Hirotaka Akita

Comparative study of treatment efficacy and the incidence of post-inflammatory hyperpigmentation with different degrees of irradiation using two different quality-switched lasers for removing solar lentigines on Asian skin

Background  Quality‐switched (QS) lasers are well‐known effective treatment for removing solar lentigines. However, the high incidence of post‐inflammatory hyperpigmentation (PIH) raises concern in darker skin types. This is the first study comparing efficacies and incidences of PIH in Asian skin with different degrees of irradiation between two QS lasers.

Six novel mutations of the ADAR1 gene in patients with dyschromatosis symmetrica hereditaria : Histological observation and comparison of genotypes and clinical phenotypes

Dyschromatosis symmetrica hereditaria (DSH), is a pigmentary genodermatosis of autosomal dominant inheritance. Since we clarified that the disease is caused by a mutation of the adenosine deaminase acting on the RNA 1 gene (ADAR1) in 2003, the molecular pathogenesis of a peculiar clinical feature of the disease has been expected to be clarified. We examined five familial cases and one sporadic case of Japanese families with DSH. The mutation analyses were done with single‐strand conformation polymorphism/heteroduplex (SSCP/HD) analysis and direct sequencing of ADAR1. The DNA analysis of each patient revealed one missense mutation (p.F1091S), two nonsense mutations (p.C893X, p.S581X) and three frame‐shift mutations (p.E498fsX517, p.F1091fsX1092, p.L855fsX856). Visual and electron microscopic findings showed abundant melanin pigment deposited all over the basal layer, and enlarged melanocytes with long dendrites located in the pigmented lesions with small or immature melanosomes scattered sparsely in the cytoplasm, but in the adjacent keratinocytes many small melanosomes were singly dispersed or aggregated. The hypopigmented areas showed little melanin deposition and reduced numbers of melanocytes in which much degenerative cytoplasmic vacuole formation could be observed by electron microscopy. Herein, we report six cases of DSH with six novel mutations. The variety of their clinical phenotypes even in the pedigree may suggest the presence of factors other than the ADAR1 gene influencing the extent of the clinical skin lesion. Microscopic findings suggest that the clinical appearance must have developed directly by melanocyte variations mainly induced by the ADAR1 gene mutations.

The clinical experience and efficacy of bipolar radiofrequency with fractional photothermolysis for aged Asian skin.

Bipolar radiofrequency (RF) technology is developed based on fractional thermolysis, and the literature concerning the efficacy of the rejuvenation and treatment of acne scars has been reported in Europe and the United States of America. Therefore, we examined bipolar RF treatment using fractional thermolysis to evaluate the efficacy and safety of the treatment of Asian photo‐aging skin, particularly ‘wrinkles’ and ‘sagging.’ Ten Japanese women (mean age: 58.6, skin type III–IV) received three fractional bipolar RF treatments every 4–6 weeks. For the objective evaluation, we evaluated the improvement of the wrinkles on the forehead, lateral canthus (crows feet) and lower eyelid, and the sagging of the nasolabial fold using digital photographs captured using Visia™. For the subjective evaluation, the participants were asked to describe the improvements observed in the wrinkles on the forehead, lateral canthus (crows feet) and lower eyelid, and sagging nasolabial fold and to evaluate the level pain experienced using a 10‐point VAS score. The objective evaluation in each category showed significant improvements in the wrinkles on the lateral canthus (crows feet) and lower eyelid. As for the nasolabial fold, 60% of the subjects showed improvements, scoring from good to excellent (51–100% improvement), although there was a little improvement of the wrinkle on the forehead. Similar improvements were observed in the subjective evaluation. During each treatment, oedema and erythema were observed in all participants, but the oedema disappeared the following day in all cases. However, mild erythema persisted for an average of 3.1 days. Micro debris disappeared after an average of 5.2 days. The participants were satisfied, as we allowed them to apply make‐up the next day. There were no other severe adverse reactions observed during the treatment. The 10‐point VAS score was 3.8, and no participants dropped out due to discomfort. Little improvement was observed in the forehead wrinkles in either the objective or the subjective evaluation. The results obtained in this study indicate that fractional bipolar RF is an effective and safe treatment for the ‘wrinkling’ and ‘sagging’ of Asian photo‐aging skin.

Histologic Study of Collagen and Stem Cells After Radiofrequency Treatment for Aging Skin

BACKGROUND Monopolar radiofrequency (mRF) devices have been shown to be clinically effective for treating aging skin, but there are few histologic studies about the mechanisms. OBJECTIVE To histologically analyze chronologic and quantitative change in collagens after mRF treatment to determine the mechanisms of the antiaging effect. METHODS Five patients were enrolled in this study. Skin specimens were taken before and 1 and 3 months after treatment. Immunostaining was performed to determine change in type I and III collagen levels and stem and other cell counts in skin layers. RESULTS In all cases, both types of collagen significantly increased after irradiation in the dermis (p < .05), and their changes were noticed uniformly in all layers. No significant change was noticed in stem and other cell counts. CONCLUSIONS This study histologically demonstrated that type I and III collagen increased significantly in the dermis after mRF treatment. The amount of stem cells did not affect the increase in collagens.

Syringoma of the face treated with fractional photothermolysis

Abstract We experienced that two Japanese women diagnosed with syringoma, confirmed by a punch biopsy, were successfully treated with fractional resurfacing. Both clinical cases have had positive results after only a few treatments, with high patient satisfaction, not only for the improvement of syringoma, but also for the improvement of aging skin, and with no side effects. From that aspect, laser treatment with fractional photothermolysis may be considered to be one of the effective treatment methods for syringoma. Although fractional photothermolysis was originally developed for an aesthetic purpose, it also can be utilized for intractable skin disease, as demonstrated by taking the concept of fractional photothermolysis and the results from this study with skin biopsy.

Erythema‐multiforme‐like occupational contact dermatitis due to bisphenol A

Case Report A 33-year-old man had carried out research on the development of facsimile paper production for 10 years. After 2 years work, he had developed hand dermatitis, and eruptions gradually began to extend to the whole body, with wheezing developing about 2 years ago. At initial consultation, his entire body was covered with erythematous papules and plaques, some with a targetlike appearance, suggesting erythema multiforme. Patch, prick, and scratch tests with various chemicals, including the Japanese standard series, were performed. The only positive reaction was to BPA on patch testing (Table 1).

Prospective study of removing solar lentigines in Asians using a novel dual-wavelength and dual-pulse width picosecond laser: PICOSECOND LASER FOR SOLAR LENTIGO IN ASIANS

Quality‐switched (QS) lasers are known to be an effective treatment for removing solar lentigines, however, high incidence of post‐inflammatory hyperpigmentation (PIH) is a concern in darker skin types. The objective of this study was to evaluate the efficacy and safety of a dual‐wavelength and dual‐pulse width picosecond Nd:YAG laser for removing solar lentigines in Asians.

Effective surgical treatment of progressive nodular histiocytosis

Abstract Progressive nodular histiocytosis (PNH) is a rare benign self-limiting histiocytic disorder of the skin that is characterised by the progressive appearance of widespread xanthomatous lesions with no spontaneous remission. We operated on a 13-year-old girl with PNH four times with a result that had stabilised the condition at 1 year.