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Background@#The forehead is a region connected to the scalp and is accompanied by various structures. In some tumors, the pattern of development may differ from that of other anatomical sites. When a noninflammatory skin-colored tumor develops on the forehead, it is difficult to diagnose accurately. @*Objective@#This study aimed to identify the epidemiologic data and clinical features of noninflammatory skin-colored tumors of the forehead. @*Methods@#We retrospectively reviewed the medical records of 200 patients with noninflammatory, skin-colored tumors diagnosed after skin biopsy over a period of 11 years. We evaluated tumor prevalence, clinical features, and differences according to sex and age. If the tumor was large and deeply located, a radiologic study was performed. @*Results@#Of the 12 different histopathologic results, lipoma (52.0%) was the most frequent, followed by epidermal cyst (17.0%), osteoma (13.5%), steatocystoma (6.0%), and pilomatricoma (3.5%). Statistical analysis showed that females were dominant in the osteoma group. For an accurate diagnosis, 25 of the 52 patients who underwent computed tomography were diagnosed with lipoma, and 19 (76.0%) of them were identified as deep-seated lipoma. @*Conclusion@#The most common tumor among noninflammatory, skin-colored tumors of the forehead was lipoma.When they occur on the forehead, the proportion of deep-seated lipomas is higher than that at other sites. In the case of a solid and fixed tumor, a deep-seated lipoma should be considered. Computed tomography should be performed in addition to ultrasonography because the sensitivity of ultrasonography for the diagnosis of deep-seated lipoma is unsatisfactory.
ABSTRACT
Juvenile temporal arteritis (JTA) is a non-giant cell inflammation of the temporal artery, characterized by eosinophilic infiltration. It generally affects both adolescents and young adults. JTA is clinically represented by an asymptomatic, palpable lump in the temporal area, with no associated signs, such as fever, myalgia, or visual symptoms. A 38-year-old female presented to our hospital with a history of bilateral linear plaques in both temporal areas for 3 months. Histopathological findings of the right temporal lesion showed infiltration of eosinophils and lymphocytes in the arterial wall and intimal hyperplasia but no giant cell or granulomatous lesions. Doppler ultrasonography revealed a tortuous tubular anechoic lesion, with non-visualization of internal vascular flow. Laboratory findings highlighted eosinophilia of up to 13.8% and a total immunoglobulin E level of 1,182 IU/mL. Here, we report a rare case of bilateral JTA with eosinophilia.
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Background@#Cellulitis is one of the most common infectious skin diseases treated by hospitalization, and presents with various clinical features and treatment responses. Therefore, more detailed analysis on this condition is required. @*Objective@#To investigate the clinical characteristics of cellulitis among dermatology inpatients in a single center. @*Methods@#We retrospectively reviewed the medical records of 84 patients hospitalized with cellulitis between January 2012 and August 2020. We analyzed the differences by dividing them into ＜60-year-old and ＞60-year-old age groups. @*Results@#The average age of the 84 inpatients in this study was 48.8 years with the peak incidence in fifties.Cellulitis was most prevalent in the calf (39.8%). Erythrocyte sedimentation rate (ESR) and risk factors such as obesity and smoking had positive correlations with duration of hospital stay (p＜0.05). There was no significant difference in duration of hospital stay between those administered first-generation cephalosporin and other antibiotics. @*Conclusion@#Our data showed that ESR, obesity, and smoking were correlated to the hospitalization periods. In particular, it showed positive correlation of C-reactive protein and ESR with duration of hospital stay in those below the age of 60 years.
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Background@#Cellulitis is one of the most common infectious skin diseases treated by hospitalization, and presents with various clinical features and treatment responses. Therefore, more detailed analysis on this condition is required. @*Objective@#To investigate the clinical characteristics of cellulitis among dermatology inpatients in a single center. @*Methods@#We retrospectively reviewed the medical records of 84 patients hospitalized with cellulitis between January 2012 and August 2020. We analyzed the differences by dividing them into ＜60-year-old and ＞60-year-old age groups. @*Results@#The average age of the 84 inpatients in this study was 48.8 years with the peak incidence in fifties.Cellulitis was most prevalent in the calf (39.8%). Erythrocyte sedimentation rate (ESR) and risk factors such as obesity and smoking had positive correlations with duration of hospital stay (p＜0.05). There was no significant difference in duration of hospital stay between those administered first-generation cephalosporin and other antibiotics. @*Conclusion@#Our data showed that ESR, obesity, and smoking were correlated to the hospitalization periods. In particular, it showed positive correlation of C-reactive protein and ESR with duration of hospital stay in those below the age of 60 years.
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Diabetic radiculoneuropathy is an uncommon complication of diabetes mellitus that can affect the cervical, thoracic, or lumbosacral nerve roots. When the thoracic nerve roots are affected, it can cause truncal pain and, more rarely, abdominal bulging. A 62-year-old man with diabetes developed sudden pain in his right abdomen with subsequent distention overlying the area for 10 days. Neither vesicular eruptions nor cutaneous scarring was noted. Imaging scans of the abdomen and spinal cord did not reveal any other causes of abdominal distention. Needle electromyography showed evidence of radiculoneuropathy in the right thoracic regions (T6 through T9), and nerve conduction study of the upper and lower extremities also showed evidence suggestive of severe distal symmetric polyneuropathy. With the exclusion of any apparent causes of abdominal distention, a diagnosis of diabetic radiculoneuropathy was made.
ABSTRACT
Background@#Facial herpes zoster can be accompanied by several complications. In particular, postherpetic neuralgia (PHN) and ocular complications (OCs) are relatively common. Both PHN and OC are of interest because they can lower the quality of life. @*Objective@#This study aimed to evaluate the clinical features of facial herpes zoster and to assess the risk factors of OCs and PHN. @*Methods@#We analyzed the medical records of 146 patients with facial herpes zoster from January 2014 to May 2019. We assessed the proportion of OCs and PHN in patients with facial herpes zoster according to several clinical factors, including age, sex, dermatomal distribution, delayed time to treatment, and associated systemic conditions. OCs were divided into mild and severe ocular complications (SOC) by ophthalmologic diagnosis. @*Results@#The incidence rate of OCs (83.8%) and SOC (37.8%) were highest in patients in their 70s. Herpes zoster involving the ophthalmic and maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of OCs and SOC than those involving only the ophthalmic branch (p=0.031, p=0.025). Patients who received antiviral treatment within 4 days showed lower rates of OCs and SOC than patients who received treatment after 5 days (p＜0.001, p=0.003). The incidence of PHN was significantly higher in those over 60 years old, when both the ophthalmic and maxillary branches were involved, and for those treated more than 4 days after the onset. @*Conclusion@#To decrease the risk of OCs and PHN in facial herpes zoster, it is important to provide early antiviral treatment and appropriate ophthalmologic consultation.
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Metastatic skin cancers are a relatively uncommon malignant tumor. Visceral tumors such as breast, lung, and colon cancers are commonly found to be the primary origin. Cutaneous metastasis with esophageal cancer is exceedingly rare, accounting for less than one percent of all skin metastasis. Here, we report a case of cutaneous metastatic squamous cell carcinoma that originated from esophageal carcinoma. The patient was a 48-year-old male who complained of a 2-cm-sized non-tender, skin-colored nodule on his left lower back. Positron emission tomography-computed tomography (PET-CT) showed focal fluorodeoxyglucose (FDG) uptake in the lesion. In the histopathological examination, the tumor cells stained positive for epithelial membrane antigen (EMA) and cytokeratin 5/6 (CK5/6), which was consistent with squamous cell carcinoma. This case suggests that patients who have been treated for primary esophageal carcinoma should undergo a skin biopsy to rule out metastatic skin cancer if the tumor appears to be suspicious.
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Background@#Alopecia areata is an autoimmune disease that presents as non-scarring hair loss and can affect all age groups. The clinical course of alopecia areata is unpredictable. @*Objective@#This study aimed to analyze the characteristics, treatment response, and relapse rate of alopecia areata in patients of different ages with long-term follow-up. @*Methods@#The medical records of 121 patients diagnosed with alopecia areata were retrospectively reviewed, and their prognosis was assessed on the basis of various indices. @*Results@#A total of 121 patients, including 24 cases of childhood-onset, 83 adult-onset, and 14 late-onset alopecia areata, were analyzed. In the first episode, 72.7%, 14.7%, and 9.9% of patients had mild, moderate, and severe alopecia areata, respectively. A significant and complete response was observed in 66.7%, 89.2%, and 100% of childhood-onset, adult-onset, and late-onset patients, respectively. The duration of the initial episode showed a negative correlation with age. The overall frequency of relapse was 47.1%, whichc significantly declined with time, with a majority (63.3%) of relapses occurring in the first year. Younger age at initial presentation and thyroid diseases were strongly associated with poor prognosis. @*Conclusion@#Younger patients showed a tendency of poor prognosis regardless of the prognostic factors. A longer follow-up period might be required for the younger onset patients.
ABSTRACT
Diabetic radiculoneuropathy is an uncommon complication of diabetes mellitus that can affect the cervical, thoracic, or lumbosacral nerve roots. When the thoracic nerve roots are affected, it can cause truncal pain and, more rarely, abdominal bulging. A 62-year-old man with diabetes developed sudden pain in his right abdomen with subsequent distention overlying the area for 10 days. Neither vesicular eruptions nor cutaneous scarring was noted. Imaging scans of the abdomen and spinal cord did not reveal any other causes of abdominal distention. Needle electromyography showed evidence of radiculoneuropathy in the right thoracic regions (T6 through T9), and nerve conduction study of the upper and lower extremities also showed evidence suggestive of severe distal symmetric polyneuropathy. With the exclusion of any apparent causes of abdominal distention, a diagnosis of diabetic radiculoneuropathy was made.
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Leprosy is a chronic infectious and granulomatous disease caused by Mycobacterium leprae. It is treated with a multidrug therapy (MDT), which is consisted of dapsone, rifampicin, and clofazimine. However, there were relapsed leprosy associated with various predisposing factors; persisting organism, multiple involved skin lesions and nerves, HIV infection, monotherapy, inadequate and irregular therapy. Early or late relapses were observed in leprosy. Early onset relapses may occur due to insufficient treatment, and late relapses are probably with persistent bacilli and drug resistant organisms. Herein, we report on an interesting case of a 78-year-old man presented with relapsed leprosy associated with ulcerative skin lesions. The patient was diagnosed with lepromatous leprosy about 40 years ago, and he was treated with dapsone monotherapy and MDT. Our case is thought to have occurred due to persistent bacilli related to irregular therapy.
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BACKGROUND@#Inpatient dermatological consultations are getting more important and, therefore, several studies ofdermatologic consultation from various inpatient departments have recently been reported. However, data regardingthe analyses of these consultations for infectious diseases inpatients are limited.@*OBJECTIVE@#The purpose of this study was to analyze and quantify the patterns of dermatologic consultations referred by the Division of Infectious Diseases.@*METHODS@#We retrospectively reviewed 149 consultation reports for inpatients referred by the Division of Infectious Diseases from January 2014 to May 2019. We analyzed the medical records and noted age, sex, reasons for dermatologic consultation, diagnosis of the dermatoses, and change in diagnosis after the consultation in a single secondary referral center.@*RESULTS@#The percentage of patients who were referred by the Division of Infectious Diseases and consulted by the Department of Dermatology was 13.2%. The most frequent age group was the 7th decade of life (24.8%) and the male to female ratio was 1:1.04. The main reasons for dermatologic consultations were dermatologic disease not related to underlying infectious disease (43.0%), dermatologic disease related to underlying infectious disease (24.2%), and skin lesions related to the treatment (18.1%). The most common dermatoses were infectious disease (40.3%), followed by eczema (22.1%), and drug eruption, erythema and urticaria (19.5%). There were 10 cases in which the diagnosis of undetermined dermatoses was changed after dermatologic consultation.@*CONCLUSION@#This study revealed the distribution of skin disorders inpatients referred by the Division of Infectious Diseases for dermatologic consultation. In conclusion, dermatologists should take an active role in dermatologic consultations for more accurate examinations and treatment of infectious diseases patients.
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Methoxy polyethylene glycol-epoetin beta (Mircera(R), Roche), a third-generation erythropoiesis-stimulating agent (ESA) is known as a continuous erythropoietin receptor activator (CERA). In patients with anemia associated with chronic kidney disease (CKD), it is administered intravenously or subcutaneously. Treatment-related adverse events induced by methoxy polyethylene glycol-epoetin beta occurred in 6%. Hypertension, diarrhea and nasopharyngitis were the most commonly reported adverse events. Cutaneous adverse reactions are rarely experienced with methoxy polyethylene glycol-epoetin beta including maculopapular eruption, facial erythema, and tinea pedis. To the best of our knowledge, no cases of leukocytoclastic vasculitis associated with methoxy polyethylene glycol-epoetin beta have ever been published in medical literature. Herein, we report on a case of leukocytoclastic vasulitis induced by methoxy polyethylene glycol-epoetin beta in a patient with anemia associated with chronic kidney disease.
Subject(s)
Humans , Anemia , Diarrhea , Erythema , Erythropoietin , Hypertension , Nasopharyngitis , Polyethylene , Polyethylene Glycols , Receptors, Erythropoietin , Renal Insufficiency, Chronic , Tinea Pedis , Vasculitis , Vasculitis, Leukocytoclastic, CutaneousABSTRACT
Giant congenital melanocytic nevi (GCMN) are defined as melanocytic nevi that are greater than 20 cm in largest dimension at birth. GCMN is a relatively rare condition, affecting approximately 1 in 20,000 newborns. Patients with GCMN on the posterior axis and in the presence of many satellite nevi are associated with neurocutaneous melanosis. A 37-year-old female with mental retardation had dark brown nevi with hair on her back (paraspinal) and on her lower extremities. In addition, she has multiple satellite lesions distributed over her trunk and extremities. Herein, we present a case that demonstrates a relationship between CNS abnormality and multiple satellite nevus in GCMN patients with a review of the relevant literature.
Subject(s)
Female , Humans , Infant, Newborn , Axis, Cervical Vertebra , Extremities , Hair , Intellectual Disability , Lower Extremity , Melanosis , Neurocutaneous Syndromes , Nevus , Nevus, Pigmented , ParturitionABSTRACT
Angiosarcoma is a rare, aggressive vascular neoplasm of the endothelial cell origin. It is usually seen in male, elderly patients and generally has a poor prognosis due to its high potential for metastasis. They arise at various sites such as skin, soft tissue, heart and great vessels. However, the tumors have a predilection for skin and superficial soft tissue. Most angiosarcomas of the skin arise in the three clinical variant; primary angiosarcoma of the face and scalp in the elderly patients; following lymphedema, and post radiation or trauma. Although, this tumor tend to recur locally and metastasize to the viscera, especially in the lung, but cutaneous metastasis of angiosarcomas from the internal organ are uncommon. Herein, we report a patient with cutaneous metastasis from primary cardiac angiosarcoma in the right atrium.
Subject(s)
Aged , Humans , Male , Endothelial Cells , Heart , Heart Atria , Hemangiosarcoma , Lung , Lymphedema , Neoplasm Metastasis , Prognosis , Scalp , Skin , Vascular Neoplasms , VisceraABSTRACT
Psoriasis vulgaris is one of the most common skin diseases in the world, which is recognized as an autoimmune disease that is caused by genetic and environmental factors. Plaque, guttate, pustular form, and psoriatic erythroderma are known as classical feature of psoriasis with tendency as generalized or sporadic appearance. There are some cases of uncommon forms in the shape and distribution, as nevoid and linear psoriasis. Linear psoriasis is a rare entity and thought as a variant of psoriasis, but its existence is still in debate. Herein, we report an interesting case of 19-year old Korean man with psoriasis, occurring on the right arm, following the line of Blaschko in a linear form.
Subject(s)
Arm , Autoimmune Diseases , Dermatitis, Exfoliative , Psoriasis , Skin DiseasesABSTRACT
BACKGROUND: Kawasaki disease (KD) is an acute inflammation of middle-sized arteries such as the coronary artery. KD is an important disease due to its high mortality rate, which approaches 1-2% without appropriate treatment. Since the various mucocutaneous lesions of KD are related to the dermatologic field, dermatologists should take an interest in this disorder and understand the lesions. OBJECTIVE: To evaluate the characteristics of cutaneous lesions in Korean patients with KD. METHODS: A total of 919 patients with KD were assessed at the department of pediatric cardiology and dermatology, Myongji hospital between January 2006 and December 2010. RESULTS: Of the 919 patients, 566 (61.6%) were diagnosed with typical KD and 353 (38.4%) with atypical KD. KD was most frequent in the 4 year-old group (22.7%), and the ratio of male to female was 1.5:1. Among the mucocutaneous manifestations, erythema of the oropharyngeal mucosa (75.7%) occurred most frequently, followed by polymorphous trunk rash (41.7%), and changes of palms and soles (25.6%). A total of 606 patients (65.9%) with KD had associated diseases as follows: pneumonia (211 patients; 34.8%), pharyngotonsilitis (168 patients; 27.7%), gastroenteritis (132 patients; 21.8%), asthma (15 patients, 2.5%), atopic dermatitis (11 patients, 1.8%). CONCLUSION: Our study shows that change in the lips or oral cavity is the most common mucocutaneous manifestation in both classic and atypical KD. Also, morbiliform rash is the most common pattern of polymorphous rashes. Interestingly, erythema multiforme-like lesions occupied accounted for a considerable portion of KD cases compared to previous studies.
Subject(s)
Female , Humans , Male , Arteries , Asthma , Cardiology , Coronary Vessels , Dermatitis, Atopic , Dermatology , Erythema , Exanthema , Gastroenteritis , Inflammation , Lip , Mouth , Mucocutaneous Lymph Node Syndrome , Mucous Membrane , PneumoniaABSTRACT
Basal cell nevus syndrome (BCNS), or Gorlin Syndrome, is an autosomal dominant disorder, characterized by multiple developmental abnormalities and associated with germline mutations in the PTCH gene. Patients show multiple and early onset basal cell carcinomas (BCCs) in skin, odontogeniccysts in the jaw, pits on palms and soles, medulloblastoma, hypertelorism, and calcification of the falx cerebri. Clinical features of BCCs in these patients are indistinguishable from ordinary BCCs. However, some patients show variable histologic findings in subtypes of BCCs, and only one case associated with several histologic types of BCCs in the syndrome has been reported in Korea. We present a case of BCNS characterized by multiple BCCs, odontogenic keratocysts, multiple palmar pits, and calcified falx cerebri. Histopathologic findings of BCCs showed several patterns, which were nodular, superficial, and pigmented types.