression of E‐Cadherin in Skin Carcinomas

In this study, we investigated the expression of E‐cadherin in 31 cases of human skin carcinoma including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Pagets disease, Bowens disease (invasive type), and trichilemmal carcinoma, by immunohistochemical staining using a monoclonal antibody specific for E‐cadherin. Similar to the E‐cadherin expression in normal epidermis, E‐cadherin was strongly expressed in all samples of BCC on the cell borders, whereas marked decrease or loss of E‐cadherin expression was found in the tumor cells of SCC, Pagets disease, and Bowens disease (invasive type). On the other hand, E‐cadherin expression of trichilemmal carcinoma was slightly reduced. Considering the clinical and histological features of these skin carcinoma, the reduction of E‐cadherin expression is considered to be associated with the invasion and metastasis of human skin carcinoma.

Age‐related decrease in the inductability of heat shock protein 72 in normal human skin

In order to know the effect of chronological ageing on the induction of heat shock protein (HSP) in normal human skill, the 72‐kDa HSP (HSP72) was examined in organ‐cultured samples of normal human skin which were obtained from 30 individuals (age range 17–86 years. The skin explants were first incubated al 37°C for 24 h. and then heat‐treated at 45°C for 1 h. After heat treatment, the skin explants were incubated al 37°C for 1 or 3h. Immunohistological analysis, using a monoclonal antibody specific for the HSP72. revealed that although the time course of the heat‐induced HSP72 expression was similar in the young and aged groups, a lower level of induction of HSP72 was observed in the aged group. This result indicates that there is an age‐related dysfunction of the heat shock response in normal human skin.

E-cadherin expression in wound healing of mouse skin

Background: E‐cadherin has been studied extensively in other systems but little attention has been paid to its role in wound healing. We investigated E‐cadherin expression in epithelial wound healing in vivo by focusing on the migrating cells in the epithelial tongue and the mitotic cells in the non–injured side apart from the original wound edge.

An evaluation of functional improvement following surgical corrections of severe burn scar contracture in the axilla

This report present an evaluation 13 consecutive cases of severe burn scar contracture of the axilla and investigates the factors that influence functional improvement. The operation was performed at various times during the period from 3 months to 63 years after the initial burn wound healed. The active range of shoulder abduction before the operation in these patients was restricted to 30-90 degrees. The scar contractures in the axilla were released in all cases and the defects of the axillary region were covered with musculocutaneous flaps or fasciocutaneous flaps. Following operation rehabilitation was performed with the range of shoulder abduction had reached a plateau. The relations between the improved range of shoulder abduction, time to reach a stable range of abduction, patient age and duration of illness in each patient are discussed. Patient with long post-injury periods required a longer time to reach a stable range of abduction. Furthermore, the patients with an extremely long period before operation had difficulties such as nerve injury or stiff joint which restricted improvement. In conclusion, adequate surgical treatment in early period after occurrence of contracture is desirable for burn scar contracture of the axilla.

Trichilemmal carcinoma developing in a burn scar: a report of two cases.

Two cases of trichilemmal carcinoma (TLC) developing in burn scars are reported. In Case 1, a 73‐year‐old man developed a TLC on his left lower leg five years after a burn. In Case 2, a 43‐year‐old man developed a cauliflower‐like mass on his head 42 years after a burn. Histologically, tumor cells showed a lobular proliferation in continuity with the epidermis. Tumor nests were mostly composed of large atypical cells with clear cytoplasms containing PAS‐positive, diastase sensitive materials. Some of the nests showed trichilemmal‐type keratinization. These cases were treated only with surgical excision, and there has been no evidence since of local recurrence or metastasis.