Gender role stereotype and poor working condition pose obstacles for female doctors to stay in full-time employment: alumnae survey from two private medical schools in Japan.

The shortage of physicians has become a serious problem in Japan. It has been pointed out that an increase in the number of female doctors may contribute to the aggravation of this shortage because it is known that women work fewer hours than male doctors. Here, we investigated how many female doctors had ever resigned from a full-time position, and elucidated the reasons why female doctors find it difficult to stay in full-time employment. An alumnae survey of 2 private medical schools was conducted in 2007. A self-administered questionnaire was sent to 1423 graduates and 711 responded with informed consent (response rate, 50%; mean age, 39 years). Overall, 55% of the respondents had previously resigned from full-time employment, of which 90% resigned within 10 years of graduating from medical school. The difficulty in balancing work, childbirth and child rearing (45%) were the top 2 reasons for resignation, followed by physical problems (12%) and long working hours (8%). Among those who resigned, only 33% returned to full-time employment. Women who had at least 1 child were only 30% of those who had never resigned and 84% of those who had previously resigned. The majority of study subjects, regardless of experience of resignation (88%), agreed that women should continue to work even after childbirth. In conclusion, the results of this study suggested that many female doctors resigned from a full-time position within 10 years of graduating from medical school, largely because of the gender role stereotype and poor working conditions.

Erythematous and bullous rash strongly indicating toxic epidermal necrolysis associated with the use of intravenous ritodrine hydrochloride.

Toxic epidermal necrolysis (TEN) is a very rare drug reaction associated with a high mortality rate. This condition warrants prompt recognition, diagnosis and treatment. Only one case report of TEN that was possibly induced by ritodrine hydrochloride, a tocolytic agent, was found in English literature. Here, we report the case of a 26-year-old pregnant woman who was suspected with TEN following the intravenous administration of ritodrine hydrochloride in the 35(th) week of gestation. An emergency cesarean section was performed because the labor pains caused systemic intolerable haphalgesia. After the surgery, intensive dermatological treatment commenced, which helped her recover from the serious condition. The result of the drug-induced lymphocyte stimulation test for ritodrine hydrochloride was positive. When a skin eruption appears during the administration of ritodrine, we must consider the benefits as well as the risks of continuous use of tocolytic agents because there is a risk of Stevens-Johnson syndrome or TEN.

Ingestion of Coffee Polyphenols Improves a Scaly Skin Surface and the Recovery Rate of Skin Temperature after Cold Stress: A Randomized, Controlled Trial.

Coffee polyphenols (CPPs) derived from coffee beans have beneficial effects on blood pressure and vascular endothelial function. In addition, CPPs suppress ultraviolet light induced erythema. However, the effects of CPPs on dry skin and cutaneous vascular function have not been clarified. We investigated the effects of CPPs on dry skin and the recovery rate (RR) of skin temperature after a cold-stress test as a measure of vascular function in subjects with visible scaliness in a double-blind, placebo-controlled, randomized study. The subjects were divided into two groups, the CPP group and the Placebo group. In the CPP group, the subjects ingested a beverage containing 297.8 mg CPPs every day for 4 wk. The degree of skin dryness was assessed quantitatively using a Visioscan to evaluate skin scaliness and smoothness. A subjective evaluation using a visual analog scale (VAS) of skin smoothness was also used. As a result, the scaliness and smoothness of cheek skin was significantly improved after 4 wk in the CPP group compared to the Placebo group. The improvements of the VAS score on 'skin smoothness' and the RR were also observed in the CPP group but the difference was not statistically significant. However, when the CPP group was divided into subgroups of high RR and low RR, the improvement of the RR was significant in the low RR subgroup. In conclusion, our results suggest that CPPs improve skin scaliness and play a role in cutaneous blood flow regulation after cold stress.

Japanese version of the Family Dermatology Life Quality Index: Translation and validation.

Skin conditions affect the quality of life (QoL) of patients and their family. To assess family members' QoL, a questionnaire uniquely designed for family members is necessary. We translated the Family Dermatology Life Quality Index (FDLQI), originally created and validated by Basra et al., into Japanese, and evaluated its reliability and validity. For psychometric evaluations, 150 dermatology patients and their family members were included. The Japanese version of the FDLQI showed high test-retest reliability (intraclass correlation coefficient = 0.95) and internal consistency reliability (Cronbach's alpha = 0.86). FDLQI scores significantly correlated with DLQI scores (r = 0.58, P < 0.01, Spearman's rho) and global question (GQ) which measured the patient's skin condition on a visual analog scale (r = 0.36, P < 0.01). Family members of patients with inflammatory skin diseases showed higher FDLQI scores than those with isolated lesions, but the difference was not statistically significant (P = 0.062, Mann-Whitney U-test). Responsiveness to change was demonstrated in a group in which the patient's skin condition was assessed as improved (n = 37, r = 0.46, P < 0.01) but not in that in which it became worse. The difference of the change between the two groups was statistically significant (P < 0.01). Additionally, the change in FDLQI scores and GQ were significantly correlated (r = 0.40, P < 0.01). Exploratory factor analysis suggested essential unidimensionality of the instrument. We showed acceptable validity and responsiveness of this Japanese version of FDLQI. Further clinical epidemiological studies are required to confirm this.

Dry skin conditions are related to the recovery rate of skin temperature after cold stress rather than to blood flow.

BACKGROUND: Cutaneous blood flow plays an important role in the thermoregulation, oxygen supply, and nutritional support necessary to maintain the skin. However, there is little evidence for a link between blood flow and skin physiology. Therefore, we conducted surveys of healthy volunteers to determine the relationship(s) between dry skin properties and cutaneous vascular function. METHODS: Water content of the stratum corneum, transepidermal water loss, and visual dryness score were investigated as dry skin parameters. Cutaneous blood flow in the resting state, the recovery rate (RR) of skin temperature on the hand after a cold-stress test, and the responsiveness of facial skin blood flow to local cooling were examined as indices of cutaneous vascular functions. The relationships between dry skin parameters and cutaneous vascular functions were assessed. RESULTS: The RR correlated negatively with the visual dryness score of skin on the leg but correlated positively with water content of the stratum corneum on the arm. No significant correlation between the resting state of blood flow and dry skin parameters was observed. In both the face and the body, deterioration in skin dryness from summer to winter was significant in subjects with low RR. The RR correlated well with the responsiveness of facial skin blood flow to local cooling, indicating that the RR affects systemic dry skin conditions. CONCLUSIONS: These results suggest that the RR but not blood flow at the resting state is associated with dry skin conditions and is involved in skin homeostasis during seasonal environmental changes.

Effect of vitamin D3 on the increased expression of Bcl-xL in psoriasis.

Psoriasis is a chronic skin disease characterized by epidermal hyperproliferation, which may be regulated by several mechanisms including apoptosis. In this study, we detected DNA fragmentation by the terminal deoxynucleotide transferase-mediated dUTP nick-end labeling (TUNEL) method and immunohistochemically examined the expression of Bcl-x and Bax in psoriasis. We determined the expression of bcl-xL mRNA by RT-PCR, and also determined the effect of vitamin D(3) (VD3) on bcl-xL mRNA expression in cultured normal human keratinocytes by RT-PCR, and the expression of Bcl-xL in psoriatic lesions before and after topical application of VD3. A large number of TUNEL-positive cells as well as Bcl-xL - and Bax-positive cells were observed throughout the epidermis in psoriatic lesions. Whereas, in nonlesional and normal skin, only a few TUNEL-positive cells were observed and only the lower epidermis showed positive staining for Bcl-x and Bax. We also observed higher expression of bcl-xL mRNA in psoriatic lesions than in nonlesional and normal skin. The expression of bcl-xL mRNA in cultured normal human keratinocytes stimulated or not with IFN-gamma and PMA was suppressed by VD3 in a dose-dependent manner, and the expression of Bcl-xL, but not Bax, in psoriatic lesional skin decreased after topical application of VD3 for 4 weeks. In conclusion, it is suggested that the apoptotic process in psoriatic lesions is in part regulated by Bcl-xL, and decreasing the expression of Bcl-xL by treatment with VD3 might ameliorate psoriatic lesions by contributing to the completion of the apoptotic process.

The Japanese version of Skindex-16: a brief quality-of-life measure for patients with skin diseases.

A practical quality-of-life measure applicable to patients with skin diseases is necessary. Recently developed dermatological quality-of-life measures must be translated and adapted for use in cultures other than the ones in which they were created. In this study, we translated and adapted culturally into Japanese a skin-disease-specific, brief quality-of-life measure, Skindex-16, and studied its reliability and validity. Forward-and back-translations of Skindex-16 were carried out. Six doubtful items as well as the term "skin condition" required a second forward- and back-translation to reach satisfactory agreement with the original instrument. Cross-cultural adaptation and cross-sectional questionnaire studies were then performed to evaluate the reliability and validity of the instrument. One hundred patients and 30 healthy adults responded to the Japanese version. The internal-consistency reliability of the final Japanese version of Skindex-16 was high (range of Cronbach's alpha for each scale, symptoms, emotions, and functioning, was 0.83-0.92). The Japanese version showed construct and content validity. As hypothesized, scores for dermatological patients were higher than those for healthy persons (mean global scores 36 +/- 23 vs 1 +/- 2, p < 0.001) and scores for patients with inflammatory diseases were higher than those for patients with isolated skin lesions (mean global scores 48 +/- 21 vs 22 +/- 17, p < 0.001), indicating a poorer quality of life. Most patients' responses to an open-ended question about their skin disease were similar to those of the American responders and were addressed according to the items. In conclusion, we have developed a semantically equivalent translation of Skindex-16 into Japanese. It is a reliable and valid measure of the effects of skin disease on the quality of life in Japanese patients.

A cross-sectional analysis of quality of life in Japanese acne patients using the Japanese version of Skindex-16.

We measured the quality of life of Japanese patients with acne using the Japanese version of Skindex-16, a semantically equivalent and validated translation of the original version produced by Chren et al. A total of 210 acne patients were enrolled in this study. The results showed that patients with acne experienced more severe emotional effects from their skin disease than functional or symptomatic effects. The scores for emotional aspects were related to the severity of the patients' acne following a prescribed scale, but the scores were high even when the patients only had a few comedones. Akaike's information criterion showed that the scores for symptoms were related to the severity of the patients' acne, and the patients' emotions were related to the interval between clinic visits. To improve patients' quality of life, treatment of comedones should be fully respected. In addition, dermatologists should encourage patients to visit clinics regularly to help them improve the emotional aspects of their quality of life.

Measurement of the impact of atopic dermatitis on patients' quality of life: a cross-sectional and longitudinal questionnaire study using the Japanese version of Skindex-16.

The impact of atopic dermatitis on patients' quality of life was measured using the Japanese version of Skindex-16 in a cross-sectional and longitudinal questionnaire study. One hundred sixty-two adult patients completed Skindex-16 and were followed-up with a standard medical therapy. Three to six months after the initial testing, 135 (83.3%) of the patients again completed Skindex-16 and also answered a general question about whether their skin condition had improved, remained the same, or become worse. The scores of Skindex-16 of 162 patients with atopic dermatitis were significantly higher than those of patients with isolated lesions, particularly in the Symptoms and Emotions scales. Patients with severe atopic dermatitis showed significantly higher scores in the three scales (Symptoms, Emotions, and Functioning), and there was a significant positive correlation between the severity and the 3-scale scores. After the follow-up period, 78 of 135 patients (57.8%) reported that their skin condition had improved. Forty-six patients (34.1%) reported that their skin condition had remained the same, and 11 (8.1%) became worse. Among the patients who said their dermatitis had improved, the scores of Skindex-16 significantly decreased. On the other hand, patients who reported their dermatitis worse showed an increase in the scores. These findings suggest that Skindex-16 responsively measures the disease severity and clinical change in the estimation of the effects of atopic dermatitis on patients' quality of life. This practical and sensitive, skin-disease specific, quality-of-life instrument is valuable for assessing patients' outcomes, especially their response to therapy, and is useful to understanding and improving the quality of life of patients suffering with atopic dermatitis.

Increased expression of CD208 (DC-LAMP) in epidermal keratinocytes of psoriatic lesions.

Psoriasis is a chronic inflammatory skin disease characterized by epidermal hyperproliferation and infiltration of inflammatory leukocytes. The aim of this study was to clarify the role of innate immunity involving dendritic cells (DC) and keratinocytes in psoriasis. We immunohistochemically examined the expression of DC markers such as CD1a, CD83, CD207 (Langerin), CD208 (DC-LAMP) and CD209 (DC-SIGN) in psoriatic skin and gamma-interferon (IFN-gamma)/12-O-tetradecanoylphorbol-13-acetate (TPA)-stimulated keratinocytes in vitro. CD208 was strongly expressed in basal and suprabasal layer keratinocytes in addition to DC in the perivascular lesions of the psoriatic dermis. Furthermore, the enhanced expression of CD208 in the perinuclear lesions of IFN-gamma-/TPA-stimulated keratinocytes was observed in vitro. Because a defect of the granular layer in psoriatic lesions has been recognized, increased expression of lysosome-related CD208 in the basal and suprabasal keratinocytes of psoriatic lesions might represent aberrant epidermal differentiation. Additionally, these CD208-positive keratinocytes possessing putative antigen-processing activity might play a key role as antigen-presenting cells in psoriatic skin.

Japanese version of cutaneous body image scale: translation and validation.

Cutaneous body image, defined as the individual's mental perception of the appearance of their skin, hair and nails, is an important psychodermatological element in skin diseases. To measure individuals' cutaneous body image, a practical and accurate instrument is necessary. In this study, we translated the Cutaneous Body Image Scale (CBIS), a 7-item instrument originally created by Gupta et al. in 2004, into Japanese using a forward- and back-translation method and evaluated the reliability and validity of the instrument by psychometric tests. A total of 298 healthy adults (64 men and 234 women, aged 28.9 +/- 9.9 years) and 165 dermatology patients (56.7% eczema/dermatitis, 9.8% acne, 7.5% alopecia, 6.9% psoriasis, 19.1% skin tumor/fleck/other) (30 men and 135 women, aged 37.9 +/- 15.2 years) responded to the Japanese version of the CBIS. The internal-consistency reliability of the instrument was high (Cronbach's alpha, healthy adults 0.88, patients 0.84). The CBIS measure demonstrates good test-retest reliability (healthy adults gamma = 0.92, P < 0.0001; patients gamma = 0.79, P < 0.001). Compared to the healthy adults (4.11 +/- 1.80), the CBIS scores among dermatology patients (3.18 +/- 1.69, P = 0.000) were significantly low. The CBIS scores showed moderate correlation with the "emotions" and "global" scores of Skindex-16 in healthy adults (gamma = -0.397 and -0.373, respectively) and in patients (gamma = -0.431 and -0.38, respectively). A stepwise multiple regression analysis revealed that an emotional aspect of skin-condition related quality of life was the best predictor of cutaneous body image in both healthy adults and patients (beta = -0.31 and -0.41, respectively) followed by "body dissatisfaction" (beta = -0.17, and -0.23, respectively). Adjusted R(2) was 0.246 in healthy adults and 0.264 in patients. These were consistent with the results from the original the CBIS. These results suggest that the Japanese version of the CBIS is a reliable and valid instrument to measure the cutaneous body image of Japanese adults and also dermatology patients.

Cutaneous granulomas associated with adult T-cell leukemia/lymphoma.

A 59-year-old Japanese woman showed recurrent violaceous, indurated erythemas and papules on the buttocks and extremities for a period of 7 years. The lesions showed histologically epithelioid cell granulomas associated with lymphocytes. After 7 years, the patient developed adult T-cell leukemia (ATL), of the acute type, the course of which was fatal. Immunohistochemical staining of the skin sections of granulomatous lesions showed prominent infiltration of CD25-positive cells. Human T-lymphotropic virus type I proviral DNA and monoclonal T-cell receptor beta gene rearrangement were detected in the skin samples by a retrospectively performed gene analysis. We believe that the patient initially had an unusual cutaneous type of ATL in which granulomas occurred as a host-protective response against ATL progression.