A 54-year-old Japanese man without apparent immunosuppression presented with nodules with purulent drainage on the right lower leg. He had ringworm of the right leg and tinea unguium. A biopsy specimen of the nodule showed intradermal abscesses with fungal elements, and Trichophyton rubrum was cultured from both the pus and the biopsy specimen. Treatment with oral terbinafine resolved the nodules. Dermatophyte abscess is a rare, deep and invasive dermatophytosis, which is often associated with immunocompromised conditions. We provide a review of the literature including Japanese cases.

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Objective To examine the clinical features of systemic sclerosis (SSc) patients negative for SSc‐related autoantibodies (autoAbs). Methods Serum samples were collected from 546 SSc patients. The presence of antinuclear antibody (ANA) was screened by indirect immunofluorescence (IIF) staining using HEp‐2 cells. SSc‐related autoantibodies were identified by specific IIF staining, enzyme‐linked immunosorbent assay, or immunoprecipitation assay. Clinical features were analyzed among patients negative for ANA/SSc‐related autoAbs, anticentromere Abs (ACA), anti‐topoisomerase I (anti‐topo I) Abs, and anti‐RNA polymerase (anti‐RNAP) Abs. Results Of the 546 SSc patients, 26 (4.8%) were negative for ANA and 29 (5.3%) were ANA‐positive but negative for SSc‐related autoAbs. Regarding clinical features, patients negative for ANA/SSc‐related autoAbs (n = 55) had a significantly shorter disease duration, higher proportion of the diffuse type, contracture of phalanges, diffuse pigmentation, higher modified Rodnan total skin thickness score (mRSS), and lower incidence of telangiectasia than those with ACA (n = 224). On the other hand, younger disease onset, lower mRSS, and lower incidence of scleroderma renal crisis were observed in patients negative for ANA/SSc‐related autoAbs than in those with anti‐RNAP Abs (n = 52). Although pitting scars were less common in patients negative for ANA/SSc‐related autoAbs than in those with anti‐topo I Abs (n = 144), their clinical features were similar. Conclusion Patients negative for ANA/SSc‐related autoAbs form a clinically distinct subset among SSc patients.

A 10-year-old Japanese girl presented with a rhomboid-shaped brown macule, 4x3 mm in size, on the sole of the right foot. Dermoscopic examination revealed a number of black dots and globules on the ridges of the skin, marking an area of symmetrical brown pigmentation. On the periphery, a streak-like arrangement of black dots/globules on the brown pigmentation was observed along the ridges, simulating a “starburst” pattern. The lesion was excised and histological examination showed a symmetrical wedge-shaped compound melanocytic lesion that consisted of junctional and intradermal nests of a mixture of large spindle and epithelioid cells. None of the cells were atypical, and maturation of the cells with increasing depth was observed. From these findings, a diagnosis of Spitz nevus was made. Transepidermal elimination of nevus cell nests was observed and there were small groups of degenerated melanin-laden cells in the cornified layer. Masson Fontana stain revealed fine melanin deposits in the nevus cells of the junctional and intradermal nests, as well as heavy melanin deposits in the small groups of degenerated cells in the cornified layer. The distribution of melanin may contribute to a unique dermoscopic finding in this case.