The Objective Evaluation Methods for Therapeutic Effectiveness and the Efficacy of Systemic Corticosteroid in the Treatment of Cellulitis / 대한피부과학회지

BACKGROUND: Because it has been known that the inflammatory process of cellulitis can be modified by the immune reaction, systemic corticosteroid may be helpful to reduce the inflammatory reaction of the cellulitis and its consequent complications such as skin necrosis and lymphangitis. OBJECTIVE: The purpose of this study was as follows; To find out the appropriate and objective examination methods to evaluate the improvement of cellulitis. To estimate the efficacy of the systemic corticosteroid of short period in the treatment of cellulitis. METHODS: First, as methods of evaluation of therapeutic effectiveness, we measured the lesional skin temperature, circumference of extremity and subjective tenderness in two groups-patients with cellulitis and controls to find out the objective tools showing the improvement of cellulitis. Second, we also measured the skin temperature, circumference of extremity and subjective tenderness in another two groups-patients with systemic corticosteroid and those without to evaluate the effect of systemic corticosteroid in cellulitis. RESULTS: The results were as follows ; Measurements of the skin temperature, circumference and subjective tenderness all showed statistic significance to evaluate the improvement of cellulitis. Patients who were treated with systemic corticosteroid showed statistically better improvement than control group in the lesion of cellulitis. CONCLUSION: The lesional skin temperature, circumference and tenderness can be an objective evaluation method of clinical effectiveness and the systemic corticosteroid may be as adjunct to improvement of the cellulitis.

Subepidermal Calcified Nodule of the Finger / 대한피부과학회지

Subepidermal calcified nodule is a rather uncommon, but peculiar subtype of calcinosis cutis. It presents as a single asymptomatic, hard, yellowish white nodule which commonly occurs on the face of children. Histopathologic examination reveals the multifocal various-sized papillary dermal collection of dark blue amorphous globular deposits confirmed by von Kossa stain for calcium. We report a 42-year-old man who had small white hyperkeratotic papule on finger tip for more than 20 years. He could recall neither preceding trauma nor systemic illness. Excisional biopsy, with the clinical impression of verruca or corn, showed typical histopathologic features of the subepidermal calcified nodule.

The Expression of the alpha-Melanocyte Stimulating Hormone (alpha-MSH) and Melanocortin-1 Receptor (MC1R) in the Epidermis of the Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is a skin disease that is characterized by the loss of cutaneous pigmentation. alpha-Melanocyte stimulating hormone (alpha-MSH) is a neuroimmunomodulating peptide derived from proopiomelanocortin, and melanocortin-1 receptor (MC1R) is a surface receptor which is expressed by several other cutaneous cells including melanocyte and keratinocyte. Both of them have been known to be the main physiologic regulator for integumental pigmentation. OBJECTIVE: To evaluate the expression pattern of alpha-MSH and MC1R in the epidermis of vitiligo patients. METHODS: Specimens were obtained in lesional, perilesional and non-lesional skin in 10 patients with vitiligo and from 3 normal persons by the punch biopsy. And then, indirect immunofluorescence was done to show the pattern of expression of alpha-MSH and MC1R. RESULTS: Pattern of expression between alpha-MSH and MC1R was nearly the same. In vitiligo patients with stable disease state (7 of 10), the expression of alpha-MSH and MC1R in the non-lesional skin was more prominent than that in lesional area. In vitiligo patients with active disease state (3 of 10), the expression of alpha-MSH and MC1R in the lesional skin was more prominent than that in non-lesional area. CONCLUSION: Between the stable and active vitiligo patients, there was a different pattern of expression of alpha-MSH and MC1R in the lesional skin.

Three Cases of Prurigo Pigmentosa / 대한피부과학회지

Prurigo pigmentosa is a chronic inflammatory dermatosis characterized by reticulated erythematous papules, hyperpigmentation with severe pruritus and usually occurs in young femals around their twenties. Most cases have been reported from Japan, but only twelve cases have been reported in Korea. Histopathologic findings of erythematous papules shows spongiosis, exocytosis, liquefaction degeneration of the basal cell, perivascular lymphohistiocytic infiltration in the dermis and finally dermal fibrosis and deposit of dermal melanophages in hyperpigmented lesions. We report three cases of prurigo pigmentosa which showed various histopathologic features of early, fully-developed and late stage, respectively.

Febrile Ulceronecrotic Pityriasis Lichenoides et Varioliformis Acuta in a child / 대한피부과학회지

Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta (PLEVA) is a very rare cutaneous disorder clinically characterized by the acute onset of erythematous papules, vesicles and large coalescent ulceronecrotic lesions on the whole body accompanied by high fever and severe constitutional symptoms. In general, ulceronecrotic lesion is preceded by a typical rash of PLEVA. Histopathologically, it shows widespread epidermal necrosis and fibrinoid necrosis of blood vessel walls in addition to the superficial and deep perivascular lymphocytic infiltrations. Several regimens including systemic corticosteroid, antibiotics, methotrexate or ultraviolet therapy have been challenged in this disorder . We report a typical case of febrile ulceronecrotic PLEVA in a 10-year-old child who showed a dramatic response to methotrexate.

The Management of Diabetic Foot Ulcer by Corporation of Dermatologists and Internists: Preliminary Report / 대한피부과학회지

BACKGROUND: Recently, the prevalence of diabetes mellitus and its complications have been increased in Korea and they cause many socioeconomic losses in both patients and their families. But, there are neither sufficient medical assistance including concern of medical personnel nor social assistance in Korea nowadays. OBJECTIVES: In this study, we tried to reduce the risk of amputation and preserve the function of the foot by an early evaluation, proper treatment and consultation by dermatologists. METHODS: We randomly chose 18 cases of diabetic foot ulcer and took care of them with proper and earlier debridement, dressing, antibiotics and cooporation with departments of internal medicine, especially endocrinology, nephrology and division of infectious disease. After healing of the ulcer, we recommended specially designed shoes and foot care products to prevent the recurrence of the foot problems. RESULTS: The average duration of diabetes was 18 years and preexisting complications were neuropathy, nephropathy, vasculopathy and/or foot deformities. The precipitating factors of foot ulcer were burn, callus, fungal infection, bony deformity or trauma. Three cases underwent toe amputation and one case with severe vasculopathy was transferred to the vascular surgery. Average healing time was 14 weeks. CONCLUSION: Proper evaluation and management of diabetic foot ulcer patients with multidisciplinary approach should achieve good wound healing. Consequently, it can reduce the risk of amputation and improve the quality of life in the patient with diabetic foot ulcer. Among them, dermatologists who has a point of view of both a medical and surgical doctor may play a pivotal role in the management of diabetic foot ulcer.

The Earlobe Keloid Treated by Compression Therapy with Earring after Shaving Excision / 대한피부과학회지

Keloid is a benign proliferative growth of dermal collagen which extends beyond the original wound. Although there are several available methods of treatment including intralesional corticosteroid injection, cryotherapy, surgical excision, laser therapy, pressure, radiotherapy, interferon-alpha injection and so on, no effective modality to prevent the recurrence of keloids may be present. We have done shaving excision of keloids on the earlobes of 4 patients and then recommended earring made to order for home compression over 4~5 months therapy with no recurrence for 1~3 years. It is suggested that compression therapy with earring following shaving excision may be proven to be not only a simple but effective method for prevention of recurrence after removal of keloid on the earlobe.

A Case of Pseudoxanthoma Elasticum Showing Transepidermal Elimination / 대한피부과학회지

Pseudoxanthoma elasticum (PXE) is an inherited disorder involving the connective tissues of skin, eye and cardiovascular system. Both a recessive and a dominant inheritance pattern have been engaged in it. The skin changes are characterized by the yellowish crepe-like, lax, redundant folds on neck, axilla and periumbilical area. In rare instances, perforating dermatoses such as keratotic erythematous papules are also accompanied in PXE and histologically characterized by transepideraml elimination of altered basophilic calcified elastic fibers, which are short, fragmented and curled in the middle portion of the reticular dermis. Now we report a case of 26 year-old female who had a typical hereditary systemic PXE showing transepidermal elimination on her neck without preceding trauma history.

A Case of Verrucous Carcinoma Arising in Penile Lichen Sclerosus et Atrophicus / 대한피부과학회지

Verrucous carcinoma(VC) is regarded as a rare, histologic variant of squamous cell carcinoma (SCC). Lichen sclerosus et atrophicus(LSA) is chronic dermatosis characterized by atrophic white papules or plaques, occurring most commonly on the anogenital skin of both sexes. Genital LSA has been associated with the development of invasive carcinoma, and the most common is SCC. There have been only a few reports of VC within a lesion of penile LSA. We now report a case of VC arising in penile LSA.