A case of anti-laminin γ1 (p200) pemphigoid developed after dipeptidyl peptidase-4 inhibitor administration.

A 73-year-old man with diabetes mellitus was referred to our department for ultraviolet treatment for erythematous skin lesions with itching. On dipeptidyl peptidase-4 inhibitor (DPP-4i) sitagliptin (Januvia®) for diabetes mellitus, the erythematous skin lesions appeared and spread to the whole body. At the initial visit, erythema multiforme-like skin lesions with crusts were observed on the trunk and extremities, and the patient was suspected to have drug eruption. Histopathology demonstrated eosinophilic infiltration in the superficial dermis and inflammatory cell infiltration in the epidermis. Sitagliptin was discontinued, and erythematous lesions improved with oral prednisolone. Thereafter the patient was treated with phototherapy and  betamethasone sodium phosphate infusion for residual prurigo. However, blistering skin lesions appeared 5 months later. Histopathological findings were subepidermal blisters with eosinophilic abscess, and bullous pemphigoid was suspected. CLEIAs for autoantibodies to desmoglein 1 (Dsg1), Dsg3 and BP180 were negative. Direct immunofluorescence showed linear depositions of immunoglobulin G (IgG) and C3 at the epidermal basement membrane zone, and indirect immunofluorescence detected IgG anti-epidermal basement membrane zone antibodies, reacting with the dermal side of 1M NaCl-split normal human skin. IgG antibodies reacted with 200 kDa laminin γ1 (p200) by immunoblotting using dermal extracts. These results indicated that this patient was diagnosed with anti-laminin γ1 (p200) pemphigoid developed after DPP-4i administration. Although reports of DPP-4i-related bullous pemphigoid have accumulated, cases of anti-laminin γ1 (p200) pemphigoid developed after DPP-4i administration are rarely reported.

Clinical effect of low-energy double-pass 1450 nm laser treatment for acne in Asians.

BACKGROUND: While the 1450 nm diode laser is highly effective for the treatment of acne, its use is associated with considerable pain. Low-energy, double-pass irradiation was attempted as an alternative to prevent the occurrence of pain as an adverse effect. PURPOSE: This study aimed to evaluate the clinical efficacy of low-energy, double-pass, 1450 nm diode laser treatment in the treatment of acne in Asian patients. METHODS: Thirty Japanese patients with inflammatory acne were treated with the low-energy, double-pass, 1450 nm diode laser at 2-4-week intervals. An open study was performed in patients that underwent at least five and up to 10 treatment sessions. The clinical effect was assessed using an acne grading scale. RESULTS: Of the 30 patients, 27 completed the study. The mean acne grades decreased from 3.9 to 1.4 (P<0.01) in the 27 patients. The pain was tolerated by 25 patients, and two patients required local anesthesia. No remarkable side effects occurred in any of the patients; all but a few patients had transient faint erythema. CONCLUSION: Low-energy, double-pass therapy is an alternative method that is beneficial for patients who complain of considerable pain. Furthermore, the method may have a lower risk of transient hyperpigmentation induced by cryogen spray, even in Asian patients who tend to develop inflammatory pigmentation.

A new targeted blue light phototherapy for the treatment of acne.

BACKGROUND: The effects of blue light phototherapy on inflammatory acne lesions were recently investigated. Many reports have used high-intensity, narrow-band 420 nm UV-free blue light delivery systems. The aim of this study was to evaluate a new blue light system (MultiClear) for targeted blue light phototherapy. METHOD: Ten Japanese patients with acne on the face or back were treated with targeted blue light once or twice a week. Acne severity was graded according to the acne severity score suggested by Allen and Smith (1982). If the acne was prevalent on the back or chest, the acne severity score of Burton et al. (1971) was adopted. The new targeting blue light system is equipped with a flexible optical light guide as a delivery system and the treatment device is placed directly only on the affected area. RESULT: Of the 10 patients, eight had a significantly reduced acne severity score without any side effects. Although two patients discontinued the study because of unsatisfactory results, none of the patients showed any harmful side effects from the targeted blue light phototherapy. CONCLUSION: Targeted blue light phototherapy with MultiClear is effective for the treatment of inflammatory acne lesions. This new irradiation device offers some advantages over previous blue light systems.