A Case of Small Bowel Obstruction and Perforation by Anisakiasis

Anisakiasis is a disease that often occurs after the ingestion of raw marine fish infected with nematodes of the Anisakis genus. Ingested Anisakis causes a variety of symptoms, including abdominal pain, nausea, and vomiting, when they invade the gastric wall. Although invasion of the gastric wall is common, rare cases of Anisakis invading the small bowel have been reported. These rare cases have resulted in small bowel obstruction and perforation and usually require surgical treatment. A 57-year-old man visited the emergency room suffering from abdominal pain and distension. He ate raw marine fish three days prior and suffered from epigastrium pain a day after this meal. X-ray and computed tomography showed small bowel obstruction without adhesion and required an operation for treatment. A laparotomy revealed dilated and congested jejunum and ileum with perforated distal ileum. We found a small thin long worm, confirmed by histopathology as a member of Anisakis. The patient was discharged after surgery without any complication.

Barium Peritonitis due to Inadvertent Vaginal Insertion rather than a Colonic Insertion: 1 Case Report / 대한내시경복강경외과학회지

Inadvertent vaginal insertion of barium sulfate is an uncommon complication of a barium enema examination. In the few reported cases, venous embolizaton of barium occurred and this usually resulted in death. We present here a case of vaginal insertion of the enema catheter in a young woman, resulting in barium in the uterus, fallopian tubes and abdominal cavity, but not in the veins. After an emergency laparoscopic operation, the patient had been doing well for 6 months without evidence of complication.

Nodular Hidradenocarcinoma / 대한피부과학회지

Nodular hidradenocarcinoma was first reported as a clear-cell papillary carcinoma by Liu et al. in 1949. With a potential for uncontrollable local recurrence, it tends to metastasize and often causes death. We report a case of a 68-year-old man with nodular hidradenocarcinoma on the left preauricular area. Histopathology of the tumor showed a multilobulated intradermal mass. In the tumor nodule, there were many cystic spaces of various sizes, resulting from tumor necrosis. The tumor consisted of large, atypical, polygonal cells with eosinophilic cytoplasm, and clear cells with clear cytoplasm. Numerous mitoses were evident. We obtained positive results from an immunohistochemical study with antibodies to cytokeratins, epithelial membrane antigen, and PAS. The patient was treated with a wide local excision. However, we observed a recurrence one month later and performed a wide excision and local skin flap. There has been no evidence of recurrence or metastasis for six months after the second excision.

Treatment of Atopic Dermatitis with a Low-histamine Diet

Atopic dermatitis (AD) has numerous trigger factors. The question of whether foods can aggravate AD remains open to debate. Although a number of published papers have detailed the relationship between food allergies and AD, little research has examined the question of how food intolerance affects AD. For the purposes of this study, a six-year-old Korean boy with AD was admitted to the hospital for evaluation of the possibility of food, particularly pork, as a triggering factor in his skin disease. He had a history of worsening of symptoms when eating pork. Total serum IgE concentration was 157 IU/ml. House dust was class 2.2 (1.5 IU/ml) in MAST. All other MAST items were negative. In an oral food challenge test, he showed a positive result after eating 200 g of pork, but did not show a positive result after eating 60 g of pork. After discharge, we attempted to keep him on a balanced diet that included various types of food and prohibited him from eating food that contains a high level of histamine. After keeping the patient on a balanced and low-histamine dietary regimen, his AD symptoms showed improvement and have not worsened for more than seven months. A low-histamine, balanced diet could be helpful for AD patients having symptoms that resemble histamine intolerance in which their AD symptoms worsened after intake of histamine-rich foods, but in which food allergy tests are negative.

A Case of a Subepidermal Calcified Nodule on the Sole without Trauma

Subepidermal calcified nodule is an uncommon form of calcinosis cutis, which most commonly occurs in children. It usually presents as an asymptomatic, solitary verrucous nodule on the head and neck region, but occasionally as multiple lesions. Serum calcium and phosphorus levels are usually normal. Histopathology shows well-formed homogeneous eosinophilic material and granules in the upper dermis. Material in the dermis stained with von Kossa was positive. We report on an unusual case of a subepidermal calcified nodule occurring on the sole. A 21-month-old male presented with an oval-shaped, whitish, hard nodule measuring 5x5 mm on the left sole, without any previous history of trauma.

A Case of Cystic Eccrine Spiradenoma on the Left Leg / 대한피부과학회지

Eccrine spiradenoma is a benign tumor that is differentiated into the direction of an eccrine gland. It is usually presents as a solitary, slowly-growing, intradermal or deeply subcutaneous nodule on the head and trunk. We report on a case of 32-year-old woman with a solitary, solid mass on the left leg that she'd had for 6 months. The mass was a 2.5x2x0.5 cm sized, round shaped, well demarcated solitary skin-colored nodule. The mass in our case was a relatively large and painful eccrine spiradenoma, and the mass showed cystic formation. The cyst was surrounded by cords of tumor cells. Hyaline materials were seen focally. There were two types of cells. Large pale nuclei existed adjacent to the cyst. Small dark nuclei existed at the periphery. To clarify the histogenesis of this tumor, immunohistochemical staining using various antibodies was also performed. We herein report on an unusual case of a large cystic eccrine spiradenoma.

Allergic Contact Dermatitis on the Periorbital Area: Report of Three Cases / 대한피부과학회지

The use of ophthalmic drugs and contact lens solutions has increased and allergic contact dermatitis due to these agents has also recently increased. The first case was a 67-year-old female patient who developed allergic contact dermatitis after application of Latano(R): The patch test with the ingredients in Latano(R) showed positive reaction to latanoprost and benzalkonium chloride. The second case was a 63-year-old female patient who developed allergic contact dermatitis after application of Ecolicin(R), Tolon(R), Forus(R) and Uniten-F(R): The patch test showed a positive reaction to Tolon(R). She didn't want further evaluation. The third case was a 51-year-old female patient who developed allergic contact dermatitis after application of Terramycin(R) eye ointment: the patch test with the ingredients of Terramycin(R) eye ointment showed a positive reaction to polymyxin B. When contact dermatitis occurs in periorbital areas, topical ophthalmic ointment or lens cleanser needs to be considered as a causative agent.

Anti-irritant Effect of Aloe Vera Gel Against a Lactic Acid Sting Test Reaction / 대한피부과학회지

BACKGROUND: Aloe vera has been used for medical purposes since antiquity, so it is known as the healing plant or silent healer. It has been claimed that aloe has several important therapeutic properties, including wound healing, thermal injury healing and anti-inflammation and immunomodulation properties. Because of these effects, it has become an ingredient in a wide variety of cosmetic products, including night creams, soaps, shampoos, suntan lotions and cleansers. OBJECTIVE: In order to determine the anti-irritant effect of aloe vera, we compared the degree of stinging intensity caused by 10% lactic acid solution and a mixture of 20% lactic acid and 100% aloe vera. METHODS: We carried out sting tests on 34 volunteers who were all over 20 years of age and they had no past and present history of atopic dermatitis and other eczema. The lactic acid sting test consisted of a 10-minute exposure on the left cheek with 10% lactic acid solution using a Hilltop chamber and the subjects recorded the degree of stinging intensity by themselves every 1 minute during 10-minutes of exposure. We also carried out a sting test with a mixed solution of 20% lactic acid and 100% aloe vera, and we compared the intensity and onset time of the stinging sensation. RESULTS: Aloe vera had some effect to ameliorate the intensity of the stinging sensation and also to delay the time required for the stinging sensation caused by lactic acid. There was a significant difference between the two groups (p<0.05). CONCLUSION: We found that aloe vera has an anti-irritant effect on the stinging sensation caused by lactic acid.

Anti-irritant Effect of Aloe Vera Gel Against a Lactic Acid Sting Test Reaction / 대한피부과학회지

BACKGROUND: Aloe vera has been used for medical purposes since antiquity, so it is known as the healing plant or silent healer. It has been claimed that aloe has several important therapeutic properties, including wound healing, thermal injury healing and anti-inflammation and immunomodulation properties. Because of these effects, it has become an ingredient in a wide variety of cosmetic products, including night creams, soaps, shampoos, suntan lotions and cleansers. OBJECTIVE: In order to determine the anti-irritant effect of aloe vera, we compared the degree of stinging intensity caused by 10% lactic acid solution and a mixture of 20% lactic acid and 100% aloe vera. METHODS: We carried out sting tests on 34 volunteers who were all over 20 years of age and they had no past and present history of atopic dermatitis and other eczema. The lactic acid sting test consisted of a 10-minute exposure on the left cheek with 10% lactic acid solution using a Hilltop chamber and the subjects recorded the degree of stinging intensity by themselves every 1 minute during 10-minutes of exposure. We also carried out a sting test with a mixed solution of 20% lactic acid and 100% aloe vera, and we compared the intensity and onset time of the stinging sensation. RESULTS: Aloe vera had some effect to ameliorate the intensity of the stinging sensation and also to delay the time required for the stinging sensation caused by lactic acid. There was a significant difference between the two groups (p<0.05). CONCLUSION: We found that aloe vera has an anti-irritant effect on the stinging sensation caused by lactic acid.

A Study of an Autologous Serum Skin Test and Helicobacter pylori Infection in Patients with Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, previous studies have identified functional histamine-releasing autoantibodies against the alphasubunit of the high affinity IgE receptor (Fcepsilon I) and Helicobacter pylori (H. pylori) infection. OBJECTIVE: To investigate a possible association of autoimmunity and H. pylori infection with chronic idiopathic urticaria. METHODS: We prospectively performed autologous serum skin tests (ASST) and urea-breath tests (UBT) on patients with CIU. We also checked clinical features. Amoxicillin and clarithromycin combined with a proton pump inhibitor was administrated as therapy for 1 week to patients that were UBT positive. We rechecked the UBT test 4 weeks later and rechecked the clinical features 6 weeks after eradication of the infection. RESULTS: A positive result to the ASST was experienced by 56 patients (39.2%) with CIU; UBT was found in 48 patients (62.5%) with CIU. There were no significant differences in clinical features between patients with positive tests and those with negative tests. After eradication, 26 of 30 (86.7%) patients that were UBT positive showed significant clinical remission of the urticaria. CONCLUSION: According to our results, ASST is not helpful for predicting the severity or clinical course of CIU, but eradication of H. pylori in patients with chronic urticaria induces clinical remission of the urticaria.

A Study of an Autologous Serum Skin Test and Helicobacter pylori Infection in Patients with Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, previous studies have identified functional histamine-releasing autoantibodies against the alphasubunit of the high affinity IgE receptor (Fcepsilon I) and Helicobacter pylori (H. pylori) infection. OBJECTIVE: To investigate a possible association of autoimmunity and H. pylori infection with chronic idiopathic urticaria. METHODS: We prospectively performed autologous serum skin tests (ASST) and urea-breath tests (UBT) on patients with CIU. We also checked clinical features. Amoxicillin and clarithromycin combined with a proton pump inhibitor was administrated as therapy for 1 week to patients that were UBT positive. We rechecked the UBT test 4 weeks later and rechecked the clinical features 6 weeks after eradication of the infection. RESULTS: A positive result to the ASST was experienced by 56 patients (39.2%) with CIU; UBT was found in 48 patients (62.5%) with CIU. There were no significant differences in clinical features between patients with positive tests and those with negative tests. After eradication, 26 of 30 (86.7%) patients that were UBT positive showed significant clinical remission of the urticaria. CONCLUSION: According to our results, ASST is not helpful for predicting the severity or clinical course of CIU, but eradication of H. pylori in patients with chronic urticaria induces clinical remission of the urticaria.

A Case of Congenital Leukemia Cutis

Congenital leukemia is a rare disease that develops from birth to 6 weeks of life. Leukemia cutis involves cutaneous infiltration by leukemic cells and is an unusual manifestation of leukemia, and has been documented in 25~30% of patients with congenital leukemia. The authors report a case of congenital leukemia cutis. A newborn male presented with widespread firm dusky red papules and nodules on almost his entire body surface. Skin biopsy specimens confirmed the presence of leukemic infiltrations, and bone marrow cytology was consistent with acute myeloid leukemia of the FAB M5 type.

Wheat-dependent, Exercise-induced Anaphylaxis: A Successful Case of Prevention with Ketotifen

Food-dependent, exercise-induced anaphylaxis (FDEIA) is the triggering of anaphylaxis after ingestion of certain foods when followed by physical exercise. Symptoms vary from the typical generalized urticaria to severe allergic reactions. We report the case of a 20-year-old woman who had a 7-year history of recurrent wheals and dyspnea after ingesting several kinds of food (wheat, pork, and beef) along with physical exercise. Based on a provocation test, she was diagnosed with wheat-dependent, exercise-induced anaphylaxis. She was instructed to take 2 mg of ketotifen 2 hours before ingestion of wheat to prevent the symptoms, and subsequently the provocation test did not elicit wheals. We therefore prescribed ketotifen (1 mg twice a day). She has not had recurrent wheals or dyspnea for 6 months. We herein report an interesting case of wheat-dependent, exercise-induced anaphylaxis with successful prevention by ketotifen.

A Case of Churg-Strauss Syndrome

Churg-Strauss syndrome (CSS) or allergic granulomatosis angiitis is a rare primary vasculitic disease. CSS can be diagnosed by the presence of any four or more of the six criteria, which include asthma, eosinophilia greater than 10%, paranasal sinusitis, pulmonary infiltration, histological proof of vasculitis and mono- or poly-neuropathy. We report here on a 45-year-old male who developed erythematous macules, papules and hemorrhagic vesicles on both right extremities along with a tingling sensation and sacral pain. He has been suffering from recurrent allergic rhinitis and bronchial asthma for 6 months. The laboratory findings showed severe eosinophilia (22.3%), hyper-IgE and positivity for p-ANCA. On the histological examination of the hemorrhagic vesicle on the right lower leg, leukocytoclsatic vasulitis and many neutrophils and eosinophils around the cutaneous vessels were observed in the dermis.

A Case of Wheat-Dependent Exercise-Induced Anaphylaxis

Foods are recognized as a common cause of urticaria; however, the role of food is considered to be more important in acute not chronic urticaria. Wheat is a basic ingredient found in many common foods. Food allergy to wheat is primarily described in children in the form of atopic dermatitis. It is rare in adults; where it is mainly reported in exercise-induced anaphylaxis. We report a case of wheat dependent exercise-induced anaphylaxis that occurred in a 54-year-old Korean woman.

Atopy Patch Tests for Atopic Dermatitis Patients according to the Concentration and Vehicle for the Cockroach Antigen / 대한피부과학회지

BACKGROUND:Recent studies have attempted to document the correlation of an atopy patch test (APT) and a skin prick test. The results have suggested a possible role of delayed allergic reaction in the development of eczematous skin lesions in patients with atopic dermatitis (AD) OBJECTIVE: The aim of this study was to evaluate the relationship of APT with skin prick test and specific IgE for cockroach antigen. And we attempted to find the optimal vehicle and concentration of APT for cockroach allergy in AD patient. METHODS: We performed APTs in 50 patients with AD with using German cockroach allergens (the extract with different concentrations and vehicles). The reactions were evaluated after 48 hours, and these were compared with the results of the skin prick test and the total and specific IgE levels. RESULTS: The AD patients who had cockroach allergy, according to a skin prick test or the specific IgE level, showed higher positive APT reactionsthan the non-allergic patients to cockroach. The APT reactions showed a significant relationship with the skin prick test and the specific IgE level (85.7%). With regard to the form of cockroach antigen, a positive APT was more frequent with using the powder form that with using the extract. Regarding the vehicle, petrolatum induced higher positive APT reactions than did distilled water. There was a close relationship between the antigen concentration in petrolatum base and a positive APT reaction. Ten and fifty percent cockroach antigen elicited positive APT reactions than did 1% cockroach antigen with using a petrolatum base. CONCLUSION: Petrolatum is an optimal vehicle for an APT for cockroach because an APT with a petrolatum base revealed the highest correlation with cockroach allergy. The dose-response relationship between antigen concentration and the frequencies of positive APT reactions demonstrated that 10% and 50% cockroach antigen is superior to 1% cockroach antigen.

A Study on the Induction of Hardening Phenomenon by Repeated Application of Sodium Lauryl Sulfate / 대한피부과학회지

BACKGROUND: Chronic irritant contact dermatitis, the common occupational dermatitis of the skin, could be caused by repetitive exposure of the skin to irritants. Adaptation of the skin to repeated influence of exogenous irritants is called the hardening. The defining characteristic of hardening phenomenon has been progressively decreasing inflammatory response with prolonged exposure to an irritant. OBJECTIVE: The purpose of this study was to evaluate the induction of hardening phenomenon by the repeated application of various concentrated sodium lauryl sulfate (SLS) solutions. METHODS: Once a day a 0.1%, 0.5%, 2% solution of SLS and distilled water were applied to the volar forearm skin in 15 healthy volunteers for 10 minutes over 3 weeks. After 3 weeks interval of rest, patch tests with 1% solution of SLS were conducted on previously irritated sites for 24 hours. We measured transepidermal water loss (TEWL) and erythema index (E-index) before irritation, during 3 weeks of repeated application. 4 days after the patches test, we measured TEWL and E-index once a day. RESULTS: During 3 weeks of irritation with repeated application of 0.1%, 0.5%, 2% SLS solution, increase of TEWL was accelerated according to concentrations of SLS. In the study of 24-h patch test with 1% SLS solution on previously irritated sites after 3 weeks interval of rest, TEWL on distilled water application site was significantly higher than other sites irritated with SLS solution on D44 and D45. The TEWL values on the site irritated with higher concentration of SLS solution were lower than those with lower concentration of SLS solution. In contrast, there were no significant differences in E-index value during 3 weeks of irritation and after 24-h patch test with 1% SLS solution. CONCLUSION: Hardening could be induced by repeated irritation with SLS solution for 3 weeks. We suggest that hardening could be induced more efficiently with the higher concentration of SLS solution than the lower concentration.

A Case of Eccrine Spiradenoma in a Neurofibromatosis Type-1 Patient / 대한피부과학회지

Eccrine spiradenoma is a rare benign tumor which is differentiated into the direction of eccrine gland. Neurofibromatosis type-1 is an autosomal dominantly inherited disorder that is characterized by neurofibroma, cafe au lait spots and axillary freckles of the skin. We report a case of a 42-year-old man with a painful, solid nodule on his right arm for 4~5 months. He was diagnosed with neurofibromatosis type-1 in childhood. He has several cafe au lait spots and diffuse freckles on whole body. On microscopy, the tumor was sharply demarcated with encapsulated lobules in the dermis. The lobules consisted of two undifferentiated epithelial cells. There was hyperpigmentation of the basal cell layer in the epidermis without increase in the number of melanocyte. We herein report an unusual case of eccrine spiradenoma in neurofibromatosis type-1 patient.

A Case of Familiar Painful Piezogenic Pedal Papules / 대한피부과학회지

We report a case of painful pizogenic pedal papules in a 10-year-old female patient who had developed tense, skin-colored papules with pain on both heels when weight was placed on the feet. Histopathologic findings showed subcutaneous fatty tissue protruding into the lower dermis and a basophilic degenerative change of part of the collagen in the dermis. Her father also had the same skin lesions on his both heels.