Giant Becker's Nevus with Agminated Lentigine / 대한피부과학회지

We report a case of a 27-year-old male showing Becker's nevus on his trunk and lower extremities. It represented symmetrically bilateral and extensive(about 50% of body surface) involvement. In addition to the usual clinical findings of Becker's nevus, grouped small darker spots were noted on the lesion of the buttock featuring agminated lentigine. Histologic findings of the brownish pigmented lesion consisted of mild acanthosis, hyperkeratosis, elongation of rete ridges, increase of basal layer pigmentation, and numerous terminal hair follicles. A dark macule in agminated lesions on the buttock showed more dense basal layer pigmentation and more regular elongation and fusion of rete ridges consistent with the histologic findings of lentigo simplex. This report describes a rare case of a giant Becker's nevus involving 50% of body surface in a bilateral and symmetrical distribution with associated agminated lentigine.

Giant Becker's Nevus with Agminated Lentigine / 대한피부과학회지

We report a case of a 27-year-old male showing Becker's nevus on his trunk and lower extremities. It represented symmetrically bilateral and extensive(about 50% of body surface) involvement. In addition to the usual clinical findings of Becker's nevus, grouped small darker spots were noted on the lesion of the buttock featuring agminated lentigine. Histologic findings of the brownish pigmented lesion consisted of mild acanthosis, hyperkeratosis, elongation of rete ridges, increase of basal layer pigmentation, and numerous terminal hair follicles. A dark macule in agminated lesions on the buttock showed more dense basal layer pigmentation and more regular elongation and fusion of rete ridges consistent with the histologic findings of lentigo simplex. This report describes a rare case of a giant Becker's nevus involving 50% of body surface in a bilateral and symmetrical distribution with associated agminated lentigine.

Acquired Generalized Blue Nevi

Blue nevus is a benign melanocytic neoplasm and represents itself usually as a solitary blue or blue-black papule. It rarely occurs as multiple lesions grouped in a circumscribed area. How-ever, non-grouped disseminated blue nevi are exceedingly rare. We report a patient with acquired multiple blue nevi that was distributed over the entire body discretely and showed an increase in the number of the nevi without any causal factors.

Age, Gender and Seasonal Variations of skin Pigmentation Levels in Koreans / 대한피부과학회지

BACKGROUND: Human skin color shows variations throughout life and many extrinsic and intrinsic factors influence melanogenesis. The characteristics of skin pigmentation have been studied largely in white Caucasians. However, pigmentary changes due to various regulatory factors may be different in Orientals. OBJECTIVE: We observed the variations in skin color due to aging, seasonal changes and gender differences in Koreans with skin type IV or V. METHODS: Skin pigmentation was measured at five body sites (buttock, glabella, V-neck area, inner arm, and dorsal forearm) using skin reflectance spectroscope in 109 subjects in winter and summer. RESULTS: Constitutive pigmentation of the buttock was at the highest level in the first decade of life. It then decreased during the next two decades. This decreased level was maintained after the third decade. The pattern of pigmentation changes of other four sites with aging was similar to that of the buttock. Gender differences were significant except in the first decade. Seasonal change of pigmentation level was observed in dorsal forearm. Interestingly, our study did demonstrate some differences from the observations in Caucasians. We found that facultative pigmentation in Koreans was not increased with aging, so the sun exposure index was not reliable as a measure of cumulative lifetime UV exposure. CONCLUSION: These differences between races could imply that genetically determined basal skin color has important effects on characterizing later responsiveness to UV lights and sex hormones. Understanding these differences in skin pigmentation would be helpful in treating pigmentary diseases and skin cancers, and in studying the regulatory mechanisms of melanogenesis.

A Case of Pseudo-Kaposi's Sarcoma; Mali's variant / 대한피부과학회지

We report herein a 82-year-old male patient having pruritic purple or violaceous grouped papules and nodules based on the dark bluish plaques of a 5-year duration on both dorsa of the feet and toes. Also he complained of moderate-degree pitting edema and varicose veins for 30 years on both lower legs. We diagnosed his skin lesion as Mali variant of pseudo-Kaposi's sarcoma probably caused by chronic lymphedema and venous insufficiency.

A Case of Herpes Gestationis Treated with Cyclosporine / 대한피부과학회지

Herpes gestationis is a rare pregnancy-associated autoimmune bullous disease resembling bullous pemphigoid in both clinical and immunohistopathological aspects. Generally it may be improved spontaneously or easily controlled by topical or low-dose corticosteroid. Very rarely, however, severe and long-standing cases that did not respond to high-dose corticosteoid therapy were reported. We present a case of an unusual severe herpes gestationis in a 26-year-old woman that was resistant to high-dose corticosteroid and/or dapsone therapy. But the lesions responded dramatically to low-dose cyclosporine.

Reactive Perforating Collagenosis Arising at the Site of Healed Herpes Zoster / 대한피부과학회지

Isotopic response describes the occurrence of a new skin disorder at the site of another one, already healed and unrelated. The preceding diseases are mostly herpes zosters. Reactive perforating collagenosis is rare dermatosis that has characteristic histopathologic features; transepidermal elimination of degenerated dermal collagen fibers. There has been only one report of an reactive perforating collagenosis occurring on the healed site of herpes zoster. We present a case of acquired reactive perforating collagenosis that was developed on the site previously affected by herpes zoster in a 67-year-old woman, which is thought to be an isotopic response.

A Case of Trichoblastoma

Trichoblastoma includes all benign follicular germinative cell tumors in skin. We presented a case of trichoblastoma which occurred on the scalp as a large pedunculated tumor. The tumor was composed of lobular aggregations of basaloid epithelial cells and numerous primitive papillary mesenchymal bodies. Stromal retraction was observed between the stroma adjacent to epithelial nests and surrounding normal dermis. Focal connection to the overlying epidermis was observed. The classification and terminology for the benign neoplasms with follicular differentiation was discussed.

Spontaneous expression of mRNA for IL - 10, GM - CSF and TNF - alpha in peripheral blood mononuclear cells from patients with atopic dermatitis / 천식및알레르기

BACKGROUND: Monocytes and T helper cells play major roles in the immunologic dysfunction of atopic dermatitis (AD). Many studies have been done on the cytokine pattern to evaluate abnormalities or differences of immune cells in AD, but the results were conflicting among studies and most of these previous reports were performed with various kinds of mitogen-stimulation. OBJECTIVE: The purpose of this study was to investigate spontaneous cytokine pattern in peripheral blood mononuclear cells (PBMC) from patients with AD. We focused on the expression of monokines that had effects on monocytes and T cells. METHODS: We measured mRNA expression of IL-10, GM-CSF and TNF-alpha in freshly isolated PBMC with semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR). The intensity of cytokine cDNA was normalized to that of beta-actin product as a standard marker. RESULTS: IL-10 mRNA expression was significantly enhanced in AD compared:with control subjects (p<0.05). Spontaneous mRNA expression of TNF-alpha was significantly lower in AD patients (p <0.01). The level of GM-CSF mRNA expression was heterogeneous and spontaneous mRNA expression was slightly increased in AD although the difference did not reach the level of statistical significance. CONCLUSION: Our data was able to represent in vivo cytokine expression state of PBMC in atopic dermatitis. Increased expression of IL-10 and GM-CSF may have been associated with monocyte dysfunction in AD although increase in the expression of GM-CSF mRNA was not statistically significant. TNF-alpha mRNA expression was decreased in AD and increased IL-10 was suggested to exert an inhibitory effect on the expression of TNF-alpha mRNA.

A Case of Erythema Nodosum-like Leukemia Cutis in a Patient with Myelodysplastic Syndrome / 대한피부과학회지

Myelodysplastic syndrome (MDS) may show various kinds of skin lesions including leukemia cutis. Frequently MDS may progress into blast transformation accompanied with the skin lesions. We present a case of MDS with multiple painful subcutaneous nodules on both extremities in a 52-year-old man. He had been suffered from MDS (RA type) for 18 months. These subcutaneous nodules showed the findings of erythema nodosum histopathologically, but obvious evidence of blast transformation was not observed.

Assessment of Quality of Life in Patient with Toenail Onychomycosis in Korea / 대한의진균학회지

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.

A Case of Darier Disease with Typical Nail Changes / 대한피부과학회지

Darier disease is a rare genodermatosis clinically characterized by multiple hyperkeratotic papules and plaques predominantly on seborrheic areas. It has characteristic histopathological features; corps-ronds, grains, suprabasal clefts or lacunae, villi projections etc. We present a case of Darier disease in a 36-year-old woman. She had suffered from skin lesions which bore a great resemblance to those of verruca plana or eruptive syringoma. We could confirm the diagnosis as Darier disease because she had the characteristic nail changes.

A Case of Callus Induced By Tophi / 대한피부과학회지

Callus is a nonpenetrating circumscribed hyperkeratosis produced by repeated friction or pressure. It occurs on parts subjected to intermittent pressure, particularly on the palms and soles, and particularly over the bony prominences of the joints. In painful callosities of the feet, ill-fitting shoes and orthopedic problems of the foot (bunions, exostoses) are some of the etiological factors to be considered. Gout is a condition of inborn metabolic and/or acquired form of the disease characterized by hyperuricemia, tophaceous deposits of sodium urate and recurrent attacks of arthritis. We present a case of callus caused by tophi. The patient was a 45-year-old man who had complained of a painful, well-demarcated, hyperkeratotic plaque on the heel of the left foot for 18 months. After the tophi beneath overlying whitish thickened skin had been removed, the skin lesion disappeared and to date has not recurred.

A Case of Solitary Myofibroma in Adult / 대한피부과학회지

Myofibroma and myofibromaiosis are uncommon, benign, mostly self-limiting, probably hamartomatous proliferation of myofibroblasts. These tumors are most often present at birth or before the age of 2 years with multiple ot solitary lesion. Adult cases are rare and most,ly showed as a solitary lesion. We present a case of solitary myofibroma that developed on the vertex of scalp in a 51-year-old man. The lesion was a mild tender and intermittent pruritic firm, pedunclated 1 1cm sized tumor. The iumor was diagnosed as myofibroma by light microscopy and immunohistochemistry.