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Cutaneous squamous cell carcinoma is the second most common tumor in humans, and its incidence is increasing. In cutaneous squamous cell carcinoma, lymph node and distant metastases are rare, and bone invasion in the lower limbs is uncommon. A 67-year-old male presented with a solitary erythematous plaque on the fifth toe, accompanied by swelling. A shave biopsy was performed. The diagnosis of bone-invaded squamous cell carcinoma with aggressive behavior was made by combining the histopathological, immunohistochemical staining, and magnetic resonance imaging results. Mohs micrographic surgery was performed to remove the skin lesion and tumor-invaded bone. However, 2 months later, squamous cell carcinoma relapsed in the same area. After confirming the absence of lymph node metastasis, additional treatment, including ray amputation, was performed. Adjuvant radiotherapy was not administered. We present a rare case of squamous cell carcinoma that relapsed after Mohs surgery and was subsequently treated with ray amputation.
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Background@#Psoriasis localized to certain body areas, such as the scalp, nails, palms, soles, intertriginous regions, and genital regions, is reportedly difficult to treat. @*Objective@#To investigate the biologics-resistant areas in South Korean patients with psoriasis treated with biologics. @*Methods@#The study included 50 patients with chronic moderate to severe plaque psoriasis from the Pusan National University Hospital and Chosun University Hospital between October 2019 and September 2020. The patients had at least one psoriatic lesion, were treated with biologics for more than six months, and exhibited a partial or good response (reaching a Psoriasis Area and Severity Index [PASI] score of 1~5 after biologics treatment). @*Results@#A total of 50 patients with psoriasis (32 male, mean±standard deviation 47.8±11 years), with a median PASI score of 1.8, were included. The most common biologics-resistant areas were the anterior lower leg (56.0%), followed by the knee (48.0%) and posterior lower leg (42.0%). The proportion of biologics-resistant areas were obtained for body regions traditionally considered as difficult-to-treat entities, including the fingernails (10.0%), toenails (14.0%), scalp (38.0%), palm (12.0%), sole (14.0%), and genital areas (10.0%). @*Conclusion@#This study determined the biologics-resistant areas in South Korean patients, successfully treated with biologics, in a real-world clinical setting.
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Background@#Mohs micrographic surgery (MMS) is a surgical technique for skin cancer that has the advantage of increasing the cure rate while having a tissue-sparing property. @*Objective@#To investigate the benefits of MMS and the characteristics of various skin cancers that are increasing in incidence in Korea. @*Methods@#We retrospectively analyzed 1,013 cases treated with MMS, including slow MMS, from 2010 to 2020. Patient and tumor characteristics, reconstruction, recurrence, metastasis, and operation time were reviewed. @*Results@#Female (61.4%) outnumbered male (38.6%), and the mean patient age was 72.7 years. The most diagnosed skin cancer was basal cell carcinoma (BCC), followed by squamous cell carcinoma (SCC) and cutaneous melanoma. BCC and SCC showed significant differences in various variables, including age, tumor location and size, and MMS stages for clearance. Although BCC was smaller than SCC, it required more MMS stages for a clear margin (p ＜0.05). The recurrence rate was 2.2% (0.7%, 3.0%, and 7.7% for BCC, SCC, and cutaneous melanoma, respectively). There have been no reported recurrences of extramammary Paget’s disease and dermatofibrosarcoma protuberans. The mean number of MMS stages for a clear margin was 1.41±1.05, and clearance was achieved in the first stage in 72.6% of cases. The mean operation time was 123.7 minutes. @*Conclusion@#MMS is an efficient surgical method that can lower the recurrence rate in the treatment of various skin cancers, and there were statistically significant differences between BCC and SCC in various parameters.
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Fixed drug eruption (FDE) is a rare type of drug reaction that involves the skin and, less commonly, the mucosal membranes. It is characterized by clinically well-defined erythematous patches or plaques with or without blisters, which relapse at the same location if the causative agent is readministered. Tamsulosin is an alpha-1 adrenergic receptor blocker used to treat benign prostatic hyperplasia, and its common side effects are dizziness and headache. Only one case of cutaneous FDE due to tamsulosin administration has been reported but no other case of mucosal involvement has been reported to date. Therefore, we present a case of mucosal FDE caused by tamsulosin administration along with a literature review.
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Background@#Ustekinumab is a humanized monoclonal antibody targeting interleukin (IL)-12 and IL-23. Although popular, data on its long-term efficacy and safety in Korean patients with psoriasis are limited. @*Objective@#To evaluate the long-term efficacy and safety of ustekinumab in Korean patients with psoriasis. @*Methods@#A retrospective study in patients with moderate-to-severe psoriasis who had been treated with ustekinumab for at least 5 years was conducted. The sex, age, body mass index, medical records, previous psoriasis therapy, psoriasis area and severity index (PASI) scores, and adverse events were evaluated. @*Results@#Twenty-five patients (median age 47.00 years) had been treated with ustekinumab for 5 years. The mean duration of psoriasis was 19.12±8.45 years, and the treatment duration with ustekinumab was 285.12±8.48 weeks. The baseline PASI was 17.52±7.38. PASI75 was achieved in 84% of the patients at week 28, and 96% of the patients maintained PASI75 during the 5-year follow-up period. Furthermore, 56% of patients reached PASI90 at 28 weeks, and 48% of patients maintained PASI90 for 5 years. No unexpected adverse events other than herpes zoster, herpes simplex, or elevated liver enzymes were reported. @*Conclusion@#Ustekinumab demonstrated long-lasting efficacy with an acceptable safety profile in Korean patients with moderate-to-severe psoriasis.
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Background@#Keloids are benign dermal fibrous growths associated with excessive collagen deposition that usually occurs after trauma or surgery. To date, the clinical features and epidemiology of ear keloids have not been comprehensively investigated. @*Objective@#We investigated the epidemiology and clinical characteristics of ear keloids in Koreans. @*Methods@#We retrospectively investigated Koreans diagnosed with ear keloids by dermatologists at the Department of Dermatology, Chosun University Hospital, between January 2010 and December 2019. @*Results@#The study included 95 patients with 120 ear keloid lesions (mean size of lesions 1.12×1.45 cm2). Based on the ear anatomy, the keloids were observed at the following sites: the helix in 61 (50.8%) patients, the earlobe in 37 (30.8%) patients, antihelix in 10 (8.3%) patients, scapha in 3 (2.5%) patients, and the postauricular region in 9 (7.5%) patients. Among the keloids evaluated, 67 (55.8%), 36 (30.0%), 9 (7.5%), and 8 (6.7%) were categorized as lobular, dumb-bell, button, and wrap-around types, respectively. Most (75%) keloids were located on the posterior surface of the ears. Notably, 26 patients had a family history of keloids, which was significantly correlated with the development of keloids at other sites (p＜0.001). @*Conclusion@#The helix was the most common site of involvement, and lobular keloids represented the most common variety of keloids observed in this study. Keloids occurred most frequently on the posterior surface of the ears and were bigger at these sites. Patients with a family history of keloids were significantly more likely to develop keloids in areas other than the ears.
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Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.
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Background@#Syphilis is an infectious and sexually transmitted disease caused by Treponema pallidum. The diagnosis and treatment of syphilis may be delayed because of the various clinical features. @*Objective@#The purpose of this study was to investigate the epidemiological changes and clinical features of syphilis in Korea. @*Methods@#We conducted a retrospective analysis of 303 subjects with positive venereal disease research laboratories results, including 208 syphilis patients who visited the Dermatology Department of Chosun University Hospital between 2008 and 2019. The analysis was performed based on variables, such as age, sex, serological results, and clinical stages. @*Results@#During the study period, the mean reactive rate of the serum venereal disease research laboratories test was 0.14%, and the annual incidence rate tended to decrease. Of the 208 syphilis patients, the male:female ratio was 1:2.7 among those aged 0 to 19 years and 2.3:1 among those aged 50 to 59 years. Eighty-six patients (41.3%) were diagnosed with symptomatic syphilis, which accounted for the highest proportion (63.6%) among those aged 0 to 19 years. The incidence tended to decrease with increasing age (p＜0.001). Maculopapular syphilis was the most commonly observed form of secondary syphilis (44.6%). One hundred and twenty-two patients (58.7%) were diagnosed with latent syphilis, and the rate tended to increase with age (p＜0.001). @*Conclusion@#Although the number of patients with syphilis is declining, the number of young and female patients is increasing compared to the past. Therefore, education and caution against syphilis by dermatologists may be necessary, especially for younger people.
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Background@#Warts are epidermal growths caused by the human papillomavirus and are commonly observed in dermatology practice. Intralesional immunotherapy is shown to be effective for treatment of warts. However, to date, no study has reported immunotherapy for warts using intralesional purified protein derivative (PPD). @*Objective@#In this clinical study, we report immunotherapy for warts using intralesional PPD. @*Methods@#We retrospectively analyzed the medical records of 81 patients with warts, who were treated with immunotherapy using intralesional PPD. All patients underwent 6 treatment sessions at 2-week intervals. Two skilled dermatologists evaluated the treatment outcomes based on a review of medical records and clinical photographs obtained after 6 treatment sessions. The treatment response was classified based on reduction in the size and number of warts as follows: complete response (CR, 100%), partial response (PR, ＞50%), and no response (NR, ＜50%). @*Results@#Of the 81 patients investigated in this study, 55 (67.9%) showed a CR and PR with regard to the size and number of warts. The response to therapy was classified as better than a PR in 61 of 81 patients (75.3%) with warts at the site of injection and in 38 of 69 patients (55.1%) with warts at distant sites. Four patients (4.9%) developed painful swelling and bullae that resolved within 1 week of treatment. @*Conclusion@#Immunotherapy using intralesional PPD is an effective and safe treatment modality for warts. Although less effective for distant warts, it may be a useful therapeutic alternative for warts with NR to other treatments.
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Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.
ABSTRACT
Background@#Syphilis is an infectious and sexually transmitted disease caused by Treponema pallidum. The diagnosis and treatment of syphilis may be delayed because of the various clinical features. @*Objective@#The purpose of this study was to investigate the epidemiological changes and clinical features of syphilis in Korea. @*Methods@#We conducted a retrospective analysis of 303 subjects with positive venereal disease research laboratories results, including 208 syphilis patients who visited the Dermatology Department of Chosun University Hospital between 2008 and 2019. The analysis was performed based on variables, such as age, sex, serological results, and clinical stages. @*Results@#During the study period, the mean reactive rate of the serum venereal disease research laboratories test was 0.14%, and the annual incidence rate tended to decrease. Of the 208 syphilis patients, the male:female ratio was 1:2.7 among those aged 0 to 19 years and 2.3:1 among those aged 50 to 59 years. Eighty-six patients (41.3%) were diagnosed with symptomatic syphilis, which accounted for the highest proportion (63.6%) among those aged 0 to 19 years. The incidence tended to decrease with increasing age (p＜0.001). Maculopapular syphilis was the most commonly observed form of secondary syphilis (44.6%). One hundred and twenty-two patients (58.7%) were diagnosed with latent syphilis, and the rate tended to increase with age (p＜0.001). @*Conclusion@#Although the number of patients with syphilis is declining, the number of young and female patients is increasing compared to the past. Therefore, education and caution against syphilis by dermatologists may be necessary, especially for younger people.
ABSTRACT
Background@#Warts are epidermal growths caused by the human papillomavirus and are commonly observed in dermatology practice. Intralesional immunotherapy is shown to be effective for treatment of warts. However, to date, no study has reported immunotherapy for warts using intralesional purified protein derivative (PPD). @*Objective@#In this clinical study, we report immunotherapy for warts using intralesional PPD. @*Methods@#We retrospectively analyzed the medical records of 81 patients with warts, who were treated with immunotherapy using intralesional PPD. All patients underwent 6 treatment sessions at 2-week intervals. Two skilled dermatologists evaluated the treatment outcomes based on a review of medical records and clinical photographs obtained after 6 treatment sessions. The treatment response was classified based on reduction in the size and number of warts as follows: complete response (CR, 100%), partial response (PR, ＞50%), and no response (NR, ＜50%). @*Results@#Of the 81 patients investigated in this study, 55 (67.9%) showed a CR and PR with regard to the size and number of warts. The response to therapy was classified as better than a PR in 61 of 81 patients (75.3%) with warts at the site of injection and in 38 of 69 patients (55.1%) with warts at distant sites. Four patients (4.9%) developed painful swelling and bullae that resolved within 1 week of treatment. @*Conclusion@#Immunotherapy using intralesional PPD is an effective and safe treatment modality for warts. Although less effective for distant warts, it may be a useful therapeutic alternative for warts with NR to other treatments.
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Aquagenic wrinkling of the palms (AWP) is a rare condition, which is characterized by appearance of whitish papules and plaques and an excessive wrinkling and swelling of the palmar skin after exposure to water. Herein, we report two cases of AWP. A 17-year-old woman presented prickling focal various sized whitish papules, plaques with wrinkles on both palms after water contact for 6 months ago. Histologic findings were consistent with AWP. A 26-year-old woman presented asymptomatic multiple various sized whitish papules, plaques with wrinkles on both palms after water contact for 1 year ago. Both patients underwent a cystic fibrosis transmembrane conduct receptor test but were negative and improved without any treatment.
Subject(s)
Adolescent , Adult , Female , Humans , Cystic Fibrosis , Skin , WaterABSTRACT
Inflammatory vitiligo with raised borders (IVRB) is characterized by central hypopigmented patches with pruritic erythematous raised borders. It is important as it may be a clinical sign associated with the disease activity. A 53-year-old woman presented with asymptomatic depigmented patches surrounded by scaly erythematous raised borders on the right axilla for 3 months. Skin biopsies were performed for the depigmented patch and erythematous raised border. A 20-year-old woman presented with 3-month history of several hypopigmented maculopatches with or without erythematous raised borders in the periorbital and perinasal areas. Both patients were diagnosed as IVRB based on clinical and histological findings. Both patients received oral steroids for one and three weeks, respectively and the erythematous borders improved and lesions were not spread. Herein, we report two cases of IVRB, a rare subtype of vitiligo.
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Prurigo pigmentosa is a rare inflammatory disease of the skin characterized by the unexpected onset of diffuse erythematous papules and macules on the chest, neck, and back, that usually resolves leaving reticular hyperpigmentation behind. Rarely, vesicular or bullous forms have been reported. We present two cases of vesiculopapular prurigo pigmentosa in two women. Two 20-year-old women presented with multiple, pruritic, erythematous vesicles and papules of various sizes on their backs for 4 months and 3 weeks, respectively. One remembered having a similar vesicular eruption 2 years ago. Histological study and clinical findings showed a vesiculopapular prurigo pigmentosa. Treatment with doxycycline 200 mg/day and topical steroid lotion showed good responses. The lesions resolved after leaving a light brown reticulated hyperpigmentation behind. Herein, we report two cases of vesiculopapular prurigo pigmentosa successfully treated with doxycycline and topical steroid lotion.
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Trichotillomania (TTM) is a medical condition characterized by an intense urge to pull out of own hair, resulting in a perceptible hair loss pattern. TTM is associated with other psychiatric processes such as obsessive-compulsive disorder and bipolar disorder. TTM generally has a chronic course in most patients and is difficult to treat and manage. There are a few options for treatment in children, and the clinical response is not satisfactory. Recently, N-acetylcysteine (NAC), a glutamate modulator, has shown efficacy in the treatment of TTM and other compulsive behaviors, and it is considered a new alternative therapy in the management of TTM. Here, we present two cases of TTM in children that were successfully treated with NAC. NAC could be an effective and safe treatment option for TTM.
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Toxic epidermal necrolysis (TEN) is a severe mucocutaneousadverse reaction characterized by extensive necrosis and epidermaldetachment involving more than 30% of the bodysurface area (BSA). It is commonly triggered by antiepileptics,sulfonamide antibiotics, and non-steroidal anti-inflammatorydrugs. A 22-year-old female without any underlyingmedical history presented with painful multiple erythematousbullae and plaques of varied sizes throughout the bodyfor 1 day. On the second hospitalization day (HD), the bullaeprogressively coalesced, leading to epidermal detachmentinvolving 60% of the BSA. On the fifth HD, the patient hada tonic–clonic seizure with eyeball deviation for 5 minutes.She was transferred to the intensive care unit (ICU) and administeredlorazepam 4 mg and levetiracetam 1,500 mg.Brain computed tomography, magnetic resonance imaging,and cerebrospinal fluid examination showed no abnormalities.Although the patient had delirium and additional seizureswhile in the ICU, her condition improved without anycomplications after 5 weeks of inpatient treatment. Severalcomplications of TEN such as dehydration, malnutrition,sepsis, and ophthalmic and pulmonary complications havebeen reported; however, seizures have not been reportedyet. Herein, we report a case of seizure in a patient duringtreatment for TEN.
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Background and Objectives@#Keloids are benign dermal fibrous growth and excessive collagen deposition that occur usually after trauma or surgery. In the treatment of keloids, the recurrence rate is relatively high after surgical excision. Fillet flap is known to be a good surgical method for keloid lesions. The purpose of this study is to find out manifestation and compare the results of ear keloids after the surgery by fillet flap.Subjects and Method We retrospectively evaluated 22 patients with ear keloids (n=31) who underwent core excision with fillet flap at the Department of Dermatology, Chosun University Hospital from May 2010 to June 2018. @*Results@#With the 22 of treated patients and 31 ear keloid lesions, the average size of keloid lesions was 0.75×1.05 cm2 . The frequencies of occurrence with respect to the location of keloids according to the anatomical structure of the ear were 12 lobule (38.7%), 17 helix (54.8%), 1 antihelical fold (3.2%), and 1 postauricle (3.2%), respectively. There were 14 lobular types (45.2%), 9 dumbbell types (29.0%), 5 button types (16.1%), and 3 wrap-around type (9.7%). Recurrence was found in 8 keloid lesions (25.8%) and 5 patients (22.7%) after the surgery. Earlobe lesions and dumbbell shaped recurred with the highest recurrence rate. Among the 5 patients who relapsed, 4 had family history of keloids. @*Conclusion@#The earlobe and dumbbell shaped types showed the highest recurrence rate and family history was also an important risk factor for recurrence. Also, surgical excision with fillet flap can be very effective and is a good way to treat ear keloids.
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BACKGROUND@#Trichotillomania (TTM) is a medical condition that involves recurrent and irresistible urges to pull out their own hair. TTM generally follows a chronic course in most patients and is difficult to treat and manage. Recently, N-acetylcysteine (NAC) has shown efficacy in the treatment of TTM.@*OBJECTIVE@#The purpose of this study was to assess the efficacy of treatment with NAC in trichotillomania children younger than 13 years of age.@*METHODS@#The purpose of this study was to assess the efficacy of treatment with NAC in trichotillomania children younger than 13 years of age.@*RESULTS@#The mean age of patients was 10.7 years; 8 were boys and 7 were girls. They presented with several asymptomatic focal patches of hair loss with different hair lengths on scalp. The dermoscopic findings were broken hairs, v-sign hairs, coiled hairs, and focal erythema. 10 out of 15 patients had a good response to NAC, whereas 5 patients did not respond to the treatment. The differences between the 2 groups were the treatment duration and total NAC doses. The effective group had a mean NAC of 973 mg/day for 11.5 weeks, while the non-effective group had a 1060 mg/day dose for 4 weeks.@*CONCLUSION@#NAC could be an effective and safe treatment option for TTM in children.
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A cutaneous sinus tract or cutaneous fistula of dental origin occurs when purulent products of dental pulp necrosis spread along the path of least resistance from the root apex to the skin on the face. As many patients present with only skin problems and without toothache, it is frequently misdiagnosed as a cyst, abscess, pyogenic granuloma, actinomycosis, squamous cell carcinomas, and so on. Incorrect diagnoses lead to invasive procedures and long-term antibiotic therapy. We present 2 cases of recurrent suppurative facial dimpled nodules. Both of the cases were referred to the maxillofacial department, where the non-restorable teeth were extracted, and root canal therapy was performed. Lesions may persist for long periods before the correct diagnosis is made and the odontogenic source is treated appropriately. With early correct diagnosis, patients can be protected from unnecessary and ineffective antibiotic therapy or surgical treatment. Herein, we report 2 cases of a cutaneous sinus tract of dental origin.