Journal of Cutaneous Immunology and Allergy最新文献

Dermatofibrosarcoma protuberans with fibrosarcomatous transformation (DFSP-FS) is a rare variant, with higher rates of recurrence and metastasis than DFSP. Detection of the collagen type I alpha 1 (COL1A1)–platelet-derived growth factor beta chain (PDGFB) fusion gene is useful for the diagnosis of DFSP. In this letter, we report a case of DFSP-FS, focusing on the expression of the COL1A1-PDGFB fusion gene in the lesions. Increased expression of the COL1A1-PDGFB fusion gene may be associated with fibrosarcomatous changes during the pathogenesis of DFSP.

Cases of skin infections caused by Panton–Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA), particularly USA300 clone, have been increasing in Japan. We report that clinical findings of 5 patients with PVL-positive MRSA and compared to those of four patients with PVL-negative MRSA. Severities of patients with PVL-positive MRSA were significantly higher than those of patients with PVL-negative MRSA. Average durations of antimicrobial therapy for patients with PVL-positive MRSA were 3.4-fold longer than those for patients with PVL-negative MRSA. Our data suggest that PVL-positive MRSA should be deal with a causative agent for intractable skin infections in Japan likewise other countries.

The coronavirus disease 2019 (COVID-19) pandemic has an enormous impact on dermatological practice. There are many articles describing COVID-19-related and COVID-19 vaccine-related hair loss, such as telogen effluvium (TE), alopecia areata (AA), friction alopecia and anagen effluvium,¹ although their clinical outcomes have been poorly documented. We report a case of extensive AA following administration of the Pfzer-BioNTech BNT162b2 mRNA COVID-19 vaccine with favorable outcome.

A 37-year-old woman with no significant medical history except for childhood atopic dermatitis, developed persistent low-grade fever (37.2°C) on day +13 after the first dose of BNT162b2 mRNA vaccine (all date numbers refer to the first dose). Subsequently, the patient noticed coin-sized hair loss on day +22, and it became widespread within 1 week. Laboratory examinations performed at a nearby clinic on day +31 showed increased serum C-reactive protein (3.53 mg/dl) and decreased white blood cells (3000/μl) with 54.0% of neutrophils, 2.4% of eosinophils, and 34.8% of lymphocytes, whereas serological tests for syphilis were negative, and serum thyroid function tests, antinuclear antibody, immunoglobulin E, and thymus activation-regulated chemokine levels were all within normal ranges. She received the second dose BNT162b2 mRNA vaccine on day +32. The persistent low-grade fever spontaneously resolved on day +34 although the hair loss continued to aggravate. She presented to our hospital on day +73 for further evaluation. Physical examination revealed widespread alopecia with a severity of alopecia tool (SALT) II score of 80 (Figure 1A), whereas her eyebrows, eyelashes, and body hair were intact. Trichoscopy showed tapering hairs, broken hairs, black dots, and increase in vacant follicular ostia (Figure 1B). Histological findings of a skin biopsy revealed perifollicular lymphocytic infiltrate and increased number of telogen hairs (Figure 1C–E). Results of direct immunofluorescence studies were negative. We treated the patient with topical betamethasone butyrate propionate lotion. On day +120, the patient showed a sign of hair regrowth. The patient's hair mostly recovered leaving only one oval bald patch on day +310, and SALT II score decreased to 5 (Figure 1F).

The hair loss in this patient occurred following a febrile condition after the first dose of BNT162b2 mRNA vaccine, and we initially considered the patient as TE. However, initial onset with coin-sized hair loss and the presence of an oval bald patch in the late phase were rather characteristic for AA.

A review of the literature including the present case identified 17 cases of AA associated with COVID-19 vaccines.^2-7 Six cases had a previous history of AA. Types of vaccines prior to the development of AA included BNT162b2 mRNA in 11 cases, AZD1222/ChAdOx1 viral vector in three cases, and mRNA-1273 in three cases. In eight cases, AA appeared after the

Systemic sclerosis (SSc) or scleroderma is an autoimmune disease of unknown etiology, the treatment of which has garnered increased research interest. Associated symptoms range from localized or diffused skin tightening to multiple organ failure, including the lungs, kidneys, heart, and gastrointestinal tract, with considerable morbidity and mortality. Given that several cytokines contribute to the immune pathogenesis of SSc, efforts have been made toward the development of treatments targeting these cytokines to control disease progression. Indeed, anti-cytokine therapy has emerged as a new therapeutic intervention. Recently, the Janus kinase signal transducer and activator of transcription (JAK–STAT) pathway has been investigated as a novel candidate for the fibrogenic pathology of SSc. However, a comprehensive scientific review of the targeted therapy for SSc has been hampered by the rarity and heterogeneous nature of the disease. In this review, we provide an overview of cytokines involved in the innate and adaptive immune pathogenesis of SSc based on recent scientific data. In particular, we focus on targeted anti-cytokine therapy and the emerging role of the JAK–STAT inhibitor, a prospective therapeutic agent for the reversal of disease pathogenesis.

We present a case of Panton-Valentine leucocidin-positive methicillin-susceptible Staphylococcus aureus infection in a couple. The isolated bacterium was not methicillin-resistant but was very closely related to the USA300 clone.