Eruptive Anetoderma in a Patient with Systemic Lupus Erythematosus

Anetoderma is a rare cutaneous disorder characterized by a loss of normal elastic tissue that presents clinically as atrophic patches located mainly on the upper trunk. Recent studies suggest immunological mechanisms may play a role in this process. Furthermore, a secondary form of macular atrophy occurs in the course of infectious diseases (e.g. syphilis and tuberculosis) and autoimmune disease (e.g. systemic lupus erythematosus [SLE]). Here, we report the case of a 20-year-old woman previously diagnosed with SLE, who presented with numerous well-circumscribed atrophic macules on the face and upper trunk. Histopathological examination showed decreased elastic tissues in the reticular dermis and mononuclear cells adhering to elastic fibers, consistent with anetoderma. Thus, the eruptive anetoderma localized widely on the face and upper trunk may have been caused by an autoimmune response of SLE.

Psoriasis Induced by Trastuzumab (Herceptin(R))

Trastuzumab (Herceptin), a humanized monoclonal antibody, is a cancer drug developed to target the human epidermal receptor (HER) 2, which is overexpressed in some cancer cells. Cutaneous side effects, such as folliculitis, xerosis, and alopecia have not been reported with therapies targeting HER2, in spite of the frequent observances of such with the therapies targeting the epidermal growth factor receptor. We experienced a patient in whom psoriasis was triggered by the trastuzumab treatment for breast cancer. She was a 57-year-old woman with erythematous and scaly plaques occurring a few months after starting trastuzumab, with repeated aggravation after the re-administration of trastuzumab for the breast cancer. Histologic examination showed the typical features of psoriasis with parakeratosis, epidermal hyperplasia, elongation of the rete ridges, and a lymphocytic and polymorphonuclear cell infiltrate in the dermis. To the best of our knowledge, this is the first report of psoriasis triggered by trastuzumab treatment for breast cancer.

Cedrol Enhances Extracellular Matrix Production in Dermal Fibroblasts in a MAPK-Dependent Manner

BACKGROUND: The extracellular matrix (ECM) produced by dermal fibroblasts supports skin structure, and degradation and/or reduced production of ECM are the main causes of wrinkle formation. OBJECTIVE: The aim of this study was to identify the active ingredient that enhances ECM production in dermal fibroblasts. METHODS: Polarity-based fractionation was used to isolate the active ingredient from natural extracts, and the effects of cedrol (isolated from Pterocarpus indicusirginia) on ECM production in cultured human dermal fibroblasts was investigated by reverse transcription-polymerase chain reaction, enzyme linked immunosorbent assay, and Western blot analysis. RESULTS: Cedrol accelerated fibroblast growth in a dose-dependent manner and increased the production of type 1 collagen and elastin. Phosphorylation of p42/44 extracellular signal-regulated kinase, p38 mitogen-activated protein kinase, and Akt was markedly increased by cedrol, indicating that enhanced ECM production is linked to activation of intracellular signaling cascades. CONCLUSION: These results indicate that cedrol stimulates ECM production, with possible applications to the maintenance of skin texture.

Erosive Adenomatosis of the Nipple / 대한피부과학회지

Erosive adenomatosis of the nipple is a rare, benign neoplasm, currently thought to originate from the terminal lactiferous ducts and subareolar breast tissue. Clinically, erosive adenomatosis of the nipple is often indistinguishable from that of mammary Paget's disease, and it could be misdiagnosed as intraductal carcinoma as it has a similar histological finding. We present the case of a 36-year-old woman who had a unilateral erythematous induration of the nipple that contained a palpable, firm nodule. It had first been noticed 2 years earlier. The surface was occasionally crusted, and there was a bloody discharge. Histopathological examination showed irregular, dilated tubular structures, which were lined by a peripheral layer of cuboidal cells and a luminal layer of the columnar cells that demonstrated decapitation secretion at their luminal border.

Epigenetic Modulation of Gene Expression during Keratinocyte Differentiation

BACKGROUND: Epigenetic modulation of gene expression occurs by various methods, including DNA methylation and histone modification. DNA methylation of specific genes may affect the chromatin structure, preventing access by the transcriptional machinery. Although gene expression is dramatically changed during keratinocyte differentiation, there is no evidence of epigenetic modulation during the process of epidermal stratification. OBJECTIVE: We investigated whether epigenetic modulation is involved in keratinocyte differentiation-specific gene regulation. METHODS: We used trypsin to produce epidermal fragmentation (named T1-T4) and performed a morphological analysis using hematoxylin-eosin stain and cytokeratin expression based on reverse transcription polymerase chain reaction. We then constructed a DNA methylation microarray. RESULTS: Each epidermal fragment showed morphological features of the epithelial layer. T1 represented the basal layer, T2 was the spinous layer, T3 was the granular layer, and T4 was the cornified layer. The level of the K14 proliferation marker was increased in the T1 fraction, and the level of K10 differentiation marker was increased in the T2-T4 fractions. Using a methylation microarray with the T1 and T4 fractions, we obtained many hypermethylated and hypomethylated genes from differentiated keratinocytes. CONCLUSION: The importance of epigenetic modulation in target gene expression during keratinocyte differentiation is identified.

An Apocrine Hydrocystoma Combined with a Dermoid Cyst / 대한피부과학회지

An apocrine hydrocystoma is a translucent cystic nodule that looks like adenomatous cystic proliferation of an apocrine gland, which originated from a hair germ. Dermoid cyst is a cystic teratoma that contains developmentally mature skin appendages, such as hair follicles, sweat glands, and other tissues derived from the ectoderm. Many investigators believe that dermoid cysts re originated from the ectoderm, specifically the hair germ cells. A 58-year-old woman was presented with a purple, asymptomatic, dome-shaped nodule on her right lower eyelid that had been slowly increasing in size for several years. Histopathological examination revealed two well-demarcated cysts: one was lined with stratified squamous epithelium with mature hair and sebaceous glands and the other contained large cystic spaces, which papillary projections extended. We report a rare case of a dermoid cyst, combined with an apocrine hydrocystoma, occurring in the right lower eyelid.

Vesicles in Chronic Graft-versus-host Disease / 대한피부과학회지

Chronic graft-versus-host disease (GVHD) usually presents 100 days after allogenic bone marrow transplantation. Chronic GVHD cutaneous lesions are characterized by lichenoid or sclerodermoid variants. Vesicles, a common presentation in patients with acute GVHD, rarely appear in chronic GVHD. We report a case of a 49-year-old man who presented with bilateral vesicles on lower extremities. He was diagnosed with myelodysplastic syndrome 2 years before and was taking oral cyclosporine after the allogenic bone marrow transplantation. Six months post-transplantation, lichenoid and sclerodermoid lesions developed on his entire body and he was diagnosed with chronic GVHD and eosinophilic fasciitis. A biopsy of the vesicles revealed detached lower margins of the epidermis, necrotized keratinocytes, and infiltration of lymphocytic inflammatory cells. Administration of oral prednisolone alleviated the patient's symptoms. This is an interesting case showing a new pattern of vesicle appearance after development of typical chronic GVHD lesions.

Unilateral Demodicidosis in a Patient with Seborrheic Dermatitis / 대한의진균학회지

Demodex mites are considered part of the normal skin flora. Typically, Demodex is harmless and causes no clinical symptoms. We present a 43-year-old woman with pruritic erythematous plaque and papulopustular eruptions on the right cheek. The patient was treated seborrheic dermatitis in face from several years ago. However, the lesion was aggravated after continuous topical steroid usage for several months at a local clinic. Histological examinations revealed Demodex mites in the follicular ostia with perivascular and perifollicular lymphohistiocytic inflammation. Treatment was initiated with metronidazole at a dose of 250 mg three times per day and then crotamiton ointment once daily. The lesion showed marked improvement after six weeks of treatment with mild residual erythema. The findings presented here indicate that Demodex infestation should be considered in the differential diagnosis of unilateral follicular eruptions of the face.

Lipoma of the Tongue / 대한피부과학회지

Lipoma is the most common benign mesenchymal neoplasm composed of mature fat. Although lipoma can occur in any part of the body, it is infrequently found in the oral cavity. Especially, lipoma of the tongue is rare and there have been no previous reports of this in the Korean dermatology literature. Lingual lipoma, which accounts for 0.3% of all tongue neoplasm, is typically described as well-circumscribed, submucosal mass and it is located on the lateral border of the anterior two-thirds of the tongue surface. We herein report on a rare case of lipoma of the tongue that occurred in a 77-year old male patient.