We reported a 15-year-old boy with extensive linear porokeratosis confirmed by clinical, histopathologic, and immunohistochemical assessment. Ixekizumab treatment lead to a near-complete clearance of lesions by 3 months, while nail dystrophy showed minimal response. The presence of IL-17A-positive infiltrates supported the immunologic basis for therapeutic efficacy. These findings suggest that ixekizumab is a promising targeted therapy for refractory linear porokeratosis.
Systemic amyloidosis is a multisystem disorder that requires histological confirmation of amyloid deposition in at least one organ for a definitive diagnosis. While biopsies of organs such as the myocardium provide high diagnostic accuracy, they are highly invasive and technically demanding. Thus, skin biopsies are frequently performed as a less invasive alternative. However, when skin biopsies fail to detect amyloid depositions, more invasive procedures—such as gastrointestinal or myocardial biopsies—are often required. Despite the clinical importance of improving diagnostic yield, few studies have systematically evaluated optimal skin biopsy techniques. Then, we conducted a retrospective observational study of 100 patients who underwent skin biopsies for suspected systemic amyloidosis at Kobe University Hospital between April 2014 and November 2024. In this study, two skin biopsy methods were analyzed: Punch biopsies from multiple random sites (1–5 sites) using Dermapunch (“punch (multiple-punch) biopsy”), and spindle-shaped biopsy of long axis approximately 10 mm or more (“incision (spindle-shaped) biopsy”). As a result, among 69 cases diagnosed as systemic amyloidosis based on amyloid detection in any organ, including the skin, 13 of 28 punch biopsies (46.4%) were positive, and 21 of 41 incision biopsies (51.2%) were positive. The difference in sensitivity was not statistically significant (p = 0.81), but incision biopsies showed a numerically higher sensitivity. Furthermore, fatty tissue was the most common amyloid deposition site, with a mean depth of 5.1 mm. In two cases, depositions were found at a depth of approximately 12 mm. In this study, no significant difference was observed in the diagnostic yield between the two biopsy methods. However, because amyloid depositions may occur deep within subcutaneous fat and incision biopsy enables deliberate and consistent sampling of this layer, it potentially improves diagnostic accuracy. We, therefore, recommend incision biopsy as the preferred method for diagnosing systemic amyloidosis.
Hyperhidrosis decreases an individual's quality of life (QOL). The Hyperhidrosis Quality of Life Index (HidroQoL) measures the impact of hyperhidrosis on QOL and has established reliability and validity. However, a Japanese version does not exist. Hence, this study aimed to develop the Japanese version of the HidroQoL (HidroQoL-J) and verify its reliability and validity. The first survey included 528 participants (272 males, 256 females, mean age ± standard deviation 41.89 ± 15.24 years) who met the criteria for hyperhidrosis and scored ≥ 2 on the Hyperhidrosis Disease Severity Scale (HDSS). The second survey was conducted for reliability and included 210 participants (105 males, 105 females, mean age ± standard deviation 43.56 ± 14.60 years). The main survey items were (1) HidroQoL-J, (2) Dermatology Life Quality Index (DLQI), (3) Skindex-16, and (4) Anxiety Scale Specific to Hyperhidrosis Symptoms (ASSHS). Confirmatory factor analysis revealed the HidroQoL-J had a two-factor structure: a “daily life activities domain” with six items and a “psychosocial life domain” with 12 items, as in the original English version of the instrument. Cronbach's alphas (α) for the HidroQoL-J were 0.93, 0.85, and 0.91 for overall, daily life activities, and psychosocial life, respectively. Test–retest reliability was r = 0.70, 0.67, and 0.69 for overall, daily life activities, and psychosocial life (all p < 0.001), respectively. Furthermore, the intraclass correlation coefficients were 0.70, 0.67, and 0.69, respectively. Moderate positive correlations were observed between the overall HidroQoL-J score and the DLQI (r = 0.56) and Skindex-16 (r = 0.43) scores (all p < 0.001). There was also a moderate positive correlation between the overall score of the HidroQoL-J and HDSS (r = 0.42) and a weak positive correlation with ASSHS (r = 0.39) (all p < 0.001). Therefore, the HidroQoL-J exhibited sufficient reliability and validity to measure the impact of hyperhidrosis symptoms on QOL.
This revision work was commissioned by the Japanese Dermatological Association (JDA) and was undertaken by a committee of experts in related fields. The committee prepared comprehensive, evidence-based guidelines by thoroughly reviewing and systematizing a wide range of literature on cutaneous squamous cell carcinoma. The literature search was conducted by the Japan Medical Library Association. Recommendations were prepared using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) scheme. These guidelines were prepared in accordance with the “Minds Clinical Practice Guideline Preparation Manual 2020 ver. 3.0”. Six clinical questions were established, and corresponding recommendations were described for each. CQs addressed the following: (1) the treatment of early lesions, (2) the possibility of reduction surgery for primary lesions, (3) the significance of sentinel lymph node biopsy, (4) the possibility of non-surgical treatment as an alternative to surgical treatment, (5) follow-ups after treatment, and (6) drug treatment for advanced stages. We are confident that the JDA Clinical Practice Guidelines for Cutaneous Squamous Cell Carcinoma will contribute to improving the treatment of cutaneous squamous cell carcinoma in Japan and worldwide.
Takada M, Pinnawala UC, Hirano S, Imokawa G. The Interleukin-1α Stimulated Expression of the Wrinkle-Inducing Elastase Neprilysin in Adult Human Dermal Fibroblasts Is Mediated via the Intracellular Signaling Axis of ERK/JNK/c-Jun/c-Fos/AP-1. J Dermatol. 2025;52:24–34. https://onlinelibrary.wiley.com/doi/10.1111/1346-8138.17520.
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Psoriatic arthritis (PsA) is a chronic immune-mediated disease with heterogeneous joint and skin manifestations. Although biologic therapies targeting TNFα, IL-17, and IL-23 have transformed PsA management, sex-specific differences in efficacy and treatment persistence remain underexplored. Previous registry and real-world data suggest that women may experience greater pain, lower treatment response, and shorter drug survival, but evidence integrating both articular and cutaneous outcomes is limited. This retrospective cohort study investigated whether female sex independently predicts reduced clinical response and persistence with biologic therapy in PsA, focusing on composite outcomes at week 52. A total of 134 patients (87 men, 47 women) who initiated biologics between 2011 and 2024 were analyzed. Diagnoses were confirmed according to CASPAR by board-certified dermatologists, with rheumatologic confirmation when required. Propensity scores derived from baseline age, BMI, duration of psoriasis, duration of PsA, baseline Psoriasis Area and Severity Index (PASI), baseline Disease Activity index for Psoriatic Arthritis (DAPSA), comorbidities, NSAID use, and biologic class were incorporated into covariate-adjusted ANCOVA models. At week 52, simultaneous achievement of PASI90 and DAPSA remission was observed in 51.2% of men versus 19.2% of women (p = 0.025). Female sex remained an independent negative predictor of response (adjusted OR = 0.19; 95% CI: 0.074–0.468; p = 0.0001). Kaplan–Meier analysis demonstrated shorter treatment persistence in women (log-rank p = 0.0099; adjusted HR = 0.316, 95% CI: 0.119–0.841). Although only a few women (n = 3) cited financial burden as a reason for not re-initiating biologics after discontinuation, this observation may still reflect underlying socioeconomic influences. Even small numbers of such cases can exemplify practical and economic barriers—often compounded by caregiving responsibilities or lower household income—that disproportionately affect women. Early and proactive intervention, prevention of unnecessary discontinuation, and timely re-initiation upon relapse are essential to optimize outcomes in women with PsA.
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