Chalazion masquerading as sporotrichosis.
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Biomedical subjects
Publications and source records attributed to Masafumi Iijima.
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We report a case of "recall-like phenomenon" caused by nonionic contrast medium. A 62-year-old woman suffering from postherpetic neuralgia developed erythematous plaques 12 h after an intercostal nerve block under X-ray guidance using iohexol (Omnipaque) as contrast medium. The erythematous plaques were preferentially located in the sites where she had experienced herpes zoster 4 months previously. The lesions cleared spontaneously leaving no pigmentation. Both patch testing and intradermal testing with iohexol and ioversol were positive. We postulate that local immunological changes in the skin, such as an increased number and/or accelerated activity of Langerhans cells and mast cells in the herpes zoster lesions, were responsible for this phenomenon. This "recall-like phenomenon", occurring preferentially in skin previously affected by herpes zoster, could facilitate understanding of the pathology of drug eruptions.
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A 35-year-old man developed well-demarcated, oedematous and erosive erythematous lesions on the nasal bridge and retroauricular regions bilaterally. His eyeglass frame was repaired by an optician 2 weeks prior to symptom onset. Patch testing revealed a positive reaction to scrapings of nose pads and temples of the frame in petrolatum. Because the patient did not take our exhortation to change eyeglass frames, we advised him to cover their nose pads and temples with vinyl tape to prevent direct skin contact. Although topical corticosteroid therapy produced clinical resolution temporally, recurrences were not prevented. After starting tacrolimus ointment therapy, recurrence has not occurred for 9 months. Tacrolimus may be effective for allergic contact dermatitis patients who cannot avoid repeated allergen exposure, as it may not only reduce inflammation but inhibit recurrences.
Tumor necrosis factor (TNF)-alpha is an important proinflammatory cytokine in contact hypersensitivity (CHS) reactions. Previous efforts to assay CHS in TNF-alpha gene-deficient (-/-) mice have demonstrated a significant reduction in ear skin weight at 24 h following challenge by oxazolone, although the mechanisms of this suppression have not been examined. To further characterize the impaired CHS during evolution of the elicitation phase in TNF-alpha -/- mice and to clarify its mechanisms, focusing on the roles of TNF-alpha and vascular endothelial growth factor (VEGF), we used an established method of CHS assay-sensitization and challenge by trinitrochlorobenzene (TNCB)- in TNF-alpha -/- and wild-type mice. We compared the histopathology of the sequential evolution of CHS between the two groups of mice and assessed both the extent of inflammatory cell infiltration and the degree of dilatation in dermal vessels labeled with CD31. We quantified the production of VEGF in the epidermis at specific time points by using a murine VEGF ELISA kit. The CHS reaction was markedly suppressed in TNF-alpha -/- mice at all time points of the elicitation phase. Histologically, in TNF-alpha -/- mice we observed diminished vascular permeability, reduced numbers of infiltrating inflammatory cells, neutrophils at 12 h, mononuclear cells and eosinophils at 24 h, and a decreased area of dilatation of vessels labeled with CD31. The level of epidermal VEGF in wild type mice increased rapidly after challenge and peaked at 24 h, paralleling the peak of ear swelling. In contrast, the peak level of epidermal VEGF in TNF-alpha -/- mice was significantly reduced. These results suggest that TNF-alpha plays an enhancing role in the elicitation phase of the CHS reaction. Diminished degrees of vascular permeability, dilatation of CD31+ vessels, and inflammatory cell infiltration in TNF-alpha -/- mice are likely to be the result of a lack of TNF-alpha and reduced production of epidermal VEGF.
Pagetoid reticulosis is a rare cutaneous T-cell lymphoma with striking epidermotropism similar to that present in Paget's disease. There are two forms of pagetoid reticulosis: localized and disseminated. Reported herein is an autopsy case of disseminated pagetoid reticulosis with CD4(-)/CD8(-) phenotype T cells and massive invasion of the lungs and pancreas. The abnormal cells in the epidermis expressed a protein derived from a rearranged T-cell receptor beta gene, and this feature was used to confirm the monoclonality of these cells by polymerase chain reaction. At present, the World Health Organization (WHO) classification system considers pagetoid reticulosis to be an indolent form of primary cutaneous T-cell lymphoma and a variant of mycosis fungoides/Sezary syndrome with prominent epidermotropism. Some differences have been observed between pagetoid reticulosis and mycosis fungoides in terms of clinical course, tumor cell phenotype, and genetic findings; and these differences are highlighted in the present case. The relation between disseminated pagetoid reticulosis, CD4(-)/CD8(-) cutaneous T-cell lymphoma, and gammadelta T-cell lymphoma, including whether pagetoid reticulosis is a variant of mycosis fungoides, remains unclear.
A 74-year-old woman presented in April, 2003, with cutaneous lesions of the face by Paecilomyces lilacinus infection. The patient had received predonisolone and azathioprine for 20 months for treatment of autoimmune hemolytic anemia. The lesion first developed on the right lateral eyelid 1.5 years earlier, and gradually enlarged. Physical examination revealed a dark reddish or brownish plaque and scattered papules and abscesses around the plaque on right lateral and lower eyelids, and the cheek. She noted mild tenderness on pressure. Cultures obtained from pus and biopsy specimen showed moulds, and those were identified as Paecilomyces lilacinus. Griseofulvin, 500 mg per day, was not effective for the lesion, so itraconazole, 200-300 mg per day, was administered orally for 11 weeks. Since culture from pus still yielded P. lilacinus despite clinical effectiveness, itraconazole pulse therapy (400 mg daily, 7 days a month) was started. The lesion cleared after three cycles of the pulse therapy.
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Staphylococcal superantigens (SsAgs) have gained attention as one of the factors aggravating atopic dermatitis (AD) and several potential mechanisms of AD aggravation by SsAgs have been reported. Tea catechin has been found to have many unique antimicrobiological activities such as antibacterial, antiviral, antifungal and antitoxic effects. In the present study, we investigated the inhibitory effect of the green tea catechin extract, Polyphenon, and (-)-epigallocatechin gallate (EGCg) on staphylococcal enterotoxin B (SEB) and its mechanisms of action, and we also discuss the possibility of therapeutic benefits for AD patients of tea catechin. Polyphenon inhibited the lethal toxicity of SEB and the SEB-induced production of TNF-alpha, IFN-gamma and IL-4 following its intraperitoneal administration to BALB/c mice. Although Polyphenon is composed of several isomers among which EGCg is approximately 50% of the total, we considered that most of the inhibitory effect of Polyphenon in mice could be attributed to EGCg. EGCg was immediately bound to SEB molecules and neutralized SEB in a dose- and incubation time-dependent manner without molecular weight alteration of the SEB molecule. Furthermore, EGCg inhibited SEB-induced TNF-alpha and IFN- gamma production and IL-2, IFN-gamma, IL-10 and IL-12 p40 mRNA expression in human PBMCs from normal donors in a dose-dependent manner. Inhibition of SsAg-induced T-cell activation by catechin was observed in both in vivo and in vitro studies, suggesting that catechin may be useful in the treatment of AD.
In Japan, gold dermatitis due to ear piercing increased in the early 1990s, but has subsequently become rare. To evaluate this clinical finding and to determine the frequency of gold allergy in Japan, we analysed the results of patch testing with 0.2% gold chloride from 1990 to 2001. 653 patients were tested from March 1990 to December 2001. 55 patients showed a positive reaction to gold (8.4%). Significantly more women (10.2%) than men (0.8%) reacted (P < 0.005), but there was no significant difference between positive rates from 1990 to 1995 (9.2%) and from 1996 to 2001 (7.2%). Our data suggest that patients with gold allergy did not decrease in number, despite a decreased number of patients showing clinically overt gold dermatitis. Thus, gold allergy has changed from being clinically overt to becoming occult in Japan.
Pagetoid reticulosis consists of 2 types: Woringer-Kolopp and Ketron-Goodman disease (K-G). Compared with the former, K-G may have disseminated lesions and a guarded prognosis. We encountered a case of K-G in a 67-year-old man with disseminated plaques on the neck, the trunk, and both extremities. Histologic specimens demonstrated medium- to large-sized, atypical cells infiltrating in the lower epidermis. The phenotype (CD3(+), CD4(-), CD8(-), CD45RO(-), CD45RA(+)) and ultrastructural findings suggest that these cells were immature T cells. Although PUVA was initially effective, new plaques in which atypical cells are still present histologically, have appeared through a 6-year follow-up. Literature review revealed the high rate of recurrence. These findings suggest that K-G is an epidermotropic or immature T-cell variant of mycosis fungoides. In patients with K-G, therefore, long-term observation is necessary: Disappearance of cutaneous lesions may not mean cure.
A study was conducted to determine the number and distribution of interstitial cells lining the epidermis of normal human skin from various anatomical locations. Five to seven normal human skin specimens per each anatomical site were collected from surgical specimens, mostly with pigmented nevi. Ten anatomical locations were classified; and a total of 65 normal human skin samples were evaluated. The number of interstitial cells lining the epidermis was quantified under light microscopy using a computer-assisted image analyzer. Two types of interstitial cells were recognized beneath the dermo-epidermal junction of normal human skin: cells containing oval nuclei and spindle-shaped cells containing elongated nuclei. As for the number of oval cells, no significant difference was found among the anatomical locations. In contrast, significantly greater numbers of spindle-shaped cells were found in the palm (4.11 + 1.24; p < 0.01), sole (3.52 + 0.83; p < 0.001) and buttock (2.52 + 0.49; p < 0.01), compared with those in the anterior trunk (0.60 + 0.22). In normal skin of the palm and sole, the number of spindle-shaped cells located beneath the apices of rete ridges (7.35 + 1.56) was significantly greater than along the dermal papillae (1.39 + 0.39, p < 0.01). However, cells containing oval nuclei also predominated beneath the apices of rete ridges, but the difference was not significant. In summary, the present study demonstrated that the number of spindle-shaped cells, quantified by H & E staining, was significantly greater beneath the apices of rete ridges than in dermal papillae. The number was greater in palm and sole skin compared with other samples of normal human skin. This data may relate to the glabrous nature of palm and sole skin.