Toshiko Ido

Oral lichen planus due to zinc in dental restorations

A 74-year-old woman had been treated for extensive odontitis with root canal disinfection and dental metal restorations. She developed painful erosion and erythema of the upper labial mucosae, white streaks on the buccal mucosae, and white enanthema over the entire molar gingiva after treatment. She had a 1year history of oral lesions. Histological findings were characteristic of oral lichen planus. Anti-HCV serum antibody was negative. Patch testing with 17 metal allergens and 24 Japanese standard allergens using Finn ChambersA (Epitest Ltd. Oy, Hyryla, Finland) on ScanporA tape (Norgesplaster A/S, Norway) gave a ππ reaction at D3 to zinc chloride 2.0% pet. and formaldehyde 1% aq. Her 14 dental metal restorations contained 5.3% zinc in the core. All other metal components were negative (Table1). Re-testing with zinc chloride 2.0% pet. and 0.5% pet. confirmed the positive reaction. Systemic corticosteroid administration was not effective. Oral lichen planus subsided 3months after the removal of metal restorations. She has been free of symptoms for 1year after the application of dental restorations without zinc.

Pigmented contact cheilitis from dipentaerythritol fatty acid ester.

Pigmented cosmetic dermatitis, which was previously known as melanosis faciei feminae, was first recognized in 1973 (1). Innumerable patients with this pigmentary disorder presented in 1960s and 1970s in Japan (2). After allergen control was performed, the disease became completely preventable and the incidence decreased. However, sporadic cases of this disease continue to be reported in the 1990s and 2000s (3, 4), so it is necessary to recognize the cosmetic allergens that produce hyperpigmentation.

Fasciitis-panniculitis syndrome and advanced gastric adenocarcinoma in association with antibodies to single-stranded DNA.

tol 1968; 80:86–9. 7 Barnes BE. Dermatomyositis and malignancy. A review of the literature. Ann Intern Med 1976; 84:68–76. 8 Grando SA. Autoimmunity to keratinocyte acetylcholine receptors in pemphigus. Dermatology 2000; 201:290–5. 9 Suzuki N, Sugawara M, Sugimoto M et al. Gene expression of human chromosome 8 in mouse cell lines. Biochem Biophys Res Commun 1997; 230:315–19. 10 Beletskaya LV, Gnezditzkaya EV. Reaction of sera of patients with pemphigus vulgaris with antigens of the cementing substance from epithelium of Hassall’s corpuscles of human and animal thymus. Bull Exp Biol Med 1974; 77:678–81.

Basal cell carcinoma with an epidermal collarette and ductal differentiation on the dorsal foot

Dear Editor, Basal cell carcinomas (BCC) usually develop on the face and neck. Fewer than 30 cases (0.42%) of BCC have been reported on the feet in the English-language published work. Only two cases have been reported on the dorsal feet, while the majority developed on the sole. An 89-year-old man presented with a 2-year history of a tumor on the left dorsal foot. The clinical appearance was a well demarcated, dome-shaped, dark-red to blue-gray nodule measuring 10 mm in diameter (Fig. 1). Dermoscopy demonstrated large blue-gray ovoid nests, multiple blue-gray globules and arborizing vessels. A homogeneous white ring surrounded these structures. Histological examination demonstrated variously shaped islands with cyst formation and lace-like pattern, which was composed of basaloid cells (Fig. 2a). Several ducts within tumor islands were lined by luminar cells as seen in normal eccrine/apocrine ducts and poromas (Fig. 2b). Elongated rete ridges at the periphery of the nodule demonstrated infolding toward the center and partial ductal structures, corresponding to an epidermal collarette (Fig. 2a). Although peripheral palisading was clearly observed, there were no obvious clefts. Immunohistochemical staining was performed using an avidin–biotin technique for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), gross cystic disease fluid protein (GCDFP)-15, epithelial cell adhesion molecule as determined by Ber-EP4, and cytokeratins detected by monoclonal

Toxic epidermal necrolysis following allergic contact dermatitis caused by occupational exposure to ultraviolet-cured inks.

Erythema multiforme is a relatively common skin disorder; the most common cause is herpes simplex infection, but topical sensitivities reportedly also provoke this reaction. We report here a case that progressed to toxic epidermal necrolysis due to contact with ultraviolet (UV)-cured inks. The diagnosis was confirmed by patch tests to acrylates in the UV-cured inks, histopathological studies of the lesions, and positive patch test to 1,6-hexanediol diacrylate.

Work-related Allergy in Medical Doctors - atopy, exposure to domestic animals, eczema induced by common chemicals and membership of the surgical profession as potential risk factors -

PurposeTo investigate the risk factors associated with work-related allergy-like symptoms in medical doctors.MethodsSelf-administered questionnaire survey and CAP test were conducted among medical school students in the 4th grade of their 6-year medical course in 1993–1996 and 1999–2001. Follow-up questionnaires were sent in 2004 to the graduates. These questionnaires enquired into personal and family history of allergic diseases, lifestyle, history of allergy-like symptoms including work-relatedness and occupational history as medical doctors. Relationships between allergy-like symptoms and relevant factors were evaluated by multivariate logistic regression analysis.ResultsOf 261 respondents at the follow-up survey, 139 (53.3%) and 54 (20.7%) had a history of any allergy-like symptoms and any work-related allergy-like symptoms, respectively. Female gender and family history of allergic diseases were significantly associated with any allergy-like symptoms. Personal history of allergic disease, exposure to domestic animals, eczema caused by rubber gloves, metallic accessories, or cosmetics during schooling days, and membership of the surgical profession were significant risk factors for work-related allergy-like symptoms. On the contrary, to work-related allergy-like symptoms, gender, age, and smoking status were not significantly related, and consumption of prepared foods was inversely related.ConclusionsPersonal history of atopy and eczema induced by common goods and the history of keeping domestic animals may be predictors of work-related allergy-like symptoms in doctors. After graduation from medical school, physicians start with exposure to various allergens and irritants at work, which relate to work-related allergy-like symptoms, especially for surgeons.

A case of lymphomatoid papulosis with extensive limb disease followed by extracutaneous involvement and acquired ichthyosis.

Primary cutaneous CD30* T-cell lymphoproliferative disorders include: (/) lymphomatoid papulosis (LyP), (//) primary cutaneous anaplastic large cell lymphoma (pcALCL), and (///) borderline lesions (1). LyP represents the benign end of this spectrum of disorders; however, some cases are associated with progressive cutaneous lesions and/or extracutaneous involvement (2). Although pcALCL usually has a favourable prognosis, extensive limb disease (ELD) is believed to indicate a poorer prognosis (3). We report here the case of a man who presented with ELD, extracutaneous involvement, and acquired ichthyosis during the fypical course of LyP.

Positive patch test for mercury possibly from exposure to amalgam.

ObjectivesMercury allergy is a serious health problem. We investigated the relationship between positive patch test for mercury and sources of mercury exposure, indicated by concentrations in biological samples from healthy medical students.MethodsPatch tests for mercury (Hg-PT) were performed on 580 students. For a group of 55 students with a positive Hg-PT result (Hg-PT(+)) and a reference group of 79 students with a negative Hg-PT result (Hg-PT)(−)), mercury concentrations in urine (Hg-u) and hair (Hg-h) were measured. In our search for environmental indicators of mercury exposure, the level of fish intake and mercurochrome usage were determined using a self-administered questionnaire. The oral cavity was investigated and the numbers of decayed teeth filled with amalgam (NA) were counted by dentists.ResultsFor the male Hg-PT(+) group, Hg-u and Hg-h were higher than those of a male reference Hg-PT(−) group; Hg-u values obtained in the early morning and after supper were significantly different. Multiple regression analysis with Hg-u as the objective variable among all students showed that increases in the level of fish intake, mercurochrome usage, and the NA independently increased Hg-u measured in the early morning for both gender groups. NA significantly affected Hg-u.ConclusionsWe showed that a higher NA was related to a higher Hg-u measured in the early morning. Therefore, exposure to amalgam may increase Hg-u. It was suggested that Hg-PT(+) might be related to a high Hg-u, and possibly to a high NA.

Dermatitis caused by Balaustium murorum

Sir, We have observed that Balaustium murorum (Acarina: Erythraeidae) can cause dermatitis. B. murorum has a habit of climbing walls and invading buildings, and has very generalized feeding habits. Its biology is not yet fully known, however, and more attention needs to be given to infestation on buildings, walls and weeds around hospitals during summer. In this paper, we report a case of extensive dermatitis caused by B. murorum. CASE REPORT AND DISCUSSION

Prurigo nodularis occurred in a patient with an allergy to pyridine derivative in desk mat

Prurigo nodularis is a characteristic chronic dermatosis of unknown etiology, showing intensely itchy nodules mainly on the extremities (1). An association of allergic contact dermatitis and prurigo nodularis was also documented (2). Here, we report a case of prurigo nodularis occurring as a direct result of allergic contact dermatitis from 2,3,5,6-tetrachloro-4 (methylsulphonyl) pyridine (TCMSP).