Changing Susceptibility of Staphylococcus aureus in Children with Skin and Soft Tissue Infections: a Single Center Experience from 2010 to 2018

PURPOSE: Staphylococcus aureus is a major cause of skin and soft tissue infections (SSTIs). This study aimed to determine the temporal trends in antibiotic susceptibility of S. aureus in SSTI patients aged <19 years.METHODS: This retrospective observational study was conducted in pediatric patients with SSTI caused by community-associated S. aureus. Microbiologic and demographic data were collected, and the trends of antibiotic susceptibility results were evaluated.RESULTS: From January 2010 to December 2018, a total of 807 S. aureus isolates were included. An overall increase in susceptibility of isolates to oxacillin was noted (P<0.001), with 75.0% of isolates being oxacillin-susceptible in 2018. S. aureus remained highly susceptible to trimethoprim/sulfamethoxazole and tetracycline, with 97.6% and 95.2% isolate susceptibility in 2018, respectively. Isolates from younger children aged 1 to 5 years had a significantly lower rate of susceptibility to oxacillin than older children aged 6 to 18 years (53.4% vs. 75.0%, P<0.001).CONCLUSIONS: The proportion of methicillin-resistant S. aureus isolates appears to decrease in pediatric patients with community-associated SSTI caused by S. aureus. Clinicians should be aware of regional susceptibility patterns when choosing empirical regimens.

Knowledge, Attitude and Practice on Maternal Immunization with Tetanus Toxoid, Reduced Diphtheria Toxoid, and Aellular Pertussis (Tdap) among Pregnant Women

PURPOSE: Despite effectiveness and safety of maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination, Tdap vaccination coverage during pregnancy remains quite low. We assessed the knowledge, attitude and practice on maternal Tdap vaccination among pregnant women. METHODS: This study was a cross-sectional survey of pregnant women who visited tertiary obstetrics and gynecologic units in Seoul and Gyeonggi province of Korea. Individual questionnaires were administered to assess knowledge, attitude and practice on maternal immunization with Tdap. RESULTS: The questionnaires were completed by 184 pregnant women; 158 (86%) had not received information from doctors about pertussis and Tdap, and 166 (90%) did not know the need for Tdap vaccination. Only 7% of pregnant women unlikely to receive Tdap vaccine during current pregnancy answered 3 or more of the 5 knowledge-based questions correctly. By logistic regression analysis, recommendation by doctor (adjusted odd ratio [OR], 236.2; 95% confidence interval [CI], 12.6–4,432), belief that the vaccine is effective (adjusted OR, 40.21; 95% CI, 2.35–687.7), and belief that the vaccine is safe (adjusted OR, 19.83; 95% CI, 1.54–255.9) were significantly important factors to respondents’ intention to be vaccinated. CONCLUSIONS: Most pregnant women seem to be neither recommended nor adequately informed about Tdap vaccination. Information given by health care professionals is very important to increase Tdap coverage among pregnant women.

A Case of Primary Cutaneous Cryptococcosis Arising on the Abdomen and Review of the Literature / 대한의진균학회지

Primary cutaneous cryptococcosis is isolated cutaneous cryptococcosis without evidence of systemic involvement. It usually presents as a solitary nodule in an exposed area, such as head and neck or extremities, and the occurrence of primary cutaneous cryptococcosis in the covered area has been rarely reported in the literature. A healthy 81-year-old immunocompetent woman presented with a solitary reddish scaly plaque on her abdomen without clinical evidence of systemic cryptococcal infection. Histopathologic examination showed numerous encapsulated spores, and the organism was identified as Cryptococcus neoformans in a series of fungal studies. We diagnosed this case as a primary cutaneous cryptococcosis by the findings mentioned above. The patient was successfully treated with surgical excision and oral fluconazole without any side effects.

Tinea Incognito on the Face and Neck / 대한의진균학회지

Tinea incognito is a dermatophytosis modified by previous treatments such as prolonged use of corticosteroids. Because the lesions often atypical appearing without classic features of ringworm, the diagnosis can be delayed or missed especially when tinea incognito is on the face and neck. A 75-year-old male patient who had been treated with topical steroids at the local dermatologic clinic for 10 years for the eczematous lesion on the scalp and face and recently the lesions spread throughout his neck and back. Physical examination showed ill-defined erythematous scaly patches on the face, neck and back and reddish crusted papules on the scalp. Potassium hydroxide (KOH) preparation on the left face and right neck showed hyphae and fungus cultures were positive for colonies of Trichophyton rubrum (T. ruburum). The result of DNA sequencing from the colony was identical to that of T. rubrum. The lesions were treated by oral terbinafine and topical isoconazole.

Primary Synovial Sarcoma of the Lung With Rapid Progression in an Old Age Female

Synovial sarcoma comprises approximately 10% of soft tissue sarcomas. Primary pulmonary synovial sarcoma is a rare tumor. It makes up only 0.5% of all primary lung malignancies. It typically presents in adolescents and young adults. The usual progress of the tumor is unknown. We report the rapid progress of a primary pulmonary sarcoma that developed in a 67-year-old woman. In this case, metastatic sarcoma was excluded by positron emission tomography-computed tomography. Synovial sarcoma was histologically confirmed by a biopsy from the lung tissue. The patient had two masses located at the upper lobe of the lung. The patient refused all medical treatment and left our hospital. Two months later, she was readmitted and diagnosed with multiple metastases in the other lung and pancreas. She expired due to syndrome of inappropriate antidiuretic hormone secretion and superior vena cava syndrome four days after admission.

Reconstruction with Sutureless Burow's Graft Using Adhesive Skin Tape (Steri-strip(R)) for Cutaneous Defect after Skin Surgery / 대한피부과학회지

BACKGROUND: There are various methods of reconstruction of cutaneous surgical defect after removal of skin tumor, and skin graft is frequently used. Classically, in full-thickness skin graft (FTSG), nylon basting sutures with a tie-over bolster dressing are used in securing skin graft to the recipient wound bed, but this method is complicated, time-consuming, and may cause complications. OBJECTIVE: The aim of this study was to evaluate the usefulness of an adhesive skin tape (Steri-strip(R)) for securing a graft without suture when performing a Burow's skin graft, one of the types of FTSG. METHODS: We conducted a case-controlled retrospective study. A total of 45 patients (total 46 cases) treated with Burow's skin graft after removal of skin tumor between May 2006 and August 2010 were enrolled in this study, and grafts were secured with Steri-strip(R) (case, n=26) or conventional tie-over bolster dressings (control, n=20). The cosmetic results were scored at 1, 3, and 6 months after the operation. Also, the size and depth of the defect were measured and the run-time of the operation for the skin graft was checked. RESULTS: The operation time for the Steri-strip(R) group was significantly less than for the conventional tie-over bolster dressing group (p0.05). CONCLUSION: Sutureless Burow's graft with skin tape required less time than the conventional method with a similar cosmetic result. Thus we suggest that sutureless Burow's graft with skin tape may be an easy and useful method to reconstruct the defect after skin surgery.

Halo Congenital Nevus Associated with Extralesional Vitiligo / 대한피부과학회지

Halo nevus is a pigmented nevus surrounded by a round or oval depigmentation. Of patients with halo nevus, 18 to 26% patients have vitiligo, either involving the nevus or at a distant site. While the exact etiology of halo formation and vitiligo is unknown, several theories suggest that common immunologic mechanisms are involved in the destruction of melanocytes of both phenomena. Unlike common melanocytic nevus, congenital nevus associated with both halo formation and concurrent extralesional vitiligo is very uncommon and only one case has been reported in the Korean dermatological literature. A 19-year-old female presented with surrounding depigmentation around a congenital hairy nevus on the left forearm. Simultaneously, vitiligo appeared on the lowerabdomen and surrounding regions of both areola. The halo depigmented lesion around congenital nevus and the periareolar vitiliginous lesion shared some histological and immunohistochemical features. These findings further support common immunological mechanisms of pigment destruction in both phenomena.

Foreign Body Granuloma Following Dried Honey Bee Venom (Apitoxin Inj) Injection / 대한피부과학회지

Bee sting therapy is sometimes used for the treatment of chronic recalcitrant neuralgia and arthralgia in traditional Korean herbal medicine, but retained sting materials at the treatment site may induce granulomatous inflammation. Recently, dried honey bee venom (Apitoxin Inj, Guju Pharma. Co., Seoul, Korea) has been approved by the Korea Food and Drug Administration (KFDA) as an anti-inflammatory drug. The adverse events associated with dried honey bee venom injection include itching, edema, pain, headache, fever and myalgia, but foreign body granuloma caused by drug injection has not been previously reported. We herein report two interesting cases of foreign body granuloma induced by dried honey bee venom injection.

Nicolau Syndrome in Which Split-thickness Skin Graft Was Required for Reconstruction / 대한피부과학회지

Nicolau syndrome is a rare adverse reaction and characterized by the acute onset of necrosis of the skin and soft tissue following intramuscular drug injection. Conservative treatments with dressings, debridement, and pain control are the mainstay of therapy. Surgical intervention such as skin graft is rarely required. We report a case of 21-year-old man with this syndrome on the right buttock after an intramuscular injection of diclofenac in which skin graft was necessary. The lesion eventually required debridements and split-thickness skin graft for reconstruction because it was very extensive and not successfully treated by the conservative method for four months.

Tinea Incognito with Changes in Clinical Feature Related to Antifungal Treatment / 대한의진균학회지

Clinical features of the dermatophyte infections of the glabrous skin can be altered by inappropriate treatment such as topical steroid treatment. We describe a case of dermatophyte infection with changes in clinical feature related to antifungal treatment. A 23-year-old woman presented with reddish annular scaly lesions on her right forearm. On the basis of the detection of hyphae on KOH examination, oral terbinafine 250 mg/day in combination with topical isoconazole was used for 3 weeks, but scattered papulopustules on erythematous bases occurred. Histopathologic examination revealed the presence of hyphae within the follicular infundibulum. Oral itraconazole 100 mg/day was administered for 2 weeks in combination with topical flutrimazole and produced a good clinical response. At her visit about 7 weeks after stopping itraconazole, agminated papulopustules on erythematous bases were seen on her right forearm. Trichophyton mentagrophytes was isolated on the culture of skin scraping from the surface of agminated lesions. She was successfully treated with oral fluconazole 150 mg weekly for 6 weeks and topical flutrimazole and isoconazole.

The Three Dimensional Conformal Radiotherapy for Hyperkeratotic Plantar Mycosis Fungoides

The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.

Basal Cell Carcinoma on the Pubic Area: Report of a Case and Review of 19 Korean Cases of BCC from Non-sun-exposed Areas

Basal cell carcinoma (BCC) is one of the most commonly diagnosed malignant skin tumors and develops characteristically on sun-exposed areas, such as the head and neck. Ultraviolet light exposure is an important etiologic factor in BCCs, and BCCs arising from non-sun- exposed areas are, therefore, very rare. In particular, the axilla, nipple, the genital and perianal areas are not likely to be exposed to ultraviolet light; thus, if BCC develops in these areas, other predisposing factors should be considered. Herein, we report a case of BCC arising on the pubic area in a 70-year-old man. We also performed a survey of the literature and discussed the 19 cases of BCC from non-sun-exposed areas reported to date in Korea.

A Case of Cutaneous Alternariosis Treated with Fluconazole / 대한의진균학회지

Alternaria is a common saprophytic fungus found in the environment such as soil, air, and a variety of objects. The cutaneous infection caused by this fungus occurs more frequent in patients with immunocompromission than in immunocompetent people. We report a case of cutaneous alternariosis in a 63-year-old woman presented with a tender erythematous patch on the right forearm. She was on medication only for hypertension. Histopathologic examination showed a dermal mixed-cell infiltrate including multinucleated giant cells. PAS staining revealed fungal elements in the dermis. Microscopic examination of the colonies showed muriform conidia. A diagnosis of cutaneous infection due to Alternaria species was made on the basis of the above mentioned findings. Oral administration of fluconazole revealed resolution of her cutaneous lesion.

A Case of Cutaneous Carcinosarcoma / 대한피부과학회지

Carcinosarcoma is a biphasic tumor that has both epithelial as well as mesenchymal components. It most commonly occurs at the esophagus, lung, upper respiratory tract and urinary bladder, however it rarely occurs on the skin. A 62-year-old men presented with a bean sized crusted ulcer on his right cheek. A biopsy specimen revealed atypical sqamous cells mixed with spindle-shaped cells with hyperchromatic nuclei. Furthermore, immunohistochemical study showed positive reactions for AE1/AE3, cytokeratin7, epithelial membrane antigen and vimentin, but negative reactions for S100 protein, CD34 and smooth muscle actin. Based on these histopathological and immunohistochemical findings, we diagnosed this case as cutaneous carcinosarcoma. The patient was treated with complete excision and a local flap.

Two Cases of Tinea Capitis Caused by Microsporum canis in Elderly Women / 대한의진균학회지

Tinea capitis is the most common in children, but can be seen in adults. In the adult population, tinea capitis is more frequent in elderly women than other adults. We report two cases of tinea capitis occurring in an 85-year-old female and an 80-year-old female. The vertex of the former showed an erythematous scaly patch with slight hair loss and the scalp of the latter showed a painful erythematous plaque with severe hair loss. From two patients, Microsporum canis was isolated.

Magic Perm Alopecia / 대한피부과학회지

A 7 year-old girl had developed multiple bald patches on her scalp for two months and was treated as alopecia areata or trichotillomania at another institution. Biopsy findings of the scalp lesion showed catagen follicles, trichomalacia and pigment clumps in the hair canals with little inflammatory cell infiltrates. Careful history revealed the patient had had "a magic perm" - a hair-straightening perm - one month before the bald patch began to develop. The condition could be called "a magic perm alopecia" as a form of cosmetic traumatic alopecia. The alopecic lesions showed further extension for three to four months. The lesions were beginning to recover five months after they first developed.

Sutureless Burow's Graft Using Adhesive Skin Tape (Steri-strip(R)) / 대한피부과학회지

Immobilization of skin grafts on the recipient bed is essential for graft survival. There are several methods of securing skin grafts to the recipient wound bed. Classically, nylon basting sutures and a tie-over bolster dressing are commonly used. This method is currently recognized to ensure that the full thickness skin grafts "take"; however, this method is complicated and time-consuming. Moreover, suturing in this manner may also pull the edges of the skin with too much tension, cause elevation and crater-like deformity and suture marks. We experienced two cases of sutureless Burow's graft using skin tapes to reconstruct a skin defect after Moh's micrographic surgery. Instead of the conventional method, the Steri-strip(R) was used to fix the graft and a light compressive dressing with dry gauze and Tegaderm(R) was applied over the graft. This method has the advantage of being convenient to apply and remove, time-saving and inexpensive. Therefore, we recommend the use of the sutureless method using skin tape as an alternative to suturing small skin grafts, and particularly for the relatively immobile areas on the face.

A Case of Neurofibromatosis with Multiple Pseudoatrophic Macules / 대한피부과학회지

Neurofibroma usually manifests as a soft nodule that protrudes from the skin surface of patients with neurofibromatosis. Pseudoatrophic macule is a rare variant of neurofibroma, and it is described as a slightly depressed macular lesion. To the best of our knowledge, only one case of neurofibromatosis associated with pseudoatrophic macules has been reported in the Korean dermatologic literature. A 20-year-old man presented with multiple round shaped macules scattered on the trunk. The surface of the skin lesion was slightly depressed compared with the normal adjacent skin. He had multiple cafe-au-lait macules on the body and freckles in the axillae and inguinal areas. Histopathologic examination of the depressed macule demonstrated a relatively well-demarcated mass that was composed of spindle cells intermingled with loosely arranged collagen fibers in the dermis. The spindle cells showed a positive reaction for S-100 protein. Herein, we report on a rare case of type 1 neurofibromatosis with multiple pseudoatrophic macules.

A Case of Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) / 대한피부과학회지

Paraneoplastic autoimmune multiorgan syndrome (PAMS) is also known as paraneoplastic pemphigus, and this is a heterogenous autoimmune syndrome involving the skin, mucosa and internal organs and it is caused by autoantibodies related to the underlying neoplasm. Painful stomatitis is the earliest and most constant feature. The cutaneous lesions of this disease are polymorphic. The majority of cases of this syndrome are associated with a lymphoproliferative disorder such as non-Hodgkin lymphoma, chronic lymphocytic leukemia and Castleman disease. A 40-year-old woman presented with a 1-month history of a pruritic erythematous papulomacular rash on the trunk and extremities. She also had a 4-month history of painful oral stomatitis that had failed to respond to steroid therapy. Despite the vigorous treatment, the skin lesions progressed to generalized polymorphic lesions with persistent oral lesions. The histopathologic findings of these lesions revealed polymorphous characteristics according to the clinical features, and they mimicked erythema multiforme, graft-versus-host disease, lichen planus and pemphigus vegetans. Finally, a mass of lymphatic tissue 7.2 cm in diameter and that was diagnosed as Castleman disease was found in her retroperitoneal pelvic cavity. With removal of the lymphatic mass, her skin lesions subsided except for the glossal lesion.

A Case of Borderline Lepromatous Leprosy Presenting in a Immigrant Woman / 나학회지

A 36 year-old woman immigrated from Nepal showed erythematous plaques on her face, buttock and legs one month after the immigration. Before the correct diagnosis was made, the patient had been erroneously treated as anallergic dermatitis for three months. Clinico-pathologically, her skin lesion was borderline lepromatous type leprosy with bacilli positive. We report the case to keep the high index of suspicion for leprosy when we meet with patients from the countries where leprosy is still epidemic.