Pitted keratolysis (PK) has been reported to be more common among bare-footed people living in tropical regions. It is now known that the disease is not limited to the tropics but has a world-wide distribution. However, no study has previously been performed analysing the clinical manifestations of the disease in temperate countries. A survey of 53 patients revealed several distinctive clinical features. Hyperhidrosis is the most frequently observed symptom of this condition. Malodour and sliminess of the skin are also distinctive features, evident in 88.7% and 69.8% of the cases, respectively. The most common sites of onset of PK are the pressure-bearing areas, such as the ventral aspect of the toe, the ball of the foot and the heel. The next most common site is a friction area, the interface of the toes. Lesions are rarely seen on the non-pressure-bearing locations. Some of the primary lesions originate as a small defect along the plantar furrow, which gradually grows into the characteristics crateriform pit. Several clinical features are helpful in diagnosing PK.

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Programmed cell death (PCD) in normal human skin tissues was studied by using in situ specific labelling of fragmented DNA. This labelling method clearly stained the nuclei of Henle's layer in the bulb of the anagen hair follicle in serial sections, and the nuclei of the inner root sheath cuticle cells and Huxley's layer cells showed positive staining in the upper part of the hair follicles. This staining pattern was consistent with the sequence of keratinization in the three layers. The nuclei of differentiated cells located at the centre of the sebaceous glands, and those of the granular keratinocyte layer, were also stained. These findings suggest that PCD might play a key role in the terminal differentiation of the epidermis and epidermal appendages.

Systemic plasmacytosis (SP), which has a histologic appearance similar to that of multicentric Castleman's disease (MCD), is also known as benign plasma cell proliferation with polyclonal hypergammaglobulinemia, cutaneous plasmacytosis, and/or generalized plasmacytic lymphadenopathy. The prognosis of SP reportedly has been good. A 59-year-old Japanese man was treated for multiple cutaneous lesions of his trunk as well as polyclonal hypergammaglobulinemia. A skin biopsy showed infiltration of lymphocytes and polyclonal plasma cells in the dermis. The patient developed enlarged superficial lymph nodes 5 years later, and T-cell lymphoma, diffuse mixed type, was diagnosed. At that time, his cutaneous plasmacytosis remained but the polyclonal hypergammaglobulinemia had resolved. Ours is the first reported case of SP to be complicated by the development of T-cell lymphoma.

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