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尋常性乾癬患者19例を対象に，カルシポトリオール軟膏(ドボネックス® 軟膏50μ/g)とベタメタゾン酪酸エステルプロピオン酸エステル軟膏(アンテベート® 軟膏0.05％)を用いた9週間の外用連続療法を実施し，その臨床的有用性をPASIとVASスコア，患者QOLにより評価した。外用連続療法の導入期では両剤を1日2回併用塗布し，続く移行期では平日はカルシポトリオール軟膏のみを，土・日は両剤を1日2回併用した。維持期ではカルシポトリオール軟膏の単独塗布を行った。皮膚症状の評価はPASIスコアから顔面，頭部を除いた準PASIスコアと患者によるVAS評価を併用した。QOL評価はDermatology Life Quality Index(DLQI日本語版)を用いた。その結果，治療開始時20.2であった準PASIスコア平均値は導入終了時には8.1となり60％の低下を示し(p

Cosmetic moisturisers were applied to one side of the face of 18 male Japanese patients with acne vulgaris who were treated with a topical administration of adapalene and clindamycin phosphate gels. We assessed the alleviating effect of the moisturisers on the side effects of the treatment. The severity of acne and the number of inflammatory and non-inflammatory lesions were measured at 0, 2, and 4 weeks. The water content in the stratum corneum and transepidermal water loss were measured by comparing the moisturiser-treated and untreated sides of the face. The sensation of skin dryness and irritation on both sides of the face were assessed by the subjects. We observed that the use of moisturisers did not impact the efficacy of the standard topical treatment and they significantly improved the water content in the stratum corneum and the sensation of dryness. These results suggested that the use of moisturisers in combination with the standard topical treatment may improve adherence to therapy by alleviating the sensation of dryness.

Dear Editor: Cutaneous mucinosis comprises of a heterogenous group of pathological disorders characterized by mucin deposition in the dermis. Nodular mucinosis can be an unusual skin manifestation of discoid lupus erythematosus (DLE)1. It is associated with increased glycosaminoglycan production by dermal fibroblasts, apparently due to an unidentified serum molecule2-5. We describe herein a case of DLE in which cutaneous mucinosis was anticipated because of the sticky gelatinous material from the biopsy sites when the specimens were obtained. Our case had more than 125 mucin nodules on whole body surface area. To the best of our knowledge, this is the first report of a case demonstrating numerous mucin nodules in DLE. A 38-year-old Japanese man developed cutaneous lesions when he was 25-years-old in 1997. The skin lesions had been treated by his local physician with 0.12% betamethasone valerate ointment. He first presented at our department in June 2006. There was no history of systemic illness. Physical examination showed round, atrophic, erythematous, telangiectatic, and scaly plaques on the face, neck, and all extremities (Fig. 1A). The most dramatic changes were in sun-exposed areas. Irregular encroachment of ear auricular cartilage and overlying skin were noted (Fig. 1A). Blood cell count showed normal values. Serum aspartate transaminase was 50 U/L (normal range 10~35 U/L). Serum alanine transaminase was 110 U/L (normal range 5~40 U/L). Serum gamma-glutamyl transpeptidase was 120 U/L (normal range 0~60 U/L). Fig. 1 (A) Round, atrophic, erythematous, telangiectatic, and scaly plaques on the face. Irregular encroachments of the ear auricular cartilage and overlying skin were observed. (B, C) Multiple flesh-colored nodules were observed on the back (arrows). (D) Each ... Serum triglyceride was 190 mg/dl (normal range 30~149 mg/dl). Serum high density lipoprotein was 28 mg/dl (normal range 40~75 mg/dl). Blood urea nitrogen was 8.3 mg/dl (normal range 7~20 mg/dl). Serum creatinine was 0.72 mg/dl (normal range 0.7~1.3 mg/dl). Serum uric acid was 6.0 mg/dl (4.3~8.2 mg/dl). Normal vales for serum C3 and C4 components of complement were found. Antinuclear antibody was positive at 40-fold dilution (normal range is positive at less than 40-fold dilution). Anti dsDNA antibody was 5.0 IU/ml (normal range 0~11.9 IU/ml). Anti-cardiolipin antibodies were negative. The skin lesion was not induced by both ultraviolet A (UVA) and ultraviolet B (UVB) irradiation. There were no signs of serositis, oral ulcers, arthritis, hematological disorder, renal disorder, immunologic disorder, neurologic disorder, or malar rash. Because we could not find any symptoms other than skin symptoms, DLE was diagnosed and therapy with 0.1% tacrolimus ointment, 0.05% betamethasone butyrate propionate ointment (trunk and extremities), and 0.1% dexamethasone propionate (face) was initiated. Lupus erythematosus (LE) tumidus was excluded because urticaria-like, succulent, erythematous plaques had never been observed. Although the skin lesion was not induced by both UVA and UVB irradiation, it was strongly recommended that the patient avoid sunlight. During the next 3 years, the patient noted that the eruptions waxed and waned. The patient noticed that skin-colored papules and nodules began to appear on the trunk in September 2008. Examination of the skin in May 2009 showed numerous skin-colored nodules involving mainly in the trunk and extremities (Fig. 1B, C, D). He denied having fever, malaise, and arthralgia. There were numerous nodules on the entire body surface. When a biopsy specimen was taken for light microscopy, the dermis was soft, and mucinous material clung to the biopsy site. The scanning histologic examination of a biopsy specimen from a scaly erythematous lesion on the shoulder showed focal epidermal atrophy and hyperkeratosis. Liquefactive degeneration in the basal cell layer of the epidermis was present. Papillary edema and perivascular mononuclear cell infiltrate were also present in the dermis. The epidermal appendages were normal, but heavy mononuclear cell infiltrate was present around the epidermal appendages (Fig. 2A). Direct immunofluorescence microscopic findings of a specimen from a lesion on the shoulder demonstrated IgA, IgM, and C3 deposition at dermal endothelial cells and band-like IgG deposition along the epidermal basement membrane. Fig. 2 Histological findings. (A) Focal epidermal atrophy and hydropic degeneration in the basal layer were observed. Papillary edema and a mild perivascular mononuclear cell infiltrate were present in the dermis. The epidermal appendages were normal. Heavy ... Alcian blue staining at pH 4 confirmed the acidic mucopolysaccharide nature of the amorphous material in the dermis (Fig. 2B). At this time point, we still cannot find any symptoms other than skin symptoms. We also could not observe malar rash, oral ulcers, arthritis, serositis, renal disorder, neurological disorder, hematological disorder, or immunological disorder. We carefully follow up this patient because he may come to systemic lupus erythematosus (SLE) status. Mucin deposition is a common histopathologic finding in LE but is rarely present in sufficient quantities to produce clinically apparent skin eruptions. To date, 46 cases of papulonodular mucinosis associated with LE were found in the English literature1-5. Among them, 34 patients (74%) were diagnosed with SLE, 3 patients (6%) with subacute cutaneous LE, and 9 patients (20%) with DLE. Papulonodular mucinosis differs from other cutaneous eruptions of LE5. These lesions present as asymptomatic slightly elevated papules and/or nodules that typically involve the trunk and arms, although the face and other areas of the body may also be affected. Histological examination demonstrates massive mucin deposits in the dermis. Epidermal changes that are typically seen in LE are absent. Several factors are said to contribute to the pathogenesis of papulonodular mucinosis. It has been reported that ultraviolet light exposure can aggravate these lesions4. Numerous skin-colored nodules appeared in May in our case. Ultraviolet light exposure may be related to the appearance of many mucin nodules. It has also been suggested that androgen or other sex-related factors may contribute to the pathogenesis5. The patient had mild hyperlipidemia. This hyperlipoproteinemia may be related to numerous mucin nodules6. In summary, we report a Japanese patient with DLE developed nodular mucinosis 11 years later. Also, he did not have any systemic involvement signs until now.

The efficacy of combined therapy with a retinoid and antibiotic for Japanese patients with acne vulgaris remains to be established. Further, maintenance strategies limiting the use of topical retinoids must be identified. The objectives of this study are to determine the efficacy of sequential application of topical adapalene and clindamycin phosphate and to assess the impact of this regimen on patients' quality of life. Sixty-six patients were recruited. The regimen comprised two phases. For the 4-week initial treatment, 1% clindamycin phosphate gel was applied twice daily and 0.1% adapalene gel, once. In the 4-week maintenance phase, patients were randomly assigned to the OD group (adapalene applied once daily) or the TW group (adapalene applied once daily on 2 days per week). The acne severity score, lesion counts, microcomedone count, and sebum amount were measured. Quality of life (QOL) was assessed using Skindex-16. All parameters improved significantly by week 4 of initial treatment. No statistically significant differences were found in the improvement of clinical findings between the groups. All QOL scores improved significantly and did not significantly differ between the groups. Our regimen may enable clinical control of acne in Japanese patients and improve their QOL. For limiting retinoid use, weekly application of adapalene during maintenance is suitable.

Background The involvement of oxidative stress in the pathogenesis of various skin disorders has been suggested for decades. However, few clinical studies have assessed oxidative stress in skin diseases. The easiest and least invasive method to assess oxidative stress in patients may be the measurement of oxidation products in urine. Objective This study aims to assess oxidative stress in psoriasis and atopic dermatitis patients. Methods Urine samples were collected from 29 psoriasis patients (25 males and 4 females), 21 atopic dermatitis patients (14 males and 7 females) and 20 healthy controls (16 males and 4 females). The severity and extent of psoriasis and atopic dermatitis was assessed by their area and severity index. We measured nitrate as a metabolite of nitric oxide, malondialdehyde as a major lipid oxidation product, and 8-hydroxydeoxyguanosine (8-OHdG) as a DNA oxidation marker. Results Urinary nitrate and 8-OHdG levels, but not malondialdehyde, were significantly higher in psoriasis patients than those in healthy controls. On the contrary, only urinary nitrate level was significantly higher in atopic dermatitis patients than those in healthy controls. The severity and extent of both psoriasis and atopic dermatitis significantly correlated with urinary nitrate level and malondialdehyde level, but it did not correlate with urinary 8-OHdG level. Conclusions Measurement of these three urinary oxidative products is non-invasive. Above all, measurement of urinary nitrate may be most useful in the clinical assessment of oxidative stress in both psoriasis and atopic dermatitis patients. There is a possibility that urinary 8-OHdG level may indicate the different pathogenesis between psoriasis and atopic dermatitis.

ejd.2012.1684 Auteur(s) : Emiko Ishikawa emiko-i@med.kagawa-u.ac.jp, Kozo Yoneda, Kozo Nakai, Junko Moriue, Ikumi Yokoi, Asuka Munehiro, Yasuo Kubota Department of Dermatology, Kagawa University, 1750-1 Ikenobe Kitagun Mikicho, 761-0793 Kagawa, Japan Cryptococcus neoformans is an encapsulated yeast. In these days of globalization, the vast majority of patients with cryptococcosis have an underlying immunocompromised condition, with prolonged corticosteroid treatments. Cutaneous involvement is reported [...]

ejd.2012.1674 Auteur(s) : Asuka Munehiro munehiro@med.kagawa-u.ac.jp, Kozo Yoneda, Ayako Koura, Kozo Nakai, Yasuo Kubota Department of Dermatology, Kagawa University, 1750-1 Ikenobe, Kitagun Mikicho, 761-0793 Kagawa, Japan Macular lymphocytic arteritis (MLA) is a recognized variant of lymphocytic vasculitis. We describe MLA associated with rheumatoid arthritis. To the best of our knowledge, this is the first MLA case associated with rheumatoid arthritis. A 56-year-old Japanese man with polyarthritis [...]

Auteur(s) : Kozo Nakai, Kozo Yoneda, Reiko Maeda, Ikumi Yokoi, Natsuko Fujita, Asuka Munehiro, Tetsuya Moriue, Yasuo Kubota Department of Dermatology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan 761-0793 The prevalence of multiple pilomatricomas (MPs) in patients with myotonic dystrophy (MyD) is greater when compared to that of the general population [1]. We report a giant perforating pilomatricoma and psoriasis vulgaris developing in [...]