Keiji Hanada

Symmetrical Drug-Related Intertriginous and Flexural Exanthema Caused by Valacyclovir

Drug-related eruptions that appear only on intertriginous or flexural folds and in gluteal areas have recently been termed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). We report a case of a 56-year-old woman with acute erythematous rash in the intertriginous areas after treatment with the L-valine ester of acyclovir, valacyclovir. Oral-challenge tests resulted in erythematous pruritic rash in the intertriginous area by valacyclovir. The patient was diagnosed as having SDRIFE due to valacyclovir.

Peripheral choline acetyltransferase in rat skin demonstrated by immunohistochemistry

Conventional choline acetyltransferase immunohistochemistry has been used widely for visualizing central cholinergic neurons and fibers but not often for labeling peripheral structures, probably because of their poor staining. The recent identification of the peripheral type of choline acetyltransferase (pChAT) has enabled the clear immunohistochemical detection of many known peripheral cholinergic elements. Here, we report the presence of pChAT-immunoreactive nerve fibers in rat skin. Intensely stained nerve fibers were distributed in association with eccrine sweat glands, blood vessels, hair follicles and portions just beneath the epidermis. These results suggest that pChAT-positive nerves participate in the sympathetic cholinergic innervation of eccrine sweat glands. Moreover, pChAT also appears to play a role in cutaneous sensory nerve endings. These findings are supported by the presence of many pChAT-positive neuronal cells in the sympathetic ganglion and dorsal root ganglion. Thus, pChAT immunohistochemistry should provide a novel and unique tool for studying cholinergic nerves in the skin.

Pedunculated lipofibroma (Hoffmann-Zurhelle) on the palm.

matosus cutaneous superficialis (NLCS). The lesions are large, slow-growing, pedunculated tumours, characterized histologically by ectopic adipose tissue in the dermis. We report here a case of pedunculated lipofibroma in a Japanese woman. CASE REPORTA 47-year-old woman presented with a 1-year history of a nodule on her right palm. She stated that the lesion had originally appeared without any trigger one year previously and that it had gradually increased in size. Physical examination revealed a pedunculated, solitary, asymptomatic nodule, 30×30 mm (Fig. 1). The prominent stalk was 8 mm long. The nodule was smooth, skin-coloured and soft. Histopathological examination revealed a slightly acanthotic epidermis with flattened rete ridges. Both the papillary and reticular dermis were thin and con-tained scattered lobules of fat cells entrapped between bundles of dermal collagen fibres. Great irregularity in the dermal-subcutaneous interface was observed as a result of the marked increase in adipose tissue. In the dermis, moderately dense perivascular lymphocytic infiltrates were observed, and adnexal structures were absent (Fig. 2 a, b). Based on these findings, the diag-nosis of pedunculated lipofibroma was established. The nodule was completely excised and there has been no recurrence for 2 years. DISCUSSIONPedunculated lipofibroma is a rare, benign connective tissue neoplasm. The lesion is solitary, slow growing and is characterized by ectopic adipose tissue in the

Malignant Melanoma with Probable Smooth Muscle Differentiation

Malignant melanomas occasionally exhibit various divergent differentiation types. Of these, smooth muscle differentiation is extremely rare; only 1 case has been reported in the literature until recently. We report an extremely rare case of malignant melanoma with smooth muscle differentiation, which appeared as an amelanotic reddish nodule on the left toe.

Verrucous lesions arising in lymphedema and diabetic neuropathy: Elephantiasis nostras verrucosa or verrucous skin lesions on the feet of patients with diabetic neuropathy?

Verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) develop in areas with sensory loss in diabetic patients. Although various types of chronic stimulation, such as pressure or friction, are considered an important factor in the development of such lesions, the precise pathogenesis of VSLDN remains obscure, and there is currently no established treatment for this disease. Here, we present a case of VSLDN on the dorsum of the right foot. However, because lymphedema was also observed at the same site, this lesion could also be diagnosed as elephantiasis nostras verrucosa arising in diabetic neuropathy. The lesion was successfully treated with a combination of elastic stocking and mixed killed bacterial suspension and hydrocortisone ointment, which suggested that VSLDN might have been exacerbated by the pre‐existing lymphedema. Because various types of chronic stimulation can trigger VSLDN, treatment plans should be devised on a case‐by‐case basis. Therefore, it is important to investigate the presence of factors that can induce or exacerbate chronic inflammatory stimulation, such as lymphedema in our case, in each patient with VSLDN.

Myxofibrosarcoma arising from a chronic burn scar.

the relief of the patient’s severe stabbing pain, which despite the previous use of a wide spectrum of therapeutic regimens had never been successfully controlled. Thus, we initiated a monotherapeutic trial with oral doxazosin (Cardura; Pfizer, Athens, Greece), a specific antagonist of a-1 adrenergic receptors at a dose of 1 mg/day (gradually increasing to 2 mg/day), which is widely used in the treatment of hypertension and urinary retention. The pain completely resolved approximately 24 h after the onset of treatment and pain attacks were no longer triggered. The patient has presently completed an 8-month follow up without any recurrence of her symptoms or occurrence of any side-effects. Our findings, taken together with those of Batchelor et al., suggest that a-1 adrenergic receptors may be of paramount importance in the pathogenesis of leiomyoma-associated pain. Additionally, they indicate that oral doxazosin may represent a safe and extremely effective approach to the management of pain associated with multiple cutaneous leiomyomas. Nevertheless, long-term clinical trials are now warranted to fully elucidate its analgesic efficacy and safety in this disorder. CONFLICT OF INTEREST: None declared.

Dermatoscopy for Diagnosis of Creeping Hair: A Case Report and Mini-review of the Literature.

© 2011 The Authors. doi: 10.2340/00015555-1124 Journal Compilation