No abstract

Kawasaki Disease (KD) is acute, febrile, multisystem vasculitis of early childhood, the detailed mechanism of which is still unclear. Skin symptoms occur in KD, such as edema of the hands and feet with subsequent desquamation and redness at the inoculation site of bacillus Calmette-Guerin (BCG). The change at the BCG inoculation site has been considered as a specific feature of KD, although its mechanism is not fully understood. We present an 11-month-old boy who developed fever with redness of the BCG site due to infection with human herpes virus type 6 (HHV6). At the age of 3 months, the patient received BCG. His fever remitted 7 days after the onset of skin redness, with sequential desquamation at the BCG site and extremities, which is not a common feature of HHV6 infection that typically lasts for 3 days. The final diagnosis was exanthema subitum. Characteristically, the HHV6 infection in our patient appeared to be associated with the invigoration of the T cell system, as represented by the elevated serum levels of soluble interleukin-2 receptor (3,490 U/ml vs. normal range 145-519 U/ml). This patient clearly showed redness and crusting at the BCG inoculation site, suggesting that HHV6 infection might cause skin changes similar to those of KD via an unknown mechanism. In addition, we suggest that the activation of the T cell system may account for the skin lesions in KD, characterized by redness and subsequent crusting of the BCG inoculation site and desquamation of the extremities. Kawasaki disease (KD) is acute, febrile, multisystem vasculitis of early childhood, the detailed mechanism of which is still unclear. Skin symptoms occur in KD, including polymorphous rash, edema of the hands and feet with subsequent desquamation, and redness and desquamation of the bacillus Calmette-Guerin (BCG) inoculation site. The skin lesions at the BCG inoculation site were reported to be a specific feature of KD, although its mechanism is not fully understood (Sinha and Balakumar 2005;Weinstein 2006).Here, we report a patient with redness of the BCG site with subsequent crusting of the site and desquamation of the extremities in the recovery phase and who was proven serologically to have infection with human herpes virus type 6 (HHV6). Clinical FindingsAn 11-month-year-old boy developed fever of 38-40°C, without symptoms suggesting an infection focus.His medical and family histories were unremarkable. He received a BCG inoculation at the age of 3 months. There was no cough or throat redness, and was only a non-specific rash. He was referred to our hospital at day 4 because of persistent fever and poor general condition. He was not active in eating. On admission to our hospital, he showed redness at the BCG inoculation site (Fig. 1a), which is regarded as specific to KD (Weinstein 2006). However, his clinical features were far from those of typical KD. There was no non-exudative conjunctivitis, oral findings, extremity changes, or obvious cervical lymphadenopathy. The peripheral blood cell examination showed white blood cel...

BACKGROUND/AIMS: The physical properties of the stratum corneum (SC) change with its water content, which is regulated by the presence of water solutes (natural moisturizing factors) and lipids in the SC, and are considered to be responsible for the induction of desquamation, skin surface roughness, and fine wrinkles. Recently a new type of tactile sensor developed for evaluating the physical properties of objects has been introduced as a simple, non-invasive method to evaluate them; because the data obtained with this sensor have not yet been characterized in detail, we compared them with other physical parameters of the skin. METHODS: A change in resonant frequency (Deltaf ) was measured under various levels of pressure applied by a tactile sensor placed on the cheeks of 29 women. We also measured high-frequency conductance that reflects the hydration state of the skin surface, water holding capacity of the SC, transepidermal water loss (TEWL), skin flexibility, skin elasticity, amino acid composition of the SC, and desquamation index of the SC at the same time, and evaluated the correlation between Deltaf and other physical parameters. RESULTS: The correlation between Deltaf and high-frequency conductance of the SC, and that between Deltaf and the water holding capacity of the SC were substantially high. Deltaf under high pressure was more closely correlated with the acidic amino acid ratio of the SC. Deltaf also showed a correlation with desquamation index for thickness of the SC as well as with skin elasticity, independent of the applied pressure. CONCLUSIONS: Because Deltaf determined with the tactile sensor correlated with other physical parameters specific to the properties of the SC, such as high frequency conductance of the SC, its water holding capacity, ratio of acidic amino acids, and the desquamation index for thickness, the physical properties of the SC may be adequately evaluated with the measurements of Deltaf.

Basal cell carcinomas arising from epidermal cysts are rare. A 76-year-old Japanese man had had a blackish nodule on his right knee for 15 years, under which he later noticed the development of a subcutaneous nodule. On histological examination masses of tumour cells showed the feature of adenoid and solid patterns of basal cell carcinoma that were connected to the wall of epidermal cysts in many places as well as with the overlying epidermis.

Backgroundaims:Various attempts have been made to measure mechanical properties of the skin quantitatively and noninvasively. However, no attempt has been made to measure a tactile sense of our finger that palpates the skin; when we palpate the skin to search for any change, we at first rub the skin surface softly with a finger tip to detect a surface change and then press the finger against the skin to perceive any alteration in consistency. The problem here is how to record such tactile sense quantitatively, because the palpating examination for smoothness or softness of the skin totally depends on a subjective perception. A new tactile sensor from robot technology is equipped with a fingertip-like sensing probe oscillating at a resonant frequency of 60 kHz; it is capable of clearly sensing small differences in hardness of solid substances from a change in the oscillating frequency and from a displacement sensor that detects depressability of the skin. We have used this new measuring system to evaluate the hardness and elasticity of skin. Methods: We constructed a probe with two independent sensors, i.e., a newly developed tactile vibration sensor and a displacement sensor. To determine its usefulness we first used an in vitro skin model and subsequently used normal and lesional skin, such as neutrophilic erythema, keloid, hypertrophic scar, and scleroderma. Results: Two parameters were obtained with our probe: one that reflected superficial firmness of the skin, which mainly correlated with the hydration state of the stratum corneum, and the other that reflected the firmness of deeper tissue. Conclusion: Our results showed that this probe is useful for evaluating the physical properties of skin lesions that accompany changes in skin firmness.