Shigeki Numata

Analysis of Facial Skin-Resident Microbiota in Japanese Acne Patients

Objectives: We investigated the facial skin microbiota of Japanese acne patients. Methods: Skin swab samples were obtained from 100 acne patients and 28 healthy controls to evaluate Propionibacterium and Staphylococcus spp. using a culture method. Malassezia spp. were evaluated using a nonculture method. Antibiotic resistance of Propionibacterium spp. was also examined. Results: Acne patients and controls did not show significant differences in Propionibacterium and Staphylococcus spp. populations. However, the number of Malassezia globosa from patients was greater than that from controls. Moreover, the number of Propionibacterium spp. from patients carrying antibiotic-resistant strains was significantly greater than that from patients not carrying them. Conclusions: The present study characterized the facial skin microbiota of Japanese acne patients, suggesting a correlation between acne and quantitative differences in Malassezia microbiota. It was also found that the antibiotic resistance of Propionibacterium spp. may affect its abundance in the skin.

Microorganisms inhabiting follicular contents of facial acne are not only Propionibacterium but also Malassezia spp.

To clarify the relationship between major cutaneous microorganisms (Propionibacterium, Staphylococcus and Malassezia spp.) and acne vulgaris (acne), we examined the microbiota quantitatively in the follicular contents of inflammatory acne and on the facial skin of patients with acne. Fifteen Japanese untreated acne outpatients were studied. The follicular contents from inflammatory acne lesions of the face were collected using a comedo extractor. The skin surface samples were obtained by the swab method from 10 cm2 of facial skin. The microbiota was analyzed using polymerase chain reaction. The microbiota in follicular contents was similar to that on the skin surface, namely, there were large populations of Propionibacterium spp., Staphylococcus spp. and Malassezia spp. Moreover, the number of Malassezia spp. on the skin surface was correlated with that of inflammatory acne and that in follicular contents. This study clarified that there are large populations of Propionibacterium spp., Staphylococcus spp. and Malassezia spp. in follicular contents. These results suggest the possibility that not only Propionibacterium acnes but also other cutaneous resident microorganisms are related to acne. Particularly, we considered that Malassezia spp. is closely related.

Quantitative effect of face washing on cutaneous resident microbiota in female subjects who wear make-up.

include staphylococcal furunculosis, pyoderma, leishmaniasis, dracunculiasis, actinomycosis, tungiasis and herpes zoster. The diagnostic clinical feature is a nodule with a small central punctum. The larvae’s 1–3-mm thread-like posterior respiratory spiracle protrudes to maintain contact with the air and may withdraw when touched. Recent travel history should be elicited with emphasis on endemic areas. Goals of therapy are removal of larvae and treatment of any associated infection. After removal of the larvae, the lesions typically heal quickly as seen with our patient. Rare complications resulting from incomplete extraction of the larvae include cellulitis, abscess formation, osteomyelitis and tetanus. Rarely, deeper myiasis infections of the striated muscles and even bone may cause tissue destruction. Removal of larvae with hemostat, forceps or by manual pressure is often curative. Injection into the furuncle with lidocaine or pilocarpine to paralyze the worm may ease larval extraction. Larvae may also be suffocated by obstructing the cutaneous orifice with substances such as oil, petroleum jelly and liquid paraffin. Limiting the oxygen supply induces the larvae to migrate to the surface through the central punctum. Larvae in deeper tissues can also be induced to migrate by applying turpentinesoaked gauze over the lesions and by use of systemic antihelminthics. All patients should receive tetanus prophylaxis, and antibiotics are appropriate if bacterial infection is suspected. Physicians may aid patient awareness of ectoparasitic infestations associated with international travel to endemic regions by teaching patients simple preventive strategies. Patient education about C. anthropophaga myiasis should emphasize thorough washing of clothes, drying garments on a clothesline located in the bright sunshine or in a house with closed windows, and ironing of clothes on both sides.

Enhancement of individual differences in proliferation and differentiation potentials of aged human adipose-derived stem cells

Background Adipose-derived stem cells (ASCs) are a robust, multipotent cell source. They are easily obtained and hold promise in many regenerative applications. It is generally considered that the function of somatic stem cells declines with age. Although several studies have examined the effects of donor age on proliferation potential and pluripotency of ASCs, the results of these studies were not consistent. Objective This study tested whether the donor age affects the yield of ASCs from adipose tissue, as well as the proliferation and differentiation potentials of ASCs. Methods This study used ASCs obtained from adipose tissues of 260 donors (ages 5–97 years). ASCs were examined for individual differences in proliferation, and adipogenic, osteogenic and chondrogenic differentiation potentials in vitro. Characteristics of ASCs from each donor were evaluated by the principal component analysis (PCA) using their potential parameters. Results Analyses on ASCs demonstrated that adipogenic potentials declined with age, but proliferation, osteogenic and chondrogenic potentials were not correlated with age. Interestingly, in all ASC potentials, including adipogenesis, individual differences were observed. Principal component analysis (PCA) revealed that individual differences became evident in the elderly, and those variations were more prominent in females than in males. Conclusions This study demonstrated age-related changes in the potentials of ASCs and revealed that the individual differences of ASCs become significant in people over 60 years of age (for females over 60, and for males over 80). We believe that it is important to carefully observe ASC potentials in order to achieve effective regenerative medicine treatments using ASCs.

Successful treatment of continuous intra-arterial administration of prostaglandin E1, urokinase and heparin for intractable digital ulcers by upper extremity arterial occlusion in diffuse cutaneous systemic sclerosis patient

Dear Editor, We present a case of diffuse cutaneous systemic sclerosis (dcSSc) with arterial occlusion in the upper extremities, in which a positive outcome was obtained after continuous intraarterial infusion (CIAI) of prostaglandin E1 (PGE1), urokinase and heparin. A 38-year-old Japanese man with anti-topoisomerase Ipositive dcSSc had been treated for digital ulcers (DU) with oral antibiotics, vasodilators or i.v. infusion of PGE1 for 20 years. However, 2 months before visiting our hospital, he developed severe pain and swelling in his left forearm and hand, which developed into marked edema and pain in his entire left hand. In addition, his left hand was colder than the right, and DU appeared worse on his left fingers (Fig. 1a). He had no medical history of smoking, trauma or hyperlipidemia. Antiphospholipid antibody, prothrombin time, activated partial thromboplastin time, thrombin time, serum cholesterol, triglycerides and cryoglobulin were all within normal limits. The occlusion of radial and ulnar arteries revealed by contrast-enhanced computed tomography (CT) and angiography (Fig. 1b,c). We began treating with i.v. injection of PGE1 (20 lg/day) for 1 week; however, it was ineffective. Next, we performed CIAI therapy with PGE1 (20 lg/day), urokinase (60 000 U/day) and heparin (5000 U/day) via the left brachial artery. Surprisingly, his symptoms went into remission after two courses of therapy (each 2 weeks). Recanalization of arteries was confirmed by CT angiography (Fig. 1d–f). He had no recurrence of ulcers for 12 months after treatment. Microvascular disease is one of the hallmarks of SSc and macrovascular involvement is generally rare, although is observed in some patients. The angiographic evaluation of eight SSc patients with DU were reported, seven of whom had

Extracellular proteoglycan decorin maintains human hair follicle stem cells

Hair follicle stem cells (HFSC) are localized in the bulge region of the hair follicle and play a role in producing hair. Recently, it has been shown that the number of HFSC decreases with age, which is thought to be a cause of senile alopecia. Therefore, maintaining HFSC may be key for the prevention of age‐related hair loss, but the regulatory mechanisms of HFSC and the effects of aging on them are largely unknown. In general, stem cells are known to require regulatory factors in the pericellular microenvironment, termed the stem cell niche, to maintain their cell function. In this study, we focused on the extracellular matrix proteoglycan decorin (DCN) as a candidate factor for maintaining the human HFSC niche. Gene expression analysis showed that DCN was highly expressed in the bulge region. We observed decreases in DCN expression as well as the number of KRT15‐positive HFSC with age. In vitro experiments with human plucked hair‐derived HFSC revealed that HFSC lost their undifferentiated state with increasing passages, and prior to this change a decrease in DCN expression was observed. Furthermore, knockdown of DCN promoted HFSC differentiation. In contrast, when HFSC were cultured on DCN‐coated plates, they showed an even more undifferentiated state. From these results, as a novel mechanism for maintaining HFSC, it was suggested that DCN functions as a stem cell niche component, and that the deficit of HFSC maintenance caused by a reduction in DCN expression could be a cause of age‐related hair loss.

Nasal dermoid sinus cyst in a young girl: A case report

Dear Editor, Nasal dermoid sinus cyst (NDSC) is a rare congenital anomaly caused by a cephalic neural tube defect occurring in the early embryonic period. It primarily occurs in the midline and is associated with a defect in the bone without herniation of neural tissue, while it is often accompanied by the presence of dermoid sinuses and cysts. These lesions rarely result in definite and striking clinical findings and therefore the diagnosis is

Metastatic Crohn's disease in childhood: A case report

Dear Editor, Metastatic Crohn’s disease (MCD) is difficult to diagnose in children because they usually present with only genital lesions and not the usual gastrointestinal symptoms. We describe a 10-year-old girl who was examined 3 months after symptom onset for a small vulvar nodule that had shown enlargement despite topical steroid and antibiotic therapy. Upon initial examination, we observed a 60 mm 9 30 mm red-colored elastic hard mass in the right vulvar region, another redcolored abdominal nodule measuring 20 9 15 mm (Fig. 1a), and a perianal skin tag (Fig. 1b). A biopsy performed on the vulvar lesion revealed dense lymphocytic and neutrophilic infiltrates in the superficial dermis, and multiple deep dermal epithelial granulomas (Fig. 1c,d). No pathogenic microorganisms were observed using immunostaining with periodic acidSchiff, Gram and Grocott stains. Differential granulomatous diseases including sarcoidosis were distinguished from various examinations including ophthalmologic findings, chest radiography, computed tomography and blood tests. Based on her clinical presentation and histopathological findings, she was diagnosed with MCD without endoscopically observed gastrointestinal involvement. We initiated the p.o. administration of prednisolone (PSL) (20 mg/day), and 5 months later she showed gradual resolution of her skin lesions (Fig. 1e).

Case of lichenoid-lichen scrofulosorum: A rare variety of lichen scrofulosorum mimicking lichen planus in an elderly patient

Dear Editor, Lichen scrofulosorum (LS) is a rare tuberculid typically found in adolescents. It presents with a symptomless rash, commonly around the trunk. Some clinical variants, including lichenoid, psoriasiform and granuloma annulare-like variants, have been described previously. Here, we present the case of an elderly patient with an atypical clinical presentation of lichenoid-LS, which is clinically a mimic of lichen planus. To our knowledge, only one case of lichenoid-LS has been reported in Caucasians, and this is the first case reported in Asia. An 81-year-old man presented with a papular eruption on his face and trunk, which persisted for 2 months (Fig. 1a,b). He had a medical history of hypertension and teenage tuberculosis, with a family history of tuberculosis (four of his siblings had died between 10 and 11 years of age). Serological tests for hepatitis B, hepatitis C and syphilis were negative. Histopathology of skin biopsy specimens showed superficial dermal granulomas, without caseation necrosis, surrounding hair follicles (Fig. 1c,d). Ziehl–Neelsen staining showed no evidence of acid-fast bacteria, and tissue polymerase chain reaction analysis were negative for Mycobacterium tuberculosis. The tuberculin test was moderately positive, with an erythema measuring 15 mm 9 15 mm at 48 h. The QuantiFERON TB-Gold test (QIAGEN, Hilden, Germany) was also positive. Although a chest X ray and chest computed tomography demonstrated several 2–3-mm tiny pulmonary nodule shadows, the lung lesions were diagnosed as old pulmonary tuberculin, not pulmonary tuberculosis, by pulmonologists and radiologists. Collectively, lichenoid-LS was diagnosed and administration of isoniazid (300 mg/day), which is a standard treatment for latent tuberculosis, was initiated. The eruption almost disappeared within 2 weeks (Fig. 1e), and a chest X ray showed no deterioration in condition.

Bilateral anterior uveitis and unilateral facial palsy due to ipilimumab for metastatic melanoma in an individual with human leukocyte antigen DR4: A case report

CRP and IgG titer were normal, and his lesions disappeared gradually. Interstitial granulomatous dermatitis needs to be differentiated from interstitial granuloma annulare (IGA), palisaded neutrophilic granulomatous dermatitis (PNGD) and interstitial granulomatous drug reaction (IGDR). Mucin deposition is generally prominent in IGA. Unclear dust and vasculitis can be observed in PNGD. The key histological features of IGDR include prominent eosinophils and interface dermatitis. Thus, the histopathology of these entities help to distinguish them from IGD. In our case, the patient was diagnosed with IGD after 10-year abnormal liver function, which was finally diagnosed as PBC. Interestingly, when the liver function became normal after UDCA treatment, the skin lesions gradually disappeared. Thus, our case highlights a rare cutaneous presentation of PBC and increases the awareness of association between IGD and autoimmune diseases. Our case also indicates that IGD may be skin presentation of some autoimmune diseases, and the skin lesions may disappear when the systemic diseases are alleviated. CONFLICT OF INTEREST: None declared.