赤松 浩彦

55歳の女性。2年前より前額部，背部に痒みを伴う皮疹が出現してきた。近医において内服薬と外用薬によって加療を受けるも軽快せず，8ヵ月前からは，食物摂取時に，口腔内の痛みも出現してきたため，当科を紹介され受診した。初診時，前額部，背部に紫紅色の丘疹が散在し，口腔内には白色レース様粘膜疹が認められた。口腔粘膜の皮疹は生検により，また皮膚症状は臨床所見より扁平苔癬と診断した。金属アレルギーを疑いパッチテストを施行したところ，0.5%pet. 金チオ硫酸ナトリウムに確実陽性を示した。金を含有している歯科金属を除去したところ，3ヵ月後に皮膚の症状および6ヵ月後に粘膜症状は改善し，現在までのところ再燃はみられない。

14歳から17歳の思春期女子尋常性痤瘡患者65例と同年齢分布の対照健常女子38例について，卵胞期中期採血によりtestosterone（T），free testosterone（FT），sex hormone binding globulin（SHBG），dihydrotestosterone（DHT），dehydroepiandrosterone sulfate（DHEA-S），androstenedione（Δ⁴A），luteinizing hormone（LH），follicle stimulating hormone（FSH）を測定し，本症と血中ホルモンの関係について検討した．また尋常性痤瘡患者群はKligman分類により重症群（33例）と中等度群（32例）の2群に分け，重症度と血中ホルモンの関係についても検討した．健常群と比較して尋常性痤瘡患者では血中T，FT，SHBG，DHT，Δ⁴A，FSH，LH値は有意差は認めなかったが，血中DHEA-S値のみ有意の高値を認めた（p＜0.001）．更に血中DHEA-S値は尋常性痤瘡群の重症度に相関した（p＜0.001）．そこでDHEAの皮脂腺に及ぼす影響を，ハムスターの耳介より単離した皮脂腺を組織片培養して得られた脂腺細胞を用いて検討し，DHEAが濃度依存性に培養脂腺細胞の細胞増殖と脂質合成を亢進させることが判明した．以上よりDHEAが尋常性痤瘡の発症機序において，重要な役割を果たしている可能性が示唆された．

We report a case of electric shock injury in a 42-year old man who was electrocuted with a current of 200. V voltage while performing civil engineering work. Electric current spots were observed on both his right and left forearms and the back of his right hand, suggesting that the electric current entered through the back of the hand, exiting from the forearm on the right side, and through the switch to the palm, and then exiting from the forearm on the left side. We performed an MRI, which provided confirmation of the degree and range of local muscular tissue damage. A relaxation incision, debridement and the attachment of an artificial dermis preceded full-thickness grafting. Following post-surgical rehabilitation, a mild contracture of finger joints was observed, but the motor functions were observed to have significantly improved.

A case of occupational contact dermatitis due to epoxy resins is reported. A 27-year-old man, with a 6-year history of pruritic eruptions on his hands consulted our clinic. We treated him with topical steroids and antiallergic agents, however, the lesions gradually worsened. He was thereafter given a series of patch tests using various products in his work place to find the causative product. The patch test demonstrated positive reactions to bisphenol A epoxy-resin. After making changes in the work environment, his symptoms improved.

The patient is a 34-year-old female with aortitis syndrome. In May 1999. an eruption occurred on the lower limbs but spontaneous remission was observed. However, she visited this department in July when similar eruptions occurred on the lower limbs and buttocks. She had a painful erythema accompanied with induration and crust as well as a localized undermining ulcer. Histopathological finding from erythema with induration was showed infiltration of neutrophilis lymphocytes, and not vasculitis. Based on these clinical findings and histopathological findings, she was diagnosed to have pyoderma gangrenosum. In addition to 20mg/day of oral predonisolone prescribed at the internal department. she was treated with zinc oxide ointment stratified by a topical steroid containing antibiotic. The ulcer disappeared in 5weeks while she was placed under observation. © 2001, Meeting of Osaka Dermatological Association. All rights reserved.

Background: It has been shown that in acne comedones the proportion of linoleic acid is markedly decreased, while palmitic acid is significantly increased. We previously reported that the decreased proportion of linoleic acid, which markedly suppresses neutrophil reactive oxygen species (ROS) generation and phagocytosis, contribute to the worsening of acne inflammation. The aim of this study was to examine the effect of palmitic acid on neutrophil functions in vitro. Methods: We investigated the effect of palmitic acid on inflammatory parameters such as neutrophil chemotaxis, phagocytosis, and ROS generation. Reactive oxygen species generation in a cell-free, xanthine-xanthine oxidase system was also assessed. The species examined were superoxide radical anion (O2-), hydrogen peroxide (H2O2), and hydroxyl radical (OH·). Results: Palmitic acid significantly decreased H2O2 generation both by neutrophils and in the xanthine-xanthine oxidase system, while neutrophil chemotaxis and phagocytosis as well as O2- and OH· generation by both systems were not markedly affected in the presence of palmitic acid. Conclusions: The present study suggests that palmitic acid may be involved in the pathogenesis of acne inflammation from a standpoint of oxidative tissue injury.

We demonstrated the immunoreactivity of the receptor proteins, VR1, ion channels associated with pain sensation, on the epidermis of the human skin. Immunohistochemistry using antiserum against VR1 derived peptide showed immunoreactivity on the keratinocytes cell membrane of the human epidermis and cultured keratinocytes. The blocking peptide of the antiserum reduced the immunoreactivity on the epidermis. RT-PCR assay of cultured human keratinocyte also showed expression of VR1 mRNA. These results suggest the existence of VR1-like protein in epidermal keratinocytes of human skin. © 2001 Academic Press.

膿疱性ざ瘡患者20例について, ロキシスロマイシン錠(150mg力価)を1回1錠, 1日2回, 14日間経口投与し, 投与前後における顔面の皮脂中の遊離脂肪酸量の推移と治療効果について検討した。その結果, グリセロールエステル量に対する遊離脂肪酸量の比率および炎症性皮疹の個数ともに, 投与前と比較して投与後において有意な減少が認められ, 両者には高い相関が得られた。またPropionibacterium acnesの菌量においても投与前と比して減少傾向が認められた。

The effect of clindamycin (CLDM) at subminimal inhibitory concentrations (sub-MIC), i.e. one-tenth MIC, on the production of human neutrophil chemotactic factors in comedonal bacteria, Propionibacte-rium acnes (P. acnes) strains and coagulase-negative staphylococci (CNS) strains, was assayed using Boyden chamber method. Sub-MIC of CLDM markedly inhibited the production of neutrophil chemotactic factors in all strains of P. acnes and CNS. Our results seem to suggest that sub-MIC of CLDM has an anti-inflammatory effect presumably due to the inhibition of neutrophil chemotactic factors production in comedonal bacteria on the inflammatory process of acne.