Mikihisa Sakurane

Beneficial Effect of Helicobacter pylori Eradication in Dermatologic Diseases

A relationship between skin diseases, particularly rosacea and chronic urticaria, and H. pylori infection has been suggested.

Slow acetylator genotypes as a possible risk factor for infectious mononucleosis-like syndrome induced by salazosulfapyridine.

Summary We report two patients with infectious mononucleosis‐like syndrome induced by salazosulfapyridine (SASP). In both cases, high fever, skin rash, liver dysfunction and atypical lymphocytosis developed 3 weeks after initiating treatment with SASP. SASP is known to be mainly metabolized by N‐acetyltransferase 2 (NAT2), and acetylation phenotypes (rapid, intermediate and slow acetylator) correlate with NAT2* genotypes. In our two patients, we investigated NAT2* genotypes by the polymerase chain reaction–restriction fragment length polymorphism method. We identified NAT2*6/*7 in one patient, and NAT2*6/*5 in the other, suggesting that both were slow acetylator phenotypes. In 20 healthy volunteers we found no slow acetylator genotypes. Genotyping prior to medication may be useful in evaluating patients with a high risk of severe systemic reaction to SASP.

Therapeutic Effects of Antibacterial Treatment for Intractable Skin Diseases in Helicobacter pylori-Positive Japanese Patients

In order to understand the pathogenic relationship between Helicobacter pylori (H. pylori) and skin diseases, we examined the serum levels of IgG antibody against H. pylori and then performed gastroscopic examinations in Japanese patients with chronic skin diseases. These H. pylori‐positive patients were treated with antibacterial eradication therapy, and therapeutic efficacy was evaluated. A total of 198 patients who were resistant to conventional therapies were randomly selected. They included 50 cases with chronic urticaria, 32 with pruritus cutaneous, 74 with atopic dermatitis, 15 with nummular dermatitis, 17 with prurigo chronica multiformis, 6 with psoriasis vulgaris, and 4 with erythroderma. Positive anti‐H. pylori antibody was detected in 102 out of these 198 patients; more than half of the ones with chronic urticaria, pruritus cutaneous, nummular dermatitis, and prurigo chronica multiformis had positive antibodies. Gastroscopy was then performed in 48 cases with positive antibodies. Eradication therapy was effective in 60% of the patients with chronic urticaria, in 58% with pruritus cutaneous, in 54% with nummular dermatitis, and in 50% with prurigo chronica multiformis. In chronic skin diseases, persistent infection with H. pylori may be an eruption trigger and may cause deterioration of the disease into an intractable and chronic form.

A case of symmetrical leukemia cutis on the eyelids complicated by B-cell chronic lymphocytic lymphoma

We describe herein a case of symmetrical bilateral leukemia cutis on the eyelids, especially on the lower lids, in a patient with B‐cell chronic lymphocytic leukemia (CLL). The patient was a 63‐year‐old Japanese man who had been diagnosed with CLL. Eyelid swelling is well known to result from local skin or systemic diseases including tumors, hyperthy‐roidism, nephritic syndrome, and hypoalbuminemia. To our knowledge, symmetrical, bilateral, flesh‐colored leukemia cutis on the eyelids has not been previously reported.

Helicobacter pylori-positive patients with pruritic skin diseases are at increased risk for gastric cancer

Background : Helicobacter pylori infection has been implicated as a possible cause of extraintestinal disorders such as skin diseases. A number of case reports describe patients with skin diseases, such as prurigo nodularis, that are associated with gastric cancer.

Complicated case of Paget disease after nipple conservative operation of mammary cancer with multiple Bowen disease.

We report herein a case of mammary Pagets disease complicated by multiple Bowens disease in a patient who had received successive chemotherapy during follow-up for surgical resection of breast cancer preserving the nipple 8 years earlier.Subject: The patient was a 52-year-old housewife.In 1988, she underwent left breast cancer resectomy preserving the nipple at another hospital.In 1991, erosion on the left nipple was noted.In 1993, erythema on the inner portion of the right breast was noticed.In 1995, since erosion of the left nipple expanded to the areola and was accompanied by gradual extension of erythema on the inner portion of the right breast as well as dispersion of erythema on other parts of the trunk, the patient consulted a local dermatologist.Because Bowens disease was diagnosed by biopsy of the left areola with erythema due to suspected Pagets disease, the patient was reffered to our hospital.At our department, biopsy of the left areola as well as the erythematous area of the trunk was performed again.On histopathological examination, the patient was diagnosed with mammary Pagets disease and multiple Bowens disease.The findings of the biopsy performed at the other hospital also indicated Pagets disease.