Shinichi Takahashi

Langerhans’ cells in the murine oral mucosa in the inductive phase of delayed type hypersensitivity with 1-chloro-2, 4-dinitrobenzene

We created a murine model of delayed‐type hypersensitivity (DTH) to 1‐chloro‐2, 4‐dinitrobenzene (DNCB). Using this murine model, we compared oral mucosal sensitization and skin sensitization for the difference in reaction during the elicitation phase. Evaluation of sensitizability, using the mouse ear swelling test (MEST) after oral mucosal or skin sensitization, showed that the ear swelling response peaked 24 h after challenge. The optimal induction concentration was 1·0% in both oral mucosal and skin sensitization, resulting in a positive reaction rate of 100%. However, the ear swelling response 24 h after challenge with the optimal concentration of DNCB (1·0%) was significantly lower in oral mucosal than in skin sensitization. We compared the oral mucosal and skin sensitization sites for the number of Langerhans’ cells (LC) and the antigen‐presenting capability in the induction phase. The numbers of F4/80+ major histocompatibility complex (MHC) class II+ LC before induction did not differ significantly between the oral mucosa and the skin. After induction, F4/80+ MHC class II+ LC increased in number, but the increase was significantly smaller in the oral mucosa than in the skin. MEST on anti‐CD86 antibody‐administered mice showed that ear swelling was similarly suppressed after oral mucosal or skin sensitization. In murine models of DTH after oral mucosal sensitization, the number of F4/80+CD86+ LC increased after induction, but the increase was significantly smaller than that in murine models of DTH after skin sensitization. This study showed that, in murine models of DTH, oral mucosal sensitization elicited a weaker reaction than skin sensitization. This was presumably because oral mucosal sensitization induced fewer LC, resulting in lower antigen‐presenting capability.

Structural, enzymatic and molecular studies in a series of nonbullous congenital ichthyosiform erythroderma patients

Causative gene defects have not been demonstrated in the majority of nonbullous congenital ichthyosiform erythroderma (NBCIE) cases. The purpose of this study was to further elucidate the pathogenesis of NBCIE. Immunohistochemical and ultrastructural observations, transglutaminase activity assays and sequencing of TGM1 were performed in five patients from four NBCIE families. Transglutaminase 1 (TGase 1), involucrin and loricrin expression and in situ transglutaminase activity were present in all of the cases. Ultrastructurally, two cases out of five showed incomplete thickening of the cornified cell envelope (CCE) during keratinization and the other three exhibited abnormal lipid droplets in the cornified cells and malformed lamellar granules. No TGM1 mutation was found in any of the four families by direct sequence analysis. NBCIE cases with normal TGase 1 seemed to have two distinct patterns of abnormality, one with abnormal lipid droplets and malformed lamellar granules and the other with defective CCE formation.

Quantitative evaluation of eyelid elasticity using the cutometer SEM575 and its clinical application in assessing the efficacy of tacrolimus ointment treatment in eyelid atopic dermatitis.

Purpose: To study the clinical efficacy of a noninvasive suction device that measures eyelid skin elasticity in the treatment of eyelid atopic dermatitis using tacrolimus (FK-506) ointment. Methods: Ten patients with eyelid atopic dermatitis treated with tacrolimus ointment and 10 normal volunteers participated in this study. The cutometer SEM575 was used to quantitatively evaluate eyelid skin elasticity. Severity of the eyelid atopic dermatitis was scored, and comparisons were made before and after treatment. Results: Skin elasticity of patients with eyelid atopic dermatitis was significantly lower than that of normal volunteers (31.3 ± 5.2% vs 40.2 ± 7.8%, respectively). Skin elasticity of patients with eyelid atopic dermatitis improved significantly to 37.5 ± 6.3% after treatment with tacrolimus ointment. The total severity score for eyelid atopic dermatitis also improved from 2.77 ± 1.11 to 1.77 ± 1.15. Conclusion: Measurement of skin elasticity using the cutometer SEM575 is a useful and reliable method for objective and quantitative evaluation of eyelid skin condition in patients with eyelid atopic dermatitis. The efficacy of short-term tacrolimus ointment treatment in patients with eyelid atopic dermatitis was confirmed quantitatively using this apparatus.

Kaposi varicelliform eruption associated with 0.1% tacrolimus ointment treatment in atopic blepharitis

Objective To report the association of Kaposi varicelliform eruption (KVE) with 0.1% tacrolimus ointment treatment of atopic blepharitis in a patient with atopic dermatitis (AD). Method We encountered KVE in a 20-year-old male patient with atopic blepharitis and AD who developed generalized herpetic lesions on his face 28 days after commencement of treatment. Result The lesions resolved quickly with intravenous acyclovir treatment. Conclusion Ophthalmologists should be well aware of KVE as a complication of immunosuppressive treatment in patients with atopic blepharitis.

Unusually extensive disseminated herpes zoster with multiple ulcer formation in a methotrexate-treated rheumatoid arthritis patient

effects of lenalidomide therapy for amyloidosis and multiple myeloma. Arch Dermatol 2006; 142: 1298–1302. 4 Phillips J, Kujawa J, Davis-Lorton M, Hindenburg A. Successful desensitization in a patient with lenalidomide hypersensitivity. Am J Hematol 2007; 82: 1030. 5 Seki JT, Banglawala S, Lentz EM, Reece DE. Desensitization to lenalidomide in a patient with relapsed multiple myeloma. Clin Lymphoma Myeloma Leuk 2013; 13: 162–165.

Retrospective analysis of the clinical response of palmoplantar pustulosis after dental infection control and dental metal removal

Both metal allergy and dental focal infection have been considered as causative factors for palmoplantar pustulosis, and several case reports described that the skin lesions were ameliorated after dental metal removal or dental infection control. However, limited data are available to evaluate the association of these factors with disease severity of palmoplantar pustulosis. This study is designed to analyze the clinical outcome of 85 palmoplantar pustulosis patients after dental infection control (n = 70), tonsillectomy (n = 6) and dental metal removal (n = 9). More than half of the patients (63%, 44/70) showed positive clinical outcome after dental infection control. The skin lesions of all patients with tonsillitis were improved after tonsillectomy (100%, 6/6). On the other hand, one‐third of patients (33%, 3/9) showed positive response after dental metal removal. These results suggest that focal infection is more closely associated with palmoplantar pustulosis than dental metal allergy. According to our findings, palmoplantar pustulosis patients should be preferentially examined for focal infections.

SAPHO syndrome with mandibular manifestation.

A 47-year-old man was referred to our hospital due to symptoms of trismus and exacerbation of palmoplantar pustulosis. He had been presenting, for 20 years, with refractory and recurrent mandibular osteomyelitis accompanied by palmoplantar pustulosis and anterior chest pain—symptomatic treatment and surgery had been given at each presentation. When the mandibular lesion got worse this time, he also had anterior chest pain. He had experienced similar episodes before this event. MRI (STIR: short tau inversion recovery) showed high signal intensity in the right ramus of the mandible, with perilesional soft tissue swelling …

An Unusual Clinical Presentation of Kimura Disease Manifesting with a Typical Cephalocervical Lesion and an Atypical Subcutaneous Hip Mass Lesion.

Kimuras disease (KD) is a rare lymphoproliferative inflammatory disorder, typically presenting as firm, painless or pruritic single or multiple subcutaneous lesions in the head and neck, especially in the parotid and submandibular regions. We herein report a case of a 39-year-old Japanese man presenting with a typical cephalocervical KD lesion around the salivary glands with a rare association with a distant subcutaneous mass at the hip. We also emphasize the radiologically and clinically important features in the differential diagnosis and management. To the best of our knowledge, this case is the first report of KD manifesting with a typical cephalocervical lesion and an atypical subcutaneous hip mass lesion.

Objective Assessment of Erythema caused by Metal Patch Testing using an Erythema Index Meter

Abstract The patch test is the most reliable method for diagnosing a metal allergy. However, interpretation of patch test results depends on the experience of the investigator and on the conditions of the individual patient. In the case of patch tests for metal salts, irritant reactions such as pustular or follicular reactions are quite common. Therefore, one must be careful not to interpret irritant reactions as allergic responses, and objective standards to evaluate erythema in patch tests need to be established. In the present study, we attempted to objectively evaluate patch test results for metal salts using an erythema index meter. We used the Erythema Index Difference (EID) (patch test site erythema index (EI) minus the mean EI of healthy skin outside the patch test area and at the unit tape site) rather than the EI itself in order to eliminate the effects of the patch test unit and individual differences. We measured the EID over time in patients with suspected metal allergies to various metals. Significant differences in EID were observed among ++ assessments, + assessments and irritant reactions based on International Contact Dermatitis Research Group (ICDRG) standards. In considering changes in EID over time, allergic and irritant reactions can be discriminated with high sensitivity (73.3%) and specificity (91.2%). These results suggest that the measurement of erythema over time with an erythema index meter is useful for the objective assessment of metal patch test reactions.

Application of non-radiolabeled in situ hybridization system for the detection of polyadenylated RNA to normal and psoriatic human skin

The concentration and distribution of total mRNA is thought to reflect cellular activity. To clarify the distribution of total mRNA in normal and psoriatic human skin, in situ hybridization with a digoxigenin-labeled poly(dT) probe was carried out. In normal skin, polyadenylated RNA was distributed uniformly throughout the epidermis, including the basal, spinous, and granular layers. The nucleus and cytoplasm of skin appendages were stained more strongly than those of epidermal cells. The concentration of total mRNA in the epidermis of psoriatic skin was thought to be increased because of strong staining, especially in the basal layer, compared with that in normal epidermis, possibly reflecting hyperproliferation of keratinocytes. Results suggest that in situ hybridization with a poly(dT) probe is a useful strategy to study total mRNA distribution in human skin.