Validation of a lateral flow immunochromatographic assay for tinea unguium diagnosis.

Tinea unguium is a common nail disease caused by dermatophytes. Although direct potassium hydroxide (KOH) microscopy and fungal culture are considered the gold standard for diagnosing this disease, their accuracy is insufficient. A lateral flow immunochromatographic assay (LFIA) kit, using a monoclonal antibody against Trichophyton rubrum, was developed and its sensitivity was recently improved 50% in vitro relative to its earlier version. The present study aimed to validate the clinical utility of this improved LFIA kit for diagnosing tinea unguium in comparison with direct KOH microscopy. A similar trial was simultaneously performed using scale samples from patients with tinea pedis to determine the assay's diagnostic potential. Nail samples, approximately 2 mg in weight, were collected from 112 non-treated tinea unguium patients and 56 non-tinea unguium patients. Samples from 25 tinea pedis patients and 20 non-tinea pedis patients were also collected. The sensitivity and specificity of the LFIA kit for tinea unguium was 84.8% (95/112) (95% confidence interval [CI], 76.8-90.9) and 83.9% (47/56) (95% CI, 71.7-92.4), respectively. The inconsistency rate was 15.5% (26/168) (95% CI, 10.4-21.9). The sensitivity and specificity of the LFIA kit for tinea pedis was 84.0% (21/25) and 100.0% (20/20), respectively. These results suggest that for diagnosing tinea unguium, the LFIA kit is a useful supplement to, but not a replacement for, direct KOH microscopy. For definitive diagnosis of suspected cases, appropriate sampling, repeated examinations, and a combination of diagnostic techniques are essential.

Guidelines for the diagnosis and treatment of male-pattern and female-pattern hair loss, 2017 version.

Male-pattern hair loss (MPHL, androgenetic alopecia) is a slowly progressive form of alopecia which begins after puberty. In 2010, we published the first Japanese edition of guidelines for the diagnosis and treatment of MPHL. It achieved the original goal of providing physicians and patients in Japan with evidence-based information for choosing efficacious and safe therapy for MPHL. Subsequently, new therapeutic drugs and treatment methods have been developed, and women's perception of MPHL has undergone change and the term "female-pattern hair loss (FPHL)" is becoming more common internationally. Thus, here we report a revised version of the 2010 guidelines aimed at both MPHL and FPHL. In these guidelines, finasteride 1 mg daily, dutasteride 0.5 mg daily and topical 5% minoxidil twice daily for MPHL, and topical 1% minoxidil twice daily for FPHL, are recommended as the first-line treatments. Self-hair transplantation, irradiation by light-emitting diodes and low-level lasers, and topical application of adenosine for MPHL are recommended, whereas prosthetic hair transplantation and oral administration of minoxidil should not be performed. Oral administration of finasteride or dutasteride are contraindicated for FPHL. In addition, we have evaluated the effectiveness of topical application of carpronium chloride, t-flavanone, cytopurine, pentadecane and ketoconazole, and wearing a wig. Unapproved topical application of bimatoprost and latanoprost, and emerging hair regeneration treatments have also been addressed. We believe that the revised guidelines will improve further the diagnostic and treatment standards for MPHL add FPHL in Japan.

Case of localized scleroderma successfully treated with bath psoralen and ultraviolet A therapy.

The patient was a 12-year-old girl with linear scleroderma distributed on the right abdomen, dorsal aspect of the right thigh, lower leg and foot. The initial regimen of oral prednisolone and methotrexate, or i.v. methylprednisolone failed in the treatment of the scleroderma. Then bath psoralen and ultraviolet A therapy (bath-PUVA) therapy of 0.2 J-4.0 J/cm(2) daily to total doses 62.8 J/cm(2) combined with oral prednisolone was started. After bath-PUVA therapy, regression of the skin sclerosis was observed, the possible mobile range of the right ankle was increased and histological examination confirmed improvement of the sclerosis. The successful results of bath-PUVA therapy in this case suggest its utility for localized scleroderma.

In vitro activities of azole antifungal agents against Propionibacterium acnes isolated from patients with acne vulgaris.

The Gram-positive bacterium Propionibacterium acnes is the causative agent of acne vulgaris. Antibiotics such as tetracycline and macrolide derivatives are used to treat this skin disease; however, the isolation frequency of antibiotic-resistant P. acnes has been increasing. The anti-P. acnes activity of imidazole antifungal agents was reported more than 20 years ago, and since then, new azole antifungal agents have been marketed. Thus, this study determined the in vitro activities of azole antifungal agents against P. acnes isolated from patients with acne vulgaris. Of the five agents tested, miconazole, ketoconazole, and itraconazole showed concentration-dependent anti-P. acnes activity, including against antibiotic-resistant isolates. Time-kill assay also showed the time-dependent activity of the drugs. Fluconazole and voriconazole showed no anti-P. acnes activity.

Athlete's nodule.

Three cases of athlete's nodule on the feet are reported. In case 1, a 30-year-old man, who had been an amateur football player, presented with nodules on the lateral side of the feet and on the right lateral malleolus with a duration of 1 year. In case 2, a 22-year-old man, who had participated in karate and track-and-field, presented with nodules on the lateral side of the feet and on the right lateral malleolus with a duration of 10 years. In case 3, a 25-year-old man, who had skied, presented with a nodule on the right lateral malleolus with a duration of 4 years. The biopsy specimens from the lesion demonstrated hyperkeratosis, acanthosis of the epidermis and thickness of the dermis. In 1991, Cohen et al. proposed the concept of athlete's nodule which indicated an acquired cutaneous nodule caused by chronic stimuli with sports. Histopathology of the athlete's nodule shows hypertrophy of the epidermis and dermis. To the best of our knowledge the term "athlete's nodule" has not been used in Japan, but it is a useful term to refer to the lesion induced by athletics or the use of sporting equipment.

Folliculotropic mycosis fungoides and a leonine clinical appearance of the face.

A 73-year-old man presented with a two year history of multiple nodules and follicular papules accompanied by slight itching on the face and the forearm. A physical examination showed multiple, soft, erythematous nodules on the forehead, cheek, and jaw, contributing to a generally leonine appearance of the face. Histopathological examination from the forehead revealed dense, massive concentrations of atypical lymphocytes in the dermis, and the forearm showed infiltration of atypical lymphocytes predominantly around the follicles. We diagnosed this condition as folliculotropic cutaneous T cell lymphoma (CTCL). EPOCH therapy was very effective and the lesions of the forehead and forearm showed a decrease in tumor elevation; the histology showed a precipitous decrease in the number of the atypical lymphocytes.

Effects of arachidonic acid analogs on FcepsilonRI-mediated activation of mast cells.

Polyunsaturated fatty acids (PUFAs) such as arachidonic acid (AA) have been shown to modulate a number of inflammatory disorders. Mast cells play a critical role in the initiation and maintenance of inflammatory responses. However, the effects of PUFAs on mast cell functions have not been fully addressed. We here-in examined the effects of PUFAs on the high affinity IgE receptor (FcepsilonRI)-mediated mast cell activation using RBL-2H3 cells, a rat mast cell line, that were cultured in the medium containing palmitic acid (PA), AA, or the AA analogs mead acid (MA) and eicosapentaenoic acid (EPA). In AA-supplemented cells, the FcepsilonRI-mediated beta-hexosamidase and TNF-alpha release, calcium (Ca(2+)) influx, and some protein tyrosine phosphorylations including Syk and linker for activation of T cells (LAT) were enhanced, whereas, in MA- or PA-supplemented cells, they were not changed when compared with cells cultured in control medium. In EPA-supplemented cells, the enhancements of beta-hexosamidase release and protein tyrosine phosphorylations were observed. Furthermore, in AA- or EPA-supplemented cells, FcepsilonRI-mediated intracellular production of reactive oxygen species (ROS) that is required for the tyrosine phosphorylation of LAT and Ca(2+) influx were enhanced when compared with the other cells. Thus, preincubation of AA or EPA augmented FcepsilonRI-mediated degranulation in mast cells by affecting early events of FcepsilonRI signal transduction, which might be associated with the change of fatty acid composition of the cell membrane and enhanced production of ROS. The results suggest that some PUFAs can modulate FcepsilonRI-mediated mast cell activation and might affect FcepsilonRI/mast cell-mediated inflammation, such as allergic reaction.

Linear polarized infrared irradiation using Super Lizer is an effective treatment for multiple-type alopecia areata.

BACKGROUND: Super Lizer trade mark is a linear polarized light instrument, which has been used with good effect in orthopedics and anesthesiology to treat arthralgia and neuralgia with a high output of infrared radiation. AIM: To test Super Lizer trade mark 's efficacy for the treatment of alopecia areata. METHODS: Fifteen patients over 18 years of age, diagnosed with alopecia areata and displaying symptoms of patchy hair loss, were topically irradiated with infrared radiation using the Super Lizer trade mark. The patients were irradiated intermittently for an interval of 3 min once every week or every 2 weeks. RESULTS: Seven of 15 (46.7%) of the irradiated areas showed hair regrowth 1.6 months earlier than the nonirradiated areas (chi2 official approval, P = 0.003). With regard to adverse effects caused by Super Lizer trade mark treatment, only one patient complained of a sensation of heat in the irradiated area. CONCLUSIONS: These findings suggest that Super Lizer trade mark, with its noninvasive properties, is a useful apparatus for the treatment of mild forms of alopecia areata.