Yosuke Aikawa

Skin barrier defect in atopic dermatitis: increased permeability of the stratum corneum using dimethyl sulfoxide and theophylline

The existence of a defect in the skin barrier of patients with atopic dermatitis (AD) was demonstrated and its importance in the pathogenesis of AD was emphasized. In order to evaluate the penetration properties of the stratum corneum of AD patients, the in vivo skin response to the penetration of dimethyl sulfoxide (DMSO) and in vitro response to the penetration of theophylline utilizing a diffusion chamber were studied. Both methods demonstrated an increasing level of penetration through the epidermal stratum corneum, with greatest penetration being evident with lesional skin, followed by AD non-lesional and then the normal control. However, statistical significances existed only between non-lesional and lesional skins in the case of the DMSO test, and between the normal control and non-lesional skin in the case of the diffusion chamber analysis using theophylline. Increased penetration of a non-specific nature is important in the pathogenesis of AD.

A proposed guideline for psoralen photochemotherapy (PUVA) with atopic dermatitis: successful therapeutic effect on severe and intractable cases.

Psoralen photochemotherapy with UVA (PUVA) has been reported to be successfully substitutional for, or an adjunct to, conventional treatments in patients with atopic dermatitis (AD). Against the considerable advantages of utilizing PUVA for AD patients, however, it must also be balanced against the possible hazards for individual patients. We attempted herein to formulate a guideline for the selection of AD patients assigned to PUVA. According to this guideline, 114 patients were selected for PUVA treatment. Forty-five percent of the patients did not respond adequately to other conventional forms of treatment. Side effects from former treatments, particularly steroids, appeared in 39% of the patients. Subsequent to the treatments, the skin lesions significantly decreased in 81% of the inpatients and 67% of the outpatients, while some patients lesions disappeared, despite that other forms of treatment had been unsuccessful in many cases.

More Than 13 Years of Hypereosinophila Associated With Clonal CD3−CD4+ Lymphocytosis Of TH2/TH0 Type

A 65-year-old Japanese woman was referred to our hospital because of hypereosinophilia lasting for more than 10 years, and skin ulceration, especially on the hands. Closer examination revealed the clonal proliferation of CD3-CD4+ T-lymphocytes. The patient had generalized pruritus without severe end-organ involvement and high serum levels of IgE. A diagnosis of monoclonal CD3-CD4+ T-lymphocyte-associated idiopathic hypereosinophilic syndrome (HES) was made based on these findings.This case showed that this newly recognized entity of HES is not restricted to Western countries. The abnormal T-cell clone was not merely Th2 type but was clearly Th2/Th0 type. Although this disease is considered prelymphoma, this patient did not develop lymphoma during more than 13 years of follow-up.Therefore, in some patients, clonal CD3-CD4+ lymphocyte-associated HES may take a more indolent course. In this subgroup, the control of clinical manifestations seems very important. In the present case, treatment with hydroxyurea quite dramatically improved the intractable skin manifestations, although the treatment lessened only the number of peripheral eosinophils and not the number of clonal CD3-CD4+ T-lymphocytes.

Topical Psoralen Photochemotherapy for Atopic Dermatitis: Evaluation of Two Therapeutic Regimens for Inpatients and Outpatients

Forty‐seven adolescent and adult patients suffering from long‐standing atopic dermatitis (AD) too severe to respond to conventional therapies were treated with topical psoralen photochemotherapy (PUVA) and relatively low doses of ultraviolet (UV) irradiation. For practicality and convenience, two different therapeutic regimens were implemented; short‐term hospitalization with almost daily irradiation (inpatient group, n=23) and weekly irradiation combined with topical corticosteroids which had failed to manage symptoms before initiating the treatment (outpatient group, n=25). Excellent therapeutic effects were achieved in 72% of the inpatients after 5–38 (mean 18.2) times of irradiation (mean cummulative dose; 44.7 J/cm2). In addition, 56% of outpatients responded excellently to the treatment after 6–22 (mean 13.0) times (mean cummulative dose; 25.8 J/cm2). In fact, 16 of the inpatients and 10 of the outpatients achieved almost complete remission. The duration of remission in these patients was 1–25 months (mean 6.3 months) in the inpatients and 1–6 months (mean 3.0 months) in the outpatients.

HLA-DR Antigen Expression on Peripheral T Cell Subsets in Pityriasis rosea and Herpes zoster

Using 2-color fluorescein-activated cytometric analysis, HLA-DR antigen expression on peripheral blood T cell subsets was studied in patients with herpes zoster (HZ), pityriasis rosea (PR) and psoriasis. In HZ and PR, HLA-DR was found to be significantly expressed on T cell surfaces (CD3+ cells), when compared to that of the normal control (HZ: p less than 0.001, PR: p less than 0.05). Among T cell subsets, such HLA-DR antigen was predominantly expressed on suppressor/cytotoxic cells (CD8+) in HZ (vs. normal control, p less than 0.01). However, in the case of PR, it was predominantly expressed on helper cells (CD4+; vs. control, p less than 0.05). On the other hand, activated T cell antigen (CD25+) was not significantly expressed on T cells (CD3+) in either HZ or PR. In the T cell subsets, HLA-DR antigen expression returned to normal levels during the recovery phases of HZ and PR.

Antikeratin 14 monoclonal antibody staining in psoriasis and seborrhoeic keratosis: immunofluorescence and two colour FACS studies

SummaryA monoclonal antibody (ES3A) was raised against a mouse graft-versus-host reaction (GVHR) model. This antibody was against basal cell cytoplasm and reacted with an acidic (pI 6.2) 50 kDa keratin of human epidermis. However, ES3A reacted with several lower layers of epidermal cells in psoriasis and seborrhoeic keratosis. Acanthotic seborrhoeic keratosis showed varying patterns even in a single lesion. If combined with FACS analysis, ES3A-positive cells could be quantified. Normal skin showed 28%, while psoriasis and seborrhoeic keratosis showed 44% and 51%, respectively. ES3A-positive compartments of the acanthotic type of seborrhoeic keratosis were larger than those of the hyperkeratotic type. ES3A may be suitable for quantification of germinative or proliferative cells.

Effect of Glycyrrhizin on Pain and HLA-DR Antigen Expression on CD8-Positive Cells in Peripheral Blood of Herpes zoster Patients in Comparison with Other Antiviral Agents

Glycyrrhizin (GL) is a saponin widely used as an anti-inflammatory agent. Pain intensity and HLA-DR antigen expression on CD8+ cells were assessed during and after treatment with GL. Other agents such as acyclovir, gamma-globulin and interferon beta were also administered for comparison. Pain resolved most rapidly among those treated with acyclovir followed by those treated with GL. Pain resolution correlated with the regression of HLA-DR+ in CD8+ subpopulations in peripheral blood. GL is suggested to be an alternative or additive antiviral agent to herpes zoster.