In patients with atopic dermatitis (AD), psychosomatic factors are important elements in treating the condition. In this study, we surveyed 51 outpatients with AD who consulted the Department of Dermatology of Fujita Health University Hospital using a questionnaire involving present illness/treatment history regarding AD to analyze psychosomatic factors. The severity of AD was evaluated using the severity classification described by Yoshiike et al. Four psychological tests were used to examine depression, anxiety, personality, and upbringing experiences during childhood. Beck Depression Inventory (BDI) was used as a scale for depression, Self-rating Anxiety Scale (SAS) as a scale for anxiety, the Temperament and Character Inventory (TCI) as a scale for the personality tendency, and the Parental Bonding Instrument (PBI) as a scale for upbringing experiences during childhood. The BDI and SAS scores were high in the severe AD group. Among patients with the same grade of AD, the BDI and SAS scores were higher in the low IgE RIST group. In the patients with AD, the BDI scores were significantly higher than those in the healthy controls (P<0.05). In clinical practice, the treatment of AD should include psychosomatic approaches.
Darier disease (DD; Darier-White disease; OMIM 124200) is an autosomal dominant inherited disorder. 1 Clinically, it is characterized by recurrent and multiple hyperkeratotic papules or nodules affecting the trunk and flexural aspects of the extremities. 1 Characteristic histopathological features are dyskeratotic cells in the form of corps ronds and grains, suprabasal acantholysis forming suprabasal lacunae and irregular upward proliferation into the lacunae of papillae lined with a single layer of basal cells, the so-called villi. 2 The causative gene is ATP2A2 (OMIM 108740) on chromosome 12, which encodes the sarco ⁄endoplasmic reticulum calcium pump ATPase (SERCA2). 2 Clinical variants include the hypertrophic, vesiculobullous, hypopigmented, cornifying, zosteriform and linear subtypes, and the rare subtype comedonal Darier disease (CDD). 1,3-6 CDD tends to appear in seborrhoeic areas. The characteristic morphological features are prominent follicular involvement, sometimes associated with keratotic plugs, and the presence of greatly elongated dermal villi and papillary projections. 4 There have been no conclusive reports on the aetiology of CDD and it is still controversial as to whether or not CDD is a variant of DD, and if it is caused by ATP2A2 gene mutations, although a combination of CDD and classic DD was reported in one patient. 7 The present study identifies a previously unreported three-base deletion mutation in ATP2A2 in a patient with CDD. Patient and methodsA 22-year-old Japanese man presented with acne-like comedonal lesions on the face and chest, most densely distributed on the forehead, cheeks, back, axillae and chest. The comedonal lesions had first appeared in his teens and had gradually increased in number. Physical examination showed open comedones, closed comedones, red papules, nodules, cysts and ice-pick scars (Fig. 1a,b). His parents were clinically healthy, without any skin problems. He had been treated with oral biotin, Korean ginseng, an antihistamine, topical bufexamac ointment, calcipotriol ointment and betamethasone butyrate propionate ointment without any improvement. Histopathological observations revealed suprabasal acantholytic clefts and numerous dyskeratotic cells (corps ronds) in the outer root sheath in the affected follicular infundibulum, which was surrounded by plasma cells and lymphocytes (Fig. 1c,d). We made a diagnosis of CDD. Oral etretinate 10 mg daily combined with adapalene gel remarkably improved most of the skin lesions, except those on the forehead.Polymerase chain reaction (PCR) amplification and direct sequencing of the entire coding region and exon ⁄intron boundaries of ATP2A2 were performed using the proband's and his parents' genomic DNA samples and genomic DNA samples from 50 healthy Japanese individuals as controls. A detected mutation was verified by mutant allele-specific amplification analysis 8 with mutant allele-specific primers carrying the substitution of two bases at the 3¢ end, a PCR product band derived from the mutant allele.This study was a...
Opium alkaloids can cause immunological reactions. Cross-sensitization among them must be considered in these situations.
Reticulated acanthoma with sebaceous differentiation (RASD) is characterized by the reticulated proliferation of spinous cells with aggregates of mature sebocytes in the bases of the strands of the keratinocytes, often linking rete ridges. Here, we report the first case reported as RASD. A 55-year-old woman presented with a 15-year history of a slightly pruritic patch on the upper back, and the histology was typical for RASD. She had been bothered by a yellow discharge from the tumor. Skin tumors with sebaceous differentiation are occasionally associated with Muir-Torre syndrome. However, immunohistochemical staining for mutS homolog 2 (MSH-2) and mutL homolog 1 (MLH-1) showed positive staining within the nuclei of sebaceous cells and cells in the dermis. Therefore, it is most likely that the present case is not associated with Muir-Torre syndrome.
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