皮膚病診療 41巻2号 (2019年2月)

特集 臀部の皮膚疾患

臨床例

  • 文献概要を表示

・寝たきり状態の高齢者の臀部に,集簇性に多発する肉芽腫様結節を認めた. ・病変はおむつや下痢との接触が多い部分に一致していた. ・病理組織像では表皮の肥厚と真皮浅層での炎症細胞浸潤を認めたが,肉芽腫性変化は認めなかった. ・diaper area granuloma of the aged(DAGA)は患部の清潔保持のみにて略治する良性疾患である. (「症例のポイント」より)

A case of diaper area granuloma of the aged

Hirata, Yoshiko1)Yokouchi, Mariko2) 1)Department of Dermatology, Tokyo Saiseikai Central Hospital 2)Department of Dermatology, Nerima General Hospital

Abstract Diaper area granuloma of the aged is a skin problem in the diaper contact area among elderly people. We report a case of an 84-year-old man with urinary catheter, presenting with cerebral infarction and a 2-month history of clusters of reddish and flat topped nodules on his genitocrural area. His histological examination of the nodules revealed parakeratosis, acanthosis, and perivascular inflammatory cell infiltration, and vascular dilation in dermis. These conditions were caused directly by constant contacts to diapers with feces. The primary treatment and prevention would be to avoid any irritants and to keep the lesion clean.

  • 文献概要を表示

・臀部に生じた固定薬疹を経験した. ・原因薬剤の検索で,ピコスルファートナトリウム,センノシドの両剤で薬剤リンパ球刺激試験(DLST)陽性となった. ・両薬剤を中止し,ステロイド外用を開始したところ,皮疹は改善した. (「症例のポイント」より)

A case of fixed drug eruption caused by sodium picosulfate or sennoside

Michishita, Kazunori1)Ishida, Wataru2) 1)Department of Dermatology Toyama Red Cross Hospital 2)Department of Dermatology Tonami General Hospital

Abstract The patient was an 83-year-old man who was prescribed Sodium picosulfate and Sennoside for his constipation by a neighborhood doctor. He subsequently developed a rash a few months later. There was a black plaque on the hip, suggesting fixed drug eruption. The DLST(drug-induced lymphocyte stimulation test) was positive for both Sodium picosulfate and Sennoside, whereas patch test was negative. He was successfully treated with discontinuance of both medicines. We diagnosed this case as fixed drug eruption due to Sodium picosulfate or Sennoside.

  • 文献概要を表示

・広範囲な臀部慢性膿皮症に瘻孔上蓋開放術を施行し良好に経過した. ・切開した部位が再度閉じてしまわないように工夫しながら,辺縁と下床の裏打ちされた上皮成分から上皮化させていくことが重要である. ・臀部皮膚のボリュームを保てること,採皮しなくてよい(新たな傷ができない)ことが利点である. (「症例のポイント」より)

Hidradenitis suppurativa on the buttocks treated by deroofing

Tanaka, Ryo1) 1)Department of Dermatology, Kawasaki Medical School

Abstract We report a case of hidradenitis suppurativa (HS) on the buttocks that was treated by deroofing. Deroofing is a simple technique whereby the roof of a sinus tract is electrosurgically incised or removed. It is important to lead the epithelialization from the margin and the bottom side of the fistulous epithelium so that the incised wounds do not close again. The advantage of this technique is that the volume of the buttocks can be retained. If the fistula develops again, additional incisions must be considered each time. However, deroofing is a valuable technique whose adoption can be considered even in advanced cases of HS.

  • 文献概要を表示

・腰部から臀部,大腿にかけて広範囲に生じたガス壊疽を経験した. ・末期大腸癌で余命が短かったことから,手術侵襲の負担を考え、抗菌薬投与のみで治療していた期間があった. ・CT画像にて直腸から臀部筋層内に侵入したガス像を認め,直腸癌の腸管穿孔によるガス壊疽と診断した. (「症例のポイント」より)

Massive gas gangrene secondary to perforated colorectal cancer

Morimura, Sohshi1)Watanabe, Mitsuko1)Takeshima, Kenichiro2)Takahashi, Yutaka3)Sugaya, Makoto1) 1)Department of Dermatology,Ichikawa Hospital,Faculty of Medicine,International University of Health and Welfare 2)Department of Orthopedic Surgery,Ichikawa Hospital,Faculty of Medicine,International University of Health and Welfare, 3)Department of Medical Oncology,Ichikawa Hospital,Faculty of Medicine,International University of Health and Welfare

Abstract An 81-year-old man who had terminal colon cancer with liver and lung metastasis developed a large indurated erythematous plaque with severe pain on the left lumbar and thigh. The X-ray and computed tomography revealed a huge free air from the left iliac crest to the left thigh. He was diagnosed with gas gangrene and treated with antibiotics without surgical debridement due to the poor prognosis of colon cancer. However,due to the liver dysfunction induced by antibiotics,we eventually performed surgical debridement. After the operation,the intestinal perforation was revealed by computed tomography. Thus,he was finally diagnosed with gas gangrene secondary to perforated colorectal cancer.

  • 文献概要を表示

・臀部に生じた疣状皮膚結核を経験した. ・結核菌が少ない症例において組織液からの培養では結核菌の証明が困難なことがあり,組織培養が有用と考えた. (「症例のポイント」より)

A case of tuberculosis verrucosa cutis on the right buttock

Kikuzawa, Chiaki1)Takahashi, Reiko1)Fukuyama, Kunitaro1) 1)Department of Dermatology, Kansai Rosai Hospital

Abstract An 87-year-old man presented with purpulish-red indurated erythema on the right buttock. Ziehl–Neelsen staining for skin specimens and tissue fluid swab culture for mycobacteria were negative. Finally, M. tuberculosis was cultured from his tissue after 12 weeks. He was successfully treated with combinations of multiple anti-tuberculosis drugs. When the density of M. tuberculosis is small, it may be difficult to confirm it’s presence in cultures of tissue fluids and tissue culture should thus be considered.

  • 文献概要を表示

・coccygeal padの1例を経験した. ・MRI検査の矢状断で尾骨の前方への屈曲偏位を認めたが,尾骨との連続性を認めなかった. ・局所麻酔下にて結節を単純切除し,2年10カ月を経過したが,再発はみられなかった. (「症例のポイント」より)

A case of coccygeal pad

Okahashi, Kazunori1)Watanabe, Keiko1)Yanagihara, Shigeto1)Oiso, Naoki1)Kawada, Akira1) 1)Department of Dermatology, Kinki University Faculty of Medicine

Abstract A 15-year-old man presented with a coccygeal nodule of 40×17 mm in diameter. Physical examination revealed a reddish, hyperkeratotic nodule on the coccygeal region. MRI(T1 and T2)showed that the coccyx was bending forward. Surgical excision of the nodule was performed under local anesthesia. Histopathological examination revealed hyperkeratosis, irregular acanthosis and dermal collagen fibers hyperplasia. No recurrence was occurred at 34 months after the surgical excision.

  • 文献概要を表示

・17歳男性,尾骨部に腫瘤を自覚し当科を受診した.病理組織像で角質増殖と膠原線維の増生がありcoccygeal padと診断した. ・本症の発症機序はいまだ不明であり,先天的,後天的いずれの原因でも生じる可能性がある. ・仙骨,尾骨部の腫瘤を診察した際は,本症も考慮し,生活歴や遺伝的背景などの詳細な問診が大切であると考えた. (「症例のポイント」より)

Coccygeal pad

Inoue, Tsuyoshi1)Watabe, Daisuke1)Amano, Hiroo1) 1)Department of Dermatology, Iwate Medical University School of Medicine

Abstract A 17-year-old man visited our department with a mass observed in the coccygeal region. Histopathological examination revealed hyperkeratosis and proliferation of collagen fibers, leading to the diagnosis of a coccygeal pad.The pathogenesis of this disease remains unknown. It can be caused by either congenital or acquired factors. When a mass is observed in the sacrococcygeal region, it appears important to consider this disease and perform detailed history taking, including life history and genetic background.

  • 文献概要を表示

・臀部に皮疹が集中していたことから,共用男性トイレの便座が感染経路であると推察された疥癬の集団感染を経験した. ・35〜36℃に設定された暖房便座であったことが,疥癬の感染を容易にしたと考えられた. ・疥癬の感染対策として,暖房便座についても対応することが必要である. (「症例のポイント」より)

Outbreak of scabies spread via a heated toilet seat in a hospital restroom

Nishihara, Katsuhiko1)Miyawaki, Saori2)Tohyama, Mikiko1)Tauchi, Hisamichi3)Aono, Harutaka3)Sayama, Koji1) 1)Department of Dermatology, Ehime University Graduate School of Medicine 2)Sanbanncho SAORI Dermatology 3)Infection control part of Ehime University Hospital

Abstract We experienced a hospital outbreak of scabies that was limited to the buttocks for the first time. The outbreak involved 15 infected men and the eruptions were all distributed around the buttocks. We postulated that the toilet seat in the patient restroom that the proband used was the source of the outbreak. The temperature the toilet seat was set to 35-36°C, which was warm enough to sustain the arthropods. Clinicians should consider heated toilet seats as a route of infection and take measures when an outbreak of scabies occurs.

  • 文献概要を表示

・局所麻酔薬による全身型接触皮膚炎(systemic contact-type dermatitis)と考えられた1例を報告した. ・自験例はパッチテストでJapanese stan­dard allergen(JSA)を貼布することで皮疹の原因を明らかにすることができ,JSAの貼布が有意義であることを示した. (「症例のポイント」より)

A case of postoperative left thigh rash caused by local anesthetics

Baba, Kanako1)Kanto, Hiromi1)Ito, Takashi1)Nakagawa, Mari1)Iwabuchi, Chikako2)Ishiko, Akira1) 1)Department of Dermatology, School of medicine, Toho University 2)Division of Dermatology Nissan Tamagawa Hospital

Abstract A 40-year-old male patient visited our hospital complaining the rash on the left buttock and the thigh, which he noticed three days after the operation of hemorrhoids. We initialy thought his eruption was induced by oral medicines or disinfectants, so we did patch test using these components and the Japanese standard allergens. As a result, the patch test showed a positive reaction only to the anesthetic allergen (caine mix) included in Japanese standard allergens.He had a history of using the commercial topical ointment frequently, and we supposed that he had been already sensitized to the local anesthetic by commercial antipruritic ointment.Finally we concluded his postoperative eruption was a systemic contact dermatitis, due to the local anesthetics which was used during the hemorrhoids operation.

  • 文献概要を表示

・臀部に生じた限局性リンパ管腫(lymphangioma circumscriptum:LC)を経験した. ・生下時より右臀部の肥大を自覚していたが精査はしておらず,感染を契機に診断に至った. ・抗菌薬投与で症状は速やかに改善した.根治治療は希望されず経過観察となった. (「症例のポイント」より)

A case of lymphangioma circumscriptum with infection

Yano, Yumiko1)Inami, Maiko2)Matsuo, Haruka2)Ota, Mayumi2)Idezuki, Takeo2)Igarashi, Atsuyuki2) 1)Department of Dermatology, Tokyo Teishin Hospital 2)Department of Dermatology, Nippon telegraph and Telephone East Corporation Kanto Medical Center

Abstract A 28 - year - old man presented with erythema, swelling, and pain in the right buttock. He was aware of the fact that the right buttock was larger than the time of birth. Laboratory data showed inflammatory reaction, and pelvic CT scanning revealed multifocused cyst in the subcutaneous tissue. In histpathological study, there were dilated limphatic channels in the dermis. From these findings, the case was diagnosed with Lymphangioma circumscriptum with infection. The patient’s symptoms improved by the treatment with antibiotics and drainage.

  • 文献概要を表示

・抗リン脂質抗体症候群は皮膚に初発症状が出現することが多く,網状皮斑が最多で,次いで皮膚潰瘍が多い. ・皮膚潰瘍は下肢,指尖・足趾が多く,自験例のような臀部に潰瘍を生じる例はまれであるが,上肢や体幹の報告もあり,基礎疾患のない症例も多いので,難治性の皮膚潰瘍の鑑別には抗リン脂質抗体症候群を念頭に置く必要がある. ・潰瘍周辺に網状皮斑がある場合,皮膚生検は網状皮斑でも行うべきである. (「症例のポイント」より)

A case of anti-phospholipid antibody syndrome presenting with refractory buttock ulcer

Matsuo, Yuji1)Miyagi, Takuya1)Yonamine, Shuhei1)Kariya, Yoshiyuki1)Yamamoto, Yu-ichi1)Takahashi, Kenzo1) 1)Department of dermatology, University of the Ryukyus

Abstract A 69-year-old Japanese woman, who had suffered from SLE and angina pectoris, presented with refractory buttock ulcer. Histopathological examination obtained from surrounding livedo reticularis showed the presence of multiple arterio-venous thrombus. Collectively with the results of head MRI and presence of anti-phospholipid antibody, she was diagnosed as skin ulcer due to antiphospholipid antibody syndrome. She was treated with warfarin, clopidogrel and aspirin, and ulcer was cured by 3 months.

  • 文献概要を表示

・約10年間罹患した臀部慢性膿皮症(chronicperianal pyoderma:CPP)から発症した有棘細胞癌(squamous cell carcinoma:SCC)を経験した. ・初診時リンパ節腫脹,画像検索でリンパ節転移を認めなかった. ・広範囲切除を施行し,摘出標本の切除断端は陰性であった. ・術後2年6カ月経過した現在も再発を認めていない. (「症例のポイント」より)

A case of squamous cell carcinoma at the site of a chronic gluteal pyoderma

Takeda, Kana1)Kunikata, Nagisa1)Tanita, Muneo1)Iwama, Noriyuki2)Nakayama, Fumie2) 1)Department of Dermatology, Tohoku Rosai Hospital 2)Department of Pathological diagnosis, Tohoku Rosai Hospital

Abstract A 62-year-old man had purulent discharge from the gluteal skin approximately 10 years prior. A palpable mass gradually developed at the site of the discharge but was untreated. In January 2016, the mass increased rapidly in size concomitant with a significant discharge of malodorous pus. The patient consulted our department in April 2016 due to constant pain. Biopsy findings revealed squamous cell carcinoma. Magnetic resonance imaging revealed no metastases in the surrounding lymph nodes. The tumor was resected surgically with a split-thickness skin graft and negative resection stump. No recurrence has been detected in the 2.5 years since the surgery.

  • 文献概要を表示

・慢性膿皮症から生じた有棘細胞癌は原発性の有棘細胞癌と比較し,予後が不良といわれている. ・臀部慢性膿皮症に続発した有棘細胞癌を経験したため,文献的考察を加えて報告する. (「症例のポイント」より)

A case of squamous cell carcinoma developed from pyodermia chronic glutealis

Numata, Tomofumi1)Kobayashi, Hiroko1)Morikawa, Hirofumi2) 1)Department of Dermatology, Hiroshima University Graduate School of Biomedical & Health Sciences 2)Morikawa Dermatology Clinic

Abstract A 65-year-old man developed folliculitis-like lesions from his buttocks to the back of his thighs since he was a high school student. Two years before the first visit, a tumor with ulcer appeared on the back of his right thigh. We diagnosed the tumor as squamous cell carcinoma based on the finding of a skin biopsy. In contrast CT, neither distant metastasis nor lymph node enlargement were observed. We performed enlarged resection of the tumor. Three month after the surgery, metastases in right inguinal lymph node and right pleura were identified. We conducted radiochemotherapy on the metastases.

  • 文献概要を表示

・臀部潰瘍を契機に診断された全身型未分化大細胞リンパ腫(anaplastic large cell lymphoma:ALCL)を経験した. ・ALK陰性かつCD56陽性であり,極めて悪性度が高く,急速な転帰をとった. (「症例のポイント」より)

A case of CD56-positive ALK-negative anaplastic large cell lymphoma with rapid progression to death

Takashima, Yuka1)Moriuchi, Reine1)Hotta, Moeko1)Yamaguchi, Keisuke2)Yamamoto, Satoshi2)Shimizu, Satoko1) 1)Department of Dermatology, Sapporo City General Hospital 2)Department of Hematology, Sapporo City General Hospital

Abstract A 65-year-old female was referred to our hospital with ulcers on the right buttock. A skin biopsy specimen from the buttock showed infiltrates of massive large atypical cells that were positive for CD3, CD4, CD30, CD56 and negative for ALK. A PET-CT scan showed multiple FDG uptake throughout the body. We made the diagnosis of ALK-negative systemic ALCL, which is known to have a very poor prognosis. The patient died 45 days after the first visit. CD56 positivity is known to be an indicator of poor prognosis in ALCL. As seen in previous studies, our case had a rapidly progressive course.

editorial

Malignant〜 山本 俊幸

  • 文献概要を表示

褥瘡は,「身体に加わった外力は骨と皮膚表層 の間の軟部組織の血液を低下,あるいは停止させ る.この状況が一定時間持続されると組織は不可 逆的な阻血性障害に陥り褥瘡となる」と日本褥瘡 学会によって定義されている1).すなわち,褥瘡 の発生要因としては,長時間,同一部位に応力が 加わることがあげられる.また,褥瘡がある場合, 創部への刺激を最小限にすることから除圧が行わ れ,さらに,剪断力が働かないようにと,動かさ ず創の治癒を待つという選択をすることも多い. しかし,臥床生活が長期にわたると,褥瘡以外に も多くの問題を併発することになるため,離床支 援を考えていくことが重要となっている.  その一方で,創の治癒後,活動性を高めること によって,創を再発させてしまえば,やはり問題 となる.したがって,褥瘡ならびに褥瘡発生リス クを有する方においても,ベッド上での臥床生活 のみならず,車椅子座位を含めた座位生活に目を 向けることが大切になっている.また,これらの 対応は活動性が低い方のみならず,活動性が高い 方の場合においても,座位で生活する時間が長い ことから褥瘡を形成する要因を増すため,座圧の 再分散や除圧動作が適切に行われることが求めら れる.そのための支援策がシーティングである.  本稿では,座位姿勢の構築であるシーティング について,「褥瘡形成の予防・悪化防止」の視点か ら目的,アセスメント,そして,ポイントについ て紹介する.(「はじめに」より)

蝶の博物詩

生態44 西山 茂夫

私の視点

最初に痒みありき!! 石川 治

皮膚科医学史

  • 文献概要を表示

 『暴瀉病ニ付』という古文書は実に衝撃的だった. その後,『安政記聞』という古文書の中にもやはり 暴瀉病(コレラ)を見つけた.幕末,江戸でも上州 でも暴瀉病が蔓延して,その驚きを本誌に「古文 書と暴瀉病」1)と題して報告した.しかしそのとき の感染分布図は限局していた.当然,全国ではど の程度の惨状があったのだろうか,という疑問が 湧いてくる.  何気なく瀬戸内海沿岸に焦点を絞って,愛媛県 在住の友人に同県の調査をお願いした.彼はいろ いろ検索して,県史の中に暴瀉病を見つけてくれ たのである! なるほど,古文書でなくとも,県 史を調べることで感染分布がわかるかもしれない. 都合の良いことに,地元の群馬県立文書館には42 都道府県の県史が陳列されている.早速調べてみ ることにした.(「はじめに」より)

診察室の四季

斉藤 隆三

皮膚科のトリビア

第164回 浅井 俊弥

------------

目次

編集後記・次号予告

基本情報

pd-41-2_cover.jpg
皮膚病診療
41巻2号 (2019年2月)
電子版ISSN:2434-0340 印刷版ISSN:0387-7531 協和企画

文献閲覧数ランキング(
2月11日~2月17日
)