A Case of Cutaneous Sinus Tract of Dental Origin / 대한피부과학회지

Cutaneous sinus tract of dental origin is a syndrome rather than a disease entity, and is composed of a periapical abscess, sinus tract and granulomatous skin change at the opening of the tract. The presence of an intermittently-draining, granulomatous lesion on the face or neck should alert clinicians to the necessity of a routine dental examination, including radiographic studies. Early correct diagnosis and appropriate dental treatment can prevent unnecessary and ineffective antibiotic therapy or surgical treatment. We report a case of a 68 year-old woman with a cutaneous sinus tract on the right nasolabial fold, secondary to infection of eight maxillary remnant teeth.

A Case of Pleomorphic Adenoma on the Upper Lip / 대한피부과학회지

Pleomorphic adenoma is the most common salivary neoplasm and occurs mainly in major salivary glands, especially the parotid gland. It is characterized by a variable histopathologic appearance, and a high recurrence rate with malignant transformation depending on previous surgical treatment method used. A benign mixed tumor occurring in minor salivary glands is believed to show the same clinicopathologic appearance and a relatively low recurrence rate as in major salivary glands. Pleomorphic adenoma is the most common intraoral salivary gland tumor and characteristically presents as a slow, painless growth. Herein, we report a case of a patient with pleomorphic adenoma that affected the upper lip.

A Case of a Hybrid Cyst Composed of an Epidermal Cyst and a Pilomatricoma / 대한피부과학회지

It is known that different parts of a pilosebaceous unit, namely the infundibulum, isthmus, sebaceous ducts, and bulbar or inferior portion, can give rise to a variety of cutaneous cysts, such as epidermal, trichilemmal, steatocystoma, or pilomatricoma. In rare instances, a cyst can arise from various portions of a hair follicle and combine to form a hybrid cyst. The pathogenesis of this lesion is uncertain. Studying the clinicopathological features of hybrid cysts helps us to understand the pathogenesis of disease which can arise from pilosebaceous units. Epidermal cysts and pilomatricoma are recognised to be clinically similar but histologically distinct entities. We present a case of a patient with a solitary nodule on the posterior neck, showing combined histologic features of both an epidermal cyst and pilomatricoma.

Reconstruction of a Helical Rim Defect Following Excision of Squamous Cell Carcinoma in the Ear by Chondrocutaneous Advancement Flap / 대한피부과학회지

About three percent of all skin cancers occur on the helix of the ear. Excision of the cancer results in a defect of the helical rim. Primary closure and wedge excision may produce cupping and helical notching deformities, except in small defects. In 1967, Antia and Buch described a chondrocutaneous advancement flap for marginal defects of the ear. This technique provides a reliable, single-stage procedure an excellent cosmetic result. We report a case of squamous cell carcinoma on the helical rim, of which the surgical defect was repaired with a chondrocutaneous advancement flap.

Histopathological and Immunohistochemical Study of Lichen Nitidus and Lichen Striatus / 대한피부과학회지

BACKGROUND: Lichen nitidus and lichen striatus are often confused because they are thought to share similar clinical and histopathologic features. OBJECTIVE: The purpose of this study was to histopathologically and immunohistochemically evaluate the characteristic differences and common features between the two disorders. METHOD: Histopathological and immunohistochemical slides of 14 patients with lichen nitidus and 14 patients with lichen striatus were reviewed. Immunohistochemical staining with anti CD45RO, CD68, CD4, CD8 and CD20 antibodies was performed. RESULTS: 1) In lichen nitidus, the frequent histopathologic findings were liquefaction degeneration of the basal layer (100%), edema of the dermis within the areas of the infiltate (100%), and claw-like rete ridges (96.8%). 2) In lichen striatus, the frequent histopathologic findings were edema of the dermis within the areas of the infiltate (100%), liquefaction degeneration of the basal layer (92.9%), and perivascular inflammatory cell infiltrate (92.9%). 3) The majority of the cells in the infiltrate of lichen nitidus were T lymphocytes mixed with histiocytes. In most cases, CD4+ T lymphocytes predominated CD8+ T lymphocytes. 4) However, in lichen striatus, infiltrating cells in the dermis were composed dominantly of T lymphocytes, with a minority of histiocytes. CD8+ T lymphocytes were also found to outnumber CD4+ T lymphocytes. CONCLUSION: Our study did differentiate each disease as having distinctive characteristics and differences. Furthermore, the immunologic pathophysiology of lichen nitidus and lichen striatus was proved to be distinctive. Therefore, we conclude that these two diseases are not in the spectrum of the same disease, but separate disease entities which are indeed different from each other.

A Case of Calcaneal Petechiae in a Child / 대한피부과학회지

Calcaneal petechiae (black heel) is a traumatic lesion affecting the back or posterolateral aspect of the heel. An asymptomatic, pigmented, macular lesion is found on one or both heels immediately above the hyperkeratotic border of the foot. It is caused by any sport, such as basketball, tennis, or football, that leads to slamming of the foot against the shoe. Calcaneal petechiae is probably more common than is realized. As it is usually symptomless, it may be disregarded or only observed by chance. The importance of the lesion lies in its clinical resemblance to a malignant melanoma. We report a case of calcaneal petechiae which was confused clinically with a melanoma.

Multiple Granulation Tissues During Acitretin Therapy / 대한피부과학회지

Acitretin, the principal and free acid metabolite of etretinate, is used to treat patients with several types of psoriasis. The common side effects encountered with acitretin therapy are cheilitis, conjunctivitis, xerosis, dryness of the nasal mucosa with minor nosebleeds, pruritis, and desquamation of the palms and soles. Granulation tissue is a well recognized side effect of oral acitretin. This reaction is characterized by ulceration, hemorrhagic crusting and excess granulation tissue. It occurs between the third and 12th weeks of therapy, most commonly affects the hands and feet. We present a case of multiple granulation tissues associated with acitretin therapy.

A Case of Papulopustular Lesions in Behcet's Disease / 대한피부과학회지

Cutaneous lesions of Behcet's disease are varied and include papulopustular lesions, erythema nodosum-like lesions, superficial thrombophlebitis, erythema multiforme-like lesions, Sweet's syndrome-like lesions, furuncles, pyoderma gangrenosum and subungal infarctions. Papulopustular lesions, the most common presentation of skin lesions in Behcet's disese, are cutaneous, sterile folliculitis or acne-like lesions on an erythematous base. Disagreement exists as to the exact nature of these acneiform and folliculitis-like lesions and whether they should be included as a major criteria. We report a case of papulopustular lesions in Behcet's disease which developed in a 41-year-old male.

Hypopigmentation Occurred After Er: YAG Laser Resurfacing / 대한피부과학회지

BACKGROUND: Hypopigmentation is one of the complications developed after laser resurfacing. There have been few data about hypopigmentation developed after Er: YAG laser resurfacing, especially in darker skin. OBJECTIVE: The objective of this study was to assess the clinical and histopathologic features of hypopigmentation developed after Er: YAG laser resurfacing. METHODS: One hundred and ninety patients have been included in this study. Ninety seven patients were treated with short pulsed Er: YAG laser, 2mm spot sized handpiece at the setting of 12.5-15.0J/cm2. Fifty two patients were treated with variable pulsed Er: YAG laser, 5mm spot sized handpiece at the setting of 7.0-7.5J/cm2 and 7msec pulse duration. Forty one patients were treated with dual mode Er: YAG laser, 4mm spot sized scanner at the setting of 17.5J/cm2 ablation mode and 3.15J/cm2 coagulation mode. Incidence, time of onset, duration of hypopigmentation were evaluated throughout the medical charts and serially checked photographs. Skin biopsy was performed in four patients at the hypopigmentation site for histopathologic and electron microscopic examinations with informed consents. RESULTS: Hypopigmentation was observed in twenty six patients; eight in short pulsed Er: YAG laser, eight in variable pulsed Er: YAG laser, ten in dual mode Er: YAG laser. According to the time of onset of hypopigmentation, twelve patients developed hypopigmentation within one month, five patients in two months, three patients within three months, three patients within four months, two patients within five months, and one patient within six months. Twenty out of twenty six patients recovered skin coloration within six months, and two patients within twelve months. On the other hand, four patients had persisted hypopigmentation for more than one year. Melanosome appeared to be decreased but melanocytes appeared to be present in normal numbers on the histopathologic and electron microscopic examinations. CONCLUSION: Although hypopigmentation is one of the frequent complicaions of Er: YAG laser resurfacing, it is temporary in most cases. Thermal damage due to long pulse duration of laser seems to be a very important factor in inducing hypopigmentation.

A Case of Eosinophilic Panniculitis Associated with Paragonimiasis / 대한피부과학회지

Eosinophilic panniculitis is characterized by a prominent infiltration of numerous eosinophlis in the subcutaneous fat, and has been identified in patients with a variety of associated clinical conditions, including arthropod bites, parasitic infections, vasculitis, atopic dermatitis, contact dermatitis, Wells syndrome, bacterial infection, and injection reactions. We experienced a case of eosinophilic panniculitis in a 40-year-old woman who had developed multiple pruritic tender erythematous subcutaneous nodules on her abdomen and legs associated with pleural effusion and respiratory distress symptoms because of pulmonary paragonimiasis.

Surgical gems in dermatologic surgery I / 대한피부과학회지

A bolster, simply defined, is any device used to support or cushion. In surgery, bolsters have been used under sutures to reduce skin and subcutaneous tension. Bolsters function to reduce the potential for necrosis and laceration by distributing the wound closure tension over a broader surface area. Pexing stitich is placed between the mobilized tissue and the deep fascia and periosteum to prevent the secondary motion of closure from disrupting anatomic landmarks and moveable structures. The technique aids in obtaining linear closures, prevents distortion of free margins, prevents tenting across concavities, and fixes the closure line at the junction of cosmetic units. Standard treatment of lipoma commonly includes incision with extrication or elliptical excision. Unfortunately, these treatments often elicit a large scar. Using pressure technique, risk of hemorrhage and infection may be minimized secondary to the decreased degree of invasion. In cosmetically sensitive areas, this technique is an effective and aesthetically pleasing method for removal of lipoma.

A Case of Klippel-Trenaunay Syndrome with Bilateral Nevus Flammeus in a Neonate / 대한피부과학회지

Klippel-Trenaunay syndrome is characterized as a triad of skin capillary malformations, varicose veins and venous malformations, and soft tissue hypertrophy of the affected extremity. Venous malformations are the main cutaneous manifestation of this syndrome, present at birth and are usually unilateral. The patient, a 3-day-old male neonate, was consulted to our clinic with the skin lesions of dark red to violaceous patches on both lower extremites and swelling on the right lower extremity. Histopathologically, a specimen from the dark violaceous skin of the right swollen extremity showed dilatation of capillaries of both dermis and subcutaneous fat. We present a case of Klippel-Trenaunay syndrome with the bilateral nevus flammeus of both lower extremities in a 3-day-old male neonate.