The Effect of Full Spectrum Light Phototherapy for Patients with Tinea pedis / 대한의진균학회지

BACKGROUND: Tinea pedis is the most common dermatophytosis which is usually treated by antifungal agent. Recently, there has been a resurgence of interest in potential phototherapy for the local treatment of bacterial and fungal infection. OBJECTIVE: The aim of this study is to evaluate the therapeutic effect of full spectrum light (F.S.L) phototherapy for patients with tinea pedis. METHODS: Lesions were irradiated for 20 minutes, 2 times a week for 4 consecutive weeks with F.S.L. emitting wavelengths from 320 nm to 5000 nm. Clinical symptoms were observed and KOH direct smear and fungal culture were done. RESULTS: Global assessment score was improved after the application of eight sessions of F.S.L phototherapy. 18% of total patient were cleared, 45.4% a marked improvement, 27.3% a mild improvement and 9.1% of patients had no effect. And the fungal exams, KOH direct smear and culture, were conversion to negative in 7 out of 11 patients. Significant adverse effects were not observed. CONCLUSION: F.S.L phototherapy might be another treatment option for the tinea pedis patients.

Effect of Trans-4-Aminomethylcyclohexanecarboxylic Acid on the Proliferation and Melanization in Cultured Normal Human Melanocytes

BACKGROUND: Trans-4-aminomethylcyclohexanecarboxylic acid (tranexamic acid) has recently been reported to inhibit prostaglandin synthesis and hinder the pigmentation caused after UV radiation. OBJECTIVE: we evaluated the influence of tranexamic acid on the viability, morphogenesis and melanization of cultured normal human melanocytes. METHOD: The cultured melanocytes from neonatal foreskin were exposed to UVB 20mJ/cm2, then treated with tranexamic acid [0.05microgram/ml, 0.05microgram/ml, and 0.5microgram/ml]. After 24 hours, the viability of melanocytes and the melanin concentration was measured. The number and length of the melanocytes' dendrites, and the expression level of tyrosinase, TRP-1 and TRP-2 were also evaluated. RESULTS: The viability of the melanocytes was decreased by tranexamic acid in a dose dependent manner (p<0.05). The increased melanin synthesis by UVB irradiation was decreased by tranexamic acid in a dose dependent manner (p<0.05). Also, the increased expressions of TRP-1, TRP-2 and tyrosinase after exposure to UV were statistically decreased by tranexamic acid in a dose dependent manner (p<0.05). CONCLUSION: tranexamic acid may prevents UVB induced pigmentation.

A Case of Merkel Cell Carcinoma with Unusual Clinical Manifestation / 대한피부과학회지

Merkel cell carcinoma is a rare, aggressive skin cancer that occurs most frequently in the elderly on sun-exposed areas. However, any possible cutaneous or mucosal sites may also be involved. It usually presents as a rapidly- growing, painless, single red or purple colored cutaneous papule, nodule or indurated plaque that may elude diagnosis until histopathologic examination. We report a case of an 83-year old female patient who presented with a 3 x 3.5 cm sized, skin-colored, painful nodule on the left mandibular angle area. A new red nodule had combined on the original lesion after 6 months, and showed unusual clinical manifestation. Microscopically, the tumor cells were uniform with round to oval-shaped nuclei and scanty cytoplasm, and they showed a trabecular arrangement. In immunohistochemical studies, the patient was reactive to cytokeratin-20, and focally reactive to NSE and synaptophysin.

Study of Causative Organisms in Pitted Keratolysis / 대한의진균학회지

BACKGROUND: Pitted keratolysis is a superficial bacterial infection which usually affects the pressure bearing areas of the feet. Some bacterial organisms were identified as etiologic agents, including Corynebacterium species, Micrococcus species and Dermatophilus congolensis. However, in Korea, studies to prove the causative organisms have not been performed. OBJECTIVE: We performed this study to identify causative organisms of pitted keratolysis in Korea. METHOD: Twelve normal healthy men and 27 pitted keratolysis patients were enrolled. We cultured the scraped specimens of the stratum corneum and identified the cultured organisms. We compared the cultured organisms of pitted keratolysis group with those of control group. We also compared the distribution of cultured organisms in pitted keratolysis with and without tinea pedis. RESULT: Micrococcus species and Corynebacterium species were identified in pitted keratolysis group much more frequently than in normal control group. In most cases of pitted keratolysis combined with tinea pedis, the identified organisms were Micrococcus species. CONCLUSION: Micrococcus species and Corynebacterium species are thought to be the major causative organisms of pitted keratolysis in Korea. Micrococcus species might play a certain antagonistic role, especially in patients of pitted keratolysis with tinea pedis.

Clinical Observation of Cellular Phone Dermatitis in Korea / 대한피부과학회지

BACKGROUND: Recently, the use of cellular phones has greatly increased, and allergic contact dermatitis (ACD) ascribed to the use of cellular phones has been one of the problems. OBJECTIVE: The purpose of this study was to evaluate clinical characteristics of allergic contact dermatitis due to cellular phone use. METHODS: Three male and 7 female patients who were diagnosed as ACD due to cellular phone use were evaluated. A patch test was performed on the upper back and any history of metal allergy was checked. We also evaluated the content of nickel in the cellular phones currently being sold on the market, using a dimethylglyoxime spot test. RESULTS: The results of this study are summarized as follows; There was female predominance in cellular phone dermatitis with an average onset of age 27.4 years old. A history of metal allergy was found in 40.0% of the patients. The most common site and mobile phone type were cheek (60.0%) and slider type (60.0%), respectively. In addition to erythematous patches, itching was accompanied in 60.0% of the patients. But the other patients did not report any pruritus at all. Except in three cases, patch tests were performed on the upper back. Five patients were positive to nickel and 4 patients were positive to chrome. The dimethylglyoxime test showed 21.2% positivity in 104 cellular phones of 27 different models. CONCLUSION: Cellular phone dermatitis usually occurs on both cheeks, or the dominant hand-sided cheek area. The causative metals are mostly nickle and chrome.

Circulating Levels of IFN-gamma, IL-10 and IL-16 in Patients with Alopecia Areata / 대한피부과학회지

BACKGROUND: Alopecia areata (AA) is an autoimmune condition of the hair follicle, resulting in bald patches. The details of the pathogenesis of AA still remain unclear. However, several recent studies have indicated that AA is an organ-specific autoimmune disease in which T cells (especially CD8+T cells), as well as certain cytokines (especially Th1 cytokines, IL-1, IFN-gamma, and TNF-alpha) may play an important role in its development. OBJECTIVE: The purpose of this study was to characterize the cytokine response in the peripheral blood of patients with AA, before and after treatment. METHODS: Twenty one active AA patients and 10 healthy people were evaluated in this study. The levels of 3 cytokines, including IFN-gamma, IL-10, and IL-16, in all subjects were measured at the first visit and 3 months after treatment. RESULTS: The levels of IFN-gamma, IL-10, and IL-16 in the AA group were significantly elevated (p75%), and was decreased in comparision to the level before treatment (p=0.003). There was no difference in the cytokine levels after PUVA, DPCP, or a combination therapy of PUVA and DPCP (p>0.05). CONCLUSION: The results suggest the involvement of IFN-gamma in the AA process. Also, IFN-gamma could be a potential marker for treatment. Even though different treatments have different mechanisms, IFN-gamma is considered to be a common pathway for alopecia areata treatment.

The Effect of Autologous Epidermal Grafting in the Treatment of Intractable Vitiligo / 대한피부과학회지

BACKGROUND: There are many therapeutic methods for treating vitiligo including PUVA, narrow-band UVB, topical corticosteroids, tacrolimus, calcipotriol, intralesional injection of steroids or oral corticosteroids, but there is no reliable treatment. Autologous epidermal grafting has been used by several authors, and is reported to be a surgical method which has minimal adverse effect, little risk of scarring, and is easily performed in the clinic. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of autologous epidermal grafting in the treatment of vitiligo, and investigate both patient satisfaction, and any adverse effects. METHODS: The evaluation was conducted using 44 patients (48 cases) with intractable vitiligo who had been treated by autologous epidermal grafting using suction blistered epidermis. We investigated both patient satisfaction, and any problems or adverse effects during the procedure. The efficacy was rated as excellent (repigmentation >75%), good (repigmentation 75-50%), fair (repigmentation 50-25%), or poor (repigmentation <25%). Efficacies according to clinical type, recipient sites, the preparation method for recipient sites, the disease duration at operation and the duration after operation were also investigated. RESULTS: Eexcellent repigmentation was shown in 77.1% of the patients. The epidermal graft was more effective in treating segmental vitiligo, and when the disease duration was more than 36 months. Patient satisfaction was more than 75%. CONCLUSION: The autologous epidermal graft is an effective treatment modality. However, for more effective results and a high level of patient satisfaction we think doctors should only treat stable vitiligo. They should explain the operation procedure, side effects, and postoperative PUVA therapy in detail to the patient.

Two Cases of Allopurinol Hypersensitivity Syndrome due to Use of Allopurinol for the Patient with Asymptomatic Hyperuricemia / 대한피부과학회지

Allopurinol (4-hydroxypyrazolo[3, 4-d]pyrimidine) is a xanthine oxidase inhibitor and is widely used in the treatment of hyperuricemia. Allopurinol hypersensitivity syndrome (AHS) includes a prolonged illness initially manifested by fever, a prominent cutaneous reaction, eosinophilia, hepatic abnormalities, and decreased renal function. Two patients in our study had a decreased renal function; one due to bilateral polycystic kidneys and the other due to bilateral ureteral stones. Both had received allopurinol for asymptomatic hyperuricemia. Whilst taking this medication, they showed a generalized erythematous, maculopapular eruption with fever, leukocytosis, eosinophilia, a further decrease of renal function and prolonged severe hepatic abnormalities. One patient showed an improvement after they stopped taking allopurinol and were treated with steroids, however, died, due to combined giant cell pneumonia. However, the other patient did improve when they stopped taking allopurinol.

Cicatrical Alopecia due to The Hair Coloring Burn / 대한피부과학회지

Primary or secondary cicatrical alopecia is devided by depending on the pattern of follicular destruction. Secondary cicatrical alopecia by significant hairdressing related burns are rare. A 24-year-old man, college student developed round 4x2.5cm sized erythematous bald patch with crust on the top of the occipital scalp. He was injured after being overheated by the steam cap at the hair salon 46 days ago. He received burn dressing and triamcinolone intralesional injection treatment in the private clinic, but no symptom was improved. In our hospital, initially he was treated by wet dressing with KMNO4 and topical anitibiotics for prevention of secondary infection and then treated by topical minoxidil solution for 7months. After 7months, his symptom was not observed any improvement and then performed biopsy. Histologic exam showed an perifollicular fibrosis and complete absence of follicles. After 13 months, he received excision and closure of scar by the plastic surgeon.

A Case of Basal Cell Carcinoma Which Responded to Imiquimod / 대한피부과학회지

Basal cell carcinoma (BCC) in the skin is the most common malignancy worldwide. Surgery is still the golden standard treatment for BCCs, but it may be intensive and sometimes excessively destructive. Imiquimod is a member of novel class of immune response modifiers which stimulate or enhance both the innate immune system and cell-mediated immune response and approved by FDA for treating anogenital wart. A 73-year-old male patient was presented with 8x10cm sized erythematous scaly, peripheral ridging patch with central black colored crust on the back. Histopathological finding showed masses of various shapes and sizes composed of basalioma cells. He refused surgery treatment, so we tried 5% imiquimod cream (AldaraTM, 3M) topically three times weekly for the duration of 7 months. Although lesions had incompletely resolved, clinically and histopathologically improvement was observed. Herein we report a case of basal cell carcinoma which responded to imiquimod.