Yukikazu Numata

Linear lichen planus distributed in the lines of Blaschko developing during intramuscular triamcinolone acetonide therapy for alopecia areata multiplex

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Phaeohyphomycosis Caused by Phaeoacremonium rubrigenum in an Immunosuppressive Patient: A Case Report and Review of the Literature

Phaeohyphomycosis (PHM) is a rare, deep fungal infection of the skin and subcutaneous tissues caused by dematiaceous fungi. In this report, we describe a case of PHM caused by Phaeoacremoniumrubrigenum, which is generally known to infect woody plants. We detected the gray-blackish villi by biopsy culture material, and slide culture revealed the conidia arising from slightly tapering phialides. Furthermore, we differentiated these fungi as P.rubrigenum by Basic Local Alignment Search Tool (BLAST) algorithm. We performed surgical debridement of disseminated nodules and administered oral itraconazole for a duration of 4 weeks. One year after stopping itraconazole, there was no sign of relapsing subcutaneous nodules. To our knowledge, this is the third case report of PHM developing from skin infection by P. rubrigenum in human.

Generalized granulomatous dermatitis accompanied by myelodysplastic syndrome.

Cutaneous manifestations associated with myelodys-plastic syndrome (MDS) are uncommon. Recognizing MDS skin manifestations is important as they can precede blood or bone marrow transformation to leukaemia and are associated with a poor prognosis (1, 2). Recently, 2 cases of granulomatous dermatitis associated with MDS were reported as non-specific cutaneous manifestations of MDS, with subsequent development into acute myeloid leukaemia with leukaemia cutis (1, 2). An imbalance of T-cell subsets, regulatory T cells (Tregs) and Th17 in MDS is also correlated with disease progression (3, 4). We describe here a case of granulomatous dermatitis accompanied by MDS, which we hypothesized might show correlations with Tregs and interleukin (IL)-17 producing cells. We therefore employed immunohisto-chemical staining for Foxp3 and IL-17 to characterize the granuloma.CASe RepoRT

Squamous cell carcinoma arising from Keratitis-ichthyosis-deafness syndrome.

Inherited ichthyoses are rare genodermatoses caused by mutations in the genes involved in epidermal develop-ment. Keratitis–ichthyosis–deafness (KID) syndrome is a debilitating ectodermal dysplasia that predisposes patients to develop squamous cell carcinomas (SCC) in addition to leading to profound sensory deafness and erythrokeratoderma already present at birth (1–5). Re-cent reports have provided evidence that KID syndrome is caused by a mutation of connexin 26 (Cx26) (2–5), a gap junction protein, encoded by GJB2, with the ma-jority of patients harbouring the D50N mutation (2–8). Interestingly, a previous review suggested that the mis-sense D50N mutation in patients with KID syndrome is strongly connected with the development of skin SCC (1), although not every case develops malignancies (6, 7). We describe here a case of large areas of SCC arising from KID syndrome after severe infection. Our report also suggests that severe bacterial infection might be one of the reasons for the establishment of this aggres-sive skin cancer. CaSe RepORt

Cutaneous Squamous Cell Carcinoma Developing from Recessive Dystrophic Epidermolysis Bullosa: A Case Report and an Immunohistochemical Study

We describe a 49-year-old Japanese woman with cutaneous squamous cell carcinoma (SCC) developing from recessive dystrophic epidermolysis bullosa (RDEB). Interestingly, immunohistochemical staining revealed dense infiltration of CD163+ M2 macrophages and numerous Foxp3+ regulatory T cells (Tregs) around the tumor. Since the contribution of immunosuppressive factors (e.g. TGFβ) to the carcinogenesis of SCC from RDEB was recently reported, our present findings suggest one of the possible contributions of immunosuppressive cells, such as CD163+ M2 macrophages and Tregs, to the carcinogenesis of SCC from RDEB.

Successful Treatment of Cutaneous Botryomycosis with a Combination of Minocycline and Topical Heat Therapy

Cutaneous botryomycosis is a chronic focal infection characterized by a granulomatous inflammatory response to bacterial pathogens such as Staphylococcus aureus. Treatment requires antibiotic therapy and may also require surgical debridement. We employed topical heat therapy and oral minocycline. The lesions became flattened and pigmented after 1 month. We consider that this simple treatment can be an effective and harmless complementary therapy for cutaneous botryomycosis.

Apocrine Nevus in Abdominal Skin

Apocrine nevus, a rare tumor occurring in the axilla and upper chest, is composed of a large number of mature apocrine glands extending from the reticular dermis into the subcutis [1–8] . We describe a 47-year-old Japanese woman who presented with aggregated papules in the abdominal wall just to the left of the umbilicus. Our case is unique in that the apocrine nevus occurred outside of the regions in which apocrine glands are distributed. She had already noticed the presence of the small eruption during early childhood. It gradually increased in size with the appearance of a few erosive papules several years previously. She had been suffering from hypothyroidism for 20 years and had been taking thyroxine. The lesion consisted of aggregated brownish papules in an area of 8.5 ! 4.5 cm on her left umbilical region ( fi g. 1 a). Slightly wrinkled, linear, fi ne atrophy overlapped the lesion. A few papules were accompanied by small pits with erosive surfaces. We removed the lesion to make a diagnosis. Histologically there were numerous cysts surrounded by a small fi brous sheath ( fi g. 1 b). The luminal layers of the cysts were composed of cuboidal cells with basophilically stained cytoplasm showing decapitation activities into the luminal spaces ( fi g. 1 c). These features were consistent with those of apocrine nevus. There was no hallmark of organoid nevus, such as papillomatous epidermal hyperplasia, immature hair follicles, and sebaceous glands. On the other hand, the erosive papules, which appeared later, demonstrated the histologic characteristics of syringocystadenoma papilliferum, namely, irregularly tubular invaginations with villous or papillomatous projections into the luminal spaces ( fi g. 1 d). Gross cystic disease fl uid protein-15, a specifi c marker for apocrine epithelium, was expressed in the upper portion of the cyst walls [8] . Moreover, cytokeratin 19 was positive only in the luminal cells but not in the basal cells, which is compatible with maturated apocrine glands, because in the case of immature glands, cytokeratin 19 is expressed not only in luminal cells

Apocrine hidrocystoma on the finger.

Sir, Apocrine hidrocystomas usually present as superficial, solitary, cutaneous nodules on the face. However, it is extremely rare for apocrine hidrocystomas to develop on a finger (1, 2). According to their histological characteristics and presumed histogenetic derivation, two types of hidrocystoma have been distinguished, but the precise classification of this tumour have not been clarified. We describe here a patient with an apocrine hidrocystoma on a finger, and discuss the histopathological, histochemical and immunohistochemical features.

Profiles of Tumor-Infiltrating Lymphocytes in a Case of Trichilemmal Carcinoma with Spontaneous Regression

We describe the case of a 69-year-old Japanese patient with spontaneous regression of trichilemmal carcinoma. We investigated the immunohistochemical profiles of tumor-infiltrating lymphocytes, focusing on cytotoxic granules, granulysin-bearing cells and immunosuppressive cells, such as regulatory T cells and tumor-associated macrophages. Our present study describes some of the possible mechanisms of the self-regression of cutaneous malignant tumors and potential therapies for trichilemmal carcinoma by modifying the tumor microenvironment.

Non-pigmenting fixed drug eruption caused by allylisopropylacetylurea.

An unusual case of a non‐pigmenting fixed drug eruption caused by allylisopropylacetylurea is reported. Several hours after taking an analgesic (New Kaiteki A®), a 30‐year‐old Japanese woman, who had experienced similar eruptions several times after taking other analgesics, developed numerous variously sized, itchy, round‐to‐oval erythematous eruptions on the trunk and extremities. After she discontinued taking this drug, all such eruptions resolved within 2 weeks, without leaving postinflammatory pigmentation. Patch testing with New Kaiteki A® itself and one of its active ingredients, allylisopropylacetylurea, on lesional skin, but not on uninvolved skin, showed positive erythematous reactions after 2 days.