Non-cultured Epidermal Cellular Graft for Treatment of Localized Area of Vitiligo / 대한피부과학회지

A woman aged 40 years presented with symmetric band of depigmented patches on her hand dorsum and forearms. Under the diagnosis of focal vitiligo, we initially treated her with oral and topical steroids and local UVB irradiation. However, the wrist lesions were recalcitrant. Therefore, we tried a non-cultured epidermal cellular graft using autologous melanocyte-keratinocyte suspension. Twelve months after the procedure, higher than 70% of repigmentation was observed. This procedure seems to be an effective and practical treatment for recalcitrant vitiliginous lesions.

The Effects of Tacrolimus on Keratinocytes and Melanocytes of Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is caused by the destruction of melanocytes, however the precise mechanism is still not known. Recently, abnormalities of both humoral and cell-mediated immunity have been documented in patients with this disorder, thus providing a theoretical basis for introducing tacrolimus ointment which works as an immunomodulator in the treatment of vitiligo. OBJECTIVE: This study was undertaken to examine the effects of tacrolimus on the survival rates of keratinocytes and melanocytes in vitiligo patients, as well as the melanization of melanocytes. METHODS: Keratinocytes and melanocytes from the normal skin of 4 vitiligo patients were cultured. They were then treated with various concentrations of tacrolimus (0.01, 0.1, 1, 10, 100micrometer) for 5 days. Thereafter, MTT (3-(4,5-cimethylthiazol-2-yl)-2,5-di-phenyl tetrazolium bromide) assay and melanin content analysis were performed. RESULTS: Tacrolimus showed no significant effect on the survival rates of keratinocytes. However, a mild proliferative effect on melanocytes was observed at 10micrometer concentration. On the other hand, marked cytotoxicity was observed at higher than 100micrometer concentration, and there was no effect under 1micrometer concentration. The melanin content of individual melanocytes were decreased in proportion to the concentration. CONCLUSION: These findings indicate that tacrolimus does not have a proliferative effect on keratinocytes and melanocytes in vitiligo patients, and has a tendency to decrease the melanin content in the melanocytes.

A Case of Norwegian Scabies in a Patient with Pemphigus Foliaceus / 대한피부과학회지

Norwegian scabies can be defined as a generalized, severe scabies infestation which usually affects immunocompromised patients. The diagnosis is commonly missed, and can lead to mismanagement. We describe a patient with Norwegian scabies affecting the whole body. The patient had suffered with pemphigus foliaceus for several years and had an immunosuppressed status due to long-term use of oral corticosteroids. He was admitted to our hospital. At first, we made a diagnosis of exfoliative dermatitis secondary to pemphigus foliaceus. However, no improvement of the condition was seen after an increased dosage of oral corticosteroids, azathioprine, and mycophenolate mofetil. We then identified adult scabietic mites, eggs and scybala upon microscopic examination of skin scales. He was treated with an application of gamma benzene hexachloride cream. We recommend that the diagnosis of scabies be considered in immunocompromised patients with thick skin scales and associated night pruritus.

A Case of Pyoderma Gangrenosum Associated with Takayasu's Arteritis Responding to Methotrexate / 대한류마티스학회지

Pyoderma gangrenosum (PG) is a vasculitic process, often associated with systemic diseases, including Takayasu's arteritis (TA), rheumatoid arthritis, and inflammatory bowel disease. Most cases of PG associated with TA have been observed in Japan. However, this association is not commonly observed in North American and European patients. PG is often refractory to therapy, requiring high dosages of glucocorticoids. Here, we describe a case of recalcitrant PG that was associated with TA and successfully treated with methotrexate.

Clinical Effects of Dihydroxyacetone Solution for Vitiligo Patients / 대한피부과학회지

BACKGROUND: Vitiligo is a common, acquired, progressive depigmenting disorder. It is not physically destructive, however often leaves patients visibly disfigured by uneven color of the exposed areas such as the face or hands, especially in colored races. Most treatment protocols for vitiligo usually require a long treatment duration and do not result in complete repigmentation. Therefore, cosmetically-acceptable and easily-usable alternatives are needed. OBJECTIVE: The purpose of this study was to evaluate the clinical effects of dihydroxyacetone (DHA) solution for Korean vitiligo patients. METHODS: Thirty eight patients were treated with DHA, who suffered from vitiligo affecting the face, hands, trunk and thighs. They were instructed to apply DHA once every other day. Thereafter, the number of applications and intervals were adjusted according to the status of coloring. We surveyed the grade of subjective satisfaction, and also measured the L*, a* and b* values of normal skin, vitiligo lesion, DHA-applied site (n=10) and autologous suction blister graft site (n=6) and compared color difference between those areas using the Minolta Chromoameter gap (Minolta, Ramsey, New Jersey, USA). RESULTS: The characteristic pigmentation showed an acceptable cosmetic improvement in 27 of the 38 patients after 4-6 weeks of treatment. L* value was improved after DHA application, while a* and b* values showed more discrepancy than normal skin color. As a whole, the color difference between normal skin and vitiligo lesion was decreased after DHA application. CONCLUSION: The results suggest that DHA could be used for Korean vitiligo patients as an additional option for cosmetic correction.

Clinical Features of Herpes Zoster according to Immune State / 대한피부과학회지

BACKGROUND: Varicella zoster virus (VZV) can be reactivated as a consequence of declining VZV-specific cellular immunity, leading to herpes zoster. OBJECTIVE: The purpose of this study was to compare the clinical features of herpes zoster according to immune state. METHODS: We classified 343 cases of herpes zoster into three groups, according to the presence of underlying disease and immune state; immunocompetent state without underlying disease (Group A), immunocompetent state with underlying disease (Group B), immunocompromised state (Group C). We compared the distribution of age, sex, season and dermatome, severity of skin lesion and pain, and the incidence of postherpetic neuralgia among these groups. RESULTS: 1. There was a significant difference between group A and B in age distribution. 2. The ratio of male to female, seasonal distribution and severity of skin lesion were not significantly different among the three groups. 3. The incidence of trigeminal involvement was significantly, higher in group A and B with statistical significance, while that of thoracic involvement was higher in group C. 4. The percentage of severe pain was significantly higher in group B than in group C. However, the rate of pain relief was not significantly different among the three groups. 5. The incidence of postherpetic neuralgia was not significantly different. CONCLUSION: It is suggested that immune state may significantly influence the clinical features, such as distribution of age, dermatome and severity of pain in herpes zoster.

A Case of Pyoderma-Pyostomatitis Vegetans / 대한피부과학회지

Pyoderma-pyostomatitis vegetans (PD-PSV) is a rare, benign, eosinophilic pustular and vegetating mucocutaneous disease characterized by skin lesions which typically involve the axillary and genital regions, the face and the scalp. PD-PSV was at first regarded as a subtype of bullous disease. However, due to the lack of abnormality under a immunofluorescent microscope, it could be diffentiated from bullous disease. A 48-year woman presented with a 6-month history of sharply-outlined, exudative, papillomatous and vesiculopustular vegetating plaques on the perioral, umbilicus and nasal mucosa, tips of her fingers and toes and perianal region. A skin biopsy taken from the lip and umbilicus showed papillary dermal edema and focal inflammatory cell infiltration composed of many eosinophils, intraepithelial microabscesses, focal spongiosis, and exocytosis. No abnormalities were found during an immunofluorescence study. The lesions were almost cleared with 20 mg of triamcinolone and 200 mg of cyclosporin medication during a 3-month treatment period.

Eight Cases of Deep Lipoma of the Forehead / 대한피부과학회지

Lipomas are the most common benign mesenchymal tumors composed of mature fat cells. They can be classified into superficial lipoma (subcutaneous lipoma) or deep lipoma (subfascial lipoma) depending on the depth they develop. The latter is quite rare and tends to be less circumscribed and relatively fixed compared to the superficial ones. Therefore, it is initially misdiagnosed as other superficial lesions, and pre-operative awareness of deep tumors is important to differentiate them from other superficial lesions. Futhermore, the removal of the tumor also requires a detailed knowledge of the anatomy of the forehead, plus more sophisticated surgical skills so as not to damage important structures in the forehead such as vessels and nerves. Herein, we report 8 cases of deep lipoma on the forehead, demonstrating that it is not as rare as reported.

A Case of Malignant Rhabdoid Tumor on the Face / 대한피부과학회지

In 1978, the malignant rhabdoid tumor was known as a sarcomatous variant of Wilm's tumor because of its histological similarities to rhabdomyosarcoma. Since then, it has been regarded as a clinico-pathologic entity which commonly occurs in childhood and shows aggressive biologic behavior. However, histologically, identical tumors have been reported in various extrarenal organs and tissues, but have turned out to have different characteristics. Therefore, whether the rhabdoid tumor was a phenotype or an entity became controversial. We report herein, a case of a malignant rhabdoid tumor on the face.

A Case of Malignant Rhabdoid Tumor on the Face / 대한피부과학회지

In 1978, the malignant rhabdoid tumor was known as a sarcomatous variant of Wilm's tumor because of its histological similarities to rhabdomyosarcoma. Since then, it has been regarded as a clinico-pathologic entity which commonly occurs in childhood and shows aggressive biologic behavior. However, histologically, identical tumors have been reported in various extrarenal organs and tissues, but have turned out to have different characteristics. Therefore, whether the rhabdoid tumor was a phenotype or an entity became controversial. We report herein, a case of a malignant rhabdoid tumor on the face.

Five Cases of Congenital Triangular Alopecia / 대한피부과학회지

Congenital triangular alopecia has been reported as a rare form of focal hair loss, characterized by a triangular patch of permanant alopecia on the frontoparietal area of the scalp, present from birth. However, it shows diverse clinical spectra of onset, shape and location and, furthermore, it may not be as rare as previously thought. Therefore, in order to avoid inappropriate management, it is very important to differentiate it from preclinical nevoid entities such as epidermal nevus, aplasia cutis and, especially, alopecia areata. We herein report five cases of congenital triangular alopecia.

Clinical Study on Dermatologic Disease of the Elderly / 대한피부과학회지

BACKGROUND: With the advance of socioeconomy and medical sciences, geriatric health care has become a world wide concern and disease of the skin is no exception. OBJECTIVE: The aim of this study was to investigate the epidemiology, past history and the prevalence of various skin disorders of the elderly. METHODS: In this trial, a total of 1082 new patients older than 65 years, who visited the Department of Dermatology, Kyungpook National University Hospital in Daegu, Korea in the last 3 years (2002~2004), were selected. The data was studied on the basis of a retrospective survey of hospital records. RESULTS: Of total patients who were seen at the dermatologic outpatient department, 10.1% were 65 years and older. The male to female ratio was 1 to 1.01. The patients between 65 and 74 years old compromised the majority (72.8%), and the patients older than 85 years old were 4.1%. They visited hospital most frequently in summer. Of the common complaints recorded, pruritic rash was the most frequent. The commonly diagnosed disorders were herpes zoster followed by senile pruritus, tinea/onychomycosis, and seborrheic dermatitis in decreasing order. The most common dermatologic disease was hespes zoster and postherpetic neuralgia for all three age groups : 65~74 years old, 75~84 years old, and over 85 years old. A total of 901 patients, which constituted 83.3% of the total patients, had at least more than one underlying disease, of which cardiovascular disease was the most common. CONCLUSION: This study is expected to be of help to understand the characteristics and the distribution of dermatologic diseases in the elderly.

Change of Skin Barrier Function According to Stratum Corneum Removal by Tape Stripping / 대한피부과학회지

BACKGROUND: The major function of the skin is to prevent loss of water and electrolytes and transepidermal penetration of harmful materials. The stratum corneum is known to play a major role in the skin barrier function. Tape stripping (TS) with adhesive cellophane tape is one of the best method of removing the stratum corneum on the skin surface, and has been used in studies of the skin barrier function when investigating material distribution in the stratum corneum and transepidermal absorption of drugs. OBJECTIVE: This study was performed to evaluate the skin barrier function according to removal of the stratum corneum by TS. METHOD: Six vitiligo patients who had undergone autologous suction blister grafting were tested. Transepidermal water loss (TEWL) was measured on the normal skin of the buttocks in each patient after every fifth TS, plus on the skin where the entire epidermis had been removed by autologous suction blister grafting. We compared these two values and also examined morphological change of the stratum corneum after TS, by both light and electron microscope. RESULTS: The TEWL value slightly increased when TS was carried out up to 30 times, but greatly increased to 20g/m2h of TEWL when TS was done 30-40 times. Thereafter, no increase in TEWL was observed when TS was carried out up to 100 times. The pattern of TEWL according to numbers of TS approximately plotted a sigmoid curve. On average, there was about 88% impairment to the skin permeability barrier function after TS. When the TEWL increased to more than 70g/m2h over baseline TEWL, the stratum corneum was almost removed, as revealed by light and transmission electron microscope. CONCLUSION: The stratum corneum acts as a major skin barrier, and the mid to lower portion of the entire stratum corneum appears to play a significant role in the skin permeability barrier function.

Treatment of Vitiligo with Broad-band UVB Targeted-phototherapy / 대한피부과학회지

No abstract available.

Five Cases of Permanent Alopecia Following Chemotherapy / 대한피부과학회지

With the development of chemotherapeutic agents and bone marrow transplantation, high dose conditioning chemotherapy before bone marrow transplantation, such as busulphan, have become more widely used. Of the side effects following chemotherapy, the cutaneous side effects of hair loss occur in high incidence. Alopecia following chemotherapy was generally known to recover completely in spite of subtle changes to the hair shaft. However, we recently experienced five cases of permanent incomplete regrowth of hair after cessation of conventional chemotherapy or high dose conditioning chemotherapy. In Korea, permenant alopecia following chemotherapy has not yet been reported and we reviewed them with the possible risk factors such as duration and kind of chemotherapeutic agents.

Clinical Study on Nummula Eczema / 대한피부과학회지

BACKGROUND: Nummular eczema, known as nummular dermatitis or discoid eczema, is an idiopathic disease that manifests coin-shaped, circular, or oval-shaped plaques with definite margins. These plaques can be exudative, erythematous, or edematous. The plaques are composed of tiny vesicles in the early stage, and later tend to be more scaly, dry, lichenified and thickened. It is a chronic condition which exhibits long periods of recurrence and relapse, plus changes depending on environmental conditions. For example, it is known that the eczema worsens in low humidity, or during winter. OBJECTIVE: Since there has been an absence of studies conducted since the 1970's, we investigated epidemiology, etiology, aggravation factors, family and past history, associated diseases such as atopic dermatitis, clinical menifestations, laboratory abnormalities, and course and prognosis with statistical analysis. METHOD: A total of 211 individuals, who had visited the Department of Dermatology, Kyungpook National University Hospital in Daegu, Korea between 2000-2004 with a diagnosis of nummular eczema, were selected. The data was based on a retrospective survey of hospital records. However, whenever the information was lacking, we called patients to ask lists of questions for this investigation. To clarify the prognosis and course of nummular dermatitis, we classified the course of the disease into 5 groups; "healed" (cleared completely), "almost healed" (more than 90% cleared), "improved" (from 50 to 90% cleared), "stationary" (less than 50% improvement), and "wax & waned" (repetitive recurrence). RESULTS: The male to female distribution showed about a 1.4-fold predominance for males. The onset of the disease in patients was often in their twenties, which correlated with previous reports which noted that onset of lesions in patients occurred in their twenties and sixties. Nummular eczema was most frequently aggravated in summer. Thirty five of the 211 patients had atopic dermatitis, and 53 had dry skin. Thirty five of 103 patients showed an elevated serum Ig E level (more than 250 IU/ml). Seventeen of 120 patients had an elevated eosiophil count (more than 7%). If the patients had had the eczema for a short duration, these seemed to be a better chance of the condition healing. CONCLUSION: This investigation is expected to help understand and obtain more information on nummular eczema.

A Case of Hypomelanosis of Ito with Diploid/triploid Mosaicism / 대한피부과학회지

Hypomelanosis of Ito was first described by Ito in 1952 as incontinentia pigmenti achromians. The consistent feature of the disease is a characteristic cutaneous hypopigmentation following the lines of Blaschko, and associated extracutaneous manifestations include anomalies of the central nervous system, eye and musculoskeletal system. It is a sporadic condition and more than half of patients are found to have chromosomal abnormalities, such as mosaicism. It has been suggested that hypomelanosis of Ito is not a single condition, but rather a nonspecific manifestation of chromosomal mosaicism. We report a case of a 6 year-old girl with hypomelanosis of Ito with diploid/triploid mosaicism (46, XX/69, XXX). She did not show any other extracutaneous symptoms, except a mild developmental delay. Hypopigmented lesions showed a gradual improvement but new hyperpigmented, brownish macules developed within hypopigmented lesions without any treatment.

The Significance of Mantoux Test and Antitubercular Therapy in the Patients with Inflammatory Nodules on the Legs / 대한피부과학회지

BACKGROUND: The inflammatory nodules on the legs are often difficult to distinguish because of clinical variations and similarity of histopathologic features. Both erythema nodosum and erythema induratum are known to be associated with various conditions, especially tuberculosis. In Korea where tuberculosis is still a major health problem, it may be a cause for the inflammatory nodules on the legs. OBJECTIVE: The purpose of this study was to establish the correlation with Mantoux test and inflammatory nodule and evaluate the efficacy of antitubercular therapy in Korea. METHODS: We performed the prospective study of 26 patients with inflammatory nodules on the legs. All patients preformed Mantoux test and skin biopsy. The patients who had strongly positive Mantoux reaction were treated with antitubercular therapy. RESULTS: The ages of the 26 patients (Male 4:Female 22) ranged from 12 to 76 years. All patients had recurrent painful, tender subcutaneous nodules on the legs. Fourteen patients of total 26 patients had a strongly postive Mantoux reaction (induration > or = 20 mm). They were treated with combination antitubercular therapy. After antitubercular therapy, skin lesions subsided in 12 patients within 2 months and in the remaining 2 patients, subsided within 4 months. The therapy was well tolerated except for flu-like symptom in one patient and drug induced hepatitis in the other patient. CONCLUSION: We suggest that antitubercular therapy is effective in the management of patients with a strongly positive Mantoux reaction with chronic recurrent inflammatory nodules on the legs in Korea.

A Case of Sweet's Syndrome in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Sweet's syndrome is an uncommon reactive dermatosis characterized by fever, polymorphonuclear leukocytosis, painful erythematous cutaneous plaques and dense dermal infiltrate of neutrophils at the skin lesions. Unlike Sweet's syndrome associated with patients with malignancies, autoimmune diseases, antecedent infectons-most commonly the upper respiratory infections, it is reported to be rarely associated with systemic lupus erythematosus (SLE). Here we report a rare case of young female with Sweet's syndrome and SLE presenting with high fever.

Comparision of Results of Sting Tests Using Various Kinds of Alpha Hydroxy Acids on Sensitive Skin / 대한피부과학회지

BACKGROUND: Users of cosmetics and skin care products often report adverse reactions ranging from itching, stinging and dryness to intense inflammatory responses such as erythema, wheals and rashes. Sensitive skin has been described as a skin type showing higher reactivity than normal skin, and it develops exaggerated reactions when exposed to internal stimulants and external irritants. The alpha hydroxy acids (AHAs), naturally occurring organic acids which include lactic acid, glycolic acid, citric acid, malic acid and tartaric acid are all kinds of noncorrosive irritants. The lactic acid sting test is widely accepted as a marker of sensitive skin and is employed for the selection of subjects experiencing invisible sensory irritation. OBJECTIVE: This study was performed to compare the results of sting tests conducted on the sensitive and nonsensitive skin group which had been exposed to various kinds of AHAs. METHOD: A total of 50 individuals (25 individuals with a sensitive skin group and 25 individuals with a nonsensitive skin group) were selected by the method of self-assessment questionnaires relating to sensitive skin. The subjects were tested on the face with 2 variables of 5 AHA types ( with or without Hilltop chamber occlusion), at 2 weeks intervals, for a total of 10 times. RESULTS: The positive response rate of stinging in the sensitive skin group was higher than that in the nonsensitive skin group for all tests except the glycolic acid sting test using Hilltop chamber (p<0.05). The mean value of sting scores in the sensitive skin group was higher than that in the nonsensitive skin group for all tests (p<0.05). CONCLUSION: Sting tests using various kinds of AHAs are a useful method in determining sensitive skin.