Four Cases of Facial Discoid Lupus Erythematosus Successfully Treated with Topical Pimecrolimus or Tacrolimus

Discoid lupus erythematosus (DLE), which is a cutaneous form of lupus erythematosus (LE), is generally refractory to a wide range of topical or systemic therapies. Although the main treatment option for DLE is topical steroids, it is often ineffective or likely to produce long-term side effects. New drugs, including tacrolimus and pimecrolimus, have been developed to overcome the adverse effects of steroids and treat the lesions of DLE for a prolonged period. We herein report 4 cases of facial DLE successfully treated with therapeutic adjuvants, topical tacrolimus or pimecrolimus.

Therapeutic Effects of Topical Application of Ozone on Acute Cutaneous Wound Healing

This study was undertaken to evaluate the therapeutic effects of topical ozonated olive oil on acute cutaneous wound healing in a guinea pig model and also to elucidate its therapeutic mechanism. After creating full-thickness skin wounds on the backs of guinea pigs by using a 6 mm punch biopsy, we examined the wound healing effect of topically applied ozonated olive oil (ozone group), as compared to the pure olive oil (oil group) and non-treatment (control group). The ozone group of guinea pig had a significantly smaller wound size and a residual wound area than the oil group, on days 5 (P<0.05) and 7 (P<0.01 and P<0.05) after wound surgery, respectively. Both hematoxylin-eosin staining and Masson-trichrome staining revealed an increased intensity of collagen fibers and a greater number of fibroblasts in the ozone group than that in the oil group on day 7. Immunohistochemical staining demonstrated upregulation of platelet derived growth factor (PDGF), transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF) expressions, but not fibroblast growth factor expression in the ozone group on day 7, as compared with the oil group. In conclusion, these results demonstrate that topical application of ozonated olive oil can accelerate acute cutaneous wound repair in a guinea pig in association with the increased expression of PDGF, TGF-beta, and VEGF.

Clinical Study of Porokeratosis Associated with Immunosuppressive Therapy in Renal Transplant Recipients

BACKGROUND: The etiology of porokeratosis (PK) remains unknown, but immunosuppression is known to be a factor in the pathogenesis of PK and it may also exacerbate PK. OBJECTIVE: The aim of this study was to examine the clinical characteristics of PK associated with immunosuppressive therapy in renal transplant recipients. METHODS: A total of 9 renal transplant patients diagnosed with biopsy-proven PK from January 2001 to December 2006 were enrolled. The authors analyzed the patient and medication histories, clinical characteristics, and associated diseases. RESULTS: The ages of the 9 patients ranged from 38 to 67 years (mean 52 years). All received multi-drug regimens comprised of two or three immunosuppressive agents (steroids, cyclosporine, mycophenolate mofetil, azathioprine and/or tacrolimus). Times between transplantation and the onset of PK ranged from 2 to 9 years (mean 4.1 years). No family history of PK or a history of intense sun-exposure was elicited. The number of the lesions was less than ten in 8 of the 9. Lesions were mainly located in the extremities, though some affected the trunk or neck (3). Three patients had disseminated superficial actinic PK (DSAP), PK Mibelli, or both types. Associated diseases included verruca (4), recurrent herpes simplex (1), actinic keratosis (1), and cutaneous B cell lymphoma (1). CONCLUSION: The three clinical patterns of PK occurred equally in our patients, namely, coexistent PK Mibelli and DSAP, or the DSAP and Mibelli types as independent forms. Our findings support the notion that the different variants of PK be viewed as parts of a heterogeneous clinical spectrum. Further studies are needed in order to establish the clinical patterns of PK in immunosuppressed patients.

A Case of Palisaded Neutrophilic Granulomatous Dermatitis in Rheumatoid Arthritis / 대한피부과학회지

Palisaded neutrophilic granulomatous dermatitis (PNGD) is an unusual entity that has been described under several different names including, linear subcutaneous bands, interstitial dermatitis with cutaneous cords and arthritis, rheumatoid papules and Churg-Strauss granuloma. The condition is seen in patients with rheumatoid arthritis and other connective tissue diseases. PNGD shows variable clinical manifestations and represents a histologic spectrum, starting with early vasculitic lesions, then palisaded granulomatous lesions and dermal fibrosis with minimal leukocytoclastic debris in the late stage lesions. We report an unusual case of a 49-year old woman with rheumatoid arthritis who presented with multiple acral nodules. The histologic examination revealed palisaded neutrophilic granulomatous dermatitis.

A Case of Dermatofibroma: Aneurysmal and Atypical Variants / 대한피부과학회지

Dermatofibroma is a common benign fibrohistiocytic tumor which may present with a variety of pathological variants. Combined dermatofibromas are defined as dermatofibromas which show two or more histological variants in a single lesion. We herein report an unusual case of dermatofibroma in a 39-year-old man who presented with a solitary asymptomatic black-colored nodule on his right thigh, which showed histological features of aneurysmal and atypical variants simultaneously. Histologically, it showed cleft-like vascular spaces with hemorrhaging and focal cellular atypia in the background of typical dermatofibroma.

A Case of Generalized Plane Xanthoma Associated with Monoclonal Gammopathy of Unknown Significance / 대한피부과학회지

Generalized plane xanthoma is a group of plane xanthomas that appear as yellow to yellowish-brown flat patches or slightly-elevated plaques with a wide-spread distribution. This disease is not common and may occur in hyperlipidemic or nomolipidemic states. Generalized plane xanthoma with normolipidemia is often associated with multiple myeloma, other reticulo-endothelial malignancies and monoclonal gammopathy with unknown siginificance (MGUS). We report a case of generalized plane xanthoma associated with monoclonal gammopathy of unknown siginificance in a 40 year-old man.

A Case of Methotrexate-induced Bullous Acral Erythema

Chemotherapy-induced acral erythema (CIAE) is a toxic reaction to a number of different chemotherapeutic agents, and causes symmetrical, well-demarcated, painful erythema on the palms and soles which is self-limiting. CIAE with bullous reaction in relation to methotrexate has been reported, but it is more commonly associated with cytosine arabinoside. The differential diagnosis of this condition from more serious conditions such as graft-vs-host disease or toxic epidermal necrolysis is essential. In this paper, we report the case of a 65-year-old man who developed bullous acral erythema after the administration of high-dose methotrexate for the treatment of Non-Hodgkin's lymphoma.

A Case of Sweet's Syndrome with Pulmonary Manifestation

Sweet's syndrome is a reactive process characterized by the abrupt onset of tender erythematous plaques and typical histological findings. Currently, the entity recognized as Sweet's syndrome ranges from classic Sweet's disease to a more aggressive neutrophilic process that may be associated with various diseases, malignancy and drug intakes. Also, extracutaneous manifestations of Sweet's syndrome have the potential to involve other organ systems. Pulmonary manifestation of Sweet's syndrome is rare and may be experienced as a cough, dyspnea, pleurisy or pulmonary infiltration upon chest X-ray. We, herein, report a 46-year-old woman with Sweet's syndrome who showed pulmonary infiltration and pleural effusion upon chest X-ray.

A Case of Acral Pseudolymphomatous Angiokeratoma of Children (APACHE) / 대한피부과학회지

Acral pseudolymphomatous angiokeratoma of children (APACHE) is a recently recognized, rare clinical entity with only 20 reported cases worldwide. It is characterized by unilateral eruptions of multiple angiomatous papules, mostly on acral areas and mainly in children, although some cases have also been reported with involvement of non-acral areas and occurring in adults. The histopathologic examination revealed diffuse dermal infiltrates of lymphohistiocytes and thick-walled vessels lined with prominent plump endothelial cells. APACHE is a cutaneous pseudolymphoma, rather than a vascular neoplasm, because of distinct histopathologic and immunohistochemical findings. We report a case of a 9-year-old girl who presented with multiple angiomatous papules on her right upper arm. The histopathologic and immunohistochemical findings in our patient were consistent with a diagnosis of APACHE.

Three Cases of Melanocytic Nevi with Pseudovascular Spaces / 대한피부과학회지

Melanocytic nevus may be histologically associated with clefts or slits of nests, resembling lymphatic or vascular spaces. This unique histologic feature is known as an artifact of injection or tissue processing. The pseudovascular space may resemble the lymphatic invasion of malignant melanoma. Therefore it is important that dermatologists are aware of this histologic variant of melanoctic nevus in order to prevent misdiagnosis. We report three cases of melanocytic nevi with pseudovascular spaces in a 48-year-old, 43-year-old and 44-year-old women. Histologic examination of one case identified a compound melanocytic nevus and two cases identified intradermal nevi. Nevus cell nests were clustered in the dermis or dermoepidermal junction. Vessel-like spaces also were seen in the nevus cell nest. Immunohistochemically, the cells lining the pseudovascular space were positive for S-100 protein, and negative for factor VIII-related antigen and CD31 stain. We concluded that these spaces were lined by nevomelanocytes and were not truly vascular. We herein report on three melanocytic nevi with pseudovascular spaces.

A Case of Fibroma of Tendon Sheath on the Big Toe / 대한피부과학회지

Fibroma of tendon sheath presents as a small subcutaneous nodule that slowly increases in size, and it is most frequently found on the hands, with the thumb being the most common site of involvement. A 60-year-old woman presented with an asymptomatic, solitary, 1.5 x 2.0 cm-sized, firm, subcutaneous nodule on the left big toe. On magnetic resonance imaging view, the tumor was adherent to tendon sheath of the volar aspect of the left big toe. The skin biopsy specimen showed that the well-circumscribed tumor contained hypocellular, hyalinized, collagenous area and hypercellular densely-arranged collagen area with spindle-shaped fibroblasts and slit-like vascular channels. We herein report a rare case of fibroma of tendon sheath on the left big toe.

A Case of Miliary Osteoma Cutis on the Face / 대한피부과학회지

Osteoma cutis is a rare disorder characterized by compact bone formation in the dermis or subcutaneous tissue. According to the absence or presence of previous cutaneous lesions, it is classified as primary and secondary forms. Miliary osteoma of the face is a form of primary osteoma cutis that generally occurs in middle-aged to older adult women. A 50-year-old woman presented with asymptomatic, multiple, 2~3 mm-diameter, skin-colored, firm papules on both cheeks for 5 years. The histopathologic specimen of the papule showed compact bone formation in the dermis. We herein report a rare case of military osteoma cutis on the face.

A Case of Atypical Melanocytic Hyperplasia / 대한피부과학회지

In atypical melanocytic hyperplasia, histopathologically atypical melanocytes are not distributed throughout the epidermis, but are present in some parts of the basal layer of the epidermis without dermal invasion, despite the lesion being present for a long time. Differential diagnosis of melanoma in situ (MIS) from atypical melanocytic hyperplasia is difficult. Furthermore, the concept of atypical melanocytic hyperplasia remains controversial, and the criteria for clinical and histologic diagnosis of atypical melanocytic hyperplasia have not yet been fully determined. Many further studies are needed to define the clinical and histologic characteristics of atypical melanocytic hyperplasia. A 48-year-old man presented with asymptomatic, solitary, 2 x 1.5 cm sized, poorly-defined, irregular, brownish to black patch on the volar area of the left index finger for 5 years. The histopathologic findings revealed an increased number of large atypical melanocytes in the basal layer, consistent with atypical melanocytic hyperplasia. Therefore, we report a case of atypical melanocytic hyperplasia.

A Case of Clear-Cell Bowen's Disease Which May Have Developed Following Cryotherapy / 대한피부과학회지

Bowen's disease is a kind of squamous cell carcinoma in situ. In some cases, a pagetoid growth pattern can be observed with cytologically atypical clear cells arranged singly or in nests. The differential diagnosis of clear-cell Bowen's disease includes primarily Paget's disease and malignant melanoma in situ. A 66-year-old man presented with intermittently painful, solitary, well-demarcated, annular, erythematous, scaly plaque on the left fourth finger for 7 months. This had been treated by cryotherapy 8 months earlier, following the diagnosis of Bowen's disease. The skin biopsy specimen revealed nests of atypical clear cells in upper layer of the epidermis in addition to typical features of Bowen's disease. We, herein, report a rare case of clear-cell Bowen's disease, which is thought to have developed after cryotherapy.

A Case of Melanocytic Nevus Combined with a Vellus Hair Cyst / 대한피부과학회지

The combination of melanocytic nevus with other tumors of epidermal or adnexal origin has been described since the first case reported by Andresen and Enos in 1952. Most of reported cases are melanocytic nevi combined with common epidermoid cysts. The combination of nevus and cyst could possibly be misdiagnosed clinically as a malignant melanoma upon initial examination. A 58-year-old woman presented with an asymptomatic, solitary, skin-colored, erythematous 1.0 cm-diameter pedunculated nodule on the occipital scalp which had been present childhood. The histopathologic specimen of the nodule showed a solitary cyst surrounded by intradermal melanocytic nevus. The cyst was located in the dermis lined by squamous epithelium, which was ruptured and inflamed. It contained degenerated keratin materials and multiple transversely and obliquely cut vellus hairs. We herein report a rare case of melanocytic nevus combined with a vellus hair cyst.