The Recognition of Skin Health and Diseases in the Geriatric Population / 대한피부과학회지

BACKGROUND: With the development of medical science and technology, the proportion of the aged in the population has significantly increased. For the same reasons, concerns regarding skin aging and skin diseases in the geriatric population has increased. OBJECTIVE: To evaluate the recognition of skin health and disease in the elderly. METHODS: On April 2009, 190 elderly persons were asked to complete a questionnaire in 5 senior welfare centers in the city of in Korea. The questions included: satisfaction with the subject's own skin; treatment-seeking behavior; knowledge and common sense about representative skin problems; efforts taken to achieve healthy skin. RESULTS: Among the elderly, 44.74% were dissatisfied with their own skin. The most complained about skin diseases in the elderly were pruritus and xerosis. Also, interest in esthetic problems such as wrinkles and pigmentation was high. On the question of whether they visit a dermatologic clinic when they develop skin problems, 40.53% of subjects said that they visited the dermatologic clinic. However, this means that 59.47% did not visit a dermatologic clinic. A somewhat unexpected finding was that knowledge of skin diseases and esthetic problems were plentiful in the geriatric population. Among the elderly, 81.05% did something to achieve skin health such as using a moisturizer or sunscreen. CONCLUSION: The present study contributes to our understanding of the recognition of dermatologic problems in the geriatric populations. Dermatologists and society should pay more attention to the provision of correct information and appropriate treatments for skin diseases in the elderly.

Phosphatidylcholine Formula for the Treatment of Lipoma / 대한피부과학회지

BACKGROUND: Lipomas are benign neoplasms composed of mature fat cells. Current treatments are invasive and carry the risk of scarring. For this reason, phosphatidylcholine (PPC) formula has been widely used to treat areas of localized fat accumulation. However, there are few reports on injection lipolysis with injection of PPC formula. OBJECTIVE: The purpose of this study was to investigate whether injection lipolysis with PPC formula is an effective therapeutic option for patients with lipoma. METHODS: Twenty-two lipomas in 7 patients were included. Three sessions at intervals of 6 to 8 weeks were done. Sonographic measurements of lipoma size were repeated before each session. Any side-effects and the patients' satisfaction were noted. In one lipoma, histological changes after lipolysis were described. RESULTS: After three sessions, a significant reduction in lipoma size of 47.4% was achieved. Histology showed a fibrosis with loss of adipocytes. Inflammation occurred in one case, so the patient was excluded from this study. Transient burning sensation and swelling at the injection site were the most common adverse effects. No severe side-effects or systemic reactions were observed. CONCLUSION: Treatment of lipoma with PPC formula has the potential to be a patient-friendly and well-tolerated therapy that can achieve cosmetically pleasing treatment outcomes.

Treatment of Striae Distensae by Thermage and 585-nm Pulsed Dye Laser(V-star(R)) / 대한피부과학회지

Striae Distensae is a very common cosmetic problem. The effectiveness of various lasers, such as the 585-nm pulsed dye laser on the treatment of striae distensae has recently been reported. However, the potential pigmentary alteration of dark skin by pulsed dye laser is known. Thermage is a radiofrequency capable of delivering higher energy fluences to a greater volume of tissue than nonablative lasers, with no epidermal injury. We report three patients who had striae distensae. They were treated with Thermage and 585-nm pulsed dye laser. The treatment was effective and safe for dark skin.

A Case of Hidroacanthoma Simplex / 대한피부과학회지

Hidroacanthoma simplex is a rare skin tumor which most often develops on the lower extremity of an elderly person. Clinically, the lesion appears as a well-demarcated brownish flat or verrucous plaque, resembling seborrheic keratosis or Bowen's disease. Histologically, it is characterized by intraepidermal nests of basaloid cells within an acanthotic epidermis. there is some controversy over the histogenesis of hidroacanthoma simplex, many consider it an epidermal tumor differentiation into intraepidermal eccrine duct cells. We report a case of hidroacanthoma simplex presented a small verrucous papule on the left foot with the results of an immunohistochemical study.

Immunohistochemical Expression of Placental Form of Glutathione S-transferase (GST-pi) in Fetal Skin / 대한피부과학회지

BACKGROUND: Glutathione S-transferases(GST) are a family of multi-functional enzymes involved in cellular detoxification and excretion of a variety of exogenous and endogenous toxic or carcinogenic compounds. The GST family has been divided into three classes, alpha, mu, and pi, based on substrate specificity and sequence homology. GST-pi is an acidic type and predominant in skin, small intestine, breast, lung and prostate. The overexpression of GST-pi associated with skin tumor and tumor-like lesion suggests that GST-pi is a major detoxifying enzyme in skin tumors. OBJECTIVE: The purpose of this study was to observe the expression and the distribution pattern of GST-pi in the human fetal skin. METHODS: Skin was obtained from the scalp, chest, and sole of 49 human fetuses, ranging from 8th to 40th weeks of gestational age. Immunohistochemical staining was performed using avidin biotin peroxidase complex method on paraffin embedded tissue using antirabbit polyclonal antibody against the human GST-pi. RESULTS: GST-pi was expressed in intermediated layer of epidermis at 8th week, and gradually increased in strength of expression stronger in suprabasal layer. In hair unit, GST-pi was expressed in sebaceous gland, bulge, hair matrix cell and outer root sheath cell from 15th week. In eccrine gland, also GST-pi was expressed in central differentiated cells of intradermal eccrine duct from 18th week, and in terminal duct and acini from 26th week of fetal age. CONCLUSION: GST-pi was expressed from the 8th week of gestation suggesting that GST-pi plays an important role in detoxification for the protection of the skin in fetal stage from the various toxic agent.

The Expressions of Androgen Receptors and Estrogen Receptors in Bald and Non-bald Area of Androgenic Alopecia / 대한피부과학회지

BACKGROUND: Androgenic alopecia, commonly known in men as male pattern baldness is the gradual balding of the scalp in response to androgens in genetically predisposed individuals. Androgens can gradually transform large scalp hair follicles to smaller vellus ones, causing balding. The mechanisms involved are unclear, although androgens are believed to act on the epithelial hair follicle via the mesenchymal derived dermal papilla. During pregnancy, hair growth is increased, as estrogen appears to prolong the anagen phase, and postpartum hair loss may be related to a rapid decrease in estrogen. OBJECTIVE: The aim of the present study was to evaluate the difference of the expressions of androgen receptors(AR) and estrogen receptors(ER) by monoclonal antibodies in biopsy specimens between bald area and non-bald area. METHODS: Immunohistochemical analysis of AR and ER receptor were preformed on the paraffine-embedded tissue sections of bald area and non-bald area in 6 cases of androgenic alopecia using anti-AR and anti-ER monoclonal antibodies with avidin-biotin peroxidase complex procedure. RESULTS: The results were that androgen receptors were higher level in bald area and estrogen receptors showed no difference between bald and non-bald area. CONCLUSION: This study supports that locally increased androgen activities may be related with hair loss in androgenic alopecia and estrogens have less relationship in the pathogenesis of androgenic alopecia.

A Case of Desmoplastic Melanoma / 대한피부과학회지

Desmoplastic melanoma is a rare variant of the spindle cell melanoma that first was recognized and described in 1971 as an invasive fibrosarcoma-like tumor that exhibits an abundant collagenous stroma. These tumors usually arise in sun-damaged skin of the head and neck in older persons, in association with lentigo maligna or de novo. The clinical presentation is often not characteristic, and they may clinically simulate other tumors of the skin. Hence they are often diagnosed late. Histologically, desmoplastic melanoma appears as a nodule of fibrous tissue containing hyperchromatic pleomorphic spindle cells that either are scattered singly, lie in fascicles, or aggregate in nests, and collagenous tissue replacing the reticular dermis. Immunohistochemistry is usually quite helpful as the tumors are almost always immunoreactive with S-100 protein and negative for HMB-45. We report a case of desmoplastic melanoma in a 67-year old male who had a walnut sized tumor upon large indurated plaque on the left thigh. A biopsy specimen of the tumor showed that fascicles of spindle cells are interspersed throughout collagenous tissue and most tumor cells are immunoreactive with S-100 protein. To our knowledge, this is the first case report in Korea.

Two Cases of Lichen Amyloidosis Stained Negatively for Antikeratin Antibodies / 대한피부과학회지

Localized primary cutaneous amyloidosis consists of three types: nodular, macular, and lichenoid amyloidosis. Lichen amyloidosis is characterized by the appearance of paroxysmally itchy lichenoid papules on the shins. Although the origin of the amyloid is controversial and can not provide any definite answer, some of amyloid substances can be derived from epidermal cells and others from degenerative collagen fibers. We suggested the origin of amyloid in our cases as epidermal keratinocyte and collagen degenerations. Because degeneration of basal keratinocyte is observed on electron microscopy and degeneration of collagen is in H&E and Masson's trichrome stain although amyloid materials are negatively stained against pankeratin antibody and collagen antibody. The skin lesion was improved after triamcinolone intralesional injections which reduce collagen synthesis. We report two cases of lichen amyloidosis which stained negatively for antikeratin antibodies and improved with triamcinolone intralesional injection.

A Case of Tinea Incognito on the Face due to Trichophyton mentagrophytes / 대한피부과학회지

Recently, we have encountered an increasing number of patients who have obtained topical steroids to self-treat various dermatosis. Tinea incognito has been used to describe a dermatophyte infection modified by corticosteroid treatment. Lesions are often atypical appearing and the diagnosis can be delayed or missed. We report a case of tinea incognito with ill-defined erythematous patch and nodules on the right upper eyelid and taken intermittently application with corticosteroid ointment over a period of l year. Mycologic studies including KOH mount and fungus culture were positive for hyphae and colonies of Trichophyton mentagrophytes. The lesion was treated with of itraconazole and cured 3 weeks later.

A Case of Allergic Contact Dermatitis from Calcipotriol(Daivonex(R)) / 대한피부과학회지

The vitamin D3 analogue calcipotriol ointment(Daivonex(R)) has now been used successfully in the treatment of psoriasis for several years. It is usually well tolerated and safe. The adverse effects are mainly lesional and perilesional irritations, facial irritations, hypercalcemia, etc. The nature of calcipotriol-induced dermatitis is usually considered to be of irritant nature but allergic contact reactions have also been reported. We report a case of allergic contact dermatitis from calcipotriol (Daivonex(R)).