松永 佳世子

職業性皮膚疾患は多岐にわたるが、アレルギー機序で生じるアレルギー性接触皮膚炎、光アレルギー性接触皮膚炎、アレルギー性蕁麻疹、protein contact dermatitis、について、日本職業・環境アレルギー学会ガイドライン専門部会監修の職業性アレルギー疾患診療ガイドライン2013に基づき、疾患概念と原因物質、診断に必要な検査であるパッチテスト、プリックテスト、そして、治療と管理についてポイントを述べた。(著者抄録)

背景:ゴム製品に含まれるthiuram mixの陽性率が近年上昇傾向にある。目的:ゴム関連アレルゲンmix陽性例について、臨床的関連性を検討した。対象:2007年1月〜2011年12月に当院でパッチテスト(以下PT)を施行した1,209例のうち、Japanese standard allergen series(以下JSA)に含まれているゴム関連アレルゲンmix 4種のいずれかに陽性であった21例を対象とした。結果:職業では専業主婦(7例)、皮疹部位は手(15例)が最多であり、アレルゲンはthiuram mix(19例)が最多であった。臨床診断でゴム手袋によるアレルギー性接触皮膚炎を疑ったのは21例中12例で、そのうち貼布した患者持参の手袋は陽性7例、陰性5例であった。臨床診断とは別に偶発的に発見されたゴム関連アレルゲンmix陽性例が21例中9例であった。結論:ゴム関連アレルゲンmixは偶発的に発見される陽性例もあるため、PTの際にJSAを貼布することは思わぬ原因を明らかにし、患者の生活指導に有用である。(著者抄録)

皮膚のアレルギーは、食物アレルギー、花粉症、接触皮膚炎、遅延型アレルギー、アトピー性皮膚炎、薬疹など多岐にわたる。近年のトピックスとしては、石鹸に含まれた加水分解コムギ末による経皮・経粘膜感作により誘発された"小麦アレルギー"が挙げられる。本稿では、茶のしずく石鹸により誘発された即時型アレルギーの疫学調査を行ってきた、日本アレルギー学会「化粧品中のタンパク加水分解物の安全性に関する特別委員会(委員長:藤田保健衛生大皮膚科学教授松永佳世子)」で集計された情報を基に本疾患について概説し、我々が日常的に使用している香粧品に潜むアレルギーのリスクについて述べる。(著者抄録)

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)

Patch testing (PT) can be used to identify allergens and irritants responsible for contact allergic and irritant dermatitis, respectively. However, the reproducibility of PT and correlation between PT and use test has not been fully evaluated. The aim of the present study was to examine the reproducibility of PT and its usefulness in assessing the safety of topical drugs. A total of 55 topical drugs were applied to the backs of two groups of subjects for either 24 or 48 h, and skin irritant reactions were graded at 2 and 24 h after patch removal. For the repeat open application test, six topical drugs with different irritation scores were applied to the arms of two groups of subjects twice daily for 3 weeks, and local symptoms were recorded. The mean irritation scores were similar between the two PT groups. The percentage of subjects positive for symptoms provoked by the use tests was similar between the two groups. The mean irritation scores 24 h after patch removal correlated with the skin symptoms provoked by the use test. PT was reproducible and the results correlated with the use test results. PT is a useful method for evaluating the safety of commercial topical drugs.

Background: Immediate-type wheat allergy caused by a specific hydrolyzed wheat protein (HWP-IWA), Glupearl 19S (GP19S), typically develops food-dependent exercise-induced anaphylaxis (FDEIA), but is different from conventional FDEIA, or simple wheat allergy in many aspects. The skin prick test (SPT) is considered to be the most effective method for diagnosis of HWP-IWA. As SPT is a relatively qualitative method, we developed quantitative and high-throughput test method for HWP-IWA. Methods: An enzyme-linked immunosorbent assay (ELISA)-based GP19S-specific IgE assay was tested using sera from 14 HWP-IWA and five conventional wheat-dependent exercise-induced anaphylaxis (CO-WDEIA) patients, as well as five healthy subjects. Then a validation study at five different institutions was carried out using sera from 10 HWP-IWA and five CO-WDEIA patients, as well as five healthy subjects different from the previous studies. Results: The mean unit values converted from measured absorbance of ELISA were 68.3, 1.3 and 1.1 respectively. Furthermore, the validation study revealed reproducible results across all five institutions, with the standard deviation (SD) being 0.3-0.4 for the healthy group, 0.2-0.6 for the CO-WDEIA group, and 3.8-9.6 for HWP-IWA group except for one case. One case of HWP-IWA was excluded from analysis due to the high SD of 53.3 units, indicating that samples with a unit value > 100.0 will affect inter-laboratory reproducibility. Conclusions: Our findings suggest that the ELISA-based GP19S-specific IgE assay can be used to test HWP-IWA using venous blood samples, except for those with a unit value > 100.0.

The patient was a 13-year-old female. Six years previously, she developed alopecia areata when her parents divorced. One year after that, the bald area drastically expanded when her mother remarried. She was treated at her local hospital however, no improvement was observed. She then visited our hospital for examination. A bald patch was covering &gt 80% of her head. Self Grow-Up Egogram indicated the basic interpersonal relationship stance of 'I am not OK, You are OK'. We therefore implemented a transactional analysis approach to increase the patient's score on the Free Child subscale. New hair growth was observed after 6 months and the bald patch disappeared after 2 years. Our results suggest that this method could also be easily applied in a clinical setting by dermatologists.

背景・目的:医師は職業性接触皮膚炎の原因について知る機会が少なく、患者に対して適切な指導を行えていないことがある。当院での職業性接触皮膚炎例についてまとめた。方法:2006〜2010年に当科を受診し、臨床症状とパッチテストの結果から職業性接触皮膚炎と診断した38例(男性23例、女性15例)に対し、皮疹部位、職業、原因製品、就業から発症までの期間について検討し、患者自身の病識の理解についてのアンケート調査を行った。結果:皮疹部位は手が最多(34例)で、職業は理・美容師が最多(13例)、原因製品は染毛剤が最多(12例)であった。発症までの期間は5年以内での症例が多かった。アンケートは15例が回答し、15例中14例が自身の原因アレルゲンを正しく認識し、指導に基づいて原因アレルゲンとの接触を避け、14例中1例をのぞいて症状の再燃は認めなかった。考察:職業性接触皮膚炎の予防には原因アレルゲンの接触回避と、手などのスキンケアが重要である。(著者抄録)

Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), are acute inflammatory vesiculobullous reactions of the skin and mucous membranes. Cold medicines including non-steroidal anti-inflammatory drugs (NSAIDs) and multi-ingredient cold medications are reported to be important inciting drugs. We used two sample sets of Japanese patients to investigate the association between HLA genotypes and cold medicine-related SJS/TEN (CM-SJS/TEN), including acetaminophen-related SJS/TEN (AR-SJS/TEN) with severe mucosal involvement such as severe ocular surface complications (SOC). HLA-A*02: 06 was strongly associated with CM-SJS/TEN with SOC and AR-SJS/TEN with SOC. HLA-B*44: 03 was also detected as an independent risk allele for CM-, including AR-SJS/TEN with SOC. Analyses using data obtained from CM-SJS/TEN patients without SOC and patients with CM-unrelated SJS/TEN with SOC suggested that these two susceptibility alleles are involved in the development of only CM-SJS/TEN with SOC patients.

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.

＜症例のポイント＞壊疽性膿皮症の主な合併症として炎症性腸疾患があり、10〜15%で潰瘍性大腸炎やCrohn病を合併する。壊疽性膿皮症は、炎症性腸疾患の活動性に並行して推移する症例報告もあるが、さまざまな治療に抵抗性を示し、非常に難治である症例も存在する。今回われわれは、潰瘍性大腸炎に合併した下腿の難治性壊疽性膿皮症にインフリキシマブが奏効した症例を報告する。治療抵抗性の壊疽性膿皮症に遭遇した際に、インフリキシマブが認可されている基礎疾患が存在する場合は、インフリキシマブ投与を積極的に考慮するべきである。(著者抄録)