BackgroundCeramides are the main lipid component of the stratum corneum and are a structurally heterogeneous and complex group of sphingolipids of which sphingoid bases are the basic structural constituents. Altered levels of sphingoid bases have been reported in skin conditions that involve dryness and barrier disruption, including atopic dermatitis.ObjectiveThe purpose of this study was to investigate the altered levels of sphingoid bases in psoriatic epidermis and their relationship with the clinical severity of the psoriasis.MethodsSamples from the lesional and non-lesional epidermis were obtained from eight psoriasis patients. Levels of sphingosine and sphinganine were analyzed by high-performance liquid chromatography. The expression of ceramide synthase and ceramidase proteins, which are related to sphingosine and sphinganine metabolism, were measured using Western blot analysis.ResultsLevels of sphingosine and sphinganine in the lesional epidermis were significantly higher than those in the non-lesional epidermis. Although there was no altered ceramide synthase and ceramidase, there was a highly significant positive correlation between the % change of ceramidase, the degradative enzyme of ceramide into sphingosine, and the Psoriasis Area Severity Index (PASI) score.ConclusionThe levels of sphingosine and sphinganine were significantly increased in psoriatic epidermis and the % change of ceramidase was positively correlated with the clinical severity of psoriasis.

BackgroundThe purpose of this study was to evaluate the efficacy of a quantitative analysis method for comitant exotropia using video-oculography (VOG) with alternate cover.MethodsThirty-four subjects with comitant exotropia were included. Two independent ophthalmologists measured the angle of ocular deviation using the alternate prism cover test (APCT). The video files and data of changes in ocular deviation during the alternate cover test were obtained using VOG. To verify the accuracy of VOG, the value obtained using VOG and the angle of a rotating model eye were compared, and a new linear equation was subsequently derived using these data. The calculated values obtained using VOG were compared with those obtained using the APCT.ResultsRotation of the model eye and the values obtained using VOG demonstrated excellent positive correlation (R = 1.000; p < 0.001). A simple linear regression model was obtained: rotation of the model eye = 0.978 × value obtained using VOG for a model eye – 0.549. The 95% limit of agreement for inter-observer variability was ±4.63 prism diopters (PD) for APCT and that for test-retest variability was ±3.56 PD for the VOG test. The results of APCT and calculated VOG test demonstrated a strong positive correlation. Bland-Altman plots revealed no overall tendency for the calculated values obtained from VOG to differ from those obtained using APCT.ConclusionsVOG with alternate cover is a non-invasive and accurate tool for quantitatively measuring and recording ocular deviation. In particular, it is independent of the proficiency of the examiner and, can therefore, be useful in the absence of skilled personnel.Trial registrationClinicalTrial.gov, NCT03119311, Date of registration: 04/17/2017, Date of enrolment of the first participant to the trial: 04/25/2017.

The tuberculids are a group of eruptions resulting from hypersensitivity reactions to Mycobacterium tuberculosis or its products. 1 As a result, the diagnosis of tuberculid may be uncertain when there is an atypical clinical presentation, insufficient or inconsistent circumstantial evidence, and lack of direct evidence. We report a rare case in which two tuberculids, erythema induratum and papulonecrotic tuberculid, occurred together, and the identification of latent tuberculosis by tuberculosis (TB) interferon (IFN)-c assay.A 34-year-old man visited our clinic because of mild tenderness on both lower legs and no symptomatic skin lesion on either arm. The physical examination revealed multiple, coin-sized, brownish colored, indurated subcutaneous nodules on both lower legs (Fig. 1a) and scattered, bean-sized, dusky-red papules with some central necrosis and whitish atrophic scars on both arms (Fig. 1b). In addition, there was palpable right cervical lymphadenopathy. Routine blood and serological tests for syphilis and HIV as well as chest X-ray showed no abnormal findings. A Mantoux (purified protein derivative) test produced an induration area of 18 mm 9 23 mm in 48 h. Acid-fast bacilli were not found in sputum smear microscopy.A biopsy specimen of a nodular lesion from the lower leg revealed inflammation involving the lower dermis and subcuta-neous fat lobule with fat necrosis and vasculitis, producing lobular panniculitis (Fig. 2a). However, the biopsy specimen of a papular lesion from the left arm showed poorly formed palisading granulomas around foci of connective tissue degeneration and vasculitis with perivascular lymphohistiocytic infiltration in the dermis (Fig. 2b). These findings were consistent with erythema induratum (EI) and papulonecrotic tuberculid (PNT), respectively. Acid-fast bacilli were not found in the skin biopsy specimens. The result of polymerase chain reaction (PCR) assays for TB from paraffin-embedded tissue of arm and leg specimens was negative. Neck lymph node aspiration biopsy revealed few inflammatory cell and only reactive change. TB interferon IFN-c assay (QuantiFERON-TB gold, Cellestis, Carnegie, Victoria, Australia) showed a positive result. After the diagnosis of PNT and EI was made, anti-tuberculous therapy (isoniazid, 300 mg/day; rifampicin, 600 mg/day) brought a rapid clinical improvement of both lesions within a month. Treatment was continued for a total of 9 months and a complete resolution occurred.Erythema induratum, PNT and lichen scrofulosorum are generally classed as tuberculids. It is difficult to find a primary tuberculous focus despite an intensive search due to the inability to demonstrate or culture tubercle bacilli from the skin (a) (b) (c) (d) Figure 2. (a) Vasculitis and inflammation involve the dermis and subcutaneous fat lobule (lower leg; hematoxylin-eosin [HE], original magnification 940). (b) At higher magnification, fat necrosis with lobular panniculitis HE, 9100). (c) Vasculitis and palisading granulomas in the deep dermis (forearm; HE, 940). (d) At hig...

Eosinophilic cellulitis, or Wells syndrome, is a rare but well-described condition in which bullous lesions are uncommon, especially in childhood. We report a case of bullous eosinophilic cellulitis recalcitrant to steroid therapy in a 9-year-old boy who was successfully treated with oral dapsone.

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.