A Case of Allergic Contact Dermatitis from Silmazine(R) Cream / 대한피부과학회지

Silmazine(R) cream is an antibiotic agent widely used in burn therapy. It consists of Propylene glycol, Stearyl alcohol, Isopropyl Myristate, Sorbitan mono-oleate, Methyl-p-hydroxybenzoate, Polyoxyl 40 stearate and varseline. A 24-year- old female presented with well-demarcated erythematous papules and vesicles with an itching sensation on the dorsal area of her right hand. She had applied Silmazine(R) cream on the dorsal area of her right handfor 4 days and the skin lesion became aggravated. A patch test with Silmazine(R) cream 'as is' showed a positive reaction and propylene glycol and stearyl alcohol, ingredients in Silmazine(R) cream, revealed a positive reaction. These two agents are known as weak sensitizers that can produce allergic contact dermatitis. There are some reports of allergic contact dermatitis from propylene glycol and stearyl alcohol used topically. As far as we know, there are no reports of allergic contact dermatitis from propylene glycol and stearyl alcohol in the Silmazine(R) cream (Silver sulfadiazine) that is commonly used as topical antibiotic medication for burns. We report this rare case of allergic contact dermatitis from propylene glycol and stearyl alcohol in Silmazine(R) cream (Silver sulfadiazine).

A Case of Diffuse Neurofibroma with Hair / 대한피부과학회지

Diffuse neurofibroma is an uncommon subtype of neurofibroma that occurs principally in children and young adults. It is most common in the head and neck region and appears clinically as a plaque-like elevation of the skin. A 3-year-old girl presented to our hospital with a complaint of skin-colored elevated plaques with hair on her lower back since birth. An ultrasonogram showed several 5~10 mm sized subcutaneous hypoechoic nodules with increased vascularity. The histopathologic examination revealed ill-defined, uncapsulated infiltrative, spindle shaped cells within the dermis and subcutaneous tissue. Immunohistochemical examination with antibodies to S-100 protein showed positive. We report a rare case of diffuse neurofibroma with hair.

A Case of CD30 (+)/ALK (-) Systemic Anaplastic Large Cell Lymphoma / 대한피부과학회지

Systemic CD30 positive anaplastic large cell lymphoma (ALCL), a subtype of non-Hodgkin lymphoma (NHL), developes in the internal organs and invades the skin. There have been many cases of primary cutaneous CD30 positive T-cell lymphoproliferative disorder, but reports of systemic ALCL have been rare. We describe herein CD30 positive ALK negative systemic ALCL in a 90-year-old woman with multiple masses and nodules on the skin, lung and liver, as well as enlargement of the hilar and abdominal lymph nodes, of 3 months duration. She died of sudden aggravation of the general condition after 7 days.

Two Cases of Dermatomyositis Associated with Malignant Tumor / 대한피부과학회지

Dematomyositis is an idiopathic inflammatory myopathy characterized by specific skin manifestations and progressive symmetric proximal muscle weakness. Importantly, dermatomyositis is occasionally associated with the internal malignant tumor, which is clearly correlated with poor prognosis. We report two cases of dermatomyositis, showing characteristic skin lesions, that associated with small cell lung cancer in a 64-year old man and gallbladder cancer in a 54-year old man, respectively. On laboratory findings muscle enzymes and liver function markers were elevated prominently. We tried to treat these patients with systemic corticosteroid and chemotherapy. The patient with small cell lung cancer died of SAH due to head trauma and in the case of the patient with gallbladder cancer, the symptoms of the muscle weakness and the skin lesions are getting better and worse repeatedly fluctuating and regular periodic follow up is required.

Scrofuloderma Derived from Tuberculous Sternoclavicular Osteoarthritis / 대한피부과학회지

Scrofuloderma, also called tuberculosis cutis colliquativa, is a subacute form of cutaneous tuberculosis, which is characterized by subcutaneously-located, cold abscess formation and secondary changes of the overlying skin. Recently, the occurrence of cutaneous tuberculosis has decrease due to improved quality of life and development of effective anti-tuberculous drugs. However, the tendency of diminution of scrofuloderma has grown smaller because the number of old and immunocompromised patients has increased. We report a rare case of scrofuloderma derived from tuberculous sternoclavicular osteoarthritis in a 71-year old woman.

A Case of Leukoderma Punctata after Topical PUVA Therapy in Segmental Vitiligo Patient / 대한피부과학회지

Leukoderma punctata is a rare side effect of photochemotherapy such as psoralen with solar ultraviolet light (PUVASOL) or psoralen with ultraviolet A (PUVA), and manifests as numerous discrete punctate, hypopigmented and achromic spots. Histopathologically, a focal reduction of melanocytes and melanin granules are found in the depigmented macules, revealed by S-100 and Fontana-Masson staining. The phototoxic effect of photochemotherapy on melanocytes has been suggested as the most likely cause. This occurs mostly after systemic psoralen on photochemotherapy. However, a case following topical PUVA therapy is very rare. We report a rare case of leukoderma punctata in a 6-year-old female after topical PUVA therapy for segmental vitiligo.

Two Cases of Sweet's Syndrome with Atypical Clinical Features / 대한피부과학회지

Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by tender, erythematous vesiculopapules and plaques, a high fever and general weakness. Histologically, a dense infiltration is composed predominantly of neutrophils, with edema in the upper dermis. We report two cases of sweet's syndrome with atypical clinical features: one presented with a carcinoma en cuirasse-like clinical feature, and the other presented with a cellulitis-like clinical feature.

A Case of Primary Cutaneous Adenoid Cystic Carcinoma / 대한피부과학회지

Adenoid cystic carcinoma of the skin is the rarest type of eccrine sweat gland carcinoma. Although it is mostly known as a neoplasm of the salivary gland, it could occur as a primary tumor of the skin. We report a case of primary cutaneous adenoid cystic carcinoma in a 75-year-old male patient with two local recurrences. It was a lobulated tender erythematous nodule on the scalp measuring 2.5x1cm. Histopathologic examination after total excision showed cribriform, tubular, and solid masses of various size and shape involving dermis and the upper part of subcutis including perineural invasion. They consisted of almost uniform basaloid cells surrounded by myxoid or slightly fibrotic stroma. Adjacent organ such as salivary gland, bronchus, esophagus, and regional lymph nodes were examined with no evidence of neoplasm. Systemic evaluation for metastasis were also negative.

Differential Gene Expression Screening Between Black and Gray Hairs Using Subtractive Library and DNA Chip / 대한피부과학회지

The identification of differential gene expression between gray and black hairs is an important study in modern hair pigment research. In this experiment, the authors have applied new methods by the integration of three updated molecular biological tools, T7 RNA polymerase-based RNA amplification, representational difference analysis (RDA), and microarray analysis, to screen the differentially expressed genes in gray and black hairs. The genes more abundantly expressed in black hairs were pigment related proteins, such as Pmel17, 95kD melanocyte-specific secreted glycoprotein, MART-1, tyrosinase, tyrosinase-related protein 1 etc. Also, expression of the selenium-binding protein (hSBP) gene and the spast gene for spastin protein were up-regulated in black hairs compared to those in gray hairs. In gray hairs, many kinds of genes related with keratin, trichohyalin and transmembrane glycoprotein were more expressed. In particular ch 17, hRPK.142_H_19 was expressed in gray hairs as high signal intensity.

Comparison of Results of Lactic Acid Sting Tests between Sensitive Skin and Nonsensitive Skin after Tape Stripping / 대한피부과학회지

BACKGROUND: Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to internal stimulants and external irritants. The Lactic acid sting test is a widely accepted method for evaluating sensitive skin and is employed for the selection of subjects experiencing invisible sensory irritation. Tape stripping of skin is a useful method for removing stratum corneum which plays a most important part in the barrier function of the skin. Measurement of the transepidermal water loss (TEWL) is the standard method to determine stratum corneum barrier status. A disturbed skin barrier is characterized by high TEWL. OBJECTIVE: The author performed this study to compare lactic acid sting test between sensitive skin and nonsensitive skin after tape stripping, not on the face but on the forearm. METHODS: A total of 40 individuals (20 individuals of the sensitive skin group and 20 individuals of the nonsensitive skin group) were selected by the method of self-assessment questionnaires related to sensitive skin. The individuals were tested a total of 6times, at internals of 2weeks, on the volar aspects of both forearms with 10% lactic acid after tape stripping, with or without a Hilltop chamber. The frequency of tape stripping was divided according to the TEWL into 3 groups as follows: mild(increase of TEWL> or = 5g/m2h compared to baseline TEWL), moderate (> or = 10g/m2h), and severe (> or = 20g/m2h). RESULTS: When 10% lactic acid sting tests were performed after mild and moderate tape stripping of skin, irrespective of the Hilltop chamber, there were more positive responders in the sensitive skin group (p<0.05). Also statistically, there was a significant difference between the sensitive skin group and the nonsensitive skin group in the comparison of the mean values of lactic acid sting scores (p<0.05). However, when 10% lactic acid sting tests were conducted after severe tape stripping of skin, irrespective of the Hilltop chamber, there were no statistically significant difference between two groups when comparison of the positive rates and the mean values were made. CONCLUSION: The Lactic acid sting test with the Hilltop chamber, after mild and moderate tape stripping is a useful method to discover sensitive skin.

Two Cases of Nodular Cystic Fat Necrosis Possibly Related to Previous Trauma

Nodular cystic fat necrosis, first described by Przyjemski and Schuster, is a peculiar form of encapsulated necrosis of subcutaneous fat characterized by totally or near-totally encapsulated necrosis of fatty tissue in which clusters of nonviable adipocytes are surrounded by condensed fibrous tissue. We report two cases of nodular cystic fat necrosis associated with history of trauma about the site of the lesion. Each lesion was a subcutaneous movable nodule on buttock (case 1) and shin (case 2) which has evolved over months. Both cases showed possible relation to multiple intramuscular injection or direct trauma injury. Pathologically, encapsulated nodule showed a characteristic feature of nodular cystic fat necrosis which composed of the ghosts of anucleated adipocytes showing fairly well-preserved outline.

The Mycological and Molecular Biological Studies on Arthroderma benhamiae Isolated for the First Time in Korea / 대한의진균학회지

BACKGROUND: Arthroderma (A.) benhamiae, one of three telemorphs of Trichophyton (T.) mentagrophytes, has not been isolated until recently in Korea, but in Japan the first report on it was made in 1998. OBJECTIVE: To identify A. benhamiae for the first time in Korea. METHODS: Twelve strains suggestive of A. benhamiae grossly and microscopically were detected among 1, 059 of T. mentagrophytes isolated at the Catholic Skin Clinic, Daegu, from 1998 to 2000. They were examined by mating tests and molecular methods. In mating tests, they were respectively crossed with "+" and "-" tester strains of A. vanbreuseghemii, A. benhamiae African race, A. benhamiae Americano-European race. Molecular methods included the sequence analysis of internal transcribed spacer 2 (ITS2) region of ribosomal DNA and chitin synthase 1 (CHS1) gene, and random amplified DNA polymorphism (RAPD) with random primer OPAO-15 (5'-GAA GGC TCC C-3'). RESULTS: Mating tests revealed that 12 strains of T. mentagrophytes consisted of 6 of A. benhamiae, 4 of A. vanbreuseghemii and 2 of indeterminate. Six strains of A. benhamiae, all isolated from the patients with a history of contact with rabbits, included 1 of Americano-European race and 5 of African race of Americano-European race and 5 of African race. One clinical isolate, a strain of A. benhamiae Americano-European race "-" in mating tests, was almost identical with the standard strains of A. benhamiae Americano-European race with molecular methods as 99.2% (351/354) similarity of ITS2 sequence, 99.1% (313/ 316) similarity of CHS1 sequence, and similar RAPD pattern. Five clinical strains of A. benhamiae African race were identical with standard strains in ITS2 and CHS1 gene and RAPD pattern. CONCLUSION: The first isolation of 6 strains of A. benhamiae in Korea was reported. Five were identified as A. benhamiae African race "+", and 1 as A. benhamiae Americano-European race "-".

The Mycological and Molecular Biological Studies on Arthroderma benhamiae Isolated for the First Time in Korea / 대한의진균학회지

BACKGROUND: Arthroderma (A.) benhamiae, one of three telemorphs of Trichophyton (T.) mentagrophytes, has not been isolated until recently in Korea, but in Japan the first report on it was made in 1998. OBJECTIVE: To identify A. benhamiae for the first time in Korea. METHODS: Twelve strains suggestive of A. benhamiae grossly and microscopically were detected among 1, 059 of T. mentagrophytes isolated at the Catholic Skin Clinic, Daegu, from 1998 to 2000. They were examined by mating tests and molecular methods. In mating tests, they were respectively crossed with "+" and "-" tester strains of A. vanbreuseghemii, A. benhamiae African race, A. benhamiae Americano-European race. Molecular methods included the sequence analysis of internal transcribed spacer 2 (ITS2) region of ribosomal DNA and chitin synthase 1 (CHS1) gene, and random amplified DNA polymorphism (RAPD) with random primer OPAO-15 (5'-GAA GGC TCC C-3'). RESULTS: Mating tests revealed that 12 strains of T. mentagrophytes consisted of 6 of A. benhamiae, 4 of A. vanbreuseghemii and 2 of indeterminate. Six strains of A. benhamiae, all isolated from the patients with a history of contact with rabbits, included 1 of Americano-European race and 5 of African race of Americano-European race and 5 of African race. One clinical isolate, a strain of A. benhamiae Americano-European race "-" in mating tests, was almost identical with the standard strains of A. benhamiae Americano-European race with molecular methods as 99.2% (351/354) similarity of ITS2 sequence, 99.1% (313/ 316) similarity of CHS1 sequence, and similar RAPD pattern. Five clinical strains of A. benhamiae African race were identical with standard strains in ITS2 and CHS1 gene and RAPD pattern. CONCLUSION: The first isolation of 6 strains of A. benhamiae in Korea was reported. Five were identified as A. benhamiae African race "+", and 1 as A. benhamiae Americano-European race "-".

Treatment of Discoid Lupus Erythematosus with Autologous Suction Blister Graft / 대한피부과학회지

Discoid lupus erythematosus (DLE) commonly develops on the sun-exposed area such as the bridge of the nose, malar areas, lower lip and ears. Typically lesions have well-defined discoid erythematous patches with adherent scales, horny plugs, telangiectasia, hypopigmentation and atrophy. Topical, systemic and intralesional injection of steroid and antimalarial drugs have been used. However, the most important treatments in DLE are avoidance of sunlight exposure and daily use of high SPF sunscreen. We treated two DLE patients with autologous suction blister graft (ASBG) which has been widely used for treatment of vitiligo. In general, grafted sites tend to be hyperpigmented after ASBG, so we adopted this characteristic to the treatment of DLE for the purpose of achieving natural sun protection. After one month of ASBG, not only increased pigmentation but also improved skin texture of the lesion was observed. We thought ASBG provided the biologically protective barrier to sunlight and somewhat improvement of DLE lesion. Therefore, ASBG could be regarded as one of the options in the therapeutic modalities of DLE.

Increased Sensitivity of Keratinocytes to Oxidative Stress in Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo, a disease presenting as white patches on the skin, is caused by selective destruction of melanocytes, which are completely absent in established lesions. There are many theories about the etiology of vitiligo including the self-destruct, biochemical, neural, autoimmune and genetic hypotheses. Oxidative stress has been implicated in vitiligo as a causative factor. OBJECTIVE: To examine the susceptibility of vitiligo keratinocytes to external oxidative stress, H2O2, we compared survival rates in cultured keratinocytes according to the different concentration and exposure time of H2O2. METHODS: Keratinocytes were prepared from normal control volunteer, and the center of lesion and non-lesional skin of vitiligo patients. It was evaluated in cultures at the second and third passages. And, keratinocytes were exposed to various concentrations of hydrogen peroxide (H2O2) for 10, 20 and 40 minutes. Finally, the 96 wells plate containing cells were performed MTT assay. RESULTS: Compared to normal keratinocytes, vitiligo keratinocytes, both non-lesional and lesional, showed markedly lower survival rate. At the concentration of 0.01, 0.1 and 1 mM H2O2, survival rates did not significantly affect viability of keratinocytes after neither exposure times. On the contrary, vitiligo keratinocytes, both non-lesional and lesional, were more susceptible to the toxic effect of H2O2 after the period of exposure at concentration of 10mM H2O2 compared with normal keratinocytes. The survival rate of at concentration of 10mM H2O2 inversely correlated with the exposure period in all experiments. CONCLUSIONS: Our results demonstrate the presence of an imbalance in the anti-oxidant system in vitiligo keratinocytes and provide further support for oxidative damage as a pathogenic event in vitiligo.

The Expression of the alpha-Melanocyte Stimulating Hormone (alpha-MSH) and Melanocortin-1 Receptor (MC1R) in the Epidermis of the Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is a skin disease that is characterized by the loss of cutaneous pigmentation. alpha-Melanocyte stimulating hormone (alpha-MSH) is a neuroimmunomodulating peptide derived from proopiomelanocortin, and melanocortin-1 receptor (MC1R) is a surface receptor which is expressed by several other cutaneous cells including melanocyte and keratinocyte. Both of them have been known to be the main physiologic regulator for integumental pigmentation. OBJECTIVE: To evaluate the expression pattern of alpha-MSH and MC1R in the epidermis of vitiligo patients. METHODS: Specimens were obtained in lesional, perilesional and non-lesional skin in 10 patients with vitiligo and from 3 normal persons by the punch biopsy. And then, indirect immunofluorescence was done to show the pattern of expression of alpha-MSH and MC1R. RESULTS: Pattern of expression between alpha-MSH and MC1R was nearly the same. In vitiligo patients with stable disease state (7 of 10), the expression of alpha-MSH and MC1R in the non-lesional skin was more prominent than that in lesional area. In vitiligo patients with active disease state (3 of 10), the expression of alpha-MSH and MC1R in the lesional skin was more prominent than that in non-lesional area. CONCLUSION: Between the stable and active vitiligo patients, there was a different pattern of expression of alpha-MSH and MC1R in the lesional skin.

Three Cases of Scrofuloderma-like BCGitis Showing Spontaneous Remission / 대한피부과학회지

BCG(Bacillus Calmette-Guerin) is a vaccine from living attenuated Mycobacterium bovis which produces resistance to tuberculous infection. It induces specific and nonspecific dermatologic complications on the vaccination site or out of the site. The specific reactions include lymphadenitis, scrofuloderma-like, lupus vulgaris-like, lichen nitidus-like and tuberculid. On the contrary, nonspecific reactions such as toxicoderma hemorrhagica, urticaria, erythema multiforme, erythema nodosum and granuloma annulare have also been reported. Among them the term BCGitis is used to describe the skin reaction and enlargement of the regional lymph node, with or without suppuration. We present three cases of BCGitis developed around the vaccination site after BCG vaccination with spontaneous remission within 2~6 months. Histopathologic examination respectively showed foci of palisading granuloma with central caseation necrosis and surrounding lymphohistiocytic infiltration.

Treatment of Large Lipoma by Arthroscopic Shaver / 대한피부과학회지

Lipoma is one of the most common benign tumors of soft tissue which tends to be left untreated due to unremarkable clinical features and its property of slow growth. It comes to clinical attention only when it causes concern of malignancy because of inordinate size or is perceived as faults in need of cosmetic removal and consequently the incision line is, frequently long and may result in high risk of intra- and postoperative complications such as hematoma and hypertropic scars. So it requires cosmetically acceptable and convenient methods for treatment of lipoma, especially located in the exposed area. The liposuction was tried to get less complications and smaller incision line. But for deep seated variants of lipoma they tend to be less well-circumscribed and often have thick fibrous septa around the lipoma, simple liposuction showed some limitations. So we tried the new liposuction method using arthroscopic shaver for 5 patients having lipomas larger than 5 cm in diameter. The surgery was performed with arthroscopic shaver system equipped with a motorized blade rotating in the suction cannula and emulsifying the lipoma tissue for easy aspiration. The aspirated material was collected and examined histopathologically to rule out the evidence of malignancy. Lipomas were removed completely without any remarkable complications, and no recurrence was seen till three years after surgery. The new method was easier to operate and took less operation time and left only small incision line.

Treatment of Large Lipoma by Arthroscopic Shaver / 대한피부과학회지

Lipoma is one of the most common benign tumors of soft tissue which tends to be left untreated due to unremarkable clinical features and its property of slow growth. It comes to clinical attention only when it causes concern of malignancy because of inordinate size or is perceived as faults in need of cosmetic removal and consequently the incision line is, frequently long and may result in high risk of intra- and postoperative complications such as hematoma and hypertropic scars. So it requires cosmetically acceptable and convenient methods for treatment of lipoma, especially located in the exposed area. The liposuction was tried to get less complications and smaller incision line. But for deep seated variants of lipoma they tend to be less well-circumscribed and often have thick fibrous septa around the lipoma, simple liposuction showed some limitations. So we tried the new liposuction method using arthroscopic shaver for 5 patients having lipomas larger than 5 cm in diameter. The surgery was performed with arthroscopic shaver system equipped with a motorized blade rotating in the suction cannula and emulsifying the lipoma tissue for easy aspiration. The aspirated material was collected and examined histopathologically to rule out the evidence of malignancy. Lipomas were removed completely without any remarkable complications, and no recurrence was seen till three years after surgery. The new method was easier to operate and took less operation time and left only small incision line.

A Case of Tumor Stage Mycosis Fungoides Treated with Combination of Surgical Excision and PUVA Therapy / 대한피부과학회지

This is a case of mycosis fungoides (MF) in a 60-year-old woman who showed a solitary painful tumor on the left thigh. Two years ago, she was diagnosed with MF for several scaly patches on trunk and thigh and was treated with PUVA therapy. After 8 months, the patch lesion almost disappeared and she stopped PUVA therapy. One year later, she revisited hospital with 3 x 3 cm sized painful tumor on left thigh which had developed for about 4 weeks. Histopathological examination of the tumor showed diffuse infiltration of atypical lymphocytes in the dermis, consistent with tumor stage MF. There was no systemic involvement. We removed tumor by surgical excision and started PUVA therapy instead of starting systemic chemotherapy or radiotherapy immediately. Until now, tumor has not recurred and she has been managed as patch/plaque stage for 12 months. We thought that aggressive treatment methods could be delayed by surgical excision of tumor in tumor stage MF.