A Case of Basaloid Follicular Hamartoma

Basaloid follicular hamartoma (BFH), uncommon rare benign neoplasm connected to the adnexal structures, presents with multiple clinical manifestations that can develop into basal cell carcinoma. BFH may be congenital or acquired, and the congenital form can be further divided into the generalized and unilateral type, and the acquired form may present as localized and solitary lesions. Congenital, generalized BFH is associated with systemic diseases such as alopecia, cystic fibrosis, hypohidrosis, and myasthenia gravis. In contrast, sporadic cases are observed as unilateral or localized lesions. BFH shows thick cords and thin strands of anastomosing basaloid proliferations that arise from hair follicles and are enclosed by loose fibrous stroma. Here, we report a 70-year-old man with an acquired, solitary form of BFH.

Pigmented Trichoblastoma Arising from the Nevus Sebaceous: A Rare Case in Korea

Trichoblastoma is occasionally observed in association with a pre-existing nevus sebaceous in the Korean literature. However, there has been no report on the pigmented type. Herein, we report the first Korean case of a pigmented trichoblastoma arising from the nevus sebaceous on the forehead. A 28-year-old male presented with a dark nodular lesion within a yellowish plaque on the forehead. The surrounding yellowish plaque on the forehead had existed since birth. The central, dark-pigmented nodule began to appear three years ago and enlarged gradually. Histopathologic findings of central pigmented lesion showed heavy melanin deposits within and around the tumor nests. Complete excision was made as treatment.

A Case of Vitiligo after Kawasaki's Disease

Vitiligo is a common skin disease, but its pathogenesis has not been fully determined, though an autoimmune etiology is considered likely. Kawasaki disease (KD) is an acute multisystem vasculitis of childhood associated with coronary arteriopathy, and is diagnosed based on clinical criteria. Furthermore, vitiligo has been associated with several other diseases, but no report has been issued about the relationship between vitiligo and Kawasaki's disease. The author's report the case of an 8-year-old male child that presented with depigmented lesions, which developed from the desquamative skin lesions of Kawasaki's disease.

The Effect of Treating Head Lice on Residual Lindane Concentrations in Children / 대한피부과학회지

BACKGROUND: Organochloride pesticides are prohibited around the world due to their toxicity and environmental persistence. However, lindane, one organochloride pesticide, is still widely used to treat head lice and scabies in Korea. OBJECTIVE: For evaluation of the effect of lindane usage and blood lindane concentration, we conduct an evaluation of blood lindane concentrations among children who were treated for head lice. METHODS: The total study population of 80 was divided into rural and urban areas. Age, sex, parent's farming, sea food consumption and head lice treatment information were gathered using a structured questionnaire. Blood lindane concentrations were analyzed by a solid phase extraction(SPE) method. Quantitative analysis was done by GC/ECD. Non-parametric analysis was done for comparing blood lindane concentrations between the head lice treated group and the non treatment group. After a log transformation, regression analysis was done for controlling confounding variables. RESULTS: The median age of the study population was 11. The study population involved 38 (47.5%) male and 42 (52.5%) female children. Twenty (25.6%) children were infested by head lice. The blood concentration of lindane was higher in the head licetreatment group [N.D (N.D-78.9)] than in the non-treated group [N.D (N.D-43.4), P < 0.01]. The results were the same after regression analysis controlling for confounding variables. CONCLUSION: Lindane has toxicity to the endocrine system and nervous system and persists in the environment and in the human body. Therefore, careful usage of lindane shampoo is needed to treat head lice.

The Effect of Treating Head Lice on Residual Lindane Concentrations in Children / 대한피부과학회지

BACKGROUND: Organochloride pesticides are prohibited around the world due to their toxicity and environmental persistence. However, lindane, one organochloride pesticide, is still widely used to treat head lice and scabies in Korea. OBJECTIVE: For evaluation of the effect of lindane usage and blood lindane concentration, we conduct an evaluation of blood lindane concentrations among children who were treated for head lice. METHODS: The total study population of 80 was divided into rural and urban areas. Age, sex, parent's farming, sea food consumption and head lice treatment information were gathered using a structured questionnaire. Blood lindane concentrations were analyzed by a solid phase extraction(SPE) method. Quantitative analysis was done by GC/ECD. Non-parametric analysis was done for comparing blood lindane concentrations between the head lice treated group and the non treatment group. After a log transformation, regression analysis was done for controlling confounding variables. RESULTS: The median age of the study population was 11. The study population involved 38 (47.5%) male and 42 (52.5%) female children. Twenty (25.6%) children were infested by head lice. The blood concentration of lindane was higher in the head licetreatment group [N.D (N.D-78.9)] than in the non-treated group [N.D (N.D-43.4), P < 0.01]. The results were the same after regression analysis controlling for confounding variables. CONCLUSION: Lindane has toxicity to the endocrine system and nervous system and persists in the environment and in the human body. Therefore, careful usage of lindane shampoo is needed to treat head lice.

A Statistical Study of Dermatoses in Goyang City (2004~2008) / 대한피부과학회지

BACKGROUND: There have been many reports that have focused on the incidence of skin diseases in big cities or provinces. However, there have been no reports concerning the data of a new town such as Goyang City. OBJECTIVE AND METHODS: To study the prevalence of common dermatoses in the new town and to compare this with the previous reports, we reviewed the records of 15,064 outpatients who visited the Department of Dermatology at Myongji Hospital from 2004 to 2008, and we statistically analyzed the findings. RESULTS: The study results are summarized as follows: Of the 15,064 outpatients, the total number of male patients was 6,779 (45.0%), and the number of female patients was 8,285 (55.0%). The most frequent age group was the fourth decade followed by the first decade, third decade and fifth decade, and these 4 age groups comprised 63.7% of the total outpatients. The 15 most common dermatoses were found to be viral warts, dermatophytosis, atopic dermatitis, seborrheic dermatitis, pruritus, urticaria, irritant contact dermatitis, herpes zoster, alopecia, allergic contact dermatitis, acne, other eczema, melanocytic nevus, molluscum contagiosum and postinflammatory hyperpigmentation. For the occurrence of dermatoses as disease groups, 1) viral diseases, 2) diseases resulting from fungi and yeasts, 3) atopic dermatitis, eczema and noninfectious immunodeficiency disorders, 4) contact dermatitis and drug eruptions, 5) pruritus and neurocutaneous dermatosis, 6) seborrheic dermatitis, psoriasis, recalcitrant palmoplantar eruptions, pustular dermatitisand erythroderma, 7) erythema and urticaria, 8) Melanocytic nevi and neoplasm, 9) disturbances of pigmentation, and 10) diseases of skin appendages constituted 82.2% of the total. CONCLUSION: The distinct characteristic of skin diseases of the new town Goyang City showed a high incidence of viral warts and viral skin diseases, as compared to the previous reports.

Characteristics of Patients with Common Warts Living in the Koyang and Northern Area of Kyunggi Province in 2006 / 대한피부과학회지

BACKGROUND: Common warts are benign and usually self limiting skin lesions. However, there have been few studies to assess the characteristics of patients with common warts according to their local residence. OBJECTIVE: The study was conducted to assess the characteristics of patients with common warts lived in Koyang area and northern area of Kyunggi. METHODS: We carried out a retrospective analysis of patients with common warts, who had been diagnosed in the Myongji Hospital, Kwandong University College of Medicine from January 2006 to December 2006. RESULTS: Two-hundred and eighty-one patients (128 male, 153 female) were analyzed. A group of patients aged under 10 years old showed most of the occurrences of common warts. The mean age was 16.1 years. Most of the patients visited our clinics within 10 month of the emergence of warts. Hands were more commonly involved than feet. More than half of the patients had one lesion at the time of their visit. Common warts were most prevalent in August. Cryotherapy was used to treat most of the patients. One-hundred and two patients showed complete recovery on clinical ground. The mean number of the treatment was 4.8 times. Atopic dermatitis was observed in 29 patients. Twenty-nine patients had also family members infected with common warts. CONCLUSION: We analyzed the characteristics of patients with common warts living in the Koyang area and northern area of Kyunggi. Further studies would be needed to assess the characteristics of common warts affected by different regional environments.

Two Cases of Melasma with Unusual Histopathologic Findings

We reported two cases of clinically typical melasma presenting with unusual histopathologic findings. In one case, the epidermal melanocytes were markedly increased in number and protruded into the dermis, and in the other case, increased epidermal pigmentation as well as dermal melanocytosis were found. We suggested that the various treatment modalities of melasma should be applied depend on its histopathologic finding.

Skin Organ Culture Model for Evaluation of Melanin Pigmentation / 대한피부과학회지

BACKGROUND: Skin organ culture is widely used as a tool to investigate skin biology or skin disease. OBJECTIVE: The objective of the present study was to develop an ideal skin organ culture model for evaluation of melanin pigmentation. METHODS: An air-liquid interface and submerged method were used. The histology of the cultured skin was studied with H&E stain. To examine the epidermal pigmentation, Fontana-Masson stain and NKI/beteb stain were performed. Pigment modifiers (arbutin, LY294002) were applied to the culture medium for 3 days as an air-liquid interface culture. RESULTS: The general architecture of the skin was well maintained for 5 days. The melanin pigment decreased during culture without change of the number of melanocytes. As expected from previous reports, the effect of pigment modifiers (arbutin, LY294002) on cultured skin was demonstrated. CONCLUSION: The results indicate that this skin organ culture model is useful in evaluating the melanin pigmentation

Comparison of Characteristics of Acquired Bilateral Nevus of Ota-like Macules and Nevus of Ota According to Therapeutic Outcome

Both acquired bilateral nevus of Ota-like macules (ABNOM) and nevus of Ota are characterized by the presence of dermal melanocytes. There are no differences in the method of treatment, however, postinflammatory hyperpigmentation (PIH) develops more often in ABNOM than in nevus of Ota following treatment. We investigated the differences in the development of PIH after treatment between ABNOM and nevus of Ota, and the histopathologic differences in the PIH. A total of 82 patients with ABNOM (n=47) and nevus of Ota (n=35) were treated with Q-switched alexandrite laser and followed up 2 weeks and 3 months later. Biopsies were performed on lesional skin before treatment. The distribution and the amount of melanin pigments were visualized with Fontana-Masson stain, and the distribution and the depth of melanocytes were measured by GP-100 (NK1-beteb) stain. Clinically, there was more erythema and PIH in ABNOM than in nevus of Ota. Histopathologically, intradermal melanocytes were clustered in groups and dispersed perivascularly in ABNOM, while melanocytes were scattered evenly throughout the dermis in nevus of Ota. Both groups show that when there is a statistically significant number of melanocytes in the perivascular area, erythema and PIH occur after laser therapy. In conclusion, indirect vessel injury in addition to perivascular clustering melanocytes might be considered the cause of increased PIH after treatment in ABNOM.

The Motile Properties of Vimentin Intermediate Filament in B16 Melanoma Cells / 대한피부과학회지

BACKGROUND: Intermediate filaments as well as microtubule and microfilament are major components of cytoskeleton of human cells. Melanocytes have vimentin intermediate filament, which have not been well investigated as other cytoskeletons, especially in their function. OBJECTIVE: The purpose of this study was to observe the motile characteristics of vimentin intermediate filament in living B16 melanoma cells. METHODS: The motile properties of vimentin intermediate filament have been studied in living B16 melanoma cells using green fluorescent protein(GFP). cDNA expressing GFP-vimentin fusion protein was cloned and transfected into living B16 melanoma cells. Living cells were observed under fluorescent microscope and confocal microscope. Time-lapse images were collected and analysed. RESULTS: GFP-vimentin is incorporated into the endogenous vimentin networks. Time-lapse observations of vimentin fibrils demonstrate that they are constantly changing their configurations. Intersecting points of vimentin fibrils, or foci, frequently move towards or away from each other, indicating that the fibrils can lengthen or shorten. Fluorescence recovery after photobleaching shows that bleach zones across fibrils rapidly recover their fluorescence. During this recovery, bleached zones frequently move, indicating translocation of fibrils. Short filamentous structures('squiggle') are also seen actively translocating. Melanosomes also are changing their position back-and-pro constantly. They are co-localized very well with kinesin molecules in B16 melanoma cells. CONCLUSION: The vimentin intermediate filament and melanosomes in B16 melanoma cells have very active movement, which seem to have close relation with kinesin motor proteins.

Prevalence of Fungal Infection on Foot in Diabetic Patients and Correlation between Diabetic Ulcer and Fungal Infection on Foot / 대한피부과학회지

OBJECT: The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. METHODS: A total of 21, 693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. RESULTS: 13, 271 patients had certain kinds of foot problem, accounting for 61.2% of 21, 693 diabetics examined. Of these, fungal foot disease were found in 10, 403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6, 496 (29.9%), onychomycosis in 7, 783 (35.9%), and coexistence was in 3, 883 (17.9%). Foot deformity was in 1, 346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1, 051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5, 486 patients paid a visit to the department of dermatology. Of these, 4, 519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2, 272 males and 2, 247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3, 847 patients (70%) and onychomycosis was proven mycologically in 3, 276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3, 885(70.8%) and tinea pedis was found in 3, 209 (58.5%), most commonly involving the soles. CONCLUSION: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.

A Clinicopathologic Study on Hair Follicle Tumors / 대한피부과학회지

BACKGROUND: Data on the clinicopathologic features of hair follicle tumors in Korea are limited. OBJECTIVE: The purpose was to investigate the clinical and histopathologic characteristics of hair follicle tumors in Korea. METHODS: Two hundred sixty four cases of hair follicle tumors seen from 1999 to 2001 in Korea were analyzed clinically and histopathologically. RESULTS AND CONCLUSION: The most common hair follicle tumor in Korea was pilomatricoma(81.0%), followed by trichoepithelioma(6.4%), dilated pore of Winer(3.8%), and proliferating trichilemmal tumor(2.2%). Hair follicle tumors usually occurred as a solitary skin-colored nodule. The most commonly involved site was the face, and the peak age of presentation was 10 to 19. Pilomatricoma usually occurred as a solitary skin-colored nodule. The most commonly involved site was the arm, and more than 50% of tumors occurred before the age of 20. Histopathologically, the tumor was often surrounded by fibrous capsule and was composed of basophilic and shadow cells. It was usually located in the dermis and extended into the subcutis. Retraction spaces between tumor nests and stroma were frequently observed. Trichoepithelioma usually occurred as multiple skin-colored papules on the face. Histopathologically, the tumor was usually located in the dermis with sometimes connected to the epidermis. It frequently showed peripheral palisading. Dilated pore of Winer usually occurred as a solitary brownish to pigmented papule on the face in middle-aged persons. Proliferating trichilemmal tumor occurred as a solitary or multiple tumors. Histopathologically, the tumor was usually surrounded by incomplete fibrous capsule. Tumor cells frequently showed clear cell formation, nuclear atypia, mitosis, peripheral palisading, trichilemmal keratinization, and individual keratinization.

Role of Dermal Melanocytes in Cutaneous Pigmentation of Stasis Dermatitis:A Histopathological Study of 20 Cases

Stasis dermatitis is an itchy, scaly, and hyperpigmented condition of the lower leg due to venous insufficiency. Hemosiderin and/or melanin have been considered responsible for the brown pigmentation. However, there are not sufficient histopathologic studies. In this retrospective study the hospital records and biopsy slides of 20 patients were reviewed to determine the pathogenetic mechanisms of brown pigmentation in stasis dermatitis. Fifteen were men (75%) and 5 were women (25%) with a mean age of 46.2+/-8.2 yr (18-76), mean age at onset of 43.4+/-18.0 yr (17-73), and a mean duration of the disease 2.8+/-2.5 yr (0.25-10). All patients had varicose vein and complained of pruritus. On histopathologic evaluation, two cases out of 20 (3 skin biopsy specimens from 25 samples) showed dermal melanocytes containing melanin, and incontinence of melanin pigment was observed in 5 cases, which indicates that melanin pigments from epidermis could contribute to cutaneous pigmentation in stasis dermatitis. However, the existence of dermal melanocytes in two cases cannot be explained because normally the dermis contains no melanocytes. Further studies concerning the role of iron or inflammatory cytokines on the development of dermal melanocytes should be conducted.

Melasma

Melasma is a common acquired symmetric hypermelanosis characterized by irregular light to dark brown macules and patches on sunexposed areas of the skin. Its histopathologic characteristics are important for treatment. Melasma is characterized by epidermal hyperpigmentation possibly by both the increased number of melanocytes and the increased function of melanogenic enzymes over the dermal solar changes. Until now, curative measures are not available for melasma. Current therapies include topical agents (retinoic acid, hydroquinone, steroids), peeling (Combes solution, glycolic acid, TCA), and lasers(Co2, Erbium-Yag, Q-switched).

Donor Specific Response of Estrogen and Progesterone on Cultured Human Melanocytes

The mechanisms of estrogen and progesterone in human cutaneous pigmentation are largely unknown. The molecular identification of estrogen receptor (ER) and progesterone receptor (PR) in the human melanocytes is of great importance to understand the mechanisms. We performed immunocytochemistry analysis and demonstrated that ER and PR were expressed in the cytoplasms and nuclei of human melanocytes. Reverse transcriptase-polymerase chain reaction (RT-PCR) and sequence analysis confirmed the expression of ER and PR at the transcriptional level. Despite of the presence of ER and PR, the physiological and pregnant levels of estrogen and progesterone showed inconsistent effects on the proliferation and tyrosinase activity of cultured human melanocytes. These results suggest that human melanocytes express ER and PR, which have a donor-specific action in human pigmentation. Further studies are needed to elucidate the induction mechanism and functions of these receptors, and the role of estrogen and progesterone in melanocytes.

Absence of Human Papillomavirus DNA in Nongenital Seborrheic Keratosis

Seborrheic keratosis (SK) is a benign epidermal tumor of unknown etiology. Because of its wart-like morphology, human papillomavirus (HPV) has been suggested as a possible causative agent. Viral involvement, however, has not been confirmed yet despite extensive research. The aim of this study was to evaluate the presence of HPV 6/11, 31, 33 DNA in nongenital SK. We analyzed 40 biopsy specimens taken from patients with nongenital SK using in situ polymerase chain reaction (PCR) and PCR with tissue extracts. The SK specimens (n=40), analyzed by in situ PCR, were negative for all HPV probes tested (types 6/11, 31, 33). Control slides (condyloma acuminatum, n=3) were positive for type 6/11, 31, and 33 HPV probes tested. Melasma samples (n=4), the negative controls, were consistently negative. No HPV DNA band was detected by PCR with the tissue extracts from paraffin-embedded SK samples, while condyloma acuminatum, the positive controls, showed DNA bands of the correct molecular weights. Our results show that HPV type 6/11, 31, and 33 cannot be recognized as causative agents for nongenital SK, which is in contrast to the previous studies. Further studies are required to reveal the presence of other types (more than 90) of HPV DNA.

Prurigo Pigmentosa Caused by Sweating

Prurigo pigmentosa is a peculiar pruritic pigmented dermatosis characterized by the sudden appearance of reddish papules accompanied by severe pruritus. The etiology still remains unknown but environmental factors may play a role, in which physical trauma or friction from wet clothing induces the skin lesions. It has a seasonal preference for spring to summer when there is increased sweating. We report a case of prurigo pigmentosa which may be triggered by sweating and cured with minocycline.

Expression of progesterone receptor in human keratinocytes

Despite the various responses of human skin to female sex hormones, cellular and subcellular targets and the mechanisms of action of estrogen and progesterone in human skin are not well understood. The detection of estrogen receptor (ER) and progesterone receptor (PR) in the skin is of great importance to understand the effect of estrogen and progesterone. In primary cultures of human keratinocytes, expression of ER and PR was monitored by immunocytochemistry and reverse transcriptase polymerase chain reaction (RT-PCR). Paraffin embedded skin tissues were stained with monoclonal antibodies to human ER and PR by immunohistochemistry. Cultured human keratinocytes expressed cytoplasmic PR protein and PR mRNA transcripts. By contrast, ER was detected only at the mRNA level. Suprabasal keratinocytes from samples of pruritic urticarial papules, plaques of pregnancy (PUPPP) and psoriasis were stained positively only for PR, while those from samples of erythema nodosum were negative for both ER and PR. Lesional epidermis of PUPPP showed positive PR immunoreactivity, while nonlesional epidermis did not. No other cells in the normal human skin were stained with ER and PR. The present study suggests that by expressing PR human keratinocytes act as targets for progesterone action.

Macular amyloidosis presented as poikiloderma: a Journal Article

We report a 51-year-old Vietnam War veteran with an unusual variant of macular amyloidosis presenting as poikilodermatous skin lesions. The extensive mottled brown pigmentation was checkered with small hypopigmented or normal skin-colored spots and intermingled with telangiectasia. Skin biopsy revealed subepidermal amyloid deposits. There was no evidence of extracutaneous involvements. This case could be easily confused with other true poikiloderma lesions.