ABSTRACT
Friction melanosis (FM) is an acquired pigmented disease that is caused by recurrent mechanical stress. There is no previous report explaining the presence of tiny brown-colored particles confined to the corneal layer. We describe a case of a rare form of FM of the finger that showed a relatively transient clinical course. A 17-year-old Korean female presented with a 5-month history of an asymptomatic localized hyperpigmented patch on the tip of the right index finger. The dermoscopic examination revealed homogenous globular pattern, which favored pigmentation over hemorrhage. Histopathologically, hyperkeratosis and acanthosis with lymphohistiocytic infiltration of the superficial dermis were noted on hematoxylin and eosin staining; however, there was neither a definite increase in melanophages in the upper dermis nor melanocytic proliferation in the basal layer. Per high-power field, multiple brown-colored tiny particles were scattered in the corneal layer. The particles were not dyed by Fontana-Masson stain, iron stain, and S-100. We questioned the patient about the presence of irritation and found that she had bought new shoes at the time of the onset. She was habituated to placing her fingers in her shoes while wearing them because they were slightly tight. The lesion disappeared spontaneously a week after the cause of friction was eliminated.Altogether, we encountered a rare form of FM that occurred in a rare location with a transient clinical course. Further cases on pigmentation restricted to finger tips might reveal the origin of the particles.
ABSTRACT
A 70-year-old female was referred for brown-to-gray colored papules and nodules on her lower legs. She had been diagnosed with diffuse large B-cell lymphoma (DLBCL) in her stomach, and myelodysplastic syndrome (MDS) by bone marrow biopsy. Three years after complete remission of DLBCL, she experienced DLBCL recurrence in her small bowel and was hospitalized. MDS had been stationary, but during the treatment of DLBCL, her laboratory findings suggested signs of leukemia. Bone marrow biopsy was done, and acute monoblastic leukemia (AMoL) was diagnosed. After 1 cycle of chemotherapy for AMoL, skin lesions developed, and her skin biopsy showed cutaneous T-cell lymphoma (CTCL). Terminal deoxynucleotidyl transferase staining and CD123 staining were negative, and bone marrow re-biopsy conducted after the skin lesion developed still showed monoblastic proliferation. Whether the CTCL represented with an AMoL lineage switch could not be completely proved due to the absence of molecular or clonal marker evaluations, but the possibility of coexistence of three different malignancies was higher. During treatment, a neutropenic fever developed, and the patient died due to sepsis. We herein report a rare case of CTCL accompanied by AmoL and DLBCL.
ABSTRACT
Background@#Accuracy in histological subtyping of basal cell carcinoma (BCC) is crucial for determining the appropriate treatment modality. Previous studies have assessed the concordance rateof punch biopsy and excision in subtyping BCC however, they did not calculate this rate according to the BCC location or in Asian populations. @*Objective@#This study compared the concordance rate of punch biopsy and excision for each BCC location. @*Methods@#This study included 192 patients who underwent both punch biopsy and excision. BCC subtypes identified by punch biopsy and excision were compared to calculate the concordance rate. The differences in the rates of misdiagnosis according to the BCC location were also determined. @*Results@#The overall concordance rate of punch biopsy and excision was 78.1% (150/192). The proportion of aggressive type was higher for excision than for punch biopsy. The false-positive rate, defined as the rate of misidentified nonaggressive type, was 19.7% (26/132) and was highest for nodular-type BCC. Additionally, most discrepancies occurred in BCCs located in the face, especially in the H-zone. @*Conclusion@#Owing to the inconsistencies in the results of punch biopsy and excision and the high false-positive rate of punch biopsy, dermatologists should be aware of the possibility of an aggressive type BCC even if it is identified as anonaggressive type in punch biopsy. Moreover, more aggressive treatment should be considered in cases of BCCslocated on the face, especially in the H-zone, as the discrepancy rate is higher.
ABSTRACT
A 62-year-old female, with previous history of asthma andhypertension, presented with generalized hyperpigmentedskin lesion, found a year ago. Physical examination revealedbrown colored lichenified and sclerotic patches on the lowerabdomen and flexural areas of extremities. Punch biopsywas performed and histopathological examination revealedhyperkeratosis, follicular plugging and thinning in epidermis.In dermoepidermal junction, cleft like space separating atrophicepidermis and dermis was seen. Also, lichenoid lymphocyticinfiltration was observed in mid-dermis. Based onclinical and histopathological findings, a diagnosis of generlaizedlichen sclerosus et atrophicus (LSA) was made.Other laboratory examinations were unremarkable. As thereis no standard treatment for LSA, the patient received varioustreatments including topical steroid, tacrolimus and narrow-band ultraviolet B therapy. The skin lesion has softenedand its color improved after treatment. LSA is defined as infrequentchronic inflammatory dermatosis with anogenitaland extragenital manifestations. Generalized type is rare andgenital involvement is the most frequent and often the onlysite of involvement. We report this case as it is an uncommontype of LSA with generalized hyperpigmented and scleroticskin lesion in a postmenopausal female patient.
ABSTRACT
Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural locations, including cutaneous site. The skin lesion presents as a circumscribed nodule or tumor, mainly on the head and neck. A 41-year-old male presented with 6 months history of nail lesion without symptom on the left third finger. The lesion is slightly yellowish discoloration with subungual erythematous nodule and distal onycholysis. Biopsy specimen from the nail lesion showed the spindle cells form patternless pattern with hypercellular and hypocellular area. And small blood vessels and dilated vascular spaces were present. The result of special stain for specimen showed that positive for CD34, Bcl-2, and CD99 but negative for S-100, FactorXIIIa, and smooth muscle action. Recognition of this uncommon location of SFT is important because of possible confusion with other subungual tumors, including glomus tumor, fibroma and other fibrohistiocytic tumors like dermatofibrosarcoma protuberans, superficial acral fibromyxoma and cellular digital fibroma. Here in, we report a case of SFT of subungual region. We think this case is interesting because of uncommon location and may be helpful to more understand the character of this disease.
Subject(s)
Adult , Humans , Male , Biopsy , Blood Vessels , Dermatofibrosarcoma , Fibroma , Fingers , Glomus Tumor , Head , Muscle, Smooth , Neck , Onycholysis , Pleura , Skin , Solitary Fibrous TumorsABSTRACT
Onychomycosis is a fungal nail infection caused mainly by dermatophytes. Non-dermatophytes such as yeasts, Acremonium, Aspergillus, and Fusarium species account for only 10% of onychomycosis, and Fusarium species are relatively common amongst these pathogens. However, the main Fusarium species pathogens are Fusarium solani and Fusarium oxysporum. Fusarium proliferatum is a rare pathogen in onychomycosis, and only a few cases have been reported worldwide. We report a case of a 68-year-old woman presenting with a white- to yellow-colored patch on her left third fingernail plate, which was diagnosed by fungus culture and sequencing as onychomycosis caused by Fusarium proliferatum.
ABSTRACT
A 76-year-old female presented with a 2-month history of skin lesions on both her buttocks. The skin lesions showed diffuse, erythematous scattered papules and macules with brown to black crusts. The patient believed that she had skin cancer and that the lesions had to be scrapped. She thus soaked her buttock in sikhye, a traditional Korean beverage, to treat the lesions. Based on patient history, she was diagnosed with dermatitis artefacta at the initial hospital visit. KOH examination was positive for hyphae and fungal cultures of Saccharomyces cerevisiae. She was treated with oral and topical antifungal agents for 6 months. The skin lesions improved at that time; however, she continued to scratch her buttock, and the skin lesions aggravated. Repeat fungal culture of the lesions revealed Candida glabrata, which was confirmed by genetic polymerase chain reaction sequencing. Consequently, she was treated with antifungal agents for 6 months. S. cerevisiae is widely used in baking, brewing, wine making, and biotechnology. S. cerevisiae and C. glabrata are considered relatively non-pathogenic fungal organisms. Here, we report a rare case of dermatitis artefacta combined with superficial infection of non-pathogenic fungal organism.
ABSTRACT
A 19-year-old woman presented with an asymptomatic cutaneous discoloration on her nape. Dermatological examination revealed localized dark brown to dark pigmented velvety macules and patches. She denied a past medical history, except for a 7-kg weight gain over a 6-months period. Histopathologically, the specimen showed hyperkeratosis, epidermal hyperplasia, mild acanthosis, and papillomatosis. In addition, keratin material and fungal spore were noted between the papilloma ridges. Periodic acid-Schiff special stain showed a positive result for the fungal spore in the horny layer. She was treated with a daily oral dose of terbinafine and topical flutrimazole. After 12 weeks of treatment, she is currently under observation without pigmentation and adverse effect. We considered the initial diagnosis as acanthosis nigricans because of weight gain, similar clinical features, and histological findings. However, the final diagnosis was hyperkeratotic head and neck Malassezia dermatosis considering the presence of yeast and the dramatic improvement after antifungal treatment. To the best of our knowledge, hyperkeratotic head and neck Malassezia dermatosis is not well characterized in the literature. It is an unusual variant of pityriasis versicolor. The skin lesion appears brown to dark, scaly, and hyperkeratotic macules and patches located on the face and neck. Here, we reported an unusual case of hyperkeratotic head and neck Malassezia dermatosis.
ABSTRACT
BACKGROUND: Rosacea is a chronic inflammatory disease characterized by centrofacial erythema. Excess cathelicidin is suggested to be important to the pathophysiology of the disease. Recently, presence of a vitamin D response element was revealed in the cathelicidin gene promoter. OBJECTIVE: The aim of this study was to determine whether vitamin D and cathelicidin are associated with rosacea, both serologically and histopathologically. METHODS: Subjects with rosacea and without chronic skin disorders were enrolled in the patient and control groups, respectively. Serum 25-hydroxy-vitamin D and cathelicidin levels were measured. Tissue expression of cathelicidin and vitamin D receptor were measured with immunostaining-intensity-distribution index. RESULTS: The mean serum 25-hydroxyvitamin D level of patients with rosacea was 12.18±5.65 ng/ml, which is lower than that of the controls (17.41±6.75 ng/ml). Mean serum cathelicidin levels in patients with rosacea and the controls were 85.0±26.1 ng/ml and 55.0±23.3 ng/ml, respectively. Cathelicidin expression in rosacea tissue was significantly higher than that in control tissue (5.21 vs. 4.03). No significant difference was observed in vitamin D receptor expression. CONCLUSION: Higher cathelicidin expression in rosacea supports the hypothesis that an abnormal inflammatory response of the innate immune system is important in pathogenesis of rosacea, but the role of high cathelicidin serum levels is complicated. Serum vitamin D was lower in patients with rosacea, although serum cathelicidin was higher than that of the controls. This suggests that the role of vitamin D level in the pathogenesis of rosacea merits further investigation.
Subject(s)
Humans , Erythema , Immune System , Receptors, Calcitriol , Rosacea , Skin , Vitamin D Response Element , Vitamin D , VitaminsABSTRACT
BACKGROUND: Basal cell carcinoma is the most common form of skin cancer. Surgical excision is commonly used as the therapeutic modality. However, there is insufficient data on the prognosis of Korean patients who have undergone surgical excision for basal cell carcinoma. OBJECTIVE: We therefore retrospectively analyzed the effectiveness of surgical excision in patients with basal cell carcinoma and compared it with previous studies. METHODS: From 2009 to 2015, we enrolled 138 patients with primary basal cell carcinoma who underwent surgical excision and analyzed the recurrence rate, clinical features, surgical procedures, and histopathological subtypes. RESULTS: The case series comprised 138 patients (M:F=1:1.51) with a mean age of 68.7 years. Recurrence after surgical excision was diagnosed in 0 of the 138 patients with a mean follow-up period of 47.5 months (12~93 months). The mean tumor diameter and surgical margin were 0.9 cm and 3.1 mm, respectively. Most tumors (85.5%) were of the nodular subtype. Primary closure was used most often to repair the surgical defects (44.9%). CONCLUSION: Surgical excision may be a satisfactory method for the treatment of primary basal cell carcinomas, especially in non-high-risk cases.
Subject(s)
Humans , Carcinoma, Basal Cell , Follow-Up Studies , Methods , Prognosis , Recurrence , Retrospective Studies , Skin NeoplasmsABSTRACT
BACKGROUND: Recently, the number of domestic pets has increased. As a consequence, sensitization to animal allergens, such as cat or dog allergens, has become a problem. OBJECTIVE: We studied the annual trends of sensitization to cats or dogs, and the characteristics of the patients. METHODS: We retrospectively analyzed the medical records of 7,469 patients who visited a dermatology clinic and underwent an allergic profile test, from January 2011 to December 2015. Specific immunoglobulin E (IgE) levels to cat or dog antibody greater than 3.50 IU/ml were regarded as positive results. RESULTS: In all, 274 patients showed significant increase in levels of specific IgE antibody to dog, and 307 revealed increase in levels of of specific IgE antibody to cat. The prevalence of these specific IgEs increased from 2011 to 2015. Independent risks for sensitization to cat allergens were sensitization to dog, but not to house dust, Dermatophagoides pteronyssinus, and D. farinae. Independent risks for sensitization to dog allergens were sensitization to cat, but not to house dust, D. pteronyssinus, and D. farinae. Total IgE level was not related to specific IgE level against either cats or dogs. CONCLUSION: In conclusion, the prevalence of sensitization to cat or dog has increased. Sensitization to cat or dog is related to each other, but is irrelevant to the total IgE level.
Subject(s)
Animals , Cats , Dogs , Humans , Allergens , Dermatitis, Atopic , Dermatology , Dermatophagoides pteronyssinus , Dust , Immunoglobulin E , Immunoglobulins , Korea , Medical Records , Prevalence , Retrospective StudiesABSTRACT
Syringoma is the most common type of benign intraepidermal eccrine sweat gland tumor in Korea, and is usually found in women in their forties. It presents mostly as a localized lesion, preferring the lower eyelid, cheek, or forehead, and rarely invades the vulval area, and in the case of children, vulvar invasion is even more rare. Tranilast is an antihistamine used for atopic dermatitis and asthma, and has recently been used for the treatment of keloid. A few previous studies have reported both localized and generalized forms of syringoma being effectively resolved with tranilast. Herein, we report a rare and interesting case of milium-like syringoma, which manifested on the vulval area of 10-year old girl that was successfully treated with tranilast.
Subject(s)
Child , Female , Humans , Asthma , Cheek , Dermatitis, Atopic , Eyelids , Forehead , Keloid , Korea , Sweat Glands , Syringoma , VulvaABSTRACT
BACKGROUND: Acne has been found to be associated with psychosocial problems, and the influence of acne may vary according to the era. OBJECTIVE: We aimed to compare the present quality of life (QOL) of acne patients with that in the past 10 years. Additionally, financial values that patients attach to the treatment of their acne were evaluated. METHODS: We analyzed the influences of acne on QOL using self-reported validated questionnaires (WHOQOLBREF, Skindex-29, APSEA, CADI) between June 2014 and December 2015. RESULTS: 100 acne patients and 70 controls were enrolled in the study. Compared with that in the past 10 years, the quality of life of acne patients decreased in terms of psychological and social relationships, and the difference between males and females was reduced. Clinical characteristics associated with quality of life were identified as age, duration, education, and self-reported severity score, etc. Patient-based financial valuation of treatment costs was associated with the Skindex-29, WHOQOL-BREF, and CADI scores. CONCLUSION: The impact of acne on QOL, especially psychosocial aspects, is important, and early initiation of the appropriate treatment may help to address the diminished QOL and financial burden of acne patients.
Subject(s)
Female , Humans , Male , Acne Vulgaris , Education , Health Care Costs , Quality of LifeABSTRACT
A 27-year-old male with underlying history of atopic dermatitis presented with skin lesion on the trunk and upper extremity, occurring a month ago. Scattered erythematous multiple tiny maculopapules and patches were noticed. The lesion was first diagnosed as aggravated atopic dermatitis with folliculitis based on the clinical manifestation, but had failed to improve with antibiotics and medications for atopic dermatitis. KOH examinations were performed on his upper arm's lesion, and with detection of hyphae and isolation of Trichophyton rubrum by fungus culture, he was successfully treated with oral itraconazole 200 mg/day and topical flutrimazole. Tinea incognito refers to dermatophyte infections with atypical clinical presentation caused by previous treatment with steroid. Nowadays, the cases of tinea incognito have been increasing due to the increased usage of steroid and other immunosuppressants. Therefore, it is essential to include fungal infection in the differential diagnosis when cutaneous lesions are noticed in patients taking steroid and other immunosuppressants. Herein, we present a tinea incognito that clinically mimicked folliculitis in atopic dermatitis patient.
Subject(s)
Adult , Humans , Male , Anti-Bacterial Agents , Arthrodermataceae , Dermatitis, Atopic , Diagnosis, Differential , Folliculitis , Fungi , Hyphae , Immunosuppressive Agents , Itraconazole , Skin , Tinea , Trichophyton , Upper ExtremityABSTRACT
BACKGROUND: This study aims to evaluate the importance of snacks to a balanced diet by assessing snack consumption patterns and factors associated with eating snacks of Korean elders of 60 years or more. METHODS: This analysis is based on participants from the 2013-2014 Korea National Health and Nutrition Examination Survey. Meal or snack consumption was based on a 24 hours recall data, and the adequacy of each nutrient intake was based on the Dietary Reference Intakes by the Korea Nutrition Society. The cutoff for snack consumption valued as meaningful was more than 200 kcal/day of snack energy intake. RESULTS: Korean male elders of age 60 years or more are consuming 333.6±11.1 kcal of snack and 271.7±7.4 kcal for females. When consumed together with meals, snack consumption increased the adequacy of all nutrients intake, except sodium. Based on energy contribution, male Korean elders are consuming snack food group in order of beverage and alcohols, grains, and fruits, while for females the order was grains, fruits, and dairy. Older age (men and women), joblessness (men), and chronic disease (women) were positively associated with having snack of 200 kcal or more per day, whereas ‘living with a partner (men)’, alcohol intake frequency of more than twice per week (men), and ‘doing regular aerobic physical activity (women)’ showed negative association. CONCLUSIONS: Snack consumption of Korean elders contributed to more adequate nutritional status, but improvement of food groups is needed because they were mainly concentrated on grains.
Subject(s)
Aged , Female , Humans , Male , Alcohols , Beverages , Chronic Disease , Diet , Eating , Energy Intake , Fruit , Korea , Meals , Motor Activity , Nutrition Surveys , Nutritional Status , Recommended Dietary Allowances , Snacks , SodiumABSTRACT
BACKGROUND: Topical and oral steroids are widely prescribed in dermatology. While interest in steroid use has increased rapidly, people have also acquired misinformation that causes rampant fears. OBJECTIVE: To identify fears and misunderstandings about steroid use by comparing doctors' attitudes and treatment and non-treatment group experiences with steroid use. METHODS: A total of 346 participants including outpatients who visited the Department of Dermatology at Hallym University Sacred Heart Hospital, physicians who work at the hospital, and visitors to its Department of Occupational and Environmental Medicine completed questionnaires. RESULTS: The topical treatment group had a high response rate of 46.7% regarding feeling “somewhat anxious” about using topical steroids, while the oral treatment group had a high response rate of 53.8% regarding feeling “somewhat anxious” about using oral steroids. With respect to information about the adverse effects of steroid use, those in the non-experience group obtained their information mostly from the Internet (67.5%) or the media (47.5%), whereas those in the topical treatment group obtained their information from product guides (48%) and doctors (38.7%). Meanwhile, the oral treatment group acquired information from acquaintances (39.7%) or doctors (32.1%). CONCLUSION: Dermatologists must evaluate the validity of the information that patients have about the adverse effects of topical and oral steroid use as well as the resulting phenomenon of steroid phobia. If the information possessed by patients is inaccurate, clinicians must provide a full understanding and proper education to enhance patient satisfaction and treatment compliance and success rates.
Subject(s)
Humans , Compliance , Dermatology , Education , Environmental Medicine , Friends , Heart , Internet , Outpatients , Patient Satisfaction , Phobic Disorders , SteroidsABSTRACT
A 4-month-old infant presented with asymptomatic soft nodules on his right forearm, which had developed since birth. On the suspicion of nevus lipomatosus superficialis (NLS), biopsy was performed. Histopathologic findings showed monomorphic polygonal cells with abundant granular cytoplasm. Immunohistochemical stains for CD68 and vimentin were strongly positive, but were negative for S-100 protein. Based on the pathologic findings, the patient was diagnosed as non-neural granular cell tumor (NN-GCT). GCT can be divided into conventional and non-neural GCT by immunoreactivity for S-100 protein. NN-GCT is typically manifested as a well-circumscribed, papulo-nodular dermal mass, and is known to occur in a younger group than does in conventional GCT, but is rare among children. To our knowledge, there have been no case reports of NN-GCT which appeared at birth and presented as grouped nodules. Therefore, we report this interesting case of congenital NN-GCT clinically mimicking NLS.