17 Cases of Atypical Molluscum Contagiosa / 대한피부과학회지

BACKGROUND: Molluscum contagiosum is a commom benign viral disease of the skin characterized by discrete, 2-5 mm, flesh colored, slightly umbilicated, dome-shaped papules with frequent grouping. But atypical presentation of site, number and size is recently not rare, it may give rise to difficulty in diagnosis. OBJECTIVE: The purpose of this study was to investigate the clinical and histopathological characteristics of various atypical molluscum contagiosa. METHODS: We reviewed medical records, clinical photographs, and histopathologic findings in biopsy specimens of 17 patients with molluscum contagiosa diagnosed at Korea Veterans Hospital from January 1990 to June 2001. The ratio of male to female patients was 3:1, and the mean age at diagnosis was 30 years(range: 3-67). RESULTS: 1. Most commonly involved sites were trunk(80%), extremities(30%), and perianal(12%). 2. The duration of the lesion is 15 days to 3 years. 3. The size of lesion is 2 mm to 50 mm. 4. The number of lesions is one to over a hundred. 5. The clinical features were multiple papules without umbilication(9 cases, 53%) and giant tumor(2 case), pyogenic granuloma-like lesion(2 cases), solitary papule with flat surface(2 cases). 6. The combined disease are atopic dermatitis(1 case), epidermal cyst(1 case), and liver cirrhosis(1 case), diabetes mellitus(1 cases). CONCLUSION: This study shows various atypical molluscum contagiosa in immunocompetent patients. Histopathological examination in atypical molluscum contagiosa is necessary for the proper diagnosis and treatment.

A Case of Papillary Eccrine Adenoma / 대한피부과학회지

The papillary eccrine adenoma is a rare benign sweat gland neoplasm, first described by Rulon and Helwig in 1977. It is usually present as a solitary dermal nodule on the distal extremities. Histological examination revealed a well circumscribed, non capsulated dermal nodule consisting of multiple ducts with various size. These ducts were composed of double layered epithelial cells mostly and intraluminal papillation with eosinophilic luminal materials was seen. We report a case of papillary eccrine adenoma in 52-year-old male who presented single nodule on the right midback, uncommon area.

Immunohistochemical Expression of E-Cadherin and Ur-Catenin in Fetal Skin / 대한피부과학회지

BACKGROUND: E-cadherin is the prime mediator of cell-cell adhesion in epithelial cells and the beta-catenin is the associated protein with E-cadherin in the formation of adhesion complexes in normal and tumor cells related with tumor spread. The present study aimed to find the distribution of E-cadherin and beta-catenin in fetal skin during development. OBJECTIVE: The purpose of this study was to observe the distribution of above two adhesion related proteins in the fetal skin during development, to find its relationship by expression and their distribution patterns. METHODS: Skin was obtained from the scalp, chest, and sole of 21 human fetuses, ranging from 13 to 37 weeks of gestational age. Immunohistochemical staining was performed by avidin biotin peroxidase complex method on paraffin embedded tissue using anti-human monoclonal antibody against the human E-cadherin and beta-catenin. RESULTS: E-cadherin and beta-catenin were expressed in cell membrane of intermediate cell layer of epidermis at 13th week followed by increased basal cell expression at 15th week and adult pattern in 24th week of gestation. Both showed similar distribution pattern in skin. Difference was that E-cadherin was expressed only in cell membrane, but beta-catenin was expressed in both cell membrane and cytoplasm, stronger in cell membrane. beta-catenin also expressed in mesenchymal tissue. In the skin adnexae, E-cadherin and beta-catenin were also expressed very similar distribution pattern both in hair follicular development and eccrine duct epithelium. CONCLUSION: Both E-caherin and beta-catenin showed the same expression in the fetal stage and distribution pattern suggesting that both adhesion molecules are highly related each other in function and development of epidermis and adnexae of the skin in fetal stage, though their expression are not noted in all epithelial cells.

Two Cases of Lichen Amyloidosis Stained Negatively for Antikeratin Antibodies / 대한피부과학회지

Localized primary cutaneous amyloidosis consists of three types: nodular, macular, and lichenoid amyloidosis. Lichen amyloidosis is characterized by the appearance of paroxysmally itchy lichenoid papules on the shins. Although the origin of the amyloid is controversial and can not provide any definite answer, some of amyloid substances can be derived from epidermal cells and others from degenerative collagen fibers. We suggested the origin of amyloid in our cases as epidermal keratinocyte and collagen degenerations. Because degeneration of basal keratinocyte is observed on electron microscopy and degeneration of collagen is in H&E and Masson's trichrome stain although amyloid materials are negatively stained against pankeratin antibody and collagen antibody. The skin lesion was improved after triamcinolone intralesional injections which reduce collagen synthesis. We report two cases of lichen amyloidosis which stained negatively for antikeratin antibodies and improved with triamcinolone intralesional injection.

A Case of Tinea Incognito on the Face due to Trichophyton mentagrophytes / 대한피부과학회지

Recently, we have encountered an increasing number of patients who have obtained topical steroids to self-treat various dermatosis. Tinea incognito has been used to describe a dermatophyte infection modified by corticosteroid treatment. Lesions are often atypical appearing and the diagnosis can be delayed or missed. We report a case of tinea incognito with ill-defined erythematous patch and nodules on the right upper eyelid and taken intermittently application with corticosteroid ointment over a period of l year. Mycologic studies including KOH mount and fungus culture were positive for hyphae and colonies of Trichophyton mentagrophytes. The lesion was treated with of itraconazole and cured 3 weeks later.

A Case of Allergic Contact Dermatitis from Calcipotriol(Daivonex(R)) / 대한피부과학회지

The vitamin D3 analogue calcipotriol ointment(Daivonex(R)) has now been used successfully in the treatment of psoriasis for several years. It is usually well tolerated and safe. The adverse effects are mainly lesional and perilesional irritations, facial irritations, hypercalcemia, etc. The nature of calcipotriol-induced dermatitis is usually considered to be of irritant nature but allergic contact reactions have also been reported. We report a case of allergic contact dermatitis from calcipotriol (Daivonex(R)).

Ehlers-Danlos Synrome Type II / 대한피부과학회지

The Ehlers-Danlos syndromes(EDS) are a heterogenous group of inherited connective tissue disorders characterized clinically by skin fragility, skin hyperextensibility, joint hypermobility, and excessive bruising. At least 11 different subtypes of EDS have been classified based on genetic, biochemical, and clinical characteristics. We report a 25-year-old man with EDS type II who presented mild extensibility of skin and joint, skin fragility, and "cigarette paper" like atrophic scar. The EDS type II is more common than other different subtypes. While it may present with subtle clinical features, recognition is important so that good advice can be given to reduce the risks associated with certain careers and sports and to prevent the potential complications of pregnancy and surgery.

Hailey-Hailey Disease with a Family Histroy and Unique Nail Lesions

Hailey-Hailey disease(benign familial chronic pemphigus) is a rare autosomal dominant disorder characterized by blisters at sites of friction such as the neck, axillae and groin which are caused by suprabasal epidermal acantholysis. We report two cases of Hailey-Hailey disease in the one family. One of the two cases has asymptomatic multiple longitudinal white bands in the fingernails associated with typical skin lesions. The nail lesions have not been described until reported by Burge in 1992 and it may be a characteristic finding in Hailey-Hailey disease.

A Case of Darier's Disease Improved with Oral Etretinate and Isotretinoin, and CO2 Laser Vaporization / 대한피부과학회지

We report a case of Darier's disease with typical cutaneous and nail lesions in a 50-year-old male patient. He has brownish hyperkeratotic papules on the ant.chest, back, both axilla and groins and verrucous surfaced hypertrophic plaques on the scalp, forehead and both postauricular areas, which were accompanied by a severe itching sensation and malodor. Also he has finger nail lesions such as subungual hyperkeratotic papules, distal wedge shaped notching and multiple longitudinal red lines on the nail plates. Histopathologic features taken from the inguinal area revealed hyperkeratosis, suprabasal clefts and lacuna, protruded villi lined with one layer of basal cells into the cavity and dyskeratotic cells such as corps ronds in the epidermis. Hyperkeratotic papules on the ant.chest, back, both axilla and groins disappeared after systemic treatment withe a low dose of oral etretinate but hypertrophic plaques on the scalp and both postauricular areas still remained clinically and histopathologically. We then the treated postauricular hypertrophic plaques with CO2 laser vaporization and severe malodor with oral isotretinoin and it resulted in a marked improvement.

A case of Proteus Syndrome with Characteristic Clinical Manifestations / 대한피부과학회지

The term Proteus syndrome was coined in 1983 to describe a disorder of skeletal, hamartoinatous and other mesodermal malformations. The syndrome was named after the Greek god Proteus, whose name means "the Polymorphous". Major manifestations are hemihypertrophy, macrodactyly, exostoses, epidermal nevi, characteristic cerebriform masses involving the plantar or palmar surfaces, a variety of subcutaneous masses and scoliosis. We report a 12-year-old boy with Proteus syndrome who had the unique features of this syndrome.

A Case of Kaposi's Sarcoma with Disseminated Papules on both Lower Legs / 대한피부과학회지

Kaposis sarcoma is a multicentric neoplastic vascular tumor involving the skin or internal organs. We report a case of classic Kaposis sarcoma in a 69-year-old male who had positive serum cytomegalovirus antibodies and disseminated multiple erythematous to purplish colored confluent papules and edema on both lower legs. The histopathological finding showed abnormally proliferated and dilated vessels, vascular spaces, spindle cells, and extravasated erythrocytes. He was treated with radiotherapy, but died due to ventricular tachycardia.

A Case of Ki-1 Positive Type B Lymphomatoid Papulosis / 대한피부과학회지

The monoclonal antibody Ki-1(CD30) was first described in 1982 and was reported to react selectively with Reed-Sternberg cells in Hodgkins disease, highly activated B and T cells and large cell lymphomas of both T-and B-cell origin. Lymphomatoid papulosis(LyP) is characterized by recurrent erythematous papules or nodules that undergo spontaneous healing with hyperpigmentation and scarring. Histologically, two major types of LyP can be distinguished: type A is characterized by the presence of variable numbers of Ki-1+ large, atypical lymphocytes with some Reed-Sternberg like cells and type B is characterized by Ki-1- atypical cerebriform mononuclear cells similar to those in mycosis fungoides. We report a case of Ki-1+ lymphomatoid papulosis which was histopathologically recognized as a type B lesion but represented a Ki-1 positive reaction.

Two Cases of Recurrent Extramammary Paget's Disease after Wide Local Excision / 대한피부과학회지

We report two cases of recurrent extramarnmary Pagets disease after wide local excision. Both cases involved the scrotum and the penoserotal junction, respectively. On histopathological examination, we could observed many Paget cells confined to the epidermis and the hair follicle, but not invading the underlying dermis in both cases. There was no evidence of internal malignancy. Both cases were treated with wide local reexcision.

Primary Cutaneous B Cell Lymphoma

A 7-year-old girl had a 7 × 6cm sized dark red colored tumor on the left elbow and several erythematous macules on the face, right upper arm, and both thighs. Her general health was good and all laboratory findings were within normal limit. Histopathologic examination revealed an infiltration of atypical mononuclear cells in the dermis and subcutis. L26 and leukocyte common antigen were positively stained in an immunohistochemical study. According to clinical, histological and immunohistochemical findings, we diagnosed the disease as primary cutaneous B cell lymphoma. The patient's skin lesions markedly improved after a surgical excision and chemotherapy.

Basal Cell Carcinoma and Actinic Keratosis Treated with Intralesional Injection of Recombinant Alpha-2 Interferon

BACKGROUND: The effects of intralesional recombinant alpha-2 interferon(IFN) in the treatment of basal cell carcinoma(BCC) and actinic keratosis(AK) would be of value in selected patients. OBJECTIVE: Our purpose is to evaluate the differences of cellular immune reactions between the responded and the unresponded cases treated with IFN. METHODS: We treated five patients with BCC and two patients with AK with the intralesional injection of recombinant alpha-2 IFN. We performed immunohistochemical stainings with paraffin-embedded specimens from the pretreated and posttreated skin lesions. RESULTS: Four patients(three with BCC and one with AK) were healed and three patients showed improvement after treatment. In immunohistochemical stainings, there was an increased number of T cells in the dermal infiltrate of the responded cases but not in the unresponded cases. CONCLUSION: Intralesional IFN may induce T cell-mediated immune response at the site of the tumor by immune modulation.

Immunohistochemical Study on Proliferating Cells in Alopecia using Proliferating Cell Nuclear Antigen / 대한피부과학회지

Backgroud : The number of proliferating cell populations in the hair is follicles is closely related to the regulation of hair growth. Destruction of hair germ cells and the loss of proliferating cells have been suggested to be of major pathogenetic significance in alopecia areata OBJECTIVE: The purpose of this study is to compare the growth frrections in proliferating cells of normal hair follicles with those in alopecia. METHODS: An immunohiatochemical study was done to detect the proliferating cells in hair follicles using a monoclonal antibody against proliferating cell nuclear antigen(PCNA) in the scalp biopsy of an alopecia patient on the peraffin embedded sections. RESULTS: A significant decrease of the labelling indeces of PCNA were observed in the hair follicles of alopecia compared with normal condition. But we could not find significant differences of labelling index in the clinical types of alopecia, responses to treatment, anc systemic immunologic state. CONCLUSIONS : Whole the above results confirmed that significant decreases of proliferating cells in the hair follicle could explain the part of the pathogenetic mechanism in alopecia, its direct cause which inhibit the proliferation of cells is not clear.

Immunohistochemical Study of Pi Class of Glutathione S-Transferase in Psoriasis and Eczematous Dermatitis

BACKGROUND: Glutathione S-transferase(GST) is a family of isoenzymes that play an important role in protecting cells from cytotoxic and carcinogenic agents. Strong activities of GST-Pi in the epithelial tissues was observed in the upper layer of skin, gastrointestinal tract and placenta which have been exposed to exogenous chemicals. OBJECTIVE: This study was done to observe the distribution pattern of GST-Pi in normal, acute and chronic psoriasis or eczematous dermatitis, using paraffin-embedded human skin tissues. METHODS: Twenty-one psoriatic and twenty-six eczematous dermatitis specimens were observed by immunohistochemical staining using an anti-rabbit GST-Pi polyclonal antibody. RESULTS: Stainining reaction for the GST is weakly to moderately stained in the normal epidermis. In the acute stage, upper layer shows weak and moderate staining in the lower epidermis of the psoriasis and eczematous dermatitis but in the chronic stage GST-Pi are noted strongly expression in upper epidermis. CONCLUSION: Immunohistochemical staining for the GST-Pi reveals a more abundant distribution in the chronic stage rather than in the acute stage of psoriasis and eczema tous dermatitis, showing no disease specificity. Therefore it is suggested that the detoxifying capacity decreases in the acute stage of above dermatosis.

Difference of Proliferating cell nuclear antigen and epidermal growth factor receptor in psoriases and eczematous dermatitis / 대한피부과학회지

Psoriasis and eczematous dermatitis are two major different inflarnmtory dermatitis but differential diagnosis is sometimes difficult by histologic patterns. The object of this study is to find out whether there are any differences in the expressions of proliferation related pntein between psoriasis and eczematous dermatitis by chronological evaluation on the proliferating cell nuclear antigen(PCNA) and epidermal growth factor receptor(EGFR). The detections of PCNA and EGFR were done by immunohistoc.ienical methods(alkaline phosphatase anti-alkaline phosphatase method with new fuchsin substrated usir g respective polyclonal antibod ies in the paraffin embedded tissue from psoriasis(21 cases) and eczomtous dermatitis(26 cases). The labelling indeces of PCNA were 2.4+0.9% in normal. Indece; were 27.3+2.9% in acute, 20.7+ 3.7% in chronic psoriasis, while 12.4+5.6% in acute and 21.8% 5.0% in chronic eczematous dermtitis. The expressions of EGFR were very weak in normal, and increased in acute psoriasis and chronic eczematous dermatitiy. Our immunohistochemical results of PCNA and EGFR suggest that activated proliferation is rather pronounced in acute psoriasis and chronic eczemat.ous dermatitis, thouh proliferative activity is more marked in psoriasis.

A Case of Malignant Melanoma with Multiple Myeloma

Malignant melanoma is an uncommon tumor in Korea. To the best of our knowledge, we could not find malignant melanoma with multiple myeloma in Korean literature. A 57-year-old male patient had a 4×5 cm sized, irregular bordered, dark brownish plaque on the left sole, which has extended gradually since about 1 year ago and showed an occasional bleeding tendency. Laboratory examinations revealed a low hemoglobin level, rouleaux formation on peripheral blood, monoclonal gammopathy of IgG-kappa type and Bence-Jones proteinuria. Bone marrow aspiration findings showed markedly increased immature plasma cells suggesting multiple myeloma. Histopathologic findings of the skin biopsy from the left sole revealed proliferation of atypical melanocytes. We performed a surgical excision with a skin graft for malignant melanoma and chemotherapy (melphalan, vincristine and prednisolone) for multiple myeloma.

Four cases of trichotillomania / 대한피부과학회지

Trichotillomania is the cllinical syndrome of alopecia resulting from the repetative pulling, plueking and breaking of ones own hair. We report four cases of trichotillomania in 10 year old children. The lesions were limited to the scalp. All of them had psychiatric problems in the school or home according to a psychiatric consultation. The histopathologic examinatiorii revealed a normal number of hair follices, empty hair follicles and no inflammatory reaction. The treatment led to hair growth in three cases but one case did not respond to the treatment.