Norito Katoh

Rituximab is effective for steroid-refractory sclerodermatous chronic graft-versus-host disease.

Chronic graft-versus-host disease (GVHD) is the most common late complication following allogeneic stem cell transplantation, occurring in 25–80% of transplant recipients.1 It is becoming a more frequent problem due to the increasing recipient age at transplantation as well as the increasing use of alternative donors, peripheral blood stem cells, and donor lymphocyte infusions. The most widely employed first line therapy for chronic GVHD is a combination of cyclosporine (CSA) and prednisolone, but patients who failed to respond to the initial steroid-based therapy have a poor outcome.1 Therefore, various agents have been investigated as salvage therapy for chronic GVHD, but there is no standard approach that is uniformly accepted.

Effects of tacrolimus ointment on facial eruption, itch, and scratching in patients with atopic dermatitis.

The action of tacrolimus ointment on pruritus in atopic dermatitis is still unclear. In this open study we investigated both the relationship between the severity of eruptions and the degree of itch and scratching in patients with atopic dermatitis and the effects of topical tacrolimus on these symptoms. Seventy adults with moderate to severe atopic dermatitis with facial eruptions that were recalcitrant to topical steroids applied a 0.1% tacrolimus ointment twice per day after discontinuation of topical steroid. The eruption scores and an assessment of the itch and scratching were recorded for 12 weeks. Oral antihistamine was prescribed at least one month before the study and continued unchanged during the study in each patient. The percentage reduction in the score of itch and scratching after two weeks (n=59) was significantly higher than in the score of eruption. Although there was no significant relationship between the severity of the eruptions and the degree of itch and scratching during steroid application, a relationship became significant after four weeks (n=59) of tacrolimus use by a one‐factor ANOVA analysis. This suggests that tacrolimus ointment is effective for the itch and scratching in cases where degrees might be discrepant from the severity of eruptions in patients with recalcitrant facial eruptions of AD.

Erythema Nodosum Induced by the Synergism of Acupuncture Therapy and Flu‐Like Infection

A 32‐year‐old female patient developed erythema nodosum‐like lesions at needle prick sites after acupuncture therapy. Over the next few days, she developed similar new lesions over the extremities, trunk and face along with flu‐like symptoms. There were neither genital ulcerations nor eye lesions. A skin biopsy specimen from an extremity lesion showed the characteristic findings of erythema nodosum. Treatment with oral potassium iodide at a dose of 750 mg/day was effective, and there has not been any recurrence to date. We diagnosed this case as erythema nodosum induced by a synergism between acupuncture therapy and a flu‐like infection.

Hailey‐Hailey Disease Exacerbated by Scabies

To the Editor: Hailey-Hailey disease is a rare hereditary disease characterized by recurrent eruptions of vesicles and bullae, mainly on the neck, axillae and groin. Various external stimuli can complicate the disease (1). Herein we report a case of Hailey-Hailey disease exacerbated by scabies. A 78-year-old Japanese woman was referred to our hospital for evaluation of pruritic, scaly, erythematous lesions on her trunk and limbs. She had been diagnosed with Hailey-Hailey disease 10 years earlier, based on erosive erythema and vesicles mainly in intertriginous areas. Her son had also been diagnosed with the same disease. She had been treated with topical steroids almost continuously and with oral corticosteroids at intervals when the disease worsened. Although these treatments had been effective in controlling aggravation, the lesions had spread rapidly in the one month prior to her initial consultation with our department. On physical examination, there were erythematous papules and diffuse, scaly, erythematous plaques on her trunk and limbs, and erosive changes on her axilThe Journal of Dermatology Vol. 32: 223–224, 2005

Characteristics of skin surface morphology and transepidermal water loss in clinically normal-appearing skin of patients with atopic dermatitis: a video-microscopy study.

In patients with atopic dermatitis (AD), it is debatable whether clinically normal‐appearing skin is equal to non‐atopic normal skin. The aim of this study was to quantitatively evaluate the characteristics of normal‐appearing skin of AD. We examined the value of skin surface morphological changes using a new, simple, computer‐assisted method with a video microscope. We also investigated the physiological function as represented by transepidermal water loss (TEWL) levels in 44 patients with AD and 15 normal controls. The morphological changes were represented by a variation coefficient score that reflected the irregularity of skin ridges, named the surface irregularity index (SII). There were significant differences between the normal‐appearing skin of AD and non‐atopic normal skin in both SII (P<0.001) and in TEWL (P<0.01). Especially for the SII, there were significant differences between AD subgroups subdivided by peripheral blood eosinophil count (Eo), serum lactate dehydrogenase level, and clinical score. TEWL values were significantly higher in the high‐Eo AD group (n=15) than in the low‐Eo AD group (n=29) (P<0.05). These findings indicate that clinically normal‐appearing skin of AD patients with high disease activity differs from non‐atopic normal skin in both surface morphology and physiology and that these changes reflect the current disease activity.