The Journal of dermatology最新文献

Leukoderma/vitiligo is a serious pigmentary disorder that notably impairs the patient's quality of life. In particular, chemical leukoderma (CL)/vitiligo refers to acquired depigmentation of the skin induced by exposure to certain chemicals. In this review, the term "CL" is defined as the temporary, localized loss of pigmentation at the site of direct chemical exposure. When the causative chemical is removed, these skin patches undergo re-pigmentation, indicating the restoration of melanocytes to their original condition. However, when the chemical-induced skin depigmentation does not recover after the chemical is removed, or when de novo depigmented lesions emerge, it is classified as chemical-induced vitiligo. This condition indicates that, even after chemical removal, the mature melanocytes cannot recover because of factors including, but not limited to, autoimmunity, stem cell depletion, and unknown factors. In this review, we summarized the latest pathological findings for each condition, focusing on rhododendrol, which is known to induce both phenotypes and cause an outbreak, which affected nearly 20,000 patients in Japan and other Asian countries.

Bullous pemphigoid (BP) is an autoimmune blistering disease caused by autoantibodies against the hemidesmosomal proteins BP180 and BP230. Although the histopathological features of BP are well documented, basal cell necrosis (BCN) in the blister roof has not been systematically studied. We retrospectively reviewed the clinicopathological findings of BP cases to assess the prevalence and extent of BCN and to explore its underlying mechanisms. Forty-one BP cases diagnosed between 2011 and 2017 were analyzed, with 35 cases of other subepidermal blistering disorders serving as controls. BCN was identified along the base of the blister roof in 92.7% (38/41) of BP cases, typically in a confluent linear array, whereas only 8.6% (3/35) of control cases showed BCN. The extent of BCN correlated strongly with eosinophil density in the blister cavity but not with the serum levels of anti-BP180 or anti-BP230 antibodies. Immunohistochemical study showed that BCN in BP was mediated by caspase-3 (CASP3)-dependent apoptosis and/or receptor-interacting protein kinase-3 (RIP3)-dependent necroptosis pathways. Our study indicated that BCN, mediated via CASP3-dependent apoptosis and/or RIP3-dependent necroptosis pathways, is a very common histological feature of BP and may serve as a useful diagnostic clue.

Skin tags (acrochordons) are common, benign skin growths that often appear on the neck. While they are usually asymptomatic, they can cause cosmetic concerns and discomfort. This report introduces a novel, simple, and minimally invasive technique for removing numerous skin tags using a 2-mm ring curette, demonstrating its effectiveness in three case studies. The procedure involves topical anesthesia with Eutectic Mixture of Local Anesthetics (EMLA) cream, followed by individual excision of skin tags using a 2-mm ring curette with a "pencil technique" to maintain four-way skin tension. Following removal, hemostasis is achieved only with sterile saline-soaked gauze or calcium sodium alginate, and the treated area is dressed with gentamicin ointment and a hydrocolloid dressing to promote moist wound healing. Three cases of women aged 45 to 57 with multiple neck skin tags were successfully treated. All patients reported no or minimal pain during and after the procedure. The treatment yielded the complete resolution of the skin tags, with no scar formation and only minimal post-inflammatory hyperpigmentation, and all patients expressed high satisfaction with the cosmetic outcomes. No recurrence was observed in a follow-up of over 1 year. The procedure was also found to be simple, quick, and effective, with over 50 lesions removed in less than 20 min. It offers a superior alternative to conventional methods by minimizing pain and bleeding, making it an excellent choice for patients with a high number of lesions.

In accordance with the advancement of therapies for skin malignancies, the Japanese Dermatological Association and Japanese Skin Cancer Society updated guidelines for skin malignancies to reflect current clinical practices. Basal cell carcinoma (BCC) is one of the most ordinary malignant cutaneous tumors and its incidence continues to grow in many countries. Clinically, BCCs in East Asian populations are usually pigmented, and 88.3% of total BCCs in Japanese patients are pigmented. However, a low proportion of BCCs in Western populations are pigmented. Therefore, diagnosis and tumor border evaluation of BCCs in Western populations are relatively difficult. From these characteristics, clinical guidelines for East Asian BCCs should differ from those for Western BCCs. This revised Japanese clinical guideline for BCC was also undertaken by a committee comprising experts across relevant fields who meticulously reviewed and systematized a wide range of literature on BCC to develop comprehensive, evidence-based guidelines. Literature searches were conducted by the Japan Medical Library in accordance with the Minds Clinical Practice Guideline Creation Manual 2020, ver. 3.0. Four clinical questions (CQs) were established, and corresponding recommendation statements were provided for each CQ. There are about the reduced margin resection for pigmented BCCs, the radiotherapy for the recurrent BCCs, the topical immune response modifiers, and the systemic therapy using immune checkpoint inhibitors. This Japanese clinical guideline for BCC will help clinicians select suitable therapies for BCCs in East Asia.

Accurate diagnosis is essential for timely intervention in atopic dermatitis (AD), yet delays in diagnosis remain common. To better understand current clinical practices regarding infantile AD, a questionnaire survey was conducted among Japanese pediatricians working at medical institutions with 19 or fewer beds. Respondents who provided informed consent completed an online questionnaire that included items on screening practices, physician background, understanding of diagnostic and treatment practices, and recognition of key clinical issues. In total, 238 valid responses were analyzed. Most respondents indicated that they were non-allergists (85.7% of responses), aged 50 years or older (68.9% of responses) and reported high clinical experience in treating infantile eczema. Only 44.1% of respondents correctly recognized that AD is a condition within the collective term of infantile eczema. Almost all (92.0%) respondents correctly agreed that early intervention was effective for infantile AD and most recognized that AD treatment is prolonged, that AD induces other allergic diseases, and that AD is unlikely to resolve spontaneously in most cases. Understanding of the primary nature of AD was poor with 62.6% of respondents either incorrectly stating that AD is caused by other allergic diseases or that they did not know. The mean (SD) minimum age of AD diagnosis was 7.4 (4.81) months (median, 6.0 months) and 23.9% of physicians diagnosed AD after 1 year of age. Only 16.4% of respondents correctly identified a case of infantile AD and only 19.3% of respondents correctly selected the most appropriate treatment for a known case of infantile AD. Reluctance to inform parents/caregivers of an AD diagnosis was high and mostly due to anticipation of parental shock. Certain pediatricians in Japan have misunderstandings about infantile AD. Further awareness of infantile AD is necessary to ensure early diagnosis and intervention as well as management aligned with guideline recommendations.