ABSTRACT
Notalgia paresthetica (NP) is a chronic localized itch, affecting mainly the inter-scapular area particularly between the T2-T6 dermatomes. Occasionally it has a more widespread distribution and involves the shoulders, back, and upper chest. There are no specific cutaneous signs, apart from those attributed to scratching and rubbing. Various etiologies have been reported, but the cause of NP is not established. The current hypothesis regarding its etiology postulates that a neuropathic itch develops due to nerve entrapment of the posterior rami of spinal nerve arising at T2-T6. Another recent documented case showed an increase in the number of intradermal nerves by neural immunochistochemistry staining of S-100 protein, protein gene product 9.5 (PGP 9.5). Herein, we experienced an uncommon case of NP of the back and tried to clarify pathogenesis by using quantitative sensory testing, such as neurometer and Von-Frey filaments. Also, we performed neural immunochemistry to confirm an increase in nerve fibers at the site of the lesion.
Subject(s)
Immunochemistry , Nerve Compression Syndromes , Nerve Fibers , Pregabalin , S100 Proteins , Shoulder , Spinal Nerves , ThoraxABSTRACT
BACKGROUND: Sublingual immunotherapy (SLIT) with house dust mites (HDM) preparation has recently been proven to be beneficial for treating allergic rhinitis and asthma. However, there has been no report regarding the efficacy and safety of SLIT in Korean patients with atopic dermatitis (AD). OBJECTIVE: We intended to investigate the efficacy and safety of SLIT in Korean patients with AD. METHODS: A total of 34 patients with AD and immunoglobulin E (IgE)-proven HDM sensitization (Class ≥3) were recruited. Eczema area and severity index (EASI) score, total serum IgE level, specific IgE assays to Dermatophagoides pteronyssinus, D. farinae, and adverse effects were recorded during follow-up. "Responder" was defined as a patient with ≥30% improvement in EASI score after SLIT. RESULTS: Twenty-three patients continued SLIT for 12 months or more, whereas 3 patients (8.8%) dropped out because of exacerbation of dermatitis, and 8 patients (23.5%) were lost to follow-up. The average duration of SLIT treatment was 22.4 months (range, 12~32 months). EASI scores reduced significantly after 6 months of treatment (p<0.05) compared with those at baseline. A total of 18 patients were determined to be responders to SLIT after 6 months. Total and specific IgE serum levels did not significantly reduce after SLIT. No patients experienced serious adverse events, with the exception of two patients who developed transient lip and tongue swelling. CONCLUSION: Our study demonstrated that SLIT with HDM extracts is effective and tolerable in Korean patients with AD. Further controlled long-term trials are required to reinforce the current results.
Subject(s)
Humans , Asthma , Dermatitis , Dermatitis, Atopic , Dermatophagoides pteronyssinus , Eczema , Follow-Up Studies , Immunoglobulin E , Immunoglobulins , Lip , Lost to Follow-Up , Pyroglyphidae , Rhinitis, Allergic , Sublingual Immunotherapy , TongueABSTRACT
Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of respiratory tract infections in pediatric and adult populations worldwide. M. pneumoniae is also associated with extrapulmonary complications, such as mucocutaneous eruptions. In dermatologic disorders, M. pneumoniae infection is known to be associated with erythema multiforme and Stevens-Johnson syndrome in children and young adults. Recently, several cases with M. pneumoniae-associated mucositis, which lacks typical target lesions, have been reported. The term Mycoplasma-induced rash and mucositis was suggested as a revised version of the term, Mycoplasma pneumoniae-associated mucocutaneous disease, which previously included erythema multiforme and Stevens-Johnsons syndrome. This revision helps to distinguish Mycoplasma-induced rash and mucositis, which has a distinct morphology, mild disease course, and potentially important clinical implications regarding treatment. Herein, we report a patient with Mycoplasma-induced rash and mucositis.
Subject(s)
Adult , Child , Humans , Young Adult , Erythema Multiforme , Exanthema , Mucositis , Mycoplasma pneumoniae , Mycoplasma , Pneumonia , Pneumonia, Mycoplasma , Respiratory Tract Infections , Stevens-Johnson SyndromeABSTRACT
Tuberous sclerosis complex (TSC) is a neurocutaneous disorder with variable manifestations. The diagnosis is based on clinical criteria, and is divided into definite, probable, and possible TSC. If patients present with mild symptoms, clinicians may hesitate to perform further evaluations because of the high economic burden. A 16-year-old male presented with multiple skin-colored papules on the lower back and buttock. The histopathologic findings were compatible with connective tissue nevi (CTN). No other findings were observed with the exception of one hypomelanotic macule on the left shin. As the patient's parents wished to confirm the diagnosis, genetic testing was performed, and a TSC1 gene mutation was detected. With this genetic result, further evaluations were performed without hesitation. Genetic testing is a sensitive and specific modality for the diagnosis of TSC. We report a case of TSC presenting with CTN only, in which genetic testing was very useful to confirm the diagnosis and to determine the appropriateness of further high-cost studies.
Subject(s)
Adolescent , Humans , Male , Buttocks , Connective Tissue , Diagnosis , Genetic Testing , Neurocutaneous Syndromes , Nevus , Parents , Tuberous SclerosisABSTRACT
No abstract available.
Subject(s)
Humans , Acinar Cells , Arthritis , Carcinoma, Acinar Cell , PanniculitisABSTRACT
Neutrophilic infiltrates of skin in the setting of lupus patients with bullous systemic lupus erythematosus (SLE) and leukocytoclastic vasculitis are well documented. However, most dermatology studies do not consider cutaneous involvement by SLE in the histologic differential diagnosis of neutrophilic inflammatory dermatosis in non-bullous or non-vasculitic lesions. Nevertheless, an increasing number of studies have reported cell-rich or Sweet's-like neutrophilic reactions as well as patients with skin lesions characterized by paucicellular neutrophilic dermal infiltrates. A 56-year-old female patient with history of lupus nephritis presented with multiple erythematous to brownish papulo-patches and plaques on both legs for 1 month. She had no signs or systemic symptoms of Sweet's syndrome. Histopathologic finding showed perivascular and interstitial neutrophilic infiltration with leukocytoclasia in the upper dermis, but not as dense as commonly observed in Sweet's syndrome with absence of papillary dermal edema. Herein, we present a rare case of non-bullous neutrophilic dermatosis associated with SLE. It is important to consider SLE-associated neutrophilic dermatosis in the differential diagnosis of neutrophilic tissue reactions and to be aware of the broad histologic spectrum that may be encountered in SLE-associated neutrophilic dermatosis, ranging from subtle paucicellular lesions to florid Sweet's-like lesions.
Subject(s)
Female , Humans , Middle Aged , Dermatology , Dermis , Diagnosis, Differential , Edema , Leg , Lupus Erythematosus, Systemic , Lupus Nephritis , Neutrophils , Skin , Skin Diseases , Sweet Syndrome , VasculitisABSTRACT
Leuprolide acetate is an established luteinizing hormone-releasing hormone (LHRH) agonist used as a first-line treatment in advanced prostate cancer. An 80-year-old man presented with a localized erythematous patch with an indurated plaque and nodule and pustules on the left upper arm. The patient had been treated for metastatic prostate cancer with subcutaneous injections of leuprolide acetate 18 months previously. Histopathologic findings revealed granulomas with multinucleated giant cells from the dermis to the subcutaneous fat layer. The granuloma contained numerous round vacuoles. Cultures from the tissue for bacteria, fungi, and mycobacteria were all negative. The diagnosis of leuprolide acetate-induced foreign body granuloma was made by clinicopathologic findings. Various theories on the mechanism of local reactions to leuprolide have been suggested. The formation of granulomas may be related to the poly (lactic-co-glycolic acid) polymers or leuprolide itself. The depth of injection could have also contributed; therefore, intramuscular injection is recommended to minimize granuloma formation. To the best of our knowledge, there has been no reported case of leuprolide-induced foreign body granuloma in a patient with prostate cancer in the Korean literature. Dermatologists need to know that leuprolide acetate depot injection may cause a granulomatous reaction.
Subject(s)
Aged, 80 and over , Humans , Arm , Bacteria , Dermis , Diagnosis , Foreign Bodies , Fungi , Giant Cells , Gonadotropin-Releasing Hormone , Granuloma , Granuloma, Foreign-Body , Injections, Intramuscular , Injections, Subcutaneous , Leuprolide , Polymers , Prostate , Prostatic Neoplasms , Subcutaneous Fat , VacuolesABSTRACT
Leuprolide acetate is an established luteinizing hormone-releasing hormone (LHRH) agonist used as a first-line treatment in advanced prostate cancer. An 80-year-old man presented with a localized erythematous patch with an indurated plaque and nodule and pustules on the left upper arm. The patient had been treated for metastatic prostate cancer with subcutaneous injections of leuprolide acetate 18 months previously. Histopathologic findings revealed granulomas with multinucleated giant cells from the dermis to the subcutaneous fat layer. The granuloma contained numerous round vacuoles. Cultures from the tissue for bacteria, fungi, and mycobacteria were all negative. The diagnosis of leuprolide acetate-induced foreign body granuloma was made by clinicopathologic findings. Various theories on the mechanism of local reactions to leuprolide have been suggested. The formation of granulomas may be related to the poly (lactic-co-glycolic acid) polymers or leuprolide itself. The depth of injection could have also contributed; therefore, intramuscular injection is recommended to minimize granuloma formation. To the best of our knowledge, there has been no reported case of leuprolide-induced foreign body granuloma in a patient with prostate cancer in the Korean literature. Dermatologists need to know that leuprolide acetate depot injection may cause a granulomatous reaction.
Subject(s)
Aged, 80 and over , Humans , Arm , Bacteria , Dermis , Diagnosis , Foreign Bodies , Fungi , Giant Cells , Gonadotropin-Releasing Hormone , Granuloma , Granuloma, Foreign-Body , Injections, Intramuscular , Injections, Subcutaneous , Leuprolide , Polymers , Prostate , Prostatic Neoplasms , Subcutaneous Fat , VacuolesABSTRACT
BACKGROUND: A variety of infectious, inflammatory, and neoplastic dermatoses can develop on the glans penis, and definitive diagnosis in such cases may be difficult owing to their non-specific symptoms and clinical appearance. Furthermore, data on dermatoses of the glans penis in Korea are limited. OBJECTIVE: In the present study, we aimed to determine the prevalence of dermatoses of the glans penis in Korea and provide clinical data to assist in making an accurate diagnosis. METHODS: We retrospectively reviewed the medical records, clinical photographs, and histologic slides of 65 patients with dermatoses of the glans penis that visited the Pusan National University Hospital between January 2004 and August 2013. RESULTS: Twenty-six types of dermatoses were identified: inflammatory dermatosis was the most common (38/65, 58.5%), followed by infectious (13/65, 20.0%), neoplastic (10/65, 15.4%), and other dermatoses (4/65, 6.2%). The most common dermatosis of the glans penis was seborrheic dermatitis, followed by lichen planus, herpes progenitalis, condyloma accuminatum, erythroplasia of Queyrat, Zoon's balanitis, and psoriasis. In the topographic analysis, the most common type of dermatosis was dermatoses that localized to the glans penis (39/65, 60.0%), followed by dermatoses involving the extra-genitalia and glans penis (22/65, 33.9%), and the genitalia (glans penis plus other genital areas) (4/65, 6.2%). CONCLUSION: This study shows the usefulness of a topographic approach in the diagnosis of dermatoses of the glans penis in Korea. The findings could be used as baseline data for establishing an accurate diagnosis in Koreans.
Subject(s)
Humans , Male , Balanitis , Dermatitis, Seborrheic , Diagnosis , Erythroplasia , Genitalia , Korea , Lichen Planus , Medical Records , Penis , Prevalence , Psoriasis , Retrospective Studies , Skin DiseasesABSTRACT
Nevus sebaceous appears at birth or within the first few months after birth. Secondarily to nevus sebaceous, benign or malignant tumors such as basal cell carcinoma, trichoblastoma, syringocystadenoma papilliferum, squamous cell carcinoma, sebaceoma, and sebaceous carcinoma might occur. Sebaceoma is a benign tumor composed of incompletely differentiated sebaceous cells of varying degrees of maturity. We experienced an uncommon case of malignant transformation of sebaceoma in a 47-year-old man who had a solitary, well-defined, 3.1x2.1 cm sized, round, erythematous nodule on the scalp. Histopathologic examination revealed the presence of irregular lobules of varying size with a well-defined margin from the adjacent interstitial tissue in the dermis. Focally there were atypical cells with a foamy cytoplasm and undifferentiated cells. To the best our knowledge, only one case, from another country, has been reported in the literature. Therefore, we report a very rare case of malignant transformation of sebaceoma that occurred in nevus sebaceous.
Subject(s)
Humans , Middle Aged , Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Cytoplasm , Dermis , Nevus , Parturition , ScalpABSTRACT
Erythrodermic psoriasis (EP) is a very severe variant of psoriasis whose management poses a challenge to physicians, as currently available therapies often provide unsatisfactory results. Many biologics have been used to treat chronic plaque psoriasis, the most common form of psoriasis; however, their effectiveness for EP is poorly understood. A recently developed biologic, golimumab, has been extensively studied for the treatment of moderate-to-severe active rheumatoid arthritis, psoriatic arthritis, active ankylosing spondylitis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Here, we report the case of a 32-year-old man who presented with severe psoriasis that previously failed to respond satisfactorily to methotrexate, cyclosporine, retinoid, narrow-band ultraviolet B phototherapy, and topical agents (i.e., steroids and calcipotriol). Skin lesions worsened progressively and developed into erythroderma. Psoriatic arthritis was also detected. Conventional therapies lacked efficacy. Therefore, we administered golimumab 50 mg. The skin lesions improved significantly according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Although additional studies are required to fully evaluate the efficacy and safety of golimumab, this agent may be an alternative treatment strategy for some patients with recalcitrant EP.
Subject(s)
Adult , Humans , Arthritis, Psoriatic , Arthritis, Rheumatoid , Biological Products , Cyclosporine , Dermatitis, Exfoliative , Methotrexate , Phototherapy , Psoriasis , Skin , Spondylitis, Ankylosing , SteroidsABSTRACT
Myelodysplastic syndrome (MDS) is a heterogeneous group of stem cell disorders characterized by morphological abnormalities of the erythroid, granulocytic, and megakaryocytic cells. Cutaneous lesions associated with MDS are classified as either specific or non-specific. Specific leukemic infiltrates are often referred to as leukemia cutis, and non-specific inflammatory lesions, historically called leukemids, include cutaneous infections, vasculitis, and neutrophilic dermatoses. We report the case of a 53-year-old man who had been diagnosed with MDS 8 months ago when he developed multiple erythematous tender nodules on the trunk and upper extremities for 8 days. Histopathologic findings from an erythematous nodule on his chest showed lymphohistiocytic and neutrophilic infiltration in the septa and periphery of the fat lobules consistent with neutrophilic panniculitis. Most neutrophils observed in our case had the pseudo-Pelger-Huet anomaly. Herein we present a rare case of neutrophilic panniculitis associated with MDS showing specific groups and the pseudo-Pelger-Huet anomaly.
Subject(s)
Humans , Middle Aged , Leukemia , Myelodysplastic Syndromes , Neutrophils , Panniculitis , Skin Diseases , Stem Cells , Thorax , Upper Extremity , VasculitisABSTRACT
BACKGROUND: Deficiency of vitamin D is reported to be an important factor associated with various dermatoses such as atopic dermatitis, psoriasis, urticaria, and skin cancers. However, this association is disputable and has not been clarified. OBJECTIVE: To evaluate the status of serum 25-hydroxyvitamin D in patients with atopic dermatitis, psoriasis, and chronic urticaria, and examine the relationship between vitamin D levels and disease severity/activity compared with sex- and age-matched healthy controls. METHODS: A cross-sectional study of 23, 34, and 73 patients with atopic dermatitis, psoriasis, and chronic idiopathic urticaria, respectively, and sex- and age-matched controls was conducted. Objective severity scoring of atopic dermatitis (eczema area and severity index) and psoriasis (psoriasis area and severity index), the urticaria activity score, and serum 25-hydroxyvitamin D levels were measured for each subject. RESULTS: Serum 25-hydroxyvitamin D levels were significantly lower in atopic dermatitis patients than those in the controls (p0.05). Furthermore, no significant inverse correlation was found between disease severity and serum 25-hydroxyvitamin D levels in atopic dermatitis, psoriasis, and chronic idiopathic urticaria patients (p>0.05). CONCLUSION: The impact of vitamin D in these dermatoses seems to be overestimated and needs further study to prove any true association.