A Survey on the Topical Steroid Prescriptions of Dermatologists / 대한피부과학회지

BACKGROUND: A recent survey on dermatology outpatients, which assessed their knowledge and behavior for topical steroid use, showed that topical steroids were often used without sufficient information or guidelines. OBJECTIVE: Our study aimed to evaluate the general pattern of which dermatologists prescribe topical steroids, the prevalence of topical steroid phobia among the dermatology outpatients and the way dermatologists managed such patients. METHODS: 236 dermatologists, including those in private clinics and those in the secondary and tertiary hospitals, were asked via mail or e-mail to fill in a questionnaire on their topical steroid prescription. RESULTS: About sixty percent of the total respondents answered that they prescribed topical steroid to more than half of their outpatients, with excluding those patients who came to the office for cosmetic purposes. Most respondents informed their patients about their prescription of topical steroids (85.61%), they explained the mechanism of its action and the clinical effects (65%), the potency and duration of application (70%), and the side effects (82%). But most respondents forgot or did not tell their patients about their steroid formulation (46%), the optimal amount to apply (74%) and the means and duration of optimal storage (82%). 45% of the respondents assumed that more than half of the outpatients to have topical steroid phobia. Yet 80% of the respondents replied that less than 10% of their outpatients had experienced side effects of topical steroids. 73% of the respondents in private clinics and 62% in secondary and tertiary hospitals were influenced by the patients' negative attitude on topical steroid prescription. CONCLUSION: The results show that the information on topical steroids, in terms of formulation, the optimal amounts to apply and the means and duration of optimal storage, were not sufficiently provided by dermatologists. The topical steroid phobia of patients has been exaggerated despite the low incidence of side effects.

A Case of Steatocystoma Multiplex on the Face in a Family / 대한피부과학회지

We describe a family with a two-generation history of steatocystoma multiplex with an unusual clinical manifestation. A 7-year-old boy had multiple asymptomatic, small, yellowish cysts on the face since birth. His father and 4-year-old brother also presented several similar persistent cysts localized to the face. This family had no other abnormality on physical examination. The cysts discharged oily yellow material when incised. Biopsy of several lesions disclosed that the cysts had typical features of steatocystoma multiplex histologically.

Linear Focal Elastosis Associated with Striae Distensae in an Atopic Patient / 대한피부과학회지

We report a case of linear focal elastosis associated with striae distensae. A 20-year-old man presented with asymptomatic, several, striae-like yellow palpable bands extending horizontally in the lumbar region. Histologic examination revealed many fine wavy and fragmented bundles of elastic fibers in the dermis. Striae distensae were also presented in the buttock, axilla. He had been treated with topical steroids for atopic dermatitis since childhood. This patient can be one more case to support the association between linear focal elastosis and striae distensae.

Disappearing Atypical Lentiginous Pigmentation of the Desmoplastic Malignant Melanoma

A 38-year-old man presented with a black pigmented patch overlying his upper lip, a part of the gingiva and the hard palate. An intradermal tumor mass was palpated at the central portion of the pigmented patch of the upper lip. Diphenylcyclopropenone (DPCP) is a potent contact sensitizer that could stimulate non-specific immunity. We report a case of desmoplastic malignant melanoma (DMM) in which an atypical lentiginous pigmentation disappeared with topical DPCP immunotherapy and the dermal tumor mass was removed by a surgical wedge-shaped excision. Though an atypical lentiginous pigmentation of DMM sometimes undergoes extensive spontaneous regression, in our case it could be attributed to the therapeutic effect of topical DPCP immunotherapy rather than a spontaneous regression.

A Case of Phthiriasis Occurring on the Scalp of a Child / 대한피부과학회지

Phthiriasis is a sexually transmitted disease by Phthirus pubis(pubic or crab louse) and usually affect the pubis in adult. Infestation of the eyelashes and scalp occurs rarely and mainly in children. In children, infestation may be transmitted by close contact with infected family, infected towel or other materials, or rarely by sexual abuse. So, careful examination is needed to find out familial source. We report a case of phthiriasis occuring on the scalp of a 16 month-old child whose mother has phthiriasis on the pubis and both axilla.

Giant cell tumor of tendon sheath on the fingertip / 대한피부과학회지

Giant cell tumor of tendon sheath is a benign histiocytic proliferation of the articular and peritendinous synovial tissue and manifests as a painless, firm, smooth, subcutaneous mass which occurs predominantly on the hand where it is typically located adjacent to the interphalangeal joints of the hands, especially the terminal interphalangeal joints. Histologically, it is characterized by the presence of multinucleated giant cells. We herein report a case of giant cell tumor of tendon sheath located on the fingertip with the involvement of overlying skin, which shows rare location and unusual clinical manifestation.

A Case of Trichilemmal Horn

Trichilemmal horn(trichilemmal keratosis) is a rare keratinizing tumor that resembles a cutaneous horn. Histologically, it is characterized by an abrupt maturation of keratinocytes into lamellar keratin without the formation of a granular layer. We describe a case of a trichilemmal horn on the right cheek of a 78-year-old woman.

A case of Hyperkeratosis of Areola in an Old man / 대한피부과학회지

Hyperkeratosis of the nipple and areola is a rare condition characterized by verrucous thickening and brown pigmentation of the nipple and areola, with variants involving both or alone. The most common type is a nevoid form which occurs more often in women of childbearing age. We report a 62-year-old man with bilateral hyperkeratosis of areola. He has no history of endocrinopathy or exogenous hormonal therapy. Also, he had no other additional hyperkeratotic condition. The present case is a nevoid form by the Levy-Franckel classification and interesting in that it developed in an old man without any underlying disease, just confined to both areolas.

Lipoid Proteinosis / 대한피부과학회지

Lipoid proteinosis is a rare autosomal recessively inherited disorder that is characterized by the deposition of hyaline-like material in the skin, oral cavity, and other organs. Microscopically, there is extensive deposition of amorphous eosinophilic material surrounding capillaries, sweat glands and in papillary dermis. Although the pathogenesis of this disease is not well understood, it is believed that it may result from the defect of collagen metabolism leading to abnormal accumulation of noncollagenous glycoprotein. We report a case of lipoid proteinosis in a 20-year-old female that demonstrates the characteristic clinical, histopathological, and ultramicroscopic features of this disease.

A Case of Disseminated Cutaneous Infection Caused by Fusarium oxysporum in an Immunocompromised Patient / 대한의진균학회지

With the wide and extensive use of immunosuppressive agents and broad-spectrum antibiotics, opportunistic fungla infections have been increased. Fusarium spp. are known to be significant emerging pathogens of opporthunistic local infection. But very rarely it may cause fatalc systemic infection. A 4-year-old boy with acute lymphocytic leukemia develped asymptomatic disseminated purpura with high fever unresponsive to the antibiotics during chemotherapy. The skin lesions gradually increased in size and number, and prgreassed to forming central necrosis. Many septated hyphae and variable sized spore-like fungal elements are found in the epidrmis, dermis and subcuit on histologic sections. The pathogenic fungus was idenified as Fusarium oxysporum by culture and scanning electronic microscopic findings.

A Case of Green Nail Syndrome / 대한의진균학회지

Green nail syndrome is characterized by greenish discoloration of the nail. It is caused by Pseudomonas aeruginosa and mostly associated with paronychia in persons whose hands are frequently exposed to water. Trauma of the nail fold or nail plate is another predisposing factor of this infection. Here we report a case of green nail syndrome in a 27-year-old man who develops asymptomatic greenish discoloration and fragile thickening of the nail plate on his left great toe after trauma.

Hirsutoid Papillomas of Vulvae

Hirsutoid papillomas of vulvae present as smooth or filiform papules located on the inner surfaces of the labia minora. This disease is usually considered as anatomical variants of the vestibular mucosa. Differentiation from condyloma acuminata is important to avoid unnecessary treatment. Herein we report a case of hirsutoid papillomas of vulvae in a 21-year-old female who complained of pruritic papules on the vulva of one year's duration. Papules were located on the inner surfaces of the left labia minora and vestible of the vulva. Clinically, they were quite similar to condyloma acuminata. Histologically, however, the epithelium was devoid of features of human papillomavirus(HPV) infections such as koilocytosis, double nucleation, and dyskeratosis.

Clinical and Mycological Studies of Dermatophytosis in Human Transmitted from Infected Rabbits / 대한의진균학회지

BACKGROUND: Recently, as rabbits have become a popular pet in Korea, there has been an increase in reports of dermatophytosis in humans as a result of frequent contact with rabbits. OBJECTIVE: The purpose is to investigate the clinical and mycological features of dermatophytosis in humans transmitted from rabbits. METHODS: Seventeen cases of dermatophytosis, developed after contact with rabbits, were clinically evaluated from November, 1999 to May, 2000. Mycologic studies were carried out from the lesions of rabbits and humans. RESULTS: Dermatophytes were cultured from 15 of 17 (88.2%) specimens from the lesions of humans. Trichophyton (T.) mentagrophytes, granulosum-asteoroid form, was isolated in 12 specimens (70.6%) and Microsporum (M.) canis was isolated in 3 specimens (17.6%). Human infection showed a high incidence in young children under age 10 (52.9%), with female predominance (2 times), and high familial incidence, and mainly being tinea faciale and tinea corporis. Tinea capitis also was observed in four cases, and M. canis was isolated from two of them. CONCLUSION: Rabbits can be an infectious source of human ring-worm due to T. mentagrophytes and M. canis. These zoophilic dermatophytes can be frequently transmitted to humans and induce inflammatory lesions. Therefore, epidemiologic studies of the prevalence of dermatophytes in healthy or infected rabbits, and sanitary measure are necessary.

A Case of Eruptive Steatocystoma Multiplex on the Scalp / 대한피부과학회지

A 46-year-old man had noticed an asymptomatic, small, yellowish, papular eruption on the scalp about one year ago. Since then, the lesions had slowly increased in size and number. There was no family history of similar lesions. An incision made into the cysts discharged oily yellow material. Biopsy of a lesion disclosed that the cysts had typical features of steatocystoma multiplex histologically. This case was a unique eruptive variety of steatocystoma multiplex on the scalp.

A Case of Trichilemmal Carcinoma on the Lower Lip / 대한피부과학회지

We report a case of Trichilemmal carcinoma in a 75-year-old man who was presented with an exophytic nodule on the lower lip. The tumor was composed of glycogen-rich cytoplasmic cells with PAS-positive, diastase-labile and had a characteristic trichilemmal keratinization. The trichilemmal carcinoma is well known to have originated from the outer root sheath of the hair follicle in the hair bearing area. It is interesting that our case had developed on the lip, an exceptional site for a follicular tumor : the hair follicle could not be seen. It might have been developed from an ectopic follicle or at the follicle of vermillion border and grew up into the lip.