A Case of Generalized Lichen Sclerosus et Atrophicus

A 62-year-old female, with previous history of asthma andhypertension, presented with generalized hyperpigmentedskin lesion, found a year ago. Physical examination revealedbrown colored lichenified and sclerotic patches on the lowerabdomen and flexural areas of extremities. Punch biopsywas performed and histopathological examination revealedhyperkeratosis, follicular plugging and thinning in epidermis.In dermoepidermal junction, cleft like space separating atrophicepidermis and dermis was seen. Also, lichenoid lymphocyticinfiltration was observed in mid-dermis. Based onclinical and histopathological findings, a diagnosis of generlaizedlichen sclerosus et atrophicus (LSA) was made.Other laboratory examinations were unremarkable. As thereis no standard treatment for LSA, the patient received varioustreatments including topical steroid, tacrolimus and narrow-band ultraviolet B therapy. The skin lesion has softenedand its color improved after treatment. LSA is defined as infrequentchronic inflammatory dermatosis with anogenitaland extragenital manifestations. Generalized type is rare andgenital involvement is the most frequent and often the onlysite of involvement. We report this case as it is an uncommontype of LSA with generalized hyperpigmented and scleroticskin lesion in a postmenopausal female patient.

A Case of Solitary Fibrous Tumor of Subungual Region

Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural locations, including cutaneous site. The skin lesion presents as a circumscribed nodule or tumor, mainly on the head and neck. A 41-year-old male presented with 6 months history of nail lesion without symptom on the left third finger. The lesion is slightly yellowish discoloration with subungual erythematous nodule and distal onycholysis. Biopsy specimen from the nail lesion showed the spindle cells form patternless pattern with hypercellular and hypocellular area. And small blood vessels and dilated vascular spaces were present. The result of special stain for specimen showed that positive for CD34, Bcl-2, and CD99 but negative for S-100, FactorXIIIa, and smooth muscle action. Recognition of this uncommon location of SFT is important because of possible confusion with other subungual tumors, including glomus tumor, fibroma and other fibrohistiocytic tumors like dermatofibrosarcoma protuberans, superficial acral fibromyxoma and cellular digital fibroma. Here in, we report a case of SFT of subungual region. We think this case is interesting because of uncommon location and may be helpful to more understand the character of this disease.

Fungal Melanonychia Caused by Cladosporium Species: A Case Report / 대한의진균학회지

Fungal melanonychia is typically associated with onychomycosis and is known to be a relatively uncommon nail disorder. The known pathogens causing fungal melanonychia include both dematiaceous and non-dematiaceous fungi. Here we describe the case of a 60-year-old man with a 1-year history of nail discoloration in both index fingers. The possibility of subungual neoplasm was excluded by histological examination. Subsequent mycological examination revealed the presence of Cladosporium species in the lesion. The patient was successfully treated with oral itraconazole.

Dermatitis Artefacta with Superficial Fungal Infection: a Case Report / 대한의진균학회지

A 76-year-old female presented with a 2-month history of skin lesions on both her buttocks. The skin lesions showed diffuse, erythematous scattered papules and macules with brown to black crusts. The patient believed that she had skin cancer and that the lesions had to be scrapped. She thus soaked her buttock in sikhye, a traditional Korean beverage, to treat the lesions. Based on patient history, she was diagnosed with dermatitis artefacta at the initial hospital visit. KOH examination was positive for hyphae and fungal cultures of Saccharomyces cerevisiae. She was treated with oral and topical antifungal agents for 6 months. The skin lesions improved at that time; however, she continued to scratch her buttock, and the skin lesions aggravated. Repeat fungal culture of the lesions revealed Candida glabrata, which was confirmed by genetic polymerase chain reaction sequencing. Consequently, she was treated with antifungal agents for 6 months. S. cerevisiae is widely used in baking, brewing, wine making, and biotechnology. S. cerevisiae and C. glabrata are considered relatively non-pathogenic fungal organisms. Here, we report a rare case of dermatitis artefacta combined with superficial infection of non-pathogenic fungal organism.

A Suspected Case of Hyperkeratotic Head and Neck Malassezia Dermatosis Presenting with Acanthosis Nigricans / 대한의진균학회지

A 19-year-old woman presented with an asymptomatic cutaneous discoloration on her nape. Dermatological examination revealed localized dark brown to dark pigmented velvety macules and patches. She denied a past medical history, except for a 7-kg weight gain over a 6-months period. Histopathologically, the specimen showed hyperkeratosis, epidermal hyperplasia, mild acanthosis, and papillomatosis. In addition, keratin material and fungal spore were noted between the papilloma ridges. Periodic acid-Schiff special stain showed a positive result for the fungal spore in the horny layer. She was treated with a daily oral dose of terbinafine and topical flutrimazole. After 12 weeks of treatment, she is currently under observation without pigmentation and adverse effect. We considered the initial diagnosis as acanthosis nigricans because of weight gain, similar clinical features, and histological findings. However, the final diagnosis was hyperkeratotic head and neck Malassezia dermatosis considering the presence of yeast and the dramatic improvement after antifungal treatment. To the best of our knowledge, hyperkeratotic head and neck Malassezia dermatosis is not well characterized in the literature. It is an unusual variant of pityriasis versicolor. The skin lesion appears brown to dark, scaly, and hyperkeratotic macules and patches located on the face and neck. Here, we reported an unusual case of hyperkeratotic head and neck Malassezia dermatosis.