Toshio Kusunoki

Successful treatment of vulvar lichen sclerosus in a child with low‐concentration topical tacrolimus ointment

Lichen sclerosus is a chronic inflammatory skin disorder that has a predilection for the anogenital area. Topical corticosteroid is occasionally effective; however, continuous treatment is often required and recurrence after its stoppage is frequent. Herein, we report a case of vulvar lichen sclerosus in a 5‐year‐old girl, which was refractory to topical corticosteroids. After 14 weeks of treatment with 0.03% tacrolimus ointment once daily, the lesions completely resolved without side‐effects. Of interest, the number of milia within the plaque of lichen sclerosus was reduced in tandem with the improvement of lichen sclerosus. This is the first report of topical low‐concentration tacrolimus treatment showing a dramatic effect in the treatment of childhood vulvar lichen sclerosus.

Severe hepatitis during ketoconazole therapy

SummaryKetoconazole is an imidazole derivative recently developed as an antifungal agent. There have been only a few established cases of hepatotoxicity in the literature. This report describes a case of presumed ketoconazole hepatotoxicity characterized by the development of severe hepatitis with marked centrilobular necrosis. The lack of hypersensitivity reactions in clinical findings and centrilobular location of necrosis suggested a host idiosyncrasy with metabolic abnormality as the effect of ketoconazole in the present case.

Scanning electron microscopic observation of the parasitic forms of Fonsecaea pedrosoi in a human skin lesion

The parasitic form of Fonsecaea pedrosoi in the superficial hyperkeratotic layer of the skin, in a patient with chromoblastomycosis, was observed by a scanning electron microscope using some technical improvements. The fungus elements were comprised of branched septate hyphae with spherical cells and sclerotic cells. It was observed that the sclerotic cells, divided into two or three parts, formed a germ tube.

A case of Trichophyton tonsurans infection in which incubation time can be estimated

Dear Editor, Trichophyton tonsurans is a well-known causative organism of tinea capitis in the West.1 In Japan, outbreaks of T. tonsurans infection among wrestlers and judo participants have rapidly increased since approximately 2001.2 Because judo is a national sport and a large population in Japan participates in judo, this disease poses a major public health problem for this country. We recently treated a case of T. tonsurans infection at a clinic in Tokyo that suggested that infection can spread by ordinary household contact and that allowed us to estimate the incubation time of the infection. In treating this case, we realized the pressing need to establish countermeasures against T. tonsurans infection in Japan. The patient was a 13-year-old junior-high school girl from Tokyo with no sports history. She visited our clinic on 21 September 2004, complaining of round, erythematous, scaly macules on the abdomen and left thigh. Two erythematous macules with mild itching had first appeared on the abdomen and left thigh about 1 week earlier and had gradually assumed a round shape. Medical and family history were uneventful. On the first examination, we noted an erythematous macule 2 cm in diameter with a raised border on the abdomen which was surrounded by three relatively small erythematous macules suggestive of satellite lesions. On the extensor surface of the left thigh, we observed another erythematous macule 2.5 cm in diameter with a well-defined border associated with fine scales and with a center that showed slight clearing (Fig. 1). Microscopic examination of potassium hydroxide specimens prepared from the eruptions on the abdomen and left thigh revealed many hyphae. Fungal specimens were cultured on Sabouroud’s glucose agar, and an isolate was identified as T. tonsurans using direct DNA sequencing of polymerase chain reaction amplication.3 Scalp hairs were negative for fungi by the hairbrush method. The patient was given a diagnosis of tinea corporis and treated with oral terbinafine and liranaftate cream. This case suggests that T. tonsurans can be transmitted from person to person by normal household exposure within a 4-week period, in the absence of extensive physical contact, such as judo wrestling. The patient had stayed with her mother’s family in Akita Prefecture, a northern part of the Honshu District of Japan, from 7–21 August during summer holidays. Her mother’s family consisted of three members including her 16-year-old cousin, who was a member of his high-school judo club. The cousin visited a dermatology clinic regularly for treatment of tinea corporis. His doctor had diagnosed tinea corporis on the face without performing a culture and was treating the boy only with miconazole cream. It was known that tinea was prevalent

TREATMENT OF CHROMOMYCOSIS WITH 5-FLUOROCYTOSINE

Three cases of chromomycosis caused by Fonsecaea pedrosoi were treated by oral administration of 5‐fluorocytosine. Complete cure was achieved in 2 cases which had been symptomatically mild, while the third, with a long history, was not completely cured although it showed a transient improvement of clinical symptoms. No side effects were observed in all 3 cases during the treatment period.

COMPARISON OF THE IN VITRO ANTIFUNGAL ACTIVITIES OF CLOTRIMAZOLE, MICONAZOLE, ECONAZOLE AND EXALAMIDE AGAINST CLINICAL ISOLATES OF DERMATOPHYTES

The in vitro antifungal activities of clotrimazole, miconazole nitrate, econazole nitrate, and exalamide against 64 clinical isolates of various dermatophyte species obtained from out‐patients seen at the Nippon Medical School Hospital were simultaneously compared using a liquid microculture method. The rank order of activity against the 64 isolates of dermatophytes was clotrimazole > econazole nitrate > miconazole nitrate > exalamide. For a given antimycotic, the minimal inhibitory concentration was affected by the dermatophyte species.

A case of recurrent facial herpes simplex mimicking hydroa vacciniforme

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