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Psoriasis is a chronic inflammatory skin disease that involves various systemic organs and tissues and is characterized by scaly erythematous skin. Among the different types of psoriasis, psoriatic arthritis (PsA) is frequently reported, and occasionally develops into severe arthritis leading to joint dysfunction. There are various tools, especially questionnaires, to identify the presence of PsA in European and American populations; however, little is known about the utility of these tools in the Asian population. In this study, we investigated the utility of a representative tool, the psoriasis epidemiology screening tool (PEST) questionnaire, to identify PsA among Japanese patients with psoriasis. A total of 143 patients with psoriasis were enrolled in this study. Among them, 29 patients were diagnosed with PsA. The frequency of PsA was significantly increased in patients with PEST scores > 3, with a sensitivity of 93.1% and a specificity of 78.9%. Among the questions in the PEST questionnaire, “Have you ever had a swollen joint?” showed the highest frequency to answer “Yes” among patients with PsA. Univariate and multivariate analyses revealed that high PEST scores (> 3) was an independent variable in PsA patients. Taken together, our study suggests that the PEST questionnaire is a useful tool to identify PsA among Japanese patients with psoriasis.

Telaprevir used as a protease inhibitor against hepatitis C virus is frequently associated with cutaneous adverse reactions. To explore a histological biomarker of cutaneous adverse events induced by telaprevir, we systematically searched for genes that were dysregulated by telaprevir in normal human epidermal keratinocytes (NHEKs). Microarray analysis and real-time polymerase chain reaction (PCR) revealed the significant increase in the expression of S100 calcium-binding protein A2 (S100A2) gene following treatment of NHEKs with telaprevir. Immunohistochemical analysis demonstrated that the expression of S100A2 was dominant in the spinous layer of the epidermis in patients with telaprevir-mediated severe-type drug eruptions and limited to the basal layer of the epidermis in healthy subjects. Furthermore, S100A2 expression increased after treatment with trichloroethylene and other medications, and the degree of S100A2 expression correlated with the severity of cutaneous adverse events. S100A2 expression also significantly increased in the skin of patients with atopic dermatitis and psoriasis. Taken together, S100A2 is highly expressed in the epidermis under inflammatory conditions and drug eruptions and may serve as a marker for keratinocyte damage in response to any inflammatory or toxic condition.

Photoallergic drug eruptions are induced by various drugs, and sometimes coexist with other clinical manifestations, such as erythema multiforme [1]. Tocilizumab is a biological disease-modifying antirheumatic drug that targets IL-6 receptors and is used for the treatment of autoimmune diseases, such as rheumatoid arthritis [2]. Herein, we report the first case of photosensitivity due to tocilizumab presenting with erythema multiforme-like lesions.A 55-year-old female gradually developed arthralgia [...]

Background Calciphylaxis following acute renal failure is rare. Findings We report A 57-year-old male with an acute renal failure associated with necrotizing fasciitis. We also review the cases of calciphylaxis due to acute renal disorder further. Conclusions It should be kept in mind that calciphylaxis is observed in patient with not only chronic renal disease but also acute renal failure.

Erythema papulosa semicircularis recidivans (EPSR) is a new entity characterised by centrifugally expanding erythematous plaques that exacerbate after excessive sweating or during warm seasons [1, 2]. EPSR clinically resembles erythema annulare centrifugum of Darier, however, the edge of the annular ring is composed of papules rather than erythema and scales [1, 2]. Herein, we report the first case of EPSR associated with primary pancreas B-cell lymphoma.A 39-year-old woman was referred to our [...]

Smooth muscle tumor of uncertain malignant potential (STUMP) is a tumor that cannot be histologically diagnosed as unequivocally benign or malignant [1]. Uterine STUMP is histologically characterized by the existence of standard smooth muscle differentiation, low mitotic index and diffuse atypia. We describe a case of cutaneous skull metastasis from uterine STUMP. To our knowledge, this is the first case report in English of cutaneous metastasis of STUMP.A 68-year-old woman was referred to our department [...]

© 2016 The Authors. doi: 10.2340/00015555-2435 Journal Compilation © 2016 Acta Dermato-Venereologica. ISSN 0001-5555 Limaprost alfadex is a prostaglandin E1 (PGE1) deri­ vative, which is effective in the treatment of thrombo­ angitis obliterans through its pharmacological effect of improving peripheral blood circulation (1). Although some PGE1 analogue­related adverse events have been reported, e.g. liver dysfunction, to our knowledge, there have been only 2 case reports of cutaneous drug erup­ tion caused by PGE1 analogue published in English (2, 3). We report here a case of lichenoid drug erup­ tion caused by limaprost alfadex, as an unusual skin manifestation.

Background An anaphylactoid purpura affects small capillaries in the skin and other organs. Although two cases of anaphylactoid purpura exacerbated by cellulitis have been reported in Japanese literatures, its prognosis remains still unclear. Because cellulitis exacerbates various cutaneous inflammations, it has been speculated that cellulitis might also exacerbate cutaneous inflammation, such as vasculitis. Findings In this article, we report that 78-year-old woman exhibited anaphylactoid purpura, following cellulitis. We also reviewed the literature concerning about this subject. Conclusions This type of anaphylactoid purpura is thought to have a favorable prognosis dependent on the treatment for cellulitis.

The Th17 cell is a pro-inflammatory T helper cell subset defined by the production of IL-17, which plays an important role in various inflammatory diseases [1]. IL-17 exacerbates inflammatory responses through activation of various immune cells, such as neutrophils and keratinocytes. Therefore, the IL-17 axis is a key therapeutic target for the regulation of inflammatory diseases, such as psoriasis and rheumatoid arthritis [2]. Secukinumab is an IL-17 neutralizing antibody, and widely used for the [...]

© 2016 The Authors. doi: 10.2340/00015555-2225 Journal Compilation © 2016 Acta Dermato-Venereologica. ISSN 0001-5555 Faropenem is an oral beta-lactam antibiotic, which is structurally different from carbapenems and other available beta-lactams (1). Its administration is effective for upper respiratory tract infection (pharyngitis or tonsillitis), acute bronchitis, and other infectious disease (2). Although diarrhoea and vomiting occur occasionally as adverse effects of faropenem, cutaneous side-effects have not been reported in the English literature. Furthermore, beta-lactam antibiotics, such as meropenem (4), are a common cause of acute generalized exanthematous pustulosis (AGEP) (3); however, there has been no previous report of AGEP associated with administration of faropenem. We report here a first case of AGEP caused by faropenem.

ADP-glucose pyrophosphorylase (AGPase) catalyzes the first committed step of starch biosynthesis in higher plants. Previous studies have shown that two mutations in the large subunits of the potato and Arabidopsis AGPases resulted in the generation of enzymes with up-regulated allosteric properties, i.e. elevated sensitivity to 3-phosphoglycerate (3-PGA) and/or resistance towards inorganic phosphate (Pi) inhibition. To elucidate the effect of combining these mutations on the allosteric and kinetic properties, Ala33 to Lys and Gly96 to Asn substitutions were engineered into ApL1, the large subunit of the dominant Arabidopsis leaf AGPase expressed in leaves. When co-expressed with wild-type small subunit (wtApS1) in Escherichia coli, the resulting recombinant enzyme, designated Up3, showed allosteric regulatory properties distinct from Up1 and Up2 containing the single mutations. Up3 showed a 2.5-fold increase in 3-PGA affinity compared to wild-type and was more resistance to Pi than the other up-regulatory enzymes. Hence, the allosteric regulatory properties of Up3 are a non-additive product of the two mutations. To examine the effects of up-regulated ApL1 on transitory starch biosynthesis, the wild-type, Up1, Up2 and Up3 Apl1 genes were introduced into Arabidopsis ApL1 deficient TL46. Transgenic plants expressing the wild-type Apl1 gene restored starch levels to near normal levels, indicating that the introduced gene products complemented the genetic deficiency in TL46 plants. Transgenic plants expressing up-regulatory Apl1 genes showed greater AGPase activity and turnover of transitory starch than wild-type plants, the latter resulting in elevated carbon and energy to support heterotrophic growth during the night.

A prodrug strategy is based on the temporary derivatization of a functional drug in order to improve its pharmaceutical utility [1], such that the physiological chemical conditions that are required for the release of a drug through various enzymatic activations are exploited. Fosphenytoin is a water-soluble prodrug of phenytoin and is converted to the active compound by non-specific phosphatases in the blood [2]. Owing to its prodrug form, fosphenytoin exhibits greater tolerability than phenytoin [...]

Febuxostat is a newly-developed non-purine selective inhibitor of xanthine oxidase that decreases uric acid production, and is used for the treatment of hyperuricaemia in patients with gout [1]. Although its adverse events have been reported to be mild-to-moderate [1], several cases of febuxostat-related drug eruptions have been described in the English literature [2-4]. We report here the first case of fixed drug eruption-like macules caused by febuxostat and review the previously reported cases [...]

Parkinson's disease is derived from a degeneration of the dopaminergic neurons in the substantia nigra pars compacta, which leads to a marked loss of striatal dopamine concentration. Among the treatment for Parkinson's disease, the number of patients taking dopamine D2 receptor agonist is on the rise. Ropinirole, a selective dopamine D2 receptor agonist, shows a strong inhibitory effect on the pathogenesis of Parkinson's disease. 1 Although several adverse events of ropinirole are well-known, such as sleep disturbance, a drug eruption due to ropinirole has not been reported in English so far. Herein, we describe here an unusual case of a patient with Parkinson's disease who developed multiple fixed drug eruption after ropinirole treatment. We also reviewed the past literature on drug eruption caused by other dopamine D2 receptor agonists further. A 60-year-old female with Parkinson's disease was referred to our department for evaluation of an eruption of 2 days' duration. An erythematous eruption on the extremities had developed three hours after 7th daily administration of ropinirole for her Parkinson's disease. The erythematous lesions gradually became pigmented. On physical examination, well-defined pigmentations

Tocilizumab is a biological disease-modifying anti-rheumatic drug (DMARD) that targets interleukin 6 (IL-6) receptor, blocking IL-6 signalling (1). Tocilizumab has shown efficacy in the treatment of rheumatoid arthritis (2); however, it sometimes induces cutaneous adverse reactions. We report here a case of pseudolymphoma caused by tocilizumab, manifesting as an unusual cutaneous eruption. We also review the literature concerning drug eruption caused by tocilizumab, and pseudolymphoma caused by biologics in general.

Pitavastatin inhibits 3-hydroxy-3-methyl-glutaryl coenzyme A reductase and lowers blood cholesterol levels [1]. Although pitavastatin may occasionally cause adverse events (such as abdominal pain), no reports of cutaneous drug eruption have been reported in the English literature. Herein, we report the first case of acute generalized exanthematous pustulosis (AGEP) caused by pitavastatin. Furthermore, we examined the role of IL-36-producing cells in the pathogenesis of AGEP.A 65-year-old woman was [...]

Two cDNA clones for the large and small subunits of ADP-glucose pyrophosphorylase (AGPase), designated pvagpLl and pvagpSl, respectively, were isolated from developing seeds of kidney bean (Phaseolus vulgaris L.). Each deduced amino acid sequence showed significant identity (65-86%) with those of legumi nous AGPase large or small subunits. Northern blot analysis revealed that both mRNA species accumulated abundantly at the early-to mid-stages of seed development, indicating that both genes are synchronically ex pressed during seed maturation. Both gene products were also detected in leaves, stems and roots of kidney bean. In leaves, the pvagpLl mRNA level was constant during the diurnal cycle, whereas the pvagpSl mRNA level decreased markedly during the dark period. These results indicate that the pvagpLl and pvagpSl genes are differentially regulated by environmental and spatial conditions.

Aims Few studies have examined the prevalence of diabetes using glycated hemoglobin (HbA1c), a newly recommended diagnostic test. We examined the prevalence of diabetes and pre-diabetes using both HbA1c and fasting plasma glucose (FPG) and their associations with risk factors for type 2 diabetes in a large-scale Japanese working population. Methods Participants were 47,172 men and 8280 women aged 20–69 years who received periodic health checkup in nine companies which participated in the Japan Epidemiology Collaboration on Occupational Health study. Participants were categorized into diabetes (HbA1c ≥6.5% (≥48 mmol/mol), FPG ≥126 mg/dl (≥7.0 mmol/L), or medication for diabetes), pre-diabetes (HbA1c 6.0–6.4% (42–46 mmol/mol) or FPG 110–125 mg/dl (6.1–6.9 mmol/L) among those without diabetes), and normal glucose regulation. Results The prevalence of diabetes was 8.0% and 3.3% in men and women, respectively. Of individuals with diabetes, approximately 80% were defined by HbA1c ≥6.5% (≥48 mmol/mol) criterion. The prevalence of pre-diabetes was 14.1% in men and 9.2% in women. Prevalence of these glucose abnormalities increased with advancing age, especially during mid-40s and 50s. Higher body mass index and waist circumference, hypertension, dyslipidemia, and current smoking were each associated with higher prevalence of diabetes in both men and women. Conclusions Using HbA1c and FPG criteria or current medication, one in 13 men and one in 30 women had diabetes in the present Japanese working population. Interventions targeted for those in an early stage of impaired glucose metabolism would be required to prevent diabetes.