【目的】アトピー性皮膚炎(AD)はそう痒感や湿疹を主病変とする。ADは,2型ヘルパーT細胞(Th2)へ分化が偏ることで発症する。また制御性T細胞(Treg)が免疫応答を制御しADの発症を防いでいる。腸内フローラがADに深く関わると報告されていることから,プロバイオティクスの一つであるBifidobacterium breve strain Yakult(BY)に着目した。本研究では,ヒト様ADモデル(Nc/Nga)マウスを用いてBY経口投与による,AD改善効果について検討した。【方法】NC/Ngaマウスの背中に塩化ピクリル溶液を塗布しADを発症させ,0.2mL/日の水道水を経口投与した群をAD群,BY懸濁液(5×109CFU/0.2mL/日)を経口投与しADを発症させた群をBY群とした。ADを発症させずに水道水(0.2mL/日)の経口投与した群をControl群とした。飼育期間終了後,病変部位である背中の皮膚・小腸を採取し,検討した。【結果】背中の病変部位において,AD群と比較してBY群で病変の改善が見られた。また病変部位で,炎症のマーカーであるCOX-2タンパク質発現量が有意に減少した。そして,Th1・Th2発現がAD群と比較してBY群で減少し,Treg発現は増加した。小腸において,Th1,Treg発現がAD群と比較してBY群で増加し,Th2発現は減少した。【考察】病変部位ではBY投与により,Tregの発現を増加に伴いTh2の発現が抑制され,ADが改善された。また小腸でも,Tregの増加により免疫バランスが改善した。以上より,BY投与により腸管免疫が改善されることで,ADが改善することが示唆された。(著者抄録)

【目的】アトピー性皮膚炎(AD)の発症要因として,免疫応答の異常や腸内細菌叢の乱れが報告されている。リンゴペクチンは,特定の腸内細菌のみを選択的に増殖させることや血中ヒスタミン濃度の降下作用が報告されていることから,アレルギー性疾患に対する予防効果が期待されている。しかし,ADの改善効果は明らかになっていない。本研究では,リンゴペクチンによるADの改善効果と腸内細菌叢に与える影響について検討した。【方法】NC/Ngaマウス(雄)の背中に塩化ピクリル溶液を塗布してADを発症させたAD群,0.4,4%リンゴペクチン溶液をAD発症マウスに35日間経口投与したものを0.4%P群,4%P群とした。35日後に,発症部位の皮膚と糞便を採取し,AD改善効果と腸内細菌叢の変化について検討した。【結果】ADを発症させた背部皮膚を比較すると,AD群では皮膚の乾燥や紅斑等がみられたが,全ペクチン群においてAD皮膚症状の改善がみられた。COX-2タンパク質発現量,IL-4,TSLP mRNA発現量は,Control群と比較してAD群で有意に増加(p<0.05)したが,AD群に比較して全ペクチン群で有意に低下した(p<.05)。Foxp3 mRNA発現量,およびTh1サイトカインであるIFN-γは,AD群に比較して全ペクチン群で有意に増加した(p<0.05)。腸内細菌については,AD群に比較して4%P群でFirmicutes門の減少傾向とBacteroides門の増加傾向が認められた(p=0.103)。【考察】リンゴペクチン投与は,AD発症部位でTh1/Th2バランスを改善し皮膚の炎症を抑えることおよび腸内細菌叢の組成を変化させることで,ADを改善することが示唆された。(著者抄録)

This is a report on our experience of two cases diagnosed with erythema nodosum associated with granulomatous mastitis. Case 1 was a 39-year-old female. A painful subcutaneous induration appeared in her left breast and from the fourth day after onset, erythema accompanied by tenderness appeared on the extensor surfaces of her lower legs and elbows, so she was referred to our department. Skin histopathology based on her right lower leg erythema was found to be septal panniculitis in which lymphocyte/neutrophil infiltration was observed around the dermal blood vessels and lymphocytes extended from the fat septum into the lobule. Regarding the histopathology based on the subcutaneous induration area on her left breast, a granuloma in which epithelial cells had mainly infiltrated was observed, so she was diagnosed with erythema nodosum associated with granulomatous mastitis based on the clinical course. Case 2 was a 40-year-old female. Painful erythema and subcutaneous induration appeared in her left breast approximately two weeks prior to her initial visit to our department, and the day before her initial visit, erythema accompanied by pain appeared in the vicinity of the medial malleolus of her right foot. It has been reported that approximately 20% of granulomatous mastitis cases are complicated by erythema nodosum. Granulomatous mastitis should also be considered as a contributing factor to erythema nodosum.

Given the importance of appropriate diagnosis and appropriate assessment of cutaneous symptoms in treatment of atopic dermatitis, the basics of treatment in this guideline are composed of (1) investigation and countermeasures of causes and exacerbating factors, (2) correction of skin dysfunctions (skin care), and (3) pharmacotherapy, as three mainstays. These are based on the disease concept that atopic dermatitis is an inflammatory cutaneous disease with eczema by atopic diathesis, multi-factorial in onset and aggravation, and accompanied by skin dysfunctions. These three points are equally important and should be appropriately combined in accordance with the symptoms of each patient. In treatment, it is important to transmit the etiological, pathological, physiological, or therapeutic information to the patient to build a favorable partnership with the patient or his/her family so that they may fully understand the treatment. This guideline discusses chiefly the basic therapy in relation to the treatment of this disease. The goal of treatment is to enable patients to lead an uninterrupted social life and to control their cutaneous symptoms so that their quality of life (QOL) may meet a satisfactory level. The basics of treatment discussed in this guideline are based on the "Guidelines for the Treatment of Atopic Dermatitis 2008" prepared by the Health and Labour Sciences Research and the "Guidelines for the Management of Atopic Dermatitis 2015 (ADGL2015)" prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the "Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2016" together with those for other allergic diseases.

BACKGROUND: In vivo reflectance confocal microscopy is a useful technique for non-invasive biometry of cutaneous inner structures. In this study, the changes in the inner structures were examined in a wide age range of healthy Japanese using this technique. MATERIALS AND METHODS: Skin on the flexor side of the arm and on the face, which represent sun-protected and sun-exposed sites of the skin, respectively, was examined in 52 healthy Japanese subjects aged 6 months-81 years old using a reflectance confocal microscope Vivascope(®) 3000. RESULTS: The size of granular cells increased with age and was larger in the group aged over 50 years than in the young group aged 18-21 years old, at both sites. The size of prickle cells also increased with age in the face but not in the arm. The size of dermal papillae measured at depths of 50 μm (Z = 50 μm) and 80 μm (Z = 80 μm) from the surface decreased with age. The size at Z = 80 μm was smaller in the older group than in the younger group at both sites. However, the mean size of granular cells and dermal papillae was smaller in the face than in the arm. The number of dermal papillae decreased with age in the arm at Z = 50 μm and in the face at Z = 80 μm. CONCLUSIONS: Skin aging may be reflected in the size of granular and prickle cells and dermal papillae, and the extent varies in each sun-exposed or sun-protected skin site.

Given the importance of appropriate diagnosis and appropriate assessment of cutaneous symptoms in treatment of atopic dermatitis, the basics of treatment in this guideline are composed of (1) investigation and countermeasures of causes and exacerbating factors, (2) correction of skin dysfunctions (skin care), and (3) pharmacotherapy, as three mainstays. These are based on the disease concept that atopic dermatitis is a inflammatory cutaneous disease with eczema by atopic diathesis, multi-factorial in onset and aggravation, and accompanied by skin dysfunctions. These three points are equally important and should be appropriately combined in accordance with the symptoms of each patient. In treatment, it is important to transmit the etiological, pathological, physiological, or therapeutic information to the patient to build a favorable partnership with the patient or his/her family so that they may fully understand the treatment. This guideline discusses chiefly the basic therapy in relation to the treatment of this disease. The goal of treatment is to enable patients to lead an uninterrupted social life and to control their cutaneous symptoms so that their quality of life (QOL) may meet a satisfactory level. The basics of treatment discussed in this guideline are based on the "Guidelines for the Treatment of Atopic Dermatitis 2008" prepared by the Health and Labour Sciences Research and the "Guidelines for the Management of Atopic Dermatitis 2012 (ADGL2012)" prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the "Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2013" together with those for other allergic diseases.

An infant skin disease with clusters of nodules in the diaper contact area was reported as granuloma gluteale infantum. Recently, the number of elderly patients with this condition has increased, and it has been reported as diaper-area granuloma of the aged. These lesions are presumably caused by irritation from feces and urine. We observed similar cutaneous symptoms in six elderly patients, five of whom revealed clusters of nodules arranged in a circular pattern in the gluteal region presenting a peculiar clinical picture. They were all bedridden and wore cloth diapers. We speculate that wearing a cloth diaper seems to be a major factor behind this condition. Another factor was sitting during the day. A subject had lesions with nodules on the scrotum. The distribution of nodules appeared to be related to the body position and vigorous movement of the patient. In all cases, topical steroid therapies were not effective. They were all positive for bacteriuria. Chronic urinary tract infection further irritates the skin. It is necessary to reduce urine contact and keep the lesion clean.

In this review, I summarized recent studies about nonatopic dermatitis, IgE associated atopic dermatitis and autoallergic atopic dermatitis in the natural history of atopic dermatitis with gene -gene and gene -environment interaction. Also, new hypothesis of the mechanism of atopic dermatitis which was called OUTSIDE-INSIDE-OUTSIDE story wes introduced.

In April 2008, a system of special health checks and health guidance was initiated with the aim of identifying people with metabolic syndrome (visceral fat syndrome) and pre-metabolic syndrome. In this study, we investigated the relationship between health check results and abdominal circumference in 632 university faculty members. The standard value for abdominal circumference in women (>= 90) is set higher than that for men (>= 85). When this standard value is used, only 7.4% of women may be able to receive special health guidance. In the future, a follow-up survey of female subjects focusing on the difference in the standard value and an evaluation of its relationship with lifestyle-related diseases will probably be necessary. In the present study, significant positive correlations were seen between abdominal circumference and GPT and gamma-GTP, which are related to hepatic function, and between abdominal circumference and uric acid levels in mates. These results indicate the possibility that abdominal circumference is related to alcohol intake. In addition, white blood cell count, red blood cell count, hemoglobin level, and hematocrit level were significantly higher in subjects with large abdominal circumference, and there were differences in hematopoietic function. There have been virtually no studies on the relationship between visceral fat and hepatic and hematopoietic functions, and a follow-up study of the present subjects in the future may shed new light on risk factors for various diseases with abdominal circumference as an indicator.

Minoxidil is efficacious in inducing hair growth in patients with androgenetic alopecia by inducing hair follicles to undergo transition from the early to late anagen phase. Although the efficacy of 1% topical minoxidil has been confirmed in Japan, no controlled study of 5% topical minoxidil has been conducted using male Japanese subjects. The objective of this trial was to verify the superiority in clinical efficacy of 5% topical minoxidil to 1% topical minoxidil in a double-blind controlled study with male, Japanese androgenetic alopecia patients as the subjects. The trial included 300 Japanese male patients aged 20 years or older with androgenetic alopecia who were administered either 5% topical minoxidil (n = 150) or 1% topical minoxidil (n = 150) for 24 weeks. The mean change from the baseline in non-vellus hair/cm(2), the primary efficacy variable, was 26.4 (n = 142) in the 5% topical minoxidil group and 21.2 (n = 144) in the 1% topical minoxidil group at 16 weeks, the main time point for the evaluation. The difference between the groups was significant (P = 0.020). The incidence of adverse events was 8.7% (13/150) in the 5% group and 5.3% (8/150) in the 1% group, with no significant difference between the groups (chi(2)-test: P = 0.258). Our findings confirmed the superiority of 5% topical minoxidil to 1% topical minoxidil in treating Japanese men with androgenetic alopecia.

アトピー性皮膚炎 (AD) は、近年なお減少の傾向を認めず、その診断、原因、病態、治療にはまだなお不明な点がたくさん残されている。診療中のADが悪化するとき、その原因を捉えることは容易ではない。その悪化が経年、年次、季節などによる恒常的変動なのか、それとも一人一人の個別的要因によるものなのか、あるいはそれらが同時進行的に起こっているのかの判断が難しいからである。そのために薬物療法以外の対応として何をすればよいのか苦慮する。そこで、新たに発症した症例を対象にすれば、発症状況がより単純に把握できて、発症要因の精査がより容易であり、それがすなわちADの悪化要因と認めることができるのではないかと考え、この調査を試みた。
ADが初発した可能性のある110症例を収集し、年齢、初診月、初発月、初発部位、家族歴、既往歴、さらに職、住、食、生活、空気、皮膚環境、ストレスなどを調べた。発症前3ヶ月以内に新築入居が10.9%、居住地変更が21.8%に上ったほか、体調不良が21.8%、睡眠不足が47.3%、過労状態が30.9%もあった。ADを含む湿疹、皮膚炎の発症要因として、皮膚に対する各種の刺激、ストレス、住居環境、アレルギーなどが有力候補として推測できた。(オンラインのみ掲載)

Minoxidil is effective in inducing hair growth in patients with androgenetic alopecia by stimulating hair follicles to undergo transition from early to late anagen phase. However, there have been no controlled studies of topical minoxidil in Asian women. The objective of this trial was to investigate the efficacy of 1% topical minoxidil for androgenetic alopecia in Japanese female patients using a double-blind controlled method. This trial included 280 Japanese female patients aged 20 years or older with androgenetic alopecia who were administered either 1% topical minoxidil (n = 140) or placebo (n = 140) for 24 weeks. The primary efficacy variable was mean change from baseline in non-vellus hair count/cm(2). The mean change was 8.15 in the 1% topical minoxidil group and 2.03 in the placebo group, with a significant difference between groups (p < 0.001) [difference: 6.12 (two-sided 95% confidence interval (CI): 3.29-8.96)]. Secondary variables included investigators' assessments and patients' self-assessments. As assessed by investigators, 29.2% (40/137) of the patients had moderate or better improvement in the 1% topical minoxidil group compared to 11.8% (16/136) in the placebo group (p < 0.001 versus placebo). The effect on hair growth was assessed as improved or better by 36.5% (50/137) of the patients themselves in the 1% topical minoxidil group compared to 23.5% (32/136) in the placebo group (p = 0.019 versus placebo). The patients tolerated treatment with 1% topical minoxidil well without significant adverse effects.

85歳男.約1年前に出現した左側頭部の痂皮・掻痒を伴う紅斑が悪化したため受診し,皮膚生検で日光角化症と診断された.高齢であり,心肺機能低下及び心筋梗塞の既往などからQOLを考慮し,放射線療法を施行した.治療終了から19ヵ月経過現在,腫瘍の再発は認めていない

4歳女児.右腋窩の赤色丘疹が集簇した局面を主訴とした.生後10ヵ月頃より右腋窩に多数の赤色丘疹が出現し,2歳時にリンパ管腫の診断にて切除術を受けたが,2年後に再び同部に皮疹が出現した.臨床的には"蛙の卵"様の外観を呈していた.表在性リンパ管腫と診断し,一塊として筋膜直上まで切除した.切除後3年6ヵ月経過するも,再発は認めていない.病理組織学的には,真皮深層までリンパ管の拡大がみられたことから,表在性・深在性混合型リンパ管腫と診断した

48歳女.臍部腫瘤を主訴とした.子宮筋腫のため腹腔鏡下子宮摘出術を受け,3年後,臍部の腫瘤に気付いた.臍部全体に隆起性腫瘤を認め,自発痛,痒み,圧痛があった.腹部エコー及びCTにて腫瘤深部が腹膜と連続していることが確認された.ケロイドか間葉系または神経系の良性の皮膚腫瘤が考えられ,外科的切除を行った.組織学的には,表皮直下から腹膜にかけて広い範囲に線維芽細胞が増殖し,膠原線維の著明な増生がみられた.真皮深層では浅層に比較してより太い膠原線維束が集簇している部分がみられた.術後は経過観察のみ行い,4年経過の現在,ケロイドの再発は認めていない

47歳男.有機化合物を取り扱う仕事をしていた.全身のそう痒感が出現し,皮膚そう痒症と診断され,抗アレルギー剤内服で経過観察となったが,軽快しないため受診した.膠原病と腫瘍マーカーは陰性で,既往歴のB型肝炎と職歴より,肝癌を中心とした内臓悪性腫瘍を疑い,腹部MRIを施行した.肝内に大小多数の結節を認め,肝生検を施行したところ,肝細胞癌と判明した.シスプラチン,5-FUによる動脈内持続注入療法を行ったが,癌性腹水の出現と共に,掻痒は悪化した.そのため,デルモート軟膏の外用とアレジオン,デパスの内服に治療を変更した

42歳男.1年前より左下腿後面の皮下腫瘤に気づいたが,徐々に増大し,圧痛も自覚するようになり受診した.比較的境界明瞭な弾性硬の腫瘤を認め,被覆表皮は軽度隆起していた.下肢CTで筋膜直上に境界明瞭,辺縁平滑な皮下腫瘤を認め,内部は筋肉よりやや低密度を示した.所見より線維腫,神経原性腫瘍を疑い切除術を施行した.病理組織所見より神経鞘腫と診断した

38歳男.陰嚢全体に米粒大から小指頭大の黄白色半球状隆起した10個の皮下腫瘤を認めた.胸腹骨盤CTを施行し,陰嚢のみに,石灰沈着と思われる高密度域を認めた.組織像より,特発性陰嚢石灰化症を考え,上皮小体亢進症など石灰沈着をきたす疾患を検索した.検査所見で血清Ca,PTHは正常で,石灰沈着をきたす内科的基礎疾患はないと考え,組織像と併せ,特発性陰嚢石灰化沈着症と診断した.全結節を一塊として切除した

Thymus and activation-regulated chemokine (TARC)/CCL17 and macrophage-derived chemokine (MDC)/CCL22 are a pair of CC chemokines known to selectively attract T(h)2 type memory T cells via CCR4. Here we examined circulating levels of TARC and MDC in patients with atopic dermatitis (AD) and control subjects by using plasma samples, which reflect blood contents of chemokines more accurately than serum samples. The plasma levels of TARC and MDC were significantly elevated in AD patients. These values also strongly correlated with disease severity and serum lactate dehydrogenase levels, and weakly correlated with serum total IgE levels and blood eosinophilia. Previous studies demonstrated TARC immunoreactivity in the epidermal layer of AD lesional skin and production of TARC by a human keratinocytic cell line HaCaT upon stimulation with IFN-gamma. Here we demonstrated MDC immunoreactivity in the epidermal layer of AD skin at levels stronger than that of TARC. Furthermore, primary epidermal keratinocytes expressed both TARC and MDC mRNA upon stimulation with IFN-gamma, but efficiently secreted only MDC. These results suggest a post-transcriptional regulation in TARC production. IFN-gamma also induced TARC and MDC mRNA in mouse skin. Collectively, both TARC and MDC play important roles in the local accumulation of T(h)2 cells in AD lesional skin. Production of T(h)2-attracting chemokines by epidermal keratinocytes upon treatment with IFN-gamma, which is also the potent inducer of T(h)1-attracting chemokines, may underline the pivotal role of IFN-gamma in the chronic phase of AD where both T(h)1 and T(h)2 responses are mixed.

ガングリオン2例(60歳男,63歳女)及び指趾粘液嚢腫1例(62歳男)に対して針治療を併用したところ,治療効果がみられた.3例とも再発を繰り返し,外科的治療に対して抵抗性で,潰瘍を伴っていた.潰瘍周囲と足三里に週に一度の針治療を併用したところ,3例とも4〜14ヵ月後には浸出液の減少と潰瘍の上皮化及び皮内結節の縮小化がみられた.以上より難治性のガングリオン及び指趾粘液嚢腫とそれらに合併した皮膚潰瘍の治療への補助的手段の一つとして,針治療も選択しうると考えられた

Liver- and activation-regulated chemokine (LARC)/macrophage inflammatory protein (MIP)3 alpha/ CCL20 is a CC chemokine which is constitutively expressed by follicle-associated epithelial cells in the mucosa, and attracts cells expressing CCR6 such as immature dendritic cells and alpha (4)beta (high)(7) intestine-seeking memory T cells. Here, we examine LARC/CCL20 expression in the skin. LARC/CCL20 mRNA and protein were induced in primary human keratinocytes upon stimulation with proinflammatory cytokines such as IL-1 alpha and tumor necrosis factor (TNF)-alpha, In mice, intradermal injection of IL-l a and TNF-a rapidly induced a local accumulation of transcripts for LARC/CCL20 and its receptor CCR6 with a lag of several hours in the latter. In humans, immunostaining of LARC/CCL20 was weak if any in normal skin tissues but strongly augmented in lesional skin tissues with atopic dermatitis. Furthermore, massive infiltration of cells with markers such as CD1a, CD3 or HLA-DR was present in atopic skin lesions. Many infiltrating cells were also found to be CCR6(+) by a newly generated monoclonal anti-CCR6, However, Langerhans cells residing within the epidermis were hardly stained by anti-CCR6 in normal and atopic skin tissues. Furthermore, plasma levels of LARC/CCL20 were found to be elevated in patients with atopic dermatitis. Collectively, our results suggest that epidermal keratinocytes produce LARC/CCL20 upon stimulation with proinflammatory cytokines such as IL-1 alpha and TNF-alpha, and attract CCR6-expressing immature dendritic cells and memory/effector T cells into the dermis of inflamed skin such as atopic dermatitis. LARC/CCL20 may not, however, play a major role in homeostatic migration of Langerhans cells into the skin.

A case of progressive systemic scleroderma associated with malignant fibrous histiocytoma is reported. A 58-year-old male first noticed Raynaud phenomenon five years ago. Gradually, pigmentation spread across the whole body, sclerodactyly and lung fibrosis appeared. He was diagnosed as progressive systemic scleroderma in 1991 and was treated with d-penicilamin and oral corticosteroid. In July 1992, sudden onset of chest pain occurred. Chest X-ray revealed pleural exudate in the left lower lobe. Sternal puncture was performed but pain increased and the patient developed respiratory insufficiency, resulting in death. Pleural biopsy had suggested mesothelioma of the pleura, but postmortem findings indicated malignant fibrous histiocytoma.

We investigated whether apoptosis of eosinophils is specific to atopic dermatitis (AD), or also occurs in other diseases with eosinophilia. We examined the survival of eosinophils cultured with corticosteroids: (I) Clinically, steroid administration significantly decreased high peripheral blood eosinophil cell counts in patients with AD. (2) Treatment with recombinant human (rh) IL-5 prolonged the life span of eosinophils derived from patients with AD and of those derived from non-AD patients with eosinophilia. However, there were differences in the survival rates in the presence of rhIL-5: the eosinophils from non-AD patients showed 1.4-fold higher survival rates than those from AD patients at 24 h. In the presence of steroids, the eosinophils from non-AD patients showed a survival rate double that of those from AD patients at 24 h. (3) In eosinophils from patients with AD, the survival rate decreased significantly in a time-and steroid-concentration-dependent manner. Steroid administration significantly inhibited the survival rate of eosinophils from patients with AD compared to those of monocytes and neutrophils. These findings suggest that apoptosis induced by steroids decreases the eosinophil count in vivo in patients with AD. There may be a difference in the incidence of steroid-induced apoptosis between eosinophil cells from patients with AD and those from patients with eosinophilia due to other underlying diseases.

A case of malignant trichilemmoma is reported. The patient was a 61-year-old male with haemorrhagic skin tumor which had developed from alopetia macule in his head. As immnohistochemically, the tumor cells were stained by 34 βE12 anti-cytokeratine monoclonal antidobies and by TYHF-1 which is specific in outer root sheath, this case is suggested to be a carcinoma of trichilemma origin.

We reported a 77 year-old-man who had contact dermatitis after using Anderm^®cream for dermatitis around artifical anus and xerosis of thighs.
The patient showed positive patch test reaction to anderm^®cream. He also reacted to 0.1% Bufexamac in alcohol which is the main component of Anderm^®cream, and non-dilected lactic acid which is one of the base components of Anderm^® cream. However, the negative result was obtained when 0.01%, 0.001% Bufexamac in alcohol and 0.1%, 0.01%lactic acid in distilled water were examined.
Less than 0.01% lactic acid is added in Anderm^®cream for keeping pH neutral.
From these results, it is concluded that the allergen is Bufexamac.

小児を対象として種々の皮膚疾患にリドメックス外用剤を試みた結果, 49症例中, 44.8%に治癒または著効, 36.7%に有効, 18.3%にやや有効, 無効は0%であった. 特に湿疹, 虫刺症に推奨される.

兄妹交配を繰り返し、自然発症ラットの系統を樹立した。これらのラットに数種の発毛促進剤を塗布した所、一部の薬剤に発毛効果が見られた。これらのラットは薬剤効果の判定や脱毛機序の研究に極めて優れたモデル動物と考えられる。

肝斑は、中年女性によくおこる疾患である。その原因は、ホルモン異常等が考えられているが、不明である。近年、肝斑の治療に皮膚局所療法がおこなわれる傾向があるが、全身的な治療が重要と考え、漢方療法を検討した。方法）1群；トラネキサム酸単独投与、2群；トラネキサム酸と桂枝茯苓丸（7.5mg分3）併用投与、3群；桂枝茯苓丸単独投与として、3ヶ月以上経過を観察できた患者を検討した。肝斑の程度で4段階に分類し、また寺沢のオ血スコアを参考にした。一部の症例には簡易更年期指数を測定した。治療としては、基本は1群とし、オ血スコアが高いものには2群を、漢方投与を希望し、且つオ血スコアが高いものには3群を選択した。結果）1群計7例；治癒1例(14.3%）・著効1例（14.3%）・有効3例（42.9%）・無効2例（28.6%）2群計23例；治癒3例（13.0%）・著効8例（34.9%）・有効6例(26.1%）・無効6例(26.1%）3群計4例 治癒1例（25.0%）・著効1例（25.0%）・有効3例（50.0%）・無効2例（50.0%）であ

近年、外科的手術全般の術前、術後の消毒の有無が必要であるかについて疑問を投げか ける報告が多い。皮膚科領域においては、ＥＢＭに足りうる報告はない。 そこで、今回、我々はバイオパンチ?使用における皮膚科外来小手術後の、消毒の有無や術後の抗生剤の内服の有無、術中の未滅菌手袋の使用が術後感染に影響を与えるかどうか、1年を通じて検討を行った。 結果、240例の対象患者の内、Ｄｒｏｐ ｏｕｔとなった51例を除いて、プロトコー ル通りに処置できた患者は189例であった。189例の内、明らかな感染を疑う症例は1 年を通じて1件のみであった。 以上より、性別、年齢、部位、季節、未滅菌手袋による操作でも関係なく術後感染はほ とんど起こらなかった事より、皮膚科外来小手術後は消毒の有無や術後の抗生剤の内服、術中の未滅菌手袋の使用は術後感染に影響しないのではないかと考えた。

爪白癬は、現在実質上内服治療としては塩酸テルビナフィンとイトラコナゾールが使用されている。英国の爪真菌症治療におけるガイドラインではテルビナフィンは250㎎/日、12週間連続投与が推奨され、イトラコナゾールは400㎎/日、１週間投与３週間休薬を１パルスとして３パルス実施することが推奨されている。当科にて2004年３月から2005年３月の間で爪白癬と診断し、イトラコナゾール400㎎パルス療法を施行した26例について検討した。26例のうち18例については効果判定を行うことができた。（5例が自己中断、3例が副作用で投薬中止となった。）18例中13例に治療効果を認め、5例は改善を認めなかった。副作用は2例が薬疹、1例が胃腸障害であった。以上の結果について統計的検討を加えて考察する。

肝斑発症の背景には多くの因子が指摘されている。われわれは患者更年期指数を検討したところ、肝斑患者ではあきらかに高値をしめしている。この治療に漢方的手法がよいと考え、駆於血剤の1つである桂枝茯苓丸を加えて加療し良好な成績を収めたので報告する。近畿大学医学部奈良病院皮膚科来院して肝斑と診断した患者を、皮疹の程度を3段階に分類し、全身については 漢方でいわれる？血状態を検討し、1群は、？血状態の顕著でないもの、2群は顕著なもの、3群は漢方のみの投与を希望したものと分類した。1群にトラネキサム酸単独、２群にトラネキサム酸＋桂枝茯苓丸、３群には桂枝茯苓丸単独投与として、３ヶ月以上経過を観察できた患者を検討した。結果、1群は３ヶ月での改善例が７割を占め、2群は約７割、3群は約５割あった。肝斑の患者では？血状態を改善する必要のある症例も多く、桂枝茯苓丸の併用も有用と考えられる。

７７歳男性、頭部のＳＣＣ。８４歳男性、左頬部のＳＣＣ。８５歳女性、両頬部のＳＣＣ。３人共に高齢であり、手術適応や家庭の諸事情にて入院にての外科切除が不可能であった。よって、外来にて炭酸ガスレーザーにてアブレーションを行った。内、２症例では比較的良好な結果が得られた。現在、本邦では高齢者が増加傾向にあり今後、以上のように外科手術の適応を考えさせられる症例が増加することが予想される。それに対し、どう対応していくかを考えていく必要性があるのではないだろうか。

1歳男児。出生時より左眼周囲から左頬部にかけて単純性血管腫と思われる赤色斑を認め、生後6ヶ月頃より左頬部に青色斑を生じたため当科受診。四肢に異常なく、眼科的所見、頭蓋骨、脳波等も異常なく全身性疾患の合併がないため、色素血管母斑症Ⅱa型と診断した。

しみを主訴として来院する患者のなかで、肝斑はレーザーが有効でないことが多く、漢方治療などが有効なことが多い。好発年齢が更年期障害の時期に一致することから、更年期障害の有無があるかなどをアンケートした。ＳＭＩ指数、サプリメント内服の有無など質問した。結果、肝斑の患者は更年期障害が強い傾向があった。

近年、外科的手術全般の術前、術後の消毒の有無が必要であるかについて疑問を投げかける報告が多い。皮膚科領域においては、ＥＢＭに足りうる報告はない。そこで、今回、皮膚科外来小手術後、消毒の有無が術後感染に影響を与えるかどうかの検討を行った。対象は平成１６年３月２９日より６月１５日までの期間、近畿大学医学部奈良病院皮膚科を受診し、皮膚科外来小手術、或いは生検を施行した患者の内、ID番号の下１桁が奇数なら消毒あり、偶数なら消毒無しという2群に分類して経過をみた。結果としては、消毒の有無に関わらず明らかな感染を疑う所見無し。皮膚科外来小手術後は消毒しなくても感染しないのではないかと考えた。

検診にて左肺上葉の異常陰影を指摘。後日、当院呼吸器科受診。肺腺癌（Ｓｔａｇｅ１Ａ Ｔ１Ｎ０Ｍ０ ）と診断され、左上葉切除術施行。しかし、約１年半後、画像上再発認めた為、イレッサ２５０ｍｇを内服開始したところ、５日後から左上腕内側に？痒を伴う？瘡様発疹出現。イレッサ中止とし、当科紹介受診となった。イレッサによる薬疹と診断された。腫瘍が縮小傾向示した為、治療効果考え、投薬と休薬を繰り返している。

０歳男児。２歳男児。低カルシウム血症のためグルコン酸カルシウム点滴。その後、同部位に皮下の硬結を伴う皮下結節が出現した。結節より結石状物質を採取し、分析したところリン酸カルシウムであった。

４７歳女性。左下腿内側に有痛性の発赤出現。近医受診するも改善なく当院当科受診。入院にて安静と消炎鎮痛剤、抗生剤内服にて改善得られた。しかし、退院後、発赤は遠心性に移動している。

30歳男性。63歳男性。共に足爪白癬の加療の為、テルビナフィン内服開始。共に約２週間にて躯幹を中心に？痒を伴う紅斑出現。テルビナフィンの内服中止と、抗アレルギー薬の内服にて改善を認めた。

85歳男性。左側頭部の？痒を伴う紅斑出現。生検したところ日光角化症と診断。高齢、既往歴、合併症等を考え、電子線療法を選択した。治療後、腫瘍は消失し、現在も再発を認めていない。

85歳男性。左側頭部の紅斑を生検したところ日光角化症と診断。種々のリスクを考え、オペせずに放射線療法を選択した。その後の経過も良好である。

先天性有毛性色素性母斑の3例に対しQスイッチアレキサンドライトレーザー及びロングパルスアレキサンドライトレーザー（脱毛レーザー）を組み合わせた治療を施行したところ、3例とも改善傾向を認め有効な治療法の１つと考えることができた。

38歳男性。約2年前より陰嚢に多発性の皮下腫瘤を認めたため当科受診した。皮下腫瘤を生検したところ上皮成分のない線維性被膜に囲まれた結節状の石灰沈着を認めた。検査上石灰化をきたす基礎疾患はなく特発性石灰沈着症と診断し、全摘を施行した。

42歳男性。約1年前より左下腿後面の皮下腫瘤に気付いたたため当科受診。腫瘤は腓腹皮神経と連続しており、できるだけ神経束を温存して摘出した。病理組織学的に神経鞘腫と診断した。

47歳男性。平成11年4月頃より全身の掻痒感が出現したため当科紹介受診。デルマドロームの可能性を疑い腹部ＭＲＩを施行したところ、多発肝内転移をきたした肝細胞癌がみつかった。抗癌療法を施行したが、癌性腹水の出現とともに急激に掻痒は悪化した。

アトピ－性皮膚炎の治療への骨髄移植の適応について、アトピ－性皮膚炎モデルマウス（NC/Nga)を用い検討した。正常骨髄をアトピーマウスに移植する事により、皮膚所見、サイトカイン異常の改善を認め、重症アトピ－性皮膚炎の選択肢となると考えた。

71歳男性。陰茎部右側に腫瘤が生じているのに気付き、近医にて切除。腺癌皮膚転移と診断され当科紹介受診。全身検索施行するも原発巣みつからず、経過観察していたが、3ヵ月後に再発した。再切除施行しPaget病と判明した。拡大切除施行し、経過観察中である。

【研究の目的】アンチエイジングの観点から糖化ストレスによる皮膚老化の評価法確立するため、皮膚角層サンプルを非侵襲的に採取し、糖化反応最終生成物（advansed glycation end products: AGEs）の一種であるNε-(carboxymethyl)lysine: CML）を測定する方法を構築するとともに、皮膚角層中CMLが皮膚の糖化や老化進行にどのように関わるかを解析することを目的とした。 【研究の方法】市販の粘着シートを被験者の頬または上腕内側部に貼り付けて角層を剥離採取後、界面活性剤を含む緩衝液中で角層蛋白を抽出し、蛋白あたりのCML量を測定した（テープストリッピング法）。被験者として20～60歳代の健康女性66名の上腕内側部角層中CMLを測定すると共に、キュートメーターによって皮膚弾力、AGE Readerによって皮膚中AGEs蓄積量を測定した。 【研究の結果】テープストリッピング法による蛋白の添加回収率は98.2～99.5%で良好であった。角層蛋白あたりのCML量は、頬よりも上腕内側が多かった。健康女性66名の上腕内側部角層CML量は、蛋白1mgあたり67±33.7μgであった。角層CML量は被験者の年齢および皮膚中AGEs蓄積量と正の相関性を示した。一方、角層CML量は皮膚弾力性指標とは負の相関性を示した。 【結論】テープストリッピング法による角層CMLの測定が可能になった。角層CMLは加齢、皮膚弾力、皮膚中AGEs蓄積量との関連性を示したことから、糖化ストレスによる皮膚老化の評価指標として応用できる可能性を確認した。

It is commonly refered that oral manifestations appear in the early stage of GVHD after allogeneic bone marrow transplantation (BMT), and the oral examination by lip biopsies has the predictive value of chronic GVHD, and the early recognition of oral chronic GVHD may lead to timely diagnosis resulting improved survival rate of BMT recipients. We observed the clinical appearance of oral acute and chronic GVHD, comparing the histochemical features of lip biopsies. In the GVHD cases, CD4 and CD8 lymphocytes were infiltrated into submucous and meiner salivary gland region, and the keratinocytes, submucous regions and meiner salivary glands were HLA-DR and ICAM-1 positive. We presented some macroscopic patterns of oral mucositis, and tried to make the criteria of inspection of oral chronic GVHD.We called the status as "chronic GVHD stomatitis", i.e. white thickening, licheniod lesion, teleangiectasia like lesion, ulcer formation, necrosis, scar formation and atrophy of mucosa with xerostomia.

Patients with atopic dermatitis (AD) sometimes have intercurrent asthma or rhinitis, suggesting the presence of generalized allergic disease. To investigate abdominal symptoms and colonic disorders in patients with AD,we studied 31 adult patients with severe AD.Twenty-two of 31 patients exhibited endoscopic evidence of colitis. Histologically, all patients had evidence of colitis characterized by a marked eosinophilic infiltration. Peripheral eosinophilia and high serum LDH and IgE levels were present in patients with AD and colitis. Quantitative RT-PCR of TNFalpha revealed high expression of TNFalpha mRNA in colonic and skin biopsy specimens from patients with AD-associated colitis compared to control patients. We investigated the mechanisms of eosinophil chemotaxis in atopic dermatits by examining the effect of stimulation of epidermal keratinocytes (KC) by inflammatory cytokines, IFN-_ and / or TNF-_, on the production of eosinophils chemotactic factors. Simultaneous addition of IFN-_ and TNF-_ to cultured keratinocytes synergistically increased eosinophils chemotaxis and the expression of RANTES mRNA and protein level on these cells. Our results indicate that the production of RANTES by keratinocytes may help to explain eosinophil infiltration into the skin in atopic dermatitis. We compared the effect of biological response modifiers (BRM) on development of skin lesions, in BMT.Administration of GM-CSF intravenously in five patients who received BMT resulted in atopic-dermatitis-like lesions in two patients with infiltration of neutrophils, eosinophils and lymphocytes around the follicle, without other signs of GVHD in other organ. None of the patients who were not treated with BRM developed acute GVHD (aGVHD). Our data suggest that severe AD is associated with a high prevalence of colitis which may be allergic in etiology. In allergic skin diseases such as atopic dermatitis, eosinophils migrate from the circulation to the skin. These results showed that several cytokines (RANTES,TNFalpha, GM-CSF) from skin eosinophils and pay an important role for AD.

To find the coliration of epitherial cell and bone marrow derived cells, we selected skin, rectum and lung for Atoppic desease. To know the role of cytokines in local of each resion, we try to make the system that measures the mRNA expression by RT-PCR method. AT the bigning, we selected atopic dermatitis and psoriasis vulgaris for study. From the skin and rectum samples, RNA were prepared. To make the control RNA,each cytokine cDNA was cut by appropriate restriction enz.and makes new DNA and cloned into the RNA expression vector and synthesis RNA was prepared. Each mRNA was added to the same sample tube and makes cDNA by reversed transcriptase with primer. After the step, each cDNA that has involved original cDNA and synthesis cDNA has been made PCR.TNFa is more restricted cytokine for inflammation but IL-8 has more broad expression in psoriasis vulgaris. From this study, we colud detect the cytokine gene expression in the level of quantitation. In the next step, we selected AD and athma. RNATES is a potent chemoattractant for various important inflammatory cells such as eosinophils as well as memory T cells and monocytes, potentially recruting these cells from the circulation to an inflamed focus. To extent our understanding of the participation of eosinophils and T cells in relation to the possible involvment of RANTES in the skin of patisnts with AD.We performed RT-PCR assay for simultaneous detection of mRNAS for RANTES to clarify whether RANTES is presence in AD skin. We examined expression of RANTES in the skin, obtained at biopcy, RASNTES mRNA was detected in skin and colon of AD.And also in BAL of asthma, RANTES mRNA was detected. By contrast, normal skin and colon samples were negative for RANTES.Our finding suggest that RANTES plays a part in T cell and eosinophils in skin and colon for AD.These study showde that skin asociated lymphoid tissue, gut associated lymphoid tissue and broncho assocated lymphoid tissue were very simmirer manner in the eosinophils and epithelia. These study will be very useful to find the difference and simirality of orgin specifity of allergic disaese such as AD,Asthma.