We conducted this study to clarify the progress of cutaneous arteritis.
We examined 21 cases of cutaneous arteritis that were diagnosed at our hospital between 2005 and 2020. The male-to-female ratio was 1:6 with a mean age of 52.2 years.
The lower legs were involved in all cases, and the upper extremities or trunk was also involved in some cases. Cutaneous manifestations presented as indurated erythema (n = 15), subcutaneous induration (11), edema (7), livedo (6), and ulcer (3). In addition, extracutaneous conditions including numbness (10), arthritis (8), fever (2), and myalgia (1) were observed. Laboratory tests showed an increase of inflammatory markers in most cases (14). Histopathological features showed necrotizing vasculitis of small-sized arteries at the dermo-subcutaneous junction, and the inflammatory stages of arteritis were histopathologically divided into acute stage (5), subacute stage (5), reparative stage (7), and healed stage (1). The therapies administered were oral prednisolone (11), antiplatelet drug (14), warfarin (1), non-steroidal anti-inflammatory drugs (6), biological drug (1), and other drugs (14). There were no cases showing progression to systemic polyarteritis nodosa during follow-up period. All three patients with ulceration complained of numbness, and one was revealed to have mononeuropathy multiplex. They were treated with low-dose oral prednisolone. Three ulceration cases were histopathologically classified into the acute and subacute stages.
In conclusion, all 21 patients followed a chronic course with recurrent skin lesions without systemic complications. Cases with ulceration seem to reveal neurological symptoms and need systemic steroid treatment.
Our patient developed erythematous reaction of the BCG site to Pfizer-BioNTech COVID-19 vaccine. As COVID-19 vaccination is expanded to younger ages, we have to pay attention to such reactions.
We report the first case of post-herpetic isotopic reaction (PHIR) after primary varicella infection in a healthy adult. PHIR refers to the development of new skin lesions at sites where prior herpetic skin lesions have been resolved. Herpes zoster is the most common cause of PHIR; however, only a few cases of PHIR due to primary varicella infections have been reported.
Graft-versus-host disease (GVHD) is an important complication of bone marrow transplantation. Recent reports suggest the significance of T-cell subsets (Th1, Th17, and cytotoxic CD8+ T cells) as well as CD163+ macrophages in the development of cutaneous GVHD. CD163+ macrophages produce various chemokines to establish the immunological microenvironment following stimulation by stromal factors in lesional skin. Thus, the purpose of this study is to determine the main source of IFN-inducible chemokines in the lesional skin of GVHD.
We employed immunohistochemical (IHC) staining for CD163 as well as interferon (IFN)-inducible chemokines (CXCL9, CXCL10, CXCL11) to determine if the main source of IFN-inducible chemokines in the lesional skin of GVHD was CD163+ macrophages. Moreover, we investigated the possible cytokine profiles of lesional skin in GVHD by evaluating phospho-signal transducer and activator of transcription (pSTAT) expression in epidermal keratinocytes.
Immunohistochemical staining of serial sections for CD163 revealed that CXCL9-expressing cells, CXCL10-expressing cells, and CXCL11-expressing cells were detected in adjacent to CD163+ TAMs in the dermis. In contrast, there were no CCL17-expressing cells or CCL22-expressing cells in the dermis. The nuclei of epidermal keratinocytes in GVHD expressed pSTAT1, pSTAT3, and pSTAT5B.
The chemokine expression patterns on CD163+ macrophages matched the expected phosphorylation pattern of epidermal STATs. Our present study suggested that CD163 + macrophages may be a therapeutic target in GVHD.
Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in Japan. Dupilumab, a fully human monoclonal antibody, targets a shared subunit of the interleukin (IL)-4 and IL-13 receptors. Post-marketing surveillance of the safety and effectiveness of dupilumab in adult AD patients was conducted in Japan, where the drug is also allowed for use in older adolescents (i.e., ≥15 years), and interim results are reported here.
This observational, multicenter study enrolled Japanese patients with AD who initiated dupilumab between July 2018–June 2020 (UMIN-CTR Trials Registry: UMIN000032807). Baseline demographics, clinical history, medication data and dupilumab safety and effectiveness data were collected.
By the data cut-off date of March 26, 2021, information from 600 patients has been collected. All the available safety and 1-year effectiveness data are presented. The mean (standard deviation) age was 42.0 (15.9) years, the majority (69.1%) were male, and asthma was present in 12.2%. Adverse drug reactions (ADRs) were observed in 98 patients (16.4%), including conjunctivitis (n = 40; 6.7%), conjunctivitis allergic (n = 30; 5.0%), blepharitis (n = 5; 0.8%), headache and eye pruritus (n = 4; 0.7% each) and eosinophilia (n = 3; 0.5%). Six patients experienced asthma, all of whom had a history of, or concurrent, asthma. Disease severity improved remarkably at 4 months in most patients, which was maintained up to 1 year.
Dupilumab appears to be a safe and effective treatment for patients aged ≥15 years with moderate-to-severe AD in routine clinical practice in Japan. Dupilumab was well tolerated, with no new safety signals and no new-onset asthma.
Janus kinase (JAK) inhibitors are efficacious for atopic dermatitis (AD). However, some patients receiving JAK inhibitors develop acne, especially younger patients, or herpes zoster, especially elderly patients, and desire to switch to dupilumab. We experienced two patients with immediate exacerbation of AD after switching from upadacitinib to dupilumab, and herein report these cases. This phenomenon is attributed to the difference in elimination half-life of the two drugs and a slower onset of efficacy of dupilumab than upadacitinib. When switching from a JAK inhibitor to dupilumab, short-term concomitant use, intensifying topical treatment, and/or rescue with cyclosporine should be considered.
A 70-year-old Japanese man was diagnosed with bladder cancer and started pembrolizumab. After six courses of pembrolizumab, all fingernails and toenails had fallen off and the nail beds were ulcerated. Pembrolizumab was discontinued, and he was treated with topical steroids and topical prostaglandin E1 ointment.
Here, we presented the rare case of ruptured Baker's cyst induced by immune checkpoint inhibitors (ICIs). The history of more than one immune-related adverse event (irAE) like our case was reported to be associated with a more persistent course of arthritis. Mild persistent inflammation without subjective symptoms might exist after first ICI therapy followed by ruptured Baker's cyst. It is important to pay attention to potential musculoskeletal irAEs in ICI-treated patients with multiple irAEs.
Kikuchi-Fujimoto disease is a self-limited febrile lymphadenitis of unknown etiology, possibly associated with cutaneous lesions. We report a case of Kikuchi-Fujimoto disease presenting with papular lesions limited to the elbows and knees. The skin biopsy specimen showed spongiosis and pseudo-Pautrier abscesses in addition to the typical histopathological findings of Kikuchi-Fujimoto disease. Although necrosis was not observed in the lymph node biopsy specimen, histopathological and immunohistochemical findings were consistent with Kikuchi-Fujimoto disease in the proliferating phase.
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