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A 72 year-old man was referred to our department with white curd-like material on the surface of his tongue as well as the mucosal surface of the lower lip, after unsuccessful treatment with itraconazole for 3 weeks. He also had a history of depression and had received topical steroid and/or antibiotics treatment for persistent oral aphtha and irritation of his upper lip for 4 years. A diagnosis of oral candidiasis was made through positive KOH direct microscopic examination and he was instructed to rinse his oral mucosal lesion with amphotericin B syrup. Although no significant eruption was observed on his upper lip at his first visit, he applied the steroid ointment for 4 weeks and came back to our clinic with his upper lip red and swollen. It was also covered with yellow crusty material mixed with a pustule. Histological examination of the lips revealed non-specific chronic inflammation in the mid to lower dermis. Hyphae in the cornea detected by PAS and Grocott staining. KOH direct microscopic examination from the pustule and crust showed positive pseudohyphae although no sign of parasitism to the hair was seen. Candida albicans and Candida parapsilosis were detected by culture from the crust and a biopsy sample. He was successfully treated with 2 courses of pulse therapy of oral itraconazole for sycosis candidiasis, accompanied by 2% miconazole gel for oral candidiasis.

We report two cases of drug-induced vasculitis subsequent to long-term minocycline therapy. Case 1; A 27-year-old woman, who was receiving minocycline hydrochloride for eosinophilic pustular folliculitis of 68-months'duration, showed polyarthralgia, intermittent low-grade fever, and light red reticulated erythemas with subcutaneous nodules on her extremities. Case 2; A 31-year-old man developed reddish-brown, reticulated erythemas with induration on bilateral lower legs after 24-months' duration of minocycline hydrochloride treatment for hidradenitis suppurativa. In both cases, skin biopsies demonstrated vasculitis affecting a small-sized artery at the border of the dermis and subcutis. Serum antineutrophil cytoplasmic antibodies (ANCA) showed borderline elevation. In both cases cessation of minocycline administration resulted in rapid improvement of cutaneous lesions and constitutional symptoms. Recently, attention has been focused on drug-induced ANCA-positive vasculitis. Accumulation of previous case reports of minocycline-induced vasculitis with cutaneous lesions disclosed that the duration of the treatment before clinical symptoms averaged 35 months. Patients may present with livedoid skin lesions accompanied by fever, polyarthritis, autoimmune hepatitis and drug-induced lupus. Early recognition of ANCA-positive vasculitis is essential during long-term minocycline treatment, because cessation of the drug can result in complete resolution.

A 71-year-old man was referred to our department on January 30, 1998 with hard red papules that had developed on the philtrum in mid-January. On January 2, the patient had received high-dose steroid therapy (pulse therapy) for cluster asthma attacks and antibiotics at the Department of Internal Medicine of our hospital. Infiltrative, protruding reddish plaques were observed on the philtrum, which contained a number of small pustules at sites corresponding to hair follicles. There was partial opacity and slight irregularity of the nail plates on the first and second toes of the right foot. Fungal elements were detected from a lesion on the mustache and the nail. Histological examination of the lesion on the philtrum revealed infiltration of inflammatory cells comprising neutrophils, lymphocytes, and macrophages around the hair follicles. Beard hair and nail cultures revealed Candida albicans A, indicating that the patient had candidal sycosis and candidal onychia. He was treated with oral fluconazole (100 mg/day). The lesion was clinically improved within 50-days. Recently, extensive use of steroids and antibiotics has produced an increase in reports of patients with Folliculitis barbae Candidomycetica. We believe that the present case was also induced by high-dose steroid therapy and antibiotics.

Pityriasis versicolor and malassezia folliculitis were studied clinically and mycologically. The main results were as follows: 1) The average age of pityriasis versicolor patients has gradually become higher. 2) Negative rates of Malassezia furfur after treatment were very high by direct examination but relatively low by culture. 3) Patients who were negative by culture on completion of treatment seldom recurred within 2 months. 4) We can evaluate the effectiveness of antifungal application by using Malassezia furfur as normal skin flora on the volunteer's back. 5) Malassezia furfur (orbiculare or ovale type) is detected in follicular contents of steroid acne and acne vulgaris, which makes it necessary to establish criteria for diagnosis of malassezia folliculitis.

Clinical effectiveness of TMS-19-Q, a new macrolide antibiotic, was evaluated in superficial infectious diseases classified into 6 groups at 13 departments of dermatology. The results obtained were as follows: Final global improvement rating in 311 cases were excellent in 91, good in 158, fair in 45 and poor in 17 and the effective rate was 80.1%. Effective rates in each group were 71.1% in 1st group (folliculitis and acne pustulosa), 78.6% in 2nd group (furuncle, furunculosis and carbuncle), 100% in 3rd group (impetigo), 76.9% in 4th group (phlegmone, superficial lymphangitis, erysipelas and infectious paronychia), 88.7% in 5th group (inflammatory atheroma, subcutaneous abscess, hidradenitis suppurative and acne conglobata) and 77.3% in 6th group (secondary infection). Dominant strains isolated were S. aureus (40.7%), S. epidermidis (26.9%) and anaerobic bacteria (20.8%). S. aureus was frequently isolated from most of all disease. On the other hand, S. epidermidis and anaerobic bacteria were isolated mainly from 1st and 5th group. Optimum daily doses would be over 600 mg. Slight adverse reactions such as gastrointestinal disorders, eruption and malaise were observed in 12 cases.