Kohzoh Yonemoto

Inhibitory effect of magnesium l-ascorbyl-2-phosphate (VC-PMG) on melanogenesis in vitro and in vivo

BACKGROUND An inhibitory effect of ascorbic acid (AsA) on melanogenesis has been described. However, AsA is quickly oxidized and decomposed in aqueous solution and thus is not generally useful as a depigmenting agent. OBJECTIVE Our purpose was to examine the effect on pigmentation of magnesium-L-ascorbyl-2-phosphate (VC-PMG), a stable derivative of AsA. METHODS Percutaneous absorption of VC-PMG was examined in dermatomed human skin, and its effect on melanin production by mammalian tyrosinase and human melanoma cells in culture was also measured. A 10% VC-PMG cream was applied to the patients. RESULTS VC-PMG suppressed melanin formation by tyrosinase and melanoma cells. In situ experiments demonstrated that VC-PMG cream was absorbed into the epidermis and that 1.6% remained 48 hours after application. The lightening effect was significant in 19 of 34 patients with chloasma or senile freckles and in 3 of 25 patients with normal skin. CONCLUSION VC-PMG is effective in reducing skin hyperpigmentation in some patients.

Bowen's Disease: Statistical Study of a 10 Year Period

According to histological records, a total of 74 patients were diagnosed with Bowens disease (B.d.) between 1 January 1984 and 31 December 1993 at the Department of Dermatology of Kitasato University. There was slight female predominance (36 ♂, 38 ♀), and 73% of the patients were older than 60 years; the mean age was 66.8 years. Fifteen patients had multiple (two‐five) lesions. In 13 patients, other benign skin lesions were also found. Arsenic exposure as etiologic factor could have been present in 2 cases. Only 3 patients had other associated malignant tumors, which does not confirm the paraneoplastic nature of B.d. One‐fifth of the lesions were on sun‐exposed areas (head, neck and hands). Although we excluded invasive carcinomas from our statistical study, we mention the 8 invasive carcinomas developing from B.d. in that period. Histopathological classification of B.d. is uncommon. Classifying our cases by Dariers histopathological classification, 63.3% of them belonged to the lenticular type. The malignant potential of different histopathological types of B.d. needs further investigation.

A 14-year-old girl with lichenoid sarcoidosis successfully treated with tacrolimus

We report a case of lichenoid sarcoidosis in a young girl treated by oral tacrolimus and methylprednisolone. The patient had had a skin eruption from 1 year of age and had developed uveitis at 2 years of age. Her sight had become affected by the uveitis at 8 years of age. When she was 14, she was admitted to the ophthalmology department of our hospital to start treatment with tacrolimus (FK506). She was referred to the department of dermatology for her skin lesions, which were flat, pinkish or normal skin‐colored papules scattered on her extremities and the backs of her hands. Upon histology, epithelioid granulomas were seen in the upper dermis and around the erector pili muscles. She received tacrolimus (FK506) 6 mg/day for 3 months for her uveitis. The eye lesions subsided somewhat, and the skin lesions were almost healed after the 3‐month course of tacrolimus. However, 4 months after stopping the tacrolimus, her skin and eye lesions relapsed. At that point, she was started on methylprednisolone 16 mg/day for her uveitis. With the methylprednisolone treatment, the inflammation of the eye lesion immediately healed, as did the skin lesions.

Lichen planus annularis: an immunohistochemical study.

Lichen planus annularis is a relatively rare skin manifestation of lichen planus. The mechanisms in the formation of annular lesions are not fully understood. We reported here a 57‐year‐old female with this disease. The eruption initially occurred as lichen‐papules, then enlarged (bean‐sized, umbilicated small plaques), and finally developed annular manifestations. We performed immunohistochemical examinations of specimens taken from different types of eruptions.

A case of bleomycin-induced acral erythema (AE) with eccrine squamous syringometaplasia (ESS) and summary of reports of AE with ESS in the literature.

Chemotherapy‐induced acral erythema (AE) is primarily induced by hydroxyurea, methotrexate, and cytarabine, although there are rare reports of AE induced by combination chemotherapy containing bleomycin. It is thought that the accumulation of chemotherapeutic drugs in eccrine glands may cause eccrine squamous syringometaplasia (ESS), which is characterized by metaplasia and focal necrosis of the epithelium of the eccrine duct. ESS is occasionally detected in conjunction with AE, but such occurrences are relatively uncommon. This is the first report of AE with ESS induced by the administration of bleomycin alone. We also provide a summary of past cases of AE with ESS in the literature.

Erythropoietic protoporphyria with eye complications

We herein report a case of erythropoietic protoporphyria (EPP) complicated by a decrease in eyesight that occurred in a Japanese male. An ophthalmologist initially thought that the eyesight loss might be the result of idiopathic optic nerve atrophy due to a vascular obstruction in the fundus. There are no previous reports of EPP cases with eye complications. However, an eye abnormality has been reported in an animal model of protoporphyria after long‐term, low‐level exposure to blue light. As a result, in our case, it is therefore possible that a relationship may have existed between EPP and the onset of eye complications.

Vitiligo with inflammatory raised borders with hepatitis C virus infection

Dear Editor, In patients with vitiligo vulgaris, a possible role for cell-mediated immunity in skin depigmentation has long been neglected, possibly due to the absence of overt infiltrates and the presence of antibodies to melanocytes, though early lesions of vitiligo vulgaris show a limited lymphocytic infiltration. However, it is thought that the absence of overt infiltrates, however, may be merely the result of dispersion of the target cells throughout the basal layers of the epidermis. Furthermore, vitiligo with inflammatory raised borders, which is thought to be related to cellular cytotoxicity against melanocytes, is placed in the same category as vitiligo vulgaris. While there have been some reports suggesting a relationship between vitiligo vulgaris and hepatitis C virus (HCV) infection, there have been no reports of vitiligo with inflammatory raised borders in a patient with active HCV infection. Therefore, we report this case of vitiligo with inflammatory raised borders in a patient with active HCV infection and discuss the disease process. A 38-year-old man first noticed depigmentation (vitiligo) preceded by erythema and slight itching on the buttock at the age of 36 years. Soon, depigmentation occurred inside the erythematous zone. Approximately 3 weeks later, complete depigmentation occurred after the erythema cleared. The vitiligo remained for a long time, and the lesions increased in number. The patient had been examined by a dermatologist and treated with some ointment without effect. At the age of 38 years, the patient presented to our hospital. The patient had a history of active HCV infection at the age of 18, following which he was diagnosed as having chronic hepatitis; however, he had not been examined or treated for this condition in the last few years. Upon initial examination, the patient presented with nail to egg-sized, round to irregularly shaped areas of depigmentation with peripherally edematous erythema in the axilla, inguinal region and the extremities (Fig. 1). Depigmentation without erythema was also seen on the patient’s buttocks and repigmentation occurred in some areas of vitiligo. The depigmented area with erythema was excised. Upon histopathology, degeneration of the basal layer and exocytosis of lymphocytes in the area of erythema was observed (Fig. 2). In the area of vitiligo, which existed inside of the erythema, inflammatory cell infiltration was not prominent, and there was a decreased number of melanocytes, which were stained by anti-tyrosinase antibody (MAT-1). The diagnosis of vitiligo with inflammatory raised borders was based on the typical clinical and histological findings. Upon laboratory investigation, the patient had a white cell

CD56-Positive Cutaneous Lymphoma with Multicentric Castleman's Disease-like Systemic Manifestations

We report a 55‐year‐old Japanese male with CD56+ cutaneous lymphoma. The patient had multiple cervical lymphadenopathy, a red nodule on his neck, and parotid gland nodularity. Histologic features of the biopsied cervical lymph node showed follicular hyperplasia with numerous plasma cells. A biopsied skin specimen of the nodule on his neck demonstrated dense infiltration of atypical large lymphocytes into the dermis. Immunohistochemical study of this specimen revealed CD3+, CD4+, and CD56+ expression in the majority of neoplastic cells. Polymerase chain reaction assays for the detection of Epstein‐Barr virus sequences were positive for lymph node and skin DNA. Laboratory examinations showed polyclonal gammopathy, pancytopenia, and high serum interleukin‐6 levels. These clinical and histological findings resembled those of multicentric Castlemans disease.

Characteristics of gamma glutamyl transferase in melanoma

Gamma glutamyl transferase (GGT) is widely distributed in mammalian tissues, and its biological heterogeneity has been demonstrated among various tissues. In order to investigate the biological characteristics of GGT in melanomas, enzyme-histochemical and biochemical studies were performed using amelanotic/melanotic and murine/human melanomas as materials. Enzyme-histochemically, GGT activity appeared to be present only in melanogenic cells in vitro. Biochemical assays of tissue extracts revealed that the specific activity was much higher in melanotic melanomas than in amelanotic. In addition, analysis of GGT-isoenzymes demonstrated that an isoenzyme band at approximately 110KD was expressed in tumorigenic or highly-metastatic tissues. These findings suggest that GGT in melanoma is closely related to the ability of melanin production and that the possible existence of a unique isoenzyme may reflect the intensity of tumorigenic and/or metastasis.