Two Cases of Lichen Amyloidosis Associated With Atopic Dermatitis / 대한피부과학회지

Lichen amyloidosis is a chronic intensely pruritic skin disorder characterized histologi-cally by the deposition of amyloid in the papillary dermis. Lichen amyloidosis has been reported in association with several pruritic skin disorders including atopic dermatitis, lichen planus, and mycosis fungoides. It is hypothesized that the scratching in pruritic skin diseases is the most important step in forming amyloid deposit. We report two cases of lichen amyloidosis occuring in two patients with atopic dermatitis.

Two Cases of Multiple Lichen Striatus / 대한피부과학회지

Lichen striatus is a self-limited, linear dermatosis of unknown etiology seen mainly in children. Clinically, it is usually seen as unilateral, flesh to red brown, flat-topped papules that follow Blaschko's lines. Many authors have theorized that viral or environmental agents acting on genetically predisposed individual might be involved in its etiology. We present two cases of multiple lichen striatus. The first case is 9 year-old boy, who has a past history of measles. The second case is 6 year-old girl, who was diagnosed of type I neurofibromatosis.

A Case of Pigmented Follicular Cyst / 대한피부과학회지

Pigmented follicular cyst is a rare disorder which typically presents as a pigmented papule on the head or neck. Histologically, it exhibits terminally differentiated, pigmented hair shafts in an epidermoid cyst. It was described as a variant of epidermal cyst originating from the infundibular epidermis of pilosebaceous unit. We report a case of pigmented follicular cyst on the occipital scalp in a 7-year-old girl with typical histologic features.

A Case of Granular Cell Basal Cell Carcinoma / 대한피부과학회지

Granular cell basal cell carcinoma is a rare histopathologic variant of basal cell carcinoma in which some or all of the neoplastic cells show cytologic features of granular cells. These distinctive cells contain abundant eosinophilic cytoplasm housing numerous fine and coarse refractile granules. The 62-year-old man presented with a 5-year history of asymptomatic, solitary 1 cm-diameter, hemispherical, brown to black, smooth-surfaced, hard nodule on the left chest. The histopathological features showed a tumor with the general configuration of a solid basal cell carcinoma, in which there were masses of granular cells with eosinophilic and granular cytoplasm. The tumor was positive for cytokeratin and negative for lysozyme and PAS. Surgical excision was performed.

Assessment of the Association of Iron Deficiency and Frequencies of Autoantibodies and Abnormal Thyroid Function Tests in Patients with Alopecia Areata / 대한피부과학회지

BACKGROUND: Iron deficiency is known as an aetiological factor in diffuse alopecia and androgen-dependent alopecia, especially in females. In alopecia areata, a few studies have been performed to evaluate the role of iron deficiency, but the results were not conclusive. Alopecia areata is suspected to be an autoimmune disease and increased frequencies of thyroid disease, vitiligo, and autoantibodies have been demonstrated. OBJECTIVE: The purpose of this study is to assess the role of iron deficiency in alopecia areata and to study the frequency of abnormal thyroid function tests and autoantibodies in Korean patients with alopecia areata. METHOD: A total of 40 (32 premenopausal and 8 postmenopausal) female and 33 male patients with patchy alopecia areata were included. Hematologic tests, thyroid function tests and autoantibody tests were performed. RESULTS: About 65% of premenopausal female patients with alopecia areata had low level of serum ferritin below 20 ng/ml. This percentage was increased to 87% with low limit of 40 ng/ml, and to 100% with low limit of 70 ng/ml in premenopausal women, but all postmenopausal patients showed normal ferritin level. About one-fifth of premenopausal female patients had low serum iron level and one-tenth had low hemoglobin level. Serum ferritin level was significantly lower in premenopausal women (21.5+/-12.4 ng/ml) than in postmenopausal women (71.1+/-47.1 ng/ml) (p<0.05). Hematologic test abnormalities were very infrequent in male patients with alopecia areata. Thyroid function tests were normal in most of the patients. Frequency of antinuclear antibody was 30% in female patients with alopecia areata, which was higher than 9% in male patients. Frequencies of antimicrosomal and antithyroglobulin antibodies were rather low and they were similar in female and male patients. CONCLUSION: Our results suggest possible role of ferritin deficiency in premenopausal female patients with alopecia areata. Abnormalities in thyroid function tests or autoantibodies were not a major problem in alopecia areata patients.

Abnormalities of beta-Catenin Gene in Pilomatricomas / 대한피부과학회지

BACKGROUND: beta-Catenin muations were reported to play a causal role in the development of pilomatricomas. In a recent study in Caucasians, 75% of pilomatricomas had beta-Catenin mutations. OBJECTIVE: We investigated the causal role of beta-Catenin gene mutations in pilomatricomas of Koreans. METHODS: This study included 20 formalin-fixed, paraffin-embedded pilomatricomas in Koreans. Basophilic nucleated tumor cells were microdissected and, as normal controls, infiltrating inflammatory lymphocytes were microdissected from the same histologic specimens. Sequencing analysis of exon 3 of the beta-Catenin gene (CTNNB1) was performed. Immunostaining for beta-Catenin and Lef-1 was performed by the avidin-biotin-peroxidase method. RESULTS: Sequencing analysis found missense mutations (S37Y, S37C, S33C, S33F, and S37F) in CTNNB1 in 6 samples (30%) of 20 pilomatricomas. All pilomatricomas revealed intense expression of nuclear Lef-1 and nuclear and cytoplasmic beta-Catenin. CONCLUSION: Frequencies of beta-Catenin mutations were lower in our study compared with the results in Caucasians. The immunohistochemical results suggest the abnormalities in Wnt-wingless pathway resulting in stabilization or constitutive expression of beta-Catenin, but the absence of CTNNB1 mutations in 70% of our cases suggests adenomatous polyposis coli gene inactivation, or the involvement of other components of the Wnt-wingless pathway.

A Case of Linear Lichen Planus / 대한피부과학회지

Linear lichen planus, a rare variant of lichen planus, accounts for 0.24-0.62% of all patients with lichen planus. Clinically, it consists of itchy linear-distributed violaceous papules, usually last for more than 1 year and the mucous membranes may also be affected. This disorder shows the same histologic findings of lichen planus, which is characterized by a band-like dermal inflammatory infiltration with hyperkeratosis, focal hypergranulosis, acanthosis, exocytosis and the presence of Civatte body. We report a 46-year-old woman showing typical clinical and histological features of linear lichen planus without pruritus.

A Case of Cutaneous Abscess Due to Scedosporium apiospermum / 대한피부과학회지

Scedosporium apiospermum is the asexual stage of Pseudallescheria boydii that is ubiquitous in nature. The localized cutaneous abscess due to S. apiospermum is rare and it is usually originated from the traumatic inoculation of fungal elements. We report a case of cutaneous abscess caused by S. apiospermum. A 67-year-old woman presented with one-year history of subcutaneous nodules on the left forearm, which had been misdiagnosed as cutaneous tuberculosis. Cultural isolation for definitive diagnosis showed typical S. apiospermum.

A case of postmenopausal frontal fibrosing alopecia / 대한피부과학회지

Postmenopausal frontal fibrosing alopecia is a recently described, rare scarring alopecia. The disease is characterized by progressive frontal recession in postmenopausal women with clinical features of a fibrosing alpecia. The histologic findings are indistinguishable from those seen in lichen planopilaris. Postmenopausal frontal fibrosing alopecia is especially rare in Asian women. We describe a typical case of postmenopausal frontal fibrosing alpecia in a Korean woman with clinical and histologic features.

Alternative Therapy for Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Alternative medicines may be defined as forms of therapy or examination that have no scientific basis and where no effect or diagnostic reliability have been demonstrated by scientific methods. Many patients with atopic dermatitis try various forms of alternative medicine, and several studies about the use of alternative medicine in the patients of atopic dermatitis were performed in western countries but not in Korea. OBJECT: This study was performed to evaluate the use of alternative medicine in atopic dermatitis patients. METHODS: 188 patients of atopic dermatitis attending our outpatient clinic responded to questionnaires on the use of alternative medicine and the past history of atopic dermatitis. RESULTS: 136 of 188 patients(72%) reported previous or current use of one or more forms of alternative medicine. Herbal remedies(32.4%) were used most frequently, and health food preparations, spa therapy, and diet changes were also commonly used. The most common motif of using alternative medicine was "just want to try every possible treatment"(48.6%) and main information sources were people without same skin disease(relatives and friends)(50.0%). The majority(75.2%) reported they do not use the alternative medicine now because of the poor result. The use of the alternative medicine was related to the disease duration, and the cost of the atopic dermatitis treatment. CONCLUSIONS: The use of alternative medicine in atopic dermatitis is commonplace and should be of concern to dermatologists.

Histopathology of Alopecia Areata and Male Androgenetic Alopecia in Horizontal Sections of Scalp Biopsies in Koreans / 대한피부과학회지

BACKGROUND: The advantages of horizontal, over vertical, sectioning of scalp biopsies allow morphometric analysis of follicular structures. OBJECTIVE: In this study, we performed the morphometric analysis of alopecia areata and androgenetic alopecia in Koreans using the horizontal sectioning method. METHODS: Paird, 4-mm punch biopises were taken from the margin of alopecic patch from 21 alopecia areata patients or the frontal lesion of 13 androgenetic alopcia patients, and from clinically normal occipital scalp of all subjects. RESULTS: The general histopathological features were consistent with the known descriptions, but the data on exact follicular counts showed striking differences compared with those from Caucasians. 1. In alopecia areata, numbers of vellus hairs (3.2+/-2.9) and follicular stellae (1.6+/-1.6) was increased significantly (p<0.05) compared with counts from normal occipital scalp (vellus hairs 1.1+/-1.3; follicular stellae 0.5+/-0.8). Anagen/telogen percent ratio was decreased in lesions (64.2%:35.8%) compared with normal occipital scalp (94.0%:5.7%). 2. In androgenetic alopecia, numbers of vellus hairs (4.1+/-3.7) and follicular stellae (4.4+/-3.4) was increased significantly (p<0.05) in the lesion compared with the normal occipital scalp (vellus hairs 1.1+/-1.3; follicular stellae 1.0+/-1.2). Mild decrease of anagen/telogen percent ratio was observed in lesions (86.5%:13.5%) compared with normal occipital scalp (93.5%:6.5%). CONCLUSION: Our results suggest that horizontal sectioning of scalp biopsies is a useful diagnostic method but differences in follicular counts should be considered in interpreting the morphometric data in Koreans.

Giant Becker's Nevus with Agminated Lentigine / 대한피부과학회지

We report a case of a 27-year-old male showing Becker's nevus on his trunk and lower extremities. It represented symmetrically bilateral and extensive(about 50% of body surface) involvement. In addition to the usual clinical findings of Becker's nevus, grouped small darker spots were noted on the lesion of the buttock featuring agminated lentigine. Histologic findings of the brownish pigmented lesion consisted of mild acanthosis, hyperkeratosis, elongation of rete ridges, increase of basal layer pigmentation, and numerous terminal hair follicles. A dark macule in agminated lesions on the buttock showed more dense basal layer pigmentation and more regular elongation and fusion of rete ridges consistent with the histologic findings of lentigo simplex. This report describes a rare case of a giant Becker's nevus involving 50% of body surface in a bilateral and symmetrical distribution with associated agminated lentigine.

Giant Becker's Nevus with Agminated Lentigine / 대한피부과학회지

We report a case of a 27-year-old male showing Becker's nevus on his trunk and lower extremities. It represented symmetrically bilateral and extensive(about 50% of body surface) involvement. In addition to the usual clinical findings of Becker's nevus, grouped small darker spots were noted on the lesion of the buttock featuring agminated lentigine. Histologic findings of the brownish pigmented lesion consisted of mild acanthosis, hyperkeratosis, elongation of rete ridges, increase of basal layer pigmentation, and numerous terminal hair follicles. A dark macule in agminated lesions on the buttock showed more dense basal layer pigmentation and more regular elongation and fusion of rete ridges consistent with the histologic findings of lentigo simplex. This report describes a rare case of a giant Becker's nevus involving 50% of body surface in a bilateral and symmetrical distribution with associated agminated lentigine.

Age, Gender and Seasonal Variations of skin Pigmentation Levels in Koreans / 대한피부과학회지

BACKGROUND: Human skin color shows variations throughout life and many extrinsic and intrinsic factors influence melanogenesis. The characteristics of skin pigmentation have been studied largely in white Caucasians. However, pigmentary changes due to various regulatory factors may be different in Orientals. OBJECTIVE: We observed the variations in skin color due to aging, seasonal changes and gender differences in Koreans with skin type IV or V. METHODS: Skin pigmentation was measured at five body sites (buttock, glabella, V-neck area, inner arm, and dorsal forearm) using skin reflectance spectroscope in 109 subjects in winter and summer. RESULTS: Constitutive pigmentation of the buttock was at the highest level in the first decade of life. It then decreased during the next two decades. This decreased level was maintained after the third decade. The pattern of pigmentation changes of other four sites with aging was similar to that of the buttock. Gender differences were significant except in the first decade. Seasonal change of pigmentation level was observed in dorsal forearm. Interestingly, our study did demonstrate some differences from the observations in Caucasians. We found that facultative pigmentation in Koreans was not increased with aging, so the sun exposure index was not reliable as a measure of cumulative lifetime UV exposure. CONCLUSION: These differences between races could imply that genetically determined basal skin color has important effects on characterizing later responsiveness to UV lights and sex hormones. Understanding these differences in skin pigmentation would be helpful in treating pigmentary diseases and skin cancers, and in studying the regulatory mechanisms of melanogenesis.

Treatment of Atopic Dermatitis

No abstract available.

Clinical Characteristics of Hand-foot Dermatitis in Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Hand-foot (H-F) dermatitis is common in atopic dermatitis patients, but its clinical characteristics have not been studied well. OBJECTIVE: We performed this study to examine the clinical characteristics of H-F dermatitis of AD and to assess its etiologic associations. METHODS: Clinical manifestations of H-F dermatitis were examined in 134 patients with H-F dermatitis of AD between May 1997 and July 1998 at our AD clinic. RESULTS: Both hand and foot were involved in 63(47.0%) patients, and either hand or foot involvement was observed in 20(14.9%) and 51(38.1%) patients, respectively. It usually began in childhood with an early onset of AD. Pruritus was the most frequent symptom, and erythema, scales, lichenification, hyperkeratosis, fissures, and keratolysis exfoliativa were also common. Palmar or plantar involvement showed an equal frequency with the dorsal lesions. The great toe was affected more often than the other toes. Two thirds presented with manifestations of ichthyosis triad (ichthyosis vulgaris, hyperlinear palm and keratosis pilaris) and sandpaper-like skin lesions on the elbow, knee, and lateral malleolus. Palmar or plantar hyperhidrosis was reported in 21% and 27% respectively. The ichthyosis-associated group showed a significantly higher incidence of sandpaper-like skin lesions, fissures, and scales, mainly involving the dorsa of hands and feet. The hyperhidrosis- associated group showed an association with glassy lesions, localized to palmar or plantar areas. CONCLUSION: Clinical characteristics of AD-associated H-F dermatitis were demonstrated. The disease was suggested to be associated with the nonimmunologic etiologies of AD and clinical subgroups could be identified on the basis of nonimmunologic backgrounds.

A Case of Isolated Plexiform Neurofibroma

Plexiform neurofibroma is considered to be pathognomic of neurofibromatosis type 1 (NF1). Herein we report a solitary plexiform neurofibroma which is not associated with NF1. A 61-year-old man presented with asymptomatic skin colored nodules on the medial side of his left great toe. No other abnormalities were found in his personal or family history. Clinically, the tumor was simulating the appearance of mucous cysts. Microscopically,it was a plexiform neurofibroma located in the dermis which seemed to originate from small superficial nerves. This case would seem to confirm that the superficial form of plexiform neurofibroma involving small nerves in the dermis or subcutis is not necessarily pathognomic for NF1.

Isolation of Causative Microorganism and Antimicrobial Susceptibility Test in Impetigo Developed in the Past Four Years

PURPOSE: Recently, Staphylococcus aureus has been reported as the principal microorganism isolated from impetigo, showing variable degrees of antimicrobial resistance. The aim of this work was to study the causative organism of impetigo the their antimicrobial susceptibility developed in impetigo in the past four years. METHODS: We performed bacterial cultures and antimicrobial susceptibility tests in 73 patients with impetigo who visited the Department of Dermatology and Pediatrics at St. Paul's Hospital of the Catholic University of Korea in Seoul. RESULTS: Of 73 patients, microorganisms were identified in 70 patients between May 1995 and August 1999. Staphylococcus aureus was isolated from 63 (90%) patients. Antimicrobial susceptibility test for Staphylococcus aureus revealed low resistance to bactrim (0.0%), rifampicin (0.0%), van- comycin (3.2%), ceftriaxone (4.0%), imipenem (5.4%), ampicillin-clavulanic acid (6.1%), oxacillin (8.1%), cephazolin(9.1%), cephalothin (9.7%) and cefotaxime (10.8%). However, Staphylococcus aureus had high resistance to erythromycin (65.7%) and gentamicin(85.5%). Thirty-six (57.1%) strains of isolated Staphylococcus aureus showed resistance to more than one drug, including two strains (3.1%) resistant to more than 10 drugs. CONCLUSION: Staphylococcus aureus was the most common cause of impetigo developed in the pa- st four years. It was susceptible to most antimicrobial agents except erythromycin and gentamicin, and methicillin resistance was not strong in our results.

Acquired Generalized Blue Nevi

Blue nevus is a benign melanocytic neoplasm and represents itself usually as a solitary blue or blue-black papule. It rarely occurs as multiple lesions grouped in a circumscribed area. How-ever, non-grouped disseminated blue nevi are exceedingly rare. We report a patient with acquired multiple blue nevi that was distributed over the entire body discretely and showed an increase in the number of the nevi without any causal factors.

Apocrine Mixed Tumor with Follicular Differentiation

Mixed tumor of the skin (chondroid syringoma) is a rare benign tumor composed of epithelial elements intermingled with myxoid or cartilagenous stroma which is not separated by basement membrane. It had been believed to originate from the eccrine gland but recently, it was described to be of apocrine gland origin in case of showing apparent apocrine secretion. We report on a 63-year-old man with a tumor on the right upper eyelid showing typical microscopic features of mixed tumor of the skin. Many apocrine decapitation secretions were seen in tubular structures and follicular differentiations were also seen, which represents the common origin of folliculo-sebaceous-apocrine unit.