Original Articles

　　(Abstract)

Supplementary studies on Pigmentation in Nevoid, Neoplastic,

　　　　　　　　　andother Diseases of the Skin゛゜

１

　　　　　　　　　　　　　　　　　　　　　　　　　　　By

　　　　　　　　　　　　　　　　　　　　　　　Hiroshi Tanaka**

　　　Pigment anomalies of　the foetal skin and of diseased skin were studied by means of

the dopa reaction and other routine stains, in an attempt to find some explanation for the

increase and decrease of pigments in different diseases. The results are as follows :

　　　1. In　the foetal skin, a well-defined　picture　of the　melanocytes is visible without

recourse　to　the　dopa　reaction, because　their　cytoplasm is filled with abundant melanin

granules. It is characteristic of the foetal skin that the melanocytes are situated at the

same level as the basal cell layer or at the somewhat higher level。

　　　2. The hyperfunctional conditions of melanocytes :　In Addison's disease. the me^ano-

cytes are shown to be in ａ stimulated condition by the increase of their reactivity. their

hypertrophy in size. and the increase of their number as disclosed by the　dopa reaction.

The author found that the normal rhythm of the pigment formation is maintained in this

disease, a fact endorsing Lerner-Shizume's view that the pigment formation in Addisonﾀｓ，

disease is caused by the hypersecretion of MSH. A similar phenomenon was observed

in ａ patient who had received prolonged treatment with Prednisolone.

　　　3. The findings on the pigmented nevus, nevus spilus, the pigmented macules of Reck-

linghausen's phacomatosis. and pigmented spots on palms and soles were studied　from

the etiological point of view. In the pigmented spots on palms and soles, the difierences･

between nevoid and non-nevoid pigmented spots were pointed out.

　　　4. The findings on Mongolian spot and their allied conditions were described. and it

was shown that the pigmented macules in　pigmentovascular　phacomatosis (Ota) coincide

with Mongolian St)Ot.

　　　5. The relation　between　the proliferation　of　Malpighian cells　and　the amount of

melanin was investigated. In melanoepithelioma, both the number of ］Malpighian cells and

the amount of melanin increased　together. But in the precancerous condition and actual

cancer, the co-existence of ･Malpighian cells and melanin is disturbed. and the decrease or

disappearance of melanin and　the decrease, shrinkage　or disappearance of melanocytes

are observed. In hard nevi, the epidermal pigment sometimes increases and sometimes

decreases, apparently owing to different types of proliferation of Malpighian cells.

　　　6.　Ａphenomenon common to incontinentia pigmenti (Bloch-Sulzberger) and histological

pigmentary incontinence including fixed drug eruption, multiple macular hyperpigmentation。

２

and Riehl's melanosis. is the decrease of epidermal melanin notwithstanding normal or even

enhanced production of the pigment, accompanied with the increase of dermal melanin.

These diseases show complicated histological pictures. due to the　difference in degree　or

phase of the above mechanism, aad the changes proper to each of the diseases.

　　　7. Depigmentation :　In vitiligo. the　melanocytes are seen to suffer suppressed func-

tion and degeneration. In some cases. however, large amounts of　melanin was observed

in the dermis. It may be ａ vestige of past pigmentary incontinence. Leucoderma centri-

fugum acquisitum (Sutton) is also caused by the same mechanism, with pigmented nevi

in its center. so the nevus cells suffer the same changes･

　　　8. We have hitherto had only scanty description of the leucoderma in Morbus Harada

and sympathetic ophthalmia. The author carried out histological studies on each one case

of the two diseases. and noticed their resemblance　to vitiligo.

　　　9. In nevi　depigmentosi, partial　albinism　and　albinoidism, the　melanocytes　show

pathologic changes in proportion to the degree　of　their　depigmentation. In albinoidism.

however, it was found, contrary to expectation, that the enzymic activity of melanocytes

was still maintained.

　　10.1t is generally thought that there is an　eti ological resemblance between Addison's

disease and systemic scleroderma. Leucoderma in the both diseases may be considered as

the result of exhaustion of melanocytes caused by the excessive stimulalion of MSH.

　　１Ｌ　The findings on leucoderma in Bourneville-Pringle's phacomatosis and dyschroma-

tosis hereditaria symmetrica (Toyama) were described.

　　12. Mongolian cells were found histologically in the skin from two adults and the

significance of the cells was discussed.

　* Full-length report: Japanese section pp. 1～59

** From the Dermato-Urological Clinic (Director: Prof. T. Kawamura), University of Kanazawa,

　　Kanazawa

３

　　　　　　　　　　　　　　　　　　　　　ＡCase of Para-anthrax*

　　　　　　　　　　　　　　　　　　　　　　　　　　　By

　　　　　　　　　　KiheiTanioku, Fujitaka Zenisaka and Masashi Murata**

　　　A35-year-old farmer was referred to us with the appearance of slightlypruritic,raised。

dark-purple lesions　on the　extensor　surface of right wrist and arm on January 8，1957.

The present skin disorder began in December, 1956. Physical examination revealed good

general health without significantfindings. The lesions　consisted　of Siχ　nodules, which

were sharply demarcated, round, varying in size, 0.5 to　3.５cm　in　diameter, and　were

markedly raised above　the skin surface, elastic　softon　palpation. There　were　some

vesicles on each nodule.

　　　Bacteriological　and　histological　studies―Material　was　obtained from　one nodule.

Cultures in simple agar showed ａ pure culture of a different colony among the colonies

of staphylococcus albus. The organism was observed to be a gram-positive large rod.

It was definitelymotile. There was no capsule noted. Spores were formed　with　energic

and　irregular　characteristic.　It produced　acid, but　no　gas, in glucose, maltose and

saccharose. Growth in broth resulted formation of　sediment but no pellicule。 The　rod

did not produce hemolysis on blood agar.　There was no pathogenicity for mice. Ｔｈｅ=

biopsy specimen from one nodule exhibited thin epidermis, slightly edematous superficial

layers of the corium and some large rods in the area from the basal layers of　epidermis

to the superficiallayers of corium. These rods is most likelyＢ. anthracoides.

　　　Treatment and　course―All　cutaneous　symptoms　had　completely　subsided　by the

symptomatic treatment two weeks later.

　　　Itwas felt that from these characteristics the　organism　could best be classifiedヽas

Bacillus anthracoides.

　　　Ａcase of para-anthrax due to Bacillus anthracoides was reported. The difierentiating

features between anthraχ and para-anthrax were　briefly　discussed.

　*Full-length report: Japanese section pp. 60～67

** From the Department of Dermatology & Urology (Director:　Prof. Ｋ. Tanioku), Faculty of

　　Medicine, Shiushu University, Matsumoto

４

Society Transactions

The 362nd Tokyo Society

　　　Universityof Tokyo

　　　September21, 1957

Fumiyuゐj Ishihara ；　Ａ Case　of　Unilateral

　　Pringle゛ｓ Disease｡

　　　The patient was a 23-year-old woman, who

had typical lesions of Pringle's disease on the

right side of the face alone. This was proved

to be the fourth case of unilaterally appeared

Pr ingle's disease reported in this country. ca-

nicai and histological studies on　Pringle's dis-

ease referring to literatures have also been

done.and several diagnostically important facts

were pointed out.　　　　　　　　∧

Ｓ力inichiルlitsuhashiand ＹｏｓｈｉＷｓｏＹａｍａｚaii:　Ａ

　　Case of Urticaria Caused by　Ingestion of

　　Flour｡

　　　The patient is a 55-year-old man. who　de-

velops lesions of urticaria when he takes food

containing wheat flour. in these 20 years. By

means of patch test and intracutaneous iniec-

tion using several kinds of flour, it was con-

eluded that the component, responsible for the

provocation of the disease, was g】uten.

ＫｕｎｉｏＨａｎａｉand Ma加加　Waianabe:　Venereal

　　Diseases fｒｏ皿the　standpoint of　Public

　　Health Center.

lUｕｒｏＯtａａｎｄ ＵｄtａＫａtｏ:Ａ Case of Throm-

　　boangitis Obliterans.　　　　　　　　　　　｀

　　　The patient was ａ man, 42 years of age,

who complained of cold sensation and dullness

in the extremities, and was lame in the right

leg.　The pulsation of the right posterior tibial

artery. dorsal artery of the right foot. and right

brachial artery were faint or not perceptible.

however, no necrotic lesions were observed on

the skin. Biopsy of the right posterior tibial

artery showed thromboangitis. Etiological factors

in this case seemed to be the habit of smoking

and syphilis.

Araia Maisui and　ＴａｎｅｆｉtｒｏＳａｔio:　Enzymatic

　Debridement　by　Local　Applicaation　of

　Trypsilin stick｡

　　　The effect of Trypsilin Stick (prepared by

Mochida Seiyaku Co.), consists chiefly of poly-

ethylene glycol containing 10,000 units of trypsin

per cc, was studied both chemically and clin-

ically｡It was found that the effect of Trypsilin

Stick lasted for ａ　longer time than　trypsin

powder. Proteolytic action of Trypsilin Stick

on egg albumin. casein, and gelatin were also

demonstrated experimentally.　When inserted

into the wounds of acute pyoderma and ulcer,

it　facilitated　markedly　the　debridement　of

necrotic lesions and the secretion of pus.

Ｎｏｂｏｒｕ Isfttｚ≪ｆｅｉ ａｎｄ Ｋａｚｕｚｏ Ｓａtｏご　Ｓtｕdies on

　Chrome Dermatitis。

　　　Six patients with contact dermatitis due

to chrome were observed. Three of them were

printers and the other three were dye workers.

all having subacute eczematous dermatitis on

the exposed area. such　as hands. forearms

and face. Positive patch test was observed in

printers゛group with　ammonium　bichromate

and in dye workers with sodium bichromate.

Discussion:(ｒｔichiｒｏ　Ｈａｒａｄａ:ｌ have often Ob-

served similar cases of contact dermatitis　in

printers. For the detection of the　etiological

factor in these cases. l believe the series of

patch test using various kinds of chromates are

the most valuable, because bichromate　is the

very irritating substance in itself.

Ｋｉｈｅｉ Ｔａｎｉｏｆｅｕ， Ｒｙｕｚｏ Ｍａｉｓｕｙａｍａ，ＹｏｓｗＭｆｅｏ Ｓａｉｄａ。

　YMfetＯ Ｎｉｓ恒常mra.Ｋｏｚｗhiｒｏ Ｔｓｕｒｕmi and Afejo

　Kaw心μ揖i:　studies on Skin　Metabolism

　(Fifth Report)。

　　　The changes of the contents of Sodium,

Potassium, Calcium, Magnesium, Glucose,

Glycogen, Vitamin Ｃ，Vitamin Ｂ２，Biotin, Panto-

thenic Acid, Niacin and Cholinesterase　in the

skin of rabbits. irradiated with infra-red rays,

were studied. The irradiation was carried out

for five minutes on the clipped skin of one side of

the back, and the other side was used as the

control. Lamp skin distance is about 12 cm.

The measurements were performed at inter-

vals of ｏ min., 1 hr., 2 hrs., 3 hrs., 5 hrs.,

8 hrs., 12 hrs., and 24 hrs. after the irradia-

tion. The changes of their contents　in　the

skin were observed at period from ｏ min. to

12 hrs. after　the irradiation. These observa-

tions were　different　from the experiments in

which the ultraviolet irradiation on the rabbit-

-skin　was employed.

Discussion: ＴａtｓｕｒｏＭａｓｗ竹liｚＭ:l should like to

ask you that what a different reaction between

an ultraviolet and infra-red irradiation on the

small vessels of the skin could be observed？

Ｊ?ｙＭｚｏＭａｆＳＭｙａｍａ:Theinfluences of ultraviolet

and infra･red irradiation on the blood vessels

have been uncertain･, but l would say that the

infra-red rays reach the deeper tissue of the

･skin, the　heat ray　of　infra･red　irradiations

causes the reaction　more earlier and the reac-

tion subsides more faster than the ultraviolet

irradiation.

AlｓｕｓｈｉＫｕhitａ:studies on Melanin Formation。

　　with　Special　Reference　to　Tyrosinase

　　Activity of Hair Melanocytes｡

　　　The tyrosinase activity of hair melanocytes

in the various colored human hairs (black.

red, grey and hairaof albino) and in the chick-

embryos of three different breeds (White Leg-

horn, Rhode Island Red and Black Australorp)

was determined with an autoradiographic tech-

nic using radioactive C14 tagged tyrosine pｒｅ･

viously described (Science, 121, 893, 1955; J.

Invest. Dermat･, 26, 173, 1956). Active tyrosin-

ase activity was detected in　melanocytes in

black, red and blond hairs. The degree of the

activity was found to be high in the following

５

descending order:　blond hair, red hair and

black hair. No tyrosinase activity was detected

in melanocytes in the grey hair and hair in

albino. In the chick-embryos. no tyrosinase

activity was detected in the ｍｅlanocytes of the

feather daring the embryonal development of

White Leghorn, but dopa-oxydase activity was

found in melanocytes at the limited period of

the embryonal life (11 day to 15 day).　Both

tyrosinase and dopa oxydase were detected at

the limited period of the embryonal life （10

day　t0　14　day) in the embryos of Rhode

Island Red and Black Australorp, however, the

activities were not detected in the successive

embryonal life.

Ｔｏｓfitｗfei FｕｎａｂａｓＭ ａｎｄＳａｄａｈｉｋｏ Ｈａれａt:Ａ Case

　of Acanthosis Nigricans｡

　　　A 57-year-old male having acanthosis nigri-

cans with no evidence of associated malignancy

was reported. The study on pathogenesis of

this case will appear elsewhere.

Ｒ泌垣　Ｋｏｉｉｍａ ａｎｄ Ｈｉｓ(ＩＳhi　Niｓｈｉｄｎ:　Small

　Nodular Lesions on the Skin｡

　　　Six cases with small nodular lesions were

reported. All cases were examined histologi-

cally, and　their　diagnoses were as follows :

granuloma having　necrosis, thrombosis, epi-

thelial cyst, lesion resembling calcifying epi-

thelioma, granuloma pyogenicum, and capsulat-

ed neurofibroma.

尺anehiko Kiiamu?72: The Eleventh International

　Congress of Dermatology｡

　See this journal, 67 : 723. 1957.

　　　　Demonstration of Clinical Cases

Melanoleucoderma and Poliosis observed in

　Carbon Binder Worker (Yamaiiashi Kenritsu

　Hospital)｡

　　　This patient,carbon. binder worker, was a

38-year-old male, who had ａdiffuseredness and

fever-sensation on the upper part of the chest

and the back of the feet on the firstday of his

employment. On the ｎｅχtday. the lamellar

６

desquamation and depigmented lesions　were

noticed on the upper part of the chest　and

back of the feet. Four or five days after that,

numerous freckle-like pigmented spots appeared

in the depigmented lesions, and　the　lanugos

on the　lesions, hairs on the scalp, mustache

and eyelashes started to grey･

Discussion:　Ｋｏｉｃｈt　Niｓｈｉｄａ-.　ｌ have observed

different kinds of pigmentary disorder in the

other workers of the same factory.

Basal Cell Epithelioma treated with Purified

　Vaccine Lymph (Yokohama City University).

　　　Ａ patient, 38-year-old woman, was given

local injection of Ｐ.Ｖ.Ｌ･，１ cc ａ day, for 18

days. The necrosis of the tumor was noted

two　days after　the　treatment was　started.

and subsequently the size of the tumor was

reduced.

Discussion: ＹｏｉｈｉｋｕniＮｏｇｗｃｈｉ;　The principle

of this treatment is thought to be due to the

epidermotropic action of small pox virus, and

also the excellent results have been obtained

in the treatment of verruca with　the same

mode of P.V.L. administration.

Lichen Ｐｉｇ皿entosus (Yokohama City Univer-

　sity).

　　　A　45-year-old male　has had　pigmented

pruritic eruptions on the lateral surface of the

neck, forearms and back of the　feet of　two

years' duration. Recently the pigmentation　of

the lesion hds increased. Histopathologic exam-

ination: Although there was ａ band-like infiltra-

tion　of　round　cells in the upper part of the

corium in the specimen taken from the dorsum

of　the feet, no　diagnostic characteristics　of

lichen planus　were found in the　lesion of the

side ･of the neck.

Discussion: ＫαれｅｈｉｆｅｏＫＵａ俳話ｒａ:ｌ have observ-

ed frequently the cases of lichen pigmentosus

which have no diagnostic characterstics in the

histological examination like those of Riehl's

melanosis.

Case for Diagnosis (Yokohama City Univer-

sity).

　　　A　15-year-old girl has had a well-demar-

cated, elevated, erythematous lesion on the left

cheek for ｓiχ months. The redness of the

lesion is increased by the exposure to the sun.

Biopsy was performed, and showed atrophy of

the epidermis, homogenization of the collagen

and loss of the elastic fibers.

Discussion:尺挽≪! Tanioku: l think this patient

has dermatitis atrophicans　maculosa　idiopa-

thicａ.　ＫａｉａｓhｘＹｏ恥部■ｍｏ'.l would agree with Dr.

Tanioku゛ｓ opinion. I think the lesion shows

atrophy　of the skin　clinically, which　helps

establish this diagnosis.

Urticaria Pigmentosa in Adult (Branch Hos-

pital, University of Ｔｏｋｙｏ)。

　　　A 17-year-old　woman has had numerous

flat pigmented spots on the chest. and lower

extremities for several　months. Recently the

number of　the　lesions　has been increasing｡

however, her subjective symptoms are slight･

Blood examination for syphilis was positive.

Histological examination revealed　small num-

bers of mast cells (Rona type)･

Connective Tissue Nevus (Ｔｏｋｙｏ Medicodental

　University)。

　　　A 22-year-old woman first noticed milium一一

to rice-sized, white, soft papules　distributed

on her　breasts, upper　abdomen, back　and

lumbar region two and ａ half years ago.　ＮＯ･

subjective symptoms are　complained. Micro-

scopically, the　lesion　showed　swelling　and

diminution of the elastic fibres.

Discussion:　ＫｏＭｅｆｉｉｆｅｏＫｉ拠単瓦ｙａ:　l wonder　if

the course of two and ａ half years is enough

to diagnose this　lesion as　ａ　nevus.　Giicfiiｒｏ=

Harada:　l think this case is　nevus tardus.

Case　for　Diagnosis (Juntendo　University。

　Ｔｏｋｙｏ)｡

　　　A 42-year-old woman suffered from caries.

of the femur　two　years ago.　The　present

lesion occurred as ａ　hen-egg-sized　induration

on the upper part of the left leg　about one

year ago.　The lesion thereafter has　spread

to the surrounding skin. At present time, the

lesion shows an ill-defined, firm, pigmented

macule covering the entire left leg. Histological

･examination　revealed edema and perivascular

lymphocytic　infiltration　of　the　subpapillary

　layer, and　proUferation　and　homogenization

･of　the connective tissue in the corium.

Discussion:　召7,・aki Miyazaki:　If it is ａ case

of　vasculitis, the　distribution　of the　lesion

should be arranged bilaterally･

Ａ Case of Leucoderma (University of Ｔｏｋｙｏ）。

　　　A　17-year-oId girl has had　greying　of

eyelashes of two months' duration. and f0ll0V7-

ing the sea-bathing　this summer, the ｗe11-

demarcated, numerous depigmented spots appe-

ared mostly on the exposed　regions, the fore-

head, cheeks, sternal region and extremities.

They vary in size from that of ａ rice-grain to

ａ hen-egg. and have irregular, round　or oval.

and annular　shape.　In　the lesions on the

forearms and lower legs. the spotty or reticular

normal skin is left which shows ａ monstrous

picture.

Porokeratosis Systematica (University of To-

　　ｋｙｏ）｡

　　　This patient is a 26-year･old　man. The

present skin lesions appeared shortly after his

birth. At present. there are numerous, irregular,

milium- to broad-bean-sized. pigmented lesions

scattered on the chest, the upper abdomen,

and on the flexor surface of　the left　upper

extremity.　Some of them are confluent. form-

ing irregular plaques.　The small lesions are

dark-purplish or　brownish in hue, slightly

elevated with sharp demarcation. and the larger

lesions have elevated　borders and depressed

centers, having normally colored skin or brow-

nish pigmentation. The　lesions show　linear

Ｃｏｎ丘guration and tend to affect the left side of

the body rather than the right. Microscopic･

ally, the　typical　changes　of　porokeratosis

were observed in the epidermis.

７

Precancerosis (University of Tokyo)｡

　　　Ａman, aged 33, has had gradually develop-

ing lesions for　10 years.　Extremities, espe-

cially forearms, eχtensor aspect of thighs. and

popliteal　regions　showed　well-demarcated,

round, pale pinkish or dark　brownish pea-

to coin-sized, slightly scaly　lesions. Histology

showed some anaplastic cells in the epidermis.

but no clumping cells.

Discussion:ＫａtａｓＷ　Ｙｏｋｏｙａｍａ;　Ｗｅhave experi-

enced　ａ case　of Bowen's disease with multiple

lesions, which had been diagnosed clinically as

psoriasis. I believe the case　presented here

is essentially the same as ours.

Parapsoriasis en Plaques (University of To-

　　ｋｙｏ)｡

　　　A girl, aged 15, has had the present con-

d皿on for 4 years. Coin- to palm-sized erythema

with pityriasic scales scattered on both thighs

and on the trunk。 Not pruritic. Histological

findings: Hyperkeratosis, destruction of the ba-

sal layer, exocytosia at the lower part of the

epidermis, spongiosis of the slight degree in the

prickle layer. and perivascular　lymphocytic in･

filtration in the corium.

Weber-Christian's Disease (Hitachi Hospital)｡

　　　Ａ woman, aged 54, developed the edematous

erythematous swelling on the face in winter,

15 years ago, which resulted in the formation

of the marked depression of the skin after-

wards. In fall 1956, she suffered from vertigo,

and palpitation, and at the same time subcuta-

neous nodular lesions appeared on both shoulders

which gradually extended to chest and upper

arms.　The center of the lesions again became

depressed progressively. She was afebrile dur-

ing the course of the disease. Panniculitis is

ａ predominant feature histologically･

Discussion:　Hitoshi　召''atano:　Among various

types of idiopathic　lipogranulomas, Rothman-

Makai゛ｓ syndrome is thought to be ａ favorite

diagnosis because of　the absence　of marked

general symptoms such as high fever.

８

Sqamous Cell Carcino皿ａ of the Lip (Nippon

　University)。

　　　A 65-year･old man. 3 years d゙uration. Mi-

liary to bean-sized papules with rough surfaces

were grouped on the right half of the lower

lip, forming ａ papillomatous, hard, tender no-

dule. Submandibular　and　submental　lymph

nodes were swollen. Histologically, nests of

tumor cells with dark-staining atypical nuclei

were found.

Case for Diagnosis (Poikiloderma Atrophi｡

　cans Vasculare?) (Nippon University)｡

　　　A60-year-old man had developed labial and

perioral pigmentation after the topical applica-

tion of an ointment　for　probable　cheilitis.

Later, pruritic erythema ａ耳d pigmentation had

appeared on the flexor surface of arms and

thighs. Clinical features when the patient was

presented were violaceous pigmentation of the

face, telangiectasis,pigmentation, and atrophy

on　the　trunk　and　extremities.　Histology:

The epidermis is atrophic. Narrow zones of

pigmentation and depigmentation are observed

in the basal　layer. Subepidermal band-like

infiltrationare also found in some parts of the

cutis.

Xantho皿ａ Disse皿Inatuin (Okubo Hospital, To-

　kyo).

　　　A 14-year-old boy has had the lesions on

axillae for l year, which gradually increased

in number and became generalized. Thirst

and polyuria were observed. Yellowish brown

papules, with size of ａ pin-head to ａ grain of

rice, are located on the face. head, neck, trunk.

genitalia, and thighs. Some　of　the　papules

tend to coalesce forming pea-sized lesions. Con-

sistency is elastic firm. Total cholesterol in

serum:　173 mg/dl. Specific gravity of urine :

1,001.　The lesion was found to be typical

xanthoma histologically･

Squamous Cell Carcinoma and Cutaneous Horn

　(ＯｋｕｂｏHospital, Tokyo).

　Coincidental occurrence of both dermatoses

in a 79-year-oia man.

Familial Benign Chronic Pemphigus? (Kanto

　Teishin Hospital, Tokyo).

Alopecia Areata, Vitiligo and Arsenical Me-

　lanosis (Kanto Teishin Hospital, Tokyo).

Lupus　Erythematosus　Discoides Chronicus

　(Kanto Teishin Hospital, Tokyo).