Katsutaro Nishimoto

Rhizomucor variabilis infection in human cutaneous mucormycosis

2 · 20 mm in size, was seen extending from the right lateral to the mid infraorbital crease, with a scar-like appearance (Fig. 1a). Histological examination of a biopsy taken from the lesion showed features in keeping with both nodular and superficial BCC, with a thickness of 1.3 mm. The lesion was removed by Mohs micrographic surgery (MMS) in two stages, with linear closure. Patient 2 was a 67-year-old man, who presented with an 18-month history of a palpable ridge on the left lower eyelid. On physical examination, a palpable pale translucent linear ridge, 20 mm in length, was seen on the left lower eyelid skin (Fig. 1b). Biopsy demonstrated a nodular BCC, with thickness of 0.8 mm. Excision was achieved in two stages by MMS, and the defect reconstructed using a full-thickness skin graft from the ipsilateral upper eyelid. Patient 3 was a 65-year-old man, who had received a 6week course of topical imiquimod 5% for a biopsy-proven superficial BCC of the left lower eyelid. Nine months later, the patient presented with a linear erythematous lesion in the same area (Fig. 1c). A further biopsy of the lesion showed appearances in keeping with a morphoeic BCC, 1.6 mm thick. This was excised by MMS, with clearance achieved in one stage and the defect repaired with linear closure. The lower eyelid does appear to be the commonest site of linear BCC. Including our three patients, 14 of 42 reported cases (33%) have been situated in this anatomical location. We would also highlight that, although banal in appearance, linear BCC of the lower eyelid may be of a more aggressive clinical subtype and require several stages of MMS for complete excision. Possible reasons for this include a delay in presentation or in diagnosis, or more aggressive tumour behaviour. As sparing of tissue is often desirable in the periorbital area, and aggressive subtypes or significant subclinical extension have been described, we agree with other authors that excision by MMS should be considered as the first-line treatment of linear BCC in the orbital area.

A comparative clinical study between 2 weeks of luliconazole 1% cream treatment and 4 weeks of bifonazole 1% cream treatment for tinea pedis

The aim of the study was to compare the efficacy and safety of luliconazole 1% cream and bifonazole 1% cream as applied in the treatment of tinea pedis (interdigital‐type and plantar‐type). A multi‐clinic, randomised single‐blind, parallel group study with 34 hospitals and 11 clinics formed the study design. Five hundred and eleven patients with mycologically confirmed tinea pedis were included. Of the 489 evaluable patients, 247 were randomised to luliconazole, and 242 to bifonazole. Luliconazole 1% cream applied once a day for 2 weeks, followed by a placebo cream for 2 weeks, thereafter. Bifonazole 1% cream applied once a day for 4 weeks. Mycological effect (negative result on microscopy) and improvement of skin lesions were measured at weeks 1, 2, 3 and 4. Safety frequency and severity of adverse reactions were also measured. The improvement of skin lesions after 4 weeks was comparably good with rates of 91.5% vs. 91.7% (luliconazole vs. bifonazole). The mycological effect was characterised by high negative rates of 76.1% vs. 75.9% (luliconazole vs. bifonazole). The progression of tinea‐related signs and symptom scores differed insignificantly between evaluated luliconazole and bifonazole treatment groups comprising a total of 500 patients. Both substances appeared to be comparably safe and well‐tolerated.

Dose‐finding comparative study of 2 weeks of luliconazole cream treatment for tinea pedis – comparison between three groups (1%, 0.5%, 0.1%) by a multi‐center randomised double‐blind study

Luliconazole is a newly developed imidazolyl antifungal agent. A randomised double‐blind comparative study was designed to assess the efficacy and safety of 1% luliconazole cream (group A), 0.5% cream (group B) and 0.1% cream (group C), in tinea pedis (interdigital type and plantar type), when used once daily for 2 weeks. Follow‐ups were performed at 4 weeks after the end of topical treatment. A total of 241 patients were enrolled and 213 patients were evaluated for efficacy. Rates of improvement of skin lesions in the A, B and C groups assessed at week 4 were 90.5%, 91.0% and 95.8%, respectively. Rates of mycological cure (negative result of microscopy) in the A, B and C groups assessed at week 4 were 79.7%, 76.1%, 72.2% and at week 6 (at 4 weeks after the end of topical treatment) were 87.7%, 94%, 88.9%, respectively. For the mycological effect on tinea pedis of the interdigital type at 2 weeks, the negative conversion of fungi showed a concentration‐dependent relationship and indicated a difference in tendency statistically 81.1% (1%– treatment), 62.9% (0.5%– treatment), 58.3% (0.1%– treatment) (Fishers exact test, P = 0.079) and there was a trend between three groups by Cochran–Mantel–Haenszel method (P = 0.038). The incidence of adverse events in which a causal relationship to this drug could not be ruled out was low (2.6%). All of the adverse events were mild in severity and insignificant clinically.

ELECTRON MICROSCOPIC STUDY OF PORPHYRIAS

Electron microscopic examinations were performed on skin specimens obtained from six patients with erythropoietic protoporphyria and one patient with erythropoietic porphyria (Günther).

A survey of 165 sporotrichosis cases examined in Nagasaki prefecture from 1951 to 2012

A total of 165 sporotrichosis cases occurring in Nagasaki prefecture, and examined at Nagasaki University Hospital, were evaluated. Both males and females were equally affected, with no significant differences in the affected body regions. Lesions were frequently seen on the face (49 cases, 29.5%) and upper limbs (101 cases, 60.9%). The localised cutaneous type of sporotrichosis (105 cases, 62.9%) was much more frequent than the lymphocutaneous type (62 cases, 37.1%). The infection rate in patients over 50 years of age was 73.1%. The most frequent occupation among the patients was farming (52 cases, 37.4%), and 34 patients had a history of injury. Regarding the geographical distribution of sporotrichosis, 48 cases occurred in the Shimabara peninsula (31.2%) and this is much higher than expected for the population size. Before 1994, almost all sporotrichosis cases (112 cases, 96.5%) were treated with potassium iodide (KI). After 1995, the number of patients treated with KI decreased (nine cases, 23.1%), and itraconazole (ITZ) was used in 21 cases (59.0%) and terbinafine in six cases (15.3%). The time between ITZ and KI treatment and cure was 13.8 weeks and 12.5 weeks, respectively. All 116 cases, for which the outcome was known, were cured or improved.

Chromomycosis Spontaneously Healed

Observation chez un homme de 73 ans qui fut atteint de psoriasis pendant plusieurs annees, traite par corticoides en application locale qui declenche une chromoblastomycose diagnostiquee par recherches histologiques et mycologiques

The MAT1-1:MAT1-2 Ratio of Sporothrix globosa Isolates in Japan

In order to understand the reproductive biology of pathogenic species in the Sporothrix schenckii complex, we characterized the partial mating type (MAT1-1) loci of Sporothrix schenckii, as well as the S. globosa MAT1-1-1 gene, which encoded 262 amino acid sequences. The data confirmed that the MAT1-1 locus of S. globosa was divergent from the MAT1-2 locus of the opposite mating type, suggesting that the fungus is heterothallic. To determine the mating type ratio of 20 isolates from Japanese patients, we analyzed the MAT loci by specific PCR amplification of MAT1-1-1 and MAT1-2-1 genes. The MAT1-1-1 was detected in 5 isolates but not in the other 15 isolates with the presence of MAT1-2-1. The MAT1-1:1-2 ratio of S. globosa isolates in Japan was estimated to be 1:3. Phylogenetic analysis indicated that the sequences of the MAT1-1-1 were identical among S. globosa isolates but different from S. schenckii and Ophiostoma montium.

ELECTRON MICROSCOPIC STUDY OF SEBACEOUS EPITHELIOMA

A case of sebaceous epithelioma on the scalp of a 50 year old female was reported.

Sporothrix schenckii (sensu strict S. globosa) mating type 1-2 (MAT1-2) gene.

Sporotix schenckii is a pathogenic fungus that causes human and animal sporotrichosis, and based on morphology of the sessile conidia and molecular analysis, it was recently recognized as a species complex comprising at least the following six sibling species: S. albicans, S. brasiliensis, S. globosa, S. luriei, S. mexicana and S. schenckii. However, apart from S. schenckii sensu strict, only S. brasiliensis, S. globosa and S. luriei are associated with human and animal infection. S. globosa has been most commonly isolated in Asia, Europe and the USA; therefore, molecular epidemiological study for S. globosa is important in relation to human sporotrichosis in Japan. To the best of our knowledge, this is the first study to determine the mating type 1‐2 (MAT1‐2) gene of Sporothrix schenckii with the aim of understanding the taxonomy of the genus Sporothrix. The MAT1‐2 gene (1618 bp) encodes a protein sequence of 198 amino acids. Reverse transcription polymerase chain reaction analysis also detected MAT1‐2 gene mRNA expression in all of the S. schenckii strains examined, indicating that this gene is expressed in S. schenckii cells. Phylogenetic analysis of the MAT1‐2 gene fragments of Ophiostoma himal‐ulmi, O. novo‐ulmi, O. ulmi and S. schenckii indicated that these isolates could be classified into four clusters. MAT1‐1 gene‐specific polymerase chain reaction was positive in 15 isolates, but negative in four human isolates and one feline isolate.

Case of Fusarium paronychia successfully treated with occlusive dressing of antifungal cream

We report a case of refractory Fusarium paronychia in a 42‐year‐old man with Behçets disease receiving oral cyclosporin and corticosteroid. Symptoms resembling candidal paronychia of his little finger could not be cured by topical ketoconazole and oral terbinafine. The pathogen was identified as Fusarium solani species complex by gene analysis, and was multiple drug resistant. The case eventually resolved by occlusive dressing therapy with 0.5% amorolfine cream for 3 months.