Potential Immunoinflammatory Role of Staphylococcal Enterotoxin A in Atopic Dermatitis: Immunohistopathological Analysis and in vitro Assay

BACKGROUND: The underlying mechanism of atopic dermatitis (AD) exacerbated by Staphylococcus aureus has not been established. However, we demonstrated recently that the majority of S. aureus strains colonized in the skin of Korean AD patients carried genes encoding staphylococcal enterotoxin A (SEA) and/or toxic shock syndrome toxin-1 (TSST-1). OBJECTIVE: To clarify the role of staphylococcal superantigen, SEA in AD. METHODS: With the lesional skin of 9 AD patients and normal looking skin of one healthy adult, we examined first the expression of SEA, staphylococcal enterotoxin B (SEB), and TSST-1 using immunohistochemical analysis. In addition, we investigated the effects of SEA on the expression of inflammation-related adhesion molecules and cytokines in human HaCaT keratinocytes and Human Umbilical Vein Endothelial Cells (HUVECs) by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis and enzyme-linked immunosorbent assay. RESULTS: Staphylococcal protein A (SPA) and SEA were detected with increased immunoreactivity in AD patients. However, TSST-1 showed mild-to-moderate immunoreactivity in AD patients, whereas SEB was minimally detected. In the double immunofluorescence investigation, SEA and SPA were well co-localized. SEA induced upregulation of adhesion molecules and elicited inflammatory responses in HaCaT keratinocytes and HUVECs. CONCLUSION: This study demonstrates the importance of SEA as an immunoinflammatory triggering factor of AD in Koreans.

Comparision of Results of Several Lactic Acid Sting Tests on Sensitive Skin / 대한피부과학회지

BACKGROUND: There is no clear dermatologic definition to describe sensitive skin which usually includes subjective and psychological meanings. Some individuals exhibit exaggerated response, especially on the face, ranging from itching to intense adverse reaction like erythema, wheal, and eczema in comparison to normal ones when exposed to external irritants, allergens, environmental changes or internal stimulants. OBJECTIVE: To diagnose sensitive skin, lactic acid sting test is well known to represent a person who has subjective symptoms like itching, burning, prickling and stinging. We tried to compare several lactic acid sting tests to search for sensitive skin conveniently and rationally. METHODS: A total of 50 panelists (25 people of sensitive group and 25 people of control group, respectively) were selected by the method of self-assessment questionnaires related to sensitive skin. The panelists were tested on face, by conditioning 3 variances (5% or 10% Lactic acid, Hydration, Hilltop chamber), in 2 week intervals, 8 times totally. RESULTS: When lactic acid sting tests were performed using Hilltop chamber, there were more positive responders in sensitive group(p<0.05). There was statistically a significant difference between the 2 groups in the comparison of mean values of lactic acid sting scores (p<0.05). Sensitive group showed higher sting scores and exhibited much more difference with time (p<0.05). CONCLUSION: Our experiment showed that occlusive technique using Hilltop chamber was an inspiring and useful method of several lactic acid sting tests to find out sensitive skin.

Ganglioneuroma Associated with Von Recklinghausen Neurofibromatosis / 대한피부과학회지

Ganglioneuroma is the benign tumor exclusively composed of fully differentiated mature ganglion cell, Schwann cells and fibrous tissue. It develops most commonly in the posterior mediastinum and retroperitoneum but cutaneous involvement is exceedingly rare. Cutaneous tumor showing ganglion cells includes the following three entities: 1) primary ganglioneuroma, 2) well differentiated cutaneous metastasis from neuroblastoma, and 3) ganglioneuroma associated with von Recklinghausen's neurofibromatosis. Among them, the third has been considered as a neurofibroma with entrapment of ganglion cell. We described 2 cases of ganglioneuroma associated with von Recklinghausen neurofibromatosis and reviewed the histopathological and immunohistochemical findings.

Skin Metastasis of Neuroendocrine Carcinoma Arising in the Uterine Cervix / 대한피부과학회지

Neuroendocrine carcinoma is known to have features of neuroendocrine and epithelial differentiation through immunochemical and biochemical investigation and Merkel cell carcinoma is a rare primary malignancy of the skin belonging to the broad spectrum of tumors of the neuroendocrine system. Small cell carcinoma of uterine cervix, also a kind of neuroenodcrine carcinoma, is rarely reported and it is much more exceptional in the world that cervical carcinoma metastases to distant skin. Further more this may be the first case of a uterine neuroendocrine carcinoma metastasizing to the skin in Korean medical literature. We report a case of 74-year-old woman who presented with a somewhat fixed subcutaneous nodule measuring 2.5 cmX0.8 cm on the left side of forehead. A biopsy of the nodule revealed a poorly differentiated carcinoma under the muscle without involvement of upper structures and it showed neuroendocrine differentiation by immunohistologic studies. Before appearing as cutaneous manifestation 2 months ago, she had showed a history of abnormal vaginal bleeding and diagnosed as a cervical neuroendocrine carcinoma, especially small cell carcinoma histologically.

The Effects of Dehydration, Preservation Temperature and Time on the Hair Grafts

BACKGROUND: Careful manipulation of hair grafts is essential for a good yield of transplanted hair. OBJECTIVE: The aim of this study was to evaluate some of the factors responsible for poor graft yield, such as dehydration of the graft and the temperature and duration of preservation. METHODS: First, for the dehydration study, isolated single hair follicles were left on dry gauze for 0, 5, 10, 20, and 30 minutes at room temperature. Secondly, to evaluate the effect of preservation temperature and time on the hair graft, follicles were preserved in saline for 5 minutes as a control, then for 6, 24, and 48 hours both at room temperature and at 4℃, respectively. Viability of preserved follicles was judged based on organ culture. RESULTS: Elongation of hair folliciles was seen in 96%, 94%, 94%, 83%, and 68% for 0-, 5-, 10-, 20-, and 30-minute air-exposed groups, respectively. Survival was seen in 95%, 92%, 40% and 34% at room temperature and 96%, 94%, 76% and 50% at 4℃ for follicles preserved in saline for 5 min (control), then for 6, 24, and 48 hours, respectively. CONCLUSION: We suggest that, alone with careful manipulation of hair units, high survival can be achieved with the avoidance of graft dehydration and preservation of the grafts at low temperatures if the operation time extends for more than 6 hours.

Endovenous Obliteration of Primary Varicose Vein of Greater Saphenous Vein by Radiofrequency Heating: A Preliminary Report / 대한피부과학회지

BACKGROUND: For the treatment of primary varicose vein of greater saphenous vein(GSV) due to reflux from incompetent saphenofemoral junction(SFJ), several methods such as ligation and stripping, or duplex-guided sclerotherapy have traditionally been introduced. As for sclerotherapy, the recurrence rate has been reported to be very high. In spite of higher success rate, traditional high ligation with stripping of GSV requires several days' admission with general anesthesia and several more days before returning to normal daily life. New modalities, which are less invasive and possibly have lower recurrence to rate with a chance for early ambulation, are being proposed. They are such as endovenous radiofrequency(RF) therapy, endovenous laser therapy, etc. OBJECTIVE: We tried to evaluate the efficacy and safety of endovenous RF therapy as an alternative to high ligation and stripping in case of GSV varicosity in mild to moderate degrees. METHODS: Both GSV varicosities and varicosed tributaries are marked by doppler and/or ultrasonic imaging. A catheter connected to RF generator is inserted proximally through the incision of vein wall percutaneously, usually above or below the knee. After confirming position of the SFJ using ultrasound, the catheter is progressed as far as to 1-2cm below the SFJ. Then, the generator is activated and the catheter withdrawn slowly for complete heating and occlusion of the target vein. Additional ambulatory phlebectomy or sclerotherapy is optional. We wrap the limbs with self-adhesive short stretch bandage for 2-3 days and encourage the patient to walk regularly and wear compressive stocking later. RESULTS: We performed endoluminal RF treatment on 10 legs of 9 patients(5 males and 4 females). Follow-up intervals varied from 2 to 10 months. Patients were generally satisfied with improvement of symptom. On the clinical evaluation with doppler and duplex examination, there were a few blood flows except only some segments of GSV in 7 patients CONCLUSION: Although endoluminal RF therapy may have a somewhat higher recurrence rate than that of traditional high ligation with stripping of GSV, endoluminal RF therapy is expected to have several advantages over traditional surgery, including less invasiveness, no need for admission or general / spinal anesthesia, earlier return to normal daily life, and finally easy performance, especially for the dermatologist.

Kaposi's Varicelliform Eruption in a Pair of Identical Twins / 대한피부과학회지

Kaposi's varricelliform eruption is a characteristic syndrome of disseminated vesiculopustules superimposed on variable pre-existing dermatoses. Among these, atopic dermatitis is most common disease. We report two cases of Kaposi's varicelliform eruption associated with atopic dermatitis in a pair of identical twins. Diagnosis was made by the history, clinical feature, histologic examination and serologic test. These patients' condition was much improved by the treatment with antiviral agent and antibiotics.

A Case of Solitary Myofibroma In Adult / 대한피부과학회지

Solitary myofibroma is a recently described, benign neoplasm of superficial soft tissue, which represents the adult counterpart of infantile myofibromatosis. In Korean literature, only one case has been reported, and we report an additional case of solitary myofibroma in a 57-year-old man. He presented with 2-month history of asymptomatic slightly elevated pale-skin-colored nodule occurring on the right side of philtrum. A histopathologic examination revealed diffuse proliferation of fibroblasts and spindle cells with a whorled arrangement and grouped fascicles. The tumor cells were positively stained for vimentin and smooth muscle actin.

A Case of Bilateral Herpes Zoster / 대한피부과학회지

Noncontiguous bilateral herpes zoster is very rare, especially in a child. Herpes zoster duplex bilateralis means that both halves of the body are involved with the disease. A 4-year-old female, previously healthy, was presented with painful grouped papulovesicles on an erythematous base on both sides of the trunk (left T5 dermatome and right T7,8 dermatomes). Tzanck smear showed multinucleated giant cells and the histopathologic findings were consistent with herpes viral infection. She was treated with oral acyclovir for 7 days without any significant complication.