Scald-Induced Necrobiosis Lipoidica in a Patient with Diabetes Mellitus and Psoriasis.

The Koebner phenomenon (KP) was first introduced by Heinrich Koebner in the 1870s to describe the appearance of psoriatic lesions following trauma in psoriasis patients. KP has since been defined in numerous diseases, including necrobiosis lipoidica diabeticorum (NLD). Since most Koebnerized dermatological lesions can localise to a site of previous trauma, Weiss et al. (Eur Acad Dermatol Venereol 2002;16:241-248) classified them into four categories (I-IV) according to the Boyd-Nelder classification (Int J Dermatol 1990;29:401-410) system. In this system, necrobiosis lipoidica is classified as category III, which includes diseases that occasionally localise at the site of trauma. We report a case of NLD that developed after scald in a psoriasis patient. NLD after trauma has often been reported, but this is the first case of NLD that coincidentally occurred at a scald site in a psoriasis patient.

Lipodystrophia centrifugalis abdominalis infantilis: statistical analysis of 168 cases.

Lipodystrophia centrifugalis abdominalis infantilis is a localized lipodystrophic disease affecting young children. A total of 168 cases were collected from dermatology literature. Where possible, details of the data were also obtained from the authors. Most of the patients were Japanese, Korean, or Chinese in origin. The Caucasian patients were from England, Italy, France, Germany, Spain, and the United States. The male-to-female ratio was 1:1.6. The depressed lesions developed during the first 4 years of life in the groin or axilla, surrounded by a slight erythematous change. Histologically, subcutaneous fatty tissue was lost or markedly decreased in the depressed areas, and marked or moderate mononuclear cell infiltration was observed in the fatty tissue of the surrounding erythematous area. The depressed lesions extended centrifugally to involve the abdominal or chest walls. However, in most cases, such enlargement spontaneously ceased by the age of 13 years. No drugs used were effective in preventing the enlargement of depressed lesions, but more than 60% of patients showed spontaneous improvement after the cessation of enlargement. Lipodystrophia centrifugalis abdominalis infantilis is a clinically and histologically distinct lipodystrophic disease affecting young children, mostly in Asian countries, but a few in Western countries.

Association between erythropoietin requirements and antihypertensive agents.

BACKGROUND: Angiotensin-converting enzyme inhibitors (ACI) and angiotensin II receptor blockers (ARB) have been reported to increase recombinant human erythropoietin (rHuEPO) requirements. We performed a cross-sectional study to investigate an association of antihypertensive agents including these two with the rHuEPO dose in chronic hemodialysis patients. METHODS: We studied 625 patients undergoing hemodialysis therapy in 11 dialysis units. The association between the rHuEPO dose and antihypertensive agents was statistically analyzed. RESULTS: The mean hemoglobin (Hb) level and rHuEPO dose corrected by body weight were 10.5 g/dl and 95.2 U/kg/week, respectively. When the patients were subdivided into four groups according to the number of prescribed antihypertensive agents (G-0, G-1, G-2, and G-3; patients prescribed with no medication, 1, 2, and >3 drugs, respectively), a significantly low dose of rHuEPO was observed in G-0 compared to the other groups. Unpaired t test showed a higher dose of rHuEPO in the presence of ARB, alpha-blockers, or calcium channel blockers (CCB). The rHuEPO dose was higher in the elderly, in females, and in patients with diabetes or hypertension. In multiple regression analysis, age, sex, rHuEPO dose, serum albumin level, and duration of dialysis therapy but not antihypertensive drugs were independent factors for the Hb level. In contrast, the rHuEPO dose was significantly associated with a low level of Hb, age, females, and CCB use. However, since CCB use was strongly associated not only with rHuEPO dose but also with systolic blood pressure and the use of alpha-blockers and ARB, these findings might be caused by erythropoietin (EPO)-induced hypertension. CONCLUSION: There was an association between the number of antihypertensive agents and rHuEPO dose in chronic hemodialysis patients. However, no significant relation was indicated between ARB/ACI use and EPO requirements.

Chronic superficial pyoderma of the face: an unusual male case of rosacea fulminans.

A 62-year-old Japanese male developed acneiform papules on the face in November of 2002. The eruptions progressed to exudative erythema with central necrosis, and then to thick-crusted superficial abscesses in a short period. The shallow ulcers exposed by removal of the crusts and abscesses immediately re-epithelized without leaving scars. The histology of the eruption was a dense infiltration of neutrophils associated with granulomatous changes in the upper to middle dermis. Histology of the tiny white particles in the abscess showed an irregularly proliferated mass of keratinocytes including accumulated neutrophils. The skin lesions resisted intravenous injection of antibiotics but responded to systemic administration of a corticosteroid agent. Colchicine did not work well, but the additional administration of etretinate was effective. The patient is currently receiving combined therapy with prednisolone and etretinate, but eruptions are still episodically observed. We diagnosed this case as an unusual male case of rosacea fulminans.

History of the establishment and revision of diagnostic criteria, severity index and therapeutic guidelines for pemphigus in Japan.

We summarize the process of establishing and revising the diagnostic criteria, severity index and therapeutic guidelines for pemphigus in Japan (including the results of a nationwide survey regarding these guidelines). We also summarize the content and present an evaluation of the utility of these guidelines. Due to the publication of these documents throughout the Japanese medical community, it appears that patients with pemphigus have recently begun to receive appropriate treatment, dramatically improving their quality of life and prognosis. Continuous examination of these criteria by means of follow-up studies of patients treated according to the guidelines is necessary to determine the long-term efficacy of treatment. To this end, it is hoped that these guidelines will be more extensively disseminated among the medical community.

A monoclonal antibody established from the immunization of basal cell carcinoma (BCC) tissues reacts to the intercellular space of BCC and hair follicles.

To detail the histogenetic relationship between basal cell carcinoma (BCC) and hair follicles, a monoclonal antibody, coded as MMKB-1 and established from immunization of mice by human basal cell carcinoma (BCC) tissues, was immunohistochemically studied in tissues of BCC and squamous cell carcinoma (SCC) of the skin, as well as in normal human skin tissues. On 1M-NaCl-split normal human skin tissues, it reacted against both the epidermal and the dermal sides of the basement membrane zone (BMZ). This monoclonal antibody reacted to the BMZ and intercellular space (ICS) of the solid, superficial, and fibrosing types of BCC cell nests, but, in SCC tumor cell nests, it reacted exclusively to the BMZ. Immunoelectron microscopic studies revealed that the corresponding antigen of the monoclonal antibody was distributed in the hemidesmosomes and the anchoring fibrils along the BMZ of the normal human skin and the desmosomes of the BCC cell nest. The monoclonal antibody also reacted to the ICS of the lower outer root sheath and hair matrix. We discussed the histogenesis of BCC and hair follicles, referring to the results of the staining patterns of MMKB-1 monoclonal antibody and to other studies suggesting a histogenetic relationship between BCC and hair follicles.