Dermoscopic Approach to a Small Round to Oval Hairless Patch on the Scalp

BACKGROUND: Various kinds of alopecia can show small round or oval hairless patch. Dermoscopy could be a simple, useful tool for making a correct diagnosis. OBJECTIVE: The aim of this study is to investigate clinical usefulness of dermoscopy for diseases with small round or oval hairless patch on the scalp. METHODS: Dermoscopic examination was performed for 148 patients with small round or oval hairless patch using DermLite(R) II pro. The type and its patient number of alopecia investigated in the study were as below: alopecia areata (n=81), trichotillomania (n=24), tinea captis (n=13), traction alopecia (n=12), lichen planopilaris (n=8), discoid lupus erythematosus (n=7), congenital triangular alopecia (n=2) and pseudopelade of Brocq (n=1). The significance of dermoscopic findings for each disease were evaluated. RESULTS: Characteristic dermoscopic findings of alopecia areata were tapering hairs and yellow dots. Those of trichotillomania and traction alopecia were broken hairs. Dermoscopic findings of tinea capitis included bent hairs, perifollicular white macules and greasy scales. Discoid lupus erythematosus and lichen planopilaris were characterized by dermoscopic findings of lack of follicular ostia. Furthermore, keratin plugs were frequently seen in discoid lupus erythematosus whereas perifollicular hyperkeratosis and erythema were frequently seen in lichen planopilaris. CONCLUSION: Dermoscopic examination for small round or oval hairless patch showed characteristic findings for each disease. Based on these results, we propose dermoscopic algorithm for small round or oval hairless patch on the scalp.

Comparative Study of Syphilid and Syphilid-Like Eruptions on the Palms

No abstract available.

Usefulness of Ultrasonography in the Diagnosis of Sparganosis: A Case Report / 대한피부과학회지

Sparganosis is a kind of parasitic skin disease caused by sparganum, the plerocercoid larvae of the taper worm of the genus Spirometra. Sparganosis usually manifests as migrating or fixed subcutaneous nodules; therefore, it should be differentiated from lipoma, cysts, and cutaneous malignancies. Although the final diagnosis of sparganosis in humans depends on the identification of the worm in an infected tissue, suspicion for the presence of the parasite and careful history taking are important before making the diagnosis. However, it might be difficult for a clinician to suspect the existence of sparganosis because the incidence of this disease is extremely low. Therefore, an effective method for differentiating sparganosis from other skin disorders is needed. We suggest that ultrasonography could be an answer to this problem, on the basis of our experience of a case of cutaneous sparganosis in a 65-year-old woman showing very characteristic ultrasonographic findings.

Extensive Psoriasis Induced by Pegylated Interferon Alfa-2a and Ribavirin in the Treatment of Chronic Hepatitis C

A 56-year-old man with chronic hepatitis C was treated with pegylated interferon alfa-2a in combination with ribavirin. However, psoriatic lesions appeared and worsened dramatically during therapy. Because of the extensive skin eruptions, he stopped therapy for chronic hepatitis C and subsequently started narrow-band ultraviolet B phototherapy and topical calcipotriol/betamethasone dipropionate ointment. After this, the psoriasis improved in a slow but comprehensive manner. Our case suggests that physicians should keep in mind the possibility of psoriasis as a side effect of interferon treatment for chronic hepatitis C.

A Case of Palmoplantar Psoriasis Improved by 308-nm Excimer Laser / 대한피부과학회지

Various modalities have been used for the treatment of psoriasis, including phototherapy. The choice of psoriasis treatment is based on the characteristics of the lesions, locations and amount of involved body surface area. Narrowband ultraviolet (UV) B therapy is a widely used and highly efficient method for psoriasis. But, large areas of unaffected skin may be irradiated along with the psoriatic lesions during phototherapy. The 308-nm excimer laser is a further development of narrowband UVB and was reported to be an effective and safe treatment for localized psoriasis. We experienced an excellent effect without significant adverse reactions of 308-nm excimer laser in a 9-year-old patient with palmoplantar psoriasis who was recalcitrant to oral cyclosporine and topical calcipotriol/betamethasone treatment.

A Pilot Study of 1% Pimecrolimus Cream for the Treatment of Childhood Segmental Vitiligo

BACKGROUND: There is as yet no effective and safe treatment for vitiligo. One percent pimecrolimus cream, a topical calcineurin inhibitor, has been tried for the treatment of vitiligo, with its therapeutic efficacy having mostly been reported in non-segmental vitiligo. However, questions about the therapeutic efficacy of 1% pimecrolimus cream have remained unanswered regarding segmental vitiligo. OBJECTIVE: The aim of this study was to study the therapeutic efficacy and safety of 1% pimecrolimus cream for segmental childhood vitiligo. METHODS: Nine childhood patients with segmental vitiligo were treated with 1% pimecrolimus cream twice daily for three months, after which good responders were scheduled to continue with the 1% pimecrolimus cream monotherapy. The efficacy and safety of this treatment were determined by the levels of repigmentation, initial response time and the presence of adverse events including burning, dryness, stinging and itching. RESULTS: Four of nine patients achieved mild to moderate responses after three months of treatment and thus continued with treatment. Among these four patients, three achieved an excellent response and one patient achieved a moderate response, with a mean treatment duration of 7.3 months. Transient local burning sensation was the most common adverse event. In comparison with the patients with poor response, those patients with good response showed a shorter disease duration (8.5+/-10.5 mo vs. 13.4+/-10.1 mo), more frequent facial involvement (4/4 patients vs. 3/5 patients) and earlier initial response after treatment (1.0+/-0.0 mo vs. 2.0+/-1.0 mo). CONCLUSION: This study suggests that 1% pimecrolimus cream is an effective and well-tolerated treatment for segmental childhood vitiligo.

Syphilid with a Histological Pattern of Non-caseating Epithelioid Granuloma / 대한피부과학회지

No abstract available.

A Case of Eosinophilic Ulcer of the Oral Mucosa with Nodular Change / 대한피부과학회지

No abstract available.

A Case of Disseminate and Recurrent Infundibulo-Folliculitis / 대한피부과학회지

Disseminated and recurrent infundibulo-folliculitis is an infrequent entity of unknown etiology that was first described in 1968, by Hitch and Lund. Most patient reports have been on young black male adults. It is rarely reported in Asian, and there has been only 1 case reported in the Korean medical literature in the year 1984. The syndrome has been characterized as tiny uniform, skin-colored papules similar to 'goose-bumps' of skin. These papules predominantly involve the trunk and proximal extremities, and are usually accompanied by mild pruritus. In this report, we presented a 33-year-old man with a 10-year history of generalized skin-colored, follicular papules on the chest and back with intermittent pruritus. The clinical initial differential diagnosis included keratosis pilaris, lichen spinulosus, lichen nitidus, folliculitis, and disseminated and recurrent infundibulo-folliculitis. A histopathologic examination showed predominant mononuclear cell infiltration around the infundibular portion of hair follicles, follicular spongiosis and lack of hyperkeratosis. Herein, we reported a rare case of disseminated and recurrent infundibulo-folliculitis with typical clinical and histopathological findings in a 33-year-old Korean man.

Two Cases of Eosinophilic Pustular Folliculitis Improved with Topical Tacrolimus / 대한피부과학회지

No abstract available.

Livedo Racemosa Associated with Epstein-Barr Virus-induced Post-transplant Lymphoproliferative Disorder / 대한피부과학회지

Livedo racemosa (LR) is characterized by a striking violaceous netlike patterning of the skin similar to the livedo reticularis, from which it differs by its localization (more generalized), and shape (irregular, broken circular segments). LR is probably caused by patchy impairment of cutaneous arteriolar circulation, resulting in venous dilatation and stasis of blood. LR is always associated with a pathological condition, including hematologic/hypercoagulable disease, vasculitis, connective tissue diseases, neoplasm, lymphoma, infection, cerebrovascular disease, adverse response to a drug, and etc. Hence, clinical, pathological and laboratory examinations are important for excluding these underlying diseases. To date, there have been few reports of LR secondary to posttransplant lymphoproliferative disease (PTLD) in dermatologic literatures. Herein, we report a case of LR associated with Epstein-Barr virus-induced PTLD of cervical lymph node in a 19-year-old female, who had generalized reticular erythematous to violaceous patch on the entire body after allogenic peripheral blood stem cell transplantation.

Clinicopathologic Study for 10 Cases of Cutaneous Angiosarcoma / 대한피부과학회지

BACKGROUND: Cutaneous angiosarcoma (CAS) is occasionally difficult to differentiate with other benign dermatoses, clinically, because of various clinical manifestations. OBJECTIVE: The aim of this study is to examine the clinical and histopathologic findings of CAS, and investigate specific clinicopathologic features to aid in the early diagnosis. METHODS: We reviewed photographs, medical records and biopsy specimen of 10 cases diagnosed as CAS for 5 years at our clinic. RESULTS: The male and female numbers were 7 and 3, and the mean onset age was 69.7 years old. The mean duration of disease was 5.7 months. The site of involvement was scalp or face in all patients. The most common clinical feature was erythematous or purpuric nodule, with surrounding erythematous or purpuric patch, without symptoms. Initial impressions based on clinical findings on the first visit of our clinic were CAS (n=6), squamous cell carcinoma (n=2), basal cell carcinoma (n=1), and erysipelas (n=1). Histopathologically, irregular vascular channels lined by atypical endothelial cell dissect between the collagen bundles were seen in 6 cases, malignant endothelial cells forming continuous sheets with epithelioid morphology in 3 cases, and mild vascular hyperplasia in 1 case. CD31 was positive on atypical endothelial cells in all patients. CONCLUSION: CAS should be included in differential diagnosis when cutaneous lesions show erythematous to purpuric nodule or patch with rapid progression on scalp or face of elderly patients. Histopathologically, CAS had wide spectrum from mild vascular hyperplasia to spindle cell tumors. As such, immunohistochemical stain, using endothelial markers, is valuable to diagnosis of CAS.

Clinical Study on Hypopigmentation Induced by Intralesional Corticosteroid Injection / 대한피부과학회지

BACKGROUND: Several cases of hypopigmentation induced by intralesional corticosteroid injection have been reported. However, there is little information concerning the epidemiology and clinical characteristics of such cases. OBJECTIVE: To describe the epidemiology and clinical characteristics of hypopigmentation induced by intralesional corticosteroid injection. METHODS: A retrospective clinical study was performed on 22 patients with hypopigmentation induced by intralesional corticosteroid injection, during a period of January 2003 to December 2010. Investigated factors included sex, age, previous history of intralesional corticosteroid injection, clinical manifestations, treatment modalities and clinical course. RESULTS: Of the 22 patients, 21 were female and 1 were male with the mean age of 34.3+/-17.5 (range 4~68) years old. Twelve patients were treated with corticosteroid injection for the treatment of musculoskeletal diseases, whereas, 10 patients for treatment of skin diseases. Eight patients were injected by dermatologists, 3 patients by orthopedists and 11 patients by doctors of unknown specialty. The mean number of the times of corticosteroid injection was 1.9. On the average, hypopigmentation occurred 4.2 months after corticosteroid injection. Upper extremities were most frequently affected, followed by the scalp, face, lower extremities and trunk. Hypopigmentation in most patients were localized and accompanied with skin depression and telangiectasia. There was complete resolution of hypopigmentation within 3.7 months, on average. CONCLUSION: Intralesional injections of corticosteroid are performed not only as the treatment of various skin diseases, but also for the treatment of musculoskeletal diseases. Intralesional corticosteroid injection could cause hypopigmentation of the skin, and it could be confused with other skin diseases presented with hypopigmented patch. However, dermatologist could distinguish hypopigmentaion induced by intralesional corticosteroid injection from other skin diseases, such as vitiligo, by the presence of skin depression, telangiectasia and spontaneous resolution.

A Case of Segmental Piloleiomyomatosis on the Face and Neck / 대한피부과학회지

Cutaneous piloleiomyoma is a benign, often painful, smooth muscle tumor, originating from arrector pili muscle. It is usually present as red-brown nodules on the extensor extremities, and it can be multiple in 80% of patients. A 51-year-old man with multiple papules, nodules and plaques on his left cheek, left chin and left submandibular area visited our department. He had noted papules on his left submandibular area for the past 30 years, which had spread to the left cheek and chin. These lesions caused intense pain on exposure to cold air. Histopathological examination showed a neoplastic aggregation composed of irregular interlacing bundles of smooth muscle cells, in the whole dermis. Immunohistochemical staining with smooth muscle actin was positive in tumor cells. The clinical and histopathological findings led to a diagnosis of segmental piloleiomyomatosis. To our knowledge, this case is a first report of extensive segmental piloleiomyomatosis on the face and neck in Korea.

Adult-onset Porokeratotic Eccrine Ostial and Dermal Duct Nevus and It's Dermoscopic Features / 대한피부과학회지

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare disorder of keratinization, involving acrosyringium. Most cases were congenital, and showed linear distribution of multiple hyperkeratotic comedo-like papules and plaques located on acral extremities. Adult-onset cases were extremely rare in the English literatures and there have not been any reported cases in the Korean literatures. Moreover, there has been no report describing the dermoscopic features of PEODDN so far. So, we here report a rare case of adult-onset PEODDN with its dermoscopic finding and review of the relevant literatures.

Five Cases of Onychatrophy Following Bleomycin Intralesional Injections for Periungual Warts / 대한피부과학회지

Onychatrophy is the processes in which the nail has initially formed satisfactorily and then shows total or partial regression. The causes of onychatrophy with pterygium include lichen planus, acrosclerosis, Stevens-Johnson syndrome, and cicatrical pemphigoid, and those without pterygium include severe paronychia, Stevens-Johnson syndrome, epidermolysis bullosa, and drugs. Bleomycin is an antitumor, antibacterial, and antiviral agent used in many dermatologic diseases such as warts, vascular anomalies, hemangioma, and cutaneous malignancies. Cutaneous adverse effects of bleomycin strongly depend on the route of administration and dosage. Bleomycin intralesional injection for periungual warts could result in permanent Raynaud phenomenon, nail dystrophy, and nail loss. We report five cases of onychatrophy following bleomycin intralesional injections for periungual warts. We remind that if bleomycin intralesional injection near the nail matrix is inevitable in recalcitrant periungual warts, the performer must manipulate precisely to avoid adverse effects.

Lichen Striatus-Induced Pterygium Unguis / 대한피부과학회지

Pterygium unguis occurs as a result of the scarring process between the proximal nail-fold and matrix and lichen planus is a typical example, although it has also been reported to occur in patients with sarcoidosis or leprosy. Lichen striatus is a childhood linear inflammatory dermatitis of unknown etiology. Many nail changes such as nail-bed hyperkeratosis, nail pitting, longitudinal ridging, onycholysis, and longitudinal fissures have been described in patients with lichen striatus, but pterygium unguis is very rare. It has been suggested that the onset and resolution of onychodystrophy correlates well with the course of skin eruption, but pterygium unguis results in permanent nail changes regardless of skin eruption. A 3-year-old boy presented with a linear papular eruption on the right hand and pterygium on the index finger. He was diagnosed with lichen striatus by histopathological findings, and the papular eruption was resolved with topical tacrolimus ointment, but the pterygium did not improve.

Two Cases of Irritation Fibromas on Lower Lip / 대한피부과학회지

Irritation fibroma, also known as traumatic fibroma or focal fibrous hyperplasia, is the most common soft tissue exophytic lesion occurring in the oral cavity. It is a reactive lesion, caused mostly by chronic trauma to the oral mucous membranes. There is no gender or racial predilection, and the most common sites for irritation fibromas are the buccal and labial mucosa and the lateral surface of the tongue. Typical lesion presents as smooth, dome-shaped or pedunculated nodule with color of surrounding mucosa. Histopathologically, irritation fibromas are characterized by their dome shape with a keratinized stratified squamous epithelium, dense bundles of collagen fibers, spindle- or fibroblast-like cells, relatively few blood vessels and inflammatory cells in the submucosa. Although dermatologist should have interest in irritation fibromas due to their higher prevalence, there have been few reports in dermatologic literatures. Herein, we report two cases of multiple irritation fibromas on the lower lip, following lip biting.

Two Cases of Irritation Fibromas on Lower Lip / 대한피부과학회지

Irritation fibroma, also known as traumatic fibroma or focal fibrous hyperplasia, is the most common soft tissue exophytic lesion occurring in the oral cavity. It is a reactive lesion, caused mostly by chronic trauma to the oral mucous membranes. There is no gender or racial predilection, and the most common sites for irritation fibromas are the buccal and labial mucosa and the lateral surface of the tongue. Typical lesion presents as smooth, dome-shaped or pedunculated nodule with color of surrounding mucosa. Histopathologically, irritation fibromas are characterized by their dome shape with a keratinized stratified squamous epithelium, dense bundles of collagen fibers, spindle- or fibroblast-like cells, relatively few blood vessels and inflammatory cells in the submucosa. Although dermatologist should have interest in irritation fibromas due to their higher prevalence, there have been few reports in dermatologic literatures. Herein, we report two cases of multiple irritation fibromas on the lower lip, following lip biting.

Two Cases of Cement Burns / 대한피부과학회지

Cement is increasingly used in the construction industry. Cement handling has been found to be responsible for many cases of occupational dermatitis, but cement burns have rarely been reported. Alkalinity of wet cement, abrasion by sand particulates, and prolonged contact, due to wet clothes, are relevant factors for cement burns. Although cement burns can result in full thickness burn and severe sequelae, the prevalence and severity are underestimated, due to the unawareness of patients and physicians. Herein, we report two cases of cement burns in construction workers, who had contacted with wet cement on lower extremities from their occupational exposures.