A Case of Human Gnathostomiasis Successfully Treated with Ivermectin

Cutaneous gnathostomiasis has also been called larva migrans profundus and nodular migratory eosinophilic panniculitis. Human gnathostomiasis is caused mainly by the nematode Gnathostoma spinigerum. It causes migratory cutaneous, erythematous, indurated plaques and serious visceral sequelae. Medical treatment with mebendazole, albendazole, and ivermectin has been disappointing. Surgical excision of the parasite is the treatment of choice when possible.

A Case of Papular Tuberculid and BCGitis after BCG Vaccination / 대한피부과학회지

BCG (Bacillus Calmette-Guerin), which produces resistance to tuberculosis infection, is a vaccine containing live, attenuated Mycobacterium bovis. It induces specific and nonspecific dermatologic complications. The specific reactions include scrofuloderma-like, lupus vulgaris-like, lichen nitidus-like, lymphadenitis and tuberculid. We report a case of papular tuberculid, which was presented as 3-5mm sized erythematous papules on the extremities and face, and BCGitis had developed around the vaccination site after BCG vaccination. Histopathologic examination of the papule and lymph node showed granuloma, consisting of epithelioid cells and lymphocytes.

A Case of Granuloma Pyogenicum within a Port-wine Stain / 대한피부과학회지

Granuloma pyogenicum (GP) has been reported to be associated with hemangioma and hamartomas, including port-wine stains. GP may rarely occur in association with port-wine stains, either de novo or following trauma such as laser therapy. It has been suggested that the development of GP in a port-wine stain following trauma might be associated with microscopic arteriovenous anastomosis in the port-wine stain. We report a 48 year-old woman with GP arising within port-wine stain following trauma.

A Case of Bilateral Chondrodermatitis Nodularis Chronica Helicis on Both Helices Treated with Intralesional Steroid Injection / 대한피부과학회지

We report a case of bilateral chondrodermatitis nodularis chronica helicis, on both helices, in a 60-year-old male patient. He presented with a 1-year history of two tender, firm, dark-brownish, 0.4x0.4cm-sized nodules with central ulceration on both helices. He had no history of trauma. A punch biopsy specimen taken from the nodule revealed central ulceration, hyperkeratosis, and irregular acanthosis of the epidermis. Within the dermis, there was inflammatory cell infiltration, dilatation and proliferation of vessels, and some eosinophilic collagen degeneration associated with degenerative cartilage. Based on these clinical and histologic findings, we diagnosed this as a rare case of bilateral chondrodermatitis nodularis chronica helicis occurring on both helices. We treated the lesions with intralesional steroid injections.

A Case of Molluscum Contagiosum Occuring in a Soft Fibroma / 대한피부과학회지

Molluscum contagiosum (MC) is a skin infection caused by a poxvirus, which is easily transmitted by direct skin to skin contact. MC is rarely associated with other skin diseases, including epidermal cysts, melanocytic nevus, halo nevus, soft fibroma or condyloma. The occurrence of MC on a soft fibroma is so rare that only three cases have been described so far. Here, we report an interesting a case of a solitary MC associated with soft fibroma occurring on the right popliteal fossa of a 6-year-old girl.

A Case of Symmetric Dystrophic Calcinosis Cutis Following Subcutaneous Injections / 대한피부과학회지

Calcinosis cutis is the abnormal deposition of calcium phosphate into the skin. It is classified as dystrophic if the calcium is deposited in previously damaged tissue, and serum calcium and phosphorous levels are normal. We report a case of symmetric dystrophic calcinosis cutis on the both proximal arms of a 77-year-old woman who received a subcutaneous injection at each arm 30 years ago.

A Case of Disseminated Herpes Zoster with Thrombocytopenia / 대한피부과학회지

Thrombocytopenia, a decrease in the number of blood platelets, can be observed in many varied conditions. It is a frequent finding in patients with leukemia, severe anemia, and blood dyscrasias due to drug sensitivity. Thrombocytopenia also accompanies the onset of a variety of infections, and during the convalescent period following viral diseases. We report a case of varicella zoster virus-associated thrombocytopenia in an adult following disseminated herpes zoster.

A Case of a Corn Developed on an Unusual Site / 대한피부과학회지

A corn is a circumscribed hyperkeratotic lesion with a central conical core of keratin that causes pain and inflammation. Corns result from hyperkeratosis, which is caused by an increase in keratinocyte activity associated with stimulation of the epidermis from chronic pressure or friction on the skin. The conical core in a corn, which is a thickening of the stratum corneum, is a protective response to the mechanical trauma. We experienced a man who developed a corn on the buttock, which is an unusual site.

A Case of Solitary Vellus Hair Cyst on the Forehead / 대한피부과학회지

We report a case of solitary vellus hair cyst on the forehead in a 48 year-old, female patient. She had an asymptomatic, solitary, bluish, 0.3x0.3cm sized papule on the forehead for 1 year. There was no family history of similar lesions. A punch biopsy specimen taken from the papule revealed a cystic structure in the dermis lined by squamous cell epithelium which contained laminated keratinous material and vellus hairs. Based on this histologic finding, we diagnosed this case as solitary vellus hair cyst occurring on the unusual site of the forehead.

The Association of Interleukin-4 Promoter Gene and Receptor alpha Gene Polymorphisms with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Several investigators have linked the interleukin-4(IL-4) gene nearby markers located on chromosome 5 to atopy and demonstrated that the T allele of a polymorphism in the IL-4 gene promoter region -590C/T is associated with elevated levels of total serum IgE. IL-4 receptor alpha gene has been also reported to be involved in the development of atopy. Recently, the R allele of a polymorphism in the IL-4 receptor alpha gene (IL4R*A) has been reported to be associated with atopy. OBJECTIVE: The purpose of our study is to investigate the association of IL-4 promoter gene C-590T polymorphism and receptor alpha gene (-1902) IL4R*A polymorphism with atopic dermatitis in Korea. MATERIAL AND METHODS: Seventy one Korean patients with atopic dermatitis and one hundred and sixty six normal subjects participated in this study with the analysis of polymorphism of IL-4 promoter (-590C/T) gene and IL-4 receptor alpha(-1902) gene by using PCR-SSCP. RESULTS: The frequency of IL-4 promoter (-590) genotypes (T/T, T/C, C/C), genes (T, C), alleles (T, C) did not show any significant difference between atopic dermatitis patients and normal controls (p>0.05). There were weak associations in the frequency of IL-4 receptor alpha(-1902) genotypes (IL4R*G/IL4R*G) and genes (IL4R*A) in patients of atopic dermatitis and normal controls (p=0.05). But, the frequency of IL-4 receptor alpha(-1902) genotypes (IL4R*A/IL4R*G, IL4R*A/IL4R*A), genes (IL4R*G), alleles (IL4R*A, IL4R*G) did not show any significant difference between atopic dermatitis patients and normal controls (p>0.05). CONCLUSION: These data show that IL-4 promoter polymorphism (-590C/T) and IL-4 receptor alpha polymorphism (-1902) IL4R*A are not associated with atopic dermatitis in Korean. It is suggested that the difference between our results and previous reports means racial difference, cooperation of -590C/T or IL4R*A polymorphism with the other gene, and the existence of another polymorphism.

The Clinical and Histopathological Study of Ota's Nevus / 대한피부과학회지

BACKGROUND: Ota's nevus, characterized by the presence of melanocytes in the dermis, has been familiar among dermatologists, but the etiology, the pathophysiology, the clinical and histological classification are not entirely clear. To understand and elucidate them, more clinical studies and researches are necessary. OBJECT: The aim of this study was to document the clinical and histopathological features of Ota's nevus. METHODS: We examined 299 patients with Ota's nevus who visited the dermatology clinic in Korea from February 1993 to August 2003. Among them, 188 patients were biopsied. All the specimens were stained with hematoxylin and eosin. We examined the age & sex distribution, age of onset, seasonal variation, associated skin diseases, aggravating factors and color. We clinically classified Ota's nevus into 4 types according to Tanino's classification and histologically into 5 types based on the pattern of pigmentation. RESULTS: 1. The ratio of male and female was 1: 3. 2. The peak age of onset was at birth (28.4%) and puberty (24.8%). 3. Seasonal variation was observed with distinct aggravation in the summer (60%). 4. The associated diseases were 9 cases of persistent mongolian spot, 6 cases of nevus flameus, 4 cases of blue nevus, 3 cases of vitiligo, 3 cases of nevus of Ito, 2 cases of atopic dermatitis, 2 cases of psoriasis, 2 cases of cafe au late macules and 2 cases of contact dermatitis. 5. The aggravating factors were sunlight (35.8%), emotional stress (21.0%), menstruation (12.6%), cold exposure (9.5%), pregnancy (9.5%), fatigue (9.5%) and chemical agents (2.1%). 6. The color of lesions were blue black (36.8%), brown (34.8%), dark brown (16.1%) and slate (11.0%). 7. All cases were classified according to Tanino's METHODS: type Ia (23.1%), type Ib (20.1%), type II (26.7%), type III (9.4%), type IV (20.7%). 8. The histological subtypes of Ota's nevus were classified as: the superficial type (35.6%); the middermis type (5.9%), the superficial-middermis type (18.6%); the mid-lower dermis type (2.7%); the diffuse type was composed of the superficial dominant type (19.7%), the middermis dominant type (4.8%), the dispersed (true diffuse) type (12.2%) and the deep dominant type (0.5%). 9. In the relation between histological types and the color of the lesion: the superficial type had 31 cases of brown color, 15 cases of blue black color, 11 cases of dark brown color and 9 cases of slate color; the middermis type had 6 cases of blue black color and 2 cases of dark brown color, query number of cases of slate color; the superficial-middermis type had 12 cases of blue black color, 10 cases of dark brown color, 7 cases of brown color and 6 cases of slate color: the mid-lower dermis type had 3 cases of blue black color; for the diffuse type, the superficial dominant type had 13 cases of brown color, query number of cases of blue black color and 7 cases of dark brown color; the mid-dermis dominant type had 4 cases of brown color, query number of cases of dark brown color, the dispersed type had 14 cases of blue black color and 5 cases of brown color; the deep dominant type had 1 case of blue black color. CONCLUSION: The histological reclassification of Ota's nevus may be very useful in making a therapeutic prognosis of the disease.

Clinical Characteristics of Adolescence and Adult Atopic Dermatitis in Korea / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a very common disease with peak prevalence among infants and children. Until now, adolescence and adult AD (AAD) patients have been overlooked because they were relatively small population and AAD were considered merely consecutive of infant and childhood AD. OBJECTIVE: The aim of this study is to investigate clinical characteristics of AAD in Korea and different characteristics of childhood AD. METHODS: We evaluated the clinical features of AD in 48 patients. We obtained informations about the age of onset, associated allergic diseases, aggravating factors and seasonal aggravation from the history using a standardized questionnaire. And clinical features of all subjects were evaluated by one investigator and recorded according to anatomical region. RESULTS: 23 patients (48%) reported onset of AD was after 12 years old and 25 patients (52%) reported onset before 12 years old. Only nine patients have suffered AD from infancy. 25 patients (52%) were associated with allergic asthma and/or rhinitis. Most important aggravating factor was climate with seasonal variation. Other common aggravating factors were stress, sweating, dryness and house dust. And numerous patients who experienced seasonal aggravation replied that symptoms had flared from July to August and December. The face, trunk, extremities, scalp and neck were common sites of dermatitis and most of the patients (93%) showed the facial involvement. Red face (68%) and dandruff (45%) were the most common features of the face and the scalp, respectively. About one third of the patients showed the involvement of the neck, presenting as dirty neck or dermatitis. Dryness of the trunk and eczema of flexural areas of the extremities were also common. And 13 patients had hand-foot dermatitis. Keratosis pilaris, hyperlinear palm and ichthyosis vulgaris were detected in 21 (43%), 14 (29%) and 9 patients (18%). CONCLUSION: This study shows AAD is so different from childhood AD, suggesting that AAD may not be merely consecutive of infant and childhood AD.

One Case of Linear Lichen Planus / 대한피부과학회지

Linear lichen planus, a variant of lichen planus, accounts for 0.24-0.62% of all patients with lichen planus. Clinically, it consists of itchy linearly distributed violaceous papules, usually lasts for more than 1 year and the mucous membranes may also be affected. This disorder shows the same histologic findings of lichen planus, which is characterized by a band like dermal inflammatory cell infiltration with hyperkeratosis, focal hypergranulosis, acanthosis, excytosis and the presence of Civatte body. We report a 66-year-old man showing typical clinical and histological features of linear lichen planus with pruritus.

Expression of Genetic Polymorphism of Interleukin-10 (IL-10) and Tumor Necrosis Factor-beta (TNF-beta) in Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a common inflammatory skin disease. Atopic dermatitis is associated with increased IL-4, IL-5, IL-10 and IL-13 but decreased INF-gamma and TNF production. IL-10 production has been implicated in autoimmunity because of its effect on B-cell proliferation and antibody production. The study of IL-10 gene polymorphism is of interest because of the pivotal role of IL-10 in the regulation of inflammatory and immune responses. TNF-beta significantly upregulates INF-gamma but downregulates IL-5, IL-13 and IgE, which suggests a potential role of TNF-beta in the pathogenesis of atopic dermatitis. OBJECTIVES: We have investigated polymorphism of IL-10 promoter gene and TNF-beta gene. METHODS: Seventy one patients with atopic dermatitis and one hundred and sixty six normal subjects participated in this study with analysis of polymorphism of IL-10 promoter (-1082), (-819) gene and seventy one patients with atopic dermatitis and one hundred and forty one normal subjects participated in the analysis of polymorphism of TNF-beta gene. The patients in this study were recently diagnosed with atopic dermatitis. RESULTS: The frequency of IL-10 promoter (-1082) genotypes (A/A, A/G, G/G), genes (A, G), IL-10 promoter (-819) genotypes (T/T, T/C, C/C) and genes (T, C) did not show any significant difference between atopic dermatitis patients and normal controls. There was no significant difference in the frequency of TNFB genotypes (TNFB*1/TNFB*1, TNFB*1/TNFB*2, TNFB*2/TNFB*2) and genes (TNFB*1, TNFB*2) in patients of atopic dermatitis and normal controls. CONCLUSION: The results of this study suggest that the other regions of the IL-10 promoter gene and TNFB gene should be investigated for polymorphism of atopic dermatitis. And the difference of IL-10 promoter and TNFB gene polymorphism between caucasian and Korean needs to be evaluated.

A case of postmenopausal frontal fibrosing alopecia / 대한피부과학회지

Postmenopausal frontal fibrosing alopecia is a recently described, rare scarring alopecia. The disease is characterized by progressive frontal recession in postmenopausal women with clinical features of a fibrosing alpecia. The histologic findings are indistinguishable from those seen in lichen planopilaris. Postmenopausal frontal fibrosing alopecia is especially rare in Asian women. We describe a typical case of postmenopausal frontal fibrosing alpecia in a Korean woman with clinical and histologic features.

A Case of Generalized Perforating Granuloma Annulare with Diabetes Mellitus / 대한피부과학회지

Generalized perforating granuloma annulare is a rare variety of granuloma annulare presenting a distinct clinical pattern. We, herein, report a case of generalized perforating granuloma annulare with diabetes mellitus, which developed on a 73 year-old-female who had pruritic generalized small papular lesions with central umbilication, especially on the back and lower extremities for 1 month. Histopathologic examination showed an epidermal perforation and transepidermal elimination of necrobiotic material. The epidermal perforation was communicated with areas of necrobiotic collagen surrounded by palisading granuloma in the dermis.

Alternative Therapy for Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Alternative medicines may be defined as forms of therapy or examination that have no scientific basis and where no effect or diagnostic reliability have been demonstrated by scientific methods. Many patients with atopic dermatitis try various forms of alternative medicine, and several studies about the use of alternative medicine in the patients of atopic dermatitis were performed in western countries but not in Korea. OBJECT: This study was performed to evaluate the use of alternative medicine in atopic dermatitis patients. METHODS: 188 patients of atopic dermatitis attending our outpatient clinic responded to questionnaires on the use of alternative medicine and the past history of atopic dermatitis. RESULTS: 136 of 188 patients(72%) reported previous or current use of one or more forms of alternative medicine. Herbal remedies(32.4%) were used most frequently, and health food preparations, spa therapy, and diet changes were also commonly used. The most common motif of using alternative medicine was "just want to try every possible treatment"(48.6%) and main information sources were people without same skin disease(relatives and friends)(50.0%). The majority(75.2%) reported they do not use the alternative medicine now because of the poor result. The use of the alternative medicine was related to the disease duration, and the cost of the atopic dermatitis treatment. CONCLUSIONS: The use of alternative medicine in atopic dermatitis is commonplace and should be of concern to dermatologists.

A Case of Isolated Plexiform Neurofibroma

Plexiform neurofibroma is considered to be pathognomic of neurofibromatosis type 1 (NF1). Herein we report a solitary plexiform neurofibroma which is not associated with NF1. A 61-year-old man presented with asymptomatic skin colored nodules on the medial side of his left great toe. No other abnormalities were found in his personal or family history. Clinically, the tumor was simulating the appearance of mucous cysts. Microscopically,it was a plexiform neurofibroma located in the dermis which seemed to originate from small superficial nerves. This case would seem to confirm that the superficial form of plexiform neurofibroma involving small nerves in the dermis or subcutis is not necessarily pathognomic for NF1.

A Case of Intraneural Neurofibroma in Neurofibromatosis / 대한피부과학회지

Neurofibroma occurs as a sporadic tumor or hereditary lesions associated with neurofibromatosis. Histologically, cutaneous extraneural type is the most common form. Occasionally plexiform type is observed, but deep circumscribed intraneural type is rarely found in the skin. We report a case of well-encapsulated intraneural neurofibroma on the left abdomen of a 23-year- old woman showing various histologic features of neurofibroma. The tumor was encapsulated with perineurium which was continuous with remnant nerve of origin.