Ikumi Yokoi

Extraction of acne lesion in acne patients from multispectral images

In acne treatment, it is important to accurately evaluate the severity of Acne. The acne should be classified into several skin lesions including comedo, reddish papule, pustule, and scar. However, in some cases, a visual detection from RGB image maybe difficult for the proper evaluation of acne skin lesions. This paper proposes an extraction method using the spectral information of the various type of acne skin lesions calculated from the multispectral images (MSI) of the lesions. In the experiment, we showed the possibility of classifying acne lesion types by applying a combination of several linear discriminant functions (LDFs).

Urinary biomarker of oxidative stress in patients with psoriasis vulgaris and atopic dermatitis

Background  The involvement of oxidative stress in the pathogenesis of various skin disorders has been suggested for decades. However, few clinical studies have assessed oxidative stress in skin diseases. The easiest and least invasive method to assess oxidative stress in patients may be the measurement of oxidation products in urine.

A Simple Therapeutic Strategy with Super Elastic Wire for Ingrown Toenails

An ingrown toenail, which causes pain especially with secondary infection, is one of the most common diseases of toenails. It becomes difficult for a patient to walk and subsequently impairs quality of life. Surgical procedures, including total or partial excision of the nailbed, phenolization, and carbon dioxide laser matricectomy method, are commonly performed. The disadvantages of these methods include complexity, pain, time consumption, and the need for local anesthesia during the operation. Moreover, these methods may cause a cosmetic deformity, resulting in narrower nail width, and recurrence occurs in approximately 1% to 4% of patients who receive phenolization. Physicians in clinics usually use cotton, elastic tape, polyacryl sculptured nails, or flexible tube splinting as nonsurgical procedures, but cotton insertion and elastic taping require frequent home care for maintenance, and flexible tube splinting requires local anesthesia. Some devices, such as a VHO-Osthold brace or a plastic device, have been recently designed with favorable results, although the effectiveness of these regimens awaits future evaluation.

Nodular cystic fat necrosis in a patient with diabetes mellitus.

Dear Editor, Nodular cystic fat necrosis (NCFN), first described by Przyjemski et al. in 1977, is a distinct, benign subcutaneous lesion characterized histologically by encapsulated fat necrosis showing membranocystic change. We report a case of nodular cystic fat necrosis in a patient with diabetes mellitus. An 81-year-old Japanese man presented multiple asymptomatic subcutaneous nodules on his back and extremities with a 2-year history. On physical examination, approximately 30 mobile, firm subcutaneous nodules measured 10–15 mm in diameter were scattered at the extensor aspect of the lower back, upper arm and thigh. (Fig. 1a,b) His general condition was good. He had no history of trauma. Clinical differential diagnosis included lipoma, angiolipoma, post-traumatic lipogranuloma, subcutaneous type sarcoidosis and Rothmann–Makai syndrome. He was also diagnosed with diabetes mellitus and had suffered from diabetic retinopathy for more than 10 years. Laboratory data revealed that his fasting blood sugar (FBS) level was 121 mg/dL and hemoglobin A1c was 6.1%. Histologically, the excised cutaneous mass showed well-demarcated encapsulated fat necrosis and marked lipomembranous changes. The lipomembrane was positive for periodic acid-Schiff staining (Fig. 2a,b). Two months after the first visit, the nodules decreased in size slightly with good control of FBS and HbA1c levels although no medication for skin lesions was used. Nodular cystic fat necrosis shows a distinctive spectrum of clinical and histological features. Names such as nodular cystic fat necrosis, mobile encapsulated lipoma and encapsulated fat necrotic nodules have been offered to designate the lesion. Most of the lesions are mobile subcutaneous nodules in regions vulnerable to trauma, such as the elbows, knees and shins. The histology is characterized by encapsulated fat necrosis and lipomembranous change in which multiple, non-viable adipocytes are surrounded by condensed fibrous tissue. The etiology of NCFN is still unclear. Its pathogenesis seems to be related to trauma, rapid vascular insufficiency and subsequent fibrous capsule formation. Many previously reported patients, however, had no history of trauma, as was the same with our patient. The lesion must be distinguished histologically from lipoma, angiolipoma, α-1-antitrypsin deficiency-associated panniculitis and pancreatic fat necrosis.

Successful treatment of follicular cutaneous T-cell lymphoma without mucinosis with narrow-band UVB irradiation

© 2007 The Authors 1121 JEADV 2007, 21, 1105–1147 Journal compilation

Seborrhoeic keratoses and acanthosis nigricans in a long‐term survivor of thanatophoric dysplasia

therapy, there was a marked recession of the palmoplantar hyperkeratoses. The suberythroderma, however, showed no response in either intensity or spread. After obtaining consent from the patient, who weighed 78 kg, and ruling out relevant infections (tuberculosis, viral hepatitis, HIV infection), we initiated therapy with ustekinumab 45 mg given as a single subcutaneous injection. After 4 weeks, the erythema had almost completely faded (Fig. 1). We repeated the administration of ustekinumab 45 mg subcutaneously after 4 weeks and continued it at 12week intervals. The patient was completely free of symptoms after ustekinumab therapy for a total of 16 weeks. The aetiopathogenesis of PRP remains unknown. The currently preferred explanation is a T cell-mediated autoimmunological event based on a possibly infection-reactive hypersensitivity reaction. The rather inconclusive data thus far support the hypothesis that PRP is not a single, uniform entity, but rather describes phenotypically similar states of different pathogenetic inflammation patterns. This would also explain the very different and ultimately individual response of the disease to the known therapy options. Due to the histological and clinical overlap of PRP with psoriasis vulgaris, parallels have been drawn regarding the therapeutic options including established antipsoriatic systemic therapies considered for the treatment of PRP. The extent to which knowledge of the cellular regulation of inflammatory processes in psoriasis can be applied to PRP is, however, unclear. Nonselective immunosuppressive therapy approaches show efficacy in individual cases of both diseases. TNF-a blockers and the anti-CD11a mAb efalizumab as antipsoriatics have also been found basically effective in PRP. In light of this, efficacy of ustekinumab as an anti-p40 mAb to block interleukin (IL)-12 ⁄ IL-23 could be expected, especially as ustekinumab is known to act very early at the regulatory T-cell (TH17) level, thus suppressing activation of further T-cell cascades. Although the present single case report does not enable additional statements on the pathogenetic processes of PRP, it does become clear from the apparent effectiveness of ustekinumab that an overlap with psoriasis vulgaris can also be postulated in this case. Additional clinical studies must show how reliable the therapeutic effects of ustekinumab are in PRP. Perhaps this will become a new treatment option for PRP, at least in therapy-resistant patients.

Bevacizumab-induced hand-foot syndrome: circumscribed type

compared with placebo. Indeed, the limited recommendations for the use of TNF-a blockers in BD are primarily based upon this single study. At present no formal guidelines exist to support clinicians in the use of biologics in other forms of oral mucosal disease. Furthermore, given this lack of evidence, it would seem unlikely that formal guidelines and recommendations for such use could be developed at present. Dermatologists are ideally placed to participate in the clinical care of patients with treatment-resistant ⁄refractory inflammatory oral mucosal disease, either as the sole specialist physician or in consultation with colleagues from other specialties (e.g. oral medicine, ophthalmology, and maxillofacial ⁄otorhinolaryngological surgeons). In this context, collective and individual experience of biologic agents, and the provision of formal guidelines for their use in specific indications, may serve as a basis for judicious use and ⁄or advice to colleagues with limited experience of these agents. Individual experience of off-label use in other dermatoses may also be relevant. Clearly great caution must be used when discussing ‘off-label’ use of any agent, chiefly for patient safety but also for economical considerations. Nevertheless, using established guidelines as a framework for individual case selection, certain proposals could be made for clinical decisionmaking regarding the use of ‘biologics’ in select patients with severe treatment-resistant oral mucosal disease. An appropriate reference point may be the recently updated recommendations from the British Association of Dermatologists for use of biologics in psoriasis. It should be explicitly stated that this author in no form suggests that such guidelines be used to validate off-label usage. Yet, they do represent authoritative guidance on their recommended use in dermatology, and, as such may serve as the best available resource to guide similar use on an individual trial basis as appropriate. Similar dermatology guidelines and those developed for rheumatology, including those for BD, may also assist. Each emphasizes strict eligibility criteria which include: (i) severe disease, as measured by objective measurements such as disease indices and quality of life scores and (ii) patients who are refractory to ⁄ intolerant of conventional systemic therapy or where such therapy is contraindicated. At a minimum, similar criteria (including the use of the best available objective measurements for the specific mucosal condition) should be met before one should consider use of biologics in oral disease. Biological class and agent-specific contraindications and cautions should be followed, with appropriate pretreatment clinical and laboratory assessments and continued monitoring throughout treatment. As patients must be able to provide informed consent and use of biologics must be fully documented, the strong recommendation for patient registration in the British Association of Dermatologists’ Biologic Interventions Register (BADBIR) is one that could be extended for all biologic use (including oral mucosal disease). Finally, it is essential that any use of biologics be conducted and ⁄or supervised by clinicians experienced in these agents. In this matter, dermatologists may be most suitable. I . O’NE I L L de l’immeuble 3, Centre d’Affaires Poincaré, 3 Rue Poincaré, 06000, Nice, France E-mail: iain.oneill@hotmail.com

Multiple leg ulcers in a patient with Fabry disease.

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Unilateral palm pompholyx in a patient with amyotrophic lateral sclerosis

ejd.2011.1349 Auteur(s) : Kozo Nakai kozo@kms.ac.jp, Kozo Yoneda, Tetsuya Moriue, Yoichiro Hosokawa, Ikumi Yokoi, Yasuo Kubota Dermatology, Kagawa University, 1750-1 Ikenobe, Miki-cho Kita-gun, Kagawa 761-0793, Japan Amyotrophic lateral sclerosis (ALS) is a devastating degenerative motor neurone disease affecting both the upper and lower body and is characterized by muscle weakness, atrophy, spasticity and lethal respiratory failure. Several studies have shown unique morphological and physiological [...]

Effects of Topical N-Acetylcysteine on Skin Hydration/Transepidermal Water Loss in Healthy Volunteers and Atopic Dermatitis Patients.

Dear Editor: Atopic dermatitis (AD) is a relapsing chronic inflammatory pruritic skin disorder that has been partially attributed to skin barrier dysfunction. Skin barrier function was previously estimated by measuring skin hydration and transepidermal water loss (TEWL), and low levels of skin hydration along with high levels of TEWL were reported in AD patients1,2. N-acetylcysteine (NAC) is a thiol derivative that stimulates the synthesis of glutathione, an internal antioxidant. NAC has been clinically used as a mucolytic agent as well as an antidote for acetaminophen toxicity. NAC was previously reported to be useful in the treatment of skin diseases including toxic epidermal necrolysis and lamellar ichthyosis3,4. NAC may exert beneficial effects in skin diseases by: (1) reacting with oxidative intermediates and replenishing intracellular cysteine levels; (2) inhibiting the production of proinflammatory cytokines and factors; and (3) regulating epidermal proliferation. In the present study, we assessed the clinical effects of topical NAC on skin hydration and TEWL in healthy volunteers and AD patients. We enrolled 10 healthy volunteers (6 males and 4 females, age range: 28 to 76 years) and 11 AD patients (6 males and 5 females, age range: 31 to 73 years). AD patients had been receiving topical treatments including corticosteroids and tacrolimus ointment. Patients were not receiving cyclosporine or methotrexate. Patients with severe co-existing conditions as well as those with a heavy smoking status and/or high alcohol consumption were excluded. Informed consent was obtained from all patients. This study was approved by the Ethics Committee of the Faculty of Medicine, Kagawa University (No. 20-14). A NAC solution (20 w/v%; Senju Pharmaceutical Co., Ltd., Osaka, Japan) or its control vehicle was applied to the forearm skin twice a day for 4 weeks. Forearm skin hydration and TEWL were measured before and after the topical NAC application. Skin hydration and TEWL were measured using a Corneometer and Tewameter (Courage+Khazaka Electronic GmbH, Cologne, Germany). The topical application of NAC for 4 weeks increased skin hydration in 9/10 healthy volunteers (Fig. 1A, increase from 36.2±9.9 to 48.8±15.7 arbitrary units, p=0.001) and decreased TEWL in 8/10 healthy volunteers (Fig. 1B, decrease from 13.5±8.9 to 10.1±6.1 g/hm2, p= 0.0341). Topical application of the control vehicle for 4 weeks decreased skin hydration in 8/11 AD patients (Fig. 1C, decrease from 39.3±15.1 to 33.3±11.6 arbitrary units, p=0.0409). The topical application of NAC increased skin hydration in 9/11 AD patients (Fig. 1C, increase from 35.6±12.0 to 44.7±13.9 arbitrary units, p=0.0262) and decreased TEWL in 9 AD patients (Fig. 1D, decrease from 18.1±15.1 to 10.8±11.2 g/hm2, p=0.0409). Fig. 1 (A, B) Effects of the topical application of N-acetylcysteine (NAC) (for 4 weeks) on skin hydration and transepidermal water loss (TEWL) in healthy volunteers. (C, D) Effects of the topical application of NAC on skin hydration and TEWL in atopic dermatitis ... In a mouse model of AD, NAC was reported to restore the expression of some cell adhesion molecules that contribute to skin barrier formation by reducing oxidative stress5. Therefore, the topical application of NAC may increase skin hydration and decrease TEWL by strengthening the function of this barrier. Lamellar ichthyosis exhibits abnormal keratinization due to TGM1 gene mutations and a differential pattern of filaggrin expression, which implies that the success of NAC treatment in lamellar ichthyosis may be attributed to NAC-induced amelioration of abnormal keratinization and improvements in skin barrier function. Our results also support the possibility of skin barrier function restoration by NAC. Although AD patients generally have low levels of skin hydration and high levels of TEWL1,2, we could not obtain consistent results. Some AD patients have been shown to have normal skin barrier function6, and these values can be affected by various factors such as seasonality, exercise, and lifestyle. Thus, future studies involving a larger number of patients and excluding skin barrier-deteriorating factors are required to accurately assess the effects of NAC on AD.