Kazunobu Otoyama

Clinical and Immunological Analysis of Annular Erythema Associated with Sjögren Syndrome

Clinical and immunopathological analysis was performed on 24 cases of Sjögren syndrome with annular erythema (AESjS). AESjS predominantly appears on the cheek of the face where skin temperature is relatively low in comparison with other sites. VCAM-1 and ICAM-1 were strongly expressed on endothelial cells of AESjS, while epidermal expression of ICAM-1 was focal and weak. VCAM-1 mRNA expression was also much more intense compared to systemic lupus erythematosus. The lymphocyte response to staphylococcal enterotoxin B was higher in AESjS than that of controls, and cells positive for T cell receptor V beta 6,9,12 were expanded after the culture. Superantigen-driven endothelial-cell-dependent T cell infiltration to the skin plays a crucial role in AESjS.

Cutaneous protothecosis--a case report.

The present report describes a case of cutaneous protothecosis, as confirmed by skin biopsy and culture, in a 62‐year‐old man with an erythematous plaque lesion on his back. The disease was initially detected after return from a trip to Taiwan. The characteristic sporangia and biochemical sugar assimilation tests indicated the organism to be Prototheca wickerhamii. Oral administration of (5‐FC) failed to have any effect and so finally, the lesion had to be removed by surgical excision.

Effect of Mast Cell Modulators on IgE-Mediated Murine Biphasic Cutaneous Reactions

Hapten-specific and mast cell-dependent biphasic cutaneous reactions were induced by intravenous application of anti DNP-IgE antibodies and a subsequent skin test. These reactions were also demonstrated in SCID mice, which indicates that T cell-mediated immunity might not be involved in these IgE-mediated cutaneous reactions. Simultaneous application of anti histaminics did not suppress these reactions significantly, while several immunomodulators, such as azelastine, FK506, and prednisolone, significantly inhibited both early and late phase reactions except for the failure of FK506 to inhibit the early reaction. Anti-VCAM-1 antibody and anti-tumor necrosis factor-alpha (TNF alpha) antibody but not anti-IL 5 antibody showed similar suppressive effects on both early and late phase reactions. Mast cell and inflammatory cells other than T cells are thought to play an important role in these IgE-induced biphasic reactions. TNF alpha and/or VCAM-1 are required for tissue accumulation of inflammatory cells in this system.

Topical Anthralin for Psoriasis Vulgaris : Evaluation of 70 Japanese Patients

In order to determine the usefulness of anthralin in the treatment of psoriasis, we evaluated the effectiveness of topical anthralin therapy in patients with psoriasis vulgaris in our hospital. Seventy patients with plaque‐type psoriasis (58 men and 12 women), aged 17–79 years‐old (mean; 47.6 years‐old), who were treated at the Department of Dermatology, Tokyo Medical and Dental University, between 1992 and 1999, were retrospectively evaluated. Mean psoriasis activity and severity index (PASI) score before therapy was 24.6. Patients were treated with 0.1–2.0% topical anthralin. Responses were determined by clinical examination. The mean PASI score decreased to 8.7 after three months. The most effective anthralin concentration was 0.4–0.5%. The overall response rate was 85.7%, complete remission was obtained in 21.4%, and partial remission in 64.3%. Ten patients (14.3%) were anthralin‐resistant. In all patients who entered complete remission, recurrence was noted within six months after stopping anthralin. Minor skin irritation and pigmentation occurred in most of the patients; however, no severe side effects were noted during the treatment. Our study indicated that anthralin is effective for chronic plaque‐type psoriasis.

RETINOIC ACID UPREGULATES C-KIT LIGAND PRODUCTION BY MURINE KERATINOCYTE IN VITRO AND INCREASES CUTANEOUS MAST CELL IN VIVO

Mouse-transformed epidermal cell line (Pam 212) generated the soluble mediators for promoting the growth of a mast cell line (MC9) in the presence of retinoic acid at a concentration of 10(-6)-10(-7) M. The effective molecule of MC9 cell growth promoting factor (MC9-GF) was non-dialyzable and eluted between the molecular weight of 45 K and 68 K on a TSK 2000 G column. Chromatofocusing analysis revealed that this factor had a pI range between 7.0 and 7.5. Anti-c-kit ligand antibody abrogated MC9-GF activity and RT-PCR analysis demonstrated that retinoic acid upregulates c-kit ligand mRNA expression by Pam cells. Several recombinant cytokines including IL1-alpha, IL-1 beta, IL-2, IL-3 or IL-4 did not promote MC9 cell growth at a concentration of 100 U/ml. The presence of anti-IL-1 alpha, -IL-1 beta, -IL-2, -IL-3 or -IL-4 antibodies did not abrogate the MC9-GF activity except for anti-c-kit ligand antibody.

Unusual Annular Pustular Psoriasis in a Patient with Type C Hepatitis

To the Editor: Annular pustular psoriasis (APP) is a rare form of psoriasis, characterized by gyrate, annular, or polycyclic lesions with an erythematous, scaly, pustular margin (1). Many cases reported under the diagnosis of APP have followed a relatively benign, low-grade, subacute or chronic course (2). Herein, we report a case of unusual annular psoriasis localized on the legs ina patient with type C hepatitis, who had a past history of pustular psoriasis. Case report: A 55-year-old woman has been suffering from psoriasis vulgaris since 1982. On physical examination, keratotic erythematous plaques were noted on her trunk and extremities. Histological examination revealed the typical features of psoriasis vulgaris. Laboratory examination showed positive antinuclear antibody (1:80, homogenous and speckled), rheumatoid factor (2+), RAHA (x80) , and deviating serum levels of GOT, GPT, y-GTP, LDH, TTT and ZTT. Anti-DNA antibody was within the normal range, and anti-SS-A and SS-B antibodies were negative. HLA-typing showed A-26, 31, B-61 and Cw-3.She was diagnosed with C type hepatitis and cirrhosis. She was treated with topical steroid cream and vitamin D3 (tacalcitol) ointment. However, the psoriasis exacerbated following an upper respiratory tract infection, and she developed pustules on the margin of her erythematous plaques in 1999. Physical examination revealed small, shallow pustules scattered on the margin of erythema (Fig. 1a). Cultures from pustules were sterile. The pustular lesions did not spread generally, but were localized and limited to her lower legs. She was treated with systemic etretinate (30 mg/day), and then the etretinate was gradually tapered. Vitamin D3 ointment was topically Letters to the Editor