Yoichiro Sasai

Statistical survey of 150 cases with sporotrichosis

A survey of 150 cases with sporotrichosis seen at the Dermatological Clinic of Kurume University Hospital from February 1962 to October 1986 was reported. The proportion of cases with sporotrichosis to the total number of outpatients was 0.17%. Greater percentage of cases fell into the less than 10 years old or more than 40 years old groups. The male to female ratio was 1∶1.46, and 38 cases occurred in farmers. Geographic distribution was remarkable, especially around the Chikugo and Yabe river. Sixty-four cases showed the cutaneous lymphangitic type and 85 cases the localized cutaneous type and one case atypical type. The face and upper extremities were the most affected. The sporotrichin test was positive in 117 of 131 cases. The causative organism was demonstrated in tissue sections in 69% of the cases.

Proliferating trichilemmal cyst with spindle cell carcinoma.

We report a 58-year-old woman with proliferating trichilemmal cyst (PTC), from which a spindle cell carcinoma arose. The tumor on her scalp had been removed at another hospital. Histological examination had revealed almost typical features of PTC. However, the case showed a partial transformation to spindle cell carcinoma, and transition zones between squamous epithelium and spindle cells were present. Three months after histologic examination, the patient came to us for the treatment of recurrent tumor. Despite surgical resection, the patient died as a result of distant metastases. Histologically, the recurrent tumor was composed of only spindle-shaped tumor cells. We describe the first example of this uncommon condition.

Eosinophil Involvement in Atopic Dermatitis as Reflected by Elevated Serum Levels of Eosinophil Cationic Protein

Eosinophil cationic protein (ECP), one of the eosinophil granule proteins, is released during allergic reactions. We investigated the possibility of correlations among the serum levels of ECP, clinical activity, and eosinophil number in patients with atopic dermatitis (AD). Forty‐four patients with AD and 25 normal, non‐atopic subjects were studied. ECP was quantitated by a double antibody radioimmunoassay. The levels of serum ECP correlate with the grading of severity of clinical evaluations in AD. The patients with severe and moderate AD had significantly higher ECP concentrations than normal controls (p<0.001); mild AD had levels identical with those of control groups. A positive correlation was observed between the number of peripheral blood eosinophils and serum ECP levels in the severe cases (r=0.67, p<0.05). Furthermore, these ECP levels significantly decreased in response to either improvement of clinical severity of AD or decreased numbers of blood hypodense eosinophils in anti‐allergic drug‐treated patients. No coefficient of correlation was observed between serum ECP and IgE levels. These findings indicate that eosinophils may release their granular contents, including ECP, into the peripheral circulation and/or inflammatory skin lesions and subsequently provoke a clinical exacerbation by stimulating allergic reactions.

Effect of antianaphylactic agents on substance-P induced histamine release from rat peritoneal mast cells

SummarySubstance P is known to be a potent histamine liberator for mast cells. The influence of antianaphylactic agents, disodium cromoglycate (DSCG), ketotifen, and tranilast was studied on substance-P and compound 48/80-induced histamine release from rat peritoneal mast cells. Substance-P induced histamine release was inhibited by these agents, while compound 48/80-induced histamine release was not inhibited by tranilast. Our findings suggest that these antianaphylactic agents are assumed to be effective for cutaneous diseases which might be concerned with substance P and histamine.

FK506 and cyclosporin A inhibit growth factor-stimulated human keratinocyte proliferation by blocking cells in the G0/G1 phases of the cell cycle

FK506, a new immunosuppressive agent, is effective in treating patients with psoriasis. A major feature of psoriasis vulgaris is the hyperproliferation of keratinocytes together with inflammation. To determine the effect of FK506 or cyclosporin A (CsA) on the keratinocyte cell cycle, flow cytometry and the growth factor free normal human keratinocyte-arrested system were used to assess keratinocyte proliferation. FK506 and CsA inhibit keratinocyte proliferation induced by EGF, TGF-alpha or IL-6. The antiproliferative effects of FK506 and CsA directly correlated with blockade of the keratinocyte cell cycle at the G0/G1 phases. These findings might indicate that the effects of FK506 and CsA on proliferation of cultured normal human keratinocytes are probably related to direct effects on growth regulation of keratinocytes via EGF, TGF-alpha or IL-6 stimulation.

Cutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation.

A 60‐year‐old man who had had a renal transplantation developed a nodule on the dorsum of his right middle finger, which was subsequently diagnosed as cutaneous phaeohyphomycosis caused by Exophiala jeanselmei. The patient was successfully treated with 5–fluorocytosine. To our knowledge, this case is the third reported case in the world caused by this species in a postrenal transplant patient that manifested as phaeohyphomycosis.

FURUNCULAR CUTANEOUS MYIASIS CAUSED BY DERMATOBIA HOMINIS LARVAE EOLLOWING TRAVEL TO BRAZIL

A 62‐year‐old Japanese man had visited Rondonia in central Brazii on May 28, 1994, at which time he suffered insect bites on the left axiila and ieft chest regions. Three bites persisted and became tender and painfui. These areas developed into tender nodules with moderate serous drainage from a central pore. Malaise and an intermediate‐grade fever accompanied the eruption. The tender nodules continued after he returned to Japan on July 7. The diagnosis of furunculosis was made by his family physician, but treatment with oral cefdinir (300 mg per day) and naproxen (600 mg per day) for 2 days and application of ointment containing 0.1% gentamicin sulfate failed to resolve the lesions. The patient complained of a crawling sensation under the skin. Since a maggot was removed from the axillary lesion with the aid of the patients fingers, he was referred to the Dermatology Clinic of the Kurume University Hospital on August 1, for evaluation of parasitic diseases.

Purification of rat cutaneous mast cells with Percoll density centrifugation

SummaryThe skin is the major site on anaphylaxis, and cutaneous mast cells have an important role in its reactions. The isolation and purification of rat cutaneous mast cells are described here. Rat abdominal skin was digested with collagenase and hyaluronidase, and centrifuged with Percoll. The buoyant density of cutaneous mast cells was high, and relatively pure mast cells were obtained. The purity of cutaneous mast cells was 7.4%±2.4% before and 50.0%±6.4% after Percoll density centrifugation; peritoneal mast cells revealed 5.8%±1.3% purity before and 61.0%±10.6% purity after the same procedure. The isolated cutaneous cells released 21.3%±3.8% histamine and the peritoneal mast cells released 55.5%±3.8% histamine upon stimulation with 10 μg/ml compound 48/80. These findings suggest that there are functional subsets of connective tissue mast cells.

Development of experimental sporotrichosis in normal and modified animals

The development of experimental sporotrichosis was examined in immunologically-disturbed mice. In the case of intracutaneous inoculation, the lesion in cyclophosphamide-treated mice enlarged strikingly up to 6 days, but at 12 days it was similar in size to that in non-treated mice. The lesion in irradiated mice developed slowly up to 12 days, but thereafter it developed promptly. In nude mice, the lesion was smallest during the development of the lesion. Histological examination showed that numerous organisms were present in the lesion of nude and irradiated mice. Intraperitoneal inoculation showed that dissemination of spores were easily induced in nude mice as compared with littermate mice. These results indicate an important role of cellular immunity in the defence mechanism of sporotrichosis.

Serum Levels of Eosinophil Cationic Protein Reflect the State of In vitro Degranulation of Blood Hypodense Eosinophils in Atopic Dermatitis

In patients with atopic dermatitis (AD), serum levels of eosinophil cationic protein (ECP) have been shown to be a good reflector of disease severity. To elucidate what serum levels of ECP actually reflect, ECP levels in serum and plasma and cytological aspects of blood eosinophils were examined in AD patients (n=27) and compared to healthy subjects (n=12). Significantly elevated levels of serum ECP were noted in AD patients, while plasma ECP were uniformly recorded at nadir levels in both AD patients and normal subjects. In addition to blood eosinophilia, AD patients had significantly increased numbers of hypodense eosinophils (HEo) with morphological characteristics consistent with an activated state. Serum ECP levels strongly correlated with HEo numbers rather than with total eosinophil counts. These results indicate that elevated levels of serum ECP may be a consequence of in vitro degranulation of “activated” HEo, not of ECP supplementation from lesional skin. In addition, the dynamic correlations of eosinophil‐associated parameters (total eosinophil counts, HEo numbers, and serum ECP levels) with AD severity suggest that inflammatory events in lesional skin may be involved in causing not only eosinophilopoiesis in bone marrow, but also development of HEo in the periphery, whose degree in turn may be mirrored in the levels of serum ECP in vitro.