Background: Prurigo nodularis (PN) is a chronic pruritic skin disorder with a large number of hyperkeratotic nodules. The precise mechanisms of its pathogenesis remain unknown. PN has been linked to atopic dermatitis (AD), but its association remains unclear. Objective: We aimed to investigate the clinical, histological, and immunohistochemical characteristics of patients with PN and PN underlying AD (PN-AD). Methods: Eight patients were recruited for PN, PN-AD, and eight normal subjects, respectively. Skin tissues were obtained from patients and healthy subjects for histological and immunohistochemical analyses. Results: Histological examination showed increased epidermal thickness and dermal inflammatory cell counts in the PN-AD and PN groups compared to normal subjects. Immunohistochemical analyses revealed that the expression of interleukin (IL)-4, IL-13, IL-18, IL-31, IL-33, interferon (IFN)-γ, stromal-derived factor (SDF) 1-α and thymic stromal lymphopoietin (TSLP) was increased in the tissues of PN-AD and PN groups, in which the staining intensities of IL-4, IL-13, SDF1-α and TSLP in the PN-AD group were higher than those in the PN group, but the differences were not statistically significant. Conversely, the staining intensities of IL-18, IL-33 and IFN-γ were significantly higher in the PN group than those in the PN-AD group. Conclusion The pathogenesis of PN may differ from that of PN-AD, in which IL-18, IL-33 and IFN-γ may be associated, implying that epidermal injury is the initial cause of IL-18 and IL-33 induction, which then increases IFN-γ, resulting in the inflammatory process of PN.

Transdermal drug delivery systems (TDDSs) overcome the hurdle of an intact skin barrier by penetrating the skin to allow molecules through. These systems reduce side effects associated with conventional hypodermic needles. Here, we introduce novel microneedle (MN) TDDSs that enhance drug delivery by creating micron-sized pores across the skin. Many MN TDDSs designed to deliver a diverse array of therapeutics, including allergen-specific immunotherapy, skin disease treatments, and vaccines, are under pre-clinical and clinical trials. Although epicutaneous approaches are emerging as new options for treating food allergy in many clinical trials, MN TDDSs could provide a more efficient and convenient route to deliver macromolecules. Furthermore, MN TDDSs may allow for safe vaccine delivery without permanent scars. MN TDDSs are a major emerging strategy for delivering novel vaccines and treatments for diseases, including skin diseases, allergic diseases, and so on.

There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.
Adult ; Allopurinol ; Anaphylaxis ; Anti-Bacterial Agents ; Asia ; Asian Continental Ancestry Group ; Aspirin ; Asthma ; Carbamazepine ; Child ; Cicatrix ; Contrast Media ; Coronary Artery Disease ; Diagnostic Tests, Routine ; Drug Hypersensitivity ; Ethnic Groups ; Humans ; Hypersensitivity ; Penicillins ; Percutaneous Coronary Intervention ; Phenotype ; Recurrence ; Skin Tests

Autoimmune pancreatitis (AIP) occurs in two forms. Type 1 AIP is an IgG4-related systemic fibro-inflammatory disease. Type 2 AIP is not associated with altered levels of IgG4, and involves only the pancreas. Here, we report a case of type 2 AIP manifesting as acute pancreatitis in a 20-year-old male with ulcerative colitis. The patient was definitely diagnosed with type 2 AIP based on typical pancreatic imaging, supportive histology, history of ulcerative colitis, and steroid responsiveness.
Colitis, Ulcerative* ; Humans ; Immunoglobulin G ; Male ; Pancreas ; Pancreatitis* ; Ulcer* ; Young Adult

BACKGROUND: Pores are the openings of the pilosebaceous unit or the apocrine gland. Increase in pore size or in the number of dilated pores may be a cosmetic problem. To date, epidemiological studies on the numbers of dilated pores have been rarely reported. OBJECTIVE: To analyze the distribution of pores and the factors affecting pores. METHODS: We compared the number of dilated facial pores on the face according to site, age group, and sex. The relations of pore counts to wrinkle severity and to the amount of hydration were also analyzed. Dermavision(TM), a device that can take cross-polarization, parallel polarization, and ultraviolet light images, was used. Parameters were measured at three points: the forehead, cheek, and nose. RESULTS: The results revealed that dilated pores were more common on the nose and forehead. The pore counts were increased with age, and the increment was significant between participants in their 30s and 40s. Moreover, dilated pore counts were affected by wrinkle severity. The amount of hydration did not affect the counts of dilated pores. CONCLUSION: In this study, the number of dilated pores differed depending on the location. Moreover, it was confirmed that pore counts were higher in older persons. The pore counts showed a correlation with wrinkle severity.
Aging ; Apocrine Glands ; Cheek ; Epidemiologic Studies ; Forehead ; Humans ; Nose ; Ultraviolet Rays

Cutaneous bronchogenic cysts are rare, and stem from developmental abnormalities of the tracheobronchial tree. The condition is often misdiagnosed clinically, with the correct diagnosis usually established by histopathologic examination. Published reports of bronchogenic or branchial anomalies are increasing, and the traditional defining characteristics of location and histopathology are proving to be less reliable for the identification of cutaneous bronchogenic cysts. In this report, we describe a case of a cutaneous bronchogenic cyst that presented with unusual histologic features, and was associated with several lymphoid follicles.
Bronchogenic Cyst

Dermatofibroma (DF) is a common benign mesenchymal tumor composed of fibroblastic and histiocytic cells. It occurs anywhere on the body surface but has a propensity for the extremities. To our knowledge, DF arising in the oral cavity, especially on the lip, is quite rare. DFs of the head and neck region have been known to be most often of the cellular type and frequently recur, so a wider initial excision is recommended. Herein we report a case of DF in a 41-year-old female who presented with a deep-seated nodule on her upper lip.
Adult ; Extremities ; Female ; Fibroblasts ; Head ; Histiocytoma, Benign Fibrous ; Humans ; Lip ; Mouth ; Neck

Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder that's characterized by multiple lentigines in a unilateral distribution. The lesions often have a segmental pattern with a sharp demarcation at the midline. This is sometimes combined with other disorders such as neurofibromatosis or cafe-au-lait macules (CALMs). The presence of multiple CALMs in the same distribution as the lentigines on a PUL patient makes it difficult to differentiate PUL from segmental neurofibromatosis. We present here a 25-year-old woman with an unusual combination of several caf?-au-lait macules and scattered numerous lentigines involving the left side of the abdomen, flank and back.
Abdomen ; Adult ; Female ; Humans ; Lentigo ; Neurofibromatoses

The skin lesion of herpes zoster is classically limited to single dermatomal area, and most cases of multidermatomal herpes zoster have contiguous skin lesions. Noncontigous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. The phenomenon of zoster occurring in two noncontiguous dermatomes has been referred to as zoster duplex unilateralis or bilateralis. We report a case of herpes zoster multiplex in five disparate dermatomes in a 71-year-old woman with non-Hodgkin's lymphoma.
Aged ; Female ; Herpes Zoster ; Humans ; Lymphoma, Non-Hodgkin ; Skin

Bullous pemphigoid (BP) is a chronic autoimmune subepidermal blistering disease that usually occurs in the elderly. Two types of clinical variants exist. The generalized form typically involves the lower abdomen, groin, thighs and inner arms. The localized forms of BP include (1) mucous membrane pemphigoid or cicatrical pemphigoid, (2) localized scarring pemphigoid or Brunsting-Perry pemphigoid, and (3) localized nonscarring pemphigoid. We report here on a case of localized nonscarring pemphigoid on the face of a 71-years-old man.
Abdomen ; Aged ; Arm ; Blister ; Cicatrix ; Groin ; Humans ; Mucous Membrane ; Pemphigoid, Bullous ; Thigh