Yoshinori Suenaga

Giant folliculosebaceous cystic hamartoma

We report a case of a giant cystic cutaneous adnexal hamartoma which showed fibrofollicular units embedded in the stroma with aberrant fat tissue. There were many sebaaeous lobules in the fibrofollicular units, and its histologic features were consistent with conventional folliculosebaceous cystic hamartoma. Given the unique clinical history and appearance, this lesion is considered to be a congenital variant.

A combined occurrence of neuroendocrine carcinoma of the skin and a benign appendageal neoplasm

A 76‐year‐old Japanese male presented with a subcutaneous nodule in the dorsal cubital region of the right arm. The center of the nodule showed typical features of neuroendocrine carcinoma of the skin. The peripheral portion showed epithelial islands of squamoid cells with horn cysts suggestive of benign appendageal tumor with pilar differentiation. The coexistence of two skin neoplasms in the same lesion would suggest that both tumors developed from common pluripotential stem cell.

Hair follicle nevus with hyperplasia of smooth and striated muscle

We report a peculiar nevus which occurred on the left side of the chin of an 18‐year‐old male. It had been present for four years and had grown rapidly during the last year. Histologically, many hair follicles, smooth muscles, and striated muscles were found within the reticular dermis. The hair follicles were accompanied by mature sebaceous glands; numerous eccrine glands were seen in the middle and deep dermis. Immunohistochemical stain and phosphotungstic acid hematoxylin stain supported the fact that the muscles seen between the follicles were both smooth and striated. This nevus was considered to be a hair follicle nevus accompanyed by hyperplasia of smooth muscles and striated muscles.

Six Cases of Metastatic Malignant Melanoma with Apparently Occult Primary Lesions

We report here six cases of malignant melanoma in which metastatic lesions were detected first. Of these, two cases showed some peculiar features: one exhibited widespread subcutaneous bleeding, probably due to venous rupture, and the other case had a rare primary lesion on the penis. In the Japanese literature, there have been 46 cases of malignant melanoma in which metastatic lesions were detected prior to the initial ones. The preferential site for metastasis was the lymph node (32 cases). The primary lesion was unknown in 35 patients. The outcomes were available for 36 of the 46 patients; 23 died, including 18 who died within two years.

A Case of Cutaneous Infection by Exophiala jeanselmei

A case of cutaneous infection by Exophiala jeanselmei is reported.

Natural Killer (NK) Cell Activity and NK‐related Cell Surface Markers in Patients with Atopic Dermatitis

Natural killer (NK) cell activity and NK‐related surface markers in peripheral blood mononuclear cells (PBMC) in thirty‐three patients with adult type atopic dermatitis (AD) were investigated. NK cell activity, detectable by cytolysis of erythroleukemic cell line K562 cells, was reduced in patient PBMC as compared with healthy controls. Imbalances in the lymphocyte populations reactable with the monoclonal antibodies, anti‐HNK‐1, and anti‐CD16 were found in the patient PBMC. Some positive correlations between these cell populations and the NK cell activities were recognized. In most cases, high levels of serum IgE were inversely correlated with NK cell activity. Depletion of the macrophages from patient PBMC had no effect on NK cell activities. These activities were enhanced by culture with β‐interferon for 18 hours, as were the NK cell activities of healthy controls. These results suggest that reduced numbers or imbalances in the lymphocyte population with NK cell activity, are responsible for the pathogenesis and the prognosis of adult type atopic dermatitis.

Kerion celsi in an infant treated with oral terbinafine.

To the Editor: Terbinafine is in worldwide use for tinea unguium and other dermatomycoses. We report an infant case with kerion celsi, which showed a good response to oral terbinafine. A previously healthy 9-month-old Japanese girl weighing 7.2 kg consulted us with a four week history of an erythematous, pustular, crusting lesion with hair loss on the right temporal area of her scalp (Fig. 1). She had been treated unsuccessfully with topical siccanin and bifonazol. On further questioning, we learned that she had had contact with a cat. The affected hairs were surrounded microscopically by the sheath of spores, so we started treatment with oral terbinafine 31.25 mg daily for seven weeks without topical therapy. After three weeks, the inflammation symptoms disappeared, and, after five weeks, the patient’s hair started to grow (Fig. 2). Mycological culture produced a profuse growth of Microsoprum canis (MIC<0.016 μg/ml) after two weeks. Comment: In Western countries, the standard dose of oral terbinafine for a child is 62.5 mg (one-fourth of a tablet) daily for those weighing 10 to 20 kg, 125 mg (onehalf of a tablet) for those of 20 to 40 kg, and 250 mg (one tablet) for those over 40 kg, based on the adult dose (1). However, in Japan, the dose is 125 mg/day for adults. Our case weighted less than 10 kg, so we gave her 31.25 mg/day. The drug was welltolerated with no side effects. Terbinafine is an effective drug for dermatomycosis and its use to treat kerion in child has been previously reported (2–4). In Japan, Chen W et al. reported a case of black dot ringworm treated with 30 mg/day in a 2-year-old boy (5). We were impressed with the rapidity of response to the oral terbinafine 31.25 mg daily in our infant case. Miwa Kobayashi Osamu Yamamoto Yoshinori Suenaga Masakazu Asahi

Electron Microscopic Study of Langerhans Cell Histiocytosis

Among the several forms of Langerhans cell histiocytosis (LCH), Letterer‐Siwe disease is the most acute disseminated multisystemic variant. The course of Letterer‐Siwe disease is usually rapid and fatal. We report here a cases of Letterer‐Siwe disease which showed a good response to chemotherapy. We also describe the unusual ultrastructural findings in the histiocyte‐like cells in this case.

The BamHI Restriction Fragment Length Polymorphism Detected in the c-Ha-ras Locus of Human Skin Tumors

By means of Southern blot hybridization, 13 human primary skin tumor tissues were analyzed for activated forms of three cellular oncogenes, c‐Ha‐ras, c‐myc, and c‐erbB. In the c‐Ha‐ras oncogene, a BamHI restriction fragment length polymorphism was found among human skin tumors, but it is not clear whether it is related to the malignancy of tumors selected for this study. We were not able to detect the activated forms of the three oncogenes used in this study.

Three cases of occupationally induced herpetic whitlow in health care workers

Herpetic whitlow is one of the herpes simplex virus (HSV) infections, and is known as an occupational disease. In Japan, however, there have been only a few reports of this disease. Recently, we experienced three cases of herpetic whitlow in health care workers. They presented painful vesicles on the right ring finger, the left thumb and the left index finger, respectively. All of them were considered to have been infected by HSV when they were engaged in mouth care of inpatients. We reviewed these three cases from the aspect of occupational medicine, and propose the following three points for preventing this serious nosocominal infection to health care workers: 1) re-education and enlightenment for the workers regarding hazardous behavior of HSV, 2) keeping the hands and fingers free from skin impairments, and 3) early diagnosis and treatment for herpetic whitlow of health care professionals to prevent further nosocominal infection.