Manabu Hamada

Epidemiology of cutaneous tuberculosis in Japan : a retrospective study from 1906 to 2002

Background  Interest in tuberculosis has recently been revived, especially in association with the onset of acquired immunodeficiency syndrome (AIDS). In Japan, the incidence of tuberculosis has declined since the 1950s, but has shown a tendency to increase in the past 10 years.

A case of genital folliculosebaceous cystic hamartoma with an unique aggregated manifestation

Folliculosebaceous cystic hamartoma (FCH) is a recently recognized cutaneous hamartoma composed of follicular, sebaceous and mesenchymal components, and usually occurring on the head and neck. We describe herein a case of FCH with an unique aggregated manifestation in a genital lesion. The patient was a 40‐year‐old woman with a genital lesion composed of a pedunculated nodule, a dome‐shaped nodule and a subcutaneous nodule, measuring 5 cm in the greatest dimension. The largest, pedunculated nodule was histologically composed of an infundibulo‐cystic structure with follicular, sebaceous and mesenchymal elements accompanied by cystic structures of various sizes lined by stratified squamous epithelium and follicular germinative cells suggesting follicular cysts. The dome‐shaped nodule consisted of anastomosing strands of epithelial cells with follicular components. The subcutaneous nodule had two components, an infundibulo‐cystic structure and a cyst lined by squamous epithelium. In our case, the unusual clinical feature of large and multiple nodules was due to the presence of several prominent hamartomatous cystic structures with FCH. This is the third case of giant FCH. The clinical presentation and location of giant FCH is unusual.

A progression to dermatofibrosarcoma protuberans with a fibrosarcomatous component: a special reference to the chromosomal aberrations.

Dermatofibrosarcoma protuberans (DFSP) with fibrosarcomatous areas (DFSP-FS) is differentiated from ordinary DFSP by its unfavourable prognosis. We carried out sequential analysis of numerical chromosomal abnormalities in two cases of DFSP during their progression to metastatic disease with FS areas (DFSP-M-FS). They were compared with nine cases of ordinary DFSP and three cases of DFSP-FS, but without metastases. Numerical chromosomal changes were examined by fluorescence in situ hybridization (FISH) using alpha-satellite centromeric probes for chromosomes 1, 8, 11 and 17. Numerical imbalances of chromosome 1 were not clarified. A gain of chromosome 8 was demonstrated in the two cases of DFSP-M-FS. A gain of chromosome 11 was observed in one of the two cases of DFSP-M-FS and in one case of DFSP-FS. A gain of chromosome 17 was demonstrated in both metastatic tumours and in recurrent tumours in two cases of DFSP-M-FS, in addition to two cases of DFSP-FS and four cases of ordinary DFSP with recurrent tumours or large tumours. This study raised the hypothesis that a gain of chromosome 17 developed in recurrent or large-sized DFSP, which occurs in high-risk groups with the possibility of a progression to FS.

A case of varicella-associated idiopathic thrombocytopenic purpura in adulthood.

We describe here an adult case of varicella‐associated idiopathic thrombocytopenic purpura (ITP). A 23‐year‐old Japanese male presented with generalized hemorrhagic vesicles and fever. Laboratory examinations revealed severe thrombocytopenia associated with anti‐platelet IgG auto‐antibody. The patient rapidly recovered within a few days after antiviral agent (vidarabine) administration, and the platelet count returned to normal with skin lesion improvement. Idiopathic thrombocytopenic purpura associated with viral infection in adulthood is relatively rare.

Pneumatosis Cystoides Intestinalis with Systemic Sclerosis, Limited Type Resulting in a Poor Prognosis

Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of multilocular intramural clusters of gas in the alimentary tract and has been considered to have a favorable response to conservative treatment. We describe the first case of limited type of systemic sclerosis (SSc) with PCI. A 74-year-old Japanese woman presented with a 4-month history of an unhealed cutaneous ulcer on the right third finger, along with sclerodactyly of bilateral hands. Proximal skin sclerosis was absent. The patient reported acute abdominal pain, and a diagnosis of PCI was established on plain radiography. The patient died of multiple organ failure 5 months after the development of PCI. PCI is rarely complicated with SSc, and all cases previously reported were associated with diffuse SSc. Because PCI is one of the poor prognostic factors of SSc, we should recognize the presence of this condition even in patients with limited cutaneous involvement.

Pressure cutaneous ulcer over a pacemaker successfully treated with left subcostal transplantation in an extremely thin patient

Implantation of a permanent cardiac pacemaker is becoming common with the increase in the elderly population. A cutaneous ulcer over the pacemaker is a rare complication. Most such cases previously reported demonstrate non‐specific granuloma histologically, negative patch testing of materials used in the device, and no growth in the bacterial culture taken from the generator pocket. To date, the conventional treatments often result in a disap‐pointing outcome. We describe an extremely thin 79‐year‐old Japanese male with a pressure cutaneous ulcer caused by the presence of a pacemaker device. This patient was referred to us with a 1‐month history of repeated cutaneous ulcer and exposure of the cardiac pacemaker in the left pectoral area. Conservative treatment was not effective. Treatment with left subcostal implantation of a new pacemaker, which was not wrapped, and disposition of the electrodes in the subcutaneous tissue of the thorax was successful. Cutaneous manifestations have not recurred for 5 years. Considering the poor condition of the patient, subcostal translocation of the pacemaker was a simple and acceptable treatment for pressure cutaneous ulcer over the pacemaker.

A case of multifocal lupus vulgaris that preceded pulmonary tuberculosis in an immune compromised patient.

We describe the rare case of a Japanese male with multifocal lupus vulgaris that preceded asymptomatic pulmonary tuberculosis and adult T‐cell leukemia/lymphoma (ATL). He visited our hospital with multiple reddish plaques and erythema of 4–12 months duration. A skin biopsy revealed non‐caseating epithelioid granulomas. Mycobacterium tuberculosis was detected by polymerase chain reaction (PCR)‐hybridization from a skin biopsy specimen and was also isolated from a culture of the skin biopsy sample. The result of chest roentogenography was compatible with pulmonary tuberculosis. In addition, the diagnosis of ATL was based upon the presence of atypical lymphocytes with convoluted nuclei in his peripheral blood and a positive anti‐ATL antibody reaction. Cases of cutaneous tuberculosis presenting with unusual clinical features may be on the increase, accompanying the spread of tuberculosis in immunosuppressed patients, including those with ATL and acquired immunodeficiency syndrome (AIDS).

Efficacy and Safety of the Traditional Japanese Medicine Keigairengyoto in the Treatment of Acne Vulgaris

Several traditional Japanese medicines including Keigairengyoto (KRT) are used to treat acne vulgaris, but there is no robust evidence of their effectiveness. In this study, we examined the effectiveness and safety of KRT in treating acne vulgaris. An open-label, randomized, parallel control group comparison was conducted with a conventional treatment group (adapalene and topical antibiotics; control group) and a KRT group (control treatment plus KRT). The test drugs were administered for 12 weeks to patients (15 to 64 years, outpatient) with inflammatory acne on their face, and the amount of acne at 2, 4, 8, and 12 weeks was measured. Sixty-four patients were enrolled; 29 patients in each group were included in the analysis. Twenty-eight patients in the control group and 24 patients in the KRT group were included in the efficacy analysis. The number of inflammatory skin rashes at 4 and 8 weeks in the KRT group was significantly decreased compared with the control group. There was no significant difference between the two groups in noninflammatory eruptions and general rashes. There were no serious adverse events in both groups. KRT may be a useful agent in patients with inflammatory acne in combination with conventional treatments. This trial is registered with UMIN 000014831.