The Objective Evaluation Methods for Therapeutic Effectiveness and the Efficacy of Systemic Corticosteroid in the Treatment of Cellulitis / 대한피부과학회지

BACKGROUND: Because it has been known that the inflammatory process of cellulitis can be modified by the immune reaction, systemic corticosteroid may be helpful to reduce the inflammatory reaction of the cellulitis and its consequent complications such as skin necrosis and lymphangitis. OBJECTIVE: The purpose of this study was as follows; To find out the appropriate and objective examination methods to evaluate the improvement of cellulitis. To estimate the efficacy of the systemic corticosteroid of short period in the treatment of cellulitis. METHODS: First, as methods of evaluation of therapeutic effectiveness, we measured the lesional skin temperature, circumference of extremity and subjective tenderness in two groups-patients with cellulitis and controls to find out the objective tools showing the improvement of cellulitis. Second, we also measured the skin temperature, circumference of extremity and subjective tenderness in another two groups-patients with systemic corticosteroid and those without to evaluate the effect of systemic corticosteroid in cellulitis. RESULTS: The results were as follows ; Measurements of the skin temperature, circumference and subjective tenderness all showed statistic significance to evaluate the improvement of cellulitis. Patients who were treated with systemic corticosteroid showed statistically better improvement than control group in the lesion of cellulitis. CONCLUSION: The lesional skin temperature, circumference and tenderness can be an objective evaluation method of clinical effectiveness and the systemic corticosteroid may be as adjunct to improvement of the cellulitis.

A Clinical Study of Facial Wrinkles Affected by Facial Expression Muscles Treated with Botulinum Toxin(Botox(R)) / 대한피부과학회지

BACKGROUND: Botulinum toxin type A is being widely used for the treatment of facial wrinkles affected by facial expression muscles. Due to the sudden and exponential surge in popularity of its use for facial wrinkles, there are scanty reports of facial wrinkles treated with botulinum toxin type A especially in Asians. OBJECTIVE: This study was performed to investigate the clinical features of facial wrinkles affected by facial expression muscles and the effects of botulinum toxin A on the treatment of wrinkles. METHODS: Medical records of 61 patients with facial wrinkles treated with botulinum toxin type A were reviewed. Demographic profiles of the patients, the age of onset of facial wrinkle, the distributions of facial wrinkles, treatment dose of botulinum toxin type A, side effects, and follow up data were analyzed. RESULTS: Female patients were predominant(93.4%) than male patients(6.6%). The mean age of the patients was 41.3 years. Crow's feet were the most frequently treated site of facial wrinkles. Average number of treated sites were 2.38. Side effect profiles were similar as previous reports in Cauca sians. The number of patients who took the regular retreatment was less than expected. CONCLUSION: The clinical profiles of wrinkle patients in Koreans treated with botulinum toxin A were assessed. We think it is one of the effective treatment modalities for antiwrinkling.

Botulinum Toxin Treatment in a Patient with Frey Syndrome After Upper Thoracic Sympathicotomy / 대한피부과학회지

Frey syndrome is characterized by profuse facial sweating which is provoked by the taste of food. It has been described as a consequence of upper thoracic sympathicotomy. Botulinum toxin injection is a relatively new treatment modality for Frey syndrome. Botulinum toxin type A (Botox , Allergan, USA) had been successfully used to treat Frey syndrome occurring in a 38-year-old patient following thoracic sympathicotomy for palmar hyperhidrosis. A total dose of 100U of botulinum toxin (1.0U/0.1ml/cm2) injection resulted in a 6 months' resolution of sweating, burning, and flushing sensation on eating. During the follow-up period, no systemic side effects were experienced.

Prevalence of Tinea Pedis in Korean Soldiers in a Battalion / 대한피부과학회지

BACKGROUND: It has been widely accepted that the prevalence of tinea pedis in soldiers may be higher due to their occlusive army boots and communal baths. OBJECTIVE: Our study was designed to investigate the prevalence of tinea pedis in Korean soldiers monthly throughout the year by the ranks of the soldiers and also to verify whether tinea pedis is one of the occupational diseases in Korean soldiers. METHODS: We examined the feet of soldiers in a battalion monthly throughout the year. On those with suspected skin lesions, microscopic examinations along with fungus cultures were performed in July, 1996. RESULTS: Average prevalence of tinea pedis throughout the year was 51.5% on clinical examination. The highest prevalence was 74.0% in August and the lowest in February by 36.7% . The prevalence of tinea pedis by rank was 38.3%(18/47) in the new private group, 61.7%(29/47) in the private group, 84.8%(67/79) in the private 1st class group, 72.4%(55/76) in the corporal group and 70.9%(39/55) in the sergeant group in July, 1996. Dermatophytes were demonstrated microscopically in 59.1%(123/208) of the specimens examined. Cultures were positive in 93 cases, i.e., from 44.7% of those examined. CONCLUSION: The major factor contributing to the highest prevalence of tinea pedis in August among the months of the year seems to be the hot and damp weather conditions(especially in July and August). Considering the fact that the prevalence of tinea pedis in winter season was also higher by 36.7-40.2%, Korean soldiers seem to possess higher risk of tinea pedis due to their tight-fitting army boots. The spread of infection among non-infected soldiers might have resulted from the communal bath and Korean traditional habit of taking-off their shoes in a large dormitory where they sleep together. Moreover, the fact that the prevalence of tinea pedis increases markedly with their ranks suggests that tinea pedis should be considered as an occupational disease among Korean soldiers.

The Clinical Study of Patients with Cellulitis in the ROK Army / 대한피부과학회지

BACKGROUND: Cellulitis is one of the most common infectious skin diseases in primary care units of military service in which personal hygiene could be easily neglected under special circumstances such as outdoor training. OBJECTIVE: This study was designed to elucidate the probable causes of the high incidence rate of cellulitis in military service. METHODS: We prospectively evaluated the clinical findings of 59 patients with cellulitis who were hospitalized in the medical detachment of the 1st Infantry Division of the ROK Army from May, 1995 to April, 1996. RESULTS: The mean age of patients was 21(19-25). Analysing the rank of the patients, the number of recruits was 3(5%), private 26(44%), private first class 17(29%), corporal 11(19%) and sergeant 2(3%). Seventy eight percent of them were included in ranks below corporal. The recurrence rate of cellulitis during the 2 1/2 year follow-up period was only 4%. Skin lesions noted were erythema(100%), tenderness(98%), swelling(98%), local heating(97%), lymphadenopathy(73%), pus (63%), fluctuation(32%), ulcer(27%), lymphangitis(14%), bullae(8%), etc. The most common route of infection was the previous wounds(46%) which allows a portal for invasion of microorganisms. Tinea pedis was also found to be in 39% of patients with cellulitis of the lower leg. The pus culture performed on 7 patients who had not been responsive to primary antibiotics resulted in 6 positive cases of Staphylococcus aureus. CONCLUSION: Considering the ranks of the patients and the routes of infection, we found that the incidence of cellulitis in the military service of the ROK Army could be reduced if more attention would be paid to preventive counterplans for secondary infection and tinea pedis.

The Evaluation on Medical Knowledge of Physicians About Common Dermatoses / 한국의학교육

Proper education about dermatology in medical college would have physicians appropriately diagnose and treat common dermatoses without referring patients to dermatologists. However, physicians who are not dermatologists have difficulty in diagnosing and treating common dermatoses. We have made up a questionnaire about treatment and a slide test for clinical diagnosis of common dermatoses in order to evaluate the knowledge of physicians about common dermatoses, which reflects indirectly the current status of medical education of dermatology in Korea and can be used as a basic data for modifying directions for education in medical college. Total 654 physicians answered the questionnaire, including 125 just graduated general physicians, 111 general physicians who had just finished internship and 418 medical specialists. 11 data from dermatologists were analyzed as a control for evaluation. The result showed that 84%(545) of them have difficulty in diagnosing dermatologic diseases. The probable causes answered by them are lack of easy illustrative textbook for general physician(48%), inadequate education of dermatology in their medical colleges(27%) and so on. In the field of therapy in the questionnaire, only 53% of them had proper knowledge about indication of topical steroids, 56% about acne therapy, 22% about treatment of tinea pedis, 35% about scabies and 41% about urticaria. The average score was 53%. The score of family medicine group and urologist group was 69% and 66% each, which were significantly higher than that of other major groups except 98% of dermatologist group. In the slide test for clinical diagnosis, the average score was 71%. The score of family medicine group which had received postgraduate education on dermatology in their resident training was 84%, also significantly higher than that of other major groups except 100% of dermatologist group. The percentage of correct responders about tinea faciei is only 13%, tinea versicolor 42%, tinea cruris 49%, impetigo 53%, pityriasis rosea 60%, atopic dermatitis 67%, psoriasis 72% and fixed drug eruption 74%, etc. The average score was 71%. In conclusion, this study showed that physicians who are not dermatologists have difficulty in diagnosing and treating even common dermatoses. We think it is important to put stress on the common dermatoses in the field of dermatologic education in medical college. Moreover we could find the importance and need of postgraduate education on dermatology in the resident training of primary care physicians such as not only family medicine doctors but also internists and pediatricians.

Review of the Patch Test Results in patients with the Cosmetic Contact Dermatitis / 대한피부과학회지

BACKGROUND: Contact dermatitis is frequently caused by cosmetics. Detection of causative allergens is important in prevention and treatment of cosmetic contact dermatitis. Patch test has been accepted as the only reliable diagnostic method to detect allergens. OBJECTIVE: The objectives of this study were to clarify evoluting trends of positive patch tests and to compare the positive frequencies of various allergens between different time sequences. MATERIALS AND METHODS: We reviewed patch test results of the 806 cosmetic contact dermatitis patients, who had visited our clinic from 1982 to 1997. We divided the patients into three groups as follows: I group:1982-1987, II group:1988-1992, III group:1993-1997 and compared the test results. The patch tests were performed with standard batteries, cosmetic-related allergens and the patients's own cosmetics. RESULTS: The results of the studies were summarized as follows; 1. Trends of increasing positivity in cosmetic-induced dermatitis was noted in a chronologic point of view. Among the patients, an increased proportion of males was notable. 2. In age distribution, a decreasing proportion of patients at the third & the fourth decades was observed. Contrary to this, the proportion of patients over the fifth decades was increased. 3. Among standard allergens, nickel sulphate showed the highest positive rate in all defined triple periods, whereas positive rates of neomycin sulphate & balsam of Peru were diminishing sequentially. Among fragrance allergens, cinnamic alcohol & cinnamic aldehyde revealed the highest positive rates. 4. In as is test, skin care products showed the highest positive rate, followed by toiletries and makeup products. Increasing positive rates of the toiletry products were observed in order of time. In fragrance products, positive rates reached their peak in the second period and declined in the third period. CONCLUSION: This study showed that perfume components were the most frequent allergens in cosmetics followed by preservative agents. Our study showed that comestic allergies in men seems to have increased.

Site Variation of Transepidermal Water Loss Measurement on the Normal Skin of Hands in Human Volunteers

BACKGROUND: Transepidermal water loss(TEWL) measurement is widely used in monitoring the degree of skin irritation. There have been many reports of site variation of TEWL between different body sites. However, there have been no reports concerning site variation on the different parts of the hand, which is important for the evaluation of hand eczema. OBJECTIVE: This study was done to better understand site variation of TEWL on the hands. METHODS: TEWL measurement has been performed on the mid-forearm and seven different sites of the hands in 20 normal human volunteers using an evaporimeter. RESULTS: A marked site variation has been observed and high values observed on most parts of the hands compared to forearms. CONCLUSION: Site selection should be seriously considered in any kind of study concerning TEWL measurement of hands.

Case of rat mite dermatitis / 대한피부과학회지

We report three cases of rat mite dermatitis caused by Ornithonysus bacoti(Hirst, 1913), commonly referred to it as the tropicalrat mite. The first case, a 26-year old female had multiple pinhead sized vesicles with peripheral erythematous macule on the upper arms. The second case, a 34-year-old femal had multiple variable sized vesicles with erythematous base on the extremeties. The third case, a 43-year old male had multiple erythematous macules and papules with central punctum on the trunl: and extremities. Histopathologic sections from lesions of the first and second patient showed moderate perivascular lymphahistiocytic infiltration intermingled with some eosinophils. Causative mites, Ornithonyssus bacoti, female were collected around the skin lesion in rase 1, from the house dust in case 2 and furniture in case 3.

The Effect of Diphenylcyclopropenone Immunotherapy on Molluscum Contagiosum

BACKGROUND: Contact immunotherapy using diphenylcyclopropenone (DPCP) has been used in the treatment of alopecia and warts. DPCP seemed to be a promising agent for viral disease including molluscum contagiosum (MCI). OBJECTIVE: The purpose of this study was to evaluate the effect of DPCP immunotherapy on MC in children. METHODS: Twenty three patients with multiple lesion of MC were treated with DPCP immunotherapy. RESULTS: Twelve patients (52.2%) showed cure, and eleven patients (47.8%) showed treatment failure. No severe side effects were seen. CONCLUSION: DPCP immunotherapy may be an effective treatment in children with MC without serious side effects.

A case of neuroblastoma with multiple skin metastases / 대한피부과학회지

We report a case of neuroblastoma with multiple skin metastases as a chief complaint in a 2-month-old girl. the skin lesions were rnultiple, pea-sized, bluish, nontender, moable subcutaneous nodules on abdomen, back and scalp. Histopathology showed small round or poly gonal tumor cells which have deeply stained, basophilic, hyperchromatic nuclei with some mitoses. Th.se tumor cells showed clumping tendency which is one of early menifestations of rosette formation. Immunohistochemically positive reaction was demonstrated by anti-NSE(neuron specific enolase) antilody but negative reaction by anti-NFP (neurofilament proteiin ) antibody. She has been succesfully treated with combined chemotherapy for 10 months without relapse.

A Case of Herpes Genitalis Associated with Childhood Sexual Abuse

We report a case of recurrent herpes genitalis in a 5-year-old girl which was considered to result from childhood sexual abuse. The skin lesion was an eroded erythematous macule with overlying multiple vesicles on the labia majora. We detected Herpes simplex virus DNA by using the polymerase chain reaction (PCR) in a biopsy specimen from the vesicular lesion.

A Case of Herpes Genitalis Associated with Childhood Sexual Abuse

We report a case of recurrent herpes genitalis in a 5-year-old girl which was considered to result from childhood sexual abuse. The skin lesion was an eroded erythematous macule with overlying multiple vesicles on the labia majora. We detected Herpes simplex virus DNA by using the polymerase chain reaction (PCR) in a biopsy specimen from the vesicular lesion.

A clinical study of cellulitis / 대한피부과학회지

We reviewed the 43 medical records of patients with cellulitis or erysipelas who had been admitted at the depar1ment of dermatology of Seoul National University Hospital and followed them up for mean 21.6 months. The results were as follows. 1. The sex ratio of patients with cellulitis was 1:1.4 and the average age was 49 years. 2. The lower extremity as the most frequently invloved site of cellulitis with the frequency of 58.1% (25 cases), with the head and neck being involved in 16 cases(37.2%) and trunk and upper extremity in 1 case each(2.3% ). 3. The portals of infecticin were suspected in 33 cases(76% ), where tinea pedis was detect,ed in 18 cases(41.9%), previous skin infeection 10 cases(23.3%) and trauma in 9 cases(20.9%). 4. Initial systemic symptoms were fever(76.7%), chill(65.1%) and headache(37.2%). Erythema(100%), local heating(90,7%), tenderness(88.4%), swelling(86.0%), ulcer(16.3%), bulla(14.0%), lymphangitis(9.2%) and lymphadenit,is(9.2%) were found in the skin lesions. 5. The laboratory findings revealed leukocytosis in 35.7%, elevaed ESR in 86.8% positive 6. ASO titer in 63.0% and positive CRP in 80%, Microorganism. were detected in only 1 of 15 blood cultures, in 2 of 4 bulla fluid cultures and in 7 of 9 bus cultures. There was no growth of causative microorganisms in 3 tissue cultures and 9 saline needle aspiration cultures. Penicillin was used as primary antibiotics in 19 cases, which changed to another antibiotics due to lack of improvement in 3 cases and cefazolin was used in 21 cases, which changed in 2 cases due to the same reason. 7. Average admission priod was 11 days(range from 3 to 20 days) and 30.2% of patients wit.h cellulitis experienced recurrence, but 48% on low extrernity in contrast with 6.7% on head and neck.

Pityriasis Lichenoides in Children

No abstract available.