- [Show abstract] [Hide abstract] ABSTRACT: A 63-year-old healthy female patient presented with well defined itchy erythematous lesions on the area of her eyebrows. Her eyebrows had been tattooed two months before her visit to us. The lesions had previously been treated by application of steroid ointment and anti-histamine and steroid tablets by mouth without success. We suspected the lesions to be contact dermatitis caused by some metal element contained in the dye used for tattooing. Treatment was continued for two weeks, but the lesions spread to her cheeks and forehead. No fungal element was found from the lesions by direct microscopy at this stage. The patch-testing to 20 metal substances on her skin showed no allergic reaction. After one more week of treatment, we reexamined the scale taken from the lesions by direct microscopy, and fungal elements were found at that time. Microsporum (M.) gypseum was isolated from the scale taken from the lesions. The lesions cleared after treatment of 11 weeks' oral intake of itraconazole 100mg daily.It was found that the patient was accustomed to sleep with her dog, a Chihuahua. On examination by a veterinarian, no skin lesions were found on the dog. We speculate that the paws of the dog might have carried soil contaminated by M. gypseum, a geophilic fungus, to the area of her eyebrows which had minor trauma after being tattooed.
- [Show abstract] [Hide abstract] ABSTRACT: We report two cases of candidal onychomycosis with severe nail deformities. Case 1: The patient was an 81-year-old man who complained of onycholysis and nail deformity of the right forefinger nail which had occurred over a period of a year. He had no obvious previous illness. Case 2: The patient was an 81-year-old woman who complained of nail deformity with periungual erythema which had occurred over a period of several months. She had been treated with oral corticosteroid for bronchial asthma and with Ca blocker for hypertension for a long period. The initial KOH-prepared direct microscopy in each case failed to detect any spores or pseudohyphae. Therefore, an incisional biopsy was performed in both cases. Histopathological findings demonstrated numerous fungal elements with similar appearance of dermatophytes in the middle to lower level of the horny cell layer by PAS and Grocott staining in each case. Candida albicans was isolated and identified by cultivation on ATG agar. In case 1, oral itraconazole (100 mg/day) was administered for 14 weeks, which was effective clinically and mycologically. In case 2, however, a coadministered drug (Ca blocker), oral terbinafine (125 mg/day) was not effective mycologically. Therefore, after having changed the antihypertensive agent, oral itraconazole (100 mg/day) was administered for 16 weeks, which was effective clinically and mycologically.
- [Show abstract] [Hide abstract] ABSTRACT: We report a case of inflammatory tinea corporis by Epidermophyton ( E. ) floccosum. A 73-year-old man visited our hospital with an eruption on his left arm where he wore his wristwatch. He had treated himself with a topical steroid. On KOH preparation, many hyphal elements were observed in the scale. Histological findings revealed granulomatous inflammation around hair follicles and positive fungal elements by PAS and Grocott staining in these follicles. Topical luliconazole and oral terbinafin were effective clinically and mycologically. Epidemiological survey in Japan has shown the number of cases of tinea caused by E. floccosum to be on the decrease recently. The anthropophilic dermatophyte, E. floccosum is known usually not to invade the hair follicle, and no case of inflammatory tinea corporis by this species has been reported in Japan. We consider this case of inflammatory tinea corporis due to E. floccosum to be very rare.
- [Show abstract] [Hide abstract] ABSTRACT: We herein report a case of tinea capitis initially showing a couple of nodular lesions. The patient was a 66-year-old woman who had seen a nearby dermatologist for itching on her head and had been treated with a topical steroid followed by tacrolimus application for one month. Because pseudolymphoma-like erythematous nodules developed at two sites, she visited us. Two weeks after stopping all medication, some slight scaling was found around these nodules. On KOH direct microscopic examination, many filamentous elements around hair shafts were observed. Biopsy of the nodules confirmed the destruction of hair follicles surrounded by granulomatous inflammation histologically. Grocott staining of the same specimen revealed a few short fungal hyphae as well as spores. She was also diagnosed as tinea pedis by direct microscopic examination of her feet. Trichophyton rubrum was isolated from scales of both her head and feet on Sabouraud's dextrose agar at 25 degrees C. Kerion celsi (KC) is usually clinically preceded by a gray patch or black dots. Such a typical course of KC, however, was not observed in our patient. Tacrolimus was thought to have possibly played an important role in modifying tinea capitis.
- [Show abstract] [Hide abstract] ABSTRACT: Kindler syndrome is an autosomal recessive disorder characterized by neonatal blistering, sun sensitivity, atrophy, abnormal pigmentation, and fragility of the skin. Linkage and homozygosity analysis in an isolated Panamanian cohort and in additional inbred families mapped the gene to 20p12.3. Loss-of-function mutations were identified in the FLJ20116 gene (renamed "KIND1" [encoding kindlin-1]). Kindlin-1 is a human homolog of the Caenorhabditis elegans protein UNC-112, a membrane-associated structural/signaling protein that has been implicated in linking the actin cytoskeleton to the extracellular matrix (ECM). Thus, Kindler syndrome is, to our knowledge, the first skin fragility disorder caused by a defect in actin-ECM linkage, rather than keratin-ECM linkage.
- [Show abstract] [Hide abstract] ABSTRACT: We report two cases of tinea capitis by Microsporum (M) ferrugineum. A two year old boy (case 1) visited our hospital 3 months after his return from Myanmar. About a year later, we observed the same symptom on the scalp of his mother (case 2). In both cases itraconazole was effective clinically and mycologically. In Japan, although M. ferrugineum was the most common organism of tinea capitis before the 1960s, no cases of tinea are found caused by this species nowdays. We believe these cases to have been infected in Myanmar, and suggest the possibility that tinea caused by M. ferrugineum may become a re-emergent infection or an imported fungal disease in Japan.
- [Show abstract] [Hide abstract] ABSTRACT: We herein report three cases of localized multiple neurofibromas; Case 1 was a 65-year-old woman with soft light brown nodules localized on the right side of her forehead. Case 2 was a 75-year-old man with soft light brown nodules on two different sites. One site was the right nape while and the other was in the right lower back region. Case 3 was a 51-year-old woman who presented with soft normal colored nodules on her occipital region and right submandibular region. In all cases, the nodules were limited to the previously described body regions. No cases had cafe-au-lait macules or fleckling on their lesions, nor on any parts of their bodies. In all cases, the family history was negative for any similar skin disease, and histopathological examinations revealed those soft nodules to be neurofibromas. In addition, osteomas were found close to the masses of neurofibroma in Case 1. This disorder has been suggested to possibly be a variant of neurofibromatosis. Though there are no reports of gene abnormality of localized multiple neurofibromas, in the future NF1 gene abnormality might be shown to be associated with localized multiple neurofibroma. As a result condition is considered to be an instance of mosaicism of neurofibromatosis (NF 1).
- [Show abstract] [Hide abstract] ABSTRACT: The possibility of one-week application of terbinafine cream for tinea pedis was studied in a double-blind test at four institutes, comparing four-week application as a control. Of a total of forty-three patients studied, nineteen were randomized into a four-week application group, Group I, and twenty into a one-week application group, Group II. Group I was evaluated as moderate to extremely useful in twelve (63.2%) of the nineteen patients and Group II in twelve (60.0%) of the twenty patients. No statistical differences were observed between two groups. These findings appeared to indicate that the short term, one-week application of terbinafine cream had results equivalent to the four-week application. This short-term treatment which aids in improving patient compliance and reducing the total amount of drug applied, thus lowering drug cost, is viewed as a useful way of treating tinea pedis.
- [Show abstract] [Hide abstract] ABSTRACT: We applied the freeze-substituion method to the detailed observation of the ascosporogenesis in Arthroderma simii. The ascospore formation of A. simii underwent the same processes as did that of other dermatophytes, namely an enveloping membrane system (EMS) composed of two invaginated unit membra-nes that delimit the daughter nuclei in the cytoplasm of the ascus. The inner lea-flet of the EMS was found to have changed into an ascospore plasma membrane, whereas the outer leaflet and intercisternal space became the ascos-pore cell wall. In the freeze-substituted asci, we could not observe the lomasomal structure thought to be the origin of the EMS in dermatophytes.
- [Show abstract] [Hide abstract] ABSTRACT: Kindler syndrome is a rare, inherited skin disease characterized by acral bullae formation, fusion of fingers and toes, and generalized progressive poikiloderma. The purpose of this study was to clarify the nature of the bullous component of Kindler syndrome and to determine whether this inherited skin disorder represents a variant of dystrophic epidermolysis bullosa or a unique independent clinical entity. Two unrelated patients with Kindler syndrome were studied. Electron microscopy demonstrated marked duplication of the lamina densa, and clefts were observed in areas where the lamina densa was destroyed or obscured. Hemidesmosomes and anchoring fibrils showed normal features. Indirect immunofluorescence revealed normal linear labeling with antibodies against hemidesmosomal components (alpha 6 and beta 4 integrins, BPAG1, and BPAG2) and against anchoring filament components such as uncein, as detected by the 19-DEJ-1 monoclonal antibody. However, antibodies against the 3 respective laminin 5 chains, type IV collagen, and various type VII collagen epitopes (the aminoterminal NC1 domain, the central triple helical collagenous domain, and the carboxyterminal end of the triple helical collagenous domain) revealed a broad reticular staining pattern. Molecular screening of the type VII collagen gene (COL7A1) in the patients and their parents by heteroduplex analysis failed to detect any band shifts indicative of pathologic mutations. These results suggest that the bullous component of Kindler syndrome is distinct from dystrophic epidermolysis bullosa caused by mutations in the type VII collagen gene. Additionally, the differential distribution patterns of uncein and laminin 5 in the patients' skin samples support the hypothesis that uncein and laminin 5 are different molecules.
- [Show abstract] [Hide abstract] ABSTRACT: A double-blind, comparative study on the usefulness of shampoo containing 0.75% miconazole nitrate (MZS) for the treatment of dandruff was conducted at 8 institutions, using the shampoo vehicle (BSS) without the reagent as the control. The relationship between improvement in clinical symptoms, such as dandruff and itching, and the decrease in the count of Malassezia furfur, that is, mycological response, was also studied. Of a total of 134 subjects studied, 58 were shampooed with MZS, and 50 with BSS. One hundred thirty of these were included in a safety analysis, and 108 in an efficacy and usefulness analysis. MZS was evaluated as useful in 34 (58.6%) of the 58, and BSS in 19 (38.0%) of the 50 subjects, thus MZS was significantly more useful than BSS (p = 0.020). Dandruff improved in 42 (72.4%) of the 58 with MZS, and in 26 (52.0%) of the 50 subjects with BSS, MZS significantly reduced the dandruff and thus was more effective than BSS (p = 0.017). With regard to the relationship between the mycological response of M. furfur and the efficacy of shampooing against dandruff, the count of M. furfur decreased significantly in the subjects for whom the shampooing was evaluated as effective (p = 0.0001), whereas there was no significant difference between the baseline and posttreatment counts in those for whom the shampooing was evaluated as ineffective. Stratification of results of efficacy evaluation according to the baseline count revealed that MZS was more effective than BSS in subjects with relatively high counts of M. furfur (p = 0.038). No adverse reactions to either shampoo were observed in any of the 130 subjects. The above results suggested that MZS is effective against dandruff, and further, that the usefulness of this shampoo shows a relatively close correlation between the improvement in dandruff and decrease in the count of M. furfur.
- [Show abstract] [Hide abstract] ABSTRACT: We report a case of a 32-year-old healthy woman with superficial hyperkeratotic candidiasis of the palms, a rare type of superficial candidiasis. She visited our hospital because she developed scaly erythema with hyperkeratosis on both palms. Application of a topical steroid as well as plastic gloves were considered to be contributing factors. Candida albicans (sero-type A) was isolated from scales of both palms. Direct examination using KOH on the first visit showed numerous hyphae but no spores that were not characteristic features of candidiasis, but on the second visit 2 weeks later, the topical steroid had stopped showed characteristic features of candidiasis. After treatment with oral itraconazole, direct examination method and culture of the palms became negative and the lesions were almost cured.
- [Show abstract] [Hide abstract] ABSTRACT: We describe a case of a 53-year-old Japanese female suffering from Sjögren's syndrome, systemic lupus erythematosus, and Hashimoto's thyroiditis who developed pustules, erythema, and erosions on her fingers and toes. The histological specimen showed psoriatic changes. Indirect immunofluorescent study using anti-human IL (interleukin)-8 antibody produced positive staining patterns in the lesional epidermis. These findings suggested the diagnosis of acral pustular psoriasis. Diaminodiphenylsulfone at 75 mg orally daily for 20 days and the application of 0.12% betamethasone valerate ointment led to gradual improvement.
- [Show abstract] [Hide abstract] ABSTRACT: The fungal elements observed by direct microscopic examination sometimes fail to grow on subsequent culture. To elucidate the cause of this discrepancy, the viability of dermatophytes and Candida in skin scales was evaluated by neutral red staining. Autoradiographic study using 3H-thymidine confirmed that grain-positive cells (viable cells) were stained with neutral red, whereas negative cells (non-viable cells) were not stained. Taking this as a baseline, the correlation between neutral red-positive fungal elements in scales taken from 211 patients with tinea and 27 patients with cutaneous candidosis and cultures on Sabouraud glucose agar was studied. Strong positive correlations were found in both mycoses. These findings suggest that neutral red staining provides a useful method for evaluating the viability of dermatophytes and Candida in human skin scales.
- [Show abstract] [Hide abstract] ABSTRACT: We describe an 82-year-old man with CD8+ lymphoepithelioid lymphoma localized to the skin. The skin lesion had been present for 18 years. Histologically there was a dense infiltrate that consisted of atypical lymphoid cells and large epithelioid cells, thereby resembling the so-called Lennert's lymphoma. Local radiotherapy proved effective in reducing the size of the tumor. To the best of our knowledge, this is the first report of primary lymphoepithelioid lymphoma of the skin.
- [Show abstract] [Hide abstract] ABSTRACT: Parapsoriasis en plaques (large-plaque type) is a premalignant condition capable of developing into cutaneous T-cell lymphoma (CTCL). However, it is not known whether the early stage of CTCL can be distinguished from parapsoriasis en plaques. Our purpose was to determine whether parapsoriasis en plaques can develop into CTCL. The clinical appearance, histopathologic features, immunophenotype, DNA rearrangements, and clinical course were analyzed in 20 cases. T-cell receptor beta-chain gene rearrangement was detected in four of the 20 cases. No clinical, histopathologic, or immunohistochemical differences were found between patients with and without gene rearrangement. The early stage of CTCL cannot be differentiated from parapsoriasis en plaques by clinical features, histopathologic characteristics, or immunophenotype. Patients with parapsoriasis en plaques exhibit heterogeneous findings, which may include monoclonal proliferation. Patients with long-standing parapsoriasis-like lesions resistant to conventional treatment require careful monitoring for the possible development of cutaneous lymphoma.
- [Show abstract] [Hide abstract] ABSTRACT: A malignant epithelioid schwannoma occurred on the right second toe of a 30-year-old Japanese man. It was a firm, flesh-colored, benign-appearing nodule and measured 13 x 9 mm in diameter and 6 mm in height. To our knowledge, this is the first case of malignant epithelioid schwannoma occurring on the toe. Histopathology was characterized by a circumscribed nodule in the dermis that predominantly consisted of atypical large epithelioid cells with some spindle cells whose proliferation was similar to that of the Verocay bodies seen in ordinary schwannoma. Fontana-Masson staining demonstrated no melanin pigment in the tumor at the light microscopic level. The eosinophilic cytoplasm contained abundant glycogen and was positive for S-100 protein and HMB-45, as usually seen in melanomas. Electron microscopy revealed that there was an abundance of long-spacing collagen in the extracellular matrix, and the cells contained numerous dense-cored granules. But no definite melanosomes were observed in any stage. As far as we are aware, this is the first case of a malignant epithelioid schwannoma showing HMB-45 positivity.
- [Show abstract] [Hide abstract] ABSTRACT: A clinical, histologic, and ultrastructural study of 32 cases of white fibrous papulosis of the neck was undertaken. Clinically, this condition is characterized by asymptomatic white papules that appear mainly around the neck in elderly persons. The papules are approximately 2 to 3 mm in diameter, round to oval, clearly marginated, and unrelated to the hair follicles. The major pathologic change revealed by light microscopic examination is a relatively circumscribed area of thickened collagen bundles in the papillary to mid dermis. Ultrastructurally, no remarkable morphologic change is seen in either the collagen or the elastic fibers, except for a variation in the diameters of collagen fibrils within the lesion compared with perilesional normal skin. White fibrous papulosis of the neck appears to be a new clinicopathologic entity, cases of which to date have been reported only in Japan.
- [Show abstract] [Hide abstract] ABSTRACT: Exophiala dermatitidis and Exophiala jeanselmei share similar morphological features and have been confused with each other. To clarify the relationship between the two fungi, we conducted a deoxyribonucleic acid (DNA)-DNA hybridization study using a dot blot method. Between E. dermatitidis and E. jeanselmei, only a very low level of DNA relatedness was seen and it was confirmed that these two fungi are distinct species based on DNA similarity. Close correspondence of DNA from the isolates of E. dermatitidis was obtained, whereas the isolates of E. jeanselmei were divided into 6 groups according to their DNA similarity and a possibility was shown that E. jeanselmei is composed of genetically heterogeneous groups. The subdivision of the species E. jeanselmei by the DNA-DNA hybridization method was in agreement with serotyping exoantigens. This result suggests that DNA-DNA hybridization studies provide an excellent tool for the identification and grouping of pathogenic dematiaceous fungi.
Kyoto Daini Red Cross HospitalKioto, Kyoto, Japan
Edo, Tōkyō, Japan
- Department of Dermatology