Carotenemia is characterized by an abnormal yellowish orange pigmentation of the skin, most prominently seen on the palms and soles. Although it is associated with several disease such as diabetes, hypothyroidism and anorexia nervosa, it is caused by excessive intake of carotene-rich food such as oranges and carrots in most cases. Herein, we describe an interesting case of carotenemia in a 66-year-old female secondary to increased ingestion of oral supplements of carotene in order to improve hemorrhage in the eyeground. There could be an increasing trend of intake of commercial nutrient supplements in which case it is necessary to remind ourselves that commercial nutrient supplements could cause various skin disorders as side-effects.

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Hepatocellular carcinoma with metastases to lymph nodes and adrenal glands was found in a 26-year-old male Hokkaido brown bear (Ursus arctos yesoensis). Left hepatic lobe was largely replaced by well-differentiated neoplastic cells, whereas poorly differentiated tumor cells had proliferated in part of the left hepatic lobe, in scattered nodules in the remaining liver tissue, and at the metastatic sites. Immunoreactivity for hepatocyte antigen (hepatocyte paraffin 1 antibody) and alpha-fetoprotein was observed in both well- and poorly differentiated neoplastic cells in the liver and metastatic foci. To our knowledge, this case is the first report of hepatocellular carcinoma in brown bears.

In addition to the Japanese baseline allergen series version 2008,11 we used cysteamine HCl 1% and 0.5% pet. (Table S1). We also included the participants' own perming solutions, as used by them at the salon, for open tests. RESULTSDetails of the 3 male and 4 female hairdressers, ranging in age from 22 to 73 years, are shown in Table S2. Regarding the cysteamine HCl patch tests, 5 patients showed positive reactions to both 1% and 0.5%. One patient showed a positive reaction to 1% alone, and the other patient, who had a positive reaction to 0.5%, had not been tested with 1% (Table 1). The results of the open test showed that, among 6 patients tested with the reducing agent of the permanent wave products, 5 showed erythema, partly oedema, or papules. Moreover, 6 patients also showed strong positive reactions to components of oxidative hair dye products and related substances. On the other hand, none of the 7 patients showed a positive reaction to ammonium thioglycolate. DISCUSSIONThe active chemicals used to create permanent waves are salts and esters of thioglycolic acid, L-cysteine, and cysteamine HCl. Contact dermatitis caused by cysteamine HCl is reportedly rare, and all cases were related to occupational use. 8,9 On the other hand, Tanita et al reported that 18.8% of 48 hairdressers showed positive patch test reactions to cysteamine 1% pet.in Japan. 12 In a Japanese multicentre study, 10 4.5% of patients (6/132) showed positive patch test reactions to cysteamine HCl 0.5% pet., and 12.6% (24/191) showed positive patch test reactions to cysteamine HCl 1% pet. Although 1% cysteamine HCl had exclusively been used for patch testing, the multicentre study showed that 1% cysteamine HCl may cause false-positive reactions, so a 0.5% concentration was regarded as being more suitable. 10

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