Tomonori Taniguchi

Evaluation of nail disease in psoriatic arthritis by using a modified nail psoriasis severity score index

Background  The Classification of Psoriatic Arthritis Study Group published new criteria for classifying psoriatic arthritis (PsA) which included nail psoriasis. Our aim was to clarify the clinical importance of nail disease in PsA patients.

Case of Linear IgA Bullous Dermatosis-involved Ulcerative Colitis

To the Editor: There are a number of reports of linear IgA bullous dermatosis (LABD) associated with preexisting inflammatory bowel disease (IBD), in particular ulcerative colitis (UC).1 We report the case of a patient who developed LABD while receiving treatment for UC. A 28year-old female. UC was diagnosed 1 year ago by colonoscopy (Fig. 1a) and biopsy specimen (Fig. 1b). She was receiving oral mesalazine at 2250 mg daily and prednisolone at 5 mg daily, and her disease activity was well controlled. However, within a few days after she developed a disease relapse, with severe diarrhea and bloody stool, the patient also developed bullae with pruritus on her trunk, gluteal region, and axillary fossa. She was therefore referred to our department. She had noticed clear and tender vesicles and bullae on erosion not associated with erythematous plaques on her trunk and limbs (Fig. 1c). There were no mucosal lesions. Routine laboratory examinations revealed evidence of an acute inflammatory reaction (white blood cell count, 11,000/ L, serum and an elevated erythrocyte sedimentation rate [ESR] of 77 mm/h). An immunological study was performed, including serological tests to determine the presence of autoantibodies, complement levels, rheumatologic markers and immunoglobulin levels, and thyroid tests; however, no significant abnormalities were detected. The skin biopsy specimen showed subepidermal neutrophilrich bullae. Direct immunofluorescence studies showed linear deposition of only IgA on the basement membrane. An indirect immunofluorescence test revealed the presence of circulating anti-basement membrane zone IgA antibodies at a titer of 1:80. Based on these studies, we diagnosed her disease as LABD. She did not receive systemic medications such as vancomycin with subsequent bowel flares, which are sometimes associated with drug-induced linear IgA disease. The intestinal disease activity entered remission spontaneously without any treatments and then, within a few weeks, the eruptions also cleared. No further therapies were required. The patient presented with several episodes of the bullae appearing synchronously with deterioration of the gastrointestinal symptoms and then disappearing within a short time after improvement of the gastrointestinal symptoms. We considered it important to evaluate the pattern of appearance of the skin lesions in relation to the activity of UC as assessed objectively. These usually incorporate the frequency of bowel movements and rectal bleeding, as well as the serum hemoglobin, albumin, and ESR values. The present study used the UC Activity Index (UCAI).2 In our case, the bullae cleared when the UCAI values were below 180, and relapsed when the values exceeded 190 (Fig. 2). Cutaneous diseases have been reported in 10% of patients with UC. Nonspecific eruptions are seen, including urticaria, angioedema, erythema, and purpura.3 In a study of 70 LABD patients selected from a British population, 5 (7.1%) had UC, even though the prevalence of UC in the UK in the general population is only 0.05%, while very few case reports with dermatitis herpetiformis (DH) and UC have been published in the literature.1,4,5 The exact reason for the association between UC and LABD remains unclear. IBDs may induce nonspecific immunoglobulin activation, triggering IgA crossreactive idiotype production against dermoepidermal or epidermal antigens, to produce specific bullous disorders.4,5 Antibodies enter the circulation and are deposited in the skin and mucous membranes because they crossreact with specific peptides in the lamina lucida and sublamina densa regions of the basement membrane. Antibody deposition is thought to stimulate an inflammatory response that damages the basement membrane, leading to mucocutaneous disease.6 Using previously described parameters of activity, we determined the UCAI3 in our patient; the bullae appeared with an increase of the UCAI, and disappeared with a decrease of the UCAI. These findings suggest that the appearance of LABD was related to the activity of UC, with antibodies being produced as the UC activity increased. To the best of our knowledge, this is the first case in which a clear relationship has been documented between LABD and the activity of UC.

Analysis of clinical, radiological and laboratory variables in psoriatic arthritis with 25 Japanese patients

Psoriatic arthritis (PsA) has many clinical and radiological manifestations but lacks a specific laboratory marker. The aim of the present study was to identify noteworthy features in PsA patients on routine clinical examinations. The subjects were 25 PsA patients who were classified based on the Classification of Psoriatic Arthritis (CASPAR) criteria. The clinical and radiological findings and laboratory parameters were analyzed by retrospective chart review. On clinical examination, dactylitis was present in 13 (52%) of 25 patients, swollen and/or tender Achilles tendons were present in nine (36%), and sacroiliitis was present in eight (32%). Of the radiological features, juxta‐articular new bone formation (JANF) was seen in 12 (48%), extra‐articular new bone formation was seen in nine (36%) and sacroiliitis was seen in six (24%). Dactylitis and JANF had the highest prevalence rates. The Psoriasis Area and Severity Index score, swollen and/or tender joint count, erythrocyte sedimentation rate, C‐reactive protein, and matrix metalloproteinase‐3 were higher in patients with sacroiliitis than in those without sacroiliitis (P < 0.05). Dactylitis, JANF and sacroiliitis may be noteworthy manifestations in Japanese patients with PsA.

IgA paraneoplastic pemphigus in angioimmunoblastic T-cell lymphoma with antibodies to desmocollin 1, type VII collagen and laminin 332.

© 2014 The Authors. doi: 10.2340/00015555-1660 Journal Compilation

Psoriasis vulgaris complicated by eosinophilic pneumonia during ustekinumab treatment

ejd.2013.2006 Auteur(s) : Mika Yashiro1 miimaa1118@yahoo.co.jp, Hideki Maejima1, Tomonori Taniguchi1, Kensei Katsuoka1, Michiko Kimura2, Mayuko Wada2 1 Department of Dermatology, 2 Department of Pulmonary Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan Ustekinumab has been shown to be efficacious for moderate to severe plaque psoriasis and is relatively safe [1]. Here, we report a case of eosinophilic pneumonia (EP) during ustekinumab therapy for [...]

Treatment of intractable skin ulcers caused by vascular insufficiency with allogeneic cultured dermal substitute: a report of eight cases

Chronic leg ulcers have various causes and can be difficult to treat, although topical treatments, including basic fibroblast growth factor and PGE1, have been used. We applied an allogeneic cultured dermal substitute (CDS) to eight patients with intractable ulcers. The patients had various underlying diseases, including diabetes mellitus, systemic lupus erythematosus, antiphospholipid syndrome, necrobiosis lipoidica, stasis dermatitis, livedo vasculopathy, and rheumatoid arthritis. The CDS was prepared by seeding cultured human fibroblasts on a spongy matrix consisting of hyaluronic acid and atelocollagen. Good clinical results were achieved, as demonstrated by reepithelization, healthy granulation tissue formation, and a subsequent decrease in wound size. Daily dressing changes became unnecessary when the allogeneic CDS was used. Based on these results, we suggest that CDS may be useful for the treatment of intractable skin ulcers.

Folliculotropic mycosis fungoides successfully treated with narrow band UVB

Auteur(s) : Tomonori Taniguchi, Yasuyuki Amoh, Kensei Katsuoka, Hiroshi Takasu Department of Dermatology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa, 228-8555, Japan A 56-year-old Japanese female was referred to our hospital with a 2-month history of indurated, erythematous plaques on her trunk and lower extremities. Initially, she had noticed a red plaque on the lateral aspect of her lower leg with other lesions gradually appearing over the period of 1 month [...]

Japanese version of the early psoriatic arthritis screening questionnaire (EARP)

The early psoriatic arthritis screening questionnaire (EARP) is a simple and fast method for the identification of arthritis in patients with psoriasis. We established the Japanese version of the EARP (J‐EARP) questionnaire, which includes 10 items with two choices for each. This study aimed to evaluate the utility of the J‐EARP questionnaire. A total of 90 psoriasis patients, 19 psoriatic arthritis (PsA) patients and 71 psoriasis patients without joint involvement, were administered the J‐EARP questionnaire. The diagnostic accuracy of the J‐EARP questionnaire for the diagnosis of PsA and early‐stage PsA was compared by receiver–operator curve (ROC) analysis. The J‐EARP questionnaire showed similar ROC characteristics to those of the original version of the EARP (specificity 97.2% and 91.6% and sensitivity 97.2% and 85.2%, respectively) in PsA patients using the cut‐off value of 3 for the J‐EARP questionnaire, which was the same as that used for the original EARP questionnaire. The scores of the J‐EARP questionnaire in early‐stage PsA patients (<1 year from onset) were significantly higher than in those of psoriasis patients, but not lower than in those of later stage (≥1 year from onset) PsA patients. The J‐EARP questionnaire is simple and fast to administer and has been proven to be robust for the identification of PsA. The J‐EARP questionnaire is a useful diagnostic tool for early‐stage PsA patients.

Onset of psoriatic arthritis at the hip joint without spondylitis.

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis that may have an indolent or progressive course. Several factors can contribute to delay in diagnosis of PsA, including insidious onset, lack of symptoms, and absence of a specific diagnostic biomarker (1). The diagnosis of PsA is based on clinical evaluation and imaging, and may be difficult in patients with coexisting osteoarthritis, even for rheumatologists (2). We describe here a rare case of PsA with hip joint involvement at onset. Inflammatory hip joint disease occurs in less than 10% of PsA patients, and involvement of the hip joint at onset is rare (3). In this case, inflammatory disease of the hip joints developed at a relatively young age with radiological evidence of erosion and ankylosis, requiring bilateral hip arthroplasty. Despite oral methotrexate treatment after left hip arthroplasty, computerized tomography revealed asymptomatic sacroiliitis. We suggest that psoriatic hip arthropathy may require early treatment with methotrexate or leflunomide along with intra-articular steroid injections, following anti-tumour necrosis factor alpha (anti-TNFα) therapy.

The Distribution of Anti-NKG2A and NKG2C Positive Cells in Lichen Palnopilaris

Background: Lichen planopilaris (LPP) is a rare alopecia disorder. The histopathological features of LPP may resemble discoid lupus erythematosus (DLE). However, LPP usually lacks interfollicular inflammation, which differentiates it from DLE. Methods: Skin biopsies were taken from subjects with early-stage LPP and DLE. The biopsies were evaluated for anti-CD56, anti-CD94, and anti-NKG2A/C/D-positive cells; the results were compared among two diseases. Results: Anti-CD4, -CD8, and -CD94 positive cells mainly infiltrate the perifollicular dermis from the infundibulum to the hair isthmus in patients with LPP. Anti-CD56 and-NKG2C-positive cells were observed in the hair isthmus and bulge area (LPP) and in the infundibulum (DLE). In LPP, anti-NKG2A-positive cells were mostly seen in the infundibulum (p<0.05), but there were no significant differences in the number of anti-NKG2A-positive cells between the infundibulum, hair isthmus, or bulge area in subjects with DLE. Conclusions: Our results show differences in the localization of anti-NKG2A/C-positive cells between subjects with LPP and those with DLE. The inflammation in LPP initially originates in the hair isthmus and/or bulge followed by the interfollicular upper dermis. However, anti-NKG2A-positive cells prevent further enlargement of the inflammatory lesion in the interfollicular upper dermis of subjects with LPP.