Complex Regional Pain Syndrome of the Upper Limbs Caused by Facial Pain / 계명의대학술지

Polyacrylamide hydrogel is a widely used filler material in cosmetic procedures performed on the face and breasts. Recently, however, complications including inflammation, deformity, and pain have been reported. The present article addresses unregulated materials/products injected as dermal fillers. The authors report a case involving a 29-year-old woman who developed severe facial pain after undergoing a cosmetic procedure with injectable triamcinolone and hyaluronidase. Two months later, the pain spread to her upper and lower limbs, and abdomen, which eventually led to the the development and diagnosis of complex regional pain syndrome (CRPS) in the upper limbs. The authors hypothesize that CRPS in the upper limbs was responsible for the facial pain through sensitization of third-order neurons and the trigeminal nucleus caudalis extending to the upper cervical segments.

Major Trauma induced Left Ventricular Thrombus after Acute Myocardial Infarction

Left Ventricular Thrombus (LVT) formation after acute myocardial infarction is a serious complication. And the most feared complication of LVT is the systemic thromboembolic events, especially to the brain. Nowadays patients with acute myocardial infarction are treated with primary PCI and more aggressive anticoagulation therapies, resulting in the lower incidence of LVT. Early detection of LVT is very important, and echocardiography is the definitive test for detecting intracardiac thrombus. However, the need for serial echocardiography remains controversial. In this case report, we describe a 55-year-old man with major trauma induced LVT after acute myocardial infarction who underwent successful therapy.

A Case of Gastric Mucormycosis Induced Necrotic Gastric Ulcer in Patients with Diabetic Ketoacidosis

Mucormycosis is a rare invasive disease with high mortality rates caused by fungi of the zygomycetes class and Mucorales order. Mucormycosis is manifested by a variety of clinical presentations according to the involved site and occurs in immunocompromised conditions such as diabetes mellitus and other conditions. Rhino-orbital-cerebral and pulmonary infection is known as commonly involved areas. Primary gastrointestinal mucormycosis is a very rare and life-threatening invasive fungal infection. Gastrointestinal mucormycosis may occur in any alimentary tract, with the stomach being most involved part. The early diagnosis and appropriate treatment including surgical debridement of involved tissues and antifungal agents is needed to improve survival rates. We report a case of gastric mucormycosis successfully treated with radical debridement and antifungal agents in a 45-year-old man with diabetic ketoacidosis.

The Use of Medical Devices for Medical Skin Care and the Legal Issues / 대한피부과학회지

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.

A Case of Idiopathic Eruptive Macular Pigmentation / 대한피부과학회지

Idiopathic eruptive macular pigmentation is a relatively rare disease entity characterized by asymptomatic, pigmented macules involving the face, neck, trunk, and proximal limbs. We report a case of idiopathic eruptive macular pigmentation in a 19-year-old female patient, who presented with brown colored macular pigmentation which started appearing at the age of seven. The skin lesion gradually increased in numbers and in size over trunk, neck and face without any history of prior inflammation or drug intake. The lesion showed no improvement with chemical peeling or laser therapy. The histologic study revealed an increased epidermal basal layer pigmentation and many melanophages in the papillary dermis. The patient was treated with 2% hydroquinone for six months on the face to disclose satisfactory improvement.

Diseases Associated with Psoriasis: Multicenter Study / 대한피부과학회지

BACKGROUND: The prevalence of other diseases associated with psoriasis has been investigated in recent years. OBJECTIVE: This study was performed to see diseases associated with psoriasis in Korea. METHODS: From september 1999 to May 2000, a total of 293 patients with psoriasis, who visited the department of dermatology in 6 hospitals were enrolled in a subject group for the study. We surveyed the incidence rates of associated diseases. RESULTS: In our study, diseases more concomitantly present in patients with psoriasis were dermatophyte infection, seborrheic dermatitis and benign tumor and nevus in skin diseases and obesity, diabetes mellitus, hypertension, gastritis and hepatitis in systemic diseases. Less concomitantly present in patients with psoriasis were erythroderma, acne, contact dermatitis, atopic dermatitis, bacterial infection, tonsillitis, and internal cancer. CONCLUSION: Our observations show a distinct pattern of diseases associated with psoriasis in Korea. Further investigation will be mandatory to elucidate concomitant diseases in psoriasis.

Two Cases of Steatocystoma Multiplex Localized on the Face / 대한피부과학회지

Steatocystoma multiplex is a hamartomatous malformation of the pilosebaceous duct junction. It is not common and inherited in an autosomal dominant pattern. But numerous non-hereditary cases have been reported. It is characterized by asymptomatic numerous, skin-colored to yellowish cystic papules and nodules principally located on the anterior chest, epigastrium, axillae, groin, and proximal part of the extremities. We experienced two cases of steatocystoma multiplex localized on the face. The face is an unusual site in steatocystoma multiplex. One case is that of 33-year-old male with a family history, the other case is that of 66-year-old female. We report these two cases with the review of the previous literature.

Recurrent Basal Cell Carcinomas Treated by Rhombic Transposition Flap / 대한피부과학회지

We report two cases of recurrent BCC in a 51- year-old woman and a 39-year-old woman which had been misdiagnosed aind treated as pigrnented nevi. Complete surgical resections were done followed by reconstruction using local rhombic transposition flaps. Final cosmetic results were excellent and no local recurrence was noticed during one year follow-up.

Reflectance Spectrophotometry for the Evaluation of Therapeutic Effect of Falshlamp - pumped Pulsed Dye Laser for Nevus Flammeus / 대한피부과학회지

BACKGROUND: At present, flashlamp-pumped pulsed dye lasers are treatment of choice for the treatment of congenital capillary malformations like nevus flammeus. Clinical methods have been generally used to evaluate their effectiveness in many papers. OBJECTIVE: To evaluate the effectiveness of the laser therapy in nevus flammeus patients, we used reflectance spectrophotometry as a supportive objective method in addition to the clinical evaluation. METHODS: Thirty-two patients with definite nevus flammeus skin lesion, mainly on head and neck, were treated with flashlamp-pumped pulsed dye laser(SPTL-1b) at 8 week interval. Patients without previous treatment and the others with previous treatments were grouped separately to compare the influence of previous treatment to laser therapy. Erythema/Melanin indices were measured before and after laser therapy in both normal and lesional skin. Based on these indices, relative blanching effect were calculated. RESULTS: Clinically, they showed 58.6% improvement in their skin color in average and Erythema/Melanin indices measured on normal skins were 13.09+/-3.91 a.u. and 34.65+/-2.82 a.u.. Erythema indices measured on lesional skins were 26.07+/-10.26 a.u. and 20.73+/-8.81 a.u. in non-treated group and 2453+/-6.14 a.u. and 21.18+/-5.47 a.u. in pre-treated group, alternatively. Relative blanching effect in both groups were calculated as 35.9% and 31.6%, meaning no significant difference(p>0.3). Clinical evaluation and relative blanching effect showed good correlation(r=0. 691). CONCLUSION: Reflectance spectrophotometry can be useful in evaluating successful laser treatments in nevus flammeus patients. Reflectance measurements, an objective estimate of blanching, correlate well with the clinical results, and are helpful in monitoring and predicting the therapeutic outcome in dye laser treated patients.

Evaluation of the Phototoxic Potential of the Diuretic Agents by the Photohemolysis Test and the Candida albicans Test / 대한피부과학회지

BACKGROUND: Diuretic agents are widely used in the treatment of variable diseases. Although some diuretics may cause photosensitive reactions, this has been a relatively neglwted area of investigation. OBJECTIVE: The study was undertaken to examine whether or not the diuretic agents could cause phototoxicity with the photohemolysis test and with the Candida albica as test. METHOD: Photohemolysis test: Fresh human red blood cells (RHC) were washed and diluted to 200 fold of original volume with TCM buffer. Test compound suspension, were added to the diluted blood at the final concentration of 10 M. Each sample was irradiated with 50 J/cm of UVA, and control samples were incubated in water bath with light shielding. After additional incubation in a dark water bath for 30 minutes the sarnples were centrifuged. After adding Drabkins reagent, measurement of absorbance of the supernatents by speetrophotometer at 420, 540, 550nm were performed. The degree of photohemolysis was determined by comparing the results wiith the control solution. Candide elbicens test wenty microliter of each solution of arious diuretics were applied to Sabourauds dextrose agar plate in which Candida albicanp had been diffusely applied previously. Four hours after the application, 80 J/cm of UVA was irradiated. The irraicated plates and nonirradiated controls were incubated in a darlI room for 48 hours, and were examined clearzones arround the drugs as the mean of positive results fcir the phototoxic potential of the drugs. RESULTS: The photohemolyeii; vaIues of azosemide, spironolaetonet, iamterene, and xipamide at 420, 540, and 550nm were 70.57%/28.36%/31.61%/83.65%/16.40%/15.21%/75.66%/25.40%/28.17%, and 14.02%/9.11%/8.99% respectively, which exceeds the mear,injful positive value of above 5 , With the Candida olbicans test all teat solution at concentration of 1% and 5% showed negstive results. CONCLUSION: A phototoxic reaction may be triggered by azosemide, spironolactone, triamterene, and xipamide, and the possible mechanism concerned may be directed to cellular membranes. However with the negative result of knowed photosensitizers like hydrochlorthiazid and furosemide, there may be other possibilities for the explenation of phototoxicity. Thus further stirdies may be necessary to investigate more details about the cliscrepancies in greates detail.

Evaluation of the Phototoxic Potential of the Diuretic Agents by the Photohemolysis Test and the Candida albicans Test / 대한피부과학회지

BACKGROUND: Diuretic agents are widely used in the treatment of variable diseases. Although some diuretics may cause photosensitive reactions, this has been a relatively neglwted area of investigation. OBJECTIVE: The study was undertaken to examine whether or not the diuretic agents could cause phototoxicity with the photohemolysis test and with the Candida albica as test. METHOD: Photohemolysis test: Fresh human red blood cells (RHC) were washed and diluted to 200 fold of original volume with TCM buffer. Test compound suspension, were added to the diluted blood at the final concentration of 10 M. Each sample was irradiated with 50 J/cm of UVA, and control samples were incubated in water bath with light shielding. After additional incubation in a dark water bath for 30 minutes the sarnples were centrifuged. After adding Drabkins reagent, measurement of absorbance of the supernatents by speetrophotometer at 420, 540, 550nm were performed. The degree of photohemolysis was determined by comparing the results wiith the control solution. Candide elbicens test wenty microliter of each solution of arious diuretics were applied to Sabourauds dextrose agar plate in which Candida albicanp had been diffusely applied previously. Four hours after the application, 80 J/cm of UVA was irradiated. The irraicated plates and nonirradiated controls were incubated in a darlI room for 48 hours, and were examined clearzones arround the drugs as the mean of positive results fcir the phototoxic potential of the drugs. RESULTS: The photohemolyeii; vaIues of azosemide, spironolaetonet, iamterene, and xipamide at 420, 540, and 550nm were 70.57%/28.36%/31.61%/83.65%/16.40%/15.21%/75.66%/25.40%/28.17%, and 14.02%/9.11%/8.99% respectively, which exceeds the mear,injful positive value of above 5 , With the Candida olbicans test all teat solution at concentration of 1% and 5% showed negstive results. CONCLUSION: A phototoxic reaction may be triggered by azosemide, spironolactone, triamterene, and xipamide, and the possible mechanism concerned may be directed to cellular membranes. However with the negative result of knowed photosensitizers like hydrochlorthiazid and furosemide, there may be other possibilities for the explenation of phototoxicity. Thus further stirdies may be necessary to investigate more details about the cliscrepancies in greates detail.

A Case of Trichorhinophalangeal Syndrome / 대한피부과학회지

Trichorhinophalangeal syndiome, a rare genetic disease, is characterzed by the triad of slow growing, brittle hair with early loss, a pear-shaped nose with bulbous tip and long philtrum, and coneshaped phalangeal epiphyses wiith resultant shortening and. deformity of hands and feet. A 24-year-old female visited our department for the evaluation of lalopecia. She had had sparse, thin, and brittle hair since birth. She also complained of short fingers ar d a pear-shaped nose with bulbous tip. The X-ray findings of her hands and feet showed cone-shaped epiphyses with shortening of the phalangeal bones. There was no family history of hair, nasal, or palnkoplantar phalangeal abnormality. Chromosomal study did not reveel any abnormal finding. Shortened phalangeal bones of her index and middle fingers were slightly improved by lengthening procedure with iIlizarov apparatus.

A case of acormelanosis progressiva / 대한피부과학회지

Acromelanosis progressiva is a peculiar progressive pigmentary disorder characterized by intensely dark and sharply demarcated hyperpigmentation over the dorsa of fingers and toes, and the pigmentation rapidly spread proximally. A 19-year-old female had sharply demarcated symmetric dark aroarn macules on the dorsa of her hands and feet, forearms, lower legs, face and neck. These pigmentations at first appeared at the age of 5 on the dorsa of her fingers and toes, thereafter these pigmertatons spread progressively to the proximal portion of her body. Histologically, a proliferation of mela biocyte at the epidermal-dermal junction was seen, associated with mild hyperkeratosis. She was othervise normal on physical examination and had no family historv of consanguinity.

Efficacy of oral terbinafine the treatment of onychomycosis / 대한피부과학회지

An open multicenter trial was conducted to assess the efficacy and tolerability of oral terbinafine in the treatment of onychomycosis during 10 months from April, 1992 to February, 1993. Of patients with clinically and mycologically proved onychomycosis recruited from the Department of Dermatology of 29 university and training hospitals in the Korea, 143 patients who could be followed up at the end of the study were evaluated. The group of fingernail infection received orally terbinafine 250mg once daily for 8 weeks and the group of toenail infection for 16 weeks. After stopping treatment, all patients were followed up for 12 weeks. The results were as follows: 1. On the mycological study at the initial visit, 101 causative organisms were isolated from 99 pateints and Trichophyton rubrum was common organism (40 strains). 2. The length of healthy, unaffected nail were increased significantly more than two-fold after the end of treatment and at the follow-up investigation, those were 11.8mm in fingernail group and 9.8mm in toenail group. 3. The mean of all clinical symptom scores on entry diminished significantly by the time of the end of treatment and cleared mostly at the follow-up. 4. The mycological cure rate(negative microscopy and culture) was 56.5% for fingernails and 69.3% for toenails at the end of treatment and 100% for fingernails and 89% for toenails at the follow-up investigation. 5. overall efficacy assessed by the patient and by the investigator were evaluated as more than moderate in 93.1% and 94.5% of patients and overall tolerability were evaluated as more than moderate in 100% of patients by both of them. 6. The adverse effects of terbinafine were noted in 10 patients(7%) out of the 143. The most frequent drug-related adverse events were mild-to-moderate gastrointestinal disturbances. Any changes in liver biochemical tests were not considered clinically relevant. In conclusion, oral terbinafine is effective and safe in the treatment of onychomycosis. Our results demonstrate that a treatment period of 8 weeks for fingernail onychomycosis and 16 weeks for toenail onychomycosis is sufficient.

A Case of Halo Dermatitis around Seborrheic Keratosis

A case of circular eczematous dermatitis around seborrheic keratosis was presented. A 54-year-old man presented with two weeks history of a round pruritic eruption around a preexisting lesion of seborrheic keratosis. Microscopic findings showed central tumor nest composed mainly of basaloid cells with occasional spongtosis and exocytosis. A diffuse, dense, mononuclear cell infiltrate with increased contents of melanophages was seen beneath the tumor. The surrounding lesion of halo dermatitis showed mild dilatation of the capillaries and perivascular infiltration of mononuclear cells in the upper and mid-dermis. The lesion of halo dermatitis disappeared gradually over a three week period following excision of the central lesion. This peculiar phenomenon seemed to be different from that of Suttons halo nevus, and might be a manifestation of an eczematous condition which might have a dermatitis provoking factor.

Silica granuloma / 대한피부과학회지

A 29-year-old woman complained of a painless, firm nodule with browunish patch on her left cheek for 5 months. She had had undergone a traffic accident 6 months before, and the normally healed wound on her cheek became reddish and infiltrated. A Skin biopsy specirinen obtained from her skin lesion showed a foreign body reaction with histiocytes and numerouse crystalline structures. These particle. were birefringent under polarized light microscopy. Scanning electron microscopy revealed numerous crystalline particles. Energy dispersive x-ray analysis of the crystal revealed a sharp peak representing silia.

A case of twenty-nail dystrophy associated with chronic thyroiditis and universalis / 대한피부과학회지

Twenty-nail dystrophy is a rare entity in which all 20 nail are uniformly and simultaneously affected with excess longitudinal ridging and loss of luster. This condition is thought to be idiopathic but, many cases are associated with alopecia areata, lichen planus, psoriasis, and ichthyosis. In such cases, it has been hypothesized that immunplogical disorders could play a role in pathogenesis. A 29-year-old male patient presented with dystrophic nail chatge on his all finger and toe nails for 3 years. On phisical examination, all nails were uniformly affected with longitudinal ridging and loss of luster and all body hairs were lost. Thyroid scan showed a finding of chronic thyroiditis. Herein we report a case of twenty-nail dystrophy associated with chronic thyroiditis and alopecia areata.

Therapeutic efficacy of orally administration itraconazole in onychomycosis / 대한피부과학회지

Botween April 1991 and March 1992, a multicenter open trial was done to evaluate the therapeutic efficacy of itraconazole in the treatment of onychomycosis, 116 patients with onychomycosis diagnosed by clinical and mycological finding were recruited from the 24 university hospitals in Korea. They received 100mg of oral itraconazole once a day until clinical improvement was evident or until 12 months. Response to treatment was evaluated clinically and mycologically. Cure was complete absence of clinical lesions and negative mycological results. Marked improvment was minimal clinical lesions with negative mycology. Moderate improvement was some residual clinical lesions with positive mycology. Unchanged was no clinical response until 4 months after therapy. Obtained results were as follows. 1. Mean duration of treatment was 6.3+/-2.0 months (2-12), and 83 (70.7%) were cured, 27 (23.3%) showed marked improvement, 2 (1.7%) were moderately improved, 3 (2.6%) were unchanged, and 2 (1.7%) were excluded due to the possible side effect of the medication, although they showed moderate improvement. 2. When only fingernails were involved, mean duration of treatment was 5.3+/-2.0 months with cure rate of 81.8%. when toenails were involved, mean duration of treatment was 6.5+/-2.0 months, which was significantly longer than that in fingernail, however cure rate was 66.7%, which was not different from that in fingernail. 3. In cases that Candida spp. were causative organism, 91.7% were cured with marked improvement in another 8.3%. Onychomycosis due to dermatophytes were cured in 72.9%. However, when moulds or T. beigelii were isolated, only one out of six was cured. 4. 9 out of the 116 subjects showed possible side effects during itraconazole treatment. Gastrointestinal troubles were noted in seven, whicn were mostly mild and self-limited, however, in one patient, medications were withdrawn due to continuing gastric upset. In another patient, transient visual disturbance was noted and medications were also withdrawn. However, this patient was already suffereing from glaucoma and causal relationshiop was not established. Shoulder pain was noted in another one, however it was regarded probably unrelated to the drug, and medications were contiued without aggravation of the symptoms. 5. 88 patients were followed with serial biochemical liver function tests for two month interval. None of them showed evidence of hepatic injury during the entire observation period. From the above findings, oral itraconazole was regarded as more effective than the preexisting drugs in the treatment of onychomycosis, and also it was regarded safe in long term therapy.

Secondary erythromelagia associated with bronchial asthma / 대한피부과학회지

Erythromelalgia is a rare disorder characterized by intense hun ing pain in the distal extremities associated with erythema and increased skin temperature. The patient was a 42- year-old woman with a 5 year history of burning pain, erythema, and warmth of the skin on both hands and feet. She had been suffering from bronchiali astalima since childhood. The onset of the symptoms were temporally related to the attacks of hei bronchial asthma. Physical examination revealed mottled dusky red patches on her both ha ids and feet, and purplish acrocyanosis on the finger and toe tips. We present a case of secondary erythromelalgia associated with bronchial asthma and acrocyanosis.

A case of grideofulvin-induced phototoxic reaction / 대한피부과학회지

We report a case of a phototoxic reaction in a 48-year-old female induced by griseofulvin ingestion. The patient hac! erythematous papules, vesicles and patches on the sun-exposed areas. Phototest revealed a decreased minimal erythemal dose to UVA (10J/cm). Photopatch tests with 1%, 5%, 10% Griseofulvin ointment and vaseline as a control and photoingestion tests with Griseofulvin (50mg b.i.d.) were all negative. After the cessation of Griseofulvin, her skin lesions were markedly improved with complete loss of photosensitivity.