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Kabuto Mountain virus (KAMV), the new member of the genus Uukuvirus, was isolated from the tick Haemaphysalis flava in 2018 in Japan. To date, there is no information on KAMV infection in human and animals. Therefore, serological surveillance of the infection among humans and wild mammals was conducted by virus-neutralization (VN) test and indirect immunofluorescence assay (IFA). Sera of 24 humans, 59 monkeys, 171 wild boars, 233 Sika deer, 7 bears, and 27 nutria in Yamaguchi Prefecture were analyzed by VN test. The positive ratio of humans, monkeys, wild boars, and Sika deer were 20.8%, 3.4%, 33.9% and 4.7%, respectively. No positive samples were detected in bears and nutria. The correlation coefficients between VN test and IFA in human, monkey, wild boar, and Sika deer sera were 0.5745, 0.7198, 0.9967 and 0.9525, respectively. In addition, KAMV was detected in one pool of Haemaphysalis formosensis ticks in Wakayama Prefecture. These results indicated that KAMV or KAMV-like virus is circulating among many wildlife and ticks, and that this virus incidentally infects humans.

Generalized pustular psoriasis (GPP) is a rare disease characterized by recurrent fever and systemic flushing accompanied by extensive sterile pustules. The committee of the guidelines was founded as a collaborative project between the Japanese Dermatological Association and the Study Group for Rare Intractable Skin Diseases under the Ministry of Health, Labour, and Welfare Research Project on Overcoming Intractable Diseases. The aim of the guidelines was to provide current information to aid in the treatment of patients with GPP in Japan. Its contents include the diagnostic and severity classification criteria for GPP, its pathogenesis, and recommendations for the treatment of GPP. Since there are few clinical trial data with high levels of evidence for this rare disease, recommendations by the committee are described in the present guidelines.

A local epidemiological survey of psoriasis was conducted from 19 February to 30 June 2016 in Matsumoto city, Nagano Prefecture, Japan. Patients were predominantly male (268 cases, 71.5% males vs 107 cases, 28.5% females). We estimated that the prevalence of psoriasis was 0.097% in the Matsumoto area. The clinical types of psoriasis identified were psoriasis vulgaris (90.7%), psoriatic arthritis (5.9%), pustular psoriasis (2.1%), guttate psoriasis (1.0%) and psoriatic erythroderma (0.3%). The topical therapeutic agents included corticosteroids (84.0%), vitamin D3 analogs (61.5%), and a combination of calcipotriol and betamethasone dipropionate (31.0%). Current systemic treatments included cyclosporin (9.0%), etretinate (7.4%) and methotrexate (1.3%). Biologic treatments included adalimumab (4.0%), ustekinumab (2.7%), infliximab (1.3%) and secukinumab (0.8%). Ultraviolet B therapy (11.3%) was the predominant phototherapy in which narrow band ultraviolet B therapy accounted for the majority, followed by psoralen and ultraviolet A therapy (1.0%). According to the recent evolution of psoriasis treatment, the use of biologics has been increasing. This study demonstrates the changes of treatment trends of psoriasis in a non-metropolitan regional area.

Hepatitis E virus (HEV) is the causative agent of hepatitis E, a food- and water-borne disease. In developed countries, consumption of meats from pigs, wild boars and deer is a major source of infection. Although HEV and HEV-related viruses have been detected in many animal species, their zoonotic potential and prevalence has not been completely understood. To detect anti-HEV antibody in mammalian species, a simple enzyme-linked immunosorbent assay (ELISA) was established using extract from cells expressing HEV capsid protein and protein A/G as an antigen and a reagent for detection of antibody. Absorbance in the ELISA was compared with those in our previous ELISA using VLPs and anti-swine antibody, suggesting that newly established ELISA was similarly specific and sensitive as the previous ELISA. Seroprevalence of HEV infection among wild boars was examined in Yamaguchi Prefecture, confirming that 111 of 364 wild boars (30.5%) were positive for anti-HEV antibody. Next, this ELISA was applied to humans, dogs, cats, ferrets, raccoons and masked palm civets in Japan, and anti-HEV antibodies were detected in humans, ferrets, dogs and cats. This ELISA is thus useful for serological surveys and comparison of HEV infection among various mammals, including humans.

Background Patients with steroid-resistant bullous pemphigoid (BP) require an appropriate treatment option. Objective A multicenter, randomized, placebo-controlled, double-blind trial was conducted to investigate the therapeutic effect of high-dose intravenous immunoglobulin (IVIG; 400 mg/kg/day for 5 days) in BP patients who showed no symptomatic improvement with prednisolone (≥0.4 mg/kg/day) administered. Methods We evaluated the efficacy using the disease activity score on day15 (DAS15) as a primary endpoint, and changes in the DAS over time, the anti-BP180 antibody titer, and safety for a period of 57 days as secondary endpoints. Results We enrolled 56 patients in this study. The DAS15 was 12.5 points lower in the IVIG group than in the placebo group (p = 0.089). The mean DAS of the IVIG group was constantly lower than that of the placebo group throughout the course of observation, and a post hoc analysis of covariance revealed a significant difference (p = 0.041). Furthermore, when analyzed only in severe cases (DAS ≥ 40), the DAS15 differed significantly (p = 0.046). The anti-BP180 antibody titers showed no difference between the two groups. Conclusion IVIG provides a beneficial therapeutic outcome for patients with BP who are resistant to steroid therapy.

To clarify the prevalence of skin disorders among dermatology patients in Japan, a nationwide, cross-sectional, seasonal, multicenter study was conducted in 69 university hospitals, 45 district-based pivotal hospitals, and 56 private clinics (170 clinics in total). In each clinic, information was collected on the diagnosis, age, and gender of all outpatients and inpatients who visited the clinic on any one day of the second week in each of May, August, and November 2007 and February 2008. Among 67,448 cases, the top twenty skin disorders were, in descending order of incidence, miscellaneous eczema, atopic dermatitis, tinea pedis, urticaria/angioedema, tinea unguium, viral warts, psoriasis, contact dermatitis, acne, seborrheic dermatitis, hand eczema, miscellaneous benign skin tumors, alopecia areata, herpes zoster/postherpetic neuralgia, skin ulcers (nondiabetic), prurigo, epidermal cysts, vitiligo vulgaris, seborrheic keratosis, and drug eruption/toxicoderma. Atopic dermatitis, impetigo, molluscum, warts, acne, and miscellaneous eczema shared their top-ranking position in the pediatric population, whereas the most common disorders among the geriatric population were tinea pedis, tinea unguium, psoriasis, seborrheic dermatitis, and miscellaneous eczema. For some disorders, such as atopic dermatitis, contact dermatitis, urticaria/angioedema, prurigo, insect bites, and tinea pedis, the number of patients correlated with the average high and low monthly temperatures. Males showed a greater susceptibility to some diseases (psoriasis, erythroderma, diabetic dermatoses, inter alia), whereas females were more susceptible to others (erythema nodosum, collagen diseases, livedo reticularis/racemosa, hand eczema, inter alia). In conclusion, this hospital-based study highlights the present situation regarding dermatological patients in the early 21st century in Japan.

It has not been confirmed whether tight junctions (TJs) function as a paracellular permeability barrier in adult human skin. To clarify this issue, we performed a TJ permeability assay using human skin obtained from abdominal plastic surgery. Occludin, a marker protein of TJs, was expressed in the granular layer, in which a subcutaneously injected paracellular tracer, Sulfo-NHS-LC-Biotin (556.59 Da), was halted. Incubation with ochratoxin A decreased the expression of claudin-4, an integral membrane protein of TJs, and the diffusion of paracellular tracer was no longer prevented at the TJs. These results demonstrate that human epidermis possesses TJs that function as an intercellular permeability barrier at least against small molecules (∼550 Da). UVB irradiation of human skin xenografts and human skin equivalents (HSEs) resulted in functional deterioration of TJs. Immunocytochemical staining of cultured keratinocytes showed that occludin was localized into dot-like shapes and formed a discontinuous network when exposed to UVB irradiation. Furthermore, UVB irradiation downregulated the active forms of Rac1 and atypical protein kinase C, suggesting that their inactivation caused functional deterioration of TJs. In conclusion, TJs function as a paracellular barrier against small molecules (∼550 Da) in human epidermis and are functionally deteriorated by UVB irradiation.

An 86-year-old Japanese man was referred to our department with a history of indurated masses growing rapidly on the face over the preceding few weeks. Three years earlier, the patient had undergone transrectal ultrasonography (TRUS)-guided prostate needle biopsy and had been diagnosed with prostate cancer (well-differentiated adenocarcinoma with positivity for androgen receptor (AR), Gleason score: 3 + 4 = 7, T3aN0M0 stage C1). He had declined radical prostatectomy due to his advanced age, and [...]

Background: Heat shock transcription factor 1 (HSF1) is a major transactivator of genes coding for heat shock proteins (Hsps). Recent studies demonstrate that HSF1 is involved in tumor initiation, maintenance, and progression by regulating the expression of Hsps and other molecular targets. However, the role of HSF1 in melanoma is largely unknown. Objective: The aim of this study is to analyze the role of HSF1 in melanoma. Methods: We used short hairpin RNA (shRNA) to silence HSF1 in the human melanoma MeWo cell line and investigated its effect on cell proliferation and in the efficacy of chemotherapy, hyperthermia and thermochemotherapy. Results: We found that proliferation of MeWo cells treated with HSF1 shRNA was markedly reduced, and this was associated with a G1 block of the cell cycle, whereas HSF1 shRNA treatment of normal human keratinocyte HaCat cells had no effect on proliferation. Suppression of cell proliferation by silencing HSF1 was also observed in other melanoma cell lines, HMV-I and HMV-II. Furthermore, silencing HSF1 enhanced the sensitivity of MeWo cells to heat shock, yet did not affect their sensitivity to treatment with dacarbazine. Conclusion: These findings show that HSF1 is required for normal growth and survival of melanoma cells under heat shock conditions, and suggests that HSF1 is a promising therapeutic target in melanoma. 2010 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.

症例1 : 3ヵ月, 女児。生直後から背部, 右大腿部に拇指頭大までのそう痒を伴う褐色斑および水疱が出現し, 顔面, 四肢にも同様の皮疹が拡大した。Darier徴候は陽性であった。抗アレルギー薬の内服とmediumクラスのステロイド外用剤で加療。その後9ヵ月を経た現在, 褐色斑の新生はなく, 個疹は消退傾向を示す。症例2 : 1歳9ヵ月, 男児。生後7ヵ月頃より腹部にそう痒を伴う小指頭大までの褐色斑が出現した。体幹および四肢に拇指頭大までの褐色斑が孤立性に散在しており, Darier徴候は陽性であった。Mediumクラスの外用剤のみで治療を行い, 個疹は徐々に消退傾向を示す。病理組織学的に, 2例ともに真皮乳頭層を中心に明るい胞体を有した類円形の細胞が帯状に浸潤し, リンパ球や少数の好酸球を混じていた。Toluidine blue染色にて, 豊富な細胞質を有した浸潤細胞は細胞質内顆粒の異染性を示したことから, 肥満細胞症と診断した。皮疹部組織を検体としたc-kit 遺伝子変異の検索では, 症例2にのみ, 816番目のアミノ酸がアスパラギン酸(GAC)からバリン(GTC)への点突然変異を認めた。816番目の点突然変異は成人例での報告が多く, 小児例の本邦報告例は自験例を含め13例と比較的少なかった。

We assessed the safety and efficacy of pulse therapy with terbinafine tablets in 55 patients with dermatophytic onychomycosis. One pulse consisted of oral terbinafine tablets (500 mg day(-1)) given for 1 week usually followed by a 3-week interval. This regimen was repeated twice. Topical 1% terbinafine cream was applied daily. Efficacy was assessed based on both clinical and mycological examinations 1 year after treatment initiation. We observed a complete cure in 41 patients (74.5%), marked improved in three patients (5.6%), slight improvement in three patients (5.6%) and drop out in six patients (10.7%). Two patients (3.6%) discontinued terbinafine because of gastrointestinal disturbance (one patient) and drug-induced eruption (one patient). No patient had abnormal laboratory findings, including liver function tests. In summary, a regimen of three pulses of terbinafine therapy given daily for 1 week in combination with topical application of terbinafine cream appears to be safe and effective in treating dermatophytic onychomycosis and offers advantages in convenience and cost-effectiveness compared with continuous dosing.

Genetic differences are involved in the development of lupus erythematosus (LE). Skin lesions are influenced by environmental triggers such as ultraviolet light, temperature, and chemical stresses, and the patterns of skin lesion are variable in cutaneous LE such as systemic LE (SLE), chronic discoid LE (CDLE), subacute cutaneous LE (SCLE), and LE tumidus (LET). Although there are a few conflicting reports, many Japanese dermatologists feel there are photosensitivity differences in lupus erythematosus between Asian and Caucasian subjects with SCLE and LET. HLA studies in Japanese subjects revealed that HLA-DRB1*1501 association was with both CDLE and SLE. The association between HLA-Cw6 and CDLE was first reported in Japanese population, and a HLA-A33-B44-DRB1*1302 haplotype showed a positive association in CDLE. However, these results are not compatible with those from Caucasian subjects. There are no significant associations among HLA studies, photosensitivity, and anti-Ro/SS-A antibodies in Japanese CLE patients. Photosensitivity will be a key factor to dissolve multi-factorial complexes of LE etiopathogenesis. Our present understanding is that an axis of photosensitivity, anti-Ro/SS-A antibodies and apoptosis via TNF are the best (markers) to verify the contribution of genetics in SCLE, LET, and other CLEs. The incidence and photosensitivity of SCLE and LET are much lower in Japanese than in Caucasian subjects. However, this discrepancy may open the window for investigating CLE pathogenesis through global collaborations. For this purpose and goal, a new and more conventional method should be developed for the examination of so-called photosensitivity.

医療安全を推進していくことは，良質な医療を患者に提供する上で極めて重要である．現在の医療安全対策が十分でないということも周知のことである．ここでは，インシデントレポート等でよくみられる与薬および注射に関する話題を取り上げ，そこに潜む問題点を抽出し，対応策について論じる．.

Radiation recall dermatitis (RRD) is an inflammatory reaction limited to previously irradiated areas and occurs following the subsequent administration of a drug [1]. Herein, we present a patient with severe RRD associated with pain and necrosis.

54歳，女性。母および姉に神経線維腫症あり。幼少期よりcafe au lait斑を全身に認め，思春期頃より徐々にくるみ大までの半球状に隆起した腫瘤が全身に多発してきた。初診の1年前より背部の腫瘤が急速に手拳大まで増大したため受診。術前胸部レントゲン検査にて胸腔内腫瘤を認め，胸部CT検査及び胸腔穿刺にて胸腔内髄膜瘤と診断した。神経線維腫症では，脊椎の変形を合併しやすく，そのために生じた脊柱の構造上の変形が，髄膜瘤の発生に関与すると考えられ，自験例においても後側弯の著しい部位に一致して胸腔内髄膜瘤の合併を認めた。日常診療で，神経線維腫症患者を診察する際，脊椎変形を合併している症例については，併せて胸部レントゲン検査を行い，髄膜瘤の有無について検討する必要もあると考えられた。

According to a recent classification, self-healing papular mucinosis (SHPM) is a subtype of papular mucinosis (also known as lichen myxedematosus), which is in turn a type of idiopathic localized cutaneous mucinosis. SHPM tends to occur in children, but there have been a few reports of an adult type. We report a 70-year-old Japanese woman who presented with reddish, rice-kernel-sized papules of a few days' duration on her right arm. She had a 25-year history of rheumatoid arthritis, which had been well treated with a low dose of corticosteroid as well as some other medications. No paraproteinemia or thyroid dysfunction were observed. The eruptions spontaneously resolved within 2.5 months of onset. Histological findings showed a well-circumscribed mucinous stroma surrounded by dermal mesenchymal cells, such as fibroblast-like cells in the middle of the dermis. Immunohisto-chemically, these cells were positive only for vimentin on the mucinous lesion. On the circumference of the mucinous lesion, these cells expressed either CD34 or factor XIIIa (FXIIIa). Because vimentin was common to dermal mesenchymal cells, we defined the cells expressing CD34 or FXIIIa, except for vimentin+ cells lacking CD34 or FXIIIa, as dermal dendritic cells (DDC). The findings of the present case suggest that CD34+ or FXIIIa+ DDC and tryptase-positive mast cells on the perilesional area in combination with vimentin+ cells on the mucinous lesion might have given rise to the dermal deposition of mucin in our case. These cells, which are possibly activated in an autoimmune manner associated with rheumatoid arthritis, might play important roles in the development of dermal deposition of mucin in SHPM.

29歳，女性。2003年10月下旬より発熱，頭痛が出現した。同年11月下旬より四肢末梢に出没を繰り返す有痛性の紫斑が同部位の腫脹を伴って出現した。山口県立中央病院(現山口県立総合医療センター)内科で不明熱および貧血の精査中であったが，皮疹について12月上旬，同院皮膚科紹介となった。血液検査所見では，好中球増多を含む炎症所見を認めた。初診時，左I・II趾腹側，左拇趾球に有痛性の紫斑を認め，塞栓症あるいは血管炎を考え生検を施行した。病理組織学的に真皮浅層から脂肪織にかけて核塵を伴う好中球主体の炎症細胞浸潤と比較的大きな血管に塞栓像を認めた。その3週間後，心エコー検査にて僧房弁に疣贅形成を認め，血液培養にてStreptococcus mitis(Streptococcus viridans属)が検出されたことより，感染性心内膜炎の診断に至った。自験例のように，皮膚症状の出現は，感染性心内膜炎の診断に極めて有用であり，皮膚科医は本疾患に伴う様々な皮疹を熟知しておく必要がある。

Despite the fact that cutaneous sinus tracts of odontogenic origin are well documented, the condition is still commonly misdiagnosed, because chronic periapical periodontitis may be asymptomatic and is rarely open to the skin. A 75-year-old Japanese woman presented to our clinic with the chief complaint of a left cheek skin lesion with mild pain. Physical examination revealed a subcutaneous nodule covered with erythematous skin on her left buccal region. Cultures from the subcutaneous nodule grew Bacteroides species and Peptostreptococcus micros but did not yield acid-fast bacilli, fungi, or Actinomyces. Stains of smeared pus showed a considerable number of Gram-negative rods. The histopathological examination revealed a focal abscess formation in the lower dermis and subcutaneous tissue. Dental evaluation, including an orthopantogram, showed a radiolucent alveolar area at the left lower first molar apex, suggesting a periapical abscess. Antibiotic therapy for three weeks associated with surgical root canal therapy eliminated the subcutaneous nodule. A high degree of suspicion is required to correctly diagnose a lower facial lesion as being of odontogenic origin, and prompt dental evaluation should be considered.

Nitric oxide (NO) and reactive nitrogen species (RNS) have been implicated in the pathogenesis of inflammatory diseases. However, the involvement of NO and RNS in atopic dermatitis (AD), a pruritic inflammatory skin diseases, is not fully understood. In this study, we investigated the contribution of NO and RNS to the development of AD-like skin lesions in NC/Nga mice, an animal model for human AD. AD-like skin lesions were observed in NC/Nga mice kept under conventional conditions but not in specific pathogen-free conditions. The expression of inducible NO synthase (iNOS) and endothelial NOS (eNOS) proteins was upregulated in the dermal lesions, and that of neuronal NOS (nNOS) was downregulated in the epidermal lesions of the skin. Although the concentrations of NO2(-) and NO3(-) were lower, protein-bound nitrotyrosine content was significantly increased in the skin lesions. Immunohistochemical localization of nitrotyrosine was observed in almost all eosinophils. These results suggest that RNS formation in eosinophils and imbalance of NO metabolism are involved in the pathogenesis of AD-like skin lesions in NC/Nga mice.

Summary Background and objective: Yusho occurred in western Japan in 1968 and was caused by ingestion of rice bran oil that was contaminated with polychlorinated biphenyls (PCBs) and dioxins such as polychlorinated dibenzofurans (PCDFs). At that time, the skin symptoms presented by patients with Yusho were at their most prominent and worst severity. Analysis of blood to determine the concentration of dioxins started in 2001 in Fukuoka prefecture, and in 2002 the examination was performed throughout Japan. There have been no reports on the relationship between blood concentration of dioxins and skin symptoms in Yusho. This is the first report to examine the relationship between blood concentration of dioxins and skin symptoms in Yusho, using statistical analyses. Methods: Using the global skin severity grade, we analyzed the change in skin symptoms, which were examined at the annual medical check-up of patients with Yusho. We also investigated the relationship between the items of the annual dermatological examination and blood concentrations of total PCDFs and total PCBs. Results: The severity of skin symptoms improved significantly in the first 20 years; nowadays, however, further improvement can hardly be observed. Using three-way analysis of variance (ANOVA), we found that of the 21 items of the dermatological examination, nine were significantly related to total PCDFs, and five were related to total PCBs. Only one item was significantly related both to total PCDFs and total PCBs. Conclusion: More than 36 years have passed since the Yusho incident, and about 60% of the patients currently present with no skin symptoms. In contrast, in about 40% of the patients, characteristic skin symptoms of Yusho, such as pigmentation of skin, black comedones and acneform eruptions, could still be observed. Our analysis of the relationship between skin symptoms and blood concentrations of total PCDFs and total PCBs proves that not only PCBs but also PCDFs have an important role in the skin symptoms of Yusho.

28歳，男性。この4年間，尋常性乾癬の治療中。他医から尿道炎に対して処方された塩酸ミノサイクリン服用の約2時間後より両下肢に紅斑が出現し，全身に拡大した。39℃の発熱，頭痛，全身の潮紅を認めたため当科入院となった。入院翌日より全身に粟粒大の小膿疱が多数出現した。入院時の血液検査所見では，好中球増多を含む炎症所見を認めた。病理組織学的には典型的な角層下膿疱，表皮突起の棍棒状延長，真皮浅層の血管周囲性にリンパ球，好中球，わずかに好酸球の浸潤を認めた。以前にも同様の症状経過を繰り返し，薬剤摂取が誘因と考えられた。塩酸ミノサイクリンの貼付テスト，DLSTはいずれも陰性。内服テストで小膿疱の再現がみられ，急性汎発性発疹性膿疱症(acute generalized exanthematous pustulosis: AGEP)と診断した。本症例では，膿疱性乾癬，薬剤による尋常性乾癬の増悪との鑑別を要した。

To elucidate the association between killer cell immunoglobulin-like receptors (KIRs) and psoriasis vulgaris (PV), we typed 14 KIR genes in 96 Japanese cases and 50 healthy controls using PCR with sequence-specific primers (PCR-SSP). Here we report an interesting association between certain KIRs and Japanese cases with PV. The frequencies of KIR2DS1 and KIR2DL5 were significantly increased in PV cases compared with controls (KIR2DS1, 43 of 96 (45%) in cases vs 14 of 50 (28%) in controls; KIR2DL5, 46 of 96 (48%) in cases vs 15 of 50 (30%) in controls, p

An 85-year-old Japanese woman sought a dermatologic consultation for evaluation of a walnut-sized alopecia with pityroid desquamation in the parietal region of her scalp. She had been admitted to a nursing home about three months earlier, and, at that time, a thumb-tip-sized, scaly alopecia was noted. Several hairs at the site were eroded in a black dot. Direct KOH microscopy of affected hair showed large spore endothrix infection. To isolate macro- and microconidia for fungal identification, we incubated the affected hair and scales and obtained giant colonies in a special enriched medium. Using Fungi-tape and MycoPerm-Blue, we were able to collect and identify Trichophyton violaceum macro- and microconidia from the white, powdery, fluffy colony that slowly developed after about six weeks of growth on enriched medium. Over the past 20 years, only about 20 cases of tinea capitis caused by T. violaceum have been reported in Japan, and macroconidia have been identified in only 4 cases, including this one.

山口大学医学部附属病院女性診療外来では, 女性のための, 女性医師および女性スタッフによる診療を行っている。当院で女性診療外来が開設された2003年3月から9月末までの6カ月間に皮疹を主訴として受診した患者総数は35名であり, 女性診療外来全体の新患者数302名のうち12%を占めていた。年齢分布は16歳から76歳であった。一人の患者が複数の皮膚疾患を有していることが多く (35名中20名), のべ疾患総数は62疾患であった。疾患別にみると, 湿疹・皮膚炎(37%), 腫瘍(16%), 脱毛症(10%), ざ瘡, 真菌症(各8%), ウイルス感染症, 膠原病, 色素異常症(各3%)の順で皮疹以外の疾患(11%)もあった。発症部位別頻度では, 頭部・顔面が38%と最多で, 次いで鼠径部・外陰部・臀部および乳房部が31%を占めていた。悪性疾患や急性期の疾患は少ないものの, 整容的に問題となる部位や外陰部・乳房など女性特有の部位の疾患が多かった。女性外来における皮膚科医の役割は少なくないものと考えられた。

62歳, 女性。口腔内の広範囲な糜爛および体幹, 四肢の多形滲出性紅斑様の皮疹を主訴に受診。ラット膀胱切片を用いた蛍光抗体間接法, 免疫ブロット法, 免疫沈降法の結果からparaneoplastic pemphigusと診断した。発症1カ月後に原因不明の労作時呼吸困難が出現。その後の経過でPaO2の著明な低下を認め, 閉塞性細気管支炎様症状と考えた。ステロイド内服治療にて皮膚症状は改善したが, 粘膜症状は不変であった。呼吸障害にはステロイドパルス療法, シクロスポリン内服, 血漿交換療法を試みたが, 徐々に進行。CO2ナルコーシスとなり, 発症8カ月後に死亡した。剖検にても腫瘍性病変は検出できなかった。

An epidemiological investigation was conducted to determine the prevalence and circumstances of untreated, unsuspected tinea pedis and tinea unguium, morbid conditions that could be termed occult athlete's foot, in patients visiting a dermatology clinic in Tokyo, Japan, for the first time, for other complaints. All subjects completed a questionnaire covering comprehensive anamnestic details, and were examined for disposition of toes, presence of signs suggestive of tinea pedis, other diseases of the foot, score of clinical signs and symptoms, potassium hydroxide (KOH) test, severity score, and mycological culture. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as age, disposition of toes, and predisposing disease.

The patient was a 48-year-old man who had a history of colonic polyps. About 18 months before, a dark reddish nodule had appeared on his right forearm. By peripheral growth, this lesion had formed a crateriform prominence with central healing. Similar symptoms multiplied and expanded, the largest being about the size of a child's head. Given both the clinical and histologic evidence, a diagnosis of keratoacanthoma centrifugum marginatum (KCM) was made. Oral etretinate was administered, and an involution of verrucous plaque began after 4 weeks. After 8 weeks, the lesions faded, leaving pigmentation in some areas. This is a rare disorder, only 30 such cases having been reported worldwide, and the present case was the third in which oral etretinate was found to be effective. (J Am Acad Dermatol 2003;48:282-5.)

62歳,女性。22歳時に腎孟腎炎を繰り返し慢性腎不全へ移行,30歳より腎性心不全,47歳より腹膜透析開始,59歳より腎性糖尿病で各々加療中であった。初診の2ヵ月前に口腔内にびらんが生じ,1週間前から体幹にそう痒を伴う小豆大までの紅斑が出現し,当科外来を受診。その後四肢に水疱が多発したため,初診の2週間後に当科入院。病理組織学的に水疱性類天疱瘡(以下BP)と診断。ステロイドの全身投与を開始したが,心不全·腎不全の増悪を来した。二重膜濾過法血漿交換を6回施行し,水疱は足背に限局するのみとなった。同時期より血小板数が減少し,抗血小板抗体(anti-platelet-associated IgG)が高値を示したことから,特発性血小板減少性紫斑病(以下ITP)を併発したと考えた。その後直腸潰瘍から大量出血を来したうえ,MRSA腹膜炎を併発し,敗血症に陥った。汎血球減少,フェリチン高値に加え,骨髄での血球貪食像がみられ,血球貪食症候群(hemophagocytic syndrome以下HPS)と診断した。抗生剤の全身投与及び腹腔内投与,ステロイドパルス,免疫グロブリンの大量投与を行ったが改善せず,初診より3ヵ月後に永眠された。自験例のBPは,背景に慢性腎不全があり腹膜透析加療中であったこと,ITPを合併したこと,HPSを来したことが特徴的であった。

症例は35歳,女性,主婦。約2週間前に鼻根部付近に示指頭大の比較的境界明瞭な同心円状の紅斑,丘疹が出現し,次第に皮疹は拡大した。初診時鼻根部付近に胡桃大の境界不明瞭な紅斑丘疹病変を認め,KOH陽性,体部白癬と診断した。同時期ペットのチンチラ(Chinchilla laniger)に脱毛斑があり,両者より皮膚糸状菌を分離し,発育性状からTrichophyton(以下T.)mentagrophytesと同定した。本分離株は,核リボゾームRNA遺伝子におけるinternal transcribed spacer 1(ITS 1)領域の塩基配列の解析により,Arthroderma vanbreuseghemiiと再同定された。治療はイトラコナゾール内服にて患者およびチンチラのいずれも治癒した。ここ数年ペット,特に齧歯類から感染したと推測されるT. mentagrophytes complexによる白癬の報告が散見されており,このようなケースではペットが感染源である可能性を考え,積極的に真菌検索を進めることが重要であると考えた。

Yusho was a mass food poisoning event due to the ingestion of rice oil contaminated with polychlorinated biphenyls (PCBs) and various dioxins and dioxin-like compounds. At its outbreak in 1968, Yusho patients suffered severe skin symptoms. Although the blood concentrations of PCBs and dioxins, especially highly toxic 2,3,4,7,8-pentachlorinated dibenzofuran (2,3,4,7,8-PeCDF) remain high in these patients, extensive analysis has not been performed on their current skin symptoms. We categorized and evaluated the specific skin symptoms in Yusho in 2012 by grading their severity using an arbitrary scoring system, and analyzed their correlations with the blood concentrations of 2,3,4,7,8-PeCDF and PCBs. A total of 352 Yusho patients underwent annual dermatological check-ups, in which five skin symptoms: black comedones, acneiform eruptions, scar formation, pigmentation and nail deformity, were evaluated for their distribution and severity. Approximately one-third of Yusho patients still presented with black comedones, acneiform eruptions and scar formation; the distributions of these symptoms were similar to those at the time of the Yusho outbreak. The mean blood concentrations of 2,3,4,7,8-PeCDF and total PCBs in Yusho patients were still higher than those in controls. The prevalence and severity of black comedones were correlated with age. Severity scores of black comedones and scar formation were positively correlated with 2,3,4,7,8-PeCDF blood level, and those of black comedones, scar formation, and pigmentation were positively correlated with total PCBs blood level. This study suggests that 2,3,4,7,8-PeCDF and PCBs remaining in Yusho patients still play crucial roles in the development of skin symptoms in Yusho.

The skin surface is colonized by a wide variety of fungi and bacteria. While many of these organisms, including Malassezia, Candida, Streptococcus and Staphylococcus species, are associated with provocation and/or exacerbation of psoriasis, a detailed analysis of the cutaneous fungal microbiome in psoriatic patients has yet to be performed. To identify the disease-specific fungal microbiota on psoriatic scale samples, fungal rRNA gene sequences from 12 psoriatic patients and 12 healthy controls were analyzed by pyrosequencing. A total of 317 806 high-quality sequences were obtained, representing 142 genera. Malassezia species were the most abundant sequences in both populations (46.9 ± 14.0% in psoriasis vs. 76.0 ± 14.6% for healthy controls). Principal coordinate analysis revealed that the fungal microbiomes were independent. Although an association between the cutaneous fungal microbiome and psoriasis has yet to be established, our data indicate that the microbiome in patients with psoriasis is independent of that in healthy controls.

Heat shock factor 1 (HSF1) is a major transactivator of the heat shock response. Recent studies have demonstrated that HSF1 is involved in tumor initiation, maintenance, and progression by regulating the expression of heat shock proteins (HSPs) and other molecular targets. Furthermore, HSF1 was identified as a potent proinvasion oncogene in human melanomas. However, the biological functions of HSF1 in human melanoma remain poorly understood. To determine the functional role of HSF1 in melanoma, we used short hairpin RNA (shRNA) to silence HSF1 in human melanoma cell lines and investigated its effect on cell migration and invasive ability in vitro. We found that HSF1 knockdown led to a marked reduction in migration and invasive ability, and these functions were restored by overexpression of wild-type HSF1. To confirm the in vitro results, we performed subcutaneous xenograft experiments in athymic nude mice. We found that HSF1 was required for melanoma invasion and metastasis, as well as tumorigenic potential in vivo. Overall, these results show that HSF1 is indispensable for melanoma progression and metastasis, and suggests that HSF1 could be a promising therapeutic target for melanoma.