A Case of Ant Sting by Crematogaster Matsumurai Vagala

Reactions from stinging insects are significant to dermatologists because of the wide variety of clinical presentations from mild local reaction to severe anaphylactic reaction. Although ant sting commonly occurs, it has been rarely reported in the literatures. We experienced a unique case with allergic reactions by the ant of the Cremawgaster iw6w urai vagala, subfamily Myrmicinae, family Formicidea, order Hymenoptera that has not been previously reported.

A Case of Multiple Myeloma First Presenting as Cutaneous Plasmacytoma / 대한피부과학회지

Cutaneous extramedullary plasmacytomas are rare in patients with multiple myeloma, they usually indicate a large tumor cell burden and fatal outcome. A 55-year-old man presented with multiple cutaneous tender nodules or masses on whole body. A biopsy specimen of cutaneous nodule showed dermal infiltration by well differentiated plasma cells. Many atypical and immature plasma cells were found in a bone marrow smear and biopsy. A serum protein electrophoresis revealed elevated quantities of Ig G-globulin with type lambda light chain. The patient was treated with VAD(vincristine, adriamycin, dexamethasone) chemotherapy, but died with pulmonary edema and acute respiratory distress syndrome. We report a fatal case of multiple myeloma first presenting as multiple extramedullary cutaneous plasmacytomas.

Pathogenesis of Contact Urticaria Induced by Nettle(Urtica Thunbergiana) / 대한피부과학회지

BACKGROUND: Nettles, of the plant family Urticae, cause nonimmunologic contact urticaria by stinging hairs. Light application of the leaf or stem to the skin results in the rapid development of a short-lived stinging sensation accompanied by wheal formation and itching. The types of chemical mediators causing the stinging sensation and wheal have not yet been clarified. OBJECTIVE: To investigate stinging and urticating substances causing contact urticaria when the skin is in contact with nettle(Urtica thunbergiana). METHODS: Twenty two volunteers were used for the clinical portion of this investigation. The time to wheal development and the evanescent time of pain and wheal were measured after pricking the forearm skin with nettle trichomes, following the administration of antihistamine, antiserotonin or corticosteroid, respectively or a combination of two, either with or without the application of substance P antagonist(capsaicin cream, 0.025%). Nettle extracts were prepared from dry stems and leaves of Urtica thunbergiana. Histamine, serotonin and substance P(SP) contents of nettle extracts were measured by gas chromatographic mass spectroscopy. RESULTS: After puncture of the skin by trichome of nettle, a stinging sensation developed within a few seconds but disappeared faster at the site where capsaicin cream had been applied than at the nonapplied skin site(p<0.05). The development and evanescent time of wheal were not significantly correlated with the application of capsaicin cream. The evanescent time of pain after pricking the skin with trichome following the administration of antiserotonin was significantly shortened at the nonapplied skin site. Pain disappeared more rapidly at the capsaicin applied site following the administration of antihistamine or antiserotonin than at the nonapplied sites(p<0.05), but not following prednisolone administration. Wheal development was delayed significantly at both the capsaicin applied and nonapplied sites after antihistamine administration(p<0.05). Histamine was detected only in the nettle extract. SP and serotonin were not detected because of their insolubility in solvents. CONCLUSION: These results suggest that wheal-and-flare reaction to nettle stings is due primarily to the histamine and partly to the serotonin and SP introduced by the nettle. SP may be mainly involved and partially involved by serotonin in stinging pain.

A Case of Primary Cutaneous Infection of the Burn Scar by Aspergillus niger / 대한의진균학회지

A 61-year-old healthy breeder presented with three punched out, purulent ulcers surrounded by erythematous indurated plaque on the burn scars of the dorsum of the right upper arm and hand which were developed at six months prior to visit. Aspergillus niger was isolated from the pus and tissue pieces in three consecutive cultures. After eight weeks therapy with oral itraconazole, purulent ulcers were healed leaving fibrotic scars. We report a rare case of primary cutaneous aspergillosis by A. niger in a healthy man.

A Case of Creeping Eruption / 대한피부과학회지

Creeping eruption is a syndrome characterized by the penetration in human skin of larvae from hookworms of various animals, mainly cats and dogs. A 26-year-old male presents with pruritic erythematous serpiginous linear skin lesion on the left lower leg for 2 weeks. The skin lesion was developed after walking in bare feet along the beach of an island in Philippines. Histopathologic finding showed a burrow containing numerous eosinophils and a few mononuclear cells in the epidermis. No parasite was found in multiple histologic section.

Low-dose UVA1 Phototherapy for Localized Scleroderma / 대한피부과학회지

Localized scleroderma(LS) is sclerosis of the skin characterized by one or multiple circumscribed ivory-white, indurated, sometimes confluent plaques. It has been reported that LS might result from the unbalance between synthesis and degradation of collagen in the dermis. Recently, treatment of LS with long wave UVA1, which can induce mRNA of matrix metalloproteinase-1 from dermal fibroblast and can cause apoptosis of infiltrating T lymphocytes, showed promising results. In this case, a 14-year-old girl had a 6 month history of linear, brown colored, indurated plaque on her left thigh compatible with LS histopathologically. UVA1(2.4-10.8J/cm2) was irradiated to the skin lesion at each visit, a total of 68 times for 18 months with the cumulative dose of 533J/cm2 UVA1. Her fibrotic skin lesion was resolved during treatment, but became hardened with cessation of phototherapy. She remains disease free for 11 months. We report a case of LS with improvement with low-dose UVA1 phototherapy.

Successful Treatment of Two Cases of Keratoacanthomas with Intralesional Methotrexate / 대한피부과학회지

Keratoacanthoma is a rapidly growing tumor that has the tendency of spontaneous involution but it may persist for some times, continue to enlarge and may become invasive and destructive. Many modalities are available for the treatment of keratoacanthoma. Although excisional surgery is the treatment of choice, this can result in functional and cosmetic defects when large or strategically located lesions are treated. An effective nonsurgical treatment would be desirable in such cases. We report two cases with unusually large or facial keratoacanthoma treated with intralesional methotrexate. One case showed complete resolution over 6 injections and the other after 2 injections. We suggest that intralesional injection of methotrexate is a simple, effective, safe and inexpensive method for the treatment of large keratoacanthoma.

Three Cases of Earlobe Keloids Treated with Carbon Dioxide Laser Vaporization and Pressure Earring after Partial Keloidectomy / 대한피부과학회지

Keloid is proliferative fibrous growths that result from an excessive tissue response to trauma. The earlobe is a common site for the formation of keloid and the frequent cause is ear piercing. Many modalities are available for the treatment of earlobe keloid. Surgical excision has been the most commonly used therapeutic modality but recurrence following excision is common. Intralesional triamcinolon, radiation therapy, compression device, cryosurgery, D-penicillamine or any combination of them were reported to be successful in the treatment of earlobe keloid. We report three cases of earlobe keloid treated with partial surgical keloidectomy of upper part and carbon dioxide laser vaporizing the residual keloid tissue. And then the defect was covered with a primary closure with flap. Pressure earrings were fitted 2 weeks after surgery, and were maintained for 3 months. There was no recurrence of keloid for follow-up period at least 9 months. We suggest that combined modality of CO2 laser vaporization and pressure earring after surgical keloidectomy may offer a better cosmetic and functional improvement in the treatment of primary and recurrent earlobe keloid.

A Case of Primary Inoculation Tuberculosis / 대한피부과학회지

Primary inoculation tuberculosis, also called tuberculosis chancre or tuberculosis primary complex, is the result of direct inoculation of M. tuberculosis in the skin of a host who has not been infected. A 33-year-old laboratory male presents with painless erythematous nodule and central ulcer on the left middle finger for 3 weeks. The skin lesion was developed after he punctured his finger with a needle containing M. tuberculosis. He had no history of tuberculosis. Histopathologic finding showed a wedged shaped abscess mixed with nuclear dust and eosinophils in the epidermis, and inflammatory cell infiltrations and caseation necrosis within the granuloma in the dermis. No bacillus was found in the lesion on AFB stain. We performed polymerase chain reaction with lesional tissue and obtained a positive result. So we diagnosed this case as a primary inoculation tuberculosis, and started antituberculosis medication. After 2 months of treatment, the erythema and ulcer improved. The patient completed a 9 months course of antituberculosis therapy without complication.

Malassezia Yeasts in Acne Vulgaris / 대한피부과학회지

BACKGROUND: Acne is a common follicular inflammatory dermatoses affecting sebaceous glands. It has been known that Malassezia, the lipophilic normal human skin flora, contribute to the development of acne lesion, but the detailed clinical features and effective treatment methods are lacking. OBJECTIVE: In order to elucidate clinical features and efficacy of antifungal treatment in acne associated with Malassezia, we conducted a prospective clinical study with mild to moderate acne patients. METHODS: Twenty eight patients (13 men and 15 women, mean age 19.1+/-4.4 years) with the acneiform eruptions on their face and upper trunk who showed Malassezia from comedo on the KOH/Parker ink examination (spore load 3+ over) were included in this study. Oral itraconazole, 200mg/day, was given at the beginning of treatment for one week. Clinical assessment for the acne lesions(Cunliffe score by Leeds technique and Global acne grading system) and mycological examination were done at the beginning, 2 and 4 weeks of treatment. RESULTS: Acne associated with Malassezia showed polymorphous eruption composed of open and closed comedo, inflammatory papules and pustules. Acneiform eruptions were found on the forehead(67%), cheek(64%), submental(60%) and temple area of the face. Among the patients, seborrhea(21%) and seborrheic dermatitis(14%) were accompanied. The acneiform eruption was aggravated during the summer season(18%). Systemic corticosteroids(14%) and menstruation(27% in women) were also mentioned as the aggravating factors. Systemic itraconazole significantly improved acne lesions from 2 weeks after treatment. CONCLUSION: The results imply that Malassezia should be examined in patients with mild to moderate acne on the face and upper trunk, simultaneously. Use of anti-Malassezia agent such as itraconazole can be considered as an initial treatment in those patients.

A case of Human Herpesvirus 8 Related Kaposi's Sarcoma in a Patient with Iatrogenic Cushing's Syndrome / 대한피부과학회지

Kaposi's sarcoma(KS) is a multicentric proliferative vascular tumor involving cutaneous and visceral tissues. KS was one of the first recognized manifestations of AIDS. A 71-year-old woman was seen with multiple violaceous nodules and painful erythematous cellulitis-like swelling on both lower legs. Easy bruising and senile purpura was also noted on her forearms. She had been suffered from lower back pain for 7 years, and had been treated with corticosteroids. Clinical picture and hormonal study revealed that she had iatrogenic Cushing's syndrome. The histopathologic study from skin lesion showed abnormally proliferated and dilated vessels, vascular slits, spindle shaped cells in the entire dermis. Human herpesvirus 8(HHV-8) was detected by nested polymerase chain reaction(PCR) using the paraffin-embedded skin tissue. She received localized radiotherapy(50 Gray) to both lower legs with favorable response. But five months later, her skin lesions had recurred and progressed into more aggressive pattern mainly on her left lower leg. We report a rare case of human herpesvirus 8 related KS in iatrogenic Cushing's syndrome.

Two Cases of Staphylococcal Scalded Skin Syndrome / 대한피부과학회지

Staphylococcal scalded skin syndrome(SSSS) is the term used for a collection of blistering skin disease induced by the exfoliative toxin of Staphylococcus aureus. It primarily affects neonates and young children, but cases have been reported rarely in adults. We report typical cases of generalized SSSS in two male children. They had generalized tender erythroderma and flaccid bulla with leaving a moist erythematous base resembling a scald and focal peeling of the skin, particularly on the face, neck, axilla, trunk and buttock. Methicilline sensitive staphylococcus aureus was cultured from throat in one patient and from local wound of nares in the other patient. Nikolsky's sign was present. Histopathologic finding revealed an epidermal splitting at the granular layer.