No abstract

Scherschum et al. proposed diltiazem-associated photodistributed hyperpigmentation as a novel type of drug-induced photosensitive lichenoid eruption. The characteristic clinical features were slate-gray reticulated hyperpigmentation on sun-exposed areas, while lichenoid dermatitis with prominent pigmentary incontinence was noted histologically. Although the clinical and histological features were similar to those of lichen planus pigmentosus, the histological features did not show either compact hyperkeratosis or wedge-shaped hypergranulosis, which are typical histological features of lichen planus. We describe two Japanese cases of diltiazem-associated photodistributed hyperpigmentation, who were successfully treated with topical tacrolimus, and review the published work.

Letters to the Editor 435 since 1990 have reported the use of terlipressin for the treatment of HRS with good outcomes and low risk of adverse effects. Incidence of secondary ischaemic events in HRS differs depending on series from 5% to 29% (1. 2, 8, 9). Significantly, a recent meta-analysis revealed that no permanent interruption of terlipressin was needed because of intolerance ( I ).Undesirable effects are usually mild and disappear by lowering the dose of the drug. i.e. paleness, acral cyanosis, abdominal pain, diarrhoea, headache and self-limiting cardiac arrhythmias. However, serious ischaemic events, such as skin necrosis involving the extremities, scrotum, penis or abdominal skin have been documented (1-3, 5, 6. 8. 9). Obesity, venous insufficiency and spontaneous bacterial peritonitis have been proposed as possible risk factors for the development of ischaemic cutaneous complications (3, 5).Our patient did not have a medical history of ischaemic disease and, at physical examination, he was not obese and showed no signs of venous insufficiency. Repeated negative ascitic cultures ruled out a spontaneous bacterial peritonitis. The doses of terlipressin administered were low. This case is of clinical importance due to the large area of cutaneous necrosis and its rapid occurrence, without resolution after terlipressin withdrawal.In conclusion, we report here a new case of cutaneous necrosis secondary to terlipressin therapy for management of HRS. Although rare, we must bear in mind the possibility of ischaemic complication of terlipresshi.

We describe a 10-year follow-up observation of progressive arch-form alopecia caused by centrifugal lipodystrophy (CLD) in a Japanese boy. A 2.5-year-old boy developed a slightly depressed lesion demarcated by a horseshoe-shaped erythematous border on his right neck, which then extended to the scalp. Four years later, arch-form alopecia became apparent in the right temporal region along with an erythematous border. The arch-form alopecia gradually expanded centrifugally, leaving a slight residual depression, but hair regrowth was seen within the area of alopecia. Histological examination of the erythematous border revealed non-specific inflammatory changes in the subcutaneous fat. Magnetic resonance imaging findings revealed a loss of subcutaneous fat inside the lesion. The alopecia continuously extended until he was 12 years old, but, thereafter, expansion ceased and hair regrowth gradually occurred in the arch-form alopecia. A linear non-hairy lesion 5 cm in length still remained when he was 13 years old. CLD might involve the scalp and cause linear, arch-form alopecia.

The complete amino acid sequence of a proteinaceous cysteine proteinase inhibitor from the fruit of avocado (avocado cystatin) is presented. The protein consists of 100 amino acid residues and has a molecular mass of 11,300 Da. Comparison of this sequence with sequences of plant cysteine proteinase inhibitors (phytocystatins), including oryzacystatins I and II from rice seeds, cowpea cystatin, and corn cystatin, showed that the avocado cystatin molecule has 60% and 54% residues identical with the two forms of the rice seed proteins, oryzacystatins I and II, respectively, and 64% and 63% with the cowpea and corn proteins, respectively. The totally conserved sequence, Gln-Val-Val-Ala-Gly, among several of the animal cystatins as well as phytocystatins, is at positions 47-51 in the avocado cystatin molecule.