Dermoscopic images of pigmented lesions have distinct features on the sole where skin ridges and furrows exist. Pigmentation of benign nevus usually locates on the skin furrow, while the malignant melanoma is pigmented on the skin ridge. Correspondence between dermoscopy and pathology in the pigmented lesions on soles have been studied based on conventional vertical pathological images. However, for the full understanding of the correspondence, observation of horizontal histological images would be required, because the epidermis constructs unique horizontal structures, namely crista profunda limitans, crista profunda intermedia, and transverse ridge. In this study, we analyzed basic dermoscopic images of the representative acral melanocytic lesions (nevus, lentigo, and malignant melanoma) by horizonal histological images. We created serial horizontal pathological images by digital reconstruction of a hundred of serial vertical images. We could show that parallel furrow pattern is created by the pigmentation of crista profunda limitans, parallel ridge pattern by the pigmentation of both of crista profunda limitans and crista profunda intermediate, and lattice‐like pattern by the pigmentation of transverse ridge. Our results would be useful for the intuitive histological understanding of dermoscopy.

The Journal of DermatologyVolume 48, Issue 4 p. e180-e181 LETTER TO THE EDITOR CD40L from platelet, endothelial cell, and smooth muscle cell may contribute to the proliferation of tumor cell in intravascular large B cell lymphoma Akira Kasuya, Corresponding Author Akira Kasuya casuakijo1@gmail.com orcid.org/0000-0002-2107-9091 Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan Correspondence Akira Kasuya, Department of Dermatology, Hamamatsu University School of Medicine, Higashi-Ku, Hamamatsu, Japan. Email: casuakijo1@gmail.comSearch for more papers by this authorYoshiki Tokura, Yoshiki Tokura orcid.org/0000-0001-7452-6919 Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorTetsuya Honda, Tetsuya Honda Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author Akira Kasuya, Corresponding Author Akira Kasuya casuakijo1@gmail.com orcid.org/0000-0002-2107-9091 Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan Correspondence Akira Kasuya, Department of Dermatology, Hamamatsu University School of Medicine, Higashi-Ku, Hamamatsu, Japan. Email: casuakijo1@gmail.comSearch for more papers by this authorYoshiki Tokura, Yoshiki Tokura orcid.org/0000-0001-7452-6919 Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorTetsuya Honda, Tetsuya Honda Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author First published: 09 February 2021 https://doi.org/10.1111/1346-8138.15786Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume48, Issue4April 2021Pages e180-e181 RelatedInformation

BackgroundChoroidal malignant melanoma is the most common primary malignant tumor of the eye in adults. Prognosis after recurrence of this disease has been dismal because of the absence of an effective therapy. However, resection of recurrent foci and a subsequent treatment with immune-checkpoint inhibitor may improve the prognosis after recurrence of this disease. This study presents a case of late-onset liver metastases of choroidal malignant melanoma, successfully treated with hepatectomy and postoperative adjuvant nivolumab.Case presentationA 53-year-old woman had undergone left ocular enucleation because of choroidal malignant melanoma 13years prior to admission. She visited a nearby clinic with complaints of epigastric pain. She was referred to our hospital because a giant liver tumor was observed on abdominal ultrasonography. Enhanced computed tomography revealed multiple liver tumors in the right lobe, 49mm in diameter with ring enhancement in subsegment (S) 5/6, and 14 and 8mm without any enhancement in S7 and S5, respectively. On magnetic resonance imaging, the main tumor showed high intensity on T1-weighted with fat suppression, suggesting melanin deposition. Based on the diagnosis of multiple liver metastases of choroidal malignant melanoma, right hepatectomy and regional lymphadenectomy were performed. She was discharged without postoperative complications. Histological examination revealed that all tumors were metastatic malignant melanoma. She was treated with nivolumab postoperatively, and no recurrences were observed during 22months of follow-up.ConclusionsAggressive surgery plus adjuvant nivolumab appears to be a promising treatment for choroidal malignant melanoma with late-onset liver metastases.

Pituitary stimulation tests with hypothalamic hormone. Pituitary hormones were measured after stimulation of the hypothalamic hormones. Immune checkpoint inhibitors (ICI) are now main strategies for metastatic melanoma. However, these therapies trigger immune-related adverse events (irAE). The endocrine organs of irAEs include pituitary, thyroid, and adrenal glands, as well as other downstream target organs.1 Here, we report a case of panhypopituitarism induced by ipilimumab and pembrolizumab in an advanced melanoma patient. An 82-year-old woman had a primary nodular melanoma on the left heel and underwent a wide local excision and sentinel lymph node biopsy 2 years before she was referred to us. She was diagnosed as having melanoma, stage IIIA (pT3b, N1a, M0; Breslow tumor thickness, 4 mm; Clark's level IV, with ulceration). She received an inguinal lymph node dissection and followed by weekly PEG-interferon-α injection. However, we discontinued PEG-interferon-α therapy because of occurrence of interferon-induced retinopathy. One year after the operation, positron emission tomography-computed tomography (PET-CT) showed multiple metastases in the left femur subcutis and recurrence of primary tumor. Biopsy specimens obtained from the recurrent tumor area confirmed the diagnosis of melanoma without a BRAF mutation. Thus, we administered pembrolizumab at 3 mg/kg every 3 weeks. After total five courses of pembrolizumab, she developed multiple skin metastases in the left femur. The treatment was switched to ipilimumab at 3 mg/kg every 3 weeks, which was repeated four times. She had general fatigue and appetite loss at 14 weeks after the initiation of ipilimumab. At 16 weeks, she had disturbance of consciousness and was conveyed to our emergency room. Laboratory tests indicated 35 mg/dL of fasting plasma glucose, indicating marked hypoglycemia. Endocrinologically, adrenocorticotropic hormone (ACTH; 2.0 pg/mL; normal, 7-56 pg/mL) and cortisol (5.8 μg/L; normal, 7.1-19.6 μg/L) were decreased. Magnetic resonance imaging (MRI) findings of her pituitary gland were normal. Hypothalamic hormone challenges showed a disturbance in the secretion of ACTH, growth hormone (GH), thyroid stimulating hormone (TSH), and prolactin (PRL) (Figure 1). Luteinizing hormone-releasing hormone (LH-RH) tests revealed a delayed response to LH and follicle stimulating hormone (FSH) (Figure 1). Thus, we diagnosed her condition as ipilimumab-induced panhypopituitarism. She was treated with 1 mg/day of betamethasone, which markedly improved her hypoglycemia, appetite loss, and general fatigue. Panhypopituitarism is a rare condition, but its frequency has recently been increased by the use of ICI. The phase 3 CheckMate 067 trial showed that the incidence of hypophysitis was 7% in patients receiving the combination therapy of ipilimumab and nivolumab, which was higher than 1% in those treated with nivolumab and 4% in those with ipilimumab monotherapy.2 Symptoms of hypophysitis were reported to become overt at a median time of 11 weeks after initiation of ipilimumab monotherapy.3, 4 In the mechanism underlying hypophysitis, it is proposed that anti-CTLA-4 antibody binds to CTLA-4-expressing pituitary cells, leading to type II and type IV hypersensitivity.5, 6 Alternatively, the antibody therapy might promote sensitization of pituitary cell-specific cytotoxic T cells. Hypophysitis-induced symptoms, such as fatigue and anorexia, are nonspecific in cancer-bearing patients.7 It is kept in mind that hypophysitis is one of the important irAEs, and careful attention should be paid to the patients treated with ICI. The authors declare no conflict of interest.

The Journal of DermatologyVolume 46, Issue 11 p. e432-e433 Letter to the Editor Intractable disseminated maculopapular eruption in a patient with granulocyte macrophage colony-stimulating factor-producing anaplastic thyroid carcinoma Akira Kasuya, Corresponding Author Akira Kasuya casuakijo1@gmail.com Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanCorrespondence: Akira Kasuya, M.D., Ph.D., Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan. Email: casuakijo1@gmail.comSearch for more papers by this authorShinsuke Shinkai, Shinsuke Shinkai Department of Endocrinology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorSayuri Sakamoto, Sayuri Sakamoto Department of Endocrinology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorPawit Phadungsaksawasdi, Pawit Phadungsaksawasdi Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorTakatoshi Shimauchi, Takatoshi Shimauchi orcid.org/0000-0002-0369-869X Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorSeiji Hosokawa, Seiji Hosokawa Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorAtsushi Imai, Atsushi Imai Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorShigekazu Sasaki, Shigekazu Sasaki Department of Endocrinology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYutaka Oki, Yutaka Oki Department of Community and Family Medicine and Division of Endocrinology and Metabolism, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYoshiki Tokura, Yoshiki Tokura Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author Akira Kasuya, Corresponding Author Akira Kasuya casuakijo1@gmail.com Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanCorrespondence: Akira Kasuya, M.D., Ph.D., Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan. Email: casuakijo1@gmail.comSearch for more papers by this authorShinsuke Shinkai, Shinsuke Shinkai Department of Endocrinology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorSayuri Sakamoto, Sayuri Sakamoto Department of Endocrinology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorPawit Phadungsaksawasdi, Pawit Phadungsaksawasdi Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorTakatoshi Shimauchi, Takatoshi Shimauchi orcid.org/0000-0002-0369-869X Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorSeiji Hosokawa, Seiji Hosokawa Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorAtsushi Imai, Atsushi Imai Department of Otorhinolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorShigekazu Sasaki, Shigekazu Sasaki Department of Endocrinology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYutaka Oki, Yutaka Oki Department of Community and Family Medicine and Division of Endocrinology and Metabolism, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYoshiki Tokura, Yoshiki Tokura Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author First published: 10 June 2019 https://doi.org/10.1111/1346-8138.14950Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume46, Issue11November 2019Pages e432-e433 RelatedInformation

malaise, finger swelling and low grip strength, 1.5 months before visiting our hospital for a check-up. The first medical examination revealed erythematous papules on the dorsal digits and nail fold telangiectasia (Fig. 1a). No other cutaneous manifestations, including heliotrope rash, V-neck/shawl signs, palmar violaceous macules/papules, cutaneous calcification and ulcer, were observed. Further, oral ulcerations were not observed. Respiratory symptoms were not noted. Percentage vital capacity and forced expiratory volume in 1.0 s were 94.1% and 85%, respectively. There were no abnormal findings on chest X-ray and computed tomography. Blood tests revealed elevated serum aldolase levels and anti-MDA5 Ab positivity (index value by enzyme-linked immunosorbent assay, 147; normal values, ≤32). Additionally, aspartate aminotransferase (216 U/L), lactate dehydrogenase (442 U/L), aldolase (17.9 U/L) and Krebs von den Lungen-6 (KL-6; 474 U/mL; reference range, 105–401) levels were elevated; serum creatine kinase level was normal. Histopathological findings of skin lesions on the dorsal digits were consistent with dermatomyositis; we observed liquefaction degeneration in the dermoepidermal junction and mucin deposition in the upper dermis (Fig. 1b,c). Findings of magnetic resonance imaging indicated piriformis myositis (Fig. 1d). The patient was admitted to the pediatric department and administrated two courses of steroid-pulse therapy. After treatment, symptoms and abnormal blood test results resolved. The KL-6 level normalized after steroid therapy (182 U/mL). Following careful follow up, pneumonia was not observed 3 years after the onset of JDM. Juvenile dermatomyositis and adult DM have different clinical features; for example, Gottron’s papules and calcinosis/ulceration are frequently observed in JDM and non-adult DM. Although cutaneous ulcerations and/or palmar papules are observed more frequently during RP-ILD with CADM in adult DM, the pattern of myositis-specific autoantibodies and clinical characteristics in JDM may not be similar to that observed during CADM in adult DM. Two contrasting retrospective studies have been published on JDM. Of the 285 patients with JDM included in a study from the UK, 21 showed anti-MDA5 Ab positivity. Only two of these 21 patients had RP-LID. However, of the 13 patients with JDM followed up in Japan, five of six patients who showed anti-MDA5 Ab positivity had RP-ILD, whereas the remaining seven patients did not have RP-ILD. Therefore, the association between anti-MDA5 Ab positivity and RP-ILD in JDM has not yet been confirmed. In this case, a high serum KL-6 level existed that normalized with steroid therapy, suggesting that the patient had slight and latent ILD but not the onset of RP-ILD.

The Journal of DermatologyVolume 46, Issue 10 p. e359-e360 Letter to the Editor Sarcoid-like reaction and vitiligo occurring after nivolumab therapy in a patient with metastatic melanoma Kensuke Fukuchi, Corresponding Author Kensuke Fukuchi fukuchi@hama-med.ac.jp orcid.org/0000-0002-4547-2277 Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanCorrespondence: Kensuke Fukuchi, M.D., Department of Dermatology, Hamamatsu University School of Medicine, 1-20-11 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan. Email: fukuchi@hama-med.ac.jpSearch for more papers by this authorMiho Hikawa, Miho Hikawa Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYusuke Sano, Yusuke Sano Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorAkira Kasuya, Akira Kasuya Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorMasahiro Aoshima, Masahiro Aoshima Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorKazuki Tatsuno, Kazuki Tatsuno Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYutaro Nakamura, Yutaro Nakamura Department of Respiratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorIsao Kosugi, Isao Kosugi Department of Pathology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYoshiki Tokura, Yoshiki Tokura Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author Kensuke Fukuchi, Corresponding Author Kensuke Fukuchi fukuchi@hama-med.ac.jp orcid.org/0000-0002-4547-2277 Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanCorrespondence: Kensuke Fukuchi, M.D., Department of Dermatology, Hamamatsu University School of Medicine, 1-20-11 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan. Email: fukuchi@hama-med.ac.jpSearch for more papers by this authorMiho Hikawa, Miho Hikawa Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYusuke Sano, Yusuke Sano Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorAkira Kasuya, Akira Kasuya Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorMasahiro Aoshima, Masahiro Aoshima Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorKazuki Tatsuno, Kazuki Tatsuno Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYutaro Nakamura, Yutaro Nakamura Department of Respiratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorIsao Kosugi, Isao Kosugi Department of Pathology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYoshiki Tokura, Yoshiki Tokura Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author First published: 15 April 2019 https://doi.org/10.1111/1346-8138.14887Citations: 7Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume46, Issue10October 2019Pages e359-e360 RelatedInformation

Dermoscopy is a convenient tool to diagnose melanocytic lesions, especially nevus and melanoma. Various pigmented structures, including pigment network, dots and globules, and streaks, are observed in dermoscopy. Usually, 2D vertical images are used to explain the correlation of dermoscopy and histopathology. However, because the image of dermoscopy is horizontal, it is difficult for the horizontal view of dermoscopy to refer to the vertical view of histopathology. In our study, we digitally reconstructed 2D horizontal top-down view images and 3D aerial images from 50–100 serial 2D vertical sections by using high-speed scanner and 3D software in 6 cases of melanocytic lesion. Our new technology intuitively explained the histopathological structures corresponding to the dermoscopic structures. This technique could be used as a good educational tool for beginners.

Background: De novo hair regeneration occurs in scars of normal adult mice. This interesting phenomenon is termed as wound-induced hair neogenesis (WIHN). We hypothesized that M2 macrophages are crucially involved in WIHN. Objective: To clarify the contribution of M2 macrophages to WIHN. Method: We established a mouse model of WIHN. A full thickness skin excision was implemented on the back of C57BL/6 (B6) mice. Newly developing hair follicles were detected by a whole-mount assay. WIHN took place 2 weeks after wounding. Results: At first, flow cytometry revealed increased infiltration of CD11b(+)/CD206(+) M2 macrophages at the 2nd and 3rd week after wounding. Immunohistochemistry also showed the existence of CD206(+) M2 macrophages in the vicinity of regenerated hair follicles. Secondly, the productions of growth factors were confirmed by culturing M2 macrophages isolated from the skin in a comparison with CD11b(+) spleen cells. Array for 84 genes revealed increased expressions of various growth factors including Igf1 and Fgf2. Thirdly, we verified the effect of the growth factors on WIHN. WIHN was increased by 2 folds in mice treated with Fgf2 (p = 0.05) or by 1.5 folds with Igfl (p = 0.05). Finally, we used B6.Tg(ITGAM-DTR) mice in which macrophages are ablated by diphtheria toxin. We depleted macrophages at one to 2 weeks after wounding when M2 macrophages were dominant. WIHN was attenuated to one third (P = 0.05) by the ablation of macrophages. Conclusion: Our study suggests that M2 macrophages could promote WIHN through producing a panel of growth factors. (C) 2018 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

This report shows a case of papuloerythroderma in a patient with cutaneous T-cell lymphoma infected with HTLV-1 virus. Papuloerythroderma (PE) is a rare clinical entity characterized by widespread, flat-topped solid papules that are coalesced to form erythroderma, sparing body creases (“deck-chair” sign). The patients usually have tissue and peripheral eosinophilia. PE was originally shown to occur in patients with internal malignancies.1-3 Drug eruptions also appear as PE.4 Moreover, the association of PE with cutaneous T-cell lymphoma, including mycosis fungoides and Sézary syndrome, has been reported.1-3 We present a patient with cutaneous T-cell lymphoma infected with human T-lymphotropic virus-1 (HTLV-1). A 72-year-old man was referred to our department because of widespread erythematous papular lesions that gradually extended to the whole trunk and extremities for the past three months. The erythema on the abdomen avoided skin folds, exhibiting the deck-chair sign (Figure 1A). Flat-topped solid papules were prominently observed on the thighs (Figure 1B). There was no lymphadenopathy. He had a one-year history of hemodialysis because of chronic renal failure. Blood count revealed leukocytosis (9200/μL) and eosinophilia (11%, 1012/μL). His lymphocyte count was within normal limit, and blood smear showed neither atypical lymphocyte nor flower cell. The serum levels of lactate dehydrogenase and calcium were within normal limits. Western blot analysis for anti-HTLV-1 antibodies revealed the presence of antibodies against env protein and gag protein. Integration of HTLV-1 proviral DNA was observed in the skin tissue specimen by PCR analysis. Skin biopsy showed the infiltration of lymphocytes in the epidermis and the dermis (Figure 1C). The infiltrated lymphocytes had convoluted hyperchromatic nuclei (Figure 1D). By immunohistochemistry, many of the infiltrating cells were CD4+CD25+. A PCR analysis of a skin specimen revealed monoclonal rearrangement of T-cell receptor β gene in the regions of Vβ/Jβ1,2, Vβ/Jβ2, and Dβ/Jβ1,2. Using flow cytometric analysis of peripheral blood mononuclear cells (PBMCs), it was found that 7.3% of PBMCs were CD4+CD25+ and 19.0% were CD4+CCR4+ (Figure 1D), and no swollen lymph node or involvement of internal organs was observed by whole-body CT scan. The patient was diagnosed as cutaneous T-cell lymphoma with the infection of HTLV-1. The skin lesions were regressed after the treatments with topical corticosteroids and systemic narrowband ultraviolet B. No relapse has been observed for 6 months. The author declare no conflict of interest.

The Journal of DermatologyVolume 46, Issue 2 p. e67-e69 Letter to the Editor Indeterminate cell histiocytosis presenting as a single nodule of the nose Mutsumi Moriki, Corresponding Author Mutsumi Moriki moriki.m.derm@gmail.com orcid.org/0000-0002-9773-2616 Department of Dermatology, Shizuoka General Hospital, Shizuoka, JapanCorrespondence: Mutsumi Moriki, M.D., Department of Dermatology, Shizuoka General Hospital, 4-27-1 Kita Ando Aoi-ku, Shizuoka-shi, Shizuoka 420-8527, Japan. Email: moriki.m.derm@gmail.comSearch for more papers by this authorYuko Sano, Yuko Sano orcid.org/0000-0002-0742-0062 Department of Dermatology, Shizuoka General Hospital, Shizuoka, JapanSearch for more papers by this authorHiroaki Yagi, Hiroaki Yagi Department of Dermatology, Shizuoka General Hospital, Shizuoka, JapanSearch for more papers by this authorAkira Kasuya, Akira Kasuya Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYoshiki Tokura, Yoshiki Tokura Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author Mutsumi Moriki, Corresponding Author Mutsumi Moriki moriki.m.derm@gmail.com orcid.org/0000-0002-9773-2616 Department of Dermatology, Shizuoka General Hospital, Shizuoka, JapanCorrespondence: Mutsumi Moriki, M.D., Department of Dermatology, Shizuoka General Hospital, 4-27-1 Kita Ando Aoi-ku, Shizuoka-shi, Shizuoka 420-8527, Japan. Email: moriki.m.derm@gmail.comSearch for more papers by this authorYuko Sano, Yuko Sano orcid.org/0000-0002-0742-0062 Department of Dermatology, Shizuoka General Hospital, Shizuoka, JapanSearch for more papers by this authorHiroaki Yagi, Hiroaki Yagi Department of Dermatology, Shizuoka General Hospital, Shizuoka, JapanSearch for more papers by this authorAkira Kasuya, Akira Kasuya Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorYoshiki Tokura, Yoshiki Tokura Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author First published: 26 July 2018 https://doi.org/10.1111/1346-8138.14582Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume46, Issue2February 2019Pages e67-e69 RelatedInformation

Ingrown nail and pincer nail are common diseases. Although they are sometimes indistinguishable and described together, they are different conditions. Pincer nail is a situation where nail plate is curved transversely. On the other hand, ingrown nail represents a condition, where lateral edge of nail cuts deep into the lateral nail fold causing severe inflammation and even pyogenic granuloma. Ingrown nail and pincer nail coexist in some patients. In certain occupational environments, these nail diseases frequently occur as well as irritant and allergic skin diseases. In addition, they may take place in patients receiving epidermal growth factor receptor inhibitors. Different approaches should be made for the treatment of these nail conditions. Historically, surgical interventions, as exemplified by partial avulsion of nail plate and matricectomy, were usually selected. Currently, a number of preservative methods have been emerging, including nail sculpture, Tsume Flat ® , Pedigrass ® , VHO ® , and hyperelastic wire. However, there has been no golden standard. Each facility takes its own method for the treatment. In this review, we explain these preservative methods as well as surgical interventions.

BackgroundThe status of sentinel lymph node (SLN) is one of the most predictive prognostic factors in patients with clinically localized malignant melanomas (MMs). However, since the positive SLN metastatic rate is as low as 20%, it is desirable to minimize SLN biopsy performance with imaging. By dynamic lymphoscintigraphy, we have proposed the lymphatic transit rate (LTR), the value that the distance between the primary lesion and SLN is divided by scintigraphic saturation time. LTR represents the scintigraphic saturation velocity and can be used for evaluation of metastasis of skin cancers.MethodsDynamic lymphoscintigraphy data from 36 lymph nodes in 36 patients with primary MM on the limb were analyzed. The initial sites of the MMs were the lower limb in 24 patients and the upper limb in 12 patients. Histopathologically, nodal metastasis was found in 10 patients.ResultsIn the lower limb MM, the mean LTRs were 3.49 cm/min in histologically non-metastatic SLNs and 4.49 cm/min in histologically metastatic SLNs (P = 0.0056). In the upper limb MM, the mean LTRs were 2.59 cm/min in non-metastatic SLNs and 3.94 cm/min in metastatic SLNs (P = 0.0162). Thus, significantly higher LTRs were obtained in the metastatic SLNs. All SLNs with LTR < 4.0 cm/min in the lower limb MM and those with LTR < 3.0 cm/min in the upper limb MM were non-metastatic.ConclusionLTR is a useful predictive indicator for nodal metastasis and SLN biopsy performance in MMs.

Three anti-herpetic drugs, acyclovir, valacyclovir and famcyclovir, are used in the treatment of herpes zoster (HZ). To prevent renal impairment, an appropriate dose should be considered according to each patient's clinical profile. Non-steroidal anti-inflammatory drugs (NSAIDs) may be concomitantly used for HZ neuralgia, but they are not necessarily recommended for use, because of their alleged risk of renal injury. Although there have been a number of sporadic reports on renal failure due to combination of antiviral drugs and NSAIDs, only few analytical studies have been performed to evaluate the nephrotoxicity of the drugs. By using multiple linear regression analysis, we performed a retrospective study to identify risk factors of renal injury upon treatment with antiviral drugs in 211 HZ patients. Their doses were adequately reduced according to the individual renal function. Multiple regression analysis was implemented by using the difference of serum creatinine (Cre) level between pre- and post-antiviral therapy, i.e. Cre (post)-Cre (pre) value. Explanatory variables included age, gender, Cre (pre) level, use of individual antiviral drugs, and use of NSAID. This model had statistically significant adequacy of P = 0.049 for F value. The analysis revealed that Cre (pre) level and NSAID use, but not each a specific antiviral drug use, were significantly and positively related to Cre (post)-Cre (pre) value. Thus, NSAIDs and high Cre (pre) level are risk factors for renal injury regardless of the type of antiviral drugs. Our study suggests that NSAIDs should be avoided as analgesics in HZ patients receiving antiviral drugs, especially those who have high serum Cre levels.

Mogamulizumab is a therapeutic monoclonal antibody that targets the CC chemokine receptor 4 (CCR4). The treatment exhibits strong cytotoxicity for adult T-cell leukaemia/lymphoma (ATLL) cells via antibody-dependent cellular cytotoxicity (ADCC), although it carries the risk of serious adverse reactions to the skin, such as StevensJohnson syndrome (1, 2). We report here a patient with mycosis fungoides (MF) at tumour stage treated with mogamulizumab, who developed a photosensitivity reaction during the course of treatment. At the onset of photosensitivity, a reduction in both circulating and skin infiltrating regulatory T cells (Tregs) was observed.

Cryoablation is therapeutically applied for various disorders in several organs, and skin diseases are typical targets as this cryotherapy has been widely used for viral warts, benign tumors, and actinic keratosis. The main mechanisms of cryoablation consist of direct freezing effect on skin constituents, thrombosis formation in microcirculation, and subsequent immunological responses. Among them, however, the immunological mechanism remains unelucidated, and it is an issue how the direct freezing injury induces immunological consequences. We established a mouse cryoablation model with liquid nitrogen applied to the shaved back skin, and used this system to study the immunological excitement. After application of liquid nitrogen, the thermal decrease ratio was -25°C/sec or less and the lowest temperature was less than -100°C, which was sufficient to induce ulceration. Destruction of cornified layer and necrosis of epidermal cells were observed in transmission electron microscopy image, and increased transepidermal water loss and skin permeability were detected by the functional measurements. By flow cytometry, antigen-presenting dendritic cells (DCs), including PDCA1+B220+CD19- plasmacytoid DCs (pDCs) and CD11c+ myeloid DCs, as well as neutrophils and macrophages were increased in subcutaneous tissue. In parallel, the mRNA expressions of interferon α1 which are known as pDC-producing cytokines, was elevated. We also found marked degranulation of mast cells, providing a possibility that released histamine attracts pDCs. Finally, FITC migration assay revealed that pDCs and CD11c+ DCs emigrated from the cryoablated skin to the draining lymph nodes. Our study suggests that cryoablation induces destruction of the barrier/epidermis, accumulation of pDCs and CD11c+ DCs to the skin, and migration of DCs to regional lymph nodes. Viral elements or tumor cell lysates released from damaged keratinocytes may stimulate the DCs, thereby leading to antiviral or antitumor effect.