Polypoid Basal Cell Carcinoma Mimicking Soft Fibroma / 대한피부과학회지

Basal cell carcinoma (BCC) is the most common malignant tumor of the skin and usually seen on hair-bearing skin that is frequently exposed to the sun, especially on the face. Polypoid BCC, which is thought to be a new variant, is distinguished from other histologic types by having a stalk and by restriction of the tumor aggregation to the pedunculated zone. We report a case of polypoid BCC in a 73-year old man who had a skin-colored pedunculated papule in the perianal area mimicking soft fibroma.

Acute Generalized Exanthematous Pustulosis Caused by Diltiazem

Acute generalized exanthematous pustulosis is clinically characterized by fever, pruritus and an acute pustular eruption. It can be described as having an abrupt onset and then spontaneous resolution occurs shortly after the start of symptoms, and there is usually only a single episode. Most cases have been triggered by the ingestion of drugs. Diltiazem hydrochloride is a calcium channel blocker that is commonly used for treating hypertension and angina. This drug was found to be the responsible agent in our current patient. There have been 9 such case reports in the English medical literature, yet this is the first such report in the Korean medical literature. We present the case of a 51-year-old male who experienced an acute generalized exanthematous pustulosis due to diltiazem hydrochloride and we review the relevant literature.

A Clinical Study of Childhood and Adolescent Psoriasis / 대한피부과학회지

BACKGROUND: Few clinical studies are available on childhood and adolescent psoriasis in Korea. OBJECTIVE: The purpose of this study was to analyze clinical features of childhood and adolescent psoriasis in a referral center in Korea. METHODS: We performed retrospective medical record-based analyses for 255 psoriasis patients younger than 16 years of age at the time of diagnosis at our center from March 2001 to July 2010. Age, sex, onset age, familial history, site of involvement, type of psoriasis, nail involvement, initial PASI score, and treatment modality were analyzed. RESULTS: There was no sexual predominance; mean age of onset was 8.85 years; 17.25% of patients had a familial history. Upper extremities, lower extremities, trunk, scalp and face were the most commonly involved sites in sequence. Guttate psoriasis (58.90%) was the most common type of psoriasis. Nail involvement was observed in 11.11% of patients. The mean initial PASI score at the time of diagnosis was 7.9. The most common treatment was topical steroids and topical vitamin D in combination. CONCLUSION: Childhood and adolescent psoriasis is not an uncommon disease. A larger scale epidemiological study is needed.

Increased Left Side Prevalence of Head and Neck Skin Cancers / 대한피부과학회지

BACKGROUND: Several studies have shown an increase in skin cancers on the left side of the face. But such studies have not been conducted in Korean patients. OBJECTIVE: In this study, we analyzed the prevalence of left or right sided skin cancers in head and neck areas. METHODS: We retrospectively included 384 head and neck skin cancers (Basal cell carcinoma, Squamous cell carcinoma, Bowen disease, Malignant melanoma) diagnosed at our center from January 1995 to February 2011. Location, age, and sex were recorded and analyzed. RESULTS: All types of skin cancers occurred more on the left (54.17%) than on the right (45.83%) (p=0.051), with no stronger trend in men. CONCLUSION: There are more skin cancers on the left than the right side in Korean patients. But further study is needed because of the small patient population studied.

Linear Lichen Sclerosus along the Blaschko's Line of the Face

Lichen sclerosus et atrophicus (LSA) is an inflammatory disease that primarily causes anogenital lesion in middle aged women. We present here a case of facial LSA with an asymptomatic, well-demarcated, whitish to bluish, atrophic patch in a linear pattern on the forehead of a 48-year-old woman. This case showed an atypical clinical presentation and it mimicked en coup de sabre, but the histopathologic results confirmed the diagnosis of LSA.

Subcutaneous Dermatofibroma

Dermatofibroma (DF) is usually confined to the dermis and the overlying epidermis is usually hyperplastic. Although DF with deep subcutaneous extension is commonly encountered, purely subcutaneous DF is uncommon. In this review, we describe a case of a 41-year-old male patient who presented with a painless, subcutaneous, hard papule on the left thigh. After the skin had been incised the lesion was totally removed, and histopathology revealed a subcutaneous dermatofibroma.

A Case of Celecoxib Induced Acute Generalized Exanthematous Pustulosis

Acute generalized exanthematous pustulosis (AGEP) is manifested by rapid development of many sterile, nonfollicular pustules on a background of edematous erythema. More than 90 percent of AGEP are induced by medication, mostly antibiotics. Drug patch test can be helpful in the diagnosis of AGEP. This paper reports the first case of celecoxib-induced AGEP confirmed by patch test in Korean literature.

Subungual Extraskeletal Chondroma / 대한피부과학회지

Extraskeletal chondroma is a relatively uncommon, benign soft tissue tumor that usually occurs adjacent to the periarticular tissues or tenosynovium, without any adhesion to the underlying bone. The most common site of occurrence is the hands, with more than 60% of all extraskeletal chondromas being located here. Histologically, it can resemble hyaline cartilage or chondrosarcoma of bone, which is more cellular. Whatever the histologic appearance is, the behavior is uniformly benign and it does not metastasize, therefore the recommended treatment is local excision. We report here on a case of subungual extraskeletal chondroma in a 22-year-old female who presented with a subungual nodule of the left big toe.

A Study for UV Protection Degree of Genital Protection Materials / 대한피부과학회지

BACKGROUND: Genital skin cancer is a potential side effect of phototherapy. Development of genital skin cancer lowers a patient's quality of life. However, there are no standards for genital protection during phototherapy. OBJECTIVE: This study was designed to find adequate materials for genital protection. METHODS: Eight common materials for genital protection were placed over an ultraviolet (UV) meter that was irradiated with UVA and narrowband UVB phototherapy units. The percentage of blocked UV was measured. RESULTS: White and black cotton underwear, white and black polyester underwear, and surgical drapes did not allow the transmission of UVA and narrowband UVB light. But a surgical mask allowed about 15% transmission of UV light. CONCLUSION: These results suggest that white and black cotton underwear, white and black polyester underwear and surgical drapes provide sufficient UV protection.

A Case of Plexiform Palisaded Encapsulated Neuroma of the Penis / 대한피부과학회지

Palisaded encapsulated neuroma (PEN) is a benign cutaneous neural tumor. It usually presents in adults as a solitary asymptomatic skin-colored papule that is almost always on the face. We report here on an uncommon case of plexiform PEN that developed on the penis of a 43-year-old man. It was 6 mm-sized skin colored papule. Histologically, there is an encapsulated nodule with a plexiform growth pattern in the dermis and a palisading arrangement of nuclei. On immunohistochemical staining, the tumor cells of the nodule were positive for S-100 and neurofilament.

A Case of Pleomorphic Basal Cell Carcinoma with Alopecia Areata / 대한피부과학회지

Pleomorphic basal cell carcinoma (BCC) is a pathologic variant of BCC characterized by the presence of atypical appearing, mononuclear or multinucleated giant cells. The tumor usually presents as a nodule on the head or neck. We report a case of pleomorphic BCC with alopecia areata on the scalp in a 63-year-old woman. She had had a well circumscribed, black nodule on an alopecic patch for several months.

A Case of Hydroa Vacciniforme

Hydroa vacciniforme (HV) is a rare and chronic pediatric disorder that is characterized by photosensitivity and recurrent vesicles that heal with vacciniforme scarring. The pathogenesis of HV is unknown; no chromosome abnormality has been identified. HV patients have no abnormal laboratory results, so the diagnosis of HV is based on identifying the associated histological findings in a biopsy specimen and using repetitive ultraviolet phototesting to reproduce the characteristic vesicles on a patient's skin. Herein, we present a case of HV in a 7-year-old female who was diagnosed with HV according to histopathology and ultraviolet phototesting.

A Case of Morpheaform Sarcoidosis

Sarcoidosis is an idiopathic multisystem disease with various cutaneous presentations, and it is characterized by the presence of non-caseating granulomas in the affected organs. The specific manifestations are papules, plaques, nodules, ulcers and scar. We report here on a variant of sarcoidosis on a 71-year-old woman who showed an indurated plaque on the forearm. Her lesion's appearance was clinically similar to that of a morphea and the appearance of the lesion was unlike the commonly observed manifestations of sarcoidosis.

Trends of the Bacterial Skin Infections of Dermatology Outpatients in 1996, 2001 and 2006 / 대한피부과학회지

BACKGROUND: Bacterial infections of the skin are treatable and reversible, so clinicians should be alert for the cutaneous signs of the skin infection. However, there have been only a few reports about the epidemiology of skin infections. OBJECTIVE: This study was done to evaluate the trend of the clinical features, the results of cultures and the prevalence of MRSA in the dermatology outpatients who had suspected bacterial skin infection in 1996, 2001 and 2006 and we wanted to compare the trends of bacterial skin infection over the last eleven years. METHODS: The survey was conducted via the medical records of 24 patients in 1996, 77 patients in 2001 and 88 patients in 2006 who visited the our dermatology department and who underwent Gram-stain and bacterial culture. RESULTS: Of the 347 samples, bacteria were cultured in 197 samples. Among them, 77 samples had coagulase negative Staphylococci, which were excluded as normal skin flora. Among 120 samples, the number of cases of secondary pyoderma, folliculitis, furuncle or carbuncle and cellulitis were 63, 17, 17 and 15, respectively. There was no change in the type of diagnosis during eleven years. The most common pathogen of skin infection was S. aureus (42.7%) and there was no trend to increase for ten years. However, the prevalence of methicillin resistant S. aureus (MRSA) increased for eleven years. CONCLUSION: The most common pathogen in pyogenic skin infections of the dermatology outpatients was S. aureus, which was sensitive to beta-lactamase resistant beta-lactam antibiotics, but there was an increase of the prevalence of MRSA for eleven years, and the first therapeutic choice for MRSA is vancomycin or teicoplanin.

A Case of the Facial Variant of Eruptive Vellus Hair Cyst / 대한피부과학회지

Eruptive vellus hair cysts (EVHC) are characterized by multiple, small, discrete red or brown colored papules that usually occur on the chest and extremities. Their etiology is unknown. A variant form of EVHC that occur exclusively on the face is rare and it is very characteristic for its location and color. We report here on a facial variant of EVHC that occurred on the face of 23-year-old woman with asymptomatic, skin-colored to bluish tiny papules. The lesions first appeared at the age of 22-years.

A Clinicopathologic Study of 14 Cases of Acquired Reactive Perforating Collagenosis / 대한피부과학회지

BACKGROUND: Reactive perforating collagenosis is one of the perforating disorders that are characterized by transepidermal elimination of dermal materials. It can be associated with systemic disease such as chronic renal disease and/or diabetes mellitus. OBJECTIVE: We wanted to investigate the clinical and histopathological features of reactive perforating collagenosis. METHODS: We reviewed the medical records, clinical photographs and histopathologic slides of 14 cases of reactive perforating collagenosis that were seen in our department. RESULTS: The most common clinical features were flesh-colored, dome-shaped papules with a keratinous plug. Residual scarring was seen from the previously healed lesions. Half of the patients had skin lesions on the whole body except the face, palm and sole. Most of the patients (79%) had at least one systemic disease. Chronic renal failure (21%) and diabetes mellitus (29%) were the most commonly associated conditions. The other associated conditions were hypertension, acute pyelonephritis, non-small cell lung cancer, herpes zoster, transplantation and non-Hodgkin lymphoma. Three of the cases (21%) were otherwise healthy. Most patients benefited from topical steroid and oral antihistamine when their disease was regressing. CONCLUSION: This study demonstrated the clinicopathologic features of reactive perforating collagenosis. It is frequently associated with diabetes mellitus and chronic renal failure, but this may also develop in patients with other systemic disorders, and also in those patients who are without any medical problems.

Angiosarcoma in a Chronically Lymphedematous Leg: A Case of Stewart-Treves Syndrome / 대한피부과학회지

Angiosarcoma arising from chronic lymphedema is referred to as Stewart-Treves Syndrome. It typically occurs as a complication of long-lasting lymphedema of the arm, after mastectomy and/or radiotherapy for breast cancer. Angiosarcoma associated with lymphedema of the lower extremity is rare. We report a case of angiosarcoma of the leg in a patient with a 15-year history of lymphedema due to cervical cancer operation and radiotherapy.

Cutaneous Adverse Effects Associated with Sorafenib Therapy (Nexavar(R), BAY 43-9006) / 대한피부과학회지

Sorafenib (Nexavar(R), BAY 43-9006) is a new oral multi-targeted tyrosine kinase inhibitor developed to delay disease progression in advanced solid organ malignancies and metastatic melanoma. Among the many reported toxicities attributed to sorafenib, dermatologic events, such as skin rash, acral erythema, alopecia and xerosis are the most frequently observed side effects. Recently, we experienced a case of a 41-year-old man who presented with generalized maculopapular erythematous eruptions, and acral erythema after sorafenib treatment for his metastatic hepatocellular carcinoma. Herein, we report the case and discuss the undesirable side effects of sorafenib.

Treatment-Seeking Behaviors and Related Epidemiological Features in Korean Acne Patients

Little is known about the treatment-seeking behaviors of acne patients, especially Asian acne patients. This study was performed to obtain detailed information about the treatment-seeking behaviors in Korean acne patients. Patients who visited the dermatology departments at 17 university hospitals completed a self-administered questionnaire. Most patients obtained information about acne from doctors or the Internet. The most important criteria for selecting a treatment method or choosing a particular clinic were effectiveness and accessibility. Patients used traditional medicine, visited beauty clinics, drank more water, and used over-the-counter topical agents more frequently than they sought doctors during the worsening period. The degree of satisfaction in treatment was found to depend on the total cost of treatment, number of places visited, site affected by acne, and emotional stress. Those who had experienced a side effect tended to have been treated for longer, to have paid more for treatment, and to have an associated skin disease. Treatments prescribed by dermatology clinics had the lowest aggravating rate, although improvement rates for family medicine clinics were also fairly high. This is the first study to investigate in detail the demographic features and characteristics of the treatmentseeking behaviors of acne patients in Asia.

Study for Usefulness of Ultrasonography in the Evaluation of Subcutaneous Nodules / 대한피부과학회지

BACKGROUND: Ultrasonographic imaging is very useful tool to determine various neoplasms and inflammatory changes of the human body. In addition, thanks to the use of various frequencies in ultrasonography, subcutaneous and some dermal lesions can be evaluated without invasive procedures such as a biopsy. OBJECTIVE: This study was performed to evaluate the usefulness of ultrasonography in the diagnosis of subcutaneous nodules. METHODS: We reviewed the medical records of 29 patients with subcutaneous nodules and analyzed the correlation between ultrasonographic findings and final biopsy findings. The HDI-5000 ultrasonography system (Philips, Eindhoven, Netherlands) with variable probes (from 5 to 12 MHz) was used in this study. RESULTS: In 27 patients, ultrasonographic findings were matched with final biopsy findings. One pilomatricoma was misdiagnosed as a cyst and one hemangioma as lipoma. It was very interesting to find that two malignant tumors and one subcutaneous granuloma annulare were detected by ultrasonographic examination in the absence of any clinical clues. CONCLUSION: Ultrasonography is a very useful, noninvasive, easy to apply, and relatively predictive tool for the evaluation of subcutaneous nodules. Although a skin biopsy is necessary for final diagnosis, ultrasonography would be a good substitute in the diagnosis of subcutaneous nodules when the patient refuses a skin biopsy and the nodule is located in a highly cosmetic area.