Junko Sowa

Psychosomatic analysis of atopic dermatitis using a psychological test.

In patients with atopic dermatitis (AD), psychosomatic factors are important elements in treating the condition. In this study, we surveyed 51 outpatients with AD who consulted the Department of Dermatology of Fujita Health University Hospital using a questionnaire involving present illness/treatment history regarding AD to analyze psychosomatic factors. The severity of AD was evaluated using the severity classification described by Yoshiike et al. Four psychological tests were used to examine depression, anxiety, personality, and upbringing experiences during childhood. Beck Depression Inventory (BDI) was used as a scale for depression, Self‐rating Anxiety Scale (SAS) as a scale for anxiety, the Temperament and Character Inventory (TCI) as a scale for the personality tendency, and the Parental Bonding Instrument (PBI) as a scale for upbringing experiences during childhood. The BDI and SAS scores were high in the severe AD group. Among patients with the same grade of AD, the BDI and SAS scores were higher in the low IgE RIST group. In the patients with AD, the BDI scores were significantly higher than those in the healthy controls (P<0.05). In clinical practice, the treatment of AD should include psychosomatic approaches.

Squamous cell carcinoma of the scrotum

A patient with psoriasis was found to have a large skin tumor on his scrotum. He had received psoralen and ultraviolet A radiation therapy to control psoriasis. Histopathologic study revealed that the tumor was a well-differentiated squamous cell carcinoma. We present this rare case and suggest that the genitalia be shielded during ultraviolet therapy.

Cutaneous polyarteritis nodosa induced by Mycobacterium tuberculosis

condition. In addition to the skin, the lungs and kidneys are often involved in patients with microscopic polyangiitis. Renal involvement, such as necrotizing crescentic glomerulonephritis or hemorrhagic pulmonary capillaritis, is present in 90% of the cases. In our case, hematuria and non-nephritic range proteinuria were observed, but severe renal symptoms and pulmonary alveolar hemorrhage were absent. Discontinuation of PTU at a relatively early stage and systemic, high-dose prednisolone therapy might account for the prevention of damage to the internal organs. Microscopic polyangiitis should be considered in the differential diagnosis of deep skin ulcers resembling PG during the antithyroid therapy using PTU.

Apoptosis of neutrophils resulting after emperipolesis in cutaneous Rosai-Dorfman disease: a new ultrastructural finding.

Fig. 1. A) Multiple erythematous papules extensively involve the face. B and C) Large pale-staining histiocytes show cytophagocytosis (emperipolesis) of neutrophils and lymphocytes. There is an accompanying infiltrate spanning the full thickness of the dermis (hematoxylin and eosin staining; original magnification B: ×100; C: ×400). D) Terminal deoxy-UTP nick-end labeling (TUNEL) staining of the section showed phagocytized cells exhibiting apoptosis (original magnification, ×400).

Three-base deletion mutation c.120_122delGTT in ATP2A2 leads to the unique phenotype of comedonal Darier disease

Darier disease (DD; Darier―White disease; OMIM 124200) is an autosomal dominant inherited disorder. 1 Clinically, it is characterized by recurrent and multiple hyperkeratotic papules or nodules affecting the trunk and flexural aspects of the extremities. 1 Characteristic histopathological features are dyskeratotic cells in the form of corps ronds and grains, suprabasal acantholysis forming suprabasal lacunae and irregular upward proliferation into the lacunae of papillae lined with a single layer of basal cells, the so-called villi. 2 The causative gene is ATP2A2 (OMIM 108740) on chromosome 12, which encodes the sarco/endoplasmic reticulum calcium pump ATPase (SERCA2). 2 Clinical variants include the hypertrophic, vesiculobullous, hypopigmented, cornifying, zosteriform and linear subtypes, and the rare subtype comedonal Darier disease (CDD). 1,3―6 CDD tends to appear in seborrhoeic areas. The characteristic morphological features are prominent follicular involvement, sometimes associated with keratotic plugs, and the presence of greatly elongated dermal villi and papillary projections. 4 There have been no conclusive reports on the aetiology of CDD and it is still controversial as to whether or not CDD is a variant of DD, and if it is caused by ATP2A2 gene mutations, although a combination of CDD and classic DD was reported in one patient. 7 The present study identifies a previously unreported three-base deletion mutation in ATP2A2 in a patient with CDD.

Drug Hypersensitivity Syndrome Caused by Minocycline

Background: Minocycline is a commonly prescribed drug for the treatment of acne. Its use is generally not associated with systemic side effects. Objective: To describe a case of minocycline-induced drug hypersensitivity syndrome in a 20-year-old Japanese woman. Methods and Results: Following 2 months of minocycline treatment, the patient developed skin lesions composed of exudative maculopapules, purpuratous macules, and target-like, erythema multiforme-like plaques over most of her body. In addition, she had fever, abnormal liver function tests, eosinophilia, and atypical lymphocytosis. Laboratory tests indicated no elevation of antibody titers against cytomegalovirus, Epstein-Barr virus, and human herpesvirus 6. Her ongoing exposure to minocycline was stopped, and treatment with oral prednisolone was begun. Her signs, symptoms, and laboratory abnormalities then began to resolve. Subsequently, the syndrome was observed to return briefly in response to an oral challenge with minocycline. Conclusions: Minocycline is able to elicit a drug hypersensitivity syndrome that can resemble infectious mononucleosis. This drug reaction can be treated effectively by cessation of exposure to this drug and steroid therapy.

Histopathologic findings in Unna's nevus suggest it is a tardive congenital nevus.

According to A. Bernard Ackermans clinical histopathologic classification of nevi, the essential histopathologic finding of an Unnas nevus is localization of melanocytic nevus cells to a markedly thickened papillary dermis of an exophytic lesion. In this study, we examined 94 completely resected Unnas nevi in which several sections of the same lesion could be examined. We examined that melanocytic nevus cells were not just localized to the exophytic portion but were also commonly distributed below it (81 lesions, 86.2%). Melanocytic nevus cells were found in a periadnexal distribution in most of the lesions in which they extended below the exophytic part and were most frequently noted around hair follicles (60 lesions, 63.8%), then around eccrine ducts (43 lesions, 45.7%), and least frequently around sebaceous glands or ducts (36 lesions, 38.3%). Nests of melanocytic nevus cells were present in follicular epithelium in 7 lesions, sebaceous ducts in 1 lesion, and eccrine ducts in 1 lesion. Moreover, type A nevus cells containing melanin granules were observed in 16 lesions (17.0%) when they were distributed around hair follicles, in 8 lesions (8.5%) when distributed around sebaceous glands or ducts, and in 1 lesion (1.1%) when distributed around eccrine ducts. Although Unnas nevus is clinically an acquired nevus, it has many histopathologic characteristics of a congenital melanocytic nevus and is therefore likely a tardive congenital lesion.

Linear lupus erythematosus profundus on the face, following the lines of Blaschko

described. One case treated with oral prednisone (60 mg/ d) resulted in mild improvement. Another case treated with 60 mg of prednisone daily for 1 week followed by 40 mg daily for 6 weeks resulted in healing of skin lesions with shallow atrophic scars; prednisone was slowly tapered and discontinued without cutaneous recurrence. A third case was treated with 40 mg daily tapered to 10 mg daily with decrease in the extent of lesions. In yet another case, shaving a verrucous nodule flat in combination with hydroxychloroquine at 200 mg twice daily resulted in resolution without recurrence. Our patient’s co-morbidities limited the use of high-dose systemic steroids, although low-dose prednisone stopped disease progression. Verrucous sarcoidosis is a rare variant of cutaneous sarcoidosis, but its presence should alert one to the likelihood of pulmonary disease and extrapulmonary systemic involvement. Additionally, systemic corticosteroids should be considered for treatment.

Dermoscopic features of pigmentation in Laugier-Hunziker-Baran syndrome.

Laugier-Hunziker-Baran syndrome (LHBS) is a rare, acquired, benign disorder of hyperpigmentation often involving the acral regions and the oral and genital mucosa and is frequently associated with longitudinal melanonychia. Because the lesions of LHBS often resemble various other mucocutaneous hyperpigmentary diseases such as Peutz-Jeghers syndrome, Addison’s disease, and malignant melanoma, detailed examination for systemic involvement is required for differentiation from these disorders. Dermoscopy is a useful noninvasive technique for more accurate diagnosis of various cutaneous pigmented lesions, and therefore it should also be applied to the lesions of LHBS, but the dermoscopic features of this disease are not well described. We report here a case of LHBS with results of detailed dermoscopic findings of the pigmented lesions.

Fixed food eruption caused by Japanese sand lance.

Fixed eruption (FE) is defined as recurrent, well-circumscribed pigmented lesions in the same sites after exposure to the causative agent. As most of the causative agents are drugs, fixed drug eruption (FDE) is defined as a clinical condition. In recent years, some foods have been identified as causative agents. Such cases are called fixed food eruption (FFE). We recently reported a case of FFE caused by lactose. We report an additional case of FFE, which we experienced recently, caused by Ammodytes personatus [Japanese sand lance (JSL) or sand eel], which is commonly found and eaten in western Japan. A 58-year-old woman presented to us, reporting exudative, pruritic erythema 2 days after having eaten fried JSL, and pigmentation at the same site, which had developed within 1 week. On physical examination at presentation (10 days after having eaten the JSL), slightly pigmented macules on the left upper and lower eyelids (Fig. 1a, arrowheads). The patient had previously experienced similar eruptions 2 years previously, also after eating fried JSL. Based on the clinical history, a diagnosis of FFE to JSL was made, and the patient was recommended to avoid eating JSL. She was given vitamin C tablets for 2 weeks, after which the pigmentation reduced. Six months later, we rechallenged the patient with JSL. The following day, the same exudative, violaceous erythema appeared, confirming the diagnosis. Ammodytes personatus is a fish that belonging to the order Perciformes, family Ammodytidae, genus Ammodytes. In Japan, this fish occurs in the inland Sea of Japan. Thus, people in western part of Japan often eat JSL, usually fried with soy sauce, sugar and ginger (Fig. 1b). To date, a large number of foods, including cheeseflavoured crisps, strawberries, tartrazine, lentils, tonic water and lactose, has been shown to cause FFE. However, to our knowledge, this is the first report of FFE caused by fish. As the patient ate JSL fried with soy sauce, sugar and ginger, the eruptions may have been caused by these food additives. However, we do not consider this to be the case, because Japanese people typically eat these food additives on an almost daily basis, and the patient had never noticed the same symptoms on consuming these additives. A differential diagnosis of the eruption could be anaphylaxis caused by fish. In general, fish is better known for its relationship to anaphylaxis than to FFE. However, we excluded this possibility because the lesions did not appear until the day after having JSL, and no anaphylactic symptoms were observed.