秋田 浩孝

Background Monopolar radiofrequency (mRF) devices have been shown to be clinically effective for treating aging skin, but there are few histologic studies about the mechanisms. Objective To histologically analyze chronologic and quantitative change in collagens after mRF treatment to determine the mechanisms of the antiaging effect. Methods Five patients were enrolled in this study. Skin specimens were taken before and 1 and 3months after treatment. Immunostaining was performed to determine change in type I and III collagen levels and stem and other cell counts in skin layers. Results In all cases, both types of collagen significantly increased after irradiation in the dermis (p<.05), and their changes were noticed uniformly in all layers. No significant change was noticed in stem and other cell counts. Conclusions This study histologically demonstrated that type I and III collagen increased significantly in the dermis after mRF treatment. The amount of stem cells did not affect the increase in collagens.

A 16-year-old girl presented with a 9-year history of vesicles on the vulva. She had initially taken a wait-and-see approach, but required treatment because of bleeding. Histological examination of a biopsied vesicle revealed dilated lymph channels in the upper dermis, suggesting lymphangioma circumscriptum (LC). The challenge for this pathology has been to find a conservative treatment with low morbidity and better results than those reported for surgical excision, which has been the mainstay of therapy. In this case, LC of the vulva was successfully treated using a 10,600-nm CO2 laser and long-pulsed Nd:YAG laser. Use of the 10,600-nm CO2 laser and long-pulsed Nd:YAG laser appeared effective for treating LC. © 2014 S. Karger AG, Basel.

Background Quality-switched (QS) lasers are well-known effective treatment for removing solar lentigines. However, the high incidence of post-inflammatory hyperpigmentation (PIH) raises concern in darker skin types. This is the first study comparing efficacies and incidences of PIH in Asian skin with different degrees of irradiation between two QS lasers. Method In total, 355 solar lentigines in 193 cases, skin types III-V, were randomly divided into four groups. All cases received single laser treatment. Clinical results were evaluated after 4 weeks. Groups 1 and 3 were treated 'aggressively' with endpoints of very obvious immediate whitening (IW) of the lesion. Groups 2 and 4 were treated 'mildly' with endpoints of slight IW of the lesion. Groups 1 and 2 were irradiated with the QS ruby, and groups 3 and 4 with the QS frequency doubled Nd:YAG laser. Results There were no statistically significant differences in degrees of clearance among the four groups. However, PIH incidences were very different: 33.33%, 7.47%, 23.18% and 8.47% in groups 1, 2, 3 and 4 respectively. The difference between aggressively and mildly irradiated groups (1 and 3 vs. 2 and 4) was statistically significant (P &lt 0.001). However, there was no statistical difference between the two aggressively or the two mildly irradiated groups. There were no significant differences between skin types. Conclusion Aggressive irradiation using QS lasers resulted in a high PIH incidence, while having no advantage in efficacy. For darker skin types, mild irradiation reduces the PIH risk with no disadvantage in efficacy. © 2011 European Academy of Dermatology and Venereology.

Background Paget's disease is an intraepidermal adenocarcinoma that is difficult to diagnose clinically as it mimics inflammatory or infectious diseases. As a consequence, it may be clinically misdiagnosed resulting in a delay in appropriate management. Reflectance confocal microscopy allows the visualization of the upper layers of the skin and mucosa at cellular resolution. Paget's disease is characterized histologically by the presence of neoplastic cells scattered throughout all layers of the epidermis in a pattern similar to that also observed in melanoma (and termed Pagetoid spread). Objective In vivo confocal microscopy is an excellent diagnostic tool for detecting Pagetoid spread and for diagnosing melanoma. We therefore hypothesized that it may also assist in the diagnosis of Paget's disease. Methods In this study, we describe the confocal features of nine cases of extramammary Paget's disease and one case of mammary one. Results Large atypical Pagetoid cells were present singly and in clusters in all 10 cases and were readily visualized on ex vivo and in vivo confocal microscopy. The presence of Pagetoid spread and other confocal features, in the appropriate clinical context, is suggestive Paget's disease and should allow distinction from other inflammatory diseases that may appear similar clinically. Conclusion The use of confocal microscopy is likely to facilitate earlier diagnosis of Paget's disease and the instigation of appropriate management with concomitant improvement in clinical outcomes. © 2012 European Academy of Dermatology and Venereology.

顔面に尋常性ざ瘡のある女性患者を対象に，低刺激性・低アレルギー性メーキャップ化粧品dプログラム^®スムースアップファンデーション（パウダリー)，スムースアップファンデーション（リキッド)，スムースアップフェースパウダー（おしろい）の安全性を評価することを目的とする4週間の使用試験を実施した。解析対象例（85例）における副作用発現率はパウダリー2.1％，リキッド0％，おしろい0％で，副作用の症状は軽微であった。試験開始時と比較した終了時におけるざ瘡の炎症性皮疹（紅色丘疹，膿疱）および非炎症性皮疹（面皰）数は有意に減少した。Dermatology Life Quality Index を用いた生活の質の評価は「総合」「症状・感情」「レジャー」のスコアが有意に改善された。Visual Analogue Scal (VAS) による顔面の皮膚状態に関する満足度も有意に上昇した。以上の結果より，本試験試料の低刺激性・低アレルギー性メーキャップ化粧品は女性の尋常性ざ瘡患者が安全にかつざ瘡を悪化させることなく使用することができるだけでなく，生活の質を改善すると結論した。(皮膚の科学，10: 170-182, 2011)

粉製品に含まれたダニの経口摂取によるアナフィラキシー2症例を経験したので報告する．症例1は50歳女性で，開封後に常温保存したお好み焼き粉を，自宅にて調理摂取した約30分後に全身浮腫性紅斑や動悸，嘔気が出現した．患者が摂取したお好み焼き粉は，賞味期限より2年が経過していた．患者血清ダニ抗原特異IgE値はヤケヒョウヒダニ23.4 IU/ml，コナヒョウヒダニ33.7 IU/mlで，コムギ関連特異IgE値はコムギ<0.35 IU/ml，グルテン<0.35 IU/mlと陰性であった．持参した同一銘柄の未開封お好み焼き粉と冷凍保存された薄力粉でのスクラッチテストは陰性であったが，ダニ抗原（鳥居薬品）のプリックテストはscore 3+の陽性を示した．症例2は28歳女性で，開封後に数カ月間常温保存したお好み焼き粉（以下事故粉）を自宅において調理中に喘息症状が出現し，摂取中に呼吸困難感や嘔吐，腹痛が出現し，アナフィラキシーショックとなった．患者血清ダニ抗原特異IgE値はヤケヒョウヒダニ51.6 IU/ml，コナヒョウヒダニ55.6 IU/mlで，コムギ関連特異IgEはコムギ<0.35 IU/ml，グルテン<0.35 IU/mlと陰性であった．プリックテストは事故粉でscore 3+の陽性，ダニ抗原（鳥居薬品）でscore 4+の陽性であった．また冷凍保存された薄力粉は陰性であった．事故粉にはコナヒョウヒダニが50匹/g検出され，ELISA法で測定したところ，ダニ主要抗原であるDer f 1が64.1 μg/gと多量に検出された．事故粉と患者血清（症例2）を用いたImmunoblot法ではダニ抗原と思われる25 kDa部位にバンドが検出された．さらに血清とダニ粗抽出液を用いたInhibition immunoblot法ではダニ粗抽出物と共通分子量付近に認められた複数のバンドは事故粉より消失した．この結果から事故粉に認められたバンドは粉中のダニ抗原に反応したバンドと考えられた．上記の検討を踏まえ，お好み焼き粉におけるダニ繁殖の実態を調査するため，我々は，お好み焼き用ミックス粉3銘柄と薄力粉におけるダニ数及びダニ抗原の増殖性の違いについて検討した．各粉にコナヒョウヒダニを添加培養し，3週間後と6週間後に評価した．培養6週間後にミックス粉のダニ数とダニ抗原は，薄力粉に比較して3銘柄ともに増加傾向を認め，1銘柄は有意に増加していた．粉類でダニの増殖を防ぐには冷蔵保存が良いとされる．市販のミックス粉の注意書きには冷蔵保存と明記する必要があり，また我々皮膚科医は小麦アレルギーと誤診しないよう注意が必要である．

BCG 接種後の丘疹状結核疹の3例を経験した。症例1は5ヶ月，女児。BCG を接種した5週間後より四肢に丘疹が出現した。症例2は6ヶ月，男児。BCG を接種した1ヶ月後から四肢に丘疹が出現した。症例3は5ヶ月，男児。BCG 接種した1ヶ月半後より全身に丘疹が出現した。病理組織学的に，3例とも真皮の血管周囲にリンパ球の浸潤と非乾酪性類上皮細胞肉芽腫を認め，BCG 接種による丘疹状結核疹と診断した。3例とも無治療で3ヶ月以内に略治した。1歳未満の散在性の丘疹をみた際，丘疹状結核疹を疑い BCG 接種歴を聴取することが重要であると考えられた。

We experienced that two Japanese women diagnosed with syringoma, confirmed by a punch biopsy, were successfully treated with fractional resurfacing. Both clinical cases have had positive results after only a few treatments, with high patient satisfaction, not only for the improvement of syringoma, but also for the improvement of aging skin, and with no side effects. From that aspect, laser treatment with fractional photothermolysis may be considered to be one of the effective treatment methods for syringoma. Although fractional photothermolysis was originally developed for an aesthetic purpose, it also can be utilized for intractable skin disease, as demonstrated by taking the concept of fractional photothermolysis and the results from this study with skin biopsy.