A Case of Cycloserine-Induced Lichenoid Drug Eruption Supported by the Lymphocyte Transformation Test

Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.

A Case of Linear Eruptive Collagenoma on the Chest and Neck / 대한피부과학회지

Eruptive collagenoma is a rare acquired type of connective tissue nevus that predominantly consists of collagen. It usually presents as multiple, asymptomatic, firm, flesh-colored or pink nodules or plaques that are symmetrically distributed over the trunk and upper extremities. Four cases of eruptive collagenoma in linear or zosteriform arrangements have been reported in the English literature. A 16-year-old boy presented with multiple asymptomatic erythematous papules and nodules on the left side of his sternal margin and the posterior side of his left neck. A punch biopsy taken from one of the nodules on the chest showed thickened collagen fibers in the dermis. Masson-Trichrome staining revealed an increase in the collagen fibers, which were broad and arranged haphazardly, and the elastic staining indicated a reduction in the elastic fibers in the dermis, which are findings that are consistent with collagenoma. We report a case of eruptive collagenoma that presented in a linear arrangement, which is a rare distribution pattern for connective tissue nevi.

Necrobiosis Lipoidica Presenting as Unilateral Papulovesicular Eruptions on the Lower Leg / 대한피부과학회지

Necrobiosis lipoidica is a chronic granulomatous disease that has a well-known association with diabetes mellitus. It usually affects the bilateral lower legs of middle-aged women. Over time, the clinical features vary from red-brown papules to sharply demarcated yellow-brown plaque with atrophic center. Some of the lesions may become ulcerated, especially in diabetic patients. A 61-year-old Korean female with a history of diabetes, ischemic heart disease, and pancreatic cancer was referred to our clinic for evaluation of the painful papulovesicles on her left lower leg. Under the assumptive diagnosis of herpes zoster, we immediately started an antiviral agent. However, her skin lesions rapidly increased in size and in number, and progressed to the multiple ulcerations in 9 days. Histopathologic examination showed several poorly circumscribed necrobiotic granulomas in the deep dermis and subcutis levels of the skin. In addition, prominent vascular ectasia and vasculitis were observed. We diagnosed the patient as having necrobiotic lipoidica, and treated her with oral dapsone, colchicine, phentoxifylline and antiplatelets. Her leg ulcerations healed after four weeks of treatment.

Pityriasis Rosea-Like Rash Secondary to Intravesical Bacillus Calmette-Guerin Immunotherapy

No abstract available.

Inflammatory Disseminated Superficial Porokeratosis in a Patient with Choledocholithiasis / 대한피부과학회지

Disseminated superficial porokeratosis (DSP) is an autosomal dominant specific disorder of keratinization. Clinically, the lesions show a sharply demarcated and hyperkeratotic plaque with central atrophy, with a predilection for the extensor surface of the extremities. Unusual cases of DSP accompanied by severe pruritus have been reported as "eruptive pruritic papular porokeratosis" or "inflammatory DSP." Histopathologically, inflammatory DSP is characterized by the presence of cornoid lamella with a dense infiltration of lymphocytes in the perivascular area of the upper dermis. Here we report a case of inflammatory DSP in an 80-year-old man with choledocholithiasis.

Fluconazole Induced Fixed Drug Eruption

We report on a rare case of fluconazole induced fixed drug eruption in a 62-year old female patient. She was referred to our department for multiple erythematous itchy maculopatches on the face, neck, both upper arms, and trunk area, which had occurred over the previous 6 months. Her attending physician prescribed fluconazole for treatment of onychomycosis. Patch test and oral provocation were performed. The patch test showed a negative result; however, the result for oral provocation was positive, confirming this as a rare case of fluconazole induced fixed drug eruption. To the best of our knowledge, this is the first reported case in Korean dermatologic literature.

Stevens-Johnson Syndrome Induced by Vandetanib

Vandetanib is a once-daily oral anticancer drug that selectively inhibits key signaling pathways in cancer by targeting vascular endothelial growth factor receptors, epidermal growth factor receptors tyrosine kinase, and rearranged during transfection-dependent tumor cell proliferation and survival. The most frequently reported adverse events attributed to vandetanib include diarrhea, elevated aminotransferase, asymptomatic corrected QT interval prolongation, and hypertension. Though a number of randomized, doubleblind studies, including cutaneous adverse events attributed to vandetanib, have been reported along with these general symptoms, no case of Stevens-Johnson syndrome (SJS) has been reported. This paper demonstrates a case of SJS induced by vandetanib.

A Nevus Comedonicus in the Genital Area / 대한피부과학회지

Nevus comedonicus is an uncommon skin disorder that clinically appears as linear groups of open comedones. A 6-year-old female patient presented with a nevus comedonicus accompanied by an epidermal nevus in her genital area. The histopathologic finding showed an atrophic, cystically dilated hair follicle containing abundant keratinous debris. She was treated with oral antibiotics. We report here on an unusual case of nevus comedonicus that occurred in the genital area.

Treatment of Oral Lichen Sclerosus with 1% Pimecrolimus Cream

Lichen sclerosus is a chronic inflammatory mucocutaneous disorder predominately affecting prepubertal girls and postmenopausal women. Isolated lichen sclerosus affecting the oral mucosa is exceedingly rare, and only 13 patients with biopsy-proved isolated oral disease have been reported in the literature. We report on a 7-year-old Korean girl with a well-demarcated 1.2x1.2 cm atrophic white plaque with an erythematous border and focal telangiectasia on the left vermillion lip, extending to the labial mucosa. No other cutaneous surfaces, including genitalia, were involved. An incisional biopsy of the plaque on the lip revealed a patchy lichenoid infiltrate of lymphocytes associated with sclerosis of the papillary dermis and a thinned epidermis consistent with a diagnosis of linear orofacial lichen sclerosus. Treatment with a short course of 1% pimecrolimus cream effectively prevented the progression of this lesion.

Cutaneous Malignant Melanoma Associated with Papillary Thyroid Cancer

As the survival from cutaneous malignant melanoma and its clinical concerns have been steadily increasing, the possibility has been raised of an increased risk of second primary cancers in the patients with malignant melanoma. Especially, recent studies have identified an association between cutaneous malignant melanoma and thyroid carcinoma. We here report on a case of cutaneous malignant melanoma that developed in a 61-year-old female patient who had hypothyroidism caused by papillary thyroid carcinoma. We suggest that the individuals who have cutaneous malignant melanoma may be predisposed to other primary cancers and especially thyroid carcinoma. Continuous monitoring of the thyroid function in melanoma patients is required because hypothyroidism can worsen due to malignant melanoma and this is probably associated with thyroid carcinoma.

A Case of Intra-epidermal Epithelioma with Clonal Seborrheic Keratosis and Intra-epidermal Eccrine Poroma Differentiation / 대한피부과학회지

Intra-epidermal epithelioma is a rare cutaneous neoplasm and generally used as a histologic description for superficial tumors in which nests are found in well-defined islands within the epidermis. The intra-epidermal nests are composed of keratinocytes, and basaloid or squamoid or pleomorphic cells. Some authors reported that this tumor may be considered an invasion of the epidermis from a malignant tumor and it has the potential of carcinomatous invasion. Herein, we report a case of intra-epidermal epithelioma that showed clonal seborrheic keratosis and intra-epidermal eccrine poroma differentiation on the right thigh areaof a 77-year-old female. Although intra-epidermal epithelioma shows benign features, it may be predisposed to other tumoral changes, such as eccrine poroma, eccrine porocarcinoma, and Bowen's disease. We suggest that individuals with intra-epidermal epithelioma require continuous monitoring of skin changes, including enlargement of size, inflammation, ulceration, and hemorrhages.

A Case of Clear Cell Bowen Disease / 대한피부과학회지

Cutaneous clear cell squamous cell carcinoma in situ (SCCIS) or clear cell Bowen disease is an unusual variant of SCCIS characterized by a variable component of large clear cells. We report a case of a 73-year-old woman with a solitary facial erythematous nodule. Histologically, the skin lesion revealed nests of atypical clear cells with markedly vacuolated cytoplasm in the upper layer, lack of maturation and lack of polarity of keratinocytes in the epidermis. Electron microscopy showed clear cells with many empty spaces and lysosome-like structures, suggestive of clear cell changes caused by degenerative phenomenon.

A Case of Progressive Facial Hemiatrophy / 대한피부과학회지

Progressive facial hemiatrophy (PFH) was first described by Parry and Romberg and this is a rare disorder of an unknown origin. PFH is characterized by slowly progressive, mostly unilateral facial atrophy of the skin, soft tissues, muscles and underlying bony structures and is usually develops in the first or second decade of life. Although the clinical presentation of PFH may appear similar to localized linear scleroderma en coup the sabre, some patients presenting with PFH have neither en coup the sabre nor generalized sclerosis. Herein, we report on an unusual case of a 7-year-old girl who presented with progressive hemiatrophy of the face.

A Case of Lichen Spinulosus / 대한피부과학회지

Lichen spinulosus is an uncommon idiopathic disorder characterized by scattered 2 cm to 6 cm patches of keratotic follicular papules. Individual papules are 1 to 3 mm in diameter and consist of a hairlike horny spine. Lesions are typically skin colored and asymptomatic or mildly pruritic. It occurs mainly in children and adolescents. Although several factors, such as atopy, infection, drug reaction, id reaction to fungal infection, and heredity, have been proposed as playing a role in lichen spinulosus, most cases are not associated with any systemic abnormalities. Lichen spinulosus is usually a symmetrical lesion that occurs on the trunk or extremities. Herein, we report a case of lichen spinulosus in a 7-year-old child in the submental area, an uncommon site.

A Case of Childhood Pernio Treated with Nifedipine / 대한피부과학회지

Pernio, or chilblains, are a localized inflammatory lesion of the skin resulting from an abnormal response to cold. The condition is characterized by cutaneous lesions located on the distal parts, such as the fingers, toes, nose and ears. Pernio develops among susceptible individuals who are exposed to non-freezing condition and most commonly occurs among young women and children. However, reports on childhood pernio are rarely found. Several conditions have been described as predisposing factors to pernio, including excessive cold exposure, low-grade vasculitis, the presence of cryoproteins, anorexia nervosa, systemic lupus erythematous and antiphospholipid antibodies. It is important, therefore, when evaluating a patient with chronic pernio who is resistant to conservative management, to exclude an underlying condition and also to determine whether additional testing is necessary. Herein, we present an uncommon case of a 5-year-old female patient with chronic pernio that may be associated with the presence of cold agglutinin. She received topical steroids prior to evaluation but no improvement was seen. Howere, treatment with calcium channel blocker, nifedipine, was of benefit to our patient.

A Case of Melanoacanthoma on the External Auditory Canal / 대한피부과학회지

Melanoacanthoma, a rare benign variant of seborrheic keratosis, was first introduced by Mishima and Pinkus in 1960. It is a slow-growing, painless, pigmented plaque with a verrucous surface and a diameter ranging from a few millimeters to 10 cm. It tends to develop during middle-age with an equal sex incidence, and the lesion usually presents on the head, trunk, and especially the lip. It also has a histopathologic finding of mixed neoplasm composed of melanocytes scattered throughout keratinocytic lobules, and is characterized by hyperkeratosis, parakeratosis, acanthosis, papillomatosis and pseudo-horn cysts in the epidermis. We report a case of melanoacanthoma occurring in a 52-year-old female, who presented with an easily bleeding mass on her right external auditory canal, an extremely uncommon site.

Treatment of Generalized Granuloma Annulare with Low-dose Hydroxychloroquine / 대한피부과학회지

Generalized granuloma annulare (GGA) is benign granulomatous dermatosis of unknown causes characterized by a widespread papular eruption on the trunk and limbs. This differs from the localized form as it is distinguished by later onset, a protracted response to therapy, and concomitant diabetes mellitus in 20% of patients. GGA is a chronic disease with a relapsing course and a poor long term response to treatment, GGA lasted for 5 or more years in 25% of patients. Thus, more safe and effective therapeutic modalities are needed. The effectiveness and safety of hydroxychloroquine (6.5 mg/kg/day) which has a long history of efficacy in systemic lupus erythematosus is identified. We report a case of 48-year-old man presented with GGA lesions successfully treated with a low dose hydroxychloroquine (3 mg/kg/day) without side effect and the clinical improvement observed after 2 weeks. Low doses of hydroxychloroquine might be beneficial in the treatment of GGA, compared with other drugs, with low potency of side effect.

Immunohistochemical Studies of Angiogenic Factors on Psoriatic Lesions / 대한피부과학회지

BACKGROUND: Psoriasis is a common chronic skin disorder characterized by hyperproliferation of the epidermis, inflammatory cell accumulation and increased tortuosity and dilatation of dermal papillary blood vessels. Angiogenesis plays a major role in the pathogenesis of psoriasis, however the mechanism responsible is largely unknown. Recently, some studies have identified several angiogenic factors from psoriatic epidermis, including interleukin (IL)-8, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF). OBJECTIVE: This study was aimed to elucidate the roles of VEGF and bFGF in the pathogenesis of psoriasis. METHODS: Immunohistochemical staining for VEGF and bFGF was carried out on skin samples of 15 psoriatic patients, plus 5 normal skin samples as a control. The psoriatic skins were divided into early and fully-developed stages, and differences in their expression between the stages were examined. RESULTS: The expressions of VEGF and bFGF on both epidermis and dermal structures were significantly higher in psoriatic lesional skin than in normal control skin. There was no significant differences between early and fully- developed psoriatic skin lesions. CONCLUSION: These results suggest that VEGF and bFGF may play significant roles in the pathogenesis of psoriasis.

Two Cases of Supernummerary Breast / 대한피부과학회지

Supernummerary breast is a rare developmental anomaly occurring along the course of the embryological milk lines, which run from the anterior axillary folds to the inner thighs. Kajava first described the classification of supernumerary tissue in 1915, and this term is still in use. We herein report two cases of supernumerary breast, classified as Kajava classification type 3 and 6.

Halo Dermatitis Around Junctional Nevus / 대한피부과학회지

Halo dermatitis (Meyerson's nevus) is an inflammatory, eczematous eruption usually encircling a preexisting melanocytic nevus. Spontaneous healing occurs within several weeks or months and is never concurrent with regression of the central nevus, in contrast to halo nevus (Sutton's nevus). Although halo dermatitis is often associated with central melanocytic nevi, pathogenesis leading to the morphological change of this disorder remains obscure. Herein, we report a case of a 23-year-old female who developed an eczematous halo reaction surrounding the junctional nevi.