Kaoru Nishi

Childhood generalized pustular psoriasis treated by preprandial ciclosporin administration: serum cytokine pattern during the course of the disease

Generalized pustular psoriasis (GPP) is a rare inflammatory variant of psoriasis, which presents as systemic inflammatory response syndrome (SIRS). Childhood GPP occasionally develops after streptococcal infection, and an association with acute cytokine response induced by tumour necrotic factor (TNF)-a has been suggested. We used ciclosporin microemulsion preconcentrate with excellent response in a case of GPP. We also analysed the cytokine levels during the disease course. An 8-year-old boy developed erythema on his buttock after upper respiratory infection in early December 2007. He was diagnosed by a local dermatologist as having erythema multiforme, and treated with topical steroid ointment, antihistamine administration, dexamethasone 1.5 mg ⁄ day and antibiotics for 2 weeks without any beneficial response. He was referred and admitted to our hospital at the end of December. On physical examination, generalized scaly erythema with numerous pustules were found (Fig. 1). The child s body weight was 38 kg and his temperature was 37.3 C. There was no personal or family history of psoriasis.

Livedoid vasculopathy; favorable clinical response with low dose warfarin

ejd.2011.1529 Auteur(s) : Satoshi Nakamura1,2 namu@asahikawa-med.ac.jp, Mari Kishibe2, Kaoru Nishi1, Yoshio Hashimoto1, Keiko Takeda2, Toshihiro Mizumoto1, Hajime Iizuka2 1 Asahikawa Kousei Hospital, Department of Dermatology, 1-joudori 24-chome 111, Asahikawa Hokkaido, Japan 2 Asahikawa Medical University, Department of Dermatology, Asahikawa Hokkaido, Japan Livedoid vasculopathy (LV) is a chronic, recurrent, painful skin disorder involving distal lower extremities. LV is induced by coagulation [...]

Two cases of male nipple leiomyoma: idiopathic leiomyoma and gynecomastia-associated leiomyoma.

We describe 2 cases of male nipple leiomyoma. A 70-year-old man had a painful subcutaneous tumor on his left nipple of 6 months duration. Histopathology disclosed dermal spindle cells with oval-shaped nuclei forming interlacing bundles with irregular pattern. Glandular elements were absent. The spindle cells were positive to α-smooth muscle actin, desmin, and vimentin. Estrogen receptor (ER) and progesterone receptor (PrR) were negative. We diagnosed this case as male leiomyoma of the nipple. Another patient was a 61-year-old man with gynecomastia induced by spironolactone of 6 months duration. He also had a painful nodule on his left nipple and histopathology disclosed spindle-shaped tumor cells as in the previous patient. The tumor was accompanied by glandular elements in the deep dermis and subcutaneous tissue, which showed apocrine secretion and were positive for α-smooth muscle actin, ER, and PrR. These glandular elements were interpreted as mammary gland. But ER and PrR stain did not show positive results for leiomyoma in the upper dermis. To the best of our knowledge, this is the first report of male idiopathic and gynecomastia-induced leiomyoma with ER and PrR staining.

Favorable clinical response by pre-prandial administration of low-dose ciclosporin to severe adult atopic dermatitis

Abstract Although ciclosporin is useful for atopic dermatitis (AD), appropriate dosage and therapeutic drug monitoring (TDM) has been performed only by post-prandial ciclosporin administration. We administered ciclosporin pre-prandially to eight severe adult AD patients (four cases of erythrodermic AD, three cases of AD recalcitrant to standard therapy, and one AD case with numerous pruriginous lesions). Blood concentrations of ciclosporin at various dosages were measured and appropriate dosage in terms of therapeutic efficacy was analyzed by using the area under the concentration curve (AUC). AUC was estimated by the C1 (obtained serum concentration of ciclosporin at 1 hour after ciclosporin administration), C2 (concentration of ciclosporin at 2 hours) and C4 (concentration of ciclosporin at 4 hours) concentrations of ciclosporin. The trough levels of ciclosporin with 200 mg/day, 150 mg/day, and 100 mg/day administration were 96.5 ng/ml, 66.4 ng/ml, and 75.3 ng/ml, respectively. The peak serum concentration (Cmax) was obtained at 1 hour (C1) in most cases. The AUC of 0–4 hours (AUC 0–4) were 2099.5 ng · h/ml (200 mg/day), 1782.6 ng · h/ml (150 mg/day) and 1696.2 ng · h/ml (100 mg/day). VAS scores of itching and blood eosinophil counts were decreased significantly by the ciclosporin treatment. Pre-prandial administration of a relatively low dose of ciclosporin for severe atopic dermatitis resulted in a favorable subjective and objective clinical response and the measurement of blood concentration mostly correlated with the effective dosage assessment.

Cutaneous tuberculosis simulating lymphocutaneous sporotrichosis

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Cutaneous Lymphangitis Carcinomatosis Metastasis of Extra-ovarian Primary Peritoneal Carcinoma

© 2012 The Authors. doi: 10.2340/00015555-1450 Journal Compilation

Multiple poromas following combination chemotherapy and autologous peripheral blood stem cell transplantation.

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Clinical response of acneiform eruptions caused by cetuximab to administration of oral tetracycline and topical ketoconazole.

BACKGROUND Cutaneous adverse events associated with the use of epidermal growth factor receptor inhibitors, such as cetuximab are relatively common. Although there are reports about possible treatments for acne or acneiform lesions induced by cetuximab, there are only few reports of prospective studies. OBJECTIVE The aim of the study was to analyze the efficacy of varius treatment modalities and their combinations in patients with acneiform eruptions caused by cetuximab. PATIENTS AND METHODS We studied 14 patients treated with an epidermal growth factor receptor inhibitors, including 7 patients cetuximab, who developed acneiform eruptions in the course of therapy. All patients were diagnosed as grade II according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. A corticosteroid ointment, tacrolimus ointment, and ketoconazole ointment were used in a randomized manner. Oral therapy included administration of antihistaminic drugs, tetracycline, a cyclooxygenase inhibitor, or a macrolide. We measured the numer of days required to achieve improvement from grade II to grade I during cetuximab treatment. RESULTS Our results showed that tetracycline treatment may shorten the period needed to achieve improvement. Ketoconazole cream and a combination of oral tetracycline and topical ketoconazole also significantly shortened this period. CONCLUSION The results of our short case study may indicate that a combitation therapy of oral tetracyclin and topical ketokonazole is most effective in the therapy of patients with acneiform eruptions caused by cetuximab.