Austria and Japan: Early Relations in Dermatology An “Imperial” Connection in Historical Perspective

Summary The early relations in dermatology between imperial Japan of the beginning Meiji era and Imperial Austria‐Hungary are reviewed. Keizo Dohi, the pioneer of Western dermatology in Japan, trained in Austria under Moriz Kaposi in Vienna. Emphasis is also given to dermatological iconography, to early connections in medicine, and the Japanology in Austria, in general. Today, Japan has developed into one of three centers of investigative dermatology, (USA, Europe, Japan). The country has moved herself from the position of a pupil into that of a master.     

The effect of the “stay‐at‐home” policy on requests for dermatology outpatient clinic visits after the COVID‐19 outbreak

The Coronavirus Disease 2019 (COVID‐19) emerged late in Turkey but it showed a rapid progression later. We aimed to investigate the changes in the number of patients who requested a dermatology outpatient clinic visit due to the increased social and medical burden caused by COVID‐19 in Turkey during the first days of the pandemic. We also examined the most common dermatologic diseases diagnosed during the COVID‐19 outbreak. A statistically significant negative correlation was found between the number of COVID‐19 patients in the country and the number of patients requesting a dermatology outpatient clinic visit in the secondary and tertiary care hospitals during self‐quarantine. In the first 10 days after the COVID‐19 outbreak, acne (28.2%), urticaria (12.8%), scabies (12.8%), irritant contact dermatitis (10.3%), and xerosis cutis (10.2%) were the most common diseases seen in the dermatology clinic at the secondary care hospital, while acne (23.3%), warts (5.4%), seborrheic dermatitis (4.5%), urticaria (3.8%), and psoriasis (3.32%) were the most common diseases seen in the dermatology clinic at the tertiary care hospital. This is our first study on the frequency and nature of outpatient dermatology visits during this novel coronavirus pandemic. Understanding the trends and impacts of dermatologic diseases on patients and health systems during this pandemic will allow for better preparation of dermatologists in the future.     

Bibbidi bobbidi bald: Two “hairowing” tales of Princess Package hairstyles

We present cases of localized alopecia on the vertex scalp of two girls after elaborate professional hairstyling marketed as the “Princess Package” at a major U.S. theme park. Localized alopecia followed pain, erythema, and delayed crusting due to necrosis of the scalp. The majority of the affected alopecic areas had evidence of regrowth at interval follow‐up, but small areas of scarring alopecia remained. We propose that these cases represent a type of alopecia caused by a combination of pressure ischemia and acute traction alopecia.     

Revisiting the history of the “Mongolian spot”: The background and implications of a medical term used today

“Mongolian spot” is a term still commonly used today and found in many dermatology textbooks. This article examines historic literature to understand the social and political climate at the time of its coining. By doing so, this article critically examines the choice of words in pediatric dermatology and how we can use medical terminology to gain the trust and respect of our patients.     

“Slime” dermatitis,a fad‐associated chronic hand dermatitis

“Slime” is the colloquial name for a non‐Newtonian viscoelastic putty‐like substance that is currently a popular plaything among pre‐teens and adolescents. Several ingredients in homemade slime recipes may cause irritant or allergic contact dermatitis. We report two children who developed slime‐associated chronic hand dermatitis, more prominently on their dominant hand. We review the potential for irritant and allergic contact dermatoses as the causes of dermatitis associated with homemade slime.     

Prevalence of scars and “mini‐scars”, and their impact on quality of life in Japanese patients with acne

There have been very few studies on the prevalence and severity of acne scars in Japanese patients. The aim of the present study was to investigate the prevalence of acne scars and their impact on the quality of life (QOL) in Japanese acne patients. Acne scars were classified as mini‐scars (atrophic scars of ≥0.5 and <2 mm in diameter) atrophic scars (≥2 mm in diameter), and hypertrophic scars. The severity of acne and acne scars were evaluated. The background of patients and their QOL in relation to acne were assessed. Of 240 subjects, 218 (90.8%) had scars. All patients with scars had mini‐scars; 61.2% and 14.2% of 240 had atrophic scars and hypertrophic scars, respectively. Severe scarring was found in patients who had experienced severe acne symptoms, although 15.0% of patients with scars had experienced only mild acne symptoms. The total Dermatology Life Quality Index score was significantly higher in patients with scars than in patients without scars (5.9 ± 4.4 vs 4.2 ± 4.1). Almost all the patients had small atrophic scars with a diameter of 0.5 or more and less than 2 mm, which we have termed “mini‐scars”. Acne scars had a negative impact on patient QOL. Early initiation of treatment is recommended to avoid acne scars.     

Evidence‐based (S3) guideline for the treatment of psoriasis vulgaris – Update: “Therapeutic options” and “Efalizumab”

In February 2009, the European Medicines Agency's (EMEA) Committee for Medicinal Products for Human Use (CHMP) had recommended the suspension of efalizumab's (Raptiva^®) marketing authorization, because its benefits in the treatment of psoriasis were modest, while there was a risk of serious side effects in patients receiving the medicine, including the occurrence of progressive multifocal leukoencephalopathy (PML). The guideline group has changed the guideline accordingly.     

Barbed sutures “lunch time” lifting: evidence‐based efficacy

There is a growing trend nowadays for patients to seek the least invasive treatments possible with less risk of complications and downtime to correct rhytides and ptosis characteristic of aging. Nonsurgical face and neck rejuvenation has been attempted with various types of interventions. Suture suspension of the face, although not a new idea, has gained prominence with the advent of the so called “lunch‐time” face‐lift. Although some have embraced this technique, many more express doubts about its safety and efficacy limiting its widespread adoption. The present review aims to evaluate several clinical parameters pertaining to thread suspensions such as longevity of results of various types of polypropylene barbed sutures, their clinical efficacy and safety, and the risk of serious adverse events associated with such sutures. Early results of barbed suture suspension remain inconclusive. Adverse events do occur though mostly minor, self‐limited, and of short duration. Less clear are the data on the extent of the peak correction and the longevity of effect, and the long‐term effects of the sutures themselves. The popularity of barbed suture lifting has waned for the time being. Certainly, it should not be presented as an alternative to a face‐lift.     

The “Heart Sign”: An Early Indicator of Dose‐Dependent Doxycycline‐Induced Phototoxicity

Oral doxycycline is an antibiotic commonly used for the treatment of inflammatory acne in adolescents. Dose‐dependent phototoxicity, unrelated to dose duration, is a well‐known complication of its use. We present three adolescents who developed bilateral phototoxic rashes on the dorsal thenar spaces of their hands while taking doxycycline for their acne. Identification of the “heart sign” rash as a specific doxycycline‐related phototoxic reaction should alert clinicians to the need for prompt intervention, including sun protection counseling and a possible change in antibiotics, in the uniquely vulnerable adolescent population. Early recognition may allow patients to avoid future, more widespread phototoxic drug reactions.     

“Drug‐resistant granuloma faciale”: treatment with carbon dioxide‐GaAs laser

Granuloma faciale (GF), also known as “eosinophilic granuloma,” is a rare benign leukocytoclastic vasculitis which most commonly occurs on the face of middle‐aged Caucasian males. Clinically, GF appears as single or multiple, slowly growing, reddish‐brown papules, nodules or plaques which may be cosmetically unpleasant. Its pathogenesis is unknown and GF is notoriously resistant to treatments. Both medical (dapsone, colchicine, gold injections, isoniazid, clofazimine, corticosteroids, psoralen ultraviolet radiation, and topical tacrolimus) and surgical therapies (excision, graft, dermabrasion, argon laser, carbon dioxide laser, pulsed dye laser, cryotherapy, and electrosurgery) have been used for GF but no effective treatment has yet been found. Furthermore, the typical facial location of GF requires an acceptable cosmetic result. We report two cases of drug‐resistant GF which were successfully treated with laser vaporization combining two different wavelengths: carbon dioxide (CO₂) 10,600 nm and GaAs 1540 nm.     

Dermatoses among poultry workers: “Chicken poison disease”

To investigate the causes of skin eruptions affecting poultry workers, we reviewed our medical records and surveyed a southcentral Pennsylvania poultry processing plant. Examination of the records of routine patch test clinic patients seen from January, 1981, to July, 1982, revealed three poultry workers with allergic contact dermatitis and one with irritant contact dermatitis. We then examined one hundred fifty workers at a poultry processing plant, noting the presence of occupational dermatoses, with special interest in the occurrence of contact dermatitis. We found thirteen dermatoses in nine workers. These included Candida infections, irritant contact dermatitis, allergic contact dermatitis, abrasions and cuts, warts, and dyshidrotic eczema.     

Persistent pruritic papules and plaques associated with adult‐onset Still's disease: Report of six cases

Typical skin rash, which appears and disappears along with respective rise and fall of fever, is well‐known, and included as one of the major criteria of adult‐onset Still's disease (AOSD) (Yamaguchi's criteria). In addition, various skin lesions are occasionally observed in association with AOSD. Persistent pruritic eruptions present with some clinical features, such as urticarial erythema, flagellate erythema, erythematous, slightly scaly or crusted papules, and/or plaques on the trunk and extremities. These lesions show unique histological features such as dyskeratosis with a peculiar, distinctive distribution in the upper epidermis and cornified layers with focal hyperkeratosis. We describe herein six cases of AOSD, which presented with skin lesions of persistent pruritic papules and plaques. All six cases were female, and three of them were elderly women. The patients presented with linear erythematous streaks, scaly erythema, keratotic papules, infiltrative plaques and irregular coalesced erythemas. By contrast, histological features were characteristic, and dyskeratotic cells were found in the horny layers as well as in the upper layers of the epidermis. Persistent pruritic eruption is an important cutaneous sign for the diagnosis of AOSD.