Acral Lentiginous Melanoma Developing during Long-standing Atypical Melanosis: Usefulness of Dermoscopy for Detection of Early Acral Melanoma

Clinical guidelines suggest that suspicious pigmented lesions of the plantar or palmar area require biopsy for early detection of acral melanoma. We present here a case of acral lentiginous melanoma in which various melanocytic atypia was observed at each biopsy site, including focal melanocytic proliferation. We suggest that this atypical melanosis is part of a contiguous phase of invasive tumor growth, which is known as the very early stage of melanoma in situ. In addition, noninvasive dermoscopy has been effective for the early discovery of hidden lesions of acral melanoma.

A Case of Primary Syphilis on Both Oral Angles / 대한피부과학회지

Primary syphilis affects the genital and, less frequently, the extragenital regions. Approximately two-thirds of extragenital chancres occur above the neck, and about one-half of these are seen on the lips, the perioral region, or in the oral cavity. We present a case of a 32-year-old woman with a 2-month history of discharging ulcers on both oral angles. She had a history of orogenital sexual contact. Serologic tests for syphilis was positive, particularly the VDRL (1:128), confirmed by TPHA. The biopsy specimen showed a predominant infiltration of plasma cells in the dermis. The skin lesions improved after 4 weeks treatment with doxycycline.

Use of Quality of Life Instruments in Original Articles of the Korean Journal of Dermatology / 대한피부과학회지

BACKGROUND: The measurement of quality of life (QOL) is increasingly important in patients with skin diseases. However, no study has objectively analyzed these trends in the Korean literature. OBJECTIVE: The aim of this study was to analyze original articles that measure QOL in the Korean Journal of Dermatology and to evaluate the use of QOL instruments. METHODS: We collected 14 original articles that measure QOL from the Korean Journal of Dermatology (1960 to 2008) and analyzed these articles for annual changes of the number of articles, the kind and frequency of QOL instrument, and the kind of skin disease in the articles. We also analyzed 66 original articles from the Journal of the American Academy of Dermatology (JAAD) (1979 to 2008) in the same way. RESULTS: In general, the number of articles that measure QOL in the Korean Journal of Dermatology increased. The articles for psoriasis and acne vulgaris accounted for 21.4% of the articles each. Dermatology-specific instruments were the most common QOL instruments used. These results were similar for the JAAD. Of the dermatology-specific instruments, the skindex-29 was used most frequently in the Korean Journal of Dermatology, and the Dermatology Life Quality Index in the JAAD. CONCLUSION: Measuring the impact of skin disease on QOL is increasingly important. Domestic assessment of QOL in skin disease using novel QOL instruments should increase to conform to international standards to allow Korean dermatologists to provide better care to their patients.

Quality of Life and Mental Health of Patients with Rosacea / 대한피부과학회지

BACKGROUND: Rosacea is a common and well known chronic cutaneous disease. The typical symptoms are cosmetic problems, and the recurrent nature of rosacea requires long term treatments that might have a profound effect on the quality of life (QOL) and mental health of these patients. However, there have been only epidemiological studies on Rosacea in the Korean dermatologic literature. OBJECTIVE: The aim of this study was to evaluate the QOL, psychosocial stress, anxiety and depression levels in Korean patients with rosacea and to determine the factors that have an impact on the QOL of rosacea patients. METHODS: A cross-sectional study was conducted on thirty-three adults with rosacea and who had visited our department and thirty-five healthy volunteers with no dermatologic disease or other chronic illness. The rosacea patients were diagnosed by dermatologists who decided the rosacea subtypes before the patients were enrolled in this study. The patients' subjective perceptions of severity were assessed using the Likert scales and the QOL was assessed using Skindex-29. The mental health interview included the psychosocial well-being index-short form (PWI-SF), the trait anxiety inventory (TAI) and the Beck depression inventory (BDI) as measures of psychosocial stress, anxiety and depression, respectively. The QOL, PWI-SF, TAI and BDI scores of the rosacea patients were compared with those of the controls. The subjective perceptions of severity, QOL and the PWI-SF, TAI and BDI scores were also compared between the erythemato-telangiectatic type patients and the papulopustular type rosacea patients. RESULTS: As compared with the controls (n=35), the rosacea patients (n=33) had a significantly decreased QOL (p=0.000). The scores of the PWI-SF, TAI and BDI for patients with rosacea were higher than those of the controls, meaning the rosacea patients had more psychosocial stress, anxiety and depression (p=0.000, 0.000, 0.001). No significant differences in the subjective perception of severity, QOL and mental health were found between the erythemato-telangiectatic and papulopustular type patients (p=0.825, 0.438, 0.268, 0.631). The high self-reported subjective perception of severity, psychosocial stress and anxiety showed significant correlations with low QOL. CONCLUSION: These results indicate that rosacea has a large impact on the patients' QOL and mental health. Taking into account the patients' subjective perception of disease severity and mental health as potential determinants of the QOL of rosacea patients, more attention and effort should be given to develop Korean versions of rosacea-specific QOL instruments as these might more accurately and objectively indicate the severity of the disease.

A Case of Interdigital Pilonidal Sinus in the Foot / 대한피부과학회지

An interdigital pilonidal sinus is considered a rare occupational disease related to individuals with short hair. We describe a case of a 44-year-old man who presented with a tender nodule with a purulent discharge in the fourth interdigital web space of the left foot. The biopsy specimen showed a sinus tract surrounded by keratin and squamous epithelium, and the track contained acute and chronic inflammatory cells. The skin lesion was improved with occlusion of the fistula by using 100% bichloracetic acid. We herein report on a rare case of a interdigital pilonidal sinus in the foot, and this occurred with no relation to the patietn's occupation.

A Case of Foreign Body Granuloma with Skin Necrosis Occurring after Bee Sting Therapy / 대한피부과학회지

Bee sting therapy is sometimes used for the treatment of chronic recalcitrant neuralgia and arthralgia and chronic eczema in traditional Korean herbal medicine. The stings of many insects are withdrawn after stinging. However, in certain cases, retained sting materials at the treatment site may induce granulomatous inflammation. A 76-year-old man presented with an erythematous plaque containing a central ulcer and granulation tissue after he had undergone bee sting therapy for a palpable subcutaneous nodule in the right axilla area and eczema on the back. The biopsy specimen showed a granulomatous response marked by histiocytes and giant cells surrounding foreign material. Histologic examination of the subcutaneous nodule in the right axilla showed mature fat cells consistent with a lipoma. Thus, we report a rare case of a foreign body granuloma with skin necrosis occurring after bee sting therapy.

A Case of Melanoacanthoma: Immunohistochemical Staining Using VECTOR(R) NovaRED(TM) to Distinguish Melanocytes from the Cutaneous Pigment

Melanoacanthoma is a rare benign mixed tumor of both keratinocytes and melanocytes. Although some authors said that it is a rare variant of seborrheic keratosis, it has clinical and histological features distinct from seborrheic keratosis. It has large dendritic melanin-laden melanocytes throughout all levels of epidermis showing a disruption of melanin transfer from the melanocytes to neighboring keratinocytes. However, it is difficult to distinguish melanocytes clearly from cutaneous pigment in immunohistochemical stain with usually used brown chromogen. We used chromogen with brick-red indicator product (VECTOR(R) NovaRED(TM)) in S-100 and melan-A immunohistochemical staining to distinguish melanocytes from melanin laden keratinocytes. We suggest that the immunohistochemical staining using this novel chromogen may be useful in the diagnosis of melanoacanthoma.