Study of the Patch Tests Results in Patients with Contact Dermatitis due to Cosmetics / 대한피부과학회지

BACKGROUND: With the growing use of cosmetics such as skin care products, toiletries, makeup products, fragrance on an expanding population, reports of unwanted side effects following application of these products is increasing. Allergic contact dermatitis commonly occurs with the use of cosmetics. However, treatment is extremely difficult without knowing the exact causative agent. Therefore, it is important to detect and clarify such agents in order to treat and ultimately prevent allergic contact dermatitis. OBJECTIVE: We attempted to find the popular causative factors of allergic contact dermatitis, especially within cosmetics, and compare the findings with previous Korean and international reports involving allergic contact dermatitis. METHODS: Patch test results of 332 patients suspected of having allergic contact dermatitis related to cosmetics were reviewed. The patients visited 3 hospitals in the Catholic medical center in Korea between 2000 and 2003. The patch tests adopted were of the standard series, cosmetic series, and test samples made from the patient's own cosmetics. RESULTS: The results of this study are summarized as follows; 1. Among allergens of the standard series, nickel sulfate induced the highest positive patch test results (30.5%) within the 321 patients who were tested followed by potassium dichromate, thimerosal and cobalt chloride. 2. Thimerosal showed the highest positive patch test rate (9.2%), followed by octyl gallate and t-butylhydroquinone in a cosmetic series patch test study with 109 patient. 3. A trial patch test with cosmetics from our own patients was made. Among the type of cosmetics to induce a positive patch test, skin care products constituted 47.8%, marking the highest proportion. However, toiletries were the most potent in inducing a positive test result. 4. Correlated to the patch test results from previous Korean and international studies, skin care products most commonly caused allergic contact dermatitis as in our study. However, personal cleanliness products were more common in causing allergic contact dermatitis in our study than in previous Korean and international studies. CONCLUSION: Although skin care products are most prevalent in causing allergic contact dermatitis, the prevalence of allergic contact dermatitis due to toiletries is increasing. This was a clear contrast to the result of previous Korean and international studies. The possibility of allergic contact dermatitis due to toiletries should not be overlooked.

Four Cases of Papillary Eccrine Adenoma / 대한피부과학회지

Papillary eccrine adenoma is a rare cutaneous tumor which occurs most commonly on the distal portion of extremities as a small solitary nodule. Histopathologically, the tumor consists of multiple dilated or branching tubular structures that are lined by two or more layers of epithelial cells and shows papillary projection into the lumina. Positive staining with S-100 protein, CEA, EMA and keratin in papillary eccrine adenoma is consistent with differentiation toward the secretory epithelium of eccrine sweat gland. Herein we report four cases of papillary eccirine adenoma and review the literature.

A Case of HIV-associated Eosinophilic Pustular Folliculitis / 대한피부과학회지

Eosinophilic pustular folliculitis(EPF) may be classified into 3 clinical types; classic(Ofuji's disease), HIV-associated, and infantile form. Compared with classical type, HIV-associated eosinophilic folliculitis(HIV-associated EF) reveals the distinctive features, such as scattered erythematous urticarial papules on the trunk, head, neck, and proximal aspect of the extremities. We herein report a case of HIV-associated EF occuring in a 48-year-old man who had severe pruritic, multiple, erythematous, follicular and non follicular papules and nodules on the scalp, face, neck, and anterior chest. Biopsy specimen revealed folliculitis with a predominant eosinophilic infiltrate. To our knowledge, this is the second case of HIV-associated EF in Korea.

Solitary Malignant Gastrointestinal Stromal Tumor Associated with a Neurofibromatosis Type I

From the Department of Dermatology, College of Medicine, The Catholic University of Korea, Kangnam St. Mary's Hospital, 505, Banpo-Dong, Seocho-Gu, 137-040, Seoul, Korea, Gastrointestinal stromal tumors are usually late manifestations of neurofibromatosis (von Recklinghausen's disease) and most become clinically apparent in middle-aged patients as multiple benign tumors. To our review of the literature, solitary malignant stromal tumor of gastrointestinal tract is exceptionally rare in von Recklinghausen's disease. We herein present a case of solitary jejunal stromal tumor in a 50-year-old woman with NF1, which histopathologically showed a malignant change and combined smooth muscle-neural type.

Occupational Contact Urticaria Syndrome Induced by Cefotiam Dihydrochloride in a Nurse

We herein report a case of occupational contact urticaria syndrome induced by cefotiam di-hydrochloride in a nurse. She had generalized pruritic wheals accompanied by palpitations and tachypnea during the preparation of cefotiam solution. A scratch patch test with cefotiam di-hydrochloride, a major component of cefotiam ingredient showed multiple erythema and wheals within 5 minutes, accompanied by palpitations and tachypnea. No delayed type reaction was observed. Based on her clinical history and scratch test result, we diagnosed her condition as contact urticaria syndrome caused by cefotiam.

A Case of Progressive Zosteriform Macular Pigmented Lesion / 대한피부과학회지

Progressive zosteriform macular pigmented lesion (PZMPL) is a rare pigmentary disorder characterized by uniformly tanned macular pigmented lesions in a zosteriform distribution preceded by multiple pruritic macular pigmentation in a part of the dermatome for a period. We herein report a case of PZMPL which has developed along the left T3-5 dermatome in a 48-year-old man. The histological findings revealed increased melanin pigments in the basal layer and focal pigmentary incontinence in the upper dermis. PZMPL may be differentiated from progressive cribrifom and zosteriform hyperpigmentation in the clinical and histological manifestations.

A Case of Linear and Whorled Nevoid Hypermelanosis Associated with Congenital Hemihypertrophy / 대한피부과학회지

Linear and whorled nevoid hypermelanosis(LWNH) is a congenital disorder characterized by hyperpigmented macules in a linear and whorled pattern along Blaschko's lines, and develops a few weeks after birth. Skin manifestations closely resemble hypomelanosis of Ito with inverse pigmentation. There is no preceding inflammatory event and no pigmentary incontinence histologically. It may be associated with various congenital abnormalities. We report a case of linear and whorled nevoid hypermelanosis associated with congenital hemihypertrophy of left extremities in a 10-year old boy.

A Case of Classic Kaposi's Sarcoma Treated with Interferon-alpha / 대한피부과학회지

Classic Kaposi's sarcoma is a multicentric neoplastic tumor of endothelial cell origin and has a relatively benign course even if extracutaneous sites are involved. We report a case of classic Kaposi's sarcoma of a 68-year-old man who had tender, reddish nodules and purplish papules and macules on the right sole. The biopsy specimen showed typical findings consistent with Kaposi's sarcoma such as endothelial cell proliferation, spindle cells forming slit like spaces occupied by red blood cells and positive staining with CD 34 antibody in the endothelial cells. The patient was treated with six million units of interferon alfa three times per week for 6 months. Four months after a 6 month treatment course, histopathological findings on the resolving lesion didn't show any evidence of Kaposi's sarcoma.

Occupational Dermatoses in Foundry Workers at an Automobile Manufacturing Plant / 대한피부과학회지

BACKGROUND: Many employees working in cast iron foundry process at an automobile production plant suffered from similar dermatoses due to occupational exposure. But data on the occupational dermatoses in foundry workers at an automobile production plant have not been reported in Korea. OBJECTIVE: The aim of this study was to evaluate the prevalence of dermatoses in relation to occupational exposure in cast iron foundry process at an automobile production plant. METHODS: 188 workers working in the foundry process were investigated for the presence of dermatoses using a questionnaire and a dermatological examination. The questionnaire included the past or present history of occupational exposure, dermatoses and atopy and so on. Patch test with Korean standard allergen and additional related allergen was performed in 38 workers who were suspected to have contact dermatitis in relation to occupational exposure. RESULTS: The results are summarized as follows; The most common 5 dermatoses were dermatophytoses(40), contact dermatitis(18), folliculitis (11), atopic dermatitis(9) and hand eczema(5). The determined risk factors to the skin were hot environmental condition, silica, organic solvent nickel and chrome. The incidence of irritant contact dermatitis was much higher than that of allergic contact dermatitis. The frequency of irritant contact dermatitis was much higher in atopics than in non-atopics. Contact sensitization was found in 6 workers and sensitizing substances were cobalt, nickel, colophony, quinoline mixture and balsam of Peru. CONCLUSION: Based on these clinical and epidemiological observations, it is suggested that the health and safety educational programs about the occupational dermatoses are needed for workers.

Bullous Erythema Multiforme following Herpes Zoster

Erythema multiforme is a self-limited, usually mild and relapsing exanthematic intolerance reaction of the skin that is etiologically most often related to recurrent herpes simplex virus infection. Until now, despite its increasing incidence, varicella zoster virus has rarely been considered as an etiologic agent. We herein report a case of erythema multiforme following herpes zoster. A 52-year-old man complained of multiple targetoid lesions with central bullae which developed 1 day ago and were progressively spreading to his whole body. He had suffered from the thoracic herpes zoster along the right T11-, and T12-dermatomes for 10 days. He had no history of HSV infection. He had been intermittently taking analgesics such as acetaminophen for 1 year because of low back pain, but had no history of drug eruption due to analgesics. Histopathologic examination showed subepidermal bulla with necrotic keratinocytes and vacuolization of the basal layer. Based on the clinical morphology and the histopathologic findings, our case could be presumptively diagnosed as a bullous erythema multiforme following herpes zoster.

A Case of Acral Persistent Papular Mucinosis

Acral persistent papular mucinosis is a subtype of the localized papular mucinosis. Clinically, ivory to flesh-colored papules develop exclusively on the back of the hands, the extensor surface of the wrists, and occasionally the distal forearms. Histologically, mucin accumulates in the upper reticular dermis, typically sparing a subepidermal zone and fibroblasts are not increased in number. On experiencing a case of numerous papules on both hands and forearms of a fifty year-old woman, we present it as acral persistent papular mucinosis.

A Case of Follicular Mycosis Fungoides / 대한피부과학회지

A follicular mycosis fungoides(FMF) is an unusual clinical and histological variant of mycosis fungoides(MF), characterized by selective involvement of hair follicles by atypical lymphocytes with folliculotropism. FMF is more refractory to treatment, and has a worse prognosis than classic MF. We report a case of FMF presenting as follicular papules on the left forearm in a 43-year-old man. Histologic findings showed an infiltration of mycosis cells within and around follicles and Pautrier's microabscess in the follicular epithelium without mucinosis.

Four Cases of Cutaneous Complications after Artificial Hair Implantation / 대한피부과학회지

The implantation of synthetic fibers into the human scalp to simulate natural hair has been shown to cause severe complications and be a possible danger to human health. The complications are frequent and include pain, pruritus, hemorrhage, infection, facial swelling, loss of natural hair, scarring and possible malignant degeneration of the surrounding scalp. We report herein four typical cases of severe cutaneous complications after artificial hair implantation.

Four Cases of Atopic Dermatitis with Topical Tacrolimus Therapy / 대한피부과학회지

Tacrolimus is a macrolide antibiotic that was isolated from soil microorganism. Its mechanism of action is based on calcineurin inhibition, which results in suppression of antigen-specific T-cell activation and inhibition of inflammatory cytokine release. Four patients with atopic dermatitis participated in this study of the efficacy of topical tacrolimus. Our cases showed significant improvement in the signs and symptoms of atopic dermatitis within a week of starting topical tacrolimus. We report 4 cases of atopic dermatitis treated with 0. 1% tacrolimus ointment.

A Case of Porokeratosis Developing after Immunosuppression Therapy in Renal Transplant Patient / 대한피부과학회지

We report a case of a 55-year-old male renal transplant patient, who showed 1 cm sized six round brownish macules on both arms and legs for 8 months. These lesions were stable without change in size or number and histopathologically were consistent with the finding of porokeratosis. We think that this lesion is the mixed type which shares the character of Mibelli's porokeratosis and disseminated superficial actinic porokeratosis.

A Case of Hair Follicle Nevus Associated with Accessory Tragus / 대한피부과학회지

Hair follicle nevus is a rare hamartoma that has numerous tiny but mature hair follicles with thick fibrous root sheaths. It occurs on the face at or after birth. It must be differentiated from accessory tragus by clinical and histological findings. We herein report a unique case of a hair follicle nevus that may be associated with an accessory tragus on the face of a neonate.

Therapeutic Efficacy of Mycophenolate Mofetil in Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Atopic dermatitis has been thought be a T cell mediated disease and autoimmune response may be responsible for chronicity of typical skin manifestation. Mycophenolate mofetil(MMF), a new immunosuppressive agent can be tried in the treatment of atopic dermatits. OBJECTIVE: We examined the efficacy and safety of MMF in the treatment of atopic dermatitis in Korean patients. METHODS: 7 patients with moderate to severe atopic dermatits were recruited in the treatment of oral MMF 2 g daily for 6 weeks and followed up for another 6 weeks. Severity of atopic dermatitis was measured using SCORAD index. Laboratory examination was performed to check the side effect of MMF during the study. RESULTS: Six of 7 patients finished the treatment courses. After 6 weeks of therapy with MMF, patients' symptoms were improved and mean SCORAD index was significantly reduced from 67.2+/-15.5 to 28.7+/-13.5(p<0.01). Significant side effects such as neutropenia, infection, renal toxicity and hepatotoxicity were not observed. During the follow-up period, patients could be managed by topical steroid and oral antihistamine and flare-up was not observed. CONCLUSION: According to our study, MMF is an effective, safe and well-tolerated immunosuppressive agent in the treatment of moderate to severe atopic dermatitis. MMF is a promising alternative in the treatment of severe atopic dermatitis.

A Case of Acral Type Acanthosis Nigricans Associated with Lymphoma / 대한피부과학회지

Acanthosis nigricans is a symmetric eruption characterized by a hyperpigmented, velvety cutaneous thickening that can develop on any part of the body, but characteristically affects the flexural area of the body. But many dark-skinned people have velvety hyperkeratosis of the dorsum of the hands and feet, a variant of acanthosis nigricans called acral acanthotic anomaly or acral type acanthosis nigricans. Malignant acanthosis nigricans is associated with a malignant tumor-most commonly an abdominal, and particularly a gastric carcinoma. To our knowledge, this is the first report of acral type acanthosis nigricans associated with non-Hodgkin"s lymphoma.

Patch testing in Atopic and Non-Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The frequency and importance of contact allergy in patients with atopic dermatitis(AD) have been debated. Although the study about patch test in AD is common in foreign countrles, it is rare in our country. OBJECTIVE: We performed this study to examine the patch test in patients with AD and to know the frequency of contact sensitization and the correlation between metal allergy history and patch test reaction to nickel in patients with AD and non-atopic dermatitis(NAD) METHODS: One hundred nine patients with AD and one hundred twelve patients without AD were patch tested and questioned about history of metal allergy. RESULTS: 1. The contact sensitivity rate in AD was higher than NAD by 85.3%, 72.3% respectively. But there was statistically no significant difference in the two groups. 2. Positive contact allergens in all patients were cobalt, chromate, nickel, thimerosal, mercury. 3. Positive contact allergens in AD were cobalt, nickel, potassium, thimerosal, formaldehyde, neomycin and in NAD were cobalt, chromate, nickel, mercury, fragrance mix, 4-phenylenediqamine base. 4. The frequency of metal allergy history in all patients was 29% and it was 37.6% in AD and 20.5% in NAD. 5. Patients with metal allergy history had higher positive rate to nickel than patients without metal allergy history. 6. Patients with metal allergy history and AD had higher positive rate to nickel than patients with metal allergy history and NAD. 7. Patients who were positive to nickel were also positive to cobalt, chromate. CONCLUSION: This study shows that contact sensitivity is relatively common in AD, and metals including nickel are important allergens in AD. Therefore when the symptoms of AD are aggravated, it is important to perform the patch test, considering the possibility of contact dermatitis.

A Case of Solitary Indeterminate Cell Histiocytoma / 대한피부과학회지

Indeterminate cell histiocytosis is a vary rare disease characterized by the proliferation of indeterminate histiocytes which morphologically and immunophenotypically resemble Langerhans cell but lack Birbeck granules. We report a case of solitary indeterminate cell histiocytoma in a 58-year-old woman. She presented with painless and nonprurituc solitary brownish papule on the left wrist, which had developed 10 years earlier. Histologic and immunohistochemical examination of the biopsy revealed a diffuse dermal infiltrate composed mainly of histiocytes which expressed Langerhans cell marker characteristics. Electron microscopic studies revealed no Birbeck granules within cytoplasm of the neoplastic cells, leading to a diagnosis of indeterminate cell histiocytosis.