Masahiro Kusuhara

Statistical survey of 150 cases with sporotrichosis

A survey of 150 cases with sporotrichosis seen at the Dermatological Clinic of Kurume University Hospital from February 1962 to October 1986 was reported. The proportion of cases with sporotrichosis to the total number of outpatients was 0.17%. Greater percentage of cases fell into the less than 10 years old or more than 40 years old groups. The male to female ratio was 1∶1.46, and 38 cases occurred in farmers. Geographic distribution was remarkable, especially around the Chikugo and Yabe river. Sixty-four cases showed the cutaneous lymphangitic type and 85 cases the localized cutaneous type and one case atypical type. The face and upper extremities were the most affected. The sporotrichin test was positive in 117 of 131 cases. The causative organism was demonstrated in tissue sections in 69% of the cases.

Cutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation.

A 60‐year‐old man who had had a renal transplantation developed a nodule on the dorsum of his right middle finger, which was subsequently diagnosed as cutaneous phaeohyphomycosis caused by Exophiala jeanselmei. The patient was successfully treated with 5–fluorocytosine. To our knowledge, this case is the third reported case in the world caused by this species in a postrenal transplant patient that manifested as phaeohyphomycosis.

Purification of rat cutaneous mast cells with Percoll density centrifugation

SummaryThe skin is the major site on anaphylaxis, and cutaneous mast cells have an important role in its reactions. The isolation and purification of rat cutaneous mast cells are described here. Rat abdominal skin was digested with collagenase and hyaluronidase, and centrifuged with Percoll. The buoyant density of cutaneous mast cells was high, and relatively pure mast cells were obtained. The purity of cutaneous mast cells was 7.4%±2.4% before and 50.0%±6.4% after Percoll density centrifugation; peritoneal mast cells revealed 5.8%±1.3% purity before and 61.0%±10.6% purity after the same procedure. The isolated cutaneous cells released 21.3%±3.8% histamine and the peritoneal mast cells released 55.5%±3.8% histamine upon stimulation with 10 μg/ml compound 48/80. These findings suggest that there are functional subsets of connective tissue mast cells.

A clinical study of patients with pemphigus vulgaris and pemphigus foliaceous: an 11‐year retrospective study (1996–2006)

Only a few reports have been published of detailed clinical studies of pemphigus in Japan. The aim of this study was to determine the clinical characteristics of patients with pemphigus vulgaris (PV) and pemphigus foliaceous (PF), who were newly diagnosed in the dermatology department of Kurume University Hospital, Japan, over the past 11 years. The primary site of involvement was the oral mucosa in 21 patients (75%) with PV. At the initial visit, most of the patients with PV had moderate to severe disease. With regard to management, systemic corticosteroids were the mainstay of treatment for patients with PV, and plasmapheresis was the most frequently used adjuvant therapy. Dapsone was the mainstay of treatment for the patients with PF. The patients were investigated for any association with an underlying malignancy; in patients with PV, lung, stomach and uterine cancers (one patient each) were seen.

Lymphocutaneous infection due to Scedosporium apiospermum

A 67‐year‐old Japanese man had been treated occasionally for asthma by oral administration of prednisolone at a dose between 5 and 15 mg/day for 18 years. In December 1993, the patient had a severe asthma attack, during which he developed a pneumothorax, complicated by pneumonia. He was hospitalized immediately, and antibiotics and hydrocortisone were administered intravenously. The treatment was, however, ineffective and his condition deteriorated. In February 1994, he was treated with pulse therapy of 1 g/day of sodium hydrocortisone for 3 days. During the pulse therapy, erythema and red papules were noticed on his right dorsum manus. The erythema progressed with purpura, induration, and local fever. The papules became necrotic, giving rise to small ulcers with effusions (Fig. 1). The patient also developed a subcutaneous nodule on the proximal region of his forearm.

Alterations in membrane fluidity during keratinocyte differentiation measured by fluorescence polarization

SummaryThe epidermis shows a distinctive pattern of differentiation wherein keratinocytes proliferate in the basal cell layer and mature into spinous and granular cells. Using a discontinuous density-gradient centrifugation method, guinea-pig keratinocytes were separated into high (HDF), intermediate (IDF), and low (LDF) density fractions. Morphological and flow cytometrical observations demonstrated that HDF, IDF, and LDF were basal, spinous, and granular cell-rich fractions, respectively. Membrane fluidity of the fractionated keratinocytes was measured by diphenylhexatriene fluorescence polarization. Polarization (p)-value of keratinocytes was negatively correlated with temperature. At each temperature, HDF cells showed a lower p-value than IDF or HDF cells except at 40° C. Since a low p-value indicates a high degree of Brownian motion, membrane fluidity is higher in basal cells and lower in spinous and granular cells. Our results indicate that membrane fluidity of guinea-pig keratinocytes decreases during their maturation.

Purification and characterization of prolyl endopeptidase from rat skin

An enzyme with the specificity of a prolyl endopeptidase was purified approximately 329-fold from rat skin. The enzyme has a molecular weight of 70,000 as estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and a pH optimum of 5.8 as checked with 7-(Succinyl-Gly-Pro)-4- methylcoumarinamide (Suc-Gly-Pro-MCA) as the substrate. The optimal temperature for the enzyme activity was 40 degrees C. The Km and Vmax values for Suc-Gly-Pro-MCA were 0.7 mM and 68 nmol/min per mg protein, respectively. The enzyme activity was markedly inhibited by diisopropyl fluorophosphate, p-chloromercuribenzoic acid, N-ethylmaleimide, Zn2+ and Cu2+, while it was partially inhibited by phenylmethanesulphonyl fluoride. The purified enzyme was shown to release the N-terminal tetrapeptide, Arg-Pro-Lys-Pro, from substance P producing the C-terminal heptapeptide, Gln-Gln-Phe-Phe-Gly-Met- CONH2. In the skin, this enzyme might be related to the inactivation of substance P.

Immunoserological analyses of 55 patients with pemphigus at the Dermatological Department of Kurume University Hospital: an 11‐year retrospective study (1996–2006)

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Adenoma of the nipple in a Japanese man

Adenoma of the nipple (AN, also called erosive adenomatosis of the nipple) is a rare benign disorder involving the nipple. AN was first described in 1955 as ‘‘florid papillomatosis of the nipple duct’’ by Jones et al. AN occurs mostly in middle-aged women and is extremely rare in men and children. We report a case of AN in a 42-year-old Japanese man. He presented with nodular lesion on the right nipple, which had developed over the past 2 years. On examination, a dark-red, nodular lesion was seen on the upper half of the right nipple (Fig. 1). The lesion was elastic, hard and 5 mm in size. Its surface was covered with slight scaling, but no erosions or serous discharge were seen. There was no pain and no itching. A biopsy specimen showed a well-demarcated, nonencapsulated cluster of cells showing papillary growth in the dermis (Fig. 2a). The cluster was composed of duct-like structures of various sizes (Fig 2b). Two types of cells lining the lumina were seen, and apocrine differentiation was evident. There was no nuclear atypia. A diagnosis of AN was made. After wide local excision of the nipple, the histological examination was compatible with the biopsy specimen. To our knowledge, about 60 cases of AN have been reported in the Japanese literature and only three male cases have been reported to date. The tumour is usually asymptomatic, and the most common symptoms are erosion of the nipple, serous discharge and nodule formation. These symptoms and deformity of the nipple may clinically resemble a malignant lesion. If an AN lesion shows erosion, clinical differentiation from Paget’s disease may be impossible, and the lesion can be easily confused with adenocarcinoma pathologically. Immunohistochemistry using anti-c-erbB-2 antibody is useful for differentiating between AN and Paget’s disease, which stains Paget’s cells, but not AN cells. Because of the confusion, unnecessary surgery has been performed for some cases of AN, despite it being a benign condition. For treatment, simple excision is enough for the treatment of AN. Alternatively, some cases of AN have treated by cryosurgery. Hye reported that Mohs’ micrographic surgery is useful for complete removal the lesion, if performed sufficiently early in the course. Doctors should be aware of the confusion and take particular care with the differential diagnosis of AN in cases of suspected Paget’s disease and adenocarcinoma, clinically and pathologically, as AN is a benign condition.

B-cell activating factor detected on both naïve and memory B cells in bullous pemphigoid.

B‐cell activating factor (BAFF), an important immune regulatory cytokine, is involved in development of autoimmune diseases. Although BAFF is expressed in various cells, including dendritic cells (DCs) and monocytes, BAFF expression on B cells has not been well documented. In the present study, BAFF molecules on DCs and naïve and memory B cells in autoimmune bullous diseases, including pemphigus vulgaris, pemphigus foliaceus and bullous pemphigoid (BP), were analysed by flow cytometry. Compared with healthy controls (HC), BAFF expression on naïve and memory B cells increased significantly in BP. No difference in BAFF receptor expression in naïve and memory B cells was shown among all study groups. Furthermore, BAFF expression in both naïve and memory B cells of BP, but not HC, was detected by confocal microscopic analysis. These results implied that BAFF expressed by B cells may play a pathogenic role in autoimmune bullous diseases, particularly BP.