[One-week application of terbinafine cream compared with four-week application in treatment of Tinea pedis].

The possibility of one-week application of terbinafine cream for tinea pedis was studied in a double-blind test at four institutes, comparing four-week application as a control. Of a total of forty-three patients studied, nineteen were randomized into a four-week application group, Group I, and twenty into a one-week application group, Group II. Group I was evaluated as moderate to extremely useful in twelve (63.2%) of the nineteen patients and Group II in twelve (60.0%) of the twenty patients. No statistical differences were observed between two groups. These findings appeared to indicate that the short term, one-week application of terbinafine cream had results equivalent to the four-week application. This short-term treatment which aids in improving patient compliance and reducing the total amount of drug applied, thus lowering drug cost, is viewed as a useful way of treating tinea pedis.

[A case of trichophytia profunda acuta of the glabrous skin].

We report the case of a 68-year-old man with eruption on his left arm in the lesion where he wore his wrist watch. He was treated with topical steroid ointment at another clinic. He also suffered from tinea pedis. Examination of the scale and hair showed hyphal elements. Histopathological examination revealed granulomatous reaction around the hair follicles. We found no fungal elements in the tissue in spite of detecting serial sections of them. Trichophyton rubrum was cultured from tissue and scale, and the case was diagnosed as Trichophytia profunda acuta of the glabrous skin. Spontaneous remission was shown only by topical treatment for tinea pedis. A therapy of "wait and see" may be one choice.

[Two cases of Trichophyton mentagrophytes infection contracted from a hamster and a chinchilla].

We report two cases of Trichophyton mentagrophytes infection. Case 1: A 10-year-old girl visited Tokyo Electric Power Hospital in June 1994 for evaluation of an erythematous lesion on her head. Three months of topical steroid therapy exacerbated the lesion with pustular formation. Histopathological and mycological examination revealed that the patient had tinea capitis caused by T. mentagrophytes. T. mentagrophytes was also isolated from her pet, a hamster. Case 2: A-14-year-old girl was referred to Shonan Clinic in January 1996 with scaly erythema on her face. She had been treated with neticonazole hydrochloride at another clinic, but the lesion became worse. Direct microscopic examination of the scale was negative at that time, so treatment with topical steroid was started. After 10 days, the lesion was almost cured, but one month later it recurred with an annular distribution. KOH preparation of the scale revealed mycelia and T. mentagrophytes was isolated on culture. T. mentagrophytes was also isolated from her pet, a chinchilla. In both cases, the oral administration of itraconazole at 50 mg/day was effective. The isolated pathogen was identified as Arthroderma vanbreuseghemii with species-specific primers of chitin synthase 1 gene. T. mentagrophytes is one of the most common dermatophytes isolated from man and animals. Rodents like the hamster and the chinchilla have recently become popular as pets in Japan. We should be aware that rodents may carry this kind of fungal pathogen as they become even more popular as pets.

[A case of fixed sporotrichosis with recurred in a child following itraconazole treatment].

We report a case of fixed sporotrichosis in a 2-year-old girl who showed a reddish nodule on her left cheek for 1 year without trauma. Fungi flora-Y staining showed fungal elements from the exudate onthe erosion of this nodule. Sporothrix schenckii was isolated from a culture of the fungus taken from the biopsy specimen. Treatment with itraconazole 4.5 mg/kg/day for 16 weeks resulted in an atrophic scar after 2.1 mg/kg/day for 8 weeks without side effects. Six months later, her eruption recurred and wastreated with potassium iodide for 21 weeks with complete resolution. During the 1 year follow up period, there was no recurrence. Six cases of sporotrichosis in children including ours have been reported in Japan. Each case showed complete resolution and no recurrence. However, careful follow-up is believed to be necessary based on our case.

A case of melanonychia caused by Exophiala dermatitidis.

We report a case of a healthy 61-year-old woman with discoloration of the nail on her right big toe. We first treated her with topical steroid and urea under suspected diagnosis of nail eczema, but the lesion remained. In culture, black, shiny, pasty and yeast-like colonies grew repeatedly. Examination of debris from her nail showed dematiaceous spherical cells and hyphal elements. Microscopically, annelloconidia were produced at the apical ends of anellidic conidiogenous cells. This colony grew at 40C. Mitochondrial DNA restriction fragment length polymorphism was analysed in this strain and its restriction pattern confirmed the isolate to be Exophiala dermatitidis. Based on these findings, we diagnosed this nail deformity as fungal melanonychia due to Exophiala dermatitidis. This is the third reported case of this disease.

Pityriasis versicolor with a unique clinical appearance.

We experienced an atypical case of pityriasis versicolor with a unique clinical appearance and undescribed mycological features. Although Malassezia sp. was cultured from the keratotic material, the fungal elements observed in the material were not readily identified as Malassezia. The diagnosis was established with the aid of immunohistochemical and ultrastructural studies with the aetiological agent being identified as M. globosa.

Evaluation of the clinical usefulness of measuring urinary excretion of 5-S-cysteinyldopa in melanoma: ten years' experience of 50 patients.

The urinary excretion of 5-S-cysteinyldopa (5-S-CD) is known to be increased in certain patients with melanoma. To evaluate its diagnostic and prognostic utility, we measured the urinary excretion of 5-S-CD on at least three different occasions in 50 patients with melanoma. No significant increase was found in 26 patients without metastases, in 10 patients with regional lymph node metastasis and 2 patients with amelanotic melanoma. However, all the 12 patients with distant metastases demonstrated a significant increase. The patients with 5-S-CD > 1,000 micrograms/day survived for a mean of 8.1 +/- 5.6 months, while those with 5-S-CD > 10,000 micrograms/day survived for 3.5 +/- 3.7 months. All the 4 patients with a maximum excretion of 5-S-CD > 40,000 micrograms/day had multiple liver metastases. In conclusion, while data on the urinary excretion of 5-S-CD was not useful in the detection of early regional lymph node metastases, its increase indicated the presence of distant metastases and also provided prognostic information.

Aggressive B-cell lymphoma induced by Epstein-Barr virus infection in erythrodermic cutaneous T-cell lymphoma.

The coexistence of two cutaneous non-Hodgkin's lymphomas of different lineage is rare. We report a patient with an indolent erythrodermic cutaneous T-cell lymphoma followed by an aggressive B-cell lymphoma. To our best knowledge, this is the first report describing Epstein-Barr virus-associated B-cell lymphoma in a patient with cutaneous T-cell lymphoma. We suggest that the long-standing cutaneous T-cell lymphoma, as well as the long-term chemotherapy, suppressed host immunity and caused reactivation of latent Epstein-Barr virus.

Neutral red assay in minimum fungicidal concentrations of antifungal agents.

We assayed the fungicidal effects of antifungal agents using neutral red staining. Fungal elements of Trichophyton mentagrophytes and T. rubrum were treated with various concentrations of antifungal agents in 96-well filtration plates and then stained with neutral red. The amount of neutral red incorporated by the surviving viable cells was determined from the automated spectrophotometric readings at 550 nm. The minimum fungicidal concentrations (MFCs) of antifungal agents determined by this assay correlated well with those determined by conventional assay. This newly developed procedure should provide a rapid, reproducible, quantitative, qualitative and semi-automated susceptibility test for determination of the MFCs of the fungicidal agents.

Differential expression of the 45 kDa protein (actin) during the dimorphic transition of Sporothrix schenckii.

We investigated the gene expression of a protein during the dimorphic transition from yeast to mycelial form of Sporothrix schenckii. Yeast cells were converted to mycelial cells in Sabouraud glucose broth at 25 degrees C. After 1, 3 and 5 days of culture, the intermediate form of cells between yeast and mycelium was obtained, and after 7 days these cells were morphologically similar to the mycelial cells. Proteins having the molecular weight of 45 kDa were found to by synthesized preferentially by intermediate form of day 7 and mycelial cells. On the other hand, the 45 kDa proteins were predominantly translated by the RNA isolated from the intermediate of day 7 and mycelial cells using in vitro cell-free translation assay. The 45 kDa proteins synthesized by mycelial cells were found to be identical with the 45 kDa translation products directed by the mRNA isolated from the intermediate and mycelial cells by V8 protease peptide mapping. The 45 kDa protein was considered to be actin by Western blot analysis using an anti-actin monoclonal antibody. These results suggest that the intermediate form of day 7 has the same phenotypes in the morphology and biosynthesis of actin as those of mycelial cells. The expression of the actin gene may be involved in the dimorphic transition of S. schenckii.

Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D.

We report a healthy, 73-year-old Japanese woman who presented with primary cryptococcosis on the skin of both cheeks. She had initially developed an erythematous, partly ulcerated lesion on the right cheek 2 weeks earlier following an injury. There was no regional lymphadenopathy, and chest X-rays were normal. Histopathological findings showed granulomatous cell infiltration. Periodic acid Schiff staining revealed spores that were identified by the indirect immunoperoxidase staining method as Cryptococcus neoformans. The isolate was identified as C. neoformans var. neoformans serotype D. The skin lesions healed in 1 month without antifungal therapy. A literature review indicates that this serotype tends to produce cutaneous lesions without systemic involvement.

Unusually located lymphocutaneous nocardiosis caused by Nocardia brasiliensis.

We report a patient with primary lymphocutaneous Nocardia brasiliensis infection affecting the face and left arm. The mode of infection was via skin abrasions which occurred 2 weeks prior to the development of the skin lesions. Treatment with intravenous minocycline for 4 weeks resulted in a cure. We also review 12 previously reported Japanese cases of lymphocutaneous nocardiosis.

Fonsecaea pedrosoi isolated from skin crusts of Bowen's disease.

Fonsecaea pedrosoi was isolated from scaly crusts of plaque lesions on the left thigh of a 60-year-old Japanese man. Histological examination confirmed these lesions to be due to Bowen's disease, and sclerotic cells were recognized in the stratum corneum. To our knowledge, this is the first study to demonstrate superficial colonization of a pre-existing skin lesion by F. pedrosoi.

Ultrastructure of Trichophyton mentagrophytes stained with neutral red.

The ultrastructure of Trichophyton mentagrophytes cells stained with neutral red was investigated using electron microscopy and X-ray microanalysis. Fixatives containing molybdenum and chromium were used to prevent the outflow of neutral red. Electron-dense particles composed of metals and dye were observed exclusively in the vacuoles, which were increased in number and size, but not near the cell wall. Results indicate that neutral red passes directly through the fungal cell wall and is incorporated into the vacuoles.

Association of the acral type of pustular psoriasis, Sjögren's syndrome, systemic lupus erythematosus, and Hashimoto's thyroiditis.

We describe a case of a 53-year-old Japanese female suffering from Sjögren's syndrome, systemic lupus erythematosus, and Hashimoto's thyroiditis who developed pustules, erythema, and erosions on her fingers and toes. The histological specimen showed psoriatic changes. Indirect immunofluorescent study using anti-human IL (interleukin)-8 antibody produced positive staining patterns in the lesional epidermis. These findings suggested the diagnosis of acral pustular psoriasis. Diaminodiphenylsulfone at 75 mg orally daily for 20 days and the application of 0.12% betamethasone valerate ointment led to gradual improvement.

Cutaneous T-cell lymphoma arising from parakeratosis variegata: long-term observation with monitoring of T-cell receptor gene rearrangements.

BACKGROUND: Parakeratosis variegata is a rare skin disease first described in 1890. Even today, the disease entity remains confusing because various names indicating similar skin conditions have been used. Several cases of parakeratosis variegata have been reported to develop into cutaneous T-cell lymphoma, but there have been no reports describing the occurrence of lymphoma after a long-term follow-up period nor have T-cell receptor gene rearrangements been monitored in this disease. OBJECTIVE: Our purpose was to determine whether parakeratosis variegata (long-standing premycotic condition) can develop into cutaneous T-cell lymphoma. METHODS: We analyzed skin specimens from a patient with a 33-year history of parakeratosis variegata by Southern blotting using a T-cell receptor gene probe. RESULTS: We could detect apparent rearranged bands of T-cell receptor gene in the skin specimens taken in 1993 in contrast to the DNA analysis in 1988 which featured no such rearranged band. CONCLUSION: This case represents a critical stage of parakeratosis variegata converting to lymphoma. Our results indicate that parakeratosis variegata generated monoclonality of T cells in its chronic course.

Toxic epidermal necrolysis with tracheobronchial and pulmonary complications.

A 55-year-old man developed multiple erythematous skin lesions after surgery for acoustic neurinoma. Necrosis and detachment of the epidermis developed and a diagnosis of toxic epidermal necrolysis (TEN) was made. Progressive dyspnea was evident two days after the onset of the skin lesions. Chest X-ray revealed diffuse interstitial shadows in both lung fields. On bronchoscopic examination, erosion, vesicle formation, necrosis and desquamation of the epidermis were seen in the tracheobronchial mucosa. Therapy, including prednisolone, improved the skin lesions as well as the chest X-ray and bronchoscopic findings. Tracheobronchial and pulmonary lesions were followed before, during and after treatment of TEN.

Evaluation of antifungal effects of terbinafine and itraconazole using neutral red staining.

Neutral red staining is a newly described method for evaluating the viability of fungal cells. Using this method, the antifungal effects of terbinafine and itraconazole were evaluated in vitro. When the number of neutral red-positive Trichophyton mentagrophytes conidia treated with these two oral antifungals was compared with the number of culture-proved viable T. mentagrophytes conidia, a strong positive correlation was found. This result confirms that neutral red staining is a useful method for evaluating the viability of T. mentagrophytes in vitro, and that it can be used for the evaluation of antifungal activity. We conclude that the effectiveness of an antifungal drug should not be evaluated by direct microscopic examination alone, but with the additional aid of mycological culture or neutral red staining.

Characterization of the amyloid fibril from primary localized cutaneous nodular amyloidosis associated with Sjögren's syndrome.

BACKGROUND: Primary localized cutaneous nodular amyloidosis (PLCNA) is a rare disease, and its pathogenesis of amyloid deposition is still unknown. OBJECTIVE: The purpose of this study was to know the origin of amyloid in PLCNA. METHODS: Water-soluble amyloid fibrils were isolated from the skin and resolved on SDS-PAGE, then subjected to immunoblot analysis. RESULTS: The major amyloid fibril protein was a 29-kD peptide which reacted with both anti-lambda- and anti-kappa-light-chain antibodies. CONCLUSION: Amyloids in this particular case of PLCNA are derived from the polyclonal immunoglobulin light chain and some cases of PLCNA could be reactive diseases rather than neoplastic ones.

Application of neutral red staining for evaluation of the viability of dermatophytes and Candida in human skin scales.

The fungal elements observed by direct microscopic examination sometimes fail to grow on subsequent culture. To elucidate the cause of this discrepancy, the viability of dermatophytes and Candida in skin scales was evaluated by neutral red staining. Autoradiographic study using 3H-thymidine confirmed that grain-positive cells (viable cells) were stained with neutral red, whereas negative cells (non-viable cells) were not stained. Taking this as a baseline, the correlation between neutral red-positive fungal elements in scales taken from 211 patients with tinea and 27 patients with cutaneous candidosis and cultures on Sabouraud glucose agar was studied. Strong positive correlations were found in both mycoses. These findings suggest that neutral red staining provides a useful method for evaluating the viability of dermatophytes and Candida in human skin scales.