Clinical Study of Facial Psoriasis / 대한피부과학회지

BACKGROUND: Many clinicians tend to assume that psoriasis rarely involves the face, and therefore have little interest in facial psoriasis. However, the face is the most important area of cosmetic concern and social activity, and facial involvement of psoriasis is more common than we think. A few reports have even suggested that facial psoriasis could be a marker of severe psoriasis. OBJECTIVE: To investigate the epidemiological and clinical characteristics of facial psoriasis. METHODS: A total of 235 patients with facial psoriasis were enrolled in this retrospective study at the psoriasis clinic, Department of Dermatology, Seoul National University. Epidemiological and clinical data from patient records was collected and analyzed. RESULTS: The most frequent age of onset for facial psoriasis was in the 3rd decade of life. The peak age of onset of facial psoriasis in male patients was in the 3rd and 4th decade of life, whilst for female patients it was in the 3rd decade. Most patients had presented with facial psoriasis before they were 40. The sites of the face most often affected were the upper (73.9%) and lower (46.2%) aspects of the forehead and periauricular area (45.7%). The eyelid, perioral area and nasolabial fold were relatively unaffected. Patients who had scalp-unrelated facial psoriasis presented with a more severe condition than patients who only had scalp-related facial psoriasis. With reference to the extent of psoriasis, 43.8% of patients were moderate cases, whereas 29.6% were mild and 26.6% were severe. With reference to the activity, 40.3% of patients were mild, while 38.5% were moderate and 21.2% were severe. Family history was observed in 39.9% of patients and nail involvement was observed in 27.7% of patients. Only 38.2% of patients had no pruritus, while 16.3% of patients experienced moderate or severe pruritus. CONCLUSION: The present retrospective analysis contributes to our understanding of the clinical characteristics of facial psoriasis.

Pseudolymphoma Induced by Ear Piercing

We present a patient who developed a pseudolymphoma after ear piercing. A patch test showed gold sensitivity. Therefore, long standing dermal exposure to gold from a pierced-type earring might have produced the patient's disease. This patient did not respond to an intralesional steroid injection and was finally treated with a complete resection of the lesion. It is proposed that every patient with a hyperplastic lesion in the ear lobe should be taken a biopsy in order to rule out the possibility of a pseudolymphoma. When a pseudolymphoma develops in the ear lobe, a complete surgical excision could be the treatment of choice, especially for the prevention of recurrence.

Comparison of Calcipotriol Monotherapy and a Combination of Calcipotriol and Methylprednisolone Aceponate Therapy in Psoriasis Patients

BACKGROUND: Complete clearance of the lesions by using calcipotriol alone have not been re-ported commonly in the treatment of psoriatic patients. Moreover, lesional and perilesional irritation are reported in some patients using calcipotriol, which may result in premature termination of the treatment due to impairing the compliance. OBJECTIVE: A clinical study was conducted to determine whether, in the topical treatment of psoriasis, a combination of calcipotriol cream and methylprednisolone aceponate was more effective than calcipotriol monotherapy. METHODS: Twenty-one psoriasis patients who had the symmetric lesions on the right and left lower legs were enrolled in the study. A combination of calcipotriol cream and methylprednisolone aceponate therapy was done on the left lower legs, whereas calcipotriol alone was applied on the right lower legs twice daily. PASI score and adverse events were recorded at each visit (1, 2, 3, 4, 6 week). The overall therapeutic result was also assessed by the physician and patients. RESULTS: The initial PASI score was 7.09 on both legs. After 6 weeks, the mean PASI score was 3.85 on the left leg, and 5.70 on the right leg (p<0.05). In the physicianOs global assessment, the percentage of patients who showed the improvement of more than half of lesions was 29% in the monotherapy and 62% in the combination therapy area. Two patients complained of mild itching sense on monotherapy, but there was no specific side effect on combination area. CONCLUSION: The combination therapy was more effective, as assessed by all evaluated variables. Furthermore, this combination reduces the adverse effects caused by long-term use of topical corticosterois as well as the irritation associated with. calcipotriol.

Effects of N6-L-phenylisopropyl Adenosine in Rats after Asphyxial Cardiac Arrest

PURPOSE: Cardiac arrest and resuscitation produce global cerebral ischemia and reperfusion injury to the brain, which lead to high mortality and delayed neuronal death. Adenosine has been suggested as an endogenous neuroprotective molecule, acting through multiple potential mechanisms. We investigated the possible neuroprotective effects of adenosine on cerebral recovery following global ischemia induced by asphyxial cardiac arrest. METHODS: Twenty-four rats were randomized into three groups. Group I, II, and III had anesthesia, procedures, and asphyxia for 7 minutes and then survived to 72 hours. Group I(n=8) was not administered N6- L - phenylisopropyl adenosine(L-PIA). Group II(n=8) was administered LPIA(0.8 mg/kg), and group III(n=8) was administered LPIA(1.5 mg/kg) after spontaneous circulation. The dosedependent neuroprotective effects of L-PIA were compared to the control by using a histopathological method. RESULTS: Histological observations of CA1 showed a more significant reduction of neuronal cell loss in groups II and III than in group I(p<0.05). Histological observations of CA2 and CA3 didn't show a significant reduction of neuronal cell loss in groups II and III compared to group I. CONCLUSION: These results show that post-ischemic administration of adenosine protected against delayed neuronal damage in the hippocampal CA1 area following a 7-min asphyxial cardiac arrest in rats.

A Case of Acute Hemorrhagic Edema of Childhood / 대한피부과학회지

Acute hemorrhagic edema of childhood is an uncommon form of cutaneous leukocytoclastic vasculitis that occurs in children younger than 3 years. This is characterized by tender edema and rosette-shaped purpuric patches that generally resolve without intervention. We describe a 26-month-old boy with acute hemorrhagic edema of childhood, in whom the disease appeared after an acute respiratory illness. Skin lesions presented with acral edema, and rosette-shaped purpuric plaques on the face and limbs. Some authors consider the disease as a purely cutaneous form of Henoch-Schoenlein purpura, but it is more likely that acute hemorrhagic edema of childhood could be regarded as a distinct entity within leukocytoclastic vasculitis.

A case of protein contact dermatitis / 천식및알레르기

A 24-year-old woman complained of chronic eczematous lichenified skin lesions with itching on both hands. The lesions were distributed mainly on the lateral and dorsal sides of the fingers. She had a history of atopic dermatitis and noticed itching sensation followed by erythema within minutes of contact with salmon at the respective contact sites, and subsequent formation of papules. Additionally, the ingestion of salmon resulted in swelling on her lips and throat. She had been working as a cook for 2 years and her sister had suffered from allergy to metal. Patch test with Korean standards and bakery series yielded positive to nickel and cobalt without clinical relevance. In a standardized skin prick test, strongly positive reactions to raw salmon and red snapper were observed after 20 min, but a patch test with the same substances was negative. We report a case of protein contact dermatitis due to salmon and red snapper.

A Case of Typical Pigmented Spindle Cell Nevus / 대한피부과학회지

Pigmented spindle cell nevus is a rare lesion characterized by uniform, expanding, heavily pigmented macule or papule, usually located on the thigh of a woman in the second and third decade of life. It is often misdiagnosed as Spitz nevus or malignant melanoma. A 30-year-old woman presented with black, smooth macule on her thigh. Histopathological examination confirmed the diagnosis as pigmented spindle cell nevus. This is thought to be a more typical case than previously reported two domestic cases.

Four Cases of Cutaneous Metastasis to the Scalp from Internal Malignancies / 대한피부과학회지

Cutaneous metastases from internal malignancies are relatively infrequent. The frequency of cutaneous metastases varies from 0.5 to 4.4%. Most metastases are located in close proximity to the primary neoplasm. But, the scalp is a comparatively common site of cutaneous metastasis. Various types and sites of primary tumors have been reported to disseminate to the scalp. We report four cases showing scalp metastases which developed as nodules or alopecic patch, and discuss the tendency of metastases to the scalp from internal malignancies.

Effects of a Protein Synthesis Inhibitor on Hippocampal Neuronal Damage of Rats in the Ventricular Fibrillation Cardiac Arrest Model

BACKGROUND: The goal of successful resuscitation is not only to stop the process of ischemia as soon as possible but also to overcome the secondary injury process after resuscitation, which involves a complex interplay of mechanisms. Brain damage accompanying cardiac arrest and resuscitation is frequent and devastating. Cells die by one of two mechanisms: necrosis or delayed neuronal death. Delayed neuronal death may require protein synthesis. Neurons in the CA1 subfield of the hippocampus are selectively vulnerable to death after injury by ischemia and reperfusion. Death of these neurons occurs after an interval of 1 or 2 days. We assessed the effects of a protein synthesis inhibitor, cycloheximide(CHX), on hippocampal neuronal death of rats by using the ventricular fibrillation cardiac arrest(VFCA) model. METHODS: The effect of CHX(3mg/kg, s.c.) on hippocampal neuronal death was studied in two groups of 18 rats each, one group being subjected to a 2-min VFCA and the other to a 3-min VFCA. Each group was divided into three subgroups: control(group I,II) without subcutaneous injection of CHX, 'exp-12' of group I/II treated with CHX 12 hours after return of spontaneous circulation (ROSC), and 'exp-24' of group I/II treated with CHX 24 hours after ROSC. The coronal sections of the hippocampus levels were stained with hematoxylin-eosin after 72 hours of survival. The histologic damage score(HDS) was used to assign a score to the total number of damaged neurons counted in each of the hippocampal CA1 subfields. RESULTS: 1. There were not significan differences in heart rates, blood pressures, blood sugar, and blood gas in group I & II during the pre-arrest steady state or at 5 min and 30 min after ROSC. 2. In group I & II, the HDS, were significantly reduced in rats(I exp-12, 1.1+/-0.6; I exp-24, 1.3+/-0.5; II exp-12, 1.4+/-0.7; and II exp-24, 1.8+/-0.8) treated with CHX 12 hours or 24 hours after ROSC than control rats(I, 2.5+/-0.9, II, 2.9+/-0.8)(p<0.05). CONCLUSION: These results suggest that delayed hippocampal neuronal death from ischemic insult after ventricular fibrillation cardiac arrest followed by resuscitation can be prevented by a protein synthesis inhibitor, CHX. Further experimental studies of the action mechanism of protein synthesis inhibitors to delayed neuronal death and clinical applications are required.