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.

Nasalis Island Pedicle Flap for Reconstruction of the Nasal Defect / 대한피부과학회지

BACKGROUND: Reconstruction of surgical defects of the nose is often challenging. There are many repair options for a nasal defect, including second-intention healing, primary closure, a skin graft and a skin flap. Among these, the nasalis island pedicle flap is a random pattern advancement flap that has satisfactory vascular supplies from the underlying muscular structure. OBJECTIVE: We wanted to describe the surgical technique of creating a nasalis island pedicle flap and to report on our experience with the postoperative cosmetic outcome. METHODS: Fourteen patients diagnosed with non-malignant melanoma skin cancer on the nose were treated with Mohs micrographic surgery (MMS). The surgical defects were reconstructed with a nasalis island pedicle flap. The size of the tumor and the postoperative surgical defects, the local complications and the cosmetic outcomes were assessed. RESULTS: The size of the primary defects ranged from 0.8 to 2.3 cm at the greatest dimension (with a mean of 1.51 cm). Five cases were located on the nasal ala, three on the nasal dorsum, two on the nasal root, two on the nasal side wall and two on the nasal tip. During the follow-up period, there was no significant postoperative bleeding, necrosis and infection. There was no tumor recurrence and most of the patients showed minimal discernable scarring with satisfactory aesthetic outcomes. CONCLUSION: A nasalis island pedicle flap provided aesthetically pleasing results, and it could be an useful method to reconstruct surgical defects in the nose after MMS.

Clinical Observation of Cutaneous Sarcoidosis / 대한피부과학회지

BACKGROUND: Sarcoidosis is a chronic idiopathic disorder characterized by the formation of noncaseating granulomas. Multiple organs may be involved, including the skin, lung, lymphatic systems, liver, spleen and eyes. On average, 25% of sarcoidosis cases have cutaneous involvement. OBJECTIVE: The purpose of this study was to investigate the clinical characteristics of cutaneous sarcoidosis and the involvement of systemic organs according to clinical types of skin lesions. METHODS: A total of 32 patients diagnosed by histologic examination at Hospital from 2001 to 2009 with cutaneous sarcoidosis were enrolled in this study. The clinical features were obtained by reviewing medical records, clinical photographs and radiological images. RESULTS: The male to female ratio was 1 : 3 and 78.2% of patients were in their fifth to seventh decades. The most common cutaenous lesions were nodules (56.3%), especially the subcutaneous type (21.9%). The most frequently involved organ type was intrathoracic (71.9%), followed by the peripheral lymph nodes (25%), spleen (6.3%), and eyes (6.3%). Most patients with subcutaneous nodules, erythema nodosa, lupus pernio and discoid lupus-like plaques showed systemic involvement, whereas most patients with nodules or papules did not show systemic involvement. Of particular note, patients with subcutaneous nodules and lupus pernio showed more frequent involvement of the peripheral lymph nodes, spleen and intrathoracic region. CONCLUSION: In this study, patients with subcutaneous nodules and plaques showed more frequent systemic involvement, while most patients with nodules or papules showed no systemic involvement.

Clinicopathologic Observation of Odontogenic Sinus Tracts Draining to the Skin / 대한피부과학회지

BACKGROUND: An odontogenic sinus tract draining to the skin is the most common type of cutaneous fistula that occurs on the face. This lesion can be a diagnostic challenge to clinicians who are not familiar with cutaneous fistula since many patients with an odontogenic sinus tract draining to the skin do not have any symptom such as toothache. OBJECTIVE: Our purpose was to determine the characteristic features of an odontogenic sinus tract draining to the skin. METHODS: Eleven patients who presented with an odontogenic sinus tract draining to the skin at the Dermatologic Department of Pusan National University Hospital during the last ten years were enrolled in this study. We reviewed all the medical records of the patients. RESULTS: The mean age was 51.8 years. The male to female ratio was 1.2:1. Nine patients (82%) had lesions on their chins or the mandibular region. The most common tooth with endodontic infection was the lower first premolar tooth (36%), and the most common clinical feature was pyogenic granuloma-like solitary papule (64%). The panoramic view showed radiolucent periapical abscesses in all the patients. Skin biopsy showed chronic granulomatous inflammation, and fistular tracts were present in three patients. Only 1 of 11 patients (9%) had toothache, and two patients had prior therapies for prosthetic dentures or caries, respectively. Nine patients (82%) were treated ineffectively, and their first visit was to adermatologic clinic (91%) or an otolaryngologic clinic (9%). After the diagnosis of odontogenic sinus tract draining to the skin, eight patients (73%) were treated completely by root canal therapy or extraction of teeth. CONCLUSION: In this study, most patients had no toothache or history of dental disease, and they were treated inappropriately, even in dermatologic clinics. The results of this study will help reduce the incidence of inappropriate management for odontogenic sinus tract draining to the skin at dermatologic departments.

A Case of Granulomatous Mycosis Fungoides / 대한피부과학회지

Granulomatous mycosis fungoides is a rare type of cutaneous T-cell lymphoma. The patients with this illness do not present with distinct clinical findings, so the diagnosis depends on the demonstration of a malignant lymphoid infiltration in combination with a granulomatous tissue reaction. A 38-year-old woman presented with erythematous to purple-colored, focally atrophic, scaly plaques on the right inguinal area and diffuse erythematous scaly patches and multiple erythematous papules on the trunk. The histopathological findings showed non-necrotizing granulomatous infiltrates admixed with an atypical lymphocytic component and epidermotropism. Herein, we report a case of granulomatous mycosis fungoides.

A Childhood Case of Pigmented Spindle Cell Nevus for Whom Dermoscopy Was Used as an Adjuvant Diagnostic Tool / 대한피부과학회지

Pigmented spindle cell nevus (PSCN) is a solitary heavily pigmented macule or papule that usually occurs on the lower legs of women in the second decade of life. Histologically, fascicles of uniform, elongated, pigmented nevoid cells at the dermo-epidermal junction tend to fuse with neighboring nests. PSCN should be differentiated from Spitz nevus, dysplastic nevus, and malignant melanoma. For making the differential diagnosis of PSCN from malignant melanoma of nevoid cells, the overall symmetry, relative uniformity, maturation with depth and no nuclear atypia are important clues. A 3-year-old girl presented with a black papule on the anterior aspect of the ankle. We diagnosed PSCN by the histologic findings and the specific "starburst" dermoscopic pattern.

Postauricular Island Pedicle Flap ("Flip-Flop" Flap) for Reconstruction of the External Ear Defect / 대한피부과학회지

About six percent of head and neck cancers occur on the external ears. Excision of the cancer can cause changes of morphology and poor cosmesis. Reconstruction of ear defects presents a unique and notable challenge to the dermatologic surgeons. This is due to the complex architecture of the external ear which is difficult to duplicate surgically. Several methods are available for reconstruction of defects to the external ear. However, the diversity of external ear shapes shows how difficult it is to achieve a certain solution to this problem. Postauricular island pedicle flap was initially reported as a technique for reconstruction of small defects of the concha after excision, and has since been used successfully in the repair of more extensive defects involving not only the concha, but also the antihelix and external auditory meatus. We report two cases of auricular squamous cell carcinoma in which the skin defect is reconstructed by a postauricular island pedicle flap ("flip-flop" flap).

A Case of Digital Myxoid Cyst Coexisting with Epidermal Inclusion Cyst

A 62-year-old male developed a solitary asymptomatic nodule on the lateral aspect of the distal interphalangeal joint of the right great toe. Histopathologic findings demonstrated a myxoid cyst with a concomitant epidermal inclusion cyst. To the best of our knowledge, this is the first case of concurrent occurrence of digital myxoid cyst and epidermal inclusion cyst. Although the exact mechanism for developing a digital myxoid cyst and an epidermal inclusion cyst simultaneously at the same site is not explained, trauma might be a possible cause.