A Case of Pyodermatitis-Pyostomatitis Vegetans Complicated by Gram-Negative Toe Web Infection / 대한피부과학회지

Pyodermatitis-pyostomatitis vegetans (PPV) is a rare eosinophilic inflammatory disorder characterized by pustules and vegetating lesions on the mucosa and skin. It usually occurs in the oral mucosa, axillae, genital area. Usually oral lesions (pyostomatitis) may precede the skin lesions (pyodermatitis), where it can also coincide or follow. A 54-year-old man is presented with a 3-month history of annular pustular plaques on the erythematous base affecting the dorsum of both feet. Pseudomonas aeruginosa was isolated from a culture of a wound in the foot. He was treated with antipseudomonal antibiotics for the initial two weeks, and the lesions improved slightly, but not completely. After that, erythematous vesicles, pustules and erosions developed on his oral mucosal and perianal area. The skin biopsy from right foot was done and he was diagnosed as PPV complicated by Pseudomonas aeruginosa infections. Herein, we report a case of PPV complicated by Pseudomonas aeruginosa infection.

Kaposi Sarcoma in a Patient with Chronic Renal Failure Undergoing Dialysis

Kaposi sarcoma (KS) is a multicentric proliferative vascular tumor involving the skin and other organs. Human herpesvirus 8 (HHV-8) has been detected in KS lesions and is considered the putative causative agent of KS. The relationship between chronic renal failure, HHV-8, and KS is not clear. KS appears to develop in association with renal transplantation, but is unlikely with dialysis, and there have been few reports on this. Here, we report the case of a 51-year-old man, who underwent peritoneal dialysis to treat chronic renal failure, and presented with multiple brownish plaques on his soles. On histopathological examination, abnormally proliferated vessels, vascular slits, and spindle-shaped cells were seen in the dermis. Immunohistochemical staining for HHV-8 was positive. This case is another example in which factors other than immunosuppression contributed to the development of KS, due to activation of HHV-8.

Congenital Melanocytic Nevus with Asymptomatic Neurocutaneous Melanosis / 대한피부과학회지

Congenital melanocytic nevi (CMN) are benign pigmented lesions that are defined as a tissue malformation of the neuroectoderm. Giant melanocytic nevi with multifocal involvement show significantly greater risk of developing malignant melanomas and neurocutaneous melanocytosis, particularly those in a posterior axial location. Neurocutaneous melanosis is a rare, congenital, non-inherited disorder characterized by the presence of large, multiple congenital melanocytic nevi with proliferation of melanocytes in the central nervous system. Asymptomatic neurocutaneous melanosis can be detectable only by MRI. The patients who have clinical manifestations have an extremely poor prognosis. We present a patient with giant congenital melanocytic nevi involving a major portion of the back with multiple satellite nevi scattered over the whole body associated with asymptomatic neurocutaneous melanosis. We emphasize the importance of imaging study for detection of early neurological symptoms or melanomas. To our knowledge, this is the first case of giant congenital melanocytic nevi associated with asymptomatic neurocutaneous melanosis in Korean dermatologic literatures.

Evaluation of Efficacy and Skin Irritation during Treatment of Nadifloxacin 1% Cream in Acne Vulgaris Patient / 대한피부과학회지

BACKGROUND: Nadifloxacin is a synthetic fluoroquinolone with a broad spectrum. It has been suggested to not only have antibacterial, but also anti-inflammatory actions. In addition, it is effective against antibiotic-resistant Propionibacterium acne. Upon review of the literature, however, no studies have been performed concerning the efficacy and safety in terms of irritation potential and skin barrier changes after applying nadifloxacin. OBJECTIVE: This study intended to evaluate the skin irritation and changes of the skin barrier function associated with the administration of nadifloxacin 1% cream for the treatment of acne vulgaris. Furthermore, the efficacy and safety of nadifloxacin 1% cream were also assessed. METHODS: The changes in the lesion counts, Korean Acne Grading System (KAGS) and adverse events were recorded. The biophysical profiles of the skin, including transepidermal water loss (TEWL), skin surface hydration and redness were measured by Tewameter(R), Corneometer(R) and Mexameter(R) for 3 weeks. RESULTS: At the end of the therapy, 69% of inflammatory lesions (p<0.0001) and 27% of noninflammatory lesions (p=0.26) resulting from acne were decreased from the baseline. Adverse events were reported in two patients, but they were transient and tolerable. The skin barrier function showed no changes during the treatment periods. CONCLUSION: Nadifloxacin 1% cream is effective for the treatment of acne vulgaris without the changes of skin barrier function.

The Treatment of Angiofibromas Using Multiple-Drilling Method by Carbon Dioxide Laser / 대한피부과학회지

No abstract available.

Comparison of Therapeutic Effect of ALA-PDT with Blue Light According to the Thickness of Atypical Cell Layer and the Histopathologic Subtypes in Actinic Keratosis / 대한피부과학회지

BACKGROUND: Precancerous diseases of the skin such as actinic keratosis (AK), Bowen disease (BD) and skin cancer, i.e. basal cell carcinoma (BCC), are treated successfully with photodynamic therapy (PDT). In BCC, the therapeutic effect of PDT was different according to the subtypes. However, there has been no study on the response to PDT in the thickness of atypical cell layer and the histopathologic subtype of AK. OBJECTIVE: We evaluated the responses to PDT using a topical 20% aminolevulinic acid (ALA) solution and a blue light, according to the thickness of atypical cell layer in AK. Further, we assessed the therapeutic response in the histopathologic subtypes of AK. METHODS: There were a total of 29 AK lesions from 20 patients enrolled in the study. The lesions were incubated with a topical 20% ALA solution for 2 hours and were exposed to blue light (417+/-5 nm) with 10 J/cm2. They were treated 2 times at the 4 weeks intervals. The evaluation of the response to ALA-PDT was done by the skin biopsy at the post 8 weeks period from the last treatment. The therapeutic response was assessed into 3 grades (complete remission, partial remission, no response). The relationship between the therapeutic response and the thickness of atypical cell layer was evaluated. The thickness of atypical cell layer was measured from the most superficial aspect of the Malpighian layer to the tip of rete ridge. In addition, we evaluated the therapeutic effects according to the histopathologic subtypes. RESULTS: The thickness of atypical cell layer were 0.0327+/-0.0087 mm in complete remission (CR) group, 0.1253+/-0.1128 mm in partial remission (PR) group and 0.1485+/-0.1973 mm in no response (NR) group (p=.0206). CR were achieved in 100% (4/4) of atrophic type, 43.75% (7/16) of hypertrophic type and 0% (0/9) of bowenoid type in AK. The response of ALA-PDT was the best in atrophic type (p=.032) and the lowest in bowenoid type (p=.0051) as compared with other subtypes. CONCLUSION: The responses to ALA-PDT were different in the thickness of atypical cell layer and it was statistically significant. The therapeutic effect was the best in the atrophic type of AK.

The Clinical Efficacy, Safety and Functionality of Anion Textile in the Treatment of Atopic Dermatitis

BACKGROUND: Several previous studies have suggested the improvement of atopic dermatitis (AD) in response to special fabrics. In particular, beneficial effects have been reported, following the use of anion textiles. OBJECTIVE: The purpose of this study is to evaluate the effectiveness and safety of an anion textile in patients suffering from AD. METHODS: We compared an anion textile with a pure cotton textile. Fifty-two atopic patients (n=52) were enrolled and divided into two groups. The patients in the test (n=25) and control (n=19) groups wore undergarments made of an anion textile or pure cotton over a period of 4 weeks. The overall severity of disease was evaluated using the SCORing atopic dermatitis (SCORAD) index, whereas, the treatment efficacy was measured using a Tewameter(R) (Courage & Khazaka, Cologne, Germany), Mexameter(R) (Courage & Khazaka) and Corneo meter(R) (Courage & Khazaka). RESULTS: At the end of the study, a significant decrease in the SCORAD index was observed among the patients with AD in the test group (mean SCORAD decreased from 47.2 to 36.1). Similarly, improvements in the mean transepidermal water loss, skin erythema and stratum corneum hydration were significantly greater among the patients with AD in the test group than in the control group. CONCLUSION: Anion textiles may be used to significantly improve the objective and subjective symptoms of AD, and are similar in terms of comfort to cotton textiles. The use of anion textiles may be beneficial in the management of patients with AD.

Multiple Piloleiomyoma Treated with a Suction-Assisted Cartilage Shaver / 대한피부과학회지

Piloleiomyoma is a benign neoplasm arising from the erector pili muscle in the skin. It occurs as linear or dermatomal arrangements of firm, red to brown intradermal nodules, which are fixed to the skin but not to the deeper tissues. Although various treatments have been attempted, they have shown limited success and several complications remain. A 21-year-old male presented with 3-year history of multiple, erythematous, firm 4 mm to 3 cm sized nodules on the chest. The histopathological examination was compatible with piloleiomyoma. The lesions were removed using the dermal shaving method with a suction-assisted cartilage shaver. Each lesion were markedly flattened. This treatment was quicker and caused less subjective pain to the patient compared with those of classic surgical excision. No signs of adverse events or recurrence have been observed.

A Case of Cutaneous Side Effect of Methotrexate Mimicking Behcet's Disease

Methotrexate (MTX) is an antimetabolite which interferes with DNA synthesis, and it is used for the treatment of moderate to severe psoriasis, atopic dermatitis and a wide variety of cutaneous diseases. Although many adverse effects of MTX, including cutaneous ulcerations, have been documented, multifocal mucosal ulceration mimicking Behcet's disease has not been reported. In our case, a 63-year-old female presented with oral, vaginal ulcer and multiple purpuric patches on both legs. Considering patient's clinical course and histopathologic findings, we presumed that these reactions may be the side effect of MTX administered for treatment of necrotizing scleritis. Herein we report the cutaneous side effect of MTX that manifested clinically like Behcet's disease.

Hidradenoma Papilliferum Occurring on the Nasal Skin

Hidradenoma papilliferum is a rare benign neoplasm that usually occurs in the female anogenital area. We present a 43-year-old female with a non-anogenital (ectopic) hidradenoma papilliferum on her nose. The patient had had a skin-colored subcutaneous nodule on her nose for 7 years. The histopathological findings showed variously shaped cystic spaces in the tumor. And the lumina were surrounded by a single or double layer of cell which showed decapitation secretion. In the English dermatological literature, only one case of ectopic hidradenoma papilliferum arising in nasal skin has been reported. Hence we suggest hidradenoma papilliferum occurring on the nasal skin is a peculiar and interesting event.

Steatocystoma Multiplex Confined to the Scalp with Concurrent Alopecia

Steatocystoma multiplex (SM) is an uncommon disorder of the pilosebaceous unit characterized by the development of numerous sebum-containing dermal cysts which rarely involves the scalp. Here, we report a case of a 50-year-old man with multiple cystic nodules and alopecic patches on his scalp. On histopathological examination, the folded cyst was found to be lined by stratified squamous epithelium, while flattened sebaceous gland cells were identified in the cystic wall. Pigment casts were present in the hair papillae and perifollicular regions, suggesting trichotillomania as a possible cause of the observed alopecia. This case appears to represent an unusual clinical manifestation of SM.

Steatocystoma Multiplex Treated with a Suction-assisted Cartilage Shaver / 대한피부과학회지

Steatocystoma multiplex is a rare autosomal-dominant disorder characterized by asymptomatic multiple, skin-colored to yellowish nodules on the trunk, proximal extremities, and axillae. Although surgical excision is the most effective method, treatment is difficult when lesions occur in multiple numbers. Therefore, various treatments such as CO2 laser therapy, needle aspiration, and oral isotretinoin have been attempted, but results are variable. A 37-year-old man presented with multiple skin-colored subcutaneous nodules on the abdomen and both axillae. A histopathological examination was consistent with steatocystoma multiplex. The lesions were removed by dermal shaving with a suction-assisted cartilage shaver. It was an effective therapeutic method for multiple lesions with no significant adverse events. Herein, we report a case of steatocystoma multiplex treated with a suction-assisted cartilage shaver.

Syringomas Treated by Intralesional Insulated Needles without Epidermal Damage

Syringoma is a benign adnexal tumor derived from intradermal eccrine ducts; it predominantly occurs in women at puberty or later in life. Although syringoma is a common benign neoplasm, there have been no effective therapies for its removal. Conventional therapies for syringomas, including surgical excision, electrodessication, chemical peeling, topical atropine or tretinoin, cryosurgery, and laser therapy, can lead to cosmetic defects such as hyperpigmentation or scarring due to epidermal damage. In contrast, treatment using intralesional insulated needles, which are insulated at the point of epidermal contact, has been shown to result in good cosmetic outcomes due to selective destruction of dermal lesions. This could be an effective and highly satisfying treatment for syringomas. We herein present 2 patients with syringomas treated with intralesional insulated needles.

A Case of Acquired Smooth Muscle Hamartoma on the Sole

A smooth muscle hamartoma is a benign proliferation of smooth muscle bundles within the dermis. It arises from smooth muscle cells that are located in arrector pili muscles, dartos muscles, vascular smooth muscles, muscularis mammillae and the areolae. Acquired smooth muscle hamartoma (ASMH) is rare, with only 10 such cases having been reported in the English medical literature to date. Most of these cases of ASMH were shown to have originated from arrector pili and dartos muscles. Only one case was reported to have originated from vascular smooth muscle cells. A 21 year-old woman presented with a tender pigmented nodule, with numbness, on the sole of her foot, and this lesion had developed over the previous 18 months. The lesion showed no hyperpigmentation or hypertrichosis, and the biopsies demonstrated increased smooth muscle bundles in the dermis, and especially around the blood vessels. Moreover, the specimens stained positive with Masson trichrome stain and alpha-smooth-muscle actin antibodies, thus supporting our diagnosis of ASMH of the foot sole. Herein, we report on a rare case of ASMH on the foot sole, and this lesion originated from vascular smooth muscle cells. This type of case has not been previously described in the English medical literature.

A Case of Allergic Contact Dermatitis to Duoderm Extrathin(R) Dressing / 대한피부과학회지

Even though hydrocolloid dressings have been widely used for the past 15 years in the treatment of various types of wounds; allergic contact dermatitis to these dressings have been rarely reported. Duoderm(R) is representative agent of hydrocolloid dressing, and Duoderm Extrathin(R) is a new formulation of Duoderm(R) that contains pentaerythritol ester as a tacking agent, a substance used in several other adhesives. In Korean dermatologic literature, only 1 case of the allergic contact dermatitis due to Duoderm CGF(R) has been reported. However allergic contact dermatitis due to Duoderm Extrathin(R) has not been reported. We report a case of allergic contact dermatitis in a 22-year-old female during wound management using Duoderm Extrathin(R).

A Hydroxyurea-induced Leg Ulcer

Hydroxyurea is a cytostatic agent that has recently become the drug of choice in the treatment of various myeloproliferative diseases. The cutaneous side effects of hydroxyurea include xerosis, hyperpigmentation, nail discoloration, and scaling. Leg ulcers have only rarely been reported in association with hydroxyurea treatment. A 75-year-old woman presented with leg ulcers, nail discoloration, and xerosis. The leg ulcers were refractory to conventional treatment. She had been taking oral hydroxyurea since being diagnosed with essential thrombocytosis in 2002. Hence, we suspected hydroxyurea-induced leg ulcers and discontinued her hydroxyurea treatment; the ulcers gradually healed thereafter. We present a rare case of hydroxyurea-induced leg ulcers in Korea.

A Case of Herpetic Whitlow / 대한피부과학회지

Herpetic whitlow is a painful cutaneous infection that occurs on the fingers and toes, and it is caused by herpes simplex virus (HSV)-1 or -2. It is correlated with the immunocompromised state of patients or with occupations that are in frequent contact with the secretions or mucous membranes infected by HSV. We present here a 29-year-old woman who was referred to our department with recurrent vesicles and ulcerative lesion of the right 3rd finger. She was immunocompetent and did not have any occupational hazard of herpetic whitlow. We made the diagnosis of herpetic whitlow by the clinical features and the histopathologic examinations. In addition, we used polymerase chain reaction assay to detect the type of HSV and we confirmed she suffered with herpetic whitlow that was caused by HSV-2.

A Case of Benign Symmetric Lipomatosis Limited to the Face / 대한피부과학회지

Benign symmetric lipomatosis is a very rare disease that's characterized by a symmetric accumulation of excessive amounts of adipocytes. The lesions are located mainly on the neck, trunk and proximal extremities. Although its etiology is unknown, it has been described to be associated with a heavy alcohol intake. A 51-year-old woman presented with a two year history of ill-defined soft masses on both mandibular areas. We made the diagnosis of benign symmetric lipomatosis according to the histopathologic examination. As a difference from other reports of benign symmetric lipomatosis, our patient was non-drinker for her past history. We present here a case of benign symmetric lipomatosis at an unusual predilection site and this developed in a non-drinker.

Progressive Macular Hypomelanosis in Korean Patients: A Clinicopathologic Study

BACKGROUND: Progressive macular hypomelanosis is characterized by ill-defined, non-scaly, hypopigmented macules primarily on the trunk of the body. Although numerous cases of progressive macular hypomelanosis have been reported, there have been no clinicopathologic studies of progressive macular hypomelanosis in Korean patients. OBJECTIVE: In this study we examined the clinical characteristics, histologic findings, and treatment methods for progressive macular hypomelanosis in a Korean population. METHODS: Between 1996 and 2005, 20 patients presented to the Department of Dermatology at Busan Paik Hospital with acquired, non-scaly, confluent, hypopigmented macules on the trunk, and with no history of inflammation or infection. The medical records, clinical photographs, and pathologic findings for each patient were examined. RESULTS: The patients included 5 men and 15 women. The mean age of onset was 21.05+/-3.47 years. The back was the most common site of involvement. All KOH examinations were negative. A Wood's lamp examination showed hypopigmented lesions compared with the adjacent normal skin. A microscopic examination showed a reduction in the number of melanin granules in the lesions compared with the adjacent normal skin, although S-100 immunohistochemical staining did not reveal significant differences in the number of melanocytes. Among the 20 patients, 7 received topical drug therapy, 6 were treated with narrow-band ultraviolet B phototherapy, 4 received oral minocycline, and 3 did not receive any treatment. CONCLUSION: Most of the patients with progressive macular hypomelanosis had asymptomatic ill-defined, non- scaly, and symmetric hypopigmented macules, especially on the back and abdomen. Histologically, the number of melanocytes did not differ significantly between the hypopigmented macules and the normal perilesional skin. No effective treatment is known for progressive macular hypomelanosis; however, narrow-band ultraviolet B phototherapy may be a useful treatment modality.

A Case of Lyme Disease with Various General Symptoms / 대한피부과학회지

Lyme borreliosis is a multi-systemic tick-borne infectious disease caused by the spirochaete, Borrelia burgdorferi. It has many non-specific symptoms affecting the skin, eye, musculoskeletal system, cardiovascular system, and central and peripheral nervous system. Typical cutaneous manifestations of lyme borreliosis include erythema chronicum migrans, borrelia lymphocytoma appearing a few weeks after the tick bite, and acrodermatitis chronica atrophicans developing a few years after. The diagnosis is based on clinical findings with detection of specific Ig M and Ig G antibodies to Borrelia burgdorferi. A 50-year old woman presented with an erythematous to violaceous annular patch with central scaly hyperpigmented patch on the right arm and an erythematous indurated patch on the right thigh for a month. She did not recall a deer tick bite. She had severe arthralgia on the right shoulder and myalgia on the right thigh at the first visit. Three months later, she complained of chest pain, and mild dyspnea on exertions. Serologic examinations revealed increased levels of Ig M and Ig G antibodies to borrelial antigen via ELISA, and Western blot test for Borrelia burgdorferi was positive. Her general symptoms as well as skin lesions subsided with an antibiotics (Doxycycline) and steroid therapy over 4 weeks.