Kiyohiro Takizawa

Pustular dermatosis of the scalp associated with autoimmune diseases.

A 36‐year‐old woman visited our hospital with a five month history of persistent pustulation, crusting, and alopecia on the vertex of the scalp. No pathological organisms were isolated from the lesions. Histological examination revealed non‐specific changes of chronic inflammation with destroyed follicles. Antibiotic therapy produced no response, but steroid therapy was effective. From these observations, a diagnosis of erosive pustular dermatosis of the scalp (EPDS), as described by Pye et al., was made. The patient also had Hashimotos thyroiditis, autoimmune hepatitis, and Takayasus aortitis. The laboratory studies revealed an increased erythrocyte sedimentation rate, C‐reactive protein 3+, hypergammaglobulinemia, and various auto‐antibodies, suggesting the possibility of a pathogenesis common to both this dermatosis and the autoimmune diseases.

Surgical Treatment of a Deep Fungal Infection of the Skin by Trichosporon cutaneum

We treated a patient with facial granuloma caused by Trichosporon cutaneum, in whom various therapeutic modalities had been ineffective. A surgical procedure combining excision, topical chemotherapy of the open wound, and covering the defect with a cervicofacial flap was finally successful.

A CASE OF CRYPTOCOCCAL SUBCUTANEOUS ABSCESS CAUSED BY PRIMARY OSSEOUS CRYPTOCOCCOSIS

A patient with a cutaneous manifestation of primary osseous cryptococcosis is described. Statistically 35 cases of cutaneous cryptococcosis excluding this case and one case of primary osseous cryptococcosis without any skin manifestations were reported in Japan between 1955 and 1977. Of these 36 cases, metastatic osseous lesions were observed in only two cases. Each of them was disseminated cryptococcosis, however, the examination of osteolytic lesions was not shown. Therefore, to our knowledge, this is probably the first Japanese report of a case with a cutaneous lesion following to primary osseous cryptococcosis.

SUPERFICIAL HYPERKERATOTIC CANDIDIASIS ON THE PALMS AND SOLES

This case report described a 59‐year‐old man with superficial hyperkeratotic candidiasis on the palms and soles. This rare form of cutaneous candidiasis is regarded as a complication of chronic mucocutaneous candidiasis or other immunodeficient disorders. However, the patient had no underlying disease and his cellular immunity was normal. The main abnormal findings in laboratory studies were markedly high IgE values and low vitamin A values. It was assumed that these played some role in the pathogenesis of the disease. The patient was cured through the oral administration of ketoconazole. Nine cases of superficial hyperkeratotic candidiasis on the palms have been reported in Japan, but the case given here is the first reported instance of this disease on the soles.

Ultrastructural observations of fungal elements in a Trichosporon cutaneum infection of the skin.

Using electron microscopic methods, we observed the fine structure of fungal elements occurring in a facial granulomatous infection caused by Trichosporon cutaneum.

ULTRASTRUCTURAL OBSERVATIONS OF FUNGAL ELEMENTS IN TRICHOPHYTON RUBRUM GRANULOMA

We observed fungal elements in Trichophyton rubrum granuloma ultrastructurally. Three types of fungal elements could be distinguished in relation to the phagocytes, namely (1) fungal elements existing freely in the exudate, (2) fungal elements attached to the phagocytes or just ingested into the phagocytes, (3) fungal elements digested in the phagocytes.

A STUDY ON THE CHARACTERIZATION OF CORYNEBACTERIUM ACNES

Forty‐nine strains of anaerobic gram‐positive rods were used in a systematic study of their biochemical and physiological reactions and morphological characteristics and were also subjected to gas chromatographic analyses in an effort to classify them as strains of Corynebacterium acnes (C. acnes). The strains were isolated both from lesions in acne vulgaris and from normal skin. According to their biochemical and physiological characters, these 49 strains were divided into six subgroups (Subgroup A–F). They were also separated into two morphological types. The larger of these two types included gram‐positive, unevently staining pleomorphic rods (35 strains); the smaller type contained shorter coccal rods similar to Peptostreptococci (14 strains). The macroscopic appearance of the colonies of both types was the same. All strains of the smaller type showed the same biochemical and physiological characteristics which were of the saccharolytic type (Subgroup B) suggesting a close relationship between the microscopic appearance of the strains and their biochemical and physiological characteristics. Upon microscopical observation, the changing the pH of the media did not cause any transformation of the organism from one type to another. Between pH 6.0 and 6.5 all strains grew well but above pH 8.0 growth wai poor. The gas chromatographic analyses demonstrated that selected sample strains from each of the six subgroups showed the same characteristic chromatograph, suggesting that they could be of the same species, i.e., C. acnes.