KONCPA Findings of Onychomychotic Nail Samples Where Non-dermatophytic Fungi were Cultured / 대한의진균학회지

BACKGROUND: When Candida species and molds (non-dermatophytic filamentous fungi) are cultured from the onychomycotic nail samples, it is sometimes difficult to consider whether they are the causative fungi or not. Although repeated culture is the most effective method to solve the problem, it is time-consuming and not cost-effective. But KONCPA (KOH + Nail clipping + PAS stain) is an inexpensive, quick, sensitive and very useful supportive test for considering whether the cultured non-dermatophytic fungi are real causative fungi or not. OBJECTIVES: This study was aimed to know whether KONCPA test would increase the diagnostic sensitivity of onychomycosis and whether KONCPA findings would be of help to diagnose the accurate causative fungi in case where the Candida species and molds were cultured. METHODS: Nail saacmples were obtained from 213 patients with onychomycosis for fungus culture and KONCPA test. And the KONCPA findings were reviewd for the onychomycotic nail samples where the non-dermatophytic fugi such as Candida species and molds were cultured. RESULTS: The results of this study were summarized as follows: 1. From 93 onychomycotic nail samples, dermatophytes were cultured in 24 (11.3%), Candida spp. in 36 (16.9%), and molds in 33 samples (15.5%). 2. Of the 36 samples where the Candida spp. were cultured, 24 (66.7%) showed findings of dermatophytes, 2 (5.6%) of Candida spp. and remaining 10 (27.7%) samples were inadequate for diagnosis. 3. Of 33 samples where the molds were cultured, 30 (90.9%) showed findings of dermatophytes, 1 (3.0%) of molds and remaining 2 (6.1%) samples were inadequate for diagnosis. CONCLUSIONS: Among 93 onychomycotic nail samples where the non-dermatopytic fungi were cultured, only 3 samples were compatible with KONCPA findings. Therefore, in cases where Candida spp. and molds were cultured and the KONCPA findings were not compatible with the cultured fungi, the cultured fungi should not be considered as the definite causative fungi until other material evidence was obtained.

Three Cases of Concomitant Acanthosis Nigricans with Confluent and Reticulated Papillomatosis in Obese Patients

Acanthosis nigricans (AN) is characterized by symmetric, velvety, gray-brown hypertrophied plaques most commonly on the axillae and neck. Confluent and reticulated papillomatosis (CRP) is manifested by papules in the mid-chest that coalesce in the midline, and are arranged in a reticulated pattern peripherally. Both diseases are known to be related to endocrinopathies such as diabetes mellitus (DM), an insulin resistant state and obesity with unknown mechanisms. Herein, we presented three cases of concomitant acanthosis nigricans with confluent and reticulated papillomatosis in obese patients.

Three Cases of Acquired Reactive Perforating Collagenosis Improved by Narrowband Ultraviolet B Phototherapy / 대한피부과학회지

Acquired reactive perforating collagenosis (ARPC) is difficult to treat. We herein report 3 cases of ARPC, which have been improved by narrowband UVB phototherapy. They had been treated with topical corticosteroid and oral antihistamine, which had no therapeutic effects on their conditions. They were treated with narrowband UVB phototherapy twice a week and four-week treatments resulted in relief of pruritus in three patients and eight-week treatments lead to significant reduction of skin lesions in two patients. Based on our experience, it is suggested that narrowband UVB phototherapy is a good therapeutic modality for recalcitrant skin lesions and severe pruritus of ARPC.

A Clinicopathological Study of Palmoplantar Dermatoses / 대한피부과학회지

BACKGROUND: Palmoplantar dermatoses have frequently been encountered in the dermatologic field. Many previous studies have focused on the specific diseases of palmoplantar dermatoses; however, none of them have included a the comprehensive study of palmoplantar dermatoses. OBJECTIVE: The purpose of this study was to investigate the epidemiological aspects of palmoplantar dermatoses, with a brief review of the common palmoplantar dermatoses. METHODS: We retrospectively reviewed the data of 237 patients who had been biopsied for palmoplantar dermatoses between January 2000 and December 2004 at Our Lady of Mercy Hospital, The Catholic University of Korea. RESULTS: The results were as follows; Female to male ratio was 1 : 1.01. The mean age at diagnosis was 37.5+/-20.1 years. The mean duration of the disease was 35.9 months and ranged from 2 days to 50 years. Palmoplantar dermatoses appeared on the palms in 49 (20.6%) patients, the soles in 123 (51.9%) patients, and both the palms and soles in 65 (27.4%) patients. The most common five diseases of palmoplantar dermatoses were palmoplantar pustulosis (23.2%), verruca (11.4%), pompholyx (10.1%), palmoplantar keratoderma (8.9%), and contact dermatitis (8.0%). Of the 237 patients, 65 (27.4%) patients were accompanied with other dermatoses; fungal infection (13.9%), eczema (7.6%), onychodystrophy (3.4%), psoriasis (1.7%), erythema multiforme (1.3%), hyperhidrosis (1.3%), drug eruption (0.8%), or lichen simplex chronicus (0.4%). Of the 237 patients, 51 (21.5%) patients were accompanied with systemic diseases; Cardiovascular diseases (8.4%), endocrine diseases (6.6%), hepatobiliary diseases (4.6%), malignancy (3.4%), pulmonary diseases (2.5%), or gastrointestinal diseases (1.3%). CONCLUSION: Our study shows that the biopsy of palmoplantar dermatoses is gradually increasing. Further investigation with a wider and larger population is necessary to understand the epidermiology of palmoplantar dermatoses, and, based on the epidermiology of palmoplantar dermatoses, accurate diagnosis and proper treatment of palmoplantar dermatoses could then be achieved.

A Clinicopathologic Study of Lymphangioma / 대한피부과학회지

BACKGROUND: Lymphangioma is an uncommon, benign hamartomatous malformation that consists of dilated lymphatic channels lined by normal, single-cell lymphatic endothelia. The diagnosis of lymphangioma is usually made on the basis of clinical and histopathological characteristics. The lymphangiomas are divided into lymphangioma circumscriptum, cavernous lymphangioma, cystic higroma, acquired progressive lymphangioma and lymphangiectasis. OBJECTIVE: The purpose of this study was to investigate clinical and histopathological features of lymphangioma, especially focusing on the pathologic classification. METHODS: We retrospectively reviewed the medical records and 52 biopsy specimens of 51 patients who had been diagnosed with lymphangioma between January 1991 to September 2005 in 8 Hospitals under the charge of the Catholic Medical Center. RESULTS: We compiled clinical data and histologic information on the 52 cases of 51 patients of lymphangioma as follows: The mean age at development was 16.5 years, and 56.9% of the patients were under 10 years old. Lymphangioma developed predominantly in females, at a sex ratio of 1:1.55. The disease duration exceeded 10 years in 45.1% of patients. Most patients were asymptomatic, but 13.7%, 9.8% and 2.0% of patients complained of tenderness, pruritus and pain, respectively. The lesion was usually solitary. Lymphangioma occurred on the trunk, extremities, head and neck, and genitalia in 43.6%, 30.9%, 20.0% and 5.5% of 52 cases respectively. The legs, back, abdomen and lip were also found to be commonly involved. Histopathologically, lymphangiomas were divided into lymphangioma circumscriptum, cavernous lymphangioma, cystic higroma, acquired progressive lymphangioma and lymphangiectasis in 69.2%, 17.3%, 1.9%, 5.8% and 5.8% of the 52 cases respectively. CONCLUSION: Lymphangioma is un uncommon, benign hamartomatous malformation of lymphatic endothelial cells and occurs in several forms that differ in clinical and histological characteristics and prognosis. Therefore it is important to make a diagnosis on the basis of clinical and histopathologic findings and to understand the characteristics of the subtypes of lymphangioma.

A Case of Leukemia Cutis Presenting with Extensive Nodular Lesions / 대한피부과학회지

Leukemia cutis, the specific infiltration of leukemic cells, can be seen in any leukemia, but are especially common in the acute myelogenous leukemia M4 and M5 variants. We herein report a case of a 68-year-old woman with acute monocytic leukemia who presented with generalized, grouped nodules over the whole body, including the eyelids and scalp, and were clinically suspected to be metastatic skin cancer or cutaneous lymphoma. Histologic study of the lesions revealed leukemia cutis of the monocytic type. We present this case to illustrate how leukemia cutis can clinically masquerade as other dermatoses.

A Case of Cutaneous Leiomyoma Presenting as a Large Nipple / 대한피부과학회지

Cutaneous leiomyoma is a rare, benign tumor of smooth-muscle fibers. Five types of cutaneous leiomyoma include multiple piloleiomyomas, solitary piloleiomyoma, solitary genital leiomyoma, solitary angioleiomyoma and leiomyoma with additional mesenchymal elements. Genital leiomyoma is uncommon, and leiomyomas of the nipple is a rare type of genital leiomyoma. We report a case of cutaneous leiomyoma presenting as a large nipple in a middle-aged woman.

A Case of Digital Angioleiomyoma / 대한피부과학회지

Angioleiomyoma is a benign tumor arising from the muscle layer of the vein walls and mainly develops on the lower extremities of middle-aged women. We encountered a 31-year-old man who had a 3 year history of a painless but tender, 0.6 x 0.6 cm-sized nodule on the volar aspect of his left third finger. Histopathologically, a well-circumscribed nodular tumor was observed in the dermis, which comprised of numerous, various-sized, vessels and bundles of smooth muscle fibers. It is relatively rare for an angioleiomyoma to occur on the finger.