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Acne is a common skin disease that involves the seborrheic area of the face and results from the obstruction of hair follicles followed by inflammation. Careful face washing helps to improve and prevent acne; however, intensive washing has a risk of inducing skin barrier impairment and dry skin, especially in sensitive skin. We hypothesized that skin care combining mild skin cleansing and intensive moisturizing ("combination skin care") may be effective in the care of acne in subjects with dry skin and/or sensitive skin. We developed a combination skin care with a weakly acidic foaming facial skin cleanser based on a mild detergent, an aqueous lotion with eucalyptus extract and a moisturizing gel containing pseudo-ceramide and eucalyptus extract. To optimize an ideal facial skin care system for mild acne on sensitive skin, we performed a 4-week clinical trial with 29 post-adolescent Japanese women with mild acne with dry and sensitive skin. The acne significantly decreased after this trial accompanied by the improvement of dry skin, a significantly increased endogenous ceramide level in the stratum corneum and an elongated alkyl chain length of the non-hydroxy acyl sphingosine type ceramide. No adverse events due to the test samples were observed. Based on diagnosis by a dermatologist, 97% of the subjects found the combination skin care to be "useful" or "slightly useful". Based on these findings, the combined use of a facial skin cleanser and moisturizers is safe and effective for the care of acne in post-adolescent Japanese women with sensitive skin.

Quantitative analysis of itching in patients with itching dermatitis including atopic dermatitis (AD) is indispensable for the evaluation of disease activity and response to therapy. However, the objective evaluation system for itching is limited. We have developed a new objective and quantitative scratching behavior detection system using a wristwatch-type sound detector. The scratch sound detected on the wrist is recorded on a personal computer through a filtering, squaring and smoothing process by specific hardware. Subsequently, the data is automatically processed and judged for the scratching movement using specific software based on the periodicity and energy of the signal. Twenty-four measurements for healthy volunteers and those with AD by this system were evaluated by comparison with a simultaneously recorded video analysis system. The ratio of scratching time in sleeping time evaluated by these two systems was almost identical. The healthy subjects scratched their skin approximately 2 min during 6 h of sleeping time, while the mean scratching time of AD subjects was 24 min in their sleeping time. In contrast to the time-consuming video analysis system, this system takes only several minutes for evaluation of an overnight record. This scratch sound detection system is expected to serve as a new objective evaluation tool for itching dermatitis, namely, AD, and development of anti-itch therapies for dermatitis.

Dry skin is a condition characterized by impaired skin barrier function including atopic dermatitis and senile eczemas. Fabric softening chemicals (FSC) smoothens the surface of fabrics and thus decreases friction with the skin. Scientific evaluation of fabric softener on skin dryness is very limited. We evaluated the effectiveness and safety of FSC-treated T-shirts in subjects with dry skin. This is a randomized double-blind control study that included 40 male volunteers with apparent dry skin. Subjects were randomly divided into two groups: 20 men received 28 pieces of FSC-treated T-shirts wearing them for 4 weeks, and another 20 men received non-treated T-shirts. The effect of trial was evaluated by visual grading, subjective symptom, stratum corneum water content (SCWC), transepidermal water loss (TEWL), and dermoscopic skin surface analysis on days 0, 7, 14 and 28. A significant improvement of SCWC was observed in the skin of the shoulder (days 7-28) and lateral abdomen (day 14) wearing the treated T-shirts, but not in the non-treated T-shirts. In a stratified analysis of the low and high SCWC group, significant improvement was identified in the low SCWC groups but not in high SCWC groups. The visual grading of the shoulder improved significantly in the treated T-shirts group. No significant improvement was found in TEWL, dermoscopic analysis and subjective symptom in both groups. No remarkable side-effect was identified throughout this investigation. Addition of a fabric softener during clothes laundering is a potent preventive tool for dry skin.

Recent advances in bioengineering have introduced materials that enhance wound healing. Even with such new tools, some deep ulcers surrounded by avascular tissues, including bone, tendon, and fascia, are resistant to various therapies and easily form deep cavities with loss of subcutaneous tissue. Atelocollagen sponges have been used as an artificial dermis to cover full-thickness skin defects. Topical recombinant human basic fibroblast growth factor has been introduced as a growth factor to induce fibroblast proliferation in skin ulcers. We applied these materials in combination in two patients with deep resistant wounds: one with a cavity reaching the mediastinum through a divided sternum and one with deep necrotic wounds caused by electric burns. These wounds did not respond to the topical basic fibroblast growth factor alone. In contrast, the combination therapy closed the wounds rapidly without further surgical treatment. This combination therapy is a potent treatment for resistant wounds with deep cavities.

A 55-year-old woman with dermatomyositis and small cell lung cancer was successfully treated with surgery followed by combination chemotherapy in 1987. She had been in remission without further immunosuppressive therapy for 10 years. However, myositis with cutaneous manifestations specific for dermatomyositis relapsed when the patient was 69 years old. Intensive examinations revealed no neoplasm, and she responded to a moderate dose of systemic corticosteroids. This case suggests a long-lasting autoimmune abnormality in dermatomyositis and that a neoplasm is an important factor in eliciting an occult dermatomyositis.

We report a 76-year-old woman with extra nodal NK/T-cell lymphoma nasal type (ENKL). She had large tumors on her left leg with inguinal lymphadenopathy and gastric tumors. The tumor cells showed angiocentric growth with necrosis. Immunohistologically, the tumor cells from the skin lesion expressed CD2, cytoplasmic CD3, CD56, and T-cell intracellular antigen-1 (TIA-1), but not surface CD3, CD19, and TdT. The gastric tumor cell, also expressed cytoplasmic CD3, CD45RO and CD56. She was diagnosed as having ENKL (stage IV of Ann Arbor). The tumors responded remarkably well to radiation therapy followed by multi-drug resistance independent DeVIC (carboplatin, etoposide, ifosfamide, and dexamethasone) combination therapy. After two series of this therapy, no tumors were detected in clinical, histopathological, endoscope and computerized tomogram (CT) examinations. However, she suddenly died of brain stem metastasis three months later. Although there may be a limitation of effects on metastasis of tumors in the central nervous system, radiation and DeVIC combination therapy is a potent therapeutic method for ENKL.

We present a patient with bilateral scalp necrosis caused by giant cell arteritis (temporal arteritis). A 67-year-old woman, who had been treated with 5 mg of oral prednisolone every other day for polymyalgia rheumatica, developed painful egg-sized regions of necrosis on both of her temples. Doppler pulsemetory revealed bilateral obstruction of the temporal arteries. Biopsy revealed ischemic necrosis of the skin and necrotic angiitis of the temporal arteries with giant cell infiltration. Bilateral stenosis of the internal carotid arteries and moderate retinal bleeding were revealed by angiography. Daily administration of prednisolone (20 mg/day) with intravenous and topical limaprost alphadex markedly improved her condition. The ulcers reepithelized without surgical treatment. There are few reports of bilateral scalp necrosis. Rapid and complete obstruction of the temporal artery may result in this condition. Simultaneous development of two ulcerative lesions in the ventro-parietal cranial regions is thought to correspond to systemic arterial involvement, including involvement of the internal carotid arteries.

Tzanck test has been recently re-evaluated as a method for the diagnosis of herpes virus infection. Giemsa staining for the Tzanck test is time-consuming and laborious. There is a need to develop simple and quick staining methods for bedside diagnosis of this disease. We report a single step and quick method for staining herpes giant cells in Tzanck smears using routinely available inks and physiological saline. A keratinocyte cell line (HaCaT) was cultured on a slide glass and stained with various commercially available blue, blue-black and black inks serially diluted with physiological saline. Clinical smear samples from herpes lesions were also stained with these solutions without specific pretreatment. The nuclei of HaCaT were clearly stained showing high contrast with the cytoplasm using 5% Parker-Quink blue-black ink saline solution. Concentration of ink solution higher or lower than 5% resulted in less contrast. Blue or black inks or other manufacturers' inks can also be used, but staining of the cultured keratinocytes was less clear. Smear of clinical samples from herpes lesions were also stained with 5% ink solution. The nuclei of the multinucleated giant cells were clearly stained, and the sample could be immediately used for microscopic examination. One step staining of Tzanck smear using this diluted ink solution is an inexpensive and a convenient bedside diagnostic tool for the dermatologist.

A 42-year-old woman developed severe erythema with exfoliative scaling on the bilateral palms and soles and erosive dermatitis on the axillae and groin eight days after an autologous peripheral blood stem cell transplantation for the treatment of non-Hodgkin's lymphoma. She also developed exanthema; however she did not show intestinal, hepatic, or renal involvement. The skin biopsy revealed characteristic apoptotic cell death of the epidermis with eosinophilic necrosis, and she was diagnosed with acute graft-versus-host disease (GVHD). The cutaneous lesions responded to topical corticosteroid treatments and improved within a month without systemic immunosuppressing therapies. The cutaneous GVH reaction did not recur. However, she was treated with an intermittent thrombocyte transfusion because of persistent thrombocytopenia. On day 130, she developed intestinal pneumonia and died due to respiratory dysfunction. Unlike an allo-bone marrow graft, GVHD after an autologous stem cell transplantation is not common. Even for an autologous transplantation, GVH may develop with less characteristic clinical manifestations.

Tzanck test has been recently re-evaluated as a method for the diagnosis of herpes virus infection. Giemsa staining for the Tzanck test is time-consuming and laborious. There is a need to develop simple and quick staining methods for bedside diagnosis of this disease. We report a single step and quick method for staining herpes giant cells in Tzanck smears using routinely available inks and physiological saline. A keratinocyte cell line (HaCaT) was cultured on a slide glass and stained with various commercially available blue, blue-black and black inks serially diluted with physiological saline. Clinical smear samples from herpes lesions were also stained with these solutions without specific pretreatment. The nuclei of HaCaT were clearly stained showing high contrast with the cytoplasm using 5% Parker-Quink blue-black ink saline solution. Concentration of ink solution higher or lower than 5% resulted in less contrast. Blue or black inks or other manufacturers' inks can also be used, but staining of the cultured keratinocytes was less clear. Smear of clinical samples from herpes lesions were also stained with 5% ink solution. The nuclei of the multinucleated giant cells were clearly stained, and the sample could be immediately used for microscopic examination. One step staining of Tzanck smear using this diluted ink solution is an inexpensive and a convenient bedside diagnostic tool for the dermatologist.

Dry skin is a condition characterized by impaired skin barrier function including atopic dermatitis and senile eczemas. Fabric softening chemicals (FSC) smoothens the surface of fabrics and thus decreases friction with the skin. Scientific evaluation of fabric softener on skin dryness is very limited. We evaluated the effectiveness and safety of FSC-treated T-shirts in subjects with dry skin. This is a randomized double-blind control study that included 40 male volunteers with apparent dry skin. Subjects were randomly divided into two groups: 20 men received 28 pieces of FSC-treated T-shirts wearing them for 4 weeks, and another 20 men received non-treated T-shirts. The effect of trial was evaluated by visual grading, subjective symptom, stratum corneum water content (SCWC), transepidermal water loss (TEWL), and dermoscopic skin surface analysis on days 0, 7, 14 and 28. A significant improvement of SCWC was observed in the skin of the shoulder (days 7-28) and lateral abdomen (day 14) wearing the treated T-shirts, but not in the non-treated T-shirts. In a stratified analysis of the low and high SCWC group, significant improvement was identified in the low SCWC groups but not in high SCWC groups. The visual grading of the shoulder improved significantly in the treated T-shirts group. No significant improvement was found in TEWL, dermoscopic analysis and subjective symptom in both groups. No remarkable side-effect was identified throughout this investigation. Addition of a fabric softener during clothes laundering is a potent preventive tool for dry skin.

Local flaps have the advantages of texture matching and increased flap survival rate. The proper local flap planning for each lesion causes the dermatologist to be reluctant to employ them. We propose a modified local flap, the "Cassiopeia flap", with three simple marking points made on the ends of the diameter and on the equidistant point along the diameter; two points from equilateral triangles form a "W (Cassiopeia)". We applied this modification to ten lesions on the face, scalp, trunk and thigh with excellent results.

Epidermotropic metastatic malignant melanoma (EMMM) is a form of metastatic malignant melanoma that has dermal cell nests with epidermotropism and specific histopathological features. We report a patient with eight nodular lesions of the scalp with histopathological findings compatible with EMMM. The tumors developed one year before consultation and increased in size simultaneously. The histopathological findings of all eight tumors were very similar. The tumor cells were located mainly in the dermis and partly in the basal layer of the epidermis. They contained melanin pigments and were positive for anti-HMB45 antibody. The tumors did not respond to combination chemotherapy with dacarbazine, nimustine, vincristine, and interferon-beta. Therefore, all the tumors were surgically removed. No local relapse, distant metastasis or re-elevation of plasma 5-S-cysteinyldopa was identified during nine months of follow-up. Histopathologically, all eight tumors lacked apparent vascular invasion, which may be related to a slow clinical course of the present case.

Azathioprine (AZA) is an immunosuppressant commonly used for organ transplantation and autoimmune diseases. Allergic side effects of AZA are rare, and reported allergic skin eruptions from AZA are very limited in Japan. We report AZA-induced drug eruption that developed in two cases of systemic scleroderma with polymyositis. One case presented with Stevens-Johnson syndrome, and the other had systemic papular erythema. The stimulation indices of the drug-induced lymphocyte stimulation test (DLST) for AZA in these two patients were as high as 2,180% and 430%, respectively, but those of healthy volunteers were under 120% without nonspecific suppression of lymphocyte proliferation. Other drugs used simultaneously were ruled out by patch and challenge tests. The challenge test for Stevens-Johnson syndrome type drug allergy is very risky. DLST is a good diagnostic tool for AZA allergy, especially for severe drug allergy cases.

We report a 44-year-old Japanese man who had connective tissue nevus, seborrheic keratosis-like eruptions, atrophic scars on his hands and feet, alopecia, and microtia. These concurrent abnormalities are distinct from previously described multiple malformation syndromes.

We present a large dermatofibrosarcoma protuberans on a 52 years-old woman's back that was successfully treated with transcatheter arterial embolization and radiofrequency ablation. The tumor developed on her back at the age of 14. Surgical treatment was not complete, and it relapsed at age 17 and again at age 24. The tumor enlarged to over 20 × 20 × 10 cm and flooded intermittently. The tumor cells with atypical nuclei were CD34 positive and proliferated in a storiform pattern. These findings were compatible with dermatofibrosarcoma protuberans. She was treated with blood transfusion for severe anemia. Two large feeding arteries were embolized, and the bottom of the tumor was treated with radiofrequency ablation. The tumor reduced in volume by more than 50%. It was then surgically removed and reconstructed with a free mesh skin graft. The combination pretreatment enabled radical resections of a large DFSP without severe complications.

We present a primary cutaneous follicle center cell lymphoma (PCFCCL) patient who was successfully treated with Rituximab, a new anti-CD20 monoclonal antibody. A thirty-two-year-old male developed two asymptomatic tumors on the scalp. Histopathologically, the tumors were composed of diffuse and nodular infiltration of centrocytes and centroblasts. Immunohistopathologically, the tumor cells stained positively with anti-CD20 antibody and anti-kappa antibody, but not with anti-CD5, anti-CD10, or anti-Bcl-2 antibody. Radiation therapy is effective in treating PCFCCL; however, it usually results in the permanent loss of hair. This patient was treated with Rituximab and CHOP, and achieved a complete remission. He has had no recurrence in more than 12 months and no permanent loss of hair on the scalp.

Pyoderma gangrenosum developed in a man with a five-year history of paroxysmal nocturnal hemoglobinuria and monoclonal gammopathy. He had multiple walnut sized ulcers on his back and extremities, plasma IgM-k type M-protein and low erythrocytic CD55 expression. This is an extremely rare association. However, clonal expansion of plasma cells and chimeric expression of hematopoietic cell glycosylphosphatidylinositol (GPI)-anchored proteins may represent somatic mutations of hematopoietic stem cells in PG as well as PNH. PNH is based on abnormalities in the GPI-anchor formation on various hematopoietic and non-hematopoietic cells. Since the GPI-anchored proteins have pleiotropic functions in complement mediated cell lysis, leukocyte motility, and coagulation systems, the present case may indicate the possible involvement of a GPI-anchored protein abnormality in the pathogenesis of PG.

A 68-year-old Japanese man with acute myelogenous leukemia, in long-term remission, developed cutaneous sarcoid reactions on his trunk and extremities. This may suggest that sarcoid-like granulomas be considered as a nonspecific cutaneous sign of underlying leukemia.

Eosinophil and neutrophil chemotactic activities of some collagens and their collagenase-digested fragments were measured by using a Boyden chamber method. Fragments released from bovine dermal collagen and type III collagen derived from calf skin showed chemotactic activity for guinea pig eosinophils in a dose-dependent manner, but collagen itself did not. Fragments released from bovine dermal collagen also showed chemotactic activity for human neutrophils. Gel filtration study indicated that some sizes of this collagenase-digested fragments had chemotactic activities for eosinophils. These results suggest that collagen-derived fragments may play a role in tissue eosinophilia in some inflammatory lesions.

The effect of the local heat treatment on the chemotactic activity in psoriatic scales was studied by using a modified Boyden chamber method. Hyperthermic treatments were given to psoriasis plaques and scales were taken from these plaques before and after treatment. The psoriasis improved over a two week period of these treatments, but plaques were still present and scaling at that time. Treatment with local hyperthermia significantly reduced the activity for polymorphonuclear leukocytes in psoriatic scales (p

The chemotactic activity for neutrophils and monocytes was examined in the sera of psoriatic patients and healthy controls using a Boyden chamber method. There were no significant differences in neutrophil chemotactic activity between the sera of psoriatic patients and healthy controls. However, the monocyte chemotactic activity of psoriatic serum was lower than that of control serum. Furthermore, there was a significant increase in the monocyte chemotactic activity of psoriatic sera after heat treatment (42°C, 1 hr). These results suggest that psoriatic serum has a defect of monocyte chemotaxis which can be corrected, in part, by heat treatment.

The sera of 12 patients with psoriasis vulgaris were studied for immune complexes using the polyethylene glycol (PEG) assay. Thirty three percent of sera had elevated levels of immune complexes. Neutrophil chemotactic activity of these sera was compared to the sera of healthy controls and psoriatic patients who showed low levels of immune complexes, using a Boyden chamber method. Neutrophil chemotaxis of these patients with high levels of immune complexes was decreased below that of healthy controls or patients who showed low levels of immune complexes. These results suggest that circulating immune complexes of psoriatic patients may be associated with the defect of chemotaxis in this disease.

The chemotactic activity of β-galactosidase from bovine liver for eosinophils was evaluated in vitro and in vivo. In vitro, the activity increased in a dose-dependent manner. The maximal activity was detected at the concentration of 0.1 mg/ml. In vivo, at concentrations greater than 0.5 mg/ml, eosinophil chemotactic responses were clearly seen. These results suggest that β-galactosidase, one of the acid hydrolases, may play a role in eosinophil accumulation in various inflammatory lesions.

A 61-year-old Japanese man with chronic myelogenous leukemia developed pityriasis lichenoides-like eruptions during chemotherapy. Histopathological features were also consistent with the disease. The eruption in this case may have been an allergic reaction arising in a depressed immunity induced by chemotherapy.