有馬 豪

症例1は32歳女で、アトピー性皮膚炎の治療で通院していた。臨床症状と皮膚テスト結果よりラテックス・フルーツ症候群と診断した。歯列矯正ゴムの使用の中止を指示し、今後はラテックス含有製品を使用しないように注意を促した。皮膚テスト陽性であった果物は摂取しないように指導した。症例2は25歳女で、臨床実習の頃からラテックス手袋を装着すると手首まで蕁麻疹が出ることがあった。臨床症状と皮膚テスト結果よりLAと診断した。仕事で用いる手袋はラテックスフリーのものにするよう指導し、その他のラテックス含有製品の使用を禁止した。症例3は38歳女で、就業中にラテックスゴム手袋を装着したところ腹痛、全身の蕁麻疹が出現した。臨床症状と皮膚テスト結果よりLAと診断した。仕事中はラテックスを含まない手袋を使用するように指導した。また、その他のラテックス含有製品の使用を禁止した。

患者は47歳女性,多発性硬化症による第4胸椎以下の神経障害があり,数年前より車椅子生活であった。2011年3月より左坐骨結節部に褥瘡が生じたが放置していた。3月下旬より38度台の発熱が生じ,解熱しないため,当科を受診した。初診時,左坐骨結節部の褥瘡部に壊死組織を認め,CTでは左臀部から左下腿にかけて皮下深部組織内にガス像を認めガス壊疸と診断した。創部からの細菌培養ではEnterococccus avium,Lactbacillus spが検出された。抗生剤の全身投与を開始したが,第3病日に意識障害を来したため,第4病日に広範囲にデブリードマンを行い,感染の沈静化を得ることができ救命することができた。デブリードマン部の欠損は,複数回の植皮術を行い上皮化した。坐骨部褥瘡は,各種外用剤による保存的治療,局所陰圧閉鎖療法(VAC療法)を約5ヵ月間にわたり試みるも治癒しなかった。そのため左坐骨突出部の削除を含めたデブリードマンと大臀筋皮弁形成術を行うことで退院が可能となった。(著者抄録)

2012年に持参香粧品と関連アレルゲンのパッチテストを施行した77例中、持参品に陽性反応を呈したのは14例、持参化粧品は持参しなかったか陰性であったが化粧品関連アレルゲンに陽性反応を呈した(染毛剤を持参しなかった染毛剤皮膚炎を含む)のは13例、パッチテストで持参化粧品も化粧品関連アレルゲンも陰性であったのは50例であった。ロドデノール含有製品陽性は1例であった。成分パッチテストは6例に施行し、そのうち5例で原因アレルゲンを確定できた。その内訳はラウリン酸ジエタノールアミドおよびラウリン酸ミリスチン酸ジエタノールアミド、フェニルエチルレゾルシノール、シリコーン15、3-0-エチルアスコルビン酸、アルガニアスビノサ核エキス+ココイルグルタミン酸Na+カルボマーであった。化粧品関連アレルゲンのみに陽性反応を呈した症例のアレルゲンは、ヘアダイ関連アレルゲン4例、香料6例、防腐剤2例であった。(著者抄録)

It has been reported that the abnormal regulation of melanocyte stem cells (McSCs) causes hair greying; however, little is known about the role of McSCs in skin hyperpigmentation such as solar lentigines (SLs). To investigate the involvement of McSCs in SLs, the canonical Wnt signalling pathway that triggers the differentiation of McSCs was analysed in UVB-induced delayed hyperpigmented maculae in mice and human SL lesions. After inducing hyperpigmented maculae on dorsal skin of F1 mice of HR-1x HR/De, which was formed long after repeated UVB irradiation, the epidermal Wnt1 expression and the number of nuclear -catenin-positive McSCs were increased as compared to non-irradiated control mice. Furthermore, the expression of dopachrome tautomerase (Dct), a downstream target of -catenin, was significantly upregulated in McSCs of UVB-irradiated mice. The Wnt1 expression and the number of nuclear -catenin-positive McSCs were also higher in human SL lesions than in normal skin. Recombinant Wnt1 protein induced melanocyte-related genes including Dct in early-passage normal human melanocytes (NHEMs), an in vitro McSC model. These results demonstrate that the canonical Wnt signalling pathway is activated in SL lesions and strongly suggest that the accelerated differentiation of McSCs is involved in SL pathogenesis.

近年、手術困難な悪性腫瘍に対する患者のquality of life(QOL)向上という緩和治療目的でMohsの変法が施行されている。しかし、Mohsの変法のデメリットとしてpasteによる疼痛と、正常皮膚へ付着すると潰瘍を形成することがあげられる。2010年より我々はMohs pasteの塗布時間を1時間以内に短縮し、乳癌皮膚浸潤の2症例に対しMohsの変法を施行した。2症例ともに疼痛に耐えることができ患者のQOLを改善できた。また、2012年より亜鉛華デンプン外用療法を乳癌皮膚浸潤の3症例に施行した。3症例ともに疼痛がなく、正常皮膚にも障害を起こすことなく患者のQOLを改善できた。Mohsの変法だけでなく、亜鉛華デンプン外用療法も患者のQOL改善に寄与しうると考えた。(著者抄録)

Background: Solar lentigines (SLs) are characterized by hyperpigmented macules, commonly seen on sun-exposed areas of the skin. Although it has been reported that an increase in the number of melanocytes and epidermal melanin content was observed in the lesions, the following questions remain to be answered: (1) Is acceleration of melanogenesis in the epidermis caused by an increased number of melanocytes or the high melanogenic potential of each melanocyte? (2) Why does the number of melanocytes increase? Objective: To elucidate the pathogenic mechanism of SLs by investigating the number, melanogenic potential and proliferation status of the melanocyte lineage in healthy skin and SL lesions. Methods: Immunostaining for melanocyte lineage markers (tyrosinase, MART-1, MITF, and Frizzled-4) and a proliferation marker, Ki67, was performed on skin sections, and the obtained images were analyzed by image analysis software. Results: The expression level of tyrosinase to MART-1 of each melanocyte was significantly higher in SL lesions than healthy skin. The numbers of melanocytes in the epidermis, melanoblasts in the hair follicular infundibulum and melanocyte stem cells in the bulge region were increased in SL; however, no significant difference was observed in the Ki67-positive rate of these cells. Conclusion: The melanogenic potential of each melanocyte was elevated in SL lesions. It was suggested that the increased number of melanocytes in the SL epidermis might be attributed to the abnormal increase of melanocyte stem cells in the bulge. (C) 2013 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.

A 77-year-old man with a history of surgical resection of malignant melanoma involving the fifth toe of his left foot 14 years ago presented at the Kariya Toyota General Hospital with a 3-month history of skin ulcer at the same site and red nodules on the lower left leg. Malignant melanoma was suspected, and the patient was referred to our department. On examination, a skin ulcer measuring 25 × 20 mm was observed at the amputation site on the left foot. In addition, multiple red nodules were observed on the lower left leg. Skin biopsies of the ulcer and nodules revealed recurrent malignant melanoma with in-transit metastasis. Two weeks later, he developed acute myocardial infarction and was hospitalized at the Kariya Toyota General Hospital. One month later, the myocardial infarction ameliorated, and he was transferred to our department. As the myocardial infarction had decreased the patient's tolerance to surgery, interferon-β was administered by intravenous infusion. The skin ulcer and red nodules on the lower left leg disappeared 26 weeks after infusion had been initiated. The patient's progress has been satisfactory, with no evidence of recurrence or metastasis at 1 year and 9 months after the initiation of intravenous infusion. © 2014 S. Karger AG, Basel.

Morphea is a type of localized scleroderma. It is a skin disease involving the development of fibrosis in the dermis and subcutaneous fat tissue beneath without a visceral lesion, and the cause is still unclear. An involvement of epithelial-mesenchymal transition (EMT) has been reported as a cause of tissue fibrosis, but this was mostly observed in pulmonary and hepatic fibrosis, and the involvement of EMT in a skin disease, morphea, has not been studied. Thus, we analyzed the involvement of EMT in skin fibrosis in morphea patients using pathological techniques. Skin lesions of six morphea patients were analyzed (five female and one male patient). As a control, non-light-exposed skin lesions of 11 healthy females were analyzed. Concretely, tissue samples were prepared from these subjects and subjected to immunostaining of transforming growth factor (TGF)-beta 1, alpha-smooth muscle actin (alpha-SMA) and fibronectin, which have been reported to be associated with fibrosis, and Snail1 and E-cadherin, which are considered to be involved in EMT, and expressions of these were analyzed. In morphea patients, dermal expression of TGF-beta 1, alpha-SMA and fibronectin, which are involved in fibrosis, was enhanced, and, at the same time, enhanced expression of Snail1 and reduced expression of E-cadherin, which are involved in EMT, were observed in the dermal eccrine glands. These findings suggested the progression of EMT in the dermal eccrine glands in morphea.