Itaru Dekio

Stratum corneum TARC level is a new indicator of lesional skin inflammation in atopic dermatitis.

To cite this article: Morita E, Takahashi H, Niihara H, Dekio I, Sumikawa Y, Murakami Y, Matsunaka H. Stratum corneum TARC level is a new indicator of lesional skin inflammation in atopic dermatitis. Allergy 2010; 65: 1166–1172.

Interleukin-8 content in the stratum corneum as an indicator of the severity of inflammation in the lesions of atopic dermatitis.

Background: Atopic dermatitis (AD) is an inflammatory skin disease characterized by both acute and chronic eczema. Various markers are used to clinically evaluate the severity of AD. In order to identify a marker of local severity of AD, we measured IL-8, IL-18, vascular endothelial growth factor (VEGF), and transforming growth factor-α (TGF-α) levels in the stratum corneum (scIL-8, scIL-18, scVEGF and scTGF-α) and evaluated the correlation between the levels of these cytokines and the clinical severity scores of localized skin lesions. Methods: Stratum corneum samples were collected from the skin lesions of 50 patients with AD using the tape-stripping technique, and the scIL-8, scIL-18, scVEGF and scTGF-α levels were evaluated using the ELISA method. The trans-epidermal water loss and skin water content of the lesions were also measured prior to tape stripping. Results: The levels of scIL-8, scIL-18, scVEGF and scTGF-α were significantly higher in patients with AD than in healthy controls. Additionally, the levels of scIL-8, scIL-18 and scVEGF significantly correlated with the severity of AD. Conclusions: Among these cytokines, scIL-8 showed the highest correlation with the severity scores of lesions in AD as well as other parameters. Our results also suggest that measuring cytokines in the stratum corneum by using ELISA combined with tape stripping is a convenient method to evaluate the severity of skin lesions in AD.

Content of Vascular Endothelial Growth Factor in Stratum Corneum Well Correlates to Local Severity of Acute Inflammation in Patients with Atopic Dermatitis

Background: Atopic dermatitis (AD) is an inflammatory skin disease, characterized by existence of both acute and chronic eczema. Various markers are used to clinically evaluate the severity of AD as a whole. However, little is known regarding markers that can efficiently indicate the severity of a localized lesion. Vascular endothelial growth factor (VEGF), a potent activator of vascular permeability, is known to be increased in AD lesions. In order to establish whether the VEGF content in the stratum corneum (scVEGF) can be used as a marker to evaluate severity of AD lesions, we evaluated the association between scVEGF and symptom scores of localized lesions. Methods: Fifty patients with AD and 12 healthy subjects were enrolled. Skin lesions were evaluated and transepidermal water loss and skin water content of the lesions were measured. Stratum corneum samples were collected from the skin of back, neck and arm by the tape stripping technique. The scVEGF were evaluated using a VEGF-specific ELISA method after extracting protein from the scales. Results: The scVEGF levels were significantly higher in patients with AD than in healthy controls. Moreover, the scVEGF levels highly correlated with the manifestation scores of erythema and edema/papulation, and weakly correlated with the scores of excoriation, xerosis and itch. They also correlated significantly with transepidermal water loss and skin water content. Conclusions: The scVEGF levels correlated well with the severity of clinical conditions, especially erythema and edema/papulation. scVEGF level is considered to be a useful marker to evaluate acute inflammatory conditions in individual AD lesions.

Usefulness and economic evaluation of ADSL-based live interactive teledermatology in areas with shortage of dermatologists

Background  To overcome the problem of maldistribution of dermatologists in rural areas, live interactive teleconsultation systems are being used in some countries. However, these systems are not in common use because few evaluations on their efficiency and economic viability were reported.

Pilot study on novel skin care method by augmentation with Staphylococcus epidermidis, an autologous skin microbe – A blinded randomized clinical trial

BACKGROUND AND OBJECTIVE Staphylococcus epidermidis is an autologous bacterium that is beneficial to skin health. Our goal was to develop a novel, personalized basic cosmetic that exploits this characteristic. METHODS We conducted a double-blinded, randomized clinical trial on augmentation with S. epidermidis as a pilot study, in which S. epidermidis was collected from the subject, cultured for proliferation, and then continuously applied to the subjects own face before sleep twice per week for four weeks in order to increase colonization levels. RESULTS The results showed that this treatment increased the lipid content of the skin and suppressed water evaporation, thereby markedly improving skin moisture retention. Moreover, augmentation with S. epidermidis maintained a low acidic condition on the skin surface. The low risk of undesirable effects induced by augmentation with S. epidermidis was also confirmed by measuring erythema and melanin levels. CONCLUSIONS These results may serve as a driving force to accelerate the development of novel, personalized basic cosmetics.

Actinic lichen planus in a Japanese man: first case in the East Asian population

Actinic lichen planus (ALP) is a rare variant of lichen planus in which lichen planus develops on the light‐exposed areas of the skin. ALP is reported to occur in the African, Middle Eastern, and Indian populations, with very few cases reported in Caucasians. Here, we report a case of ALP in a Japanese man; to the best of our knowledge, this is the first reported occurence of ALP in the East Asian population. A 52‐year‐old Japanese man developed recurrent painful annular erythema on the face and hands. Histopathological examination of his skin biopsy revealed lichenoid‐type infiltrates of lymphocytes and histiocytes. We established a diagnosis of ALP on the basis of the distribution of eruptions only on the sunlight‐exposed areas and histological findings. Oral administration of systemic steroids proved effective in improving his condition. Lichen planus is known to be induced by an irritant (Koebner phenomenon); we believe that our patient is genetically susceptible to sunlight exposure and that sunlight acted as an irritant stimulating the development of ALP.

Aleukaemic leukaemia cutis as an initial manifestation of myeloid/NK cell precursor acute leukaemia

Aleukaemic leukaemia cutis is a rare condition characterized by infiltration of leukaemic cells into the skin before they appear in the peripheral blood. We report a case of an aleukaemic leukaemia cutis, which had a history of exposure to atomic bomb radiation. A 57‐year‐old Japanese woman initially presented with a 20‐week history of multiple red papules and plaques mainly over the trunk. Histological examination revealed the infiltration of atypical monocytic cells in the dermis, but no leukaemic cells were detected in the peripheral blood. Twenty‐three weeks after the appearance of the eruption, leukaemic cells were detected in the peripheral blood for the first time. The results of immunohistochemistry of the skin biopsy specimen and flow cytometry of the peripheral blood indicated the rare phenotype of myeloid/NK cell precursor acute leukaemia. This is the first case report of myeloid/NK cell precursor acute leukaemia presenting as aleukaemic leukaemia cutis in the English literature, and awareness of this clinical presentation may be important to reach the correct diagnosis.

Chronology of lichen planus-like keratosis features by dermoscopy: a summary of 17 cases.

Dermoscopic findings for 17 cases of lichen planus-like keratosis (LPLK) were chronologically evaluated. Three males and 14 females were included in the study and the ages ranged from 43 to 85 years (median 65 years). Three cases were diagnosed based on stereotypical dermoscopic findings, while the other 14 cases were histopathologically diagnosed as LPLK. Dermoscopy photographs were divided into four groups depending on the number of days (D) from the initial visit: 1) D = 0 (initial visit or biopsy day); 2) D = 61 to 180; 3) D = 181 to 270; 4) D = 271 to 360. Dermoscopic findings, described as light brown pseudonetwork, pinkish area, gray pseudonetwork, annular granular structures, and blue-gray fine dots, were evaluated at every visit to the hospital. Initial dermoscopy features included light brown pseudonetworks due to residual solar lentigo and overlapping pinkish areas attributed to lichenoid inflammation. Annular granular structures and gray pseudonetwork appeared to be the main features of the regressing stage; these features seemed to progress to “blue-gray fine dots” in the late regressing stage. Blue-gray dots or globules reflecting melanophages, the hallmark dermoscopic features of LPLK, were believed to resolve in approximately one to two years. Based on the clinical and dermoscopic observations, we have specified five stages of evolution of LPLK, namely 1) pre-existing solar lentigo, 2) early inflammatory stage, 3) early regressing stage, 4) regressing stage, and 5) late regressing stage. The limitations of the study are that this is a small-sized, retrospective, observational study and that ethnicity of participants is limited to Japanese patients with skin phototype III.

High carriage rate of Staphylococcus aureus and Streptococcus agalactiae in nine cases of fungus-free intertrigo of the toe cleft

Fungus-free intertrigo is an uncommon condition that can be overlooked by clinicians. Clinical observations suggest that in a few rare cases, erythema and maceration of the toe cleft are not associated with fungal or Corynebacterium spp. infection. In such cases, antifungal treatments frequently yield unsuccessful results. To examine the nature of this often overlooked and underinvestigated condition, we analyzed nine cases of toe cleft intertrigo showing negative results for fungal culture.

Longterm digital monitoring in the diagnosis and management of congenital nevi of the nail apparatus showing pseudo-Hutchinson's sign

Congenital nail apparatus nevi often show substantial enlarge -ment and wide involvement and greatly concern parents of a child as well as dermatologists. The differential diagnosis from melanoma is critical. The biopsy of the nail matrix is very traumatic and a fearful experience for a child. Therefore, a longterm careful follow-up with digital monitoring is very important and should be the first choice of management.Ronger et al. [1] reported that only three cases of mel-anoma showed micro-Hutchinson’s sign in 148 cases of melanonychia. However, similar findings are also observed in congenital nevus of the nail apparatus. We report three cases of congenital or early-onset nevus of the nail appara-tus with minute periungual regular pigmentation found on dermoscopy.We used the terms, “Hutchinson’s sign” and “pseudo-Hutchinson’s sign” based on the original descriptions [2, 3]. Baran and Kechijian [3] originally defined the term, pseudo-Hutchinson’s sign, for three conditions, including 1) benign pigmentation of the nailfolds, 2) pigmentation of the nailfolds due to malignant but non-melanoma tumors, 3) pigmentation seen through translucent nailfolds.