Chemical Burn due to a Hair Bleaching Agent / 대한피부과학회지

Several hair dressing procedures, for example, bleaching and dyeing of the hair, are currently being frequently performed for cosmetic purposes. While allergic contact dermatitis due to hair dressing products has often been described, only a few cases of burns caused by hair dressing chemicals have been reported. A 6-year-old girl presented with an 8x6 cm sized round ulcerative lesion on the occipital area after hair bleaching with ammonium persulfate mixed with hydrogen peroxide. The skin biopsy specimen showed epidermal necrosis and sclerosing change in the dermis. She was referred to another burn center and then she was treated with skin grafting by a plastic surgeon. To the best of our knowledge, this is the first reported case of chemical burn due to a hair bleaching agent in the Korean dermatologic literature.

Angiogenesis according to Clinical Forms in Leprosy / 대한피부과학회지

BACKGROUND: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. It has recently been reported that various clinical manifestations and treatments of leprosy are associated with increased angiogenesis. However, there are few reports on this topic. OBJECTIVE: This study aims to examine the differences in angiogenesis according to clinical forms of leprosy. METHODS: Thirty-three cutaneous lesions that represented the clinical spectrum of leprosy and 7 normal skins were selected for this study. Clinical forms of leprosy included in this study were 7 cases of tuberculoid (TT), 8 cases of borderline tuberculoid (BT), 8 cases of borderline lepromatous (BL), and 10 cases of lepromatous (LL) leprosy. A total of 40 sections of formalin-fixed, paraffin embedded tissues were investigated for Factor VIII-related antigen (FVIIIRA) expression using immunohistochemical staining. The number of FVIIIRA positive blood vessels in hot spot at a power of x40 was observed by 2 independent dermatologists. RESULTS: The number of vessels ranged from 4 to 12 (mean 8.43+/-2.64) in the normal cutaneous tissues, 23 to 38 (mean 28.86+/-5.46) in the TT, 46 to 71 (mean 56.50+/-8.68) in the BT, 49 to 77 (mean 64.75+/-9.82) in the BL, and 74 to 159 (mean 104.40+/-27.71) in the LL. The mean numbers of vessels in the BT, BL, and LL leprosy lesions were significantly higher than the mean number in the normal cutaneous tissues. Also, an overall increase was observed in the mean number of vessels from TT through BT, BL to LL leprosy lesions. CONCLUSION: We suggest that increased angiogenesis is associated with pathogenesis in leprosy. This study should prove helpful to future research into leprosy treatment.

Levamisole Monotherapy for Oral Lichen Planus

BACKGROUND: Several different kinds of drugs have been used to treat chronic oral lichen planus (OLP). During the last decade, there have been several reports demonstrating success with levamisole and low dose prednisolone therapy for treating OLP. However, some OLP patients who have underlying diseases such as diabetes, hypertension and malignancy are unable to take steroids. OBJECTIVE: The aim of this study was to evaluate levamisole monotherapy for treating OLP. METHODS: Eleven patients who had OLP were treated with levamisole between 2005 and 2007. The levamisole was administered at a dose 50 mg thrice daily for three consecutive days, but then it was not administered on the following four days. RESULTS: After 2 weeks of treatment, 8 patients reported a partial response, 3 patients reported no response and no patients reported clearance of lesion. After 4 weeks of treatment, 6 patients reported a partial response, 3 patients reported no response and 2 patients reported clearance of lesion. Furthermore, after 3 months of treatment, 3 patients reported a partial response, 3 patients reported no response and 5 patients reported complete clearance of lesion. Clinical improvement was shown in 2 weeks, whilst the mean duration to achieve clearance of lesion was 6.2 weeks. Although 1 patient had mild itching, there were no significant adverse effects. CONCLUSION: Levamisole monotherapy could be a successful and safe treatment option for patients with chronic OLP and who cannot take steroids.

A Case of Lentigo Maligna and Basal Cell Carcinoma That Developed on the Face / 대한피부과학회지

Lentigo maligna (LM) is a subtype of melanoma in situ that may become lentigo maligna melanoma. LM is a pigmented lesion that most commonly occurs on sun-exposed skin inthe elderly. Intense exposure to ultraviolet light also accounts for nonmelanotic skin tumors, and particularly basal cell carcinoma (BCC). We herein report on a case of LM and BCC on the right face of a 76-year-old woman. She presented with a longstanding irregular-shaped brown to black pigmented patch on the right infra-orbital area, and a pigmented dome-shaped papule on the right nasolabial fold. The histopathologic findings were consistent with LM and BCC. We performed surgical excisions and there has been no recurrence for 10 months.

Genotype, Coagulase Type and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolated from Dermatology Patients and Healthy Individuals in Korea

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent dermatology pathogens in hospitals and increasingly recognized in communities. We determined PFGE pattern of SmaI-restricted genomic DNA, coagulase type, and antimicrobial susceptibility of MRSA isolated in 2008 from dermatology inpatients and healthy hospital employees in A Hospital and from primary school children in Iksan city, Korea. Overall, the isolation rate of MRSA was 3.8% from the 788 normal persons: 4.9% from hospital employees and 1.1% from primary school children. MRSA was isolated in six of 13 (46.2%) family members of four school children with MRSA. The most prevalent coagulase serotype was II from patients and V from healthy individuals. Ten of twenty and six of twenty MRSA isolates from patients and from healthy personnel, respectively, had identical PFGE patterns, suggesting that these are originated from identical clones. Against MRSA from patients, only vancomycin was the most active (MIC range or =90% to amikacin, clindamycin, ciprofloxacin, erythromycin, fusidic acid, gentamicin and tetracycline. In conclusion, the MRSA carriage rates of healthy hospital workers were relatively high, 2.3~7.7%, depending on groups. Family members of a few primary school children with MRSA showed a high carriage rate, suggesting that intrafamily transmission occurred. MRSAs isolated from dermatology inpatients were relatively more resistant to various antimicrobial agents, including mupirocin, but all isolates were susceptibility to vancomycin.

A Case of Fibroma of the Tendon Sheath on the Elbow / 대한피부과학회지

Fibroma of the tendon sheath is a benign soft tissue tumor and this mostly occurs in the distal portion of an extremity. The tumor usually appears as a slow-growing, firm, painless, small nodule in association with tendons and tendon sheaths. Histopathologically, it shows a well-demarcated nodule that consists of haphazardly-arranged, fibroblast-like spindle cells that are embedded in a dense collagenous matrix. A 52-year-old woman presented with a tender, solitary, 2.5x2.0 cm-sized, subcutaneous nodule on the right elbow. The skin biopsy specimen showed that the well-circumscribed tumor contained densely-arranged collagen areas with spindle cells and slit-like vascular channels. We herein report on a rare case of fibroma of a tendon sheath on the right elbow.

A Case of Primary Cutaneous Mucoepidermoid Carcinoma on the Cheek / 대한피부과학회지

Mucoepidermoid carcinoma is a rare disease that usually occurs in the salivary gland. In extremely rare cases, it can originate from the skin. These cases are more aggressive than the usual mucoepidermoid carcinoma, so they have high mortality and high recurrence rates. Herein we report a case of primary cutaneous mucoepidermoid carcinoma on the cheek. A 34-year-old man had a 1.0x1.0 cm sized cystic lesion. This lesion displayed central erosion and oily discharge. He had been operated on 4 times at a private hospital, but the lesion had recurred. Histopathologically, there were many tumor islands that consisted of mucoid cells, epidermoid cells, intermediate cells and clear cells. The tumor islets showed mild positivity for Alcian blue (pH 2.5), PAS, and d-PAS stain. There was no parotid tumor on the neck-CT scan, nor on positron emission tomography. We therefore diagnosed this cheek lesion as primary cutaneous mucoepidermoid carcinoma, and it was removed completely.

Determination of the Biogroup of Vibrio vulnificus Isolates from Patients and Oysters in Korea / 대한피부과학회지

BACKGROUND: Vibrio vulnificus are divided into 3 biogroups based on their biochemical and serological properties and the existence of eel virulence. Only a few studies can be found on the biogroups of V. vulnificus in other countries, and no such studies have been done in Korea. OBJECTIVE: The aim of this study was to determine the presence of biogroups other than biogroup 1 among the V. vulnificus isolated from septic patients and from oysters in Korea. METHODS: A total of 103 isolates (53 from septic patients and 50 from oyster) were used. The API 20E system was used to confirm identification of the V. vulnificus. Conventional biochemical tests and vvA gene detection by polymerase chain reaction (PCR) were used to determine the biogroups. RESULTS: The clinical and oyster isolates showed results similar to the biochemical tests. All of the clinical and oyster isolates showed the biochemical pattern of biogroup 1. The vvhA gene was detected in all of the isolates. CONCLUSION: All of the V. vulnificus isolates from the septic patients and oysters in Korea belong to biogroup 1.

A Case of Generalized Hyperpigmentation Caused by Antituberculosis Drugs / 대한피부과학회지

Hyperpigmentation caused by medication or toxic agents accounts for 10~20% of all the cases of acquired hyperpigmentations. Nonsteroidal anti-inflammatory drugs, antimalarials, amiodarone, cytotoxic drugs, tetracyclines, heavy metals and psychotropic drugs are most commonly responsible for hyperpigmentation. A 74-year-old man who had taken antituberculosis drugs (rifampin and isoniazid) for 4 months developed generalized hyperpigmentation. The histopathologic finding revealed an increased number of dermal melanophages with pigment incontinence. Eight months after termination of the antituberculosis medication, his skin lesion improved without any treatment. To the best of our knowledge, this is the first reported case of generalized hyperpigmentation due to rifampin and isoniazid in a patient without adrenal insufficiency in the dermatological literature.

A Case of Lymphangioma Treated by OK-432 (Picibanil(R)) Sclerotherapy / 대한피부과학회지

Lymphangioma is an uncommon, benign hyperproliferation of the lymphatic vessels, and this consists of dilated lymphatic channels lined by a normal, single layer of endothelial cells. Various methods have been tried for the treatment of lymphangioma, including cryotherapy, electrocauterization, surgical excision, laser therapy, radiotherapy and itralesional injection of sclerosing agents. Yet these methods have shown low success rates and various side effects. It has recently been reported that intralesional injection of OK-432 is a safe and effective alternative therapy for lymphangioma, and especially for macrocystic lesion. In this report, we describe a patient with lymphangioma on the upper labial mucosa and this patient was successfully treated with intralesional injection of OK-432 without any serious complications. To the best of our knowledge, this is the first such case reported on in the Korean dermatological literature.

A Pancreaticobiliary Maljunction (New Komi Classification, Type IIIc3) with a Choledochal Cyst, Common Bile Duct Stones and Pancreatic Duct Stones / 대한소화기내시경학회지

A pancreaticobiliary maljunction (PBM) is synonymous with abnormal union of the pancreaticobiliary ducts (AUPBD), anomalous arrangement of the pancreaticobiliary ductal system, etc. PBM is a congenital anomaly defined as a union of the pancreatic and biliary ducts located outside the duodenal wall. Free reflux of pancreatic juice up to the biliary tree and/or bile up to the pancreatic duct occurs. Accordingly, various pathologic conditions occur in the biliary tract and pancreas. Although the common channel is long in most cases, some patients have more complicated junctions of the pancreatic and bile ducts. We report a case of PBM with choledochal cyst and stones of the pancreaticobiliary duct in a 39 year-old woman.

A case of an anomalous union of the pancreaticobiliary duct associated with incomplete pancreas divisum / 대한내과학회지

There are many pancreatic ductal anomalies in which there are clinically significant anomalies associated with acute and chronic pancreatitis or pancreatic carcinoma. Many anomalies of pancreatic duct are diagnosed at clinical evaluation of causes of recurrent acute pancreatitis. ERCP is the gold standard method of diagnosis. Noninvasive method such as MRCP or EUS may also establish the diagnosis. There are many reports for the clinical significance and management of pancreas divisum and anomalous union of the pancreaticobiliary duct. There have been rare cases with the coexistence of a pancreas divisum and anomalous union of the pancreaticobiliary duct in the world and only one case in Korea. The case of a 33 year old man with epigastic pain and fever was recently experienced. It was diagnosed to be the coexistence of a pancreas divisum and anomalous union of the pancreaticobiliary duct by ERCP, PTC and MRCP. We report this case with review of the anomalies.

Palliative Self-expandable Metal Stents for Malignant Gastric Outlet Obstruction / 대한소화기내시경학회지

BACKGROUND/AIM: Gastric outlet obstruction due to malignancy causes various symptoms and malnutrition and so decreases the quality of life and shortens the survival. The aim of this study was to assess the feasibility, effectiveness, safety, and outcome of a self-expandable metal stent as a palliative methods. METHODS: From January, 2000 to August, 2002, 29 consecutive patients (36 cases of stent insertion) with inoperable gastric outlet obstruction were treated palliatively with through-the scope stents (Nitis Taewoong, Korea, 29 uncovered, 7 covered). All patients had malignancy. We reviewed the success rate, complications and clinical outcome. RESULTS: There were 21 cases with advanced gastric cancer, 5 with pancreatic head cancer and 2 with cholangiocarcinoma. The other one had primary duodenal carcinoma. Technical success was achieved in thirty four cases (94.4%). After successful placement, 26 patients could eat soft or solid foods with careful education about foods impaction. During the follow-up (mean: 2.6 months, range: 1~9 months), there were no procedure related early complication. Seven stent occlusion occurred due to tumor in-growth (6 case) and over-growth (1 case). CONCLUSIONS: Endoscopic self-expandable metal stent placement in patients with inoperable gastric outlet obstruction is a highly successful, safe and effective palliative method.

A Case of Spontaneous Submucosal Dissection of the Esophagus / 대한소화기내시경학회지

Spontaneous submucosal dissection of the esophagus is a rare esophageal disorder which reveals characteristic features on radiologic and endoscopic examinations. It usually presents with acute epigastric pain, typically accompanied by dysphagia and odynophagia. We experienced a case of a 56-year-old man complaining of chest discomfort and right upper quadrant abdominal discomfort. The findings of upper gastrointestinal endoscopy and barium esophagogram were compatible with submucosal dissection of the esophagus. Chest CT scan showed multiple ulcers that formed a longitudinal tunnel canal. The patient was managed conservatively with nothing by mouth and intravenous hydration. Forty days after the first upper gastrointestinal endoscopy, the patient's symptoms disappeared completely and the massive dissection of the esophagus was much improved except for slight depression on the upper esophagus.

A Case of Myelodysplastic Syndrome with Behcet's Disease / 대한혈액학회지

Myelodysplastic syndrome (MDS) is a hematologic disorder characterized by peripheral cytopenia and histologic feature of hematologic dysplasia. MDS has rarely been reported in association with Behcet's disease. We describe a patient with MDS associated Behcet's disease and a review of the literature.

A case of thrombotic thrombocytopenic purpura in systemic lupus erythematosus / 대한내과학회지

Thrombotic thrombocytopenic purpura (TTP) rarely may be seen in association with autoimmune processes such as scleroderma, rheumatoid arthritis, polyarteritis nodosa, Sj gren's syndrome, and systemic lupus erythematosusus (SLE). The diagnosis of TTP as a syndrome distinct from SLE may be challenging, because both processes may present with some or all elements of the classic pentad considered pathognomonic of the former: microangiopathic hemolytic anemia, fever, thrombocytopenia, neurological deficits, and renal abnormalities. We describe a patient with synchronous TTP and SLE, and review the literature.

Two cases of acute renal failure complicated by the poisoning of amanita virosa / 대한내과학회지

Although the most of mushroom poisoning have a clinical menifestation of mild to moderate gastroenteritis, some mushroom may cause a serious illness; acute renal failure, hepatic necrosis. We experienced two cases of acute renal failure complicated by the poisoning of amanita virosa. Amanita virosa have a amatoxin. Amatoxin deteriorate hepatocytes, renal tubular cells, intestinal mucosal cells, and pancreas. They were transferred from local hospital for renal failure management. On admission, blood urea nitrogen and serum creatinine were highly elevated. We diagnosed acute renal failure complicated by poisoning of amanita virosa. In one case, renal function was further deteriorated compared with initial laboratory findings after creatinine was normalized at fifth day. Thus, we did a kidney biopsy. Light microscopy and EM showed interstitial inflammation and moderate tubular atrophy. They were recovered with the supportive management. We report two cases of mushroom poisoning-induced acute renal failure with review of literature.