The Efficacy and Safety of Cryolipolysis for Subcutaneous Fat Reduction

No abstract available.

Intralymphatic Histiocytosis: A Rare Self-limited Disease / 대한피부과학회지

There have been a small number of recent case reports of patients with erythematous patches around the joints, which histopathologically showed histiocytic aggregations in the dermal vessels. Intralymphatic histiocytosis (ILH) is a rare group of skin diseases that are characterized by the proliferation of histiocytes in a lymphatic vessel lumen, and this is thought to arise as a benign reaction to certain stimuli such as rheumatoid arthritis. The pathogenesis of this intralymphatic proliferation of histiocytes and the reasons they commonly present on the arms are still unknown. We report on a case of ILH with arthritis in a 68-year old female who had no underlying disease, and the ILH presented as irregular erythematous patches on the left antecubital area and these patches demonstrated the distinctive histopathological features of intralymphatic histiocytosis.

A Case of Glycogen Storage Disease with Hypertrophic Cardiomyopathy / 영남의대학술지

Glycogen storage diseases are a heterogeneous group of metabolic disorder affecting multiple organ system: liver, skeletal muscle, heart and brain. Clinical features include: short status, hepatomegaly, hypoglycemia, dyslipidemia and rare involvement of the myocardium except in the case of type III, glycogen storage diseases with hypertrophic cardiomyopathy in adult, which is extremely rare. We treated a case of hypertrophic cardiomyopathy with hepatomegaly that was unknown etiology. The patient was diagnosed as having glycogen storage disease. This 46-year old women was transferred with dyspnea on exertion and abnormal LFTs. She was diagnosed with hypertrophic cardiomyopathy by echocardiography but there was no specific cause for hypertrophic cardiomyopathy. A liver biopsy was performed. The result showed glycogen storage disease possible type III, IV or IX. In conclusion, patients with hypertrophic cardiomyopathy of unknown etiology and abnormal LFTs should be evaluated for glycogen storage disease.

Clinical and Histopathological Study of Cutaneous Melanoma in Korea / 대한피부과학회지

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.

Clinical and Histopathological Study of Cutaneous Lymphomas in Korea / 대한피부과학회지

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.

Livedoid Vasculitis: a Clinico-Pathological Study of 19 Patients / 대한피부과학회지

BACKGROUND: Livedoid vasculitis is a distinctive dermatosis characterized by recurrent chronic ulceration and infiltrated purpuric papules on the lower limbs. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathological features of livedoid vasculitis. METHODS: The hospital charts and histopathologic slides of patients with livedoid vasculitis diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: Twelve male and seven female patients were enrolled in this study(M: F=1.7: 1). The mean age at onset was 30.3 years in men and 25.3 years in women. The mean duration of illness was 3.3 years in male patients and 5.7 years in female patients. All the patients were presented with recurrent chronic ulceration and atrophic scarring. Twelve patients(63.2%) complained of severe pain and tenderness of the lesions and 5 patients(26.3%) complained of itching sensation. In three patients(15.8%), the lesions developed or aggravated in summer. Alcohol intake was aggravating factor in two patients(10.5%) and smoking was in one patient(5.3%). In five patients(26.3%), livedoid vasculitis develops in association with several diseases. Associated diseases were diabetes mellitus in 2 patients(10.5%), antiphospholipids antibody syndrome in 2 patients(10.5%), and protein S deficiency in 1 patient(5.3%). Histopathological examination revealed hyalinized blood vessels, partial to complete obstruction of dermal blood vessels with fibrinoid thrombi, endothelial swelling, and extravasation of RBCs in upper and mid-dermis. Panniculitis-like feature was common finding(73%). In six patients(31%), moderate to severe inflammatory reaction was observed in dermis. Five patients were treated with aspirin, dipyridamole, and pentoxifylline, and among them, only 1 patient(20%) were improved. All the treatment response including pentoxifylline alone, or pentoxifylline plus aspirin, dipyridamole, or corticosteroid was unsatisfactory. In cases of three patients whom were treated with low-dose danazol, all the patients(100%) showed marked improvement. One patient was treated with dapsone with improvement. CONCLUSION: Livedoid vasculitis is a distinct dermatosis with characteristic clinico-pathological features. Low-dose danazol or dapsone may be useful therapeutic options in this intractable disease.

A Case of Cutaneous Mesenchymal Hamartoma on the face / 대한피부과학회지

Cutaneous mesenchymal hamartoma is a very rare disease which most often presents itself at birth and is composed of collagen fibers, immature fibroblasts, fat cells, blood vessels, and mast cells. We report a case of cutaneous mesenchymal hamartoma on the face.

A Clinico-Pathological Study of Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: Squamous cell carcinoma(SCC) may occur anywhere on the skin and on mucous membranes with squamous epithelium. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of SCC. METHODS: A total of 62 patients with SCC were enrolled in this study. Six cases with metastatic SCC were included. The hospital charts and histopathological slides of the patients with SCC diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: 1. The male and female ratio was 1.8:1. The mean age at diagnosis was 61.5 years in male patients and 71.8 years in female patients. 2. Most commonly involved sites were the face(41.8%). Upper extremities, trunk, lower extremities, genitalia and scalp were followed in decreasing order. The proximal nail fold was involved in 3 case of primary cutaneous SCC and 1 cases of metastatic SCC. 3. Six cases(9.7%) of metastatic SCC were included. Lung cancer(83.3%) was the most common cause of metastatic SCC in this study. Interestingly, one case presented with SCC of the proximal nail fold revealed metastatic SCC from the lung. 4. The possible causative diseases of primary cutaneous SCC were actinic keratosis(12.5%), burn scar(8.9%), immune suppression(8.9%) owing to kidney transplantation and chemotherapy, arsenical keratosis(7.1%), Bowen's disease(5.4%), trauma(5.4%), osteomyelitis(3.6%), and porokeratosis(1.8%). The causes of 25 cases(44.6%) were undetermined. 5. Histopathological differentiation of the primary cutaneous SCC was performed as follows: 29 cases(51.8%) of well-differentiated, 11 cases(19.6%) of moderately-differentiated, 8 cases(14.3%) of poorly-differentiated, 6 cases(10.7%) of acantholytic, and 2 cases(3.6%) of verrucous SCC. 6. Metastatic rate of primary cutaneous SCC was 16.1%. Metastasis of SCC from osteomyelitis (100%) and burn scar(40%) or trauma(33.3%) and that of poorly differentiated SCC(37.5%) were more common. Regional lymph nodes(55.6%), skin(44.4%), and lung(33.3%) were common metastatic organs.

Angiolymphoid Hyperplasia with Eosinophilia and Kimura's Disease: a Clinico-Pathologic Study in Korea / 대한피부과학회지

BACKGROUND: There has been considerable controversy about the relationship between angiolymphoid hyperplasia with eosinophilia(ALHE) and Kimura's disease. Recent reports have suggested that they are two different diseases. OBJECTIVE: The purposes of this study was aimed at evaluating the clinical and histopathological characteristics of ALHE and Kimura"s disease and differential points between them. METHODS: The hospital charts and histopathologic slides of 5 patients with ALHE and 2 patients with Kimura's disease diagnosed at Asan Medical Center from 1989 to 2000 were reviewed. We also reviewed the previously published reports of the patients with ALHE and Kimura's disease in Korea. In total, we studied 14 cases of ALHE and 29 of Kimura's disease. RESULTS: 1.Eight male and six female patients(M:F=1.3:1) were enrolled in ALHE group and twenty-four male and five female(M:F=4.8:1) in Kimura's disease. The mean age at diagnosis of ALHE was 25 years in men and 40 years in women. The mean age of Kimura's disease was 30 years in men and 33 years in women. 2.Head and neck were the most frequently involved sites in ALHE(92.9%) and Kimura's disease(89.7%). Especially, among the sites, the ear(57.1%) in ALHE and the mandible(44.8%) in Kimura's disease were the most commonly involved. One patient(7.1%) with ALHE and three(10.3%) with Kimura's disease had the lesions bilaterally. 3.Pruritus was the most common symptom in both the diseases. Lymphadenopathy was present in only one patient with ALHE, whereas 51.7% of patients with Kimura's disease had it. One patient with ALHE had underlying arteriovenous malformation. One case showing pregnancy-associated Kimura's disease was reported. Gastric lymphoma was followed in one case of Kimura's disease. 4.Laboratory investigation showed hypereosinophilia in 41.7% of patients with ALHE(5/12) and 96.4% of Kimura's disease(27/28). Elevated IgE was in 2 cases of ALHE(2/4) and 5 cases of Kimura's disease(5/6). 5.Histopathological examination revealed that angioproliferating lesion comprised of plump epithelioid or histiocytoid endothelial cells and accompanying eosinophils and lymphocytes characterized ALHE. In contrast, Kimura's disease was characterized by deeper lesions showing proliferation of vascular structure with less plump endothelial cells and more fibrotic stroma with many lymphoid follicular structures 6.ALHE was improved with CO2 laser, electrocautery, excision, embolization of underlying arteriovenous malformation and dapsone. However, Kimura's disease tended to recur despite various treatment modalities. CONCLUSIONS: In Korea, Kimura's disease was more common than ALHE. ALHE and Kimura's disease may be different diseases because they showed different clinical and histopathological features.

Clinicopathologic Study of Labial Melanotic Macule

BACKGROUND: Labial pigmented lesions include labial melanotic macule, ephelids, lentigo, venous hemangioma, amalgam tattoo, junctional nevus, Peutz-Jeghers syndrome, Addison's disease, Laugier s disease, and superficial spreading melanoma. OBJECTIVES: The purpose of this study was aimed at investigating the clinical and histopathological characteristics of labial melanotic macule during the past 10 years. METHODS: Clinical information of 49 patients with pigmented lesion of the lips diagnosed in Asan Medical Center from 1989 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated all the biopsy specimens obtained from the patients. RESULTS: Twenty-six patients with labial melanotic macule were enrolled in this study. There were 16 women and 10 men. Age at onset varied from 20 to 65 years in women and from 28 to 68 years in men. The duration of the lesion ranged from 4 months to 12 years (mean, 4.5 years). The majority of patients had solitary lesions on the lower lip. Histopathologic examination of biopsy specimens showed increased pigmentation of the basal layer, mild acanthosis without elongation of rete ridges, and scattered melanophages in the dermis. CONCLUSIONS: We suggest that labial pigmented lesions appearing in adults should be biopsied and labial melanotic macule should be diagnosed after the histopathological examination.

A Clinico-Pathologic Study of Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: Basal cell carcinomas(BCC) are seen almost on hair-bearing skin, especially on the face. There have been a few reports about BCC in Korea. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of BCC. METHODS: A total of 95 patients with BCC were enrolled in this study. The medical records and histopathological slides of BCC diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. We classified our cases based on the predominant histopathological findings as follows; solid, adenoid, pigmented, superficial multicentric, clear cell, keratotic, morpheic, basosquamous, trichoblastoma-like, fibroepithelioma of Pinkus-like. RESULTS: 1. The male- female ratio was 1.1:1. The mean age at diagnosis was 64.8 years in male patients and 66.9 years in female patients. 2. The clinical diagnoses were BCC(76.8%), melanoma, actinic keratoses, seborrheic keratosis, and so on. 3. The face was the most preferred site, especially nose(41.2%). Solid, adenoid, keratotic, morpheic, and basosquamous types developed exclusively on the face, while superficial multicentric types did not show on the favored sites. 4. Pruritus of the lesion, easy bleeding, and rapid increment of the size were the main complaints. 5. Solid type was the most frequent type(30%). Three cases of BCC arising from organoid nevus were included. In two cases of organoid nevus-origin, fibrofolliculoma of Pinkus-like histopathological findings were noted. 3 cases were recurrent after laser therapy or simple curettage. 6. Ninety two cases were successfully treated with wide excision. One case was treated with radiation therapy, but the lesion persisted. The lesion was widely excised without recurrence. Systemic metastases were absent in our study.

A Clinico-Pathological Study of Cutaneous Sarcoidosis / 대한피부과학회지

BACKGROUND: Sarcoidosis is a chronic granulomatous inflammatory disorder involving many organs including the skin with various clinical manifestations. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of sarcoidosis. METHODS: A total of 19 patients with cutaneous sarcoidosis were enrolled in this study. The hospital charts and histopathological slides of the patients with sarcoidosis diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: 1. Three male and sixteen female patients were included(M:F=1:5.3). Age at diagnosis ranged from 4 to 62 years. The mean age was 46 years in male patients and 44.9 years in female patients. 2. Multiple or several(more than 2) skin lesions were common(78.9%). Extremities were the favored sites. Clinically the lesions were presented as subcutaneous nodules, plaques, nodule, macules or papules, patches, psoriasiform, and pitted scar in decreasing order. Cutaneous lesions arising from the scar were present in 3 cases. Six patients(31.6%) complained of systemic symptoms such as fever or weight loss. 3. The systemic involvement was present in 11 cases(57.9%). Lung, hilar lymph nodes, and mediastinal lymph nodes were the most commonly involved organs. 4. Laboratory examinations revealed elevated erythrocyte sedimentation rate(71.4%) and angiotensin converting enzyme(ACE)(90%). In all the patients with elevated level of serum ACE the involvement of intrathorax was present, however one patient with systemic involvement showed normal level of ACE. Serum calcium level was normal in all the patients and the level of CD4/CD8 revealed variable results(1.3 to 3.9). 5. Histopathological evaluation revealed non-caseating epithelioid cell granulomas(100%) with multinucleated giant cells(52.6%) and asteroid body(31.6%). In 11 cases(57.9%), fibrosis was the prominent finding and in two cases(10.5%) partial interstitial necrosis was noted. Histopathologically subcutaneous pattern was predominant in 8 cases(42.1%). The patients with subcutaneous sarcoidosis did not show any specific clinical or laboratory differences from the other types in our study. CONCLUSION: Cutaneous sarcoidosis showed varied clinical and histopathological manifestations and ran various clinical courses. In cutaneous sarcoidosis women were more commonly involved than in systemic sarcoidosis and more elderly patients were involved in cutaneous sarcoidosis. Extensive work-up for systemic involvement may be mandatory when sarcoidosis is presented with cutaneous lesions or the level of serum ACE is elevated in cutaneous sarcoidosis. The level of CD4/CD8 may be a insignificant laboratory index in sarcoidosis. Also, subcutaneous sarcoidosis may not be a marker of the systemic involvement.

Kaposi's Sarcoma: a Clinico-Pathological Study of 8 Patients / 대한피부과학회지

BACKGROUND: Kaposi's sarcoma (KS) is a multicentric neoplastic vascular tumor involving the skin or internal organs. KS is an extremely common tumor in tropical Africa and it is also a prime marker of acquired immunodeficiency syndrome (AIDS). Nearly all cases of KS can be classified in four groups: 1) classic, 2) African, endemic, 3) AIDS-associated, 4) iatrogenic immunosuppression- associated KS. OBJECTIVE: The purposes of this study were aimed at evaluating the clinical and biological features of KS. METHODS: The hospital charts and histopathologic slides of patients with KS diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. Immunohistochemical studies for factor VIII, CD31, and CD34 were performed. We also performed PCR-based analysis to determine whether human herpesvirus 8 (HHV8) is present in KS included in this study. RESULTS: 1. Four male and four female patients were included. The mean age at diagnosis of KS was 59.6 years. 2. Our patients could be classified as follows, iatrogenic immunosuppression-associated (7/8) and classic KS (1/8). Iatrogenic immunosuppression-associated group was sub-classified into long-standing steroid use (2/7), chemotheraphy-associated (cancer related, 3/7), and kidney transplantation (KT)-associated group (2/7). Patients with AIDS-associated KS were absent. 3. KS was presented with varied clinical features showing from ill-defined purplish macules to fungating nodules or tumors. Interestingly, two cases were presented with zosteriform or cellulitis-like features. Although upper and especially, lower extremities were favored sites, mucosal involvement such as intraoral and perianal areas was noticed. The cases showing the involvement of systemic organ could not be detected except two cases involving the small intestine. 4. Immunohistochemical studies revealed that spindle cells in stroma were partially positive for CD31 and CD34 and negative for factor VIII. 5. HHV8 sequences were identified in all cases of KS. 6. Four patients (50%) died within 1-2 years after the diagnosis of KS due to underlying diseases. Radiation therapy and interferon-alpha were effective in one case, respectively. Classic KS showed indolent course. Conclusion: KS is a multicentric neoplasm for which the etiopathogenesis is still under discu ssion. We retrospectively studied seven cases with iatrogenic immunosuppression-associated KS and one with classic KS. KS should be considered when the cutaneous lesions newly developed in immunosuppressed patients. HHV8 may contribute to the pathogenesis of KS when other predisposing conditions are present.

A Case of Palisaded Encapsulated Neuroma / 대한피부과학회지

Palisaded encapsulated neuroma is a benign neural tumor located almost exclusively on the face of middle-aged adults. We report a case of palisaded encapsulated neuroma which developed on the upper lip of a 45-year-old man. Clinically, the lesion was asymptomatic, solitary, dome-shaped, pink papule. Histologically, there was a well-demarcated dermal nodule composed of fascicles of Schwann cells. On Bielschowsky staining, numerous axons were observed.

A Case of Palisaded Encapsulated Neuroma / 대한피부과학회지

Palisaded encapsulated neuroma is a benign neural tumor located almost exclusively on the face of middle-aged adults. We report a case of palisaded encapsulated neuroma which developed on the upper lip of a 45-year-old man. Clinically, the lesion was asymptomatic, solitary, dome-shaped, pink papule. Histologically, there was a well-demarcated dermal nodule composed of fascicles of Schwann cells. On Bielschowsky staining, numerous axons were observed.

PCR Study for Human Herpesvirus 8 in Korean Patients with Several Cutaneous Diseases / 대한피부과학회지

BACKGROUND: The association of Kaposi's sarcoma-associated human herpesvirus, or human herpesvirus 8 (HHV8) with various skin diseases has been described in many reports. However, only 3 human diseases: Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman disease were proved to be associated with HHV8. In addition to Karposi's sarcoma, sarcoidosis and Kikuchi's disease were also described to be associated with HHV8. OBJECTIVE: The purpose of this study was aimed at the association of HHV8 with various skin diseases, such as Kaposi's sarcoma, sarcoidosis, and Kikuchi's disease. METHODS: We performed PCR to examine whether the 233-bp segment of the viral DNA of HHV8 was detected in Korean patients with Kaposi's sarcoma, sarcoidosis, Kikuchi's disease, angiosarcoma, and angiolymphoid hyperplasia with eosinophilia. The medical records and histopathological specimens of patients diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: HHV8 DNA sequences were identified in 9 (69%) of sarcoid tissues from 12 patients with sarcoidosis and in all (100%) of from 8 patients with Kaposi's sarcoma but not in 2 tissues from 2 patients with Kikuchi's disease, in 3 tissues from 2 patients with angiosarcoma and 2 tissues from 2 patients with angiolymphoid hyperplasia with eosinophilia. CONCLUSION: HHV8 may be strongly associated with the pathogenesis of Kaposi's sarcoma and sarcoidosis. However, the association with Kikuchi's disease, angiosarcoma, and angiolymphoid hyperplasia with eosinophilia was denied in this study. Further extensive study will be needed.

A Clinico-Histopathological Study of Malignant Melanoma / 대한피부과학회지

BACKGROUND: Cutaneous malignant melanoma represents a tumor arising within the melanocytic systems of the skin. Once considered an uncommon cancer, melanoma is now rising in incidence at a rate faster than any other cancer. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of malignant melanoma. METHODS: A total of 61 patients with malignant melanoma were enrolled in this retrospective study. We classified malignant melanoma as follows; ALMM, acral lentigious malignant melanoma, NMM, nodular malignant melanoma, SSMM, superficial spreading malignant melanoma, MM, mucosal melanoma, LMM, lentigo maligna melanoma. We used the staging system of American Joint Committee on Cancer to evaluate the clinical status in our subjects. The hospital charts and histopathological slides of patients with malignant melanoma diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. Immunohistochemical study was performed for S-100 and HMB-45 in 10 cases and for Ki-67 in 5 cases. RESULTS: 1. The male to female ratio was 1.3. The mean age at diagnosis was 52.6 years. ALMM was the most common type(52.5%) in this study. ALMM and NMM developed in elderly persons, while SSMM developed in younger persons. Malignant melanomas arising from pre-existing mole were 10 cases(16.4%). 2. In forty two cases(68.9%), malignant lesions were limited to skin, but 19 cases(31.1%) were disseminated to lymph nodes, skin or internal organ at the initial examination. Sole and heel were the favored sites in ALMM. Lower extremities and back were the favored sites in NMM and SSMM. Four patients were initially presented with metastatic symptoms such as dyspnea, abdominal mass, headache, or axillary mass, and cutaneous malignant melanoma eventually were diagnosed as their origin. 3. Histopathologically, 6 cases were categorized into amelanotic type and 1 case was into desmoplastic type. 4. More than a half cases developed metastases to other organs. Common metastatic sites were lymph nodes, lung, brain, skin, liver, bone, and bladder in decreasing order of frequency. 5. The five-year survival rate was 100% in stage IA, IB, and IIA but 0% in stage IV. Face, chest and lower extremities showed worse prognosis. Men had worse prognosis than women. NMM revealed the lowest 5-year survival rate(30%). CONCLUSION: Among the prognostic factors such as locations, clinical types, ages, and gender, the stages at the initial presentation was the most important predictable value in our study. Therefore, the early recognition of malignant melanoma is the key to possible cure.

The Hypereosinophilic Syndrome

BACKGROUND: The hypereosinophilic syndrome(HES) represents a leukoproliferative process likely caused by a number of disorders, all of which are marked by sustained over-production of eosinophils. OBJECTIVES: The purposes of this study were aimed at evaluating the clinical and histopathological characteristics of HES. METHODS: The medical records and hist opathological slides of patients with HES who had skin biopsies performed in our department were reviewed. Criteria for the diagnosis of HES include (1) peripheral blood eosinophilia with eosinophil counts greater than 1,500/L for at least 6 months; (2) no evidence of parasitic, allergic, or other known causes of eosinophilia; and (3) presumptive signs and symptoms of multiple organ involvement. RESULTS: Four male and three female patients were included. HES developed in adulthood or old age (mean, 43.4 years). Because only the patients with cutaneous involvement were included, all the patients showed skin lesions. Heart, liver, stomach, nervous system, lymph nodes, and lung were involved organs in decreasing order of frequency. At the onset of HES, 40 to 80% of white blood cells were eosinophils in peripheral blood. White blood cell count and serum IgE level were elevated in all the tested patients. In six patients (85.7%), the level of serum erythrocyte sedimentation rate was elevated. Persistent hypereosinophilia (>1,500/L) was present for longer than 6 months in all patients. Stool examination and skin test for parasitic infestation all gave negative results. All the patients were not taking any medication. Histopathological examinations revealed perivascular mixed inflammatory cell infiltration; predominantly eosinophils in the stomach, liver, and nerve as well as in the skin. Interestingly, two patients who were presented with skin lesions showed the findings of eosinophilic vasculitis. In these patients, the skin lesions were consisted of Raynaud's phenomenon, digital gangrene, and several erythematous plaques. The most common cutaneous manifestations were papules and nodules on the extremities. The main treatment modality was systemic steroid. Except for one patient presented with central nervous system involvement of HES, all the patients were in a well-controlled state. In one patient with the typical clinical and hematologic features of HES, Hodgkin's disease followed. After the complete remission of Hodgkin's disease with chemotherapy, HES subsided. CONCLUSIONS: HES is a heterogenous collection of disorders marked by hypereosinophilia and organ damage. Most common cutaneous manifestations were papules and nodules on the extremities. Raynaud's phenomenon and digital gangrene can be the primary manifestation of HES in which cases cutaneous lesions showed eosinophilic vasculitis. Five patients (71%) responded well to systemic steroids. HES may be a herald of malignancy such as Hodgkin's disease. Further investigation will be mandatory ro elucidate the etiology and pathogenesis of HES.

A Case of Black Hairy Tongue / 대한피부과학회지

Black hairy tongue is a benign disorder characterized by hypertrophy of the filiform papillae of the tongue. A brownish-black discoloration of papillae occurs. the etiology is unclear, but the disorder has been associated with numerous predisposing conditions such as poor oral hygiene, medication, and smoking. Herein we report a case of black hairy tongue and it was successfully treated with simple brushing.

Eosinophilic Pustular Folliculitis: a Clinico-Pathologic Study in Korea / 대한피부과학회지

BACKGROUND: Eosinophilic pustular folliculitis (EPF) is a rare chronic disease of unknown cause with pruritic papulopustular lesions and a prominent eosinophilic infiltrate. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathological features of EPF. METHODS: The hospital charts and histopathologic slides of 8 patients with EPF diagnosed at Asan Medical Center from 1989 to 1998 were reviewed. We also reviewed the previously published reports of 10 patients with EPF in Korea. RESULTS: Nine male and nine female patients were enrolled in this study. The mean age at diagnosis of EPF was 26 years in men and 27 years in women. All the patients complained of mild to severe pruritus. EPF was presented with follicular papules or pustules, except 2 patients, who presented with erythematous plaques free of papules or pustules. All the patients showed the typical histopathological findings of EPF. Laboratory investigation showed hypereosinophilia in 73% of patients (11/15). The levels of blood eosinophils tended to decrease as cutaneous lesions resolved. EPF was improved with dapsone in 12 patients and the rest were treated with topical or systemic steroid or antihistamines. CONCLUSION: EPF may be more common in Korea than can be suspected. Because EPF showed characteristic histopathological findings and EPF responds well to dapsone, the knowledge with this disease may be important to diagnose and treat it.