Nontuberculous mycobacteria are increasingly recognized as causes of chronic and refractory skin and soft tissue infections, even in individuals without immunodeficiency. Among them, Mycobacterium mageritense is a rare, rapidly growing species that can lead to persistent lesions requiring prolonged antimicrobial therapy. Reports of M. mageritense infections involving both the skin and regional lymph nodes are limited, and this case adds new clinical and genomic insights. A 48-year-old previously healthy man presented with a slowly enlarging cutaneous lesion on his lower leg and ipsilateral inguinal lymphadenitis. Empirical antibacterial therapy with β-lactams and macrolides was ineffective. Wound cultures subsequently grew M. mageritense, confirmed by whole-genome sequencing. Several antimicrobial regimens were attempted, and the final successful therapy consisted of oral levofloxacin and minocycline for 4 months, leading to complete clinical resolution. Genomic analysis identified resistance-related genes, including erm(40), aac(2′)-Ib, tet(V), and RbpA, although in vitro minimum inhibitory concentrations showed variable susceptibility. Phylogenetic comparison revealed that the isolate was closely related to previously reported M. mageritense strains from Japan. This case demonstrates that M. mageritense can cause cutaneous infection with secondary lymphadenitis in an immunocompetent host. Accurate species identification using molecular or genomic methods and selection of appropriate combination antibiotic therapy based on susceptibility testing are crucial for successful management of such infections.

Obesity is an important risk factor for psoriasis, and clinical studies indicate that exercise interventions can improve disease severity. However, the mechanisms by which exercise influences psoriatic pathogenesis remain insufficiently understood. To investigate the effects of aerobic exercise on obesity-associated psoriasis, wild-type mice were fed a high-fat diet (HFD) for 7 weeks to induce obesity and subsequently underwent moderate-intensity treadmill running for 3 weeks. Psoriasiform dermatitis was induced by daily topical application of imiquimod (IMQ) to the skin for five consecutive days. HFD increased body weight, epididymal fat mass, and serum cholesterol. HFD-fed mice developed more severe IMQ-induced psoriatic skin changes compared with normal diet-fed mice. Treadmill exercise modestly reduced body weight gain and attenuated epidermal hyperplasia in HFD-fed mice. In contrast, inflammatory cytokine expression, including Tnfa, Il17a, and Il23a, showed modest increases in the skin of HFD-fed exercised mice, which did not parallel the improvement in epidermal hyperplasia. Overall, these findings indicate that while obesity exacerbates psoriasiform dermatitis, aerobic exercise ameliorates epidermal hyperplasia in obese mice without corresponding changes in inflammatory cytokine expression in the skin, suggesting that exercise may influence psoriatic skin changes through multiple metabolic and immunological pathways.

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1Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan 2Department of Dermatology, Fukushima Medical University, Fukushima, Japan Address for correspondence: Dr. Yoshio Kawakami, Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan. E-mail: [email protected] Received May 15, 2023 Received in revised form July 17, 2023 Accepted August 07, 2023

The Journal of DermatologyEarly View LETTER TO THE EDITOR Pruritic folliculitis of pregnancy with granular deposition of immunoglobulin G along the basement membrane zone Mana Usui-Taniguchi, Mana Usui-Taniguchi orcid.org/0000-0003-0729-4083 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JapanSearch for more papers by this authorYoshio Kawakami, Corresponding Author Yoshio Kawakami [email protected] orcid.org/0000-0001-5609-6118 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Correspondence Yoshio Kawakami, Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. Email: [email protected]Search for more papers by this authorYoichiro Toi, Yoichiro Toi Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JapanSearch for more papers by this authorTatsuya Kaji, Tatsuya Kaji Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JapanSearch for more papers by this authorYoshiko Matsuura, Yoshiko Matsuura Konohana Dermatology Clinic, Okayama, JapanSearch for more papers by this authorEmi Yokoyama, Emi Yokoyama orcid.org/0000-0001-8754-3806 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanSearch for more papers by this authorTomoko Miyake, Tomoko Miyake orcid.org/0000-0002-2644-6380 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanSearch for more papers by this authorYoji Hirai, Yoji Hirai orcid.org/0000-0003-2201-6129 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanSearch for more papers by this authorShin Morizane, Shin Morizane Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanSearch for more papers by this author Mana Usui-Taniguchi, Mana Usui-Taniguchi orcid.org/0000-0003-0729-4083 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JapanSearch for more papers by this authorYoshio Kawakami, Corresponding Author Yoshio Kawakami [email protected] orcid.org/0000-0001-5609-6118 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Correspondence Yoshio Kawakami, Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. Email: [email protected]Search for more papers by this authorYoichiro Toi, Yoichiro Toi Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JapanSearch for more papers by this authorTatsuya Kaji, Tatsuya Kaji Department of Dermatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JapanSearch for more papers by this authorYoshiko Matsuura, Yoshiko Matsuura Konohana Dermatology Clinic, Okayama, JapanSearch for more papers by this authorEmi Yokoyama, Emi Yokoyama orcid.org/0000-0001-8754-3806 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanSearch for more papers by this authorTomoko Miyake, Tomoko Miyake orcid.org/0000-0002-2644-6380 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanSearch for more papers by this authorYoji Hirai, Yoji Hirai orcid.org/0000-0003-2201-6129 Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanSearch for more papers by this authorShin Morizane, Shin Morizane Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JapanSearch for more papers by this author First published: 10 November 2023 https://doi.org/10.1111/1346-8138.17029Read 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 onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Zoberman E, Farmer ER. Pruritic folliculitis of pregnancy. Arch Dermatol. 1981; 117: 20–22. 10.1001/archderm.1981.01650010026017 CASPubMedWeb of Science®Google Scholar 2Ambros-Rudolph CM, Müllegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol. 2006; 54: 395–404. 10.1016/j.jaad.2005.12.012 PubMedWeb of Science®Google Scholar 3Kroumpouzos G. Specific dermatoses of pregnancy: advances and controversies. Expert Rev Dermatol. 2010; 5: 633–638. 10.1586/edm.10.59 Google Scholar 4Errichetti E, Stinco G. Photoletter to the editor: dermoscopy as a diagnostic aid for pruritic folliculitis of pregnancy. J Dermatol Case Rep. 2016; 10: 19–20. 10.3315/jdcr.2016.1227 PubMedGoogle Scholar 5Mutasim DF, Adams BB. Immunofluorescence in dermatology. J Am Acad Dermatol. 2001; 45: 803–822. 10.1067/mjd.2001.117518 CASPubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

69 歳,女性。X-2 カ月より硬口蓋・左頰・咽喉頭と鼻粘膜にびらんを認め,X-1 カ月に陰部と肛門部にもびらんが拡大し当院へ紹介となった。入院 8 日後,胸部,腹部と大腿に小豆大までの緊満性水疱が生じた。肛門部びらん病変部からの皮膚生検では,病理組織学的に表皮真皮接合部に裂隙形成と真皮の浅層にリンパ球浸潤を認めた。無疹頰粘膜の蛍光抗体直接法で基底膜に IgG と C3 の沈着を認めたが,蛍光抗体間接法は陰性であった。血液検査にて抗 Dsg1・3 抗体および抗 BP180 抗体は陰性,抗核抗体(320 倍)および抗 Sm 抗体陽性,白血球数減少(3180/μl)を認めた。血液検査結果と口腔・鼻粘膜びらんと併せて水疱性エリテマトーデス(BSLE)と診断した。プレドニゾロン 30 mg/ 日全身投与開始後,体幹・四肢の水疱は消退したため,プレドニゾロンを漸減した。体幹と四肢の緊満性小水疱と口腔粘膜と陰部のびらん以外の皮疹,臓器病変に乏しい稀な BSLE であり診断に時間を要したが,診断に難渋する水疱と粘膜病変を認めた際には BSLE も鑑別として念頭に置くべき疾患と考えた。

The effect of persistent skin inflammation on extracutaneous organs and blood is not well studied. Patients with recessive dystrophic epidermolysis bullosa (RDEB), a severe form of the inherited blistering skin disorder, have widespread and persistent skin ulcers, and they develop various complications including anaemia, hyperglobulinaemia, hypoalbuminaemia and secondary amyloidosis. These complications are associated with the bioactivities of IL-6, and the development of secondary amyloidosis requires the persistent elevation of serum amyloid A (SAA) level. We found that patients with RDEB had significantly higher serum levels of IL-6 and SAA compared to healthy volunteers and patients with psoriasis or atopic dermatitis. Both IL-6 and SAA were highly expressed in epidermal keratinocytes and dermal fibroblasts of the skin ulcer lesions. Keratinocytes and fibroblasts surrounding the ulcer lesions are continuously exposed to Toll-like receptor (TLR) ligands, pathogen-associated and damage-associated molecular pattern molecules. In vitro, TLR ligands induced IL-6 expression via NF-kappa B in normal human epidermal keratinocytes (NHEKs) and dermal fibroblasts (NHDFs). SAA further induced the expression of IL-6 via TLR1/2 and NF-kappa B in NHEKs and NHDFs. The limitation of this study is that NHEKs and NHDFs were not derived from RDEB patients. These observations suggest that TLR-mediated persistent skin inflammation might increase the risk of IL-6-related systemic complications, including RDEB.

The Journal of DermatologyEarly View LETTER TO THE EDITOR Cutaneous toxicity with subepidermal blisters and dyskeratosis following administration of pemetrexed in a patient with nivolumab-induced psoriasis and linear IgA bullous dermatosis Sayuri Yokomizo, Sayuri Yokomizo orcid.org/0009-0004-8957-9131 Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, JapanSearch for more papers by this authorTomoko Miyake, Corresponding Author Tomoko Miyake [email protected] orcid.org/0000-0002-2644-6380 Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan Correspondence Tomoko Miyake, Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. Email: [email protected]Search for more papers by this authorYoshio Kawakami, Yoshio Kawakami orcid.org/0000-0001-5609-6118 Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, JapanSearch for more papers by this authorKadoaki Ohashi, Kadoaki Ohashi Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, JapanSearch for more papers by this authorHiroshi Koga, Hiroshi Koga orcid.org/0000-0001-7027-032X Department of Dermatology, Kurume University School of Medicine, Fukuoka, JapanSearch for more papers by this authorNorito Ishii, Norito Ishii orcid.org/0000-0002-1199-6611 Department of Dermatology, Kurume University School of Medicine, Fukuoka, JapanSearch for more papers by this authorShin Morizane, Shin Morizane orcid.org/0000-0003-1374-065X Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, JapanSearch for more papers by this author Sayuri Yokomizo, Sayuri Yokomizo orcid.org/0009-0004-8957-9131 Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, JapanSearch for more papers by this authorTomoko Miyake, Corresponding Author Tomoko Miyake [email protected] orcid.org/0000-0002-2644-6380 Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan Correspondence Tomoko Miyake, Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. Email: [email protected]Search for more papers by this authorYoshio Kawakami, Yoshio Kawakami orcid.org/0000-0001-5609-6118 Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, JapanSearch for more papers by this authorKadoaki Ohashi, Kadoaki Ohashi Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, JapanSearch for more papers by this authorHiroshi Koga, Hiroshi Koga orcid.org/0000-0001-7027-032X Department of Dermatology, Kurume University School of Medicine, Fukuoka, JapanSearch for more papers by this authorNorito Ishii, Norito Ishii orcid.org/0000-0002-1199-6611 Department of Dermatology, Kurume University School of Medicine, Fukuoka, JapanSearch for more papers by this authorShin Morizane, Shin Morizane orcid.org/0000-0003-1374-065X Department of Dermatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, JapanSearch for more papers by this author First published: 21 September 2023 https://doi.org/10.1111/1346-8138.16974Read 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 onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Hanna N, Shepherd FA, Fossella FA, Pereira JR, Marinis FD, Pawel JV, et al. Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol. 2004; 22: 1589–1597. 2Tummino C, Barlesi F, Tchouhadjian C, Tasei AM, Gaudy-Marqueste C, Richard MA, et al. Severe cutaneous toxicity after pemetrexed as second line treatment for a refractory non small cell lung cancer. Rev mal Respir. 2007; 24: 635–638. 3Bosch-Barrera J, Gaztañaga M, Ceballos J, Pérez-Gracia JL, López-Picazo JM, García-Foncillas J, et al. Toxic epidermal necrolysis related to pemetrexed and carboplatin with vitamin B12 and folic acid supplementation for advanced non-small cell lung cancer. Onkologie. 2009; 32: 580–584. 4Siegel J, Totonchy M, Damsky W, Berk-Krauss J, Jr FC, Sznol M, et al. Bullous disorders associated with anti-PD-1 and anti-PD-L1 therapy: a retrospective analysis evaluating the clinical and histopathologic features, frequency, and impact on cancer therapy. J Am Acad Dermatol. 2018; 79: 1081–1088. 5Jonna S, Neiders M, Lakshmanan S, Khan A, DeKlotz T, Lanasa D, et al. Linear IgA disease of the gingiva following nivolumab therapy. J Immunother. 2019; 42: 345–347. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Brentuximab vedotin (BV), a conjugate of anti-CD30 antibody and monomethyl auristatin E, has emerged as a promising treatment option for refractory CD30+ mycosis fungoides (MF) and primary cutaneous anaplastic large-cell lymphoma (pcALCL). BV has been shown to be safe and effective in treating Hodgkin's lymphoma and peripheral T-cell lymphoma. This multicenter, prospective, single-arm phase I/II study evaluated the efficacy of BV in Japanese patients with CD30+ cutaneous lymphomas, namely CD30+ cutaneous T-cell lymphoma. Participants were divided into two groups: those with CD30+ MF or pcALCL (cohort 1, n = 13) and those with CD30+ lymphoproliferative disorders other than those in cohort 1 (cohort 2, n = 3). The studied population included the full analysis set (FAS), modified FAS (mFAS), and safety analysis set (SAF). These sets were identified in cohorts 1 and 1 + 2 and labeled FAS1 and FAS2, mFAS1 and mFAS2, and SAF1 and SAF2, respectively. Each treatment cycle lasted 3 weeks, and BV was continued for up to 16 cycles after the third cycle based on treatment response. The primary endpoint was the 4-month objective response rate (ORR4) determined by the Independent Review Forum (IRF). ORR4 was 69.2% for FAS1 and 62.5% for FAS2 (P < 0.0001). Secondary endpoints of ORR, assessed using the global response score (53.8% in FAS1) and modified severity-weighted assessment tool (62.5% in FAS1), using the IRF, provided results comparable to the primary findings. The incidence of >= grade 3 adverse events (>= 15%) in SAF1 was peripheral neuropathy in three patients (23%) and fever and eosinophilia in two patients (15%). In conclusion, BV showed favorable efficacy, tolerability, and safety profile in Japanese patients with relapsed or refractory CD30+ primary cutaneous T-cell lymphoma. The trial was registered with University Hospital Medical Information Network Clinical Trials Registry, Japan (protocol ID: UMIN000034205).