Toshiaki Uenishi

Role of Foods in Irregular Aggravation of Atopic Dermatitis

Although it is well known that patients with atopic dermatitis often show unpredictable, irregular aggravation of skin lesions, there are no previously published studies examining trigger factors for such unpredictable aggravation. We investigated whether foods play a role in the unpredictable, irregular worsening of atopic dermatitis. The patient group included 195 Japanese adult patients with atopic dermatitis who showed unpredictable, irregular aggravation of skin lesions. They were hospitalized and openly challenged with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. Challenge‐positive foods were determined by evaluating the comparable before‐after challenge photographs. One to three (average: 1.7) challenge‐positive foods were confirmed in 86 (44%) of the 195 patient examined. Predominant offending foods were chocolate, cheese, coffee, yogurt and some Japanese foods such as glutinous rice cake, soy sauce and fermented soybeans. Specific IgE values to the offending foods were mostly negative. Patients were asked to exclude challenge‐positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a progressive improvement of the disease. These results suggest that foods play an important role in unpredictable, irregular aggravation of skin lesions in patients with atopic dermatitis.

A Case of Acne Fulminans in a Patient with Ulcerative Colitis Successfully Treated with Prednisolone and Diaminodiphenylsulfone: A Literature Review of Acne Fulminans, Rosacea Fulminans and Neutrophilic Dermatoses Occurring in the Setting of Inflammatory Bowel Disease

A 19-year-old Japanese man had been treated for ulcerative colitis for 2 years. He was admitted to our hospital with nodulocystic inflammatory papules and pustules on his face and chest, high-grade fever, arthralgia and general malaise. A biopsy specimen from a pustule showed prominent infiltration of neutrophils in the epidermis and dermis, particularly around hair follicles. We made a diagnosis of acne fulminans. The systemic administration of prednisolone at 30 mg daily for 1 week immediately improved his skin lesions and other symptoms; however, during tapering of prednisolone at 20 mg daily, skin lesions flared up. The addition of oral diaminodiphenylsulfone improved the skin lesions. Although there have been a few reports of acne fulminans associated with Crohn’s disease, this is the first case report of acne fulminans in a patient with ulcerative colitis. It is noteworthy that the addition of diaminodiphenylsulfone was effective for treating the relapse of acne fulminans in this case.

Role of foods in irregular aggravation of skin lesions in children with atopic dermatitis

Atopic dermatitis is a common inflammatory skin disease that especially affects children and adolescents. Many environmental factors have been recognized as relevant in aggravating skin lesions of the disease. However, it remains to be determined whether foods play a role in worsening of skin lesions in children with atopic dermatitis. In the present study, we investigated whether foods play a role in irregular aggravation of skin lesions in children with the disease. The study population consisted of 69 patients aged 3–15 years with atopic dermatitis. They were hospitalized and open challenge tests were performed with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. We determined challenge‐positive foods by evaluating the comparable before/after challenge photographs. One to three (average, 1.9) challenge‐positive foods were confirmed in 52 (75%) of the 69 patients examined. Predominant offending foods were chocolate, cheese and yogurt. Specific immunoglobulin E values to offending foods were mostly negative. We asked patients to exclude challenge‐positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a remarkable improvement in the disease. These results suggest that foods play an important role in irregular aggravation of skin lesions in children with atopic dermatitis.

Changes in the seasonal dependence of atopic dermatitis in Japan.

Although it has been generally accepted that seasonal aggravation of skin symptoms is a basic feature of atopic dermatitis, recent studies have suggested a decrease in the seasonal dependence of the dermatosis in European countries over the past several decades. We examined incidence of seasonal deterioration of atopic dermatitis in Japanse subjects. The study population consisted of 682 patients aged 3 to 30 years with atopic dermatitis, who visited our outpatient clinic from August 1998 through July 2000. Of these, 452 (66%) showed a seasonal aggravation of skin symptoms, and 230 (34%) had perennial deterioration. The overall incidences of exacerbation in spring, summer, autumn and winter were 25%, 19%, 11% and 36%, respectively. Further, 358 (52%) showed unpredictable and irregular exacerbations of skin symptoms every few days or weeks. These irregular worsenings were more frequent in patients who showed perennial deterioration than in those with seasonal aggravation. From a comparison of the present results with those reported in the 1960s, it became evident that a real decrease in the incidence of seasonal aggravation of atopic dermatitis has occurred over the past three decades in Japan and that the incidence of summer deterioration has greatly decreased during the same period of time.

Hyperkeratotic variant of porokeratosis Mibelli with dermal amyloid deposits

We report a case of hyperkeratotic variant of porokeratosis Mibelli with dermal amyloid deposits. A 66‐year‐old man presented with multiple brownish keratotic lesions on the lower extremities, a verrucous nodule on the third toe of the left foot and brownish verrucous plaques on the buttocks for several years. Histopathological examination of the hyperkeratotic plaque in the right gluteal region revealed extreme hyperkeratosis and cornoid lamella. In the papillary dermis, there were prominent eosinophilic amorphous materials which were positive to Dylon staining. Treatment with oral etretinate resulted in a remission of the skin lesions in this case.

Aggravation of atopic dermatitis in breast-fed infants by tree nut-related foods and fermented foods in breast milk

Ninety‐two exclusively breast‐fed Japanese infants with atopic dermatitis were studied to see whether tree nut‐related foods (chocolate and coffee) and fermented foods (cheese, yogurt, bread, soy sauce, miso soup and fermented soy beans) eaten by their mothers affected their skin condition. Of the 92 infants, 67 (73%) showed improvement of skin lesions when their mothers avoided these foods and showed aggravation of skin lesions when these foods were reintroduced. The predominant offending foods were chocolate, yogurt, soy sauce and miso soup. A long‐term maternal exclusion of the trigger foods brought about progressive improvement of skin lesions in the majority of the infants. These findings suggest that tree nut‐related foods and fermented foods are important offending foods of atopic dermatitis in breast‐fed infants.

Photosensitivity with eosinophilia due to ambroxol and UVB.

Ambroxol stimulates synthesis and secretion of surfactant by pneumocytes and inhibits sodium absorption by airway epithelial cells (1). Although ambroxol is widely used for respiratory diseases, photosensitivity due to ambroxol has not been reported in the English language literature. In general, the action spectrum of drug-induced photosensitivity is in the ultraviolet (UV)A range (2). We report a case of UVB photosensitivity due to oral ambroxol.

Fluid-fluid level in a giant epidermal cyst of the buttock

We describe a case of a giant epidermal cyst of the buttock that demonstrated a fluid‐fluid level on imaging. There have been no previously reported cases of epidermal cysts containing a fluid‐fluid level, so our case was considered to be very exceptional. A 39‐year‐old man had had a slowly enlarging giant subcutaneous mass in the left buttock for more than 10 years. It was elastic‐soft, well‐circumscribed and smooth‐surfaced. Ultrasonography showed a well‐circumscribed hypoechoic mass with a fluid‐fluid level in the subcutis of the left buttock. Magnetic resonance imaging (MRI) showed a well‐circumscribed cystic mass measuring 8 cm × 5.5 cm × 5.5 cm in the same place that the ultrasonography indicated. It was hypointense on the T1‐weighted image, hyperintense on the T2‐weighted image, and contained a fluid‐fluid level on both the T1‐ and T2‐weighted images. It bordered on the anus, but neither adhered nor formed a fistula with it. A surgical excision was performed. The mass was diagnosed histopathologically as an epidermal cyst. The occurrence of fluid‐fluid levels in epidermal cysts should be kept in mind in the differential diagnosis of subcutaneous soft tissue tumors.

Case of muscle abscess due to disseminated nocardiosis in a patient with autoimmune hemolytic anemia, and review of the published work.

Although disseminated nocardiosis has been increasing with the expansion of immunosuppressive therapy and improvement in diagnostic methods, muscle abscess is a rare complication. There have been only nine case reports of muscle abscess due to Nocardia infection in the English‐language published work. We present a case of muscle abscess with disseminated nocardiosis, and review the published work. The patient had been taking prednisolone at 20 mg a day for autoimmune hemolytic anemia for 14 years. She presented with erythema on her thigh resembling cellulitis. Computed tomography showed muscle abscess. The isolated organism was identified as Nocardia farcinica employing polymerase chain reaction and antibiotic sensitivity testing. The diagnosis of muscle abscess due to nocardiosis can be easily missed because there are no characteristic symptoms.

Dermoid cyst with magnetic resonance image of sack-of-marbles

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