Intramuscular Neural Distribution of Adductor Pollicis Muscle Spasticity in Cadaver Model Regarding Botulinum Neurotoxin Treatment

Purpose@#The adductor pollicis muscle is frequently targeted for botulinum neurotoxin injective treatment for spasticity. However, there are no injective guidelines for delivering injection to the muscle. @*Materials and Methods@#A method known as the modified Sihler’s method was used to stain the adductor pollicis muscle in 16 specimens to reveal intramuscular neural distribution of the muscle. @*Results@#The most intramuscular neural distribution was located on 1/5 to 3/5 of the muscle regarding midline of 3rd metacarpal bone (0) to the base of the 1st proximal phalanx (5/5). The nerve entry point was mostly located on 0 to 1/5 of the muscle. @*Conclusion@#The result suggests that botulinum neurotoxin should be delivered at the middle of second metacarpal bone via deep injection.

A Case of Majocchi's Granuloma of the Face of an Immunocompetent Patient Caused by Trichophyton rubrum / 대한의진균학회지

Majocchi's granuloma is well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism most commonly associated with Majocchi's granuloma is Trichophyton(T.) rubrum, however, other dermatophytes may be the causative agent. A 44-year-old male patient presented with a 6 month history of two well defined erythematous nodular plaques on his right jaw and preauricular area. Histopathologic findings were consistent with the Majocchi's granuloma, showing perifolliculitis and granulomatous inflammation in the dermis. Many fungal elements were noted within the giant cells of the perifollicular dermis of PAS stained section. T. rubrum was cultured from the biopsy specimen and confirmed by slide culture. After 10 weeks of terbinafine (Lamisil(R)) therapy (250 mg/day), lesions were cleared with mild erythematous patches and atrophic scars.

A Case of Chronic Cutaneous Graft Versus Host Disease with the Clinical Features of Exfoliative Dermatitis

Graft versus host disease (GVHD) has traditionally been divided into acute GVHD and chronic GVHD based on the period it occurs after transplantation. Chronic cutaneous GVHD has traditionally been classified into the lichenoid and scleroderma-like forms. However, unusual clinical forms have been reported such as dermatomyositis, lupus erythematosus and exfoliative dermatitis. A 35-year-old woman presented with a 2 week history of a pruritic maculopapular rash on the whole body. The rash rapidly progressed to confluent erythematous scaly patches and plaques with micaceous scales and this finally led to a generalized exfoliative dermatitis in a 1 month period. Here we present an unusual case of chronic cutaneous GVHD with the clinical features of exfoliative dermatitis. The histopathologic examination demonstrated the lichenoid features of chronic cutaneous GVHD.

A Patient with Delayed Contact Dermatitis to Coral and She Displayed Superficial Granuloma

Contact with coral may cause a rare type of contact dermatitis, and the resulting skin reaction can be divided into different reactions: the acute, delayed and chronic types of coelenterate dermatitis. Granulomas of delayed skin reactions have rarely been reported. Herein, we report on a rare case of a delayed reaction of the skin to coral injury, and the patient displayed superficial granulomas and atypical CD30+ lymphocytes.

Classification of Onychomycosis in Korea / 대한의진균학회지

BACKGROUND: Clinical classification of onychomycosis is commonly divided into 4 clinical types but some authors suggest 5 clinical types. Pathogenic fungi, treatment response and prognosis of onychomycosis are different dependent upon the clinical type. Therefore, suitable clinical classification is necessary before treatment. OBJECTIVE: The primary aim of this study was to investigate the incidence and distribution of 4 clinical types of onychomycosis: distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), total dystrophic onychomycosis (TDO). The secondary aim of this study was to clarify the DLSO, the most common type of the onychomycosis, by dividing it into 4 subtypes. METHODS: The diagnosis of the patients were confirmed by more than 1 positive test among KOH smear, fungus culture, histopathologic test and KONCPA test. Total 817 onychomycotic nails of 589 patients (331 males, 258 females) who visited Department of dermatology, Catholic University, St. Mary hospital between January, 1999 and December, 2006 were included. Clinical photographs and charts of the patients were thoroughly reviewed and divided into 4 clinical types and 4 clinical subtypes in case of DLSO. RESULTS: 1. Out of 817 nails, 623 (76.3%) fell into DLSO and 82 (10.0%) TDO, 65 (7.9%) SWO, 47 (5.8%) PSO, respectively. 2. 623 nails diagnosed to be DLSO were further divided into 4 clinical subtypes: 243 (39.0%) edge types, 211 (33.9%) distal types, 104 (16.7%) linear types and 65 (10.4%) lateral types. 3. 315 males with DLSO were further divided into 4 clinical subtypes: 130 (41.3%) edge types, 96 (30.5%) distal types, 54 (17.1%) linear types and 35 (10.6%) lateral types. Females in the same group also exhibited same ranks in terms of prevalence. 4. Out of 457 big toenails, there were 193 edge types (42.2%), 141 distal types (30.9%), 77 linear types (16.8%) and 46 lateral types (10.1%). Out of 105 other toenails, there were 42 distal types (40.0%), 28 edge types (26.7%), 19 linear types (18.1%) and 16 lateral types (15.2%). CONCLUSION: DLSO composed of 76.3% of onychomycosis were further classified into 4 clinical subtypes. Further clinical studies will be necessary to evaluate the value and efficacy of this subclassification in deciding the treatment methods and presumption of prognosis.