松永 佳世子

［目的］我が国の皮膚科受診患者の皮膚疾患の頻度，性別，年齢分布，気候との関連性などを多施設大規模調査によって明らかにすることを目的とした．［方法］全国の大学病院76施設，病院55施設，診療所59施設（計190施設）において，2007年5月，8月，11月，および2008年2月の各月の第2週目を目安に，その週のいずれか1日を受診した初診・再診を問わず外来，および入院中の患者全てを対象に，「性別」，「年齢」，「診断名」を所定のマークシート調査に記録した．各調査期間における調査協力施設地域の気温，および湿度に関するデータは，気象庁・気象統計情報を使用した．［結果］4回の調査すべてに協力いただいた170施設（大学病院69施設，病院45施設，診療所56施設）から回収した67,448票を解析した．上位20疾患を列挙すると，その他の湿疹，アトピー性皮膚炎，足白癬，蕁麻疹・血管浮腫，爪白癬，ウイルス性疣贅，乾癬，接触皮膚炎，ざ瘡，脂漏性皮膚炎，手湿疹，その他の皮膚良性腫瘍，円形脱毛症，帯状疱疹・疱疹後神経痛，皮膚潰瘍（糖尿病以外），痒疹，粉瘤，尋常性白斑，脂漏性角化症，薬疹・中毒疹の順であり，上位20疾患で皮膚科受診患者の85.34%を占めた．疾患ごとに特徴的な年齢分布を示した．性差が明らかな疾患が存在した．気温や湿度と正負の相関を示す疾患が存在した．［結語］本調査によって21世紀初頭の皮膚科受診患者の実態を明らかにし得た．本調査が今後も定期的に継続されることで，社会皮膚科学的視野にたった皮膚疾患の理解が深まると考えた．

Malassezia folliculitis [MF] is caused by the invasion of hair follicles by large numbers of Malassezia cells, but it remains unclear which Malassezia species are involved in the disease. To clarify this situation, Malassezia species isolated from lesions of MF patients were analyzed by both culture and non-culture methods. In addition, Malassezia species recovered from the non-lesion areas of the skin of MF patients and skin samples of healthy subjects were included in this study. The test population consisted of 32 MF patients and 40 healthy individuals. The lesions were obtained using a comedone extractor, while swabs were employed to obtain skin samples from non-lesion areas of the patients and healthy subjects. Malassezia DNA was analyzed using a real-time PCR technique. The detection limit of the culture method was 5 CFU/cm(2) as opposes 50 cells/cm(2) with non-culture procedures. The predominant species recovered from MF lesions were M. globosa and M. sympodialis by culture method analysis, and M. restricta, M. globosa, and M. sympodialis with non-culture methods. These results were in agreement with those found with samples from non-lesion skin areas of MF patients and healthy subjects. This study clarified that MF is caused by Malassezia species that are part of the cutaneous microflora and not by exogenous species.

We report a 22-year-old woman with urticaria, dyspnea and bronchial asthma-like attacks after eating curried rice. We found the symptoms to be due to an immediate-type allergy caused by spice antigens contained in curry spices by detailed questioning, skin test and measurement of specific immunoglobulin (Ig)E antibodies. This case was complicated with pollen-food allergy syndrome (PFAS) from melon and latex allergy (LA) to natural rubber latex (NRL) antigen and she had also had atopic dermatitis, allergic rhinitis and pollinosis. Serum specific IgE antibodies to birch profilin (Bet v 2), latex profilin (Hev b 8), and timothy profilin (Phl p 12) were detected. She also showed positive reactions to several Apiaceae families, fruits and latex antigens in skin prick test. Based on these findings, we considered her symptoms to be involved with spice allergy, PFAS and latex-fruit syndrome.

Oral allergy syndrome to soy milk is classified as a phenotype of pollen-food allergy syndrome (PFAS). As causative antigens, Gly m 4 (Bet v 1 homolog, 17 kD) and oleosin (23 kD), have been reported. In this study, we report two cases of PFAS to soy milk. Both cases showed positive reactions to soy milk in skin prick tests (SPT) and to Gly m 4 in specific serum immunoglobulin (Ig)E antibody. When we measured specific serum IgE antibody of soy-related proteins using a new laboratory testing method, microarray analysis, both cases showed a positive reaction for Bet v 1. One case was weakly positive for a soybean protein, beta-conglycinin. Other results for reactivity to soy, peanut, cross-reactive carbohydrate determinants and profilin were negative. Based on these results, we diagnosed the two cases as PFAS to Gly m 4. We also performed protein microarray analysis and found it useful as a screening test for immediate allergy, such as PFAS.

Background: Natural rubber latex (NRL) allergy is a common occupational disease in health care workers (HCW). However, few reports have compared the major allergen of HCWs to those in gloves that are routinely used in the hospital. The aim of this study was to evaluate the major NRL allergens in gloves used by HCWs. Methods: We studied 20 HCWs who were suspected to have latex allergy (LA). We performed a skin prick test (SPT) using NRL allergens. Serological testing was performed using the ImmunoCAP™. The total amount of protein and the antigenic protein concentrations extracted from NRL gloves were measured. Four different types of FITkit™ were used to measure the concentrations of Hev b 1, 3, 5, and 6.02 in the gloves. Results: A SPT using NRL extract identified 14 cases with positive reactions. The sensitivity and specificity of the SPT scores to the NRL glove extract were 100%. The sensitivity of latex specific IgE was 100% but the specificity was 14.2%. The sensitivity and specificity of rHev b 6.02 specific IgE were 100% in the LA group. The total amounts of protein from the medical gloves for surgery and examination were 265 μg/g and 95 μg/g, respectively. The antigenic protein concentrations in the gloves were 24.9 μg/g and 1.0 μg/g, respectively. The total amounts of the specific four allergens in the NRL gloves were 2.18 μg/g and 0.45 μg/g, respectively. Conclusions: We concluded that the main allergen of HCWs who have been sensitized occupationally by NRL gloves was Hev b 6.02. ©2009 Japanese Society of Allergology.

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.

Objectives: This study examined the relationship between chronic refractory (CR) in-stent restenosis (ISR) and metal allergic reaction. Background: Although drug-eluting stent reduced the restenotic event compared with bare-metal stent, the mechanism of neointimal proliferation is not clear yet however, bare-metal stent still remains as one of the choices. Methods: Of 128 bare-metal stent implanted patients who experienced target lesion revascularization at least once, 60 patients with the second ISR (study group) and 68 patients without the second ISR (control group) were compared in terms of result from the skin patch test for metal allergic reaction. Results: Nickel was dominant among components of 316L stainless steel. The nickel-positive was observed in 19% (24/128) of all patients. Of 24 nickel-positive, 18 (30%) was in the study group, whereas 6 (9%) was in the control group (P=.02). According to multivariate analysis, the most significant predictor for CR-ISR was reference vessel diameter (P=.0010) followed by nickel-positive (P=.0033) and hyperlipidemia (P=.0305). The nickel-positive showed the highest odds ratio of 5.41 adjusted with confounder variables. Conclusion: This study with the second ISR showed that nickel was a major factor for CR-ISR. Further improvement of biocompatible material is required for coronary stents and strut-coating materials even in the drug-eluting stent era. © 2009 Elsevier Inc. All rights reserved.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening severe cutaneous adverse reactions. Recently, strong associations of HLA-B*1502 and HLA-8*5801 with carbamazepine- and allopurinol-induced severe cutaneous adverse reactions were found in Han Chinese patients, respectively, but ethnic differences in the associations have been reported. The objective of this study is to clarify the involvement of HLA-B*1502 and HLA-B*5801 in Japanese SJS/TEN patients. Methods: HLA-B genotyping was performed on 58 Japanese SJS/TEN patients between July 2006 and April 2008 from multicenters in Japan. Results: There were no HLA-B*1502 carriers among 58 SJS/TEN patients. This patient group included seven carbamazepine-related and 11 aromatic anti-epileptic agent-related SJS/TEN patients. In addition, there were five HLA-B*5801 carriers, which included four allopurinol-related SJS/TEN patients. Conclusion: While HLA-B*1502 is unlikely to be associated with carbamazepine-related or aromatic anti-epileptic agent-related SJS/TEN, HLA-B*5801 was significantly associated with allopurinol-related SJS/TEN in Japanese.

71歳男性。既往に慢性過敏性肺臓炎があり，プレドニゾロン10mg/日内服中で，糖尿病もある。趣味は山の開墾だった。初診の約3ヵ月前より右下肢に発赤，腫脹が出現し，放置したところ有痛性紅色結節が多発し，一部は自壊・排膿したため当科を受診。皮膚生検組織を2%小川培地35℃で培養したところ，5日目に乳白色のコロニーを形成し，DNA -DNA hybridizationでMycobacterium chelonae(以下M. chelonaeと略す。)と同定した。レボフロキサシン300mg/日，クラリスロマイシン400mg/日内服にて著明に軽快した。近年皮膚M. chelonae感染症治療においてクラリスロマイシンの有効性が注目されているが，本例においてもクラリスロマイシンが有効であった。また，本症における治療期間や治癒の判断時期に関しては一定の見解がなく，再燃を避けるためにどの時点で治療終了とするか，今後も検討が必要と思われる。

For the epidemiological surveys and evaluations of therapy, it is essential to evaluate the severity of diseases. There are several reported methods of assessment for acne severity including lesion counting, comparison of the patient's to a photographic standard and comparison of the patient's to a text description. But all of these are based on opinions of specialists. In this study, we attempted to make an evidence-based grading criteria for acne severity, which was expected to yield consents from most dermatologists. The dermatologists consulted classified the global severity of acne patients without any standard and then counted the numbers of eruptions. Three independent expert dermatologists graded the photographs of these patients. We compared the verdicts of the consulted dermatologist and three experienced dermatologists, and analyzed the relationships between these classifications and numbers of eruptions. Our results showed that most of the dermatologists have similar latent recognitions of acne severity. We selected representative photographs as standards, which would contribute to making adjustments for judgments. Global classifications of dermatologists correlated with numbers of inflammatory eruptions (papules plus pustules), but did not with numbers of comedones. The appropriate divisions of inflammatory eruptions of half of the face to decide classifications were: 0-5, "mild" 6-20, "moderate" 21-50, "severe" and more than 50, "very severe". © 2008 Japanese Dermatological Association.