A Retrospective Clinical Epidemiological Study of the Health Care Utilization of the Outpatients in the Dermatologic Field after 1 year's Separation of Dispensary from Medical Practice / 대한피부과학회지

BACKGROUND: Despite 2 years' separation of dispensary from medical practice since year of 2000, many outpatients in Korea have a lack of understanding this separation. In addition, the illegal practices of pharmacists such as medical examination have contributed to the recent problematic situation. OBJECTIVE: We performed this study to evaluate the actual situation of the separation of dispensary from medical practice in the dermatologic field. METHODS: The clinico-epidemiologic analysis of 17 months' data of 18, 230 outpatients was conducted through the available medical records and serial questionnaires. RESULTS: The medical or non-medical institutions that 18, 230 outpatients with skin diseases had chosen at first, were as follows by the order of frequency; pharmacy(78.5%), folk remedies or self-medication(9.8%), dermatologic institutions(5.5%), non-dermatologic medical clinics(3.4%), herb clinics(2.8%). Accordingly, most(94.5%, 17, 223) of the new patients did not select a dermatologic institution for the care of their skin diseases. The patterns of health care utilization of the patients mostly(72.9%) showed a fixed tendency to visit the one particular institution or formula continuously prior to final visit to the research hospitals. Most of the patients(62.8%) firstly visited a pharmacy for their disease care and did not revisit another institution. Since the first visit to a pharmacy, 9.6% of the patients repetitively utilized one or more herb clinic(s) or folk remedies in addition to one or more medical institution(s). The patients utilizing non-dermatologic measures for skin disease care at first, were mostly in their fifties(25.3%). The patients seeking herb medicine or non-dermatologic medical clinics, were in their teens(27.3% and 24.3%, respectively). Of the cases misdiagnosed as another disease or aggravated in the patients choosing non-dermatologic care, fungal infections are most common(24.0%). In front of 97.1% of the patients seeking pharmacy at first, the pharmacists practiced medicine like a physician in a wrong way instead of dispensing a prescription. CONCLUSION: In Korea, the majority of dermatologic clinics has been deprived of a position as an institution for primary care of skin diseases. It is imperative that dermatologists should be granted independent and unconstrained authority in the medical profession for the benefit of their patients.

A Case of Eccrine Carcinoma with Lung Metastasis / 대한피부과학회지

Eccrine carcinoma does not have a characteristic clinical appreranc, but does have a high incidence of metastatic spread. It may arise anywhere in the skin. The microscopic patterns that of an adenocarcinoma, which may be confused with metastatic adenocarcinoma. In the classical type the histologic features varies from fairy well-differentiated tubular structures in some areaslo anaplastic carcinoma in other areas. The patient was a 51-year-old man who showed a painful, tender, right red-calored, 4 x 5crn-sized tumor mass on the right angle of the lower lip for ten years. In the diological examinations multiple metastatic foci were seen on both lung fields, Histopathologic findings of the skin and lung biopsy specimens revealed that of the classic type of eccrine carcinoma like the bove descriptions. Immunocytochemical studies showed a positive reactivity to anti-cytokeratin anti-ibody, anti-CEA antibody, and anti-S-100 protein on the skin and lung biopsy specimens and no he reactivity to anti-S-100 protein on the lung mass. Electronrnicroscopic findings revealed eccrine glaidlar structures such as nunierous mitochondria and dense core granules in the cytoplasm of neoplastic cells. We report a case of eccririe carcinoma with lung metastases baed on the clinical, radiological and histologic findings.

Two Cases of cutis Marmorata Telangiectatica Congenita / 대한피부과학회지

Cutis naarmorata telangiectatica congenita(CMTC) was first lesribed by Van Lohuizen in 1992. Cases of CMTC were reported later under various names, includir gan Lohuizens syndrome, congenital generalized phlebectasia. congential phlebectasia and reticulatever scular nevus. It is charaterized by persistent livedo reticularis, telangiectasia and phlectnsia from birch hand atrophy and superficial ulceration of the overlying skin are uncornmonly encountered. They have a steady improvement with time, however various congenital abnormalties, such as varicosities, hen ariomas, hypoplasia or hypertrophy of soft tissue and bones, rarely generalized congenital fibrornatos ectal and genital anomaliies may be associated in approxirnately 50 percent of patients. In case 1, the patient was 45-day-old female infant with reticulated mottling and atrophy of the skin on the right leg. In case 2, the patient was 30-day-old male infant who depressed, bluish, and reticulated patches on the both upprarms, right side trunk, buttock and loen leg. Decreased circumferences of the affected extremities vas observed in case 2. No other assotated anomalies were found in physical and X-ray examinatiorwlin both cases. The skin biiopsy of bothed similar findings, which revealed mild dilatation and proliferation of capillaries, mild inflammatoryel infiltration and extravasated red blood cells in the dermis. The clinical follow-up, alneast all of th lisions disappeared spont.anously in 1 year at case 1, and some of lesions also disappeared in 3 month, 11 case 2. In addition, we reviewed and summerized the reported cases in Korea.