Makoto Ichimiya

Successful Treatment of Pyogenic Granuloma with Injection of Absolute Ethanol

Pyogenic granuloma (PG) is a small, almost always solitary, sessile or pedunculated, raspberry‐like vegetation of exuberant granulation tissue. Conservative treatment by techniques such as cryosurgery, laser surgery, and electrodesiccation are usually adequate, whereas excisional treatment can often result in noticeable scars. We attempted a different approach using an injection of absolute ethanol in five patients with recurrence due to inadequate cryosurgery. This therapy is less invasive than surgical excision and appears to be an alternative therapy for PG.

Intralymphatic Embolic Cells with Cutaneous Endometriosis in the Umbilicus

Endometriosis is defined as the presence of both functioning endometrial glands and stroma outside their usual location lining the uterine cavity. It has been identified in virtually all tissues and organs of the female body with the exception of the spleen. There have been many theories proposed regarding the etiology and pathogenesis of endometriosis. One is the transport of cells through lymphatics and blood vessels. A 44‐year‐old female suffering from an episode of endometriosis of the umbilicus, left inguinal, uterus, and bilateral ovaries in association with a Müllerian anomaly is presented. Histopathological findings of a skin biopsy from her umbilicus showed aggregated cells within the lymphatic vessel of the upper dermis. This case provides evidence suggesting that cutaneous endometriosis could occur by transport of endometrial cells through lymphatics or blood vessels.

A case of carotenemia associated with ingestion of nutrient supplements

Carotenemia is characterized by an abnormal yellowish orange pigmentation of the skin, most prominently seen on the palms and soles. Although it is associated with several disease such as diabetes, hypothyroidism and anorexia nervosa, it is caused by excessive intake of carotene‐rich food such as oranges and carrots in most cases. Herein, we describe an interesting case of carotenemia in a 66‐year‐old female secondary to increased ingestion of oral supplements of carotene in order to improve hemorrhage in the eyeground. There could be an increasing trend of intake of commercial nutrient supplements in which case it is necessary to remind ourselves that commercial nutrient supplements could cause various skin disorders as side‐effects.

A case of baboon syndrome associated with group A Streptococcal infection

We described a 21‐year‐old Japanese patient with sore throat, fever, and diffuse erythema on the neck, trunk, and limbs. Erythema markedly appeared on the neck, axillary, antecubital, and popliteal fossae. However, other skin signs of scarlet fever such as red strawberry tongue and linear petechial eruption did not appear. Before his visit to our clinic, he had been diagnosed as pharyngitis and treated with cefaclor 750 mg daily for six days. However, the symptoms did not improve. Oral prednisolone of 20 mg daily rapidly improved all the symptoms. Pharyngeal culture grew Streptococcus pyogenes that was sensitive to cefaclor. Laboratory findings showed elevated serum levels of antibody against streptolysin O. Together with the distribution of erythema, culture of Streptococcal pyogenes, and elevated anti‐streptolysin O titer, the diagnosis of baboon syndrome associated with streptococcal infection was made. This seems to be the first report of baboon syndrome due to streptococcal infection.

A case of cutaneous odontogenic sinus.

Despite the fact that cutaneous sinus tracts of odontogenic origin are well documented, the condition is still commonly misdiagnosed, because chronic periapical periodontitis may be asymptomatic and is rarely open to the skin. A 75‐year‐old Japanese woman presented to our clinic with the chief complaint of a left cheek skin lesion with mild pain. Physical examination revealed a subcutaneous nodule covered with erythematous skin on her left buccal region. Cultures from the subcutaneous nodule grew Bacteroides species and Peptostreptococcus micros but did not yield acid‐fast bacilli, fungi, or Actinomyces. Stains of smeared pus showed a considerable number of Gram‐negative rods. The histopathological examination revealed a focal abscess formation in the lower dermis and subcutaneous tissue. Dental evaluation, including an orthopantogram, showed a radiolucent alveolar area at the left lower first molar apex, suggesting a periapical abscess. Antibiotic therapy for three weeks associated with surgical root canal therapy eliminated the subcutaneous nodule. A high degree of suspicion is required to correctly diagnose a lower facial lesion as being of odontogenic origin, and prompt dental evaluation should be considered.

Successful Treatment of Non-Segmental Vitiligo: Systemic Therapy with Sex Hormone-Thyroid Powder Mixture

We previously reported a patient with generalized vitiligo improved by oral administration of the drug for menopausal syndrome (sex hormone-thyroid powder mixture). In this study, we reevaluated the efficiency of this drug for vitiligo, and examined its pharmacological action in melanogenesis.

Immunohistochemical Study of ACTH and α-MSH in Vitiligo Patients Successfully Treated with a Sex Steroid-Thyroid Hormone Mixture

We previously reported that a sex steroid‐thyroid hormone (Metharmon‐F®; MF, 2 tablets daily) was a potent drug for treatment of vitiligo. Using five patients with generalized vitiligo who were successfully treated with oral administration of MF, we performed an immunohistochemical analysis to elucidate its action mechanism at the cellular level. Histopathologically, the repigmented skin after the treatment showed increased numbers of melanocytes and melanin granules. Immunohistochemically, there was little significant difference between the depigmented lesion before treatment and the repigmented lesion after treatment in terms of the reactivity to adrenocorticotropic hormone (ACTH) and α‐melanocyte‐stimulating hormone (α‐MSH) in keratinocytes. The immunoreactivity to ACTH in melanocytes both before and after the treatment was minimal, but α‐MSH in melanocytes became much stronger after the treatment, than before the treatment. The efficacy of MF in treatment of vitiligo was proven to be due to the stimulatory effect of melanocyte proliferation and melanin production via α‐MSH.

Immune response to Streptococcus pyogenes and the susceptibility to psoriasis

Monoclonal antibodies directed against type 12 Group A streptococcal cell wall antigens cross‐react with nuclei and cytoplasm of cells from skin and synovium from controls, uninvolved skin of psoriatics and psoriatic plaques. Patients with psoriasis had high serum titres of antibody against the M12 (C‐region) streptococcal antigen compared to controls. An abnormal immune response directed against a ‘self’ antigen after initiation by Group A streptococcal infection may play an important role in the exacerbation or development of psoriasis.

Perineal Lipoma in a Neonate

Although lipoma is a subcutaneous tumor most commonly found on the trunk in adults, it is very rare in neonates. The histopathological findings show an encapsulated tumor containing normal fat cells. We report a 3‐month‐old female newborn with lipoma in the perineal region. The tumor was 4 cm in diameter, which histopathologically showed non‐encapsulated lobules composed of fat cells without cellular atypia. There were no genital abnormalities. The tumor was easily removed while the patient was under general anesthesia.

Eosinophilic cellulitis associated with molluscum contagiosum

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