Norihiro Yoshimoto

Patients with acquired idiopathic generalized anhidrosis (AIGA) demonstrate a sudden loss of sweating function without neurological or endocrine abnormalities. The main treatment is steroid pulse therapy. However, the number of courses required for improvement has been unclear. This study aims to clarify the factors associated with AIGA disease severity and with AIGA patients' responses to steroid pulse therapy. We retrospectively analysed the clinical information of 28 patients with AIGA in our department from the last 10 years. Univariate analysis revealed that patients with a large anhidrotic area need multiple courses of steroid pulse therapy.

Basal cell carcinoma (BCC) is the most common skin cancer. However, BCC on the scrotum is very rare, with an incidence of 0.03%. Giant BCC, in which the tumour is larger than 5 cm, has also been reported as a rare variant. Here, we report a 71‐year‐old male with a giant BCC on the scrotum and review similar cases reported in English. None of the four cases of giant BCC on the scrotum, including the present case, showed lymph node or distant metastasis. Wide local excision was conducted in all cases, and no recurrence was reported. The role of human papilloma virus in scrotal BCC development remains unclear.

Bullous pemphigoid (BP) is an autoimmune blistering disorder characterized by tense blisters and urticarial erythema. However, more than 20% of patients with BP do not present typical blister formation, but instead present pruritic erythema, a condition called nonbullous pemphigoid (NBP).^1,2 The present report is the first to address IgG subclasses of autoantibodies in NBP. We describe a case of NBP with IgG4 autoantibodies alone targeting BP230 but not BP180.

Bullous pemphigoid (BP) varies in severity and stratified treatments are needed. However, there are no definitive standards for choosing appropriate treatments. To elucidate the factors involved in choosing treatments and the clinical outcomes of BP, we retrospectively reviewed the clinical records of 78 BP patients at a single center. Of the 78 patients, 49 (62.8%) were treated with oral prednisolone (PSL) and 29 (37.2%) were treated without PSL. The patients with older age, lower Bullous Pemphigoid Disease Area Index (BPDAI), and/or lower anti‐BP180NC16a antibody titer at onset tended to be treated without oral PSL. Notably, only 9.1% patients without PSL experienced relapse, whereas 36.7% patients with oral PSL experienced relapse when the PSL was around 0.1 mg/kg. It suggests that the patients with mild disease severity could be well controlled without oral PSL. Receiver–operator curve analysis demonstrated that the cut‐off value for the use of oral PSL was 31 for total BPDAI and was 7 for BPDAI skin urticaria/erythema, with a high (>0.9) area under the curve. Notably, none of the patients who were negative for the anti‐BP180NC16a antibody at onset experienced relapse even though they were treated without PSL. In conclusion, in BP patients who were negative for anti‐BP180NC16a antibody at onset, with a total BPDAI score of less than 31 or with an urticaria/erythema score of less than 7 can be treated without PSL. When the PSL is tapered to around 0.1 mg/kg, we should carefully monitor the patients to detect relapse.