Masato Kashima

Moisturizing effects of topical nicotinamide on atopic dry skin

Background  Certain moisturizers can improve skin barrier function in atopic dermatitis. The effect of topical nicotinamide on atopic dry skin is unknown. We examined the effect of topical nicotinamide on atopic dry skin and compared the results with the effect of white petrolatum in a left–right comparison study.

Safe and Effective Treatment of Refractory Facial Lesions in Atopic Dermatitis Using Topical Tacrolimus following Corticosteroid Discontinuation

Background: Topical corticosteroids are commonly applied in atopic dermatitis (AD) treatment. However, their chronic use may be associated with significant side effects at the application site. Skin atrophy and other undesirable effects are frequently seen after long-term corticosteroid treatment. In addition, when application of corticosteroids is discontinued, a rebound phenomenon in the facial lesions can occur within several days. Topical tacrolimus, an immunosuppressant currently used to prevent rejection after solid-organ transplantation, presents a potential alternative therapeutic agent for AD. Objective: The present study is the first trial designed to evaluate the efficacy and safety of topically applied tacrolimus ointment after corticosteroid discontinuation without a washout phase in severe, long-term facial AD. Patients/Methods: Forty-seven patients with facial refractory AD were recruited, of whom 38 had undergone topical corticosteroid treatment for at least 4 weeks before enrollment (group 1) and the other 9 had not received steroid treatment (group 2). All 47 patients received 0.1% tacrolimus ointment, and the severity index and pruritus score were assessed as an AD clinical activity index every week and compared with baseline data. Results: Both the severity index and pruritus score improved significantly in group 1 after 1 and 2 weeks of application (p < 0.01, respectively). Group 2 showed the greatest improvement at 4 weeks (p < 0.05). In this trial, none of the patients experienced a rebound phenomenon associated with tacrolimus treatment. A transient sensation of burning at the application site was the only adverse event in 31 of the 47 (66%) enrolled patients, but this condition improved after several days. Spectrophotometric assessment of the facial lesion following treatment revealed significant improvement in group 1 (p < 0.05). Conclusion: The present results indicate that topical tacrolimus treatment following corticosteroid discontinuation is safe and effective in refractory facial AD.

Serum levels of soluble stem cell factor and soluble KIT are elevated in patients with atopic dermatitis and correlate with the disease severity

Background Mast cell infiltration in skin lesions of atopic dermatitis (AD) is considered to play an important role in the pathogenesis of the disease. The most common factor that stimulates mast cell growth, migration and differentiation is stem cell factor (SCF), and the interaction of SCF and its receptor, KIT (tyrosine kinase transmembrane receptor), appears to be the key event in the recruitment and proliferation of mast cells.

The First Isolation of Nocardia veterana from a Human Mycetoma

The clinical isolates from biopsy specimen human subcutaneous nodule developed orange‐colored and wrinkled colonies on Sabourauds dextrose agar at 24 C for 2 weeks. The isolates were aerobic and gram‐positive. The bacteria were rod‐shaped to coccoid and 1 × 5 μm in size. The assimilation tests revealed that the clinical isolate was identical to a reference strain of Nocardia veterana. A nucleotide sequence analysis of the 16S ribosomal DNA from the isolate and a reference strain of N. veterana showed 99.8% similarity. All data are consistent with the conclusion that the isolate in this human case of mycetoma is N. veterana.

A successfully treated case of mycetoma due to Nocardia veterana

We report a successfully treated case of mycetoma from which an unusual Nocardia species was isolated. The isolate was identified as N. veterana by biochemical characterization and 16S ribosomal RNA gene sequencing, and it has not been previously reported as a causative agent of human mycetomas. Treatment with various antibiotics over 6 years and surgical resection failed to cure the disease. However, the combination of intravenous imipenem/cilastatin and amikacin along with oral clarithromycin and minocycline proved very effective in this case. This is the first case report of mycetoma due to N. veterana in a clinical setting.

Detection of Human Papillomavirus Type 57 in the Tissue of a Plantar Epidermoid Cyst

Plantar epidermoid cysts with human papillomavirus (HPV) infection are not rare in Japan. Most of them show the cytopathic effect of HPV type 60 – homogeneous intracytoplasmic inclusion bodies. Our case presented a plantar epidermoid cyst with vacuolation around the granular cell layer without any features of HPV type 60. In situ hybridization and polymerase chain reaction followed by DNA sequencing analysis revealed an association with HPV type 57.

A case of black dot ringworm with a review of Japanese cases.

Black dot ringworm (BDR), caused by Trichophyton violaceum var. glabrum (T. glabrum), was observed in a 28‐year‐old Japanese female who had been treated with prednisolone (22.5 mg/day) for systemic lupus erythematosus. It was successfully treated with oral terbinafine (125 mg/day) for 12 weeks. The causative fungus was identified by molecular analysis as well as morphological and biochemical examination. The chitin synthase 1 (CHS1) gene cleavage pattern of the clinical isolate with restricted enzyme HinfI was identical to that of T. violaceum. We reviewed previous reports of BDR to determine the historical trend of this infection in Japan. Since 1974, 93 Japanese cases have been reported. The age distribution was bi‐modal: the higher peak consisted of children (aged 0–15 years), and the lower peak was composed of the elderly (aged 60–75 years). In the elderly group, females were predominant (M: F=1: 22, p<0.001). T. violaceum, including T. glabrum, was identified as the most common causative fungus of BDR (75.3%). Sixty percent of cases showed slight erythema. In 8 families, 16 cases were found to be intrafamilial infections. A history of previous steroid treatment was described in about 40%.

A case of unilateral dermatomal cavernous haemangiomatosis.

We report a 39‐year‐old man with unilateral dermatomal cavernous haemangiomatosis (UDCH). Clinically, three haemangiomas were unilaterally distributed in the C6 dermatome. Histologically, these haemangiomas were distinct from routine cavernous haemangioma in that hyperplasia of smooth muscle cells on the vascular wall was observed, and electron microscopy showed that smooth muscle cells contained myofilaments and a crystal‐like structure in the endothelial cells. This is distinct from Weibel–Palade bodies, which are rod‐shaped cytoplasmic organelles measuring approximately 0·1 µm in diameter with a parallel linear structure. In UDCH, the haemangiomas occur only in the skin. They are clinically and histologically similar to those of blue rubber bleb naevus syndrome (BRBNS), but in BRBNS there are multiple haemangiomas in the digestive tract and other organs. UDCH is distinct from Maffucci syndrome in that enchondromata and malignant tumours are absent. To our knowledge, this is the second case of UDCH reported in the literature.

Molecular confirmation of a Trichophyton violaceum isolate from human black-dot ringworm.

A clinical isolate from a black-dot ringworm lesion of a 28-year-old female Japanese was investigated by morphological and biochemical analyses as well as molecular analyses. The isolate grew well onthiamine enriched agar and did not produce violetpigment, macroconidia or microconidia on Sabourauds dextrose agar. Approximately 620-bp genomic DNA fragments of the CHS1 gene were amplified from Trichophyton mentagrophytes, T. rubrum, T. tonsurans and T. violaceum by polymerase chain reaction (PCR) and sequenced. The chitin synthase 1 (CHS1) nucleotide sequences of the clinical isolate showed more than 97% similarity to that of T. violaceum and less than 96% similarity to that of T. mentagrophytes, T. rubrum and T. tonsurans. The phylogenetic analysis of their sequences revealed that the clinical isolate was genetically close to T. violaceum and distinct from T. mentagrophytes, T. rubrum and T. tonsurans. Therefore, the isolate was confirmed as T. violaceum by mycological examination and molecular analyses.

A Rather Rare Encounter with Herpes Zoster in a Male Infant

To the editor: Herpes zoster is rare among immunocompetent children, especially in infancy. Pre-exposure to varicella zoster virus (VZV) and latent infection in the dorsal root ganglia are necessary prerequisites. Infants under six months are usually protected from chicken pox by maternal immunoglobulin against the virus. Therefore, it is very rare to encounter a baby with herpes zoster before the age of one year who also has a history of chicken pox. I report such a case of male infant. In the medical literature written in English and Japanese, between 1991 and 2001, six cases of infantile (less than 12 months old) herpes zoster preceded by chicken pox are documented. Each of these involved female infants except our current report. Case Report: The patient was born via spontaneous vaginal delivery at term. His mother was diagnosed with chicken pox in childhood, but she demonstrated no herpes zoster rash during pregnancy. The infant was in normal health until two weeks of age, when he was exposed to chicken pox by an older sibling. One week later, a single vesicle appeared on the sole and resolved without medical intervention. At the age of nine months, the infant developed erythema, papules and vesicles on the left lower extremity. Anorexia and low-grade fever were observed by the mother 3 to 5 days later. On physical exam one week after the first of the vesicles, we found him in good spirits, smiling spontaneously and in no apparent distress. There was nothing to indicate that he had neuralgia. The vesicles were abundant, in herpetiform gathering on a dermatomal band involving his left lower extremity and left buttock (Fig. 1). A few solitary vesicles were observed on the forehead. Serum IgG (FA) titer for VZV was x40. The eruption resolved with acyclovir 100 mg/ kg/day administered orally for 7 days. Comments: The patient demonstrated lesions of the left dermatomes L2 through S1, indicating latent varicella infection of at least these dorsal root ganglia. Whether the original vesicle was on the left or right sole is not documented. Some cases of herpes zoster have been reported to coincide with the site of varicella vaccination with Oka stain; DNA of the Oka strain was recoverd from the zoster vesicle of one case (1). Twenty-four cases (2–20) of infantile (younger than twelve-months) herpes zoster were indentified in Medline and J Medicine electronic searches covering almost all the English and Japanese scientific publications between 1991 and 2001. Four cases (4, 7, 11) found no evidence of prior VZV exposure. Fifteen cases (2, 3, 5–7, 8–10, 12–14, 18, 20) (male–5, female–10) included intrauterine exposure to VZV by way of maternal diagnosis of chicken pox. Five infants (7, 15–17, 19) had documented chicken pox. Each of these involved female infants. We offer no explanation for the female preponThe Journal of Dermatology Vol. 30: 348–349, 2003