Treatment of Acquired Perforating Dermatosis in Chronic Renal Failure with Allopurinol / 대한피부과학회지

The perforating disorder is characterized by transepidermal elimination of altered dermal substances, which comprises Kyrle's disease, perforating folliculitis, elastosis perforans serpiginosa, and reactive perforating collagenosis. The term 'acquired perforating dermatosis' has been suggested for cases associated with renal disease and/or diabetes mellitus. Recently, resolution of lesions in acquired reactive perforating collagenosis by allopurinol has been reported. We, hereby, report a patient with acquired perforating dermatosis associated with chronic renal failure due to diabetic nephropathy, who was treated with allopurinol. The histopathological findings were compatible with Kyrle's disease.

A Case of Folliculosebaceous Cystic Hamartoma on the Labia Majora / 대한피부과학회지

Folliculosebaceous cystic hamartoma is a distinctive skin malformation, which presents as a solitary, smooth- surfaced, skin-colored papule or nodule. This hamartoma usually occurs on the central part of the face, particularly on the nose. In 1998, Bolognia et al. described a genital variant of folliculosebaceous cystic hamartoma, which has not been reported to date in Korea. We herein report a rare case of folliculosebaceous cystic hamartoma which occurred on the labia majora of a 28-year-old woman. Histopathologically, multiple, dilated, follicular, cystic structures were observed with numerous sebaceous lobules arising from its wall. There was an excess of fibrous components around these structures, which included small venules, adipocytes and neural tissue.

A Case of Multiple Linear Lichen Planus along the Lines of Blaschko / 대한피부과학회지

Linear lichen planus (LLP) is a rare variant found in only 0.24~0.62% of all lichen planus patients. It is mostly located on the extremities and found more often in children than adults. It has been reported that LLP lesions usually occur in solitary strips, but they occasionally occur on different segments of skin or in multiple lines, which are zosteriform in distribution or follow the lines of Blaschko. LLP following Blaschko's line is extremely rare and, in most cases, the linear streaks are solitary. We present a case of multiple linear lichen planus along the lines of Blaschko in a 15-year-old female.

A Case of Progressive Cribriform and Zosteriform Hyperpigmentation Associated with Becker's Nevus and Melanonychia / 대한피부과학회지

Progressive cribriform and zosteriform hyperpigmentation (PCZH) was first described in 1978 by Rower and his colleagues as having the following clinical characteristics: a single area of uniformly-tan, cribriform, macular pigmentation in a zosteriform distribution, an histologically mild increase of melanin pigment in the basal cell layer and complete absence of nevus cells, no preceding history of skin rash, injury or inflammation, onset after birth with gradual extension - age at onset was in the second decade of life, lack of other associated cutaneous or internal abnormalities. We hereby report an atypical case of PCZH in a 16-year-old boy, who presented with multiple, cribriform and zosteriform hyperpigmented lines on his right arm and leg. This is the first ever reported case which has an association with Becker's nevus and melanonychia.

Cutaneous Plasmacytosis with Multiple Nodular Eruptions and Polyclonal Hypergammaglobulinemia

We report two patients with multiple peculiar skin eruptions and polyclonal hypergammaglobulinemia. Both patients visited our hospital for the evaluation of asymptomatic multiple nodular eruptions on almost their entire body except for the lower extremities. Histologic examinations disclosed prominent infiltration of plasma cells and lymphoid follicular hyperplasia in the dermis but these plasma cells showed neither a mitotic figure nor atypicalities. Laboratory examinations showed polyclonal hypergammaglobulinemias and increased erythrocyte sedimentation rates. In spite of various investigations, the cause of the hypergammaglobulinemia remained obscure.

CAM 5.2 Positive Cells in the Epidermis of Nevus Sebaceus

BACKGROUND: In the course of the study of keratin expression in the epidermis of nevus sebaceus, several cells in the epidermis of nevus sebaceus were positively stained with CAM 5.2 antibody, which is known to be specific for the lower molecular weight cytokeratin and used as a marker of Merkel cell. OBJECTIVE: This study was intended to verify that CAM 5.2 positive cells found in the epidermis of nevus sebaceus are Merkel cells and to understand the meaning of CAM 5.2 positive j cells in the epidermis of nevus sebaceus. METHODS: The immunohistochemical stainings with CAM 5.2 and antibody to epithelial membrane antigen (EMA) performed on specimens of normal skin, epidermal nevus, nevus sebaceus and some appendage tumors. In order to confirm the nature of CAM 5.2 positive cells, the distribution of those were compared to that of Merkel cells and double labeling with CAM 5.2 and neurofilament was performed. RESULTS: CAM 5.2 positive cells were also found in trichilemmoma developed associated with nevus sebaceus and the epidermis of normal paimoplantar skin. CAM 5.2 positive cells were also stained with antibody to EMA on serial sections cut from the same tissue blocks. The association of CAM 5.2 positive cell and nerve fiber was also demonstrated. CONCLUSION: CAM 5.2 positive cells are seemed to be Merkel cells and their presence in the covering epidermis of nevus sebaceus suggests to the epidermis of nevus sebaceus may not be nevoid proliferation of epidermal keratinocytes.

A Study of Immunologic Difference Between Responders and Non-responders to Diphencyprone in Patients with Alopecia Areata

BACKGROUND: The pathogenesis of alopecia areata is still unknown, however autoimmune mechanism is strongly suggested. The topical immunotherapy using potent sensitizer has been used as new therapeutic modality. By this method in one half and to one third of the patients, hair growth is observed. OBJECTIVE: To evaluate the immunological profile between responders and non-responders to dphencyprone (DPCP) topical immunotherapy in alopecia areata patients. METHODS: Aker sensitization, DPCP was applied to the patients' scalp weekly for three months. Before and after treatment the therapeutic effect was evaluated by clinical observation by following items: complete baldness, baldness+vellus, baldness+terminal hair and normal hair. Peripheral T cell and T cell subsets, B cell and delayed hypersensitivity with various antigens were evaluated before and after treatment. RESULTS: The immunologic difference between responders and non-responders was not statistically different. CONCLUSION: It is suggested that no major immunologic difference was observed between responders and non-responders before and after DPCP topical immunotherapy. Local mechanism seems to be related in the response to immunotherapy.

CAM 5.2 Positive Cells in the Epidermis of Nevus Sebaceus

BACKGROUND: In the course of the study of keratin expression in the epidermis of nevus sebaceus, several cells in the epidermis of nevus sebaceus were positively stained with CAM 5.2 antibody, which is known to be specific for the lower molecular weight cytokeratin and used as a marker of Merkel cell. OBJECTIVE: This study was intended to verify that CAM 5.2 positive cells found in the epidermis of nevus sebaceus are Merkel cells and to understand the meaning of CAM 5.2 positive j cells in the epidermis of nevus sebaceus. METHODS: The immunohistochemical stainings with CAM 5.2 and antibody to epithelial membrane antigen (EMA) performed on specimens of normal skin, epidermal nevus, nevus sebaceus and some appendage tumors. In order to confirm the nature of CAM 5.2 positive cells, the distribution of those were compared to that of Merkel cells and double labeling with CAM 5.2 and neurofilament was performed. RESULTS: CAM 5.2 positive cells were also found in trichilemmoma developed associated with nevus sebaceus and the epidermis of normal paimoplantar skin. CAM 5.2 positive cells were also stained with antibody to EMA on serial sections cut from the same tissue blocks. The association of CAM 5.2 positive cell and nerve fiber was also demonstrated. CONCLUSION: CAM 5.2 positive cells are seemed to be Merkel cells and their presence in the covering epidermis of nevus sebaceus suggests to the epidermis of nevus sebaceus may not be nevoid proliferation of epidermal keratinocytes.

A Study of Immunologic Difference Between Responders and Non-responders to Diphencyprone in Patients with Alopecia Areata

BACKGROUND: The pathogenesis of alopecia areata is still unknown, however autoimmune mechanism is strongly suggested. The topical immunotherapy using potent sensitizer has been used as new therapeutic modality. By this method in one half and to one third of the patients, hair growth is observed. OBJECTIVE: To evaluate the immunological profile between responders and non-responders to dphencyprone (DPCP) topical immunotherapy in alopecia areata patients. METHODS: Aker sensitization, DPCP was applied to the patients' scalp weekly for three months. Before and after treatment the therapeutic effect was evaluated by clinical observation by following items: complete baldness, baldness+vellus, baldness+terminal hair and normal hair. Peripheral T cell and T cell subsets, B cell and delayed hypersensitivity with various antigens were evaluated before and after treatment. RESULTS: The immunologic difference between responders and non-responders was not statistically different. CONCLUSION: It is suggested that no major immunologic difference was observed between responders and non-responders before and after DPCP topical immunotherapy. Local mechanism seems to be related in the response to immunotherapy.

A case of fibroma of tenden sheath / 대한피부과학회지

We report a case of fibroma of tendon sheath developed in a 22-year-old woman. The tumor of about 5 years duration was protruding on the volar surface of her 4th finger tip. It was well-demarcated rubbery-hard, and immovable on palpation. The surface on the tumor was smooth and had some telangiectasias. It was asymptomatic and non-tender. The histopathologic findings of excised specimen revealed well-demarcated lobulated mass with widely-spacd: fibroblasts in a hyalinized collagenous matrix. The characteristic slit-like spaces were found in hypoellular and fasciitis-like region. After excision, local recurrence has not been observed for about one and a half years of follow-up period.

A case of fibroma of tenden sheath / 대한피부과학회지

We report a case of fibroma of tendon sheath developed in a 22-year-old woman. The tumor of about 5 years duration was protruding on the volar surface of her 4th finger tip. It was well-demarcated rubbery-hard, and immovable on palpation. The surface on the tumor was smooth and had some telangiectasias. It was asymptomatic and non-tender. The histopathologic findings of excised specimen revealed well-demarcated lobulated mass with widely-spacd: fibroblasts in a hyalinized collagenous matrix. The characteristic slit-like spaces were found in hypoellular and fasciitis-like region. After excision, local recurrence has not been observed for about one and a half years of follow-up period.

A Case of Plexiform Neurofibroma with Multiple Skeletal Abnormalities and Giant Pigmentation / 대한피부과학회지

We experience a case of plexiform neurofibroma in a 10-year-old girl who had unusual giant pigmentation and multiple skcletal abnormalities including pectus cariimtum. Histologic examination of the lesion taken from right upper arm permitted a diagnosis of plexiform neurofibroma.

A Case of Plexiform Neurofibroma with Multiple Skeletal Abnormalities and Giant Pigmentation / 대한피부과학회지

We experience a case of plexiform neurofibroma in a 10-year-old girl who had unusual giant pigmentation and multiple skcletal abnormalities including pectus cariimtum. Histologic examination of the lesion taken from right upper arm permitted a diagnosis of plexiform neurofibroma.

A case of neuroblastoma with multiple skin metastases / 대한피부과학회지

We report a case of neuroblastoma with multiple skin metastases as a chief complaint in a 2-month-old girl. the skin lesions were rnultiple, pea-sized, bluish, nontender, moable subcutaneous nodules on abdomen, back and scalp. Histopathology showed small round or poly gonal tumor cells which have deeply stained, basophilic, hyperchromatic nuclei with some mitoses. Th.se tumor cells showed clumping tendency which is one of early menifestations of rosette formation. Immunohistochemically positive reaction was demonstrated by anti-NSE(neuron specific enolase) antilody but negative reaction by anti-NFP (neurofilament proteiin ) antibody. She has been succesfully treated with combined chemotherapy for 10 months without relapse.

A case of erythropoietic protoporphyria / 대한피부과학회지

Erythropoietic protoporphyria, sometimes also called erythrohepitic protoporphyria or simple protoporphyria, is a heritable detect of heme synthesis in which the last enzyme of the heme synthetic pathway, ferrochelatase(or heme synthetase), is functioning subopt,imally. A 23-year-old male has experi nced erythema and edema on the fae and hands during or immediately after sun exposure, since 3 years of age. The skin lesions have been accompanied by severe itching, a buring sensation and pain. Severe episodes were followed hy head iche and vomiting. We have seen a case of erythropoietic protoporphyria presenting clinically and histo athologically, wit.h a skin lesion on the sun exposured area, and free erthrocyte protoporphyrin serologically.

A clinical study of cellulitis / 대한피부과학회지

We reviewed the 43 medical records of patients with cellulitis or erysipelas who had been admitted at the depar1ment of dermatology of Seoul National University Hospital and followed them up for mean 21.6 months. The results were as follows. 1. The sex ratio of patients with cellulitis was 1:1.4 and the average age was 49 years. 2. The lower extremity as the most frequently invloved site of cellulitis with the frequency of 58.1% (25 cases), with the head and neck being involved in 16 cases(37.2%) and trunk and upper extremity in 1 case each(2.3% ). 3. The portals of infecticin were suspected in 33 cases(76% ), where tinea pedis was detect,ed in 18 cases(41.9%), previous skin infeection 10 cases(23.3%) and trauma in 9 cases(20.9%). 4. Initial systemic symptoms were fever(76.7%), chill(65.1%) and headache(37.2%). Erythema(100%), local heating(90,7%), tenderness(88.4%), swelling(86.0%), ulcer(16.3%), bulla(14.0%), lymphangitis(9.2%) and lymphadenit,is(9.2%) were found in the skin lesions. 5. The laboratory findings revealed leukocytosis in 35.7%, elevaed ESR in 86.8% positive 6. ASO titer in 63.0% and positive CRP in 80%, Microorganism. were detected in only 1 of 15 blood cultures, in 2 of 4 bulla fluid cultures and in 7 of 9 bus cultures. There was no growth of causative microorganisms in 3 tissue cultures and 9 saline needle aspiration cultures. Penicillin was used as primary antibiotics in 19 cases, which changed to another antibiotics due to lack of improvement in 3 cases and cefazolin was used in 21 cases, which changed in 2 cases due to the same reason. 7. Average admission priod was 11 days(range from 3 to 20 days) and 30.2% of patients wit.h cellulitis experienced recurrence, but 48% on low extrernity in contrast with 6.7% on head and neck.

A Case of Nodular Amyloidosis

A 65-year-old female patient visited our clinic complaining of multiple skin lesions since one year ago. There were yellowish to brownish colored, bean to walnut-sized nodules on both lower extremities. Dylon stain with polarizing microscopy, immunohistochemical stain to amyloid P and immunoglobuhn-kappa chain showed positive reactivities but keratin stain was negative. According to histopathologic and immunohistochemical findings, she was diagnosed as nodular amyloidosis.

Pityriasis Lichenoides in Children

No abstract available.

Tinea pedis in garbage workers / 대한피부과학회지

Tinea pedis is frequently found in people with poor personal hygiene and in hot, humid environments. The authors investigated the clinical, epidemiological, and mycological characteristics of tinea pedis in 170 garbage workers(166 males and 4 females) employed in a garbage plant in Seoul, Korea. 40 were clerical workers and 130 were field workers. Tinea pedis was found in 134 with a prevalence rate of 78.8%. Of those 134, 61(45.5%) also had onychomycosis. The prevalence of tinea pedis increased with age and the period working in garbage plant. However, there was no difference in the prevalence of tinea pedis between clerical workers and field workers, mitigating against the conclusion that their tinea pedis may be of occupational origin. Clinically tinea pedis was classified into 4 types ; interdigital (41.8%), vesicular(23.1%), dry squamous(22.4%), and mixed(12.7%). KOH smear positivity and culture positivity was related to clinical types of the lesion the lowest in the interdigital type. In the interdigital type, the etiology of nonmycotic lesions could not be identified. Negative fungal cultures could have been due to secondary bacterial infections. 63 strains of dermatophytes were isolated; 54 strains of Trichophyton rubrem(85.7%), 8 strains of Trichophyton mentagrophytes(12.7%) and 1 mixed infection of T. rubrum and T. mentagrophytes. T. mentagrophytes was isolated only from the vesicular lesions. 8 strains of yeast forms, positive in KOH smears and yielding pure colonies, were also isolated, and repeated mycologic examination yielded the same results. Among them, at least 4 cases of Trichosporon beigelii, and 1 case of Candida parapsilosis were considered to be of pathogenic significance.

Comparison of clinical efficacy between acitretin and etretinate in psoriasis / 대한피부과학회지

Etretinate, an effective retinoid in the treatment of pustular, erythrodermic and chronic plaque type psoriasis, has the disadvantage of a long terminal elimination half-life. On the other hand, acitretin, the active metabolite of etretinate, has much shorter terminal elimination half-life and is being reported as an agent with good antipsoriatic activity by several authors. To evaluate the clinical efficacy of acitret.in in comparison with etretinate, we treated 10 patients wit,h acitretin at a dose of 30mg per day and 11 patients with etretinate at a same dose for 12 weeks. The PASI score at 12 week was significantly reduced in each group as compared with baseline PASI score. In the acitretin treated group the initial PASI score of 14.5 reduced to 3.9, while the etretinate group PASI score reduced from 12.0 to 3.1. The PASI score differ ences between the acitretin and etretinate groups at each time during therapy and the end of therapy were not statistically significant. The severity of adverse reactions with acitretin was similar to those with etretinate but their incidence was higher. The change in laboratory parameters in the acitretin group was simlar to that of the etretinate group. In view of these results and the known pharmacokinetic advantage of acitretin, that is the short terminal elimination half-life, it is conceivable that acitretin may be a useful alternative to etretinate in the treatment of psoriasis.