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A 78-year-old man presented with cutaneous blisters of the limbs and abdominal distension. He had been treated for various diseases, including liver cirrhosis. He had begun receiving sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, for diabetes mellitus three years before the hospitalization. A skin biopsy demonstrated bullous pemphigoid. Ultrasonography (US) revealed multiple liver tumors, although he had been receiving regular US studies. We stopped sitagliptin and started insulin and corticosteroids. However, his renal dysfunction progressed, and he died 14 days after the hospitalization. We should therefore be careful of various complications, including bullous pemphigoid and progression of tumors, when using DPP-4 inhibitors.

The anti-inflammatory effect of omega 3 polyunsaturated fatty acids has been confirmed in various inflammatory disease models. Maresin-1 (MaR1) is a lipid mediator derived from the omega-3 fatty acid docosahexaenoic acid (DHA) that has displayed strong anti-inflammatory effects in various inflammatory disease models. However, the effect of topical MaR1 on cutaneous inflammation remains unclear. Therefore, we initially examined the anti-inflammatory effects of topical Maresin-1 using an imiquimod (IMQ)-induced psoriasis-like mouse model of inflammation. Topical MaR1 reduced the ear swelling response as seen in histological findings. RT-PCR and flow cytometry analyses revealed MaR1 had no inhibitory effect on IL-23, but MaR1 suppressed IL-17A production by γδTCRmid+ and CD4+ cells in the skin. These inhibitory effects were also observed in a subcutaneous IL-23-injected psoriasis model. MaR1 downmodulated IL-23 receptor (IL-23R) expression by suppressing retinoic acid-related orphan receptor γt (RORγt) expression and internalization in a clathrin-dependent manner in γδTCRmid+ and CD4+ cells. These results lead to assumptions that topical MaR1 may be a new therapeutic agent for psoriasis and other IL-17-mediated cutaneous inflammatory diseases.

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.

Doripenem is a carbapenem antibiotic drug with a strong bactericidal activity against many Gram-negative bacteria [1]. While doripenem is widely used for the treatment of various infectious diseases, only one report of drug eruption caused by doripenem has been reported, manifesting with Stevens-Johnson syndrome [2]. Herein, we report a case of doripenem-induced maculopapular drug eruption. We also review the reported cases of drug eruptions caused by carbapenem antibiotics.A 60-year-old man suffered [...]

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.

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 [...]