Survey on Perspectives and Treatment Status Regarding Skin Laser Treatment / 대한피부과학회지

BACKGROUND: Skin laser treatment has improved significantly and has become an effective treatment approach for many skin diseases while also having applications for beauty treatments. However, since skin laser transfers energy directly to the skin, the misuse of such treatment may result in permanent damage to skin tissues. OBJECTIVE: This survey of Korean adults, conducted to obtain their perspectives on and their treatment experience with skin laser treatment, will be used to determine the current status of skin laser treatment and to identify necessary changes to ensure proper and safe conduct of skin laser treatment. METHODS: From April 5th to April 12th, 2016, a survey was conducted to obtain information regarding the perspectives and the treatment experience of adults aged 20~59 years. RESULTS: Approximately 50% of the participants had experience with skin laser treatment, and among these, 24.7% had not received treatment at a dermatology clinic. Compared to treatment at a dermatology clinic, the danger of side effects was 1.7 times higher at a non-dermatology clinic, 2 times higher at a skin care shop, and 5.3 times higher at an Oriental medical clinic. Among patients who received skin laser treatment, 16.1% experienced side effects, and among these, 1 out of 4 patients visited a non-dermatologist for treatment of these side effects. CONCLUSION: The results of the survey showed that in order for the public to receive safe and effective skin laser treatment based on professional diagnosis, there is a definitive need to provide correct information to the public and to implement changes to ensure proper understanding of skin laser treatment among this population.

The Origin, Principles of Intense Pulsed Light and Its Proper Application in Clinical Practice / 대한피부과학회지

Intense pulsed light (IPL) is a high-intensity polychromatic incoherent light of a determined wavelength spectrum, fluence, and pulse duration. Clinicians can combine these variable factors of IPL for the purpose of selective destruction of target chromophores. Due to these properties, IPL has been widely used for numerous indications including hair removal and treatment of vascular or pigmented lesions. For skilled and experienced clinicians, IPL is a great treatment modality; however it can be a source of serious adverse effects when performed by untrained clinicians. Thus, to promote the proper and safe use of IPL, we summarized the origin, history, basic principles, and clinical application of IPL and discussed qualification factors needed for clinicians who use IPL.

The Principles of Intense Pulsed Light and Its Clinical Application / 대한피부과학회지

Intense pulsed light (IPL) is a high-intensity pulsed light source emitting polychromatic, non-coherent, and defocused light with a broad wavelength spectrum. However, IPL can similarly work as a conventional laser with the help of variable cut-off filters. It enables selective destruction of target chromophores based upon the theory of selective photothermolysis. Clinicians can combine variable factors including wavelengths, pulse durations, and fluences in IPL systems, which allow great versatility in treating wide ranges of dermatologic diseases and flexibility in optimizing individual treatment parameters according to different skin types or indications. These properties are of great advantage for skilled and experienced clinicians but can be a source of unwanted serious adverse effects for untrained ones at the same time. Therefore, we summarized the basic principles and clinical application of IPL devices to provide the practical guidance. In addition, critical diagnostics, a great deal of experience, and a thorough knowledge of skin pathology and physiology are required for an effective and safe IPL treatment.

Novel Photopneumatic Therapy for the Treatment of Rosacea

BACKGROUND: Rosacea is a common skin condition, but the currently available treatments are not satisfactory. OBJECTIVE: We wanted to assess the efficacy and safety of photopneumatic therapy (PPx), which delivers pneumatic energy and broadband light (400~1,200 nm), for the treatment of erythematotelangiectatic rosacea. METHODS: Twenty two patients with erythematotelangiectatic rosacea were treated 3~5 times with PPx. Three independent dermatologists evaluated the efficacy of PPx by comparing the photographs taken before and after treatment. Patient self-assessment was also done by interviews. RESULTS: The photographic assessment by the dermatologists of the improvement showed that >50% improvement occurred in 64% (14/22) of the patients. The specific categories of improvement were as follows: poor (75% improvement), 3 patients. Based on the patients' self-assessment, 20 patients (91%) acknowledged an improvement. CONCLUSION: PPx is an effective and safe treatment option for erythematotelangiectatic rosacea.

The Use of Medical Devices for Medical Skin Care and the Legal Issues / 대한피부과학회지

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.

A Clinicopathologic Study on Hair Follicle Tumors / 대한피부과학회지

BACKGROUND: Data on the clinicopathologic features of hair follicle tumors in Korea are limited. OBJECTIVE: The purpose was to investigate the clinical and histopathologic characteristics of hair follicle tumors in Korea. METHODS: Two hundred sixty four cases of hair follicle tumors seen from 1999 to 2001 in Korea were analyzed clinically and histopathologically. RESULTS AND CONCLUSION: The most common hair follicle tumor in Korea was pilomatricoma(81.0%), followed by trichoepithelioma(6.4%), dilated pore of Winer(3.8%), and proliferating trichilemmal tumor(2.2%). Hair follicle tumors usually occurred as a solitary skin-colored nodule. The most commonly involved site was the face, and the peak age of presentation was 10 to 19. Pilomatricoma usually occurred as a solitary skin-colored nodule. The most commonly involved site was the arm, and more than 50% of tumors occurred before the age of 20. Histopathologically, the tumor was often surrounded by fibrous capsule and was composed of basophilic and shadow cells. It was usually located in the dermis and extended into the subcutis. Retraction spaces between tumor nests and stroma were frequently observed. Trichoepithelioma usually occurred as multiple skin-colored papules on the face. Histopathologically, the tumor was usually located in the dermis with sometimes connected to the epidermis. It frequently showed peripheral palisading. Dilated pore of Winer usually occurred as a solitary brownish to pigmented papule on the face in middle-aged persons. Proliferating trichilemmal tumor occurred as a solitary or multiple tumors. Histopathologically, the tumor was usually surrounded by incomplete fibrous capsule. Tumor cells frequently showed clear cell formation, nuclear atypia, mitosis, peripheral palisading, trichilemmal keratinization, and individual keratinization.

Clinical and Histopathological Study of Cutaneous Melanoma in Korea / 대한피부과학회지

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.

Clinical and Histopathological Study of Cutaneous Lymphomas in Korea / 대한피부과학회지

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.

Evaluation of Cutaneous Irritancy Using Human Skin Recombinants / 대한피부과학회지

BACKGROUND: There is an increasing need for the development of in vitro models capable of substituting for animals in cutaneous irritancy studies. Until now, various culture models have been developed, including skin organ cultures, conventional and air-exposed cell cultures. The air-exposed culture forms a multilayered epidermis showing an overall structure which resembles that of a native epidermis. The presence of a coherent stratum corneum layer in these cultures permits the application of potential irritants at the concentrations and formulations which are applied in vivo. Recently, a new human skin recombinant, made of human keratinocytes cultured on de-epidermized dermis with fibroblast-populated collagen matrix, has been developed and appears to represent a better skin equivalent model than previous models. OBJECTIVE: In the present study, monolayer-cultured human keratinocytes and the new human skin recombinants were evaluated for the test models of various skin irritants. METHODS: The extent of skin irritancy induced after application of 3 different irritants (sodium lauryl sulfate, methyl paraben, and polyethylene glycol-400) was evaluated on the basis of (1) MTT assay, (2) neutral red uptake assay, (3) LDH release, and (4) release of IL-1 alpha. In the human skin recombinants, morphological perturbations and changes in the expression of differentiation-specific protein markers (keratin 1, involucrin, filaggrin, and loricrin) were also evaluated. To determine the difference between in vivo and in vitro models for the detection of irritancy, a patch test was performed on 11 normal human volunteers with various concentrations of the different irritants RESULTS: The results of the present study show that irritant cytotoxicity correlates well with irritant concentration in both monolayer-cultured human keratinocytes and the new human skin recombinant. The new human skin recombinant is superior to monolayer culture as an in vitro model for skin irritancy screening in that the concentrations of test irritants are the same as in vivo. With the human skin recombinant, morphological changes were observed according to the irritant concentration. CONCLUSION: The new human skin recombinant can be used as an alternative to animals for skin irritancy screening.

A Case of Subcutaneous Folliculosebaceous Cystic Hamartoma / 대한피부과학회지

Folliculosebaceous cystic hamartoma(FSCH) is a rare cutaneous hamartoma of follicular, sebaceous, and mesenchymal elements. The tumor usually has sessile or pedunculated papule or nodule and occurs frequently in the center of face and sometimes on the scalp, ear, and trunk. We report a case of FSCH, which a 36-year-old woman presented as a subcutaneous nodule on the occipital area of scalp. Histologic examination of the nodule showed a central large cystic structure connected with numerous sebaceous lobules, and stroma consisted of delicate fibrillary bundles of collagen in concert with dilated capillaries and venules, as well as with adipocytes.

A Case of Rheumatoid Nodule in a Systemic Lupus Erythematosus Patient / 대한피부과학회지

The twenty percent of rheumatoid arthritis patients experience rheumatoid nodules, particularly over their extensor surfaces. There have been some reports of patients with systemic lupus erythematosus and rheumatoid nodules. A 44 year-old female patient has had a skin lesion on the buttock for one year, which was a slightly depressed brownish indurated patch. She was diagnosed as systemic lupus erythematosus and treated for ten years. Histopathologic findings of the skin lesion showed appearances consistent with rheumatoid nodules. We experienced a case of rheumatoid nodule in a systemic lupus erythematosus patient and first report in Korea.

A Histopathologic Study of Alopecia Using Transverse Sections / 대한피부과학회지

BACKGROUND: Conventional vertical sections of scalp biopsy specimens are often inadequate for the diagnosis of alopecia. Alternatively, a better approach can often be provided with the use of transverse sections continues, which is readily available and continues to grow in popularity. OBJECTIVE: The purpose of this study was to compare the histopathologic findings of transverse and vertical sections of scalp biopsy specimens in various types of alopecia. METHODS:A total of 27 scalp biopsy specimens obtained during the past 16 months for the evaluation of alopecia was processed for either transverse or vertical section, or for both. With these sections a quantitative morphologic study was done by counting a variety of follicular structures, and any specific histopathologic changes were recorded. RESULTS: Diagnostic features that were better seen in vertical sections included quantitative morphologic changes of a variety of follicular structures such as total number of follicles, catagen and telogen hairs, vellus hairs and follicular stele, as were anagen-telogen ratios and terminal-vellus ratios. Other histopathologic findings that were better demonstrated in transverse sections included peribulbar inflammatory infiltrate for alopecia areata, miniaturization for androgenetic alopecia, trichomalacia and pigment cast for trichotillomania, and fat atrophy for pressure alopecia. In some cases, especially for scarring alopecia, vertical sections also allowed for useful adjunctive diagnostic information such as follicular destruction, dermal fibrosis and sclerosis, and interface change. CONCLUSION: Transverse sections of scalp biopsy specimens provided many useful information in histopathologic diagnosis of alopecia. But, in some cases of scarring alopecia, vertical sections provided more diagnostic findings. To overcome the diagnostic limitation of transverse sections, therefore, observing both transverse and vertical sections at a time could be an alternative way of enhancing diagnostic yield of alopecia.

A Histopathologic Study of Alopecia Using Transverse Sections / 대한피부과학회지

BACKGROUND: Conventional vertical sections of scalp biopsy specimens are often inadequate for the diagnosis of alopecia. Alternatively, a better approach can often be provided with the use of transverse sections continues, which is readily available and continues to grow in popularity. OBJECTIVE: The purpose of this study was to compare the histopathologic findings of transverse and vertical sections of scalp biopsy specimens in various types of alopecia. METHODS:A total of 27 scalp biopsy specimens obtained during the past 16 months for the evaluation of alopecia was processed for either transverse or vertical section, or for both. With these sections a quantitative morphologic study was done by counting a variety of follicular structures, and any specific histopathologic changes were recorded. RESULTS: Diagnostic features that were better seen in vertical sections included quantitative morphologic changes of a variety of follicular structures such as total number of follicles, catagen and telogen hairs, vellus hairs and follicular stele, as were anagen-telogen ratios and terminal-vellus ratios. Other histopathologic findings that were better demonstrated in transverse sections included peribulbar inflammatory infiltrate for alopecia areata, miniaturization for androgenetic alopecia, trichomalacia and pigment cast for trichotillomania, and fat atrophy for pressure alopecia. In some cases, especially for scarring alopecia, vertical sections also allowed for useful adjunctive diagnostic information such as follicular destruction, dermal fibrosis and sclerosis, and interface change. CONCLUSION: Transverse sections of scalp biopsy specimens provided many useful information in histopathologic diagnosis of alopecia. But, in some cases of scarring alopecia, vertical sections provided more diagnostic findings. To overcome the diagnostic limitation of transverse sections, therefore, observing both transverse and vertical sections at a time could be an alternative way of enhancing diagnostic yield of alopecia.

Rosacea: Clinical Study of 67 Cases

BACKGROUND: Rosacea is a chronic skin disease which primarily affects the face. There have been many basic and clinical studies on rosacea in the West, but little in Korea. OBJECTIVE: This study was to investigate clinical features of rosacea in Korea and to compare them with those in the West. METHODS: During a 20-month period, 67 patients diagnosed as having rosacea were examined for their clinical presentations by means of personal interview. RESULTS: Erythema and telangiectasia were found in almost all of the 67 patients. Comparing with the results in the West, flushing and telangiectasia were more common whereas papules, pustules, and rhinophyma were less common with no case of ocular complaints or migraine. CONCLUSION: Because early detection and treatment is necessary to prevent the progression of rosacea, it is important to realize that rosacea is not uncommon in Korea and to recognize its somewhat different clinical manifestations from those in the West.

Four Cases of Cutaneous Fistula of Dental Origin / 대한피부과학회지

Cutaneous fistula of dental origin is the most common type of cutaneous fistula that is formed on the face and neck. This lesion can be a diagnostic challenge to clinicians who are not familiar with cutaneous fistula since many patients with cutaneous fistula of dental origin do not have any complaints such as toothache. Diagnostic errors may result in multiple excisions, biopsies, and ineffective long-term antibiotic therapy. However, if the lesion could be suspected of being of dental origin, the diagnosis can be easily confirmed by radiologic examinations. We report four cases of cutaneous fistula of dental origin. All four patients had a characteristic cutaneous findings with chronically draining, fixed, erythematous papule on their nasolabial fold or submental region. Ultrasonography, fistulography or plain roentgenography were needed to confirm the diagnosis of cutaneous fistula originating from dental problems.

A Clinicopathological Study of Basal Cell Carcinoma in Korean Patients / 대한피부과학회지

BACKGROUND: Basal cell carcinoma(BCC) does not commonly occur in dark-skinned people, although it is the most common cancer of light-skinned people. So it has been known that incidence of BCC is lower than that of squamous cell carcinoma(SCC) in Asian and Africans. However, several recent Korean articles have reported the reversal of the ratio of SCC to BCC. There has been no report about BCC following a nationwide survey in Korea. OBJECTIVE: Our purpose was to confirm the trends in BCC and SCC, and to identify the clinical and histopathological characteristics of BCC. METHODS: A clinical and histopathological analysis was done retrospectively with patients diagnosed as BCC from the Department of Dermatology of 15 University Hospitals or General Hospitals during the last 20 years(1977-1996). Annual incidence of BCC was compared with that of SCC at the same situation. We compared the results with those in other races statistically. RESULTS: 1. Incidence of BCC was 0.16% compared with 0.11% of SCC. The increasing incidence of BCC was more pronounced than that of SCC, although they were increased gradually. 2. The male-female ratio was 1:1.07, and the most frequent age group was the 6th decade(30.1%). 95% of the patients were older than the age of 40 years with the mean age of 62.7 years. 3. The most commonly involved site was the face(84.9%), especially on the nose, cheek, and eyelids. 4. The most frequent histologic pattern was nodulocystic type(35.4%), followed by mixed(30.1%), infiltrative(9.3%), superficial(6.7%), micronodular(6.2%), adenoid(5.9%), metatypical(4.0%), morpheaform(2.1%), and fibroepithelioma type(0.3%). 5. Histologically, 45.3% of BCC contained pigment. The histologic pattern most frequently associated with pigmented BCC was mixed type(53.1%) followed by nodulocystic(51.2%), superficial(46.8%), micronodular(38.6%), and adenoid type(33.3%). 6. Overall recurrence rate was 6.3%. Morpheaform, infiltrative, and metatypical BCC have a high erincidence of recurrence(26.3%, 13.2%, 8.1%, respectively). Therapeutic modalities that showed high recurrence rate was 5-FU, curettage and electrodessication, and cryotherapy(33.3%, 28.6%, 16.8%, respectively). CONCLUSION: It was confirmed following a nationwide survey that increasing incidence of BCC was more pronounced than that of SCC since early 1980s and BCC was the most common skin cancer in Korea.

A Case of Cephalic Brain-like Heterotopia / 대한피부과학회지

Cephalic brain-like heterotopias, so called nasal gliomas, are masses of mature glial tissue resulted from an error in embryonic development and are frequently located on the bridge of the nose. They often give rise to the clinical suspicion of dermoid cyst, hemangioma, or lipoma. Histologically, they are composed of fibrillary neuroglial cells, mainly large astrocytes, which are interlaced with a variable amount of fibrous and vascular connective tissue. Mitoses are rare. The possible tumor stalk is usually fibrous without glial elements. Due to the occasional presence of connection to the intracranial space it deserves a careful preoperative evaluation including imaging studies. We report a case of cephalic brain-like heterotopia. A sixteen day-old infant presented a mass which was suspended to the forehead by a fibrous stalk. Th excised lesion showed characteristic pathologic features of cephalic brain-like heterotopia.

A Case of Postoperative (Pressure) Alopecia

Postoperative (pressure) alopecia is the temporary or permanent loss of hair that occurs following a prolonged immobilization during and/or after general anesthesia and intubation. The cause is considered to be pressure-induced ischemia. Although not an uncommon condition, it is frequently overlooked as a minor complication relative to a causative surgical procedure. We report a 22-year-old woman who was presented with focal hair loss of two weeks' duration after a 9-hour operation for a left brachial plexus injury. Histopathologic examination showed that nearly all terminal follicles were in catagen phase with marked atrophic change of subcutaneous fat.

Four Cases of Hair Shaft Breakage Caused by Hair Care Cosmetics / 대한피부과학회지

Hair shaft breakage is a common condition frequently caused by physical or chemical trauma as well as intrinsic diseases. The hair can be modified both externally and internally through the cosmetically-used chemicals. Use of these products causes a decrease in the hair shaft's elastic properties, allowing increased hair breakage. Herein we report four cases of hair shaft breakage presented with features of alopecia caused by hair care cosmetics. Microscopic examination revealed abnormal hair shaft endings such as weathering, trichoptilosis and trichoclasis. Through these cases, we remind the fact that the dermatologist can better aid the patient with hair difficulties if he or she has an understanding of the formulation and the effects of products designed to modify the hair.

A Case of Childhood Granulomatous Perioral Dermatitis / 대한피부과학회지

Childhood granulomatous perioral dermatitis(CGPD) is a distinctive granulomatous form of perioral dermatitis of unknown cause with a benign and self-limited course and no associated systemic manif estations. It is characterized by an asymptomatic monomorphous papular eruption, with or without scale or pustules, around the mouth, nose, and eyes primarily in prepubertal children. This condition may resemble sarcoidosis both clinically and histologically. A 3-year-old boy first presented with a month-history of mildly pruritic rash around the mouth. When he returned for follow-up after an eight-week period of topical corticosteroid therapy, multiple new follicular papules and pustules developed. Histopathologic examination revealed that a granulomatous lesion consisted of nodular infiltration of multiple histiocytes admixed with lymphocytes in the dermis. The condition resolved in about three weeks after using an unknown topical agent prescribed by a private practicing dermatologist.