Prevalence of dermatological disorders in Japan: a nationwide, cross-sectional, seasonal, multicenter, hospital-based study

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.     

Frequency,clinical features and prognosis of cutaneous manifestations in adult patients with reactive haemophagocytic syndrome

Background Cutaneous involvement has been reported in 30–40% of children with the familial form of haemophagocytic syndrome. However, few studies have focused on cutaneous manifestations in patients with reactive haemophagocytic syndrome (RHS). Objectives To describe the frequency, clinical features and prognosis of skin involvement in adult patients with RHS. Methods We conducted a retrospective study in a French university‐based tertiary centre. The medical records of all adult patients with a suspected or confirmed diagnosis of RHS during a 2‐year period were reviewed. Demographic, clinical, biological and histological data of patients were compared using nonparametric tests. Results The medical charts of 151 patients were reviewed, 69 of whom had a definite diagnosis of RHS (35% women; mean ± SD age 49 ± 17 years). The aetiology of RHS was mainly B‐cell or T‐cell lymphoma (n = 33) or herpesvirus infection (n = 19). Cutaneous manifestations were observed in 32 (46%) patients and were of three types: (i) specific to the underlying malignancy (Kaposi sarcoma n = 8, cutaneous lymphoma n = 4), (ii) reflecting the biological consequences of RHS (thrombopenic purpura n = 10, conjunctival jaundice n = 7), and (iii) a generalized, transient, nonpruriginous maculopapular rash (n = 18). None presented with erythroderma, or with eczematiform, ichthyosiform, psoriasiform or bullous lesions. One patient had cytophagic histiocytic panniculitis. Histological features of maculopapular rash biopsies were usually nonspecific. The rate of in‐hospital death was not significantly associated with cutaneous involvement. Conclusions A generalized, nonpruriginous, transient, maculopapular rash is frequently observed in patients with RHS. Although nonspecific, awareness of this cutaneous involvement may assist physicians in the initial diagnosis of RHS.     

Effects of moisturizing skincare on skin barrier function and the prevention of skin problems in 3‐month‐old infants: A randomized controlled trial

An effective newborn skincare protocol has not been established. We aimed to evaluate the effects of moisturizing skincare, including using lotion and reducing routine bathing. Our hypothesis was that moisturizing skincare would improve skin barrier function. This randomized controlled trial included 227 healthy Asian newborns between 1 week and 3 months old. We compared moisturizing skincare (bathing every 2 days and using lotion daily; intervention, n = 113) to daily bathing without lotion (control, n = 114). We assessed the skin barrier function (transepidermal water loss [TEWL], stratum corneum hydration [SCH], skin pH and sebum secretion) as a primary outcome at 3 months old. We also assessed the incidence of skin problems according to parents’ diary reports. Compared with the control, the intervention group had a lower face TEWL (mean ± standard deviation, 14.69 ± 7.38 vs 17.08 ± 8.26 g/m² per h, P = 0.033), higher face SCH (60.38 ± 13.66 vs 53.52 ± 14.55, P = 0.001) and higher body SCH (58.89 ± 12.96 vs 53.02 ± 10.08, P < 0.001). Compared with the control, newborns in the intervention group had significantly lower rates of diaper dermatitis between birth and 1 month old (6.3% vs 15.9%, P = 0.022), and tended to have lower rates of body skin problems between 1 and 3 months (42.1% vs 55.2%, P = 0.064). Moisturizing skincare was effective for improving skin barrier function and preventing newborns’ diaper dermatitis. The results of our study may help parents make informed decisions about newborn skincare.     

The Rash of Measles Is Caused by a Viral Infection in the Cells of the Skin: A Case Report

Measles skin rash was immunohistochemically examined in an effort to detect virus antigen in skin samples taken from a 15-year-old girl with measles. A sectioned specimen obtained by punch biopsy from a 2nd-day skin lesion showed localized parakeratosis and acanthosis with multinucleated giant cells in the epidermis, thickening and cellular edema of epithelia in the hair follicles, and vascular dilatation in the papillary plexus. Measles virus antigen was detected by ABC immunoperoxidase in the epidermis, follicular epithelia, and lympho-histiocytic cell infiltrates in the upper part of the dermis. This rash was deemed to be caused in part by direct viral infection of the epidermal cells.     

Cutaneous photodamage in schizophrenia patients

Background: Schizophrenia patients frequently engage in unhealthy lifestyle behaviors. The adverse effects of sun exposure on the human skin are well studied but only sparse data in this area have been focused on schizophrenia patients. Aim: To assess the role of sun exposure and its effects on cutaneous photoaging in schizophrenia patients compared with age‐matched healthy subjects. Method: Skin photoaging was assessed using a modification of Glogau's classification. We developed a rating for aged appearance, applied to facial skin, dorsal hand skin, and a total integrated score. The extent of photodamage was independently evaluated by two of the investigators certified in dermatology and plastic surgery. Each rater independently estimated the subjects' age. Raters were blinded to the subjects' demographic and clinical parameters as well as to each other's ratings. Results: Seventy‐four participants were enrolled. There were 37 patients, 24 men and 13 women, mean age: 42.7±9.7 years. The comparison group consisted of 20 men and 17 women, mean age: 42.4±9.2 years. Age, gender and BMI as well as smoking status did not differ significantly between groups. The variables found to differentiate between groups were: sun exposure, use of sunscreens, overall pigmentary changes, periorbital wrinkles and the intake of concurrent medications. Conclusion: Increased cutaneous photoaging in schizophrenia patients, evidenced by reduced sun safety behaviors, and objective clinical signs of skin photodamage were demonstrated in the present study. We suggest that preventive measures like sun safety education should be undertaken by mental health professionals.     

Cutaneous Metastases from Prostatic Cancer

The skin is involved in metastases from 2–9% of malignant tumors. These usually tend to spread to the skin relatively late in the course of the disease. Skin metastases of prostatic origin are quite uncommon and preferentially localized to the lower abdomen and genital area. We present a case of cutaneous metastasis from prostatic adenocarcinoma that preceded diagnosis of the primary tumor and was located on the neck.     

皮肤共振传导时间的测量及其意义

皮肤的生物物理特性是由皮肤局部及机体系统的生物功能所决定。皮肤弹性的改变系多种因素所导致真皮胶原或/和弹力纤维的变化而引起。这些变化可体现在皮肤共振传导时间的改变。通过测量同一部位不同方向共振传导时间,不仅能判断皮肤弹性的变化,同时还可推测哪个方向胶原或/和弹力纤维发生了改变。此外,本测量方法简便。因此,在判断皮肤老化(光老化和自然老化)程度和评估改善皮肤弹性产品的效果时,测量皮肤共振传导时间是值得一试的手段之一。     

Cutaneous metaplastic synovial cyst

Metaplastic synovial cyst of the skin is a recently recognized entity characterized by an intradermal nodule that usually occurs at the site of previous surgical trauma. Histologically, the lesion demonstrates a cystic structure with villous-like projections and a lining resembling hyperplastic synovium. We have studied two patients with rheumatoid arthritis, aged 46 and 55 years, who presented with cystic nodules localized on the thumb and great toes, respectively, without any history of previous trauma or surgical procedures performed in the areas. The presence of vimentin and CD 68 positivity of the cells lining the cyst walls supports the similarities between normal and metaplastic synovium. We hypothesize that constant pressure on the great toe, repeated manipulation of the finger, and chronic inflammation around the affected joints may have played roles in the pathogenesis of the lesions in our patients.     

Skin Diseases First Described in Japan

Over the 90 year history of dermatology in Japan, about 30 skin diseases have been first described by our colleagues. Although some of them have become well known internationally, many of them are less well known outside of Japan. In this article, we introduce those conditions first described in Japan which are lesser known but have international significance.     

Pemphigus treatment in Japan

Pemphigus is a group of autoimmune blistering diseases characterized by blisters and erosive lesions on the skin and mucous membranes due to loss of cell and cell adhesion of keratinocytes. In 2010, new Japanese guidelines for the management of pemphigus were published for dermatologists. Systemic corticosteroids are the gold standard and the first choice of treatment of pemphigus.     

Cutaneous embolization of cardiac myxoma

Atrial myxoma is the most common primary tumour of the heart. Skin manifestations in patients with a cardiac myxoma are frequent and may be due to cutaneous emboli, or may be specific findings as part of more complex syndromes. We present a 33-year-old-man with a history of episodes of pain in both legs and an ischaemic neurological event, who also had episodes of acral papular erythematous lesions on the legs and feet including the soles. The histological finding of dermal vessels occluded by a myxomatous material was the clue to the diagnosis of a cardiac myxoma. The diagnosis of this entity can be very difficult, because of the broad spectrum of clinical features; rarely the skin manifestations lead to the diagnosis of this tumour. The histological recognition of the myxomatous emboli is of vital importance for the diagnosis and treatment of this disease.     

Cutaneous Myiasis Due to Dermatobia hominis in Japan

A 29-year-old man with a furuncle-like lesion brought in a maggot on the next day after his first visit to our clinic. He said it moved out from the eruption spontaneously. He had previously visited Parana and Sao Paulo in Brazil before he noticed the symptom. The maggot was confirmed to be a third instar larva of Dermatobia hominis. Japanese cases of cutaneous myiasis are reviewed.     

Atopy‐related skin rash in a normal population of infants: Distribution and rates for 50 separate skin regions: Cohort study from 4 months to 3.5 years

Analysis of the rash in a normal population of infants may give new information that is different from clinical observation of atopic dermatitis (AD). For this purpose, a cohort study was undertaken on infants at 4 months, 10 months and 3.5 years. Infants who attended the local health center for health check were the subjects. Rash related to AD, dryness, scaling, erythema, papules, exudation and crusts was recorded in 50 skin regions and divided into three degrees. Examination was performed twice a month for a year at each age. The 777 infants who attended all three examinations were analyzed in this report. Rash‐positive regions were 14.7% on average at 4 months and decreased with age. Prevalence of rash‐positive infants was 93.6% at 4 months and also decreased with age. The main findings are as follows. First, rash was more frequent and more severe in younger infants. This seems to suggest that AD in early infancy is initiated and developed by immune immaturity, and is resolved by its maturation. Second, rash involved preferentially air‐exposed and air‐closed skin in younger infants. This seems to be evidence that the epidermis of young infants is easily responsive to both dryness and wetness. Third, some regions did not show age‐dependent reduction of rash rate in younger infants. Those regions are probably irritated by saliva and urine or rubbing and scratching.