Michihito Niimura

Elevated Serum Insulin-like Growth Factor-1 (IGF-1) Levels in Women with Postadolescent Acne

The purpose of this study was to measure the serum levels of IGF‐1 in women with postadolescent acne compared to normal controls, and evaluate the relationship of these levels to the levels of androgens, in order to investigate the possible role of IGF‐1 in the pathogenesis of acne. Eighty‐two female patients with acne between 20 and 25 years of age and thirty‐one age‐matched control women were studied. We measured the serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA‐S), and insulin‐like growth factor‐1 (IGF‐1).

Use of a wrist activity monitor for the measurement of nocturnal scratching in patients with atopic dermatitis.

Background The amount of nocturnal scratching can be an indirect correlate of itch in pruritic dermatoses. We have previously used an infrared video camera to measure nocturnal scratching in atopic dermatitis (AD). Although this is a reliable method of measuring nocturnal scratching, it is not suitable for routine monitoring in clinical use.

A case of febrile ulceronecrotic Mucha-Habermann disease requiring debridement of necrotic skin and epidermal autograft.

Summary We report a case of febrile ulceronecrotic Mucha–Habermann disease (FUMHD) in a 21‐year‐old man. This disease is a severe form of pityriasis lichenoides et varioliformis acuta (PLEVA) and is characterized by the sudden onset of diffuse ulcerations associated with high fever and systemic symptoms. It is sometimes lethal especially in elderly patients. In the present case, intense generalized maculopapular erythematous plaques with central necrosis developed progressively in association with a high fever. Initial treatment with systemic betamethasone had been unsuccessful and the skin lesions, which covered about 50% of the body surface, became severely ulcerated. Although the development of new lesions had ceased spontaneously, widespread ulceration of the skin remained. Debridement of the necrotic skin and skin grafting using cultured epidermal autografts and meshed allografts of cadaver skin led to prompt reepithelization.

INTRALESIONAL HUMAN FIBROBLAST INTERFERON IN COMMON WARTS

In a double‐blind trial, patients with bilateral common warts of the extremities were treated at weekly intervals with intralesional injections of either human fibroblast interferon or placebo. More than 81% of the interferon‐treated extremities were either cured or responded effectively to therapy. Only 17% of the placebo‐treated lesions responded in this fashion. A statistical analysis of these data confirms the effectiveness of intralesional interferon therapy. No adverse effects were observed.

Mild Insulin Resistance during Oral Glucose Tolerance Test (OGTT) in Women with Acne

The purpose of this study was to evaluate serum levels of basal insulin and glucose‐stimulated insulin, and to evaluate their correlations with androgen levels in women with acne. Serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA‐S), sex hormone binding globulin (SHBG), insulin‐like growth factor‐1 (IGF‐1), and immunoreactive insulin (IRI) were measured and compared in thirty women with moderate or severe acne and thirteen healthy controls. Serum FT, DHT and DHEA‐S levels in the acne group were significantly higher than those in the control group. In the acne group, there were no significant correlations between insulin or IGF‐1 levels and T, FT, DHT and SHBG, despite the positive correlation between insulin and IGF‐1. In order to determine the effects of insulin secretion as a dynamic response to an oral glucose tolerance test (OGTT) on serum androgen levels in acne patients, we examined the responses of serum insulin and androgen levels to a 75 g, 2 hour OGTT in the acne group and in the control group. Basal insulin levels were not significantly higher than those in the control group, but the summed insulin levels during the OGTT in the acne group were significantly higher than those in the control group. Serum T and FT levels in the acne group decreased during the OGTT, but these changes were not so significant when compared to normal controls. In conclusion, we tried to demonstrate mild insulin resistance during the OGTT in acne patients. However, postmeal transient hyperinsulinemia does not seem to play an important role in determining hyperandrogenemia in acne patients.

Oral Spironolactone Therapy in Male Patients with Rosacea

Spironolactone at 50 mg/day was orally administered for four weeks to 13 male patients with rosacea in order to observe its clinical effectiveness. Serum estradiol (E2), 17OH‐progesterone (17OH‐P4), testosterone (T), androstenedione (Δ4A), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA‐S) were measured prior to and after treatment. Although there were no significant changes in T, Δ4A, DHT, or DHEA‐S, the serum levels of 17OH‐P4 increased significantly. E2 tended to increase, although the change was not significant Two of the 13 patients discontinued spironolactone treatment because of general malaise, but seven of the remaining eleven patients exhibited an improvement in their rosacea. These findings demonstrate that a low dose of spironolactone is effective in the treatment of rosacea in some male patients and suggest that it is possible that changes in the metabolism of sex steroid hormones such as cytochrome p‐450 isozymes have some bearing on the etiology of rosacea.

A double-blind clinical study in patients with herpes zoster to establish YN-72 (Brovavir) dose.

Double-blind clinical trials were performed with a placebo to determine the optimum dose of YN-72 in patients with herpes zoster. YN-72 at 10, 50, and 100 mg was administered orally three times daily for 7 days. A total of 226 patients entered the present trial. Six of the 226 patients were excluded from statistical analysis of data. Furthermore, seven patients were excluded from the analysis for efficacy and usefulness, and included in the analysis for safety. The numbers of patients included in the analyses for efficacy and usefulness were 50 in the placebo group, 54 in the YN-72 30-mg/day group, 56 in the 150-mg/day group, and 53 in the 300-mg/day group. The numbers of patients included in analysis for safety were 53 in the placebo group, 58 in the YN-72 30-mg/day group, 56 in the 150-mg/day group and 53 in the 300-mg/day group. The effectiveness rate at the end of administration was 42.0% in the placebo group, 79.6% in the YN-72 30-mg/day group, 80.4% in the 150-mg/day group, and 61.5% in the 300-mg/day group. The rates in the YN-72 groups were significantly higher than in the placebo group. Evaluation at the end of the trials revealed that administration of YN-72 was effective. Among skin symptoms, administration of YN-72 accelerated the disappearance of erythema and vesicles and the formation of crust. Administration of YN-72 tended to accelerate the reduction and disappearance of pain. Reduction and disappearance in the YN-72 150-mg/day group occurred significantly earlier than in the placebo group (log-rank test).(ABSTRACT TRUNCATED AT 250 WORDS)

Coexistence of psoriasis and linear IgA bullous dermatosis

Linear IgA bullous dermatosis (LABD) is characterized by IgA autoantibodies against components of the basement membrane zone (BMZ). A 97‐kDa protein is one of the major autoantigens associated with this disease. We report a 68‐year‐old man who developed LABD after a 3‐year history of psoriasis and in the context of active hepatitis C virus infection. He had been treated with cyclosporin for psoriasis for about 9 months. Histologically, there was a subepidermal blister containing neutrophils and eosinophils with lymphocytes infiltrating predominantly in the dermis. Direct immunofluorescent staining showed linear IgA deposition at the BMZ. The patient’s IgA autoantibodies bound exclusively to the epidermal side of 1 mol/L salt‐split normal human skin. Immunoblot analysis identified a 97‐kDa autoantigen in epidermal extracts. This appears to be the first case of LABD with IgA autoantibodies against a 97‐kDa autoantigen, associated with psoriasis and hepatitis C virus infection.

Detection of Human Papillomavirus Type 60 in Plantar Cysts and Verruca Plantaris by the In situ Hybridization Method Using Digoxigenin Labeled Probes

Since 1987, many cases have been reported in which human papillomavirus (HPV) could be associated with epidermoid cysts of the palms and soles. In 1989, the HPV found in an induced epidermoid cyst was cloned and named HPV 60.

Effect of Long-Term, Low-Dose Acyclovir Suppressive Therapy on Susceptibility to Acyclovir and Frequency of Acyclovir Resistance of Herpes Simplex Virus Type 2

We have examined the susceptibility to acyclovir and frequency of acyclovir-resistant viruses in herpes simplex virus type (HSV) 2 clones isolated directly from genital lesions of 11 patients who had taken suppressive therapy (200 mg/day) for 1–9 years and 15 patients naive to acyclovir. Suppressive therapy significantly reduced the incidence of recurrence and the severity of the skin lesions. HSV samples from genital lesions were directly inoculated into Vero cells, and viral clones were isolated in the absence and presence of 10 pg/ml acyclovir. Five-hundred-and-ninety-two clones, isolated in the absence of acyclovir, were subjected to the acyclovir susceptibility test, and 155 clones isolated in the presence of acyclovir were analysed for the mechanisms of resistance to acyclovir. There were no significant differences in the susceptibility to acyclovir, the frequency of acyclovir-resistant virus and the ratio of thymidine kinase-deficient viruses in acyclovir-resistant viruses between the two groups. The frequency of acyclovir-resistant clones was about three per 10000 plaque forming units (PFU), and genital lesions contained up to 3times106 PFU of replicating virus in the specimens from the patients with genital herpes with or without acyclovir-suppressive therapy. Thus, the low dose of acyclovir suppressive therapy did not affect the susceptibility to acyclovir or increase the frequency of acyclovir-resistant viruses in the genital lesions.