Increased serum levels of interleukin 33 in patients with atopic dermatitis.

BACKGROUND: Interleukin (IL)-33 is a new member of the IL-1 cytokine family and a promoter of T helper type 2 (Th2) inflammation. IL-33 may be involved in the pathogenesis of atopic dermatitis (AD), but its relationship with disease severity, laboratory markers, and eruption types in patients with AD are unclear. OBJECTIVE: The aim of this study was to quantify serum IL-33 levels in patients with AD and to examine relationships with disease severity, laboratory markers, and eruption types. METHODS: Serum IL-33 was measured by enzyme-linked immunosorbent assay in patients with AD, chronic idiopathic urticaria, and psoriasis and in healthy control subjects. RESULTS: Serum levels of IL-33 were significantly higher in patients with AD compared with those in patients with urticaria and psoriasis and in healthy control subjects, and were correlated with the disease severity of AD. IL-33 levels were also significantly correlated with excoriation and xerosis scores, but not with blood eosinophilia, serum IgE, serum thymus and activation-related chemokine, and serum lactate dehydrogenase. Elevated IL-33 levels were significantly reduced after improvement of skin lesions by drug treatment. LIMITATION: A limitation in the study was the small number of subjects. CONCLUSION: Our results suggest that IL-33 released from mechanically injured or barrier-disrupted skin may increase inflammation in AD.

Putative Novel Species of Genus Capnocytophaga, Capnocytophaga stomatis Bacteremia in a Patient with Multiple Myeloma after Direct Contact with a Cat.

Capnocytophaga species are among the typical zoonotic pathogens causing infections following direct contact with animals. Recently, a putative novel species of zoonotic Capnocytophaga, Capnocytophaga stomatis, was reported. We herein report the first case of bacteremia caused by C. stomatis. A woman in her 80s with multiple myeloma who was receiving bortezomib and dexamethasone therapy was admitted to our hospital with a 2-day history of a fever and right calf redness. She was often licked by her cat. On a blood culture, thin, Gram-negative rods were detected, which were identified as C. stomatis by whole-genome sequencing. The patient was successfully treated with ampicillin-sulbactam treatment. Our case highlights the pathogenic potential of the putative novel Capnocytophaga, C. stomatis, in immunocompromised hosts.

Persistent congenital milia involving the skin of the whole body in an infant with trisomy 13 syndrome.

Milia are tiny pearly-white cysts on the surface of the skin. In newborns, milia are usually located around the nose and eyes and generally disappear after the first several weeks of life. Trisomy 13 is a severe chromosomal disorder, with various complications. Here, we report a case of a 9-month-old female infant with trisomy 13 who had persistent congenital milia covering her entire body surface.

Verrucous lesions arising in lymphedema and diabetic neuropathy: Elephantiasis nostras verrucosa or verrucous skin lesions on the feet of patients with diabetic neuropathy?

Verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) develop in areas with sensory loss in diabetic patients. Although various types of chronic stimulation, such as pressure or friction, are considered an important factor in the development of such lesions, the precise pathogenesis of VSLDN remains obscure, and there is currently no established treatment for this disease. Here, we present a case of VSLDN on the dorsum of the right foot. However, because lymphedema was also observed at the same site, this lesion could also be diagnosed as elephantiasis nostras verrucosa arising in diabetic neuropathy. The lesion was successfully treated with a combination of elastic stocking and mixed killed bacterial suspension and hydrocortisone ointment, which suggested that VSLDN might have been exacerbated by the pre-existing lymphedema. Because various types of chronic stimulation can trigger VSLDN, treatment plans should be devised on a case-by-case basis. Therefore, it is important to investigate the presence of factors that can induce or exacerbate chronic inflammatory stimulation, such as lymphedema in our case, in each patient with VSLDN.

Clinical usefulness of Mohs' chemosurgery for palliative purposes in patients with cutaneous squamous cell carcinoma with risk factors or without indication for surgery: three case reports.

Mohs' chemosurgery is a technique of chemical fixation of a cutaneous tumor using 20% zinc chloride, and the surgeon performs a sequential series of excisions until no residual tumor can be found in the bottom layer of the specimen by microscopic examination. This technique has also been gradually accepted as one of the palliative treatment options in patients with cutaneous tumors with risk factors for surgery. We report three cases of cutaneous squamous cell carcinoma that were treated with Mohs' chemosurgery for palliative purposes. In case 1, Mohs' chemosurgery could prevent rapid tumor growth and control the bleeding, exudation and offensive odor from ulcerated tumors. The patient was able to live enjoyably at home with her family before she was transferred to a palliative care hospital. In case 2, Mohs' chemosurgery followed by debridement of residual tumor and a full-thickness skin graft contributed to an early hospital discharge, which prevented the progression of cognitive decline. In case 3, remission of the tumor was achieved by concurrent treatment with local radiotherapy and Mohs' chemosurgery. Mohs' chemosurgery for palliative purposes is not a radical treatment, but contributes to the patient's quality of life. It has the possibility of becoming a radical treatment if eligible patients and concurrent treatment are carefully selected. An increase in the number of skin cancer patients with risk factors for surgery has been predicted because of the progression of the aging society. Mohs' chemosurgery may become one of the treatment options for such patients.