Kazunari Usuki

Effects of nicotine on peripheral cutaneous blood flow and skin temperature

We hypothesized that if nicotine was used in a form that was not adulterated with other hazardous substances found in tobacco, it would increase cutaneous blood flow (CBF) resulting in an increase in skin temperature. The effects of nicotine on CBF was investigated in 80 healthy volunteers and 6 patients with peripheral circulation disturbances. Each subject was required to chew nicotine gum (containing 2 mg nicotine) for 15 min and the CBF was then measured with laser blood flowmetry. Skin temperature of 35 volunteers was measured with thermography before and after chewing the gum for 15 min. A control study was performed using ordinary gum without nicotine. Increased CBF (> or = + 1 ml/min/100 g) was observed in 55 of 86 subjects (64%, 33.7-38.6 ml/min/100 g, P < 0.01). An elevation in skin temperature (> + 0.1 degree C) was also observed with nicotine gum in 26 of 35 healthy subjects (74%, + 0.62 +/- 0.96 degree C, P < 0.001). The increase in CBF was greater in subjects in which the initial CBF was lower than in others (P < 0.01). Nicotine gum was found to increase CBF (55/86) and elevate skin temperature (26/35). The smaller the initial CBF value, the greater was the increase in CBF. Nicotine or nicotine derivatives might prove to be useful agents for the treatment of peripheral circulation disturbances.

Three cases of pityriasis rubra pilaris successfully treated with cyclosporin A.

Background: Pityriasis rubra pilaris (PRP) is reported to respond poorly to cyclosporin A (CsA). Objective: We attempted to determine the efficacy of CsA in the treatment of classic adult-type PRP. Methods: Three patients with classic adult-type PRP were treated with 5 mg/kg/day CsA. Results: A sustained clinical response was achieved within 2–4 weeks of therapy. Relapses were noted when the CsA dose was decreased to 1.2 mg/kg/day. Conclusion: CsA should be considered in the treatment of classical adult-type PRP.

Estrogen Dermatitis: A Dendritic-Cell-Mediated Allergic Condition

Background: Most estrogen dermatitides are induced by local or systemic contact dermatitis where dendritic cells are central, and tamoxifen has a blocking effect on dendritic cells. Methods: We present 5 cases of estrogen dermatitis in which the clinical features were prurigo, urticaria, acneiform eruption and annular erythema. Results: Tamoxifen was effective in 3 of 4 cases. Three of 4 biopsy specimens showed the formation of Langerhans cell nests in the epidermis and hair follicles and perivascular infiltration of CD4+ and CD8+ lymphocytes in the dermis. Conclusion: These results suggest that a dendritic-cell-mediated allergic mechanism is involved in estrogen dermatitis.

Three Cases of Polyarteritis Nodosa Cutanea and a Review of the Literature

We describe three cases of polyarteritis nodosa cutanea (PNC) showing necrotizing arteritis and only cutaneous lesions without systemic symptoms or visceral involvement for eleven, six, and three years after the onset of the disease. Since it was first described, there has been continuous controversy as to whether PNC progresses to systemic PN. Some cases have been described which had begun with a cutaneous lesion and progressed to the systemic form 19 and 18 years after the onset of the disease, so we believe that long term follow‐up of this disease is essential.

Skin disorders with prominent eosinophilic infiltration treated successfully with Nicotine: Report of two cases

Background: Nicotine was effective in the treatment of skin disorders attributable to neutrophils such as pyoderma gangrenosum and orogenital ulcerations due to Behçet’s disease. Objective: We assessed the efficacy of nicotine for treating skin disorders with prominent eosinophilic infiltration. Patients and Methods: A 67-year-old man with Kimura’s disease was treated for 2 weeks with nicotine chewing gum (6 mg/day). A 50-year-old woman with erythema nodosum with eosinophilic infiltration was treated for 4 weeks with transdermal nicotine patches (5 mg/day). Results: Both patients showed a dramatic clinical and histopathological improvement. Conclusion: Our results suggest that nicotine may be useful for treating skin disorders with eosinophilic infiltration as well as neutrophilic dermatoses.

Sarcoidosis associated with psoriasis vulgaris.

We report a 70‐year‐old patient with sarcoidosis associated with psoriasis vulgaris. He had a nodule on the medial lower lid of his right eye. Oral corticosteroid for the sarcoid lesions and oral PUVA for psoriasis were employed. The cutaneous lesion disappeared within two months after starting the therapy. No relapse of sarcoidosis has been seen for eight years. The association of sarcoidosis with psoriasis has been previously reported; however, it is still unclear whether this association coincidental or meaningful.

Steatocystoma multiplex: a case with unusual clinical and histological manifestation.

A 35-year-old man at our clinic was found to have steatocystoma multiplex manifested by dome-shaped nodules confined to the scalp and forehead. One of four cyst biopsy specimens revealed large lining cells with granular cytoplasm adjacent to typical steatocystoma epithelial lining cells. Neither fibrosis nor inflammatory changes were noted in the surrounding connective tissue. The large granular lining cells had immunohistochemical characteristics of the macrophage/monocyte lineage. This case appears to be an unusual clinical and histological manifestation of steatocystoma multiplex.

A Case of Chromomycosis with Tumor-like Growth

A 66‐year‐old man who lived on Tokunoshima Island, a small and remote southern island of the Japanese archipelago, had suffered from chromomycosis for more than 30 years and presented with a tumor‐like growth on the posterior crural region of his right leg. Fonsecaea pedrosoi was identified as the pathogen from its growth pattern and micromorphological characteristics. The patient was successfully treated with 5‐fluorocytosine, itoraconazole, and topical thermotherapy.

EPIDERMAL NEVUS SYNDROME WITH HEMANGIOMA SIMPLEX

To the editor: We observed a case of epidermal nevus syndrome (ENS) associated with hemangioma simplex. A survey of the literaturte of the last 20 years revealed 161 (1,2) cases of ENS; only 4 (3, 4) were associated with hemangioma simplex. We present here a detailed description of our case and provide a brief discussion of the distinction between this association and phacomatosis pigmentovascularis type I. Case report: A l-year-old boy was referred to our clinic with skin lesions on the abdomen, right lower leg, and face which had been present since birth. Clinical examination revealed grayish brown papules with a hyperkeratotic papillomatous surface which had aggregated to form linear lesions. The

A Case of Pseudogout

We report a 56‐year‐old Japanese male with a gout‐like acute attack of synovitis and panniculitis in his right wrist without hyperuricemia. Calcium pyrophosphate dihydrate (CPPD) crystals were found in the synovial fluid of the affected joint. A diagnosis of pseudogout was made. The attack subsided two days after medication with 30 mg of predonisolon. Although this is a relatively common disease in elderly people, we rarely encounter such case reports in dermatological journals.