Hiromi Tsuboi

Characteristics of acquired reactive perforating collagenosis

The status of the patients associated disease can generally affect the onset or healing of acquired reactive perforating collagenosis (ARPC). We treated eight cases of ARPC and noted that the patients had similar findings. However, it was not clear why ARPC developed in the patients with these diseases. Nevertheless, several factors related to the diseases associated with ARPC could affect the degeneration of collagen fibers or the production of dermal products. Some patients had diseases that were characterized by fibrosis and an increased amount of reticular fibers. Factors related to tissue remodeling might act not only in diseases associated with ARPC but also in ARPC itself.

A 14-year-old girl with lichenoid sarcoidosis successfully treated with tacrolimus

We report a case of lichenoid sarcoidosis in a young girl treated by oral tacrolimus and methylprednisolone. The patient had had a skin eruption from 1 year of age and had developed uveitis at 2 years of age. Her sight had become affected by the uveitis at 8 years of age. When she was 14, she was admitted to the ophthalmology department of our hospital to start treatment with tacrolimus (FK506). She was referred to the department of dermatology for her skin lesions, which were flat, pinkish or normal skin‐colored papules scattered on her extremities and the backs of her hands. Upon histology, epithelioid granulomas were seen in the upper dermis and around the erector pili muscles. She received tacrolimus (FK506) 6 mg/day for 3 months for her uveitis. The eye lesions subsided somewhat, and the skin lesions were almost healed after the 3‐month course of tacrolimus. However, 4 months after stopping the tacrolimus, her skin and eye lesions relapsed. At that point, she was started on methylprednisolone 16 mg/day for her uveitis. With the methylprednisolone treatment, the inflammation of the eye lesion immediately healed, as did the skin lesions.

Characterization of infiltrating T cells in human scalp explants from alopecia areata to SCID nude mice: possible role of the disappearance of CD8+ T lymphocytes in the process of hair regrowth.

T cells may play a role in the pathogenesis of alopecia areata (AA). We attempted to elucidate the linkage between infiltrating T cells and hair regrowth processes by grafting scalp skin from the affected region of patients with AA onto severe combined immune deficiency (SCID) nude mice.

Case of pyoderma gangrenosum showing oral and genital ulcers, misdiagnosed as Behcet's disease at first medical examination

It is occasionally difficult to distinguish between Behcets disease (BD) and pyoderma gangrenous (PG). Our case showed ulcers of the oral, vaginal and perineal areas, and in the ileum, thus resulting in our initial diagnosis of BD. However, the patient showed a continued leukopenia, and she was subsequently diagnosed by bone marrow biopsy as having a myelodysplastic syndrome, which will sometimes accompany PG. In addition, following a hysterectomy, the ulcers of the stump in the vagina and the perineum showed the characteristic findings of a PG‐like destructive ulceration. Based on these findings, we finally diagnosed our case to have PG.

Ulcerative lichen planus associated with Sjögren's syndrome

Ulcerative lichen planus is a rare variant of lichen planus that is characterized by ulcerations of the feet and toes that are accompanied by toenail loss. However, the nail, oral mucosa, genital mucosa and the scalp are also sometimes affected by ulcerative lichen planus. Several authors have drawn attention to the association of ulcerative lichen planus and autoimmune diseases. We report a patient who had ulcerative lichen planus, with ulcerative erythema on the soles and palms, nail dystrophy and oral lesions, as well as Sjögrens syndrome; she was successfully treated with etretinate.

Acquired Reactive Perforating Collagenosis in a Patient with Lung Fibrosis

Reactive perforating collagenosis (RPC) is a rare disorder characterized by the transepidermal elimination of altered collagen. The inherited form of RPC begins in early childhood, but acquired reactive perforating collagenosis (ARPC) begins in adult life. ARPC is associated with diabetes mellitus, renal disease, and malignancy. ARPC with lung fibrosis has not previously been reported in the literature, and the relationship between ARPC and lung fibrosis has not been studied. The etiological relationship between the two disorders appears to be uncertain. Although their association in this case could be due to chance, it may be due to the transforming growth factor β abnormalities seen in both diseases. In this report, we describe a case of ARPC with lung fibrosis and propose an etiological association between the two diseases.

A case of bleomycin-induced acral erythema (AE) with eccrine squamous syringometaplasia (ESS) and summary of reports of AE with ESS in the literature.

Chemotherapy‐induced acral erythema (AE) is primarily induced by hydroxyurea, methotrexate, and cytarabine, although there are rare reports of AE induced by combination chemotherapy containing bleomycin. It is thought that the accumulation of chemotherapeutic drugs in eccrine glands may cause eccrine squamous syringometaplasia (ESS), which is characterized by metaplasia and focal necrosis of the epithelium of the eccrine duct. ESS is occasionally detected in conjunction with AE, but such occurrences are relatively uncommon. This is the first report of AE with ESS induced by the administration of bleomycin alone. We also provide a summary of past cases of AE with ESS in the literature.

Erythropoietic protoporphyria with eye complications

We herein report a case of erythropoietic protoporphyria (EPP) complicated by a decrease in eyesight that occurred in a Japanese male. An ophthalmologist initially thought that the eyesight loss might be the result of idiopathic optic nerve atrophy due to a vascular obstruction in the fundus. There are no previous reports of EPP cases with eye complications. However, an eye abnormality has been reported in an animal model of protoporphyria after long‐term, low‐level exposure to blue light. As a result, in our case, it is therefore possible that a relationship may have existed between EPP and the onset of eye complications.

Vitiligo with inflammatory raised borders with hepatitis C virus infection

Dear Editor, In patients with vitiligo vulgaris, a possible role for cell-mediated immunity in skin depigmentation has long been neglected, possibly due to the absence of overt infiltrates and the presence of antibodies to melanocytes, though early lesions of vitiligo vulgaris show a limited lymphocytic infiltration. However, it is thought that the absence of overt infiltrates, however, may be merely the result of dispersion of the target cells throughout the basal layers of the epidermis. Furthermore, vitiligo with inflammatory raised borders, which is thought to be related to cellular cytotoxicity against melanocytes, is placed in the same category as vitiligo vulgaris. While there have been some reports suggesting a relationship between vitiligo vulgaris and hepatitis C virus (HCV) infection, there have been no reports of vitiligo with inflammatory raised borders in a patient with active HCV infection. Therefore, we report this case of vitiligo with inflammatory raised borders in a patient with active HCV infection and discuss the disease process. A 38-year-old man first noticed depigmentation (vitiligo) preceded by erythema and slight itching on the buttock at the age of 36 years. Soon, depigmentation occurred inside the erythematous zone. Approximately 3 weeks later, complete depigmentation occurred after the erythema cleared. The vitiligo remained for a long time, and the lesions increased in number. The patient had been examined by a dermatologist and treated with some ointment without effect. At the age of 38 years, the patient presented to our hospital. The patient had a history of active HCV infection at the age of 18, following which he was diagnosed as having chronic hepatitis; however, he had not been examined or treated for this condition in the last few years. Upon initial examination, the patient presented with nail to egg-sized, round to irregularly shaped areas of depigmentation with peripherally edematous erythema in the axilla, inguinal region and the extremities (Fig. 1). Depigmentation without erythema was also seen on the patient’s buttocks and repigmentation occurred in some areas of vitiligo. The depigmented area with erythema was excised. Upon histopathology, degeneration of the basal layer and exocytosis of lymphocytes in the area of erythema was observed (Fig. 2). In the area of vitiligo, which existed inside of the erythema, inflammatory cell infiltration was not prominent, and there was a decreased number of melanocytes, which were stained by anti-tyrosinase antibody (MAT-1). The diagnosis of vitiligo with inflammatory raised borders was based on the typical clinical and histological findings. Upon laboratory investigation, the patient had a white cell

A Case of Vulvitis Granulomatosa

Merkersson‐Rosenthal syndrome (MRS) is characterized by cheilitis or pareitis granulomatosa, facial palsy, and fissured tongue. Sometimes the forehead, eyelids and chin are involved, and occasionally genital lesions are present. A vulval lesion of MRS is named vulvitis granulomatosa. Tranilast has been described as an effective treatment for cases of MRS, granulomatous cheilitis, and granulomatous blepharitis. Herein we report a successful treatment with tranilast of an adult female patient with vulvitis granulomatosa.