Nursing students’ experiences in virtual simulation practice / 한국간호교육학회지

Purpose@#The purpose of this study was to explore the meaning of nursing students’ experiences in virtual simulation practice. @*Methods@#The participants were six nursing students who have experience in a virtual simulation. Data were collected from August to September 2019 through a focus group interview. Giorgi’s phenomenological method was used for analysis. @*Results@#The study results revealed 3 constituents and 6 sub-constituents that are essential for nursing student’s experiences in a virtual simulation. The three constituents were: “Chaos in the virtual reality”, “The process of adjusting to chaos”, and “Becoming an independent nurse in a safe virtual reality”. @*Conclusion@#Based on the results of this study, the following suggestions are made. Results suggest the development of virtual simulations in Korean, the use of simulations as a group activity first, and the use of simulation between lecture and practice or in the regular curriculum. The results of the study can be used as primary data for providing virtual simulation in nursing education.

Effectiveness of Specific Sublingual Immunotherapy in Korean Patients with Atopic Dermatitis

BACKGROUND: Sublingual immunotherapy (SLIT) with house dust mites (HDM) preparation has recently been proven to be beneficial for treating allergic rhinitis and asthma. However, there has been no report regarding the efficacy and safety of SLIT in Korean patients with atopic dermatitis (AD). OBJECTIVE: We intended to investigate the efficacy and safety of SLIT in Korean patients with AD. METHODS: A total of 34 patients with AD and immunoglobulin E (IgE)-proven HDM sensitization (Class ≥3) were recruited. Eczema area and severity index (EASI) score, total serum IgE level, specific IgE assays to Dermatophagoides pteronyssinus, D. farinae, and adverse effects were recorded during follow-up. "Responder" was defined as a patient with ≥30% improvement in EASI score after SLIT. RESULTS: Twenty-three patients continued SLIT for 12 months or more, whereas 3 patients (8.8%) dropped out because of exacerbation of dermatitis, and 8 patients (23.5%) were lost to follow-up. The average duration of SLIT treatment was 22.4 months (range, 12~32 months). EASI scores reduced significantly after 6 months of treatment (p<0.05) compared with those at baseline. A total of 18 patients were determined to be responders to SLIT after 6 months. Total and specific IgE serum levels did not significantly reduce after SLIT. No patients experienced serious adverse events, with the exception of two patients who developed transient lip and tongue swelling. CONCLUSION: Our study demonstrated that SLIT with HDM extracts is effective and tolerable in Korean patients with AD. Further controlled long-term trials are required to reinforce the current results.

Dermatoses of the Glans Penis in Korea: A 10-Year Single Center Experience

BACKGROUND: A variety of infectious, inflammatory, and neoplastic dermatoses can develop on the glans penis, and definitive diagnosis in such cases may be difficult owing to their non-specific symptoms and clinical appearance. Furthermore, data on dermatoses of the glans penis in Korea are limited. OBJECTIVE: In the present study, we aimed to determine the prevalence of dermatoses of the glans penis in Korea and provide clinical data to assist in making an accurate diagnosis. METHODS: We retrospectively reviewed the medical records, clinical photographs, and histologic slides of 65 patients with dermatoses of the glans penis that visited the Pusan National University Hospital between January 2004 and August 2013. RESULTS: Twenty-six types of dermatoses were identified: inflammatory dermatosis was the most common (38/65, 58.5%), followed by infectious (13/65, 20.0%), neoplastic (10/65, 15.4%), and other dermatoses (4/65, 6.2%). The most common dermatosis of the glans penis was seborrheic dermatitis, followed by lichen planus, herpes progenitalis, condyloma accuminatum, erythroplasia of Queyrat, Zoon's balanitis, and psoriasis. In the topographic analysis, the most common type of dermatosis was dermatoses that localized to the glans penis (39/65, 60.0%), followed by dermatoses involving the extra-genitalia and glans penis (22/65, 33.9%), and the genitalia (glans penis plus other genital areas) (4/65, 6.2%). CONCLUSION: This study shows the usefulness of a topographic approach in the diagnosis of dermatoses of the glans penis in Korea. The findings could be used as baseline data for establishing an accurate diagnosis in Koreans.

The Usefulness of Dermoscopy for Detection of Subungual White Foreign Bodies

No abstract available.

The Malignant Transformation of Sebaceoma into Sebaceous Carcinoma in Nevus Sebaceous / 대한피부과학회지

Nevus sebaceous appears at birth or within the first few months after birth. Secondarily to nevus sebaceous, benign or malignant tumors such as basal cell carcinoma, trichoblastoma, syringocystadenoma papilliferum, squamous cell carcinoma, sebaceoma, and sebaceous carcinoma might occur. Sebaceoma is a benign tumor composed of incompletely differentiated sebaceous cells of varying degrees of maturity. We experienced an uncommon case of malignant transformation of sebaceoma in a 47-year-old man who had a solitary, well-defined, 3.1x2.1 cm sized, round, erythematous nodule on the scalp. Histopathologic examination revealed the presence of irregular lobules of varying size with a well-defined margin from the adjacent interstitial tissue in the dermis. Focally there were atypical cells with a foamy cytoplasm and undifferentiated cells. To the best our knowledge, only one case, from another country, has been reported in the literature. Therefore, we report a very rare case of malignant transformation of sebaceoma that occurred in nevus sebaceous.

Low Grade Myxofibrosarcoma on the Arm of an Elderly Patient / 대한피부과학회지

No abstract available.

Erythrodermic Psoriasis Treated with Golimumab: A Case Report

Erythrodermic psoriasis (EP) is a very severe variant of psoriasis whose management poses a challenge to physicians, as currently available therapies often provide unsatisfactory results. Many biologics have been used to treat chronic plaque psoriasis, the most common form of psoriasis; however, their effectiveness for EP is poorly understood. A recently developed biologic, golimumab, has been extensively studied for the treatment of moderate-to-severe active rheumatoid arthritis, psoriatic arthritis, active ankylosing spondylitis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Here, we report the case of a 32-year-old man who presented with severe psoriasis that previously failed to respond satisfactorily to methotrexate, cyclosporine, retinoid, narrow-band ultraviolet B phototherapy, and topical agents (i.e., steroids and calcipotriol). Skin lesions worsened progressively and developed into erythroderma. Psoriatic arthritis was also detected. Conventional therapies lacked efficacy. Therefore, we administered golimumab 50 mg. The skin lesions improved significantly according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Although additional studies are required to fully evaluate the efficacy and safety of golimumab, this agent may be an alternative treatment strategy for some patients with recalcitrant EP.

Neutrophilic Panniculitis in a Patient with Myelodysplastic Syndrome / 대한피부과학회지

Myelodysplastic syndrome (MDS) is a heterogeneous group of stem cell disorders characterized by morphological abnormalities of the erythroid, granulocytic, and megakaryocytic cells. Cutaneous lesions associated with MDS are classified as either specific or non-specific. Specific leukemic infiltrates are often referred to as leukemia cutis, and non-specific inflammatory lesions, historically called leukemids, include cutaneous infections, vasculitis, and neutrophilic dermatoses. We report the case of a 53-year-old man who had been diagnosed with MDS 8 months ago when he developed multiple erythematous tender nodules on the trunk and upper extremities for 8 days. Histopathologic findings from an erythematous nodule on his chest showed lymphohistiocytic and neutrophilic infiltration in the septa and periphery of the fat lobules consistent with neutrophilic panniculitis. Most neutrophils observed in our case had the pseudo-Pelger-Huet anomaly. Herein we present a rare case of neutrophilic panniculitis associated with MDS showing specific groups and the pseudo-Pelger-Huet anomaly.

A Study of the Prevalence, Distribution and Dermoscopic Patterns of Acral Melanocytic Nevi in a Korean Population / 대한피부과학회지

BACKGROUND: An awareness of the prevalence and morphologic patterns of acral melanocytic nevi (AMN) is crucial in the diagnosis of AMN and for its differentiation from acral melanoma. Although studies regarding prevalence and dermoscopic patterns of AMN in other ethnic groups have been reported, studies in Korean populations are scarce. OBJECTIVE: To investigate the prevalence, number and dermoscopic patterns of AMN cases in a Korean population. METHODS: We investigated the prevalence and dermoscopic patterns of AMN in a Korean population. RESULTS: Six hundred Korean patients were enrolled in this study. AMNs were observed on the hands in 53.2% of patients and on the feet in 30.5% of patients. The prevalence of AMN according to anatomical location was as follows: dorsum of hands (43.8%), palms (15.7%), both palms and dorsum of hands (6.3%), dorsum of feet (24.8%), soles (9.2%), and dorsa of feet and soles (3.5%). On volar skin, the common dermoscopic patterns were as follows: parallel-furrow (51.7%), lattice-like (12.1%), globular (9.2%), fibrillar (8.6%), reticular (7.5%), and homogeneous (5.7%). On dorsal skin, reticular (41.0%), homogeneous (27.0%), globular (21.6%), and reticular-homogeneous (7.7%) patterns were commonly observed. The prevalence of AMN increased with patient age until patients reached their forties and decreased according to age once patients reached their sixties. CONCLUSION: The results of our study show that AMN on hands and feet are common in Korean patients and that characteristic dermoscopic patterns of AMN exist. This study provides information regarding the prevalence and dermoscopic patterns of AMN in a Korean population.

A Case of Soft Fibroma of the Nipple with a Cauliflower-Like Appearance

No abstract available.

Mycobacterium massiliense Infection after Liposuction / 대한피부과학회지

Mycobacterium massiliense is a new emerging pathogen within the M. chelonae-M. abscessus group that has been described recently. Mycobacterium massiliense usually causes pulmonary or skin and soft tissue infections in immunocompromised patients; however, cutaneous infections have also been reported in healthy individuals following surgical procedures or laparoscopic surgery. This potentially hazardous microorganism should not be overlooked because it often shows resistance to conventional antibiotics. A 25-year-old woman presented with erythematous nodules on her left leg, which was a liposuction site. A histopathological examination showed suppurative granulomas with mixed cellular infiltrations within the dermis and fat layer. Rod-shaped bacilli were detected within the clear spaces of the dermis using Ziehl-Neelsen stain. An acid-fast bacterial culture showed colony formation, and using the polymerase chain reaction-restriction fragment length polymorphism analytical method and the ERM gene, we identified M. massiliense. After surgical excision and the systemic administration of medication comprising clarithromycin and linezolid for 6 months, all of the cutaneous lesions improved and no new lesions occurred.

A Clinical Study of Atopic Eruption of Pregnancy / 대한피부과학회지

BACKGROUND: There are limited literatures regarding the clinical characteristics of the specific dermatoses of pregnancy, and their terminology has been confusing and misleading. A simplified classification is proposed with the new terminology 'atopic eruption of pregnancy', comprising several disease entities such as eczema of pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy. OBJECTIVE: A clinical study was performed to determine the exact nature of atopic eruption of pregnancy in Korea. METHODS: We retrospectively reviewed the medical records of 75 patients who were diagnosed and reclassified as atopic eruption of pregnancy at Pusan National University Hospital. RESULTS: Among 121 patients with the specific dermatoses of pregnancy, 75 (62%) were diagnosed with atopic eruption of pregnancy. The most affected sites were the flexural surfaces of the neck and extremities, followed by the abdomen and back. The mean gestational age was 18.5 weeks. In 92% of cases, atopic eruption of pregnancy started during the 1st and 2nd trimesters of pregnancy. Major fetal problems were not seen. Atopic disease was observed in 26 (34.7%) patients. Total serum IgE levels were elevated in 10 (50%) patients among the 20 patients who were tested for IgE levels. Forty-four (58.5%) patients improved after delivery, and atopic eruption of pregnancy recurred after delivery in 6 (8%) patients. CONCLUSION: The characteristics of AEP in Korea were mostly similar to those of AEP in Western countries. However, AEP in Korea seems to show a poor prognosis and be refractory to treatment compared to that of Western countries.

Autologous Whole Blood Injection for the Treatment of Antihistamine-Resistant Chronic Spontaneous Urticaria

No abstract available.

Efficacy and Safety of Calcipotriol/Betamethasone Dipropionate Ointment for the Treatment of Trachyonychia: An Open-Label Study

BACKGROUND: Despite efforts to treat trachyonychia, there is no promising treatment modality. OBJECTIVE: This study evaluated the efficacy and safety of calcipotriol plus betamethasone dipropionate ointment on trachyonychia. METHODS: A total of 39 patients with 432 nails affected by trachyonychia were enrolled. All patients applied calcipotriol/betamethasone ointment once daily without occlusion for 6 months. Outcome measures were assessed by physician's global assessment (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at all time points. RESULTS: After 6 months of therapy, 98.6% (426/432) of nails showed significant clinical improvement; 4.2% were completely free from nail lesions. The mean physician global assessment score decreased significantly from 3.5 to 1.7 points (p< 0.05). No serious side effects were reported, except mild pruritus and erythema in 2 patients. CONCLUSION: This is the first study to prospectively evaluate the efficacy and safety of calcipotriol/betamethasone ointment for the treatment of trachyonychia. The results indicate topical calcipotriol/betamethasone is an effective and safe treatment for symptom improvement of trachyonychia.

Megalencephaly-capillary Malformation Syndrome / 대한피부과학회지

Megalencephaly-capillary malformation syndrome is a disorder characterized by megalencephaly or hemimegalencephaly, focal or generalized somatic overgrowth, and vascular malformations. Other characteristic features are neonatal hypotonia, hydrocephalus, developmental delay, syndactyly/polydactyly, frontal bossing, and connective tissue dysplasia. Previously reported patients exhibit wide phenotypic variability in clinical and neuroradiological findings. Differential diagnosis may be challenging for clinicians due to other similar neurocutaneous syndromes. Herein, we report an 11-month-old male infant that presented with extensive, diffuse, reticulated, erythematous patches on his face, trunk, and extremities. Physical examination revealed an increased head circumference (>97 percentile), frontal bossing, hypertrophy of the right arm and leg, and syndactyly on both feet. Borderline developmental delay was identified, and magnetic resonance imaging of the brain revealed an enlarged right cerebral hemisphere and non-obstructive ventriculomegaly. To our knowledge, this is the first report of megalencephalycapillary malformation syndrome in Korean literature.

Screening for Psoriatic Arthritis in Korean Psoriasis Patients Using the Psoriatic Arthritis Screening Evaluation Questionnaire

BACKGROUND: Psoriatic arthritis (PsA) is chronic seronegative inflammatory arthritis that causes irreversible joint damage. Early recognition of PsA in patients with psoriasis is important for preventing physical disability and deformity. However, diagnosing PsA in a busy dermatology outpatient clinic can be difficult. OBJECTIVE: This study aimed to validate the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire for the detection of PsA in Korean patients with psoriasis. METHODS: The PASE questionnaire was prospectively given to 148 patients diagnosed with psoriasis but without a previous diagnosis of PsA. All patients underwent radiologic and laboratory examinations, and a subsequent clinical evaluation by a rheumatologist. RESULTS: Eighteen psoriasis patients (12.2%) were diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis. The PASE questionnaire scores of differed significantly between PsA and non-PsA patients. Receiver operator characteristic analysis showed an area under the curve of 0.82 (95% confidence interval: 0.72, 0.92) for PASE score. A PASE score cut-off of 37 points had a sensitivity of 77.8% and specificity of 82.3% for the diagnosis of PsA. CONCLUSION: The PASE questionnaire is a simple and convenient screening tool for detecting PsA in Korean dermatology clinics. A PASE questionnaire score of 37 points appears to be an appropriate cut-off for screening Korean psoriasis patients.

Blue Toe Syndrome after Percutaneous Coronary Intervention / 대한피부과학회지

Blue toe syndrome involves blue or purplish toes in the absence of trauma, serious cold exposure, or disorders causing general cyanosis. Clinical presentation can range from a cyanotic toe to a diffuse, multi-organ systemic disease. A 75-year-old man presented with claudication, sudden bilateral painful discoloration of the sole, blue-colored toes, and anuria. Three weeks earlier, he had been diagnosed with acute myocardial infarction and had undergone catheterization for percutaneous coronary intervention. Histopathologic findings showed vascular ectasia with mild perivascular inflammation. Based on patient history, physical examination, and laboratory findings, he was diagnosed with blue toe syndrome. Our patient presented with clinical manifestations, including peripheral cutaneous involvement and acute deterioration of renal function. This case highlights the importance of prompt diagnosis of blue toe syndrome by careful history-taking and physical examination in order to avoid multi-organ systemic disease.

Lymphangiectatic Pilomatricoma Following an Intramuscular Injection / 대한피부과학회지

No abstract available.

A Case of Extensive Cutaneous Metastasis from Squamous Cell Carcinoma of the Uterine Cervix / 대한피부과학회지

Carcinoma of the uterine cervix is a common malignancy for women in Korea. It frequently metastasizes to the lungs, bone, or liver, but cutaneous metastasis is rare, with a reported incidence of only 1.3%. In cases of cutaneous metastasis, the lesions present in the forms of nodules, ulcers, or plaques, and are generally located in the abdominal wall, vulva, anterior chest wall, lower extremities, and upper extremities. Here, we describe a case of a 64-year-old woman diagnosed with cutaneous metastases from squamous cell carcinoma of the uterine cervix on both flanks, lower abdominal wall, and both inguinal areas, three years after receiving chemoradiation therapy. At presentation, the primary carcinoma had been resolved completely. Histological and immunohistochemical findings revealed intact epidermis and infiltration of tumor cells in the dermis, which showed positivity for cytokeratin 5/6, cytokeratin 7, and tumor protein 63, consistent with metastatic squamous cell carcinoma of the uterine cervix.

A 10-year Experience at a Single Center / 대한피부과학회지

BACKGROUND: A variety of benign and malignant tumors can occur in the nail apparatus, causing nail deformities and growth disorders. Clinical diagnosis of nail apparatus tumors can be difficult because of their similar clinical appearance. OBJECTIVE: The aim of this study was to determine the types and frequency of nail apparatus tumors and to assess the types and frequency of nail alterations induced by tumors. METHODS: We retrospectively reviewed the medical records, clinical photos, and histologic slides of 165 patients with nail apparatus tumors who had visited Pusan National University Hospital between January 2002 and August 2012. RESULTS: The most frequently diagnosed benign tumors were digital mucous cysts (22.4%), glomus tumors (21.8%), and subungual exostoses (8.5%). The most common malignant tumors were melanomas (17.0%), squamous cell carcinomas (4.9%), and Bowen's disease (3.0%). We observed nail plate alterations in 80.6% of the cases. All cases of melanomas, fibrous tumors, and subungual exostoses produced nail alterations. Most tumors were treated with surgical management. CONCLUSION: Although the sample size of this study was small, this is the first Korean dermatologic trial to identify nail apparatus tumors. The study findings may prove useful in the clinical diagnosis of various nail apparatus tumors.