Immunohistochemistry and Polymerase Chain Reaction for Detection Human Papilloma Virus in Warts: A Comparative Study

BACKGROUND: Immunohistochemistry and polymerase chain reaction (PCR) are the most widely used methods for the detection of viruses. PCR is known to be a more sensitive and specific method than the immunohistochemical method at this time, but PCR has the disadvantages of high cost and skilled work to use widely. With the progress of technology, the immunohistochemical methods used in these days has come to be highly sensitive and actively used in the diagnostic fields. OBJECTIVE: To evaluate and compare the usefulness of immunohistochemistry and PCR for detection human papilloma virus (HPV) in wart lesions. METHODS: Nine biopsy samples of verruca vulgaris and 10 of condyloma accuminatum were examined. Immunohistochemical staining using monoclonal antibody to HPV L1 capsid protein and PCR were done for the samples. DNA sequencing of the PCR products and HPV genotyping were also done. RESULTS: HPV detection rate was 78.9% (88.9% in verruca vulgaris, 70.0% in condyloma accuminatum) on immunohistochemistry and 100.0% for PCR. HPV-6 genotype showed a lower positivity rate on immunohistochemistry (50.0%) as compared to that of the other HPV genotypes. CONCLUSION: Immunohistochemistry for HPV L1 capsid protein showed comparable sensitivity for detection HPV. Considering the high cost and great effort needed for the PCR methods, we can use immunohistochemistry for HPV L1 capsid protein with the advantage of lower cost and simple methods for HPV detection.

Detailed Distribution of Liver Enzymes according to Gender, Age, and Body Mass Index in Health Check-up Subjects / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to examine the distribution of range of liver enzymes according to age and BMI in each gender using large-scale data. METHODS: Data were gathered from 65,715 subjects who underwent a routine health check-up and did not have HBsAg and anti-HCV. Boxplot analysis was used to examine the distribution of range of liver enzymes according to age and BMI in each gender. Multivariate linear regression analysis was performed for assessment of the association of liver enzymes with age and BMI, and to determine whether the range of liver enzymes was affected by risk factors for metabolic syndrome in each gender. RESULTS: ALT, AST, and GGT levels showed significant association with BMI in both male and female after adjusting for age. The range of ALT, AST, and GGT levels varied more widely according to the increase in BMI in males than in females, and this finding was more prominent in younger subjects than in older subjects. All risk factors for metabolic syndrome were shown to affect liver enzyme levels in male subjects. However, although most risk factors for metabolic syndrome affected liver enzyme levels, there might be weak or no effect of fasting hyperglycemia on AST, and low serum HDL-cholesterol level on GGT in female subjects. CONCLUSIONS: Age, BMI, and other risk factors for metabolic syndrome had a significant effect on the distribution of range of liver enzymes in each gender, even in this study conducted from Korean health checkup subjects.

Status of Primary Liver Cancer Found through Routine Health Check-up

This study aimed to investigate the status of primary liver cancers found through a routine health check-up. The data of subjects who were diagnosed with primary liver cancer for the first time through a routine health check-up during a period of 8-yr were analyzed. Primary liver cancers were detected for the first time in 34 subjects among 91,219 routine health check-up subjects. Only 11.8% of primary liver cancer subjects had been under previous surveillance. Of them, 55.8% were positive for HBsAg, 17.7% were positive for anti-HCV, and 8.8% were heavy alcohol comsumers. However, 17.7% of the subjects were neither heavy alcohol consumers nor positive for both HBsAg and anti-HCV. Of the subjects, 50.0% had a single nodular tumor, 23.5% had multi-nodular tumors, and 26.5% had an infiltrative tumor. A routine health check-up may provide beneficial opportunities to detect a liver cancer in a very early stage. It is beneficial to start surveillance in high-risk subjects for liver cancer or to detect any liver cancer in subjects without risk factors of chronic viral hepatitis or heavy alcohol consumption.

Methimazole-Induced Bullous Systemic Lupus Erythematosus: A Case Report

Bullous systemic lupus erythematosus (SLE) is a kind of LE-non-specific bullous skin disease that is rarely induced by a medication. We describe the first case of bullous SLE to develop after administration of methimazole. A 31-yr-old woman presented with generalized erythematous patches, multiple bullae, arthralgia, fever, conjunctivitis, and hemolytic anemia. Biopsy of her bulla showed linear deposition of lgG, lgA, C3, fibrinogen, and C1q at dermo-epidermal junction. She was diagnosed as bullous SLE and treated with prednisolone, dapsone, hydroxychloroquine, and methotrexate. Our experience suggests that SLE should be considered as a differential diagnosis when bullous skin lesions develop in patients being treated for hyperthyroidism.

Cutaneous Angiosarcoma Developed at Site of Herpes Zoster Scar: Wolf's Isotopic Response / 대한피부과학회지

Angiosarcoma is a rare malignant vascular tumor of endothelial origin. It can involve any organ, including the skin, soft tissue, liver, bone, spleen, and orbit. Skin is the most frequent site of primary angiosarcoma, however, metastatic skin involvement of angiosarcoma is exceptional. Wolf's isotopic response implies that the new disease appeared at the site of an already healed skin disease. Several types of cutaneous lesions have been described, occurring within cleared cutaneous herpes zoster, or herpes simplex lesions. These lesions include comedones, granulomatous diseases, tinea, furunculosis, wart, psoriasis, pseudolymphoma, leukemia, lymphoma, basal cell carcinoma, squamous cell carcinoma and cutaneous metastases, from internal carcinoma. Herein, we report a case of cutaneous angiosarcoma of unknown origin that has developed at the site of a scar, after herpes zoster in a 79-year-old man as isotopic response.

A Case of Primary Cutaneous CD4 Positive Small/medium T Cell Lymphoma

Primary cutaneous CD4 positive small/medium T cell lymphoma (PCSM-TCL) is a provisional entity in the new WHO-EORTC classification for cutaneous lymphoma, and it is a rare disease with a favorable clinical course. PCSM-TCL may present with different clinical and pathologic features associated with the biologic behavior of the disease. Herein we report on a 63-year-old woman with multiple, multifocal, erythematous to violaceous papules and plaques that progressed despite local radiotherapy.

Metastatic hepatocellular carcinoma presenting as facial nerve palsy and facial pain / 대한간학회지

Facial nerve palsy due to temporal bone metastasis of hepatocellular carcinoma (HCC) has rarely been reported. We experienced a rare case of temporal bone metastasis of HCC that initially presented as facial nerve palsy and was diagnosed by surgical biopsy. This patient also discovered for the first time that he had chronic hepatitis B and C infections due to this facial nerve palsy. Radiation therapy greatly relieved the facial pain and facial nerve palsy. This report suggests that hepatologists should consider metastatic HCC as a rare but possible cause of new-onset cranial neuropathy in patients with chronic viral hepatitis.

Distribution of Malassezia Species on the Scalp in Korean Seborrheic Dermatitis Patients

BACKGROUND: Malassezia species play an important role in the pathogenesis of seborrheic dermatitis. In particular, M. restricta and M. globosa are considered to be the predominant organisms in seborrheic dermatitis of Western countries. However, species distribution of Malassezia in seborrheic dermatitis has not been clearly determined yet in Asia. OBJECTIVE: To identify the distribution of Malassezia species on the scalp of seborrheic dermatitis patients in Korea using 26S rDNA PCR-RFLP analysis. METHODS: A total of 40 seborrheic dermatitis patients and 100 normal healthy volunteers were included in this study. For the identification of Malassezia species, the scalp scales of the subjects were analyzed by 26S rDNA PCR-RFLP analysis. RESULTS: The most commonly identified Malassezia species were M. restricta in the seborrheic dermatitis patients, and M. globosa in the normal controls. In the seborrheic dermatitis group, M. restricta was identified in 47.5%, M. globosa in 27.5%, M. furfur in 7.5%, and M. sympodialis in 2.5% of patients. In the healthy control group, M. globosa was identified in 32.0%, M. restricta in 25.0%, M. furfur in 8.0%, M. obtusa in 6.0%, M. slooffiae in 6.0%, and M. sympodialis in 4.0% of subjects. CONCLUSION: M. restricta is considered to be the most important Malassezia species in Korean seborrheic dermatitis patients.

A Case of Polypoid Clear Cell Acanthoma on the Nipple

Clear cell acanthoma (CCA) is a rare benign epidermal tumor. It usually presents as a flat nodule or dome-shaped plaque and is often localized on the legs of the elderly. We observed an unusual case of polypoid CCA on the nipple of a 14-year-old girl. At present, a few cases of CCA on the nipple area have been reported in the literature. However, CCA presented as a polypoid tumor on the nipple area has been reported very rarely. We herein report the very rare case of polypoid CCA on the nipple and suggest that CCA should be included in the clinical differential diagnosis of polypoid lesions on the nipple.

A Study on the Antimicrobial Effect of Bamboo (Phyllosrachys bambusoides) Essential Oil on Malassezia / 대한의진균학회지

BACKGROUND: Malassezia is considered as major factor in dandruff of human scalp. OBJECTIVE: In order to develop an antimicrobial agent, bamboo oil was extracted by high temperture suction from dried bamboo truk abd then antimicrobial activities against Malassezia are investigated. METHODS: Minimum inhibitory concentration and antimicrobial activity were measured in Malassezia species. RESULTS: 1. Minimum inhibitory concentration of the Bamboo (Phyllosrachys bambusoides) Essential Oil Malassezia furfur standard, Malassezia furfur patient, Malassezia sympodialis standard, Malassezia sympodialis patient, Malassezia dermatis standard, Malassezia dermatis patient were 10 microliter/ml, 5 microliter/ml, 5 microliter/ml, 10 microliter/ml, 5 microliter/ml and 10 microliter/ml respectively. 2. Minimum inhibitory concentration of the Itraconazole Malassezia furfur standard, Malassezia furfur patient, Malassezia sympodialis standard, Malassezia sympodialis patient, Malassezia dermatis standardntia, Malassezia dermatis patient were 10 microgram/ml, 10 microgram/ml, 10 microgram/ml, 0.1 microgram/ml, 1 microgram/ml, and 0.01 microgram/ml, respectively. 3. Minimum inhibitory concentration of the ketoconazole Malassezia furfur standard, Malassezia furfur patient, Malassezia sympodialis standard, Malassezia sympodialis patient, Malassezia dermatis standard, Malassezia dermatis patient were 0.01 microgram/ml, 10 microgram/ml, 10 microgram/ml, 0.1 microgram/ml, 0.01 microgram/ml, and 0.01 microgram/ml, respectively. 4. Malassezia furfur standard, Malassezia furfur patient, Malassezia sympodialis patient and Malassezia dermatis patient showed the strongest antimicrobial effect on bamboo oil > ketoconazole > itraconazole. 5. Malassezia sympodialis standard, Malassezia sympodialis patient and Malassezia dermatis standard strongest antimicrobial effect on ketoconazole > bamboo oil > itraconazole. CONCLUSION: Bamboo oil might be applied as antidandruff treatment modality by its anti-malassezial effect.

Clinical Evaluation of Dermatology Consultation in Inpatients / 대한피부과학회지

BACKGROUND: Dermatologic problems may represent a primary cutaneous disorder or an underlying systemic disease and are common but frequently overlooked in inpatients. OBJECTIVE: We described and quantified dermatologic consultations in Seoul National University Hospital over 9 years for comparison with other reports. METHODS: We retrospectively studied the records of 9,529 hospitalized patients for which a dermatologist consultation was requested. RESULTS: Consult patients numbered 9,529 among 506,927 inpatients (1.88%). The total number of male and female patients were 5,428 (56.96%) and 4,101 (43.04%), respectively (M:F=1.32:1). The most frequent age group was the 6th decade (19.05%) and the lowest age group was the 1st decade (5.14%). In 2008, most of the consultations (72.24%) were made by internal medicine, followed by neurology (6.34%), and pediatrics (4.59%). Patients with cancer were most frequently consulted for underlying disease (24.58%), followed by hematologic malignancy (22.66%), and liver disease (10.69%). The most common skin disorders were drug eruption (24.5%), followed by eczema (15.7%), and viral infection (12.6%), and with more consults for drug eruption and viral infection than previous studies. The most common reasons for consultation were: dermatologic diseases or conditions (73.8%), diseases related to treatment (16.2%), and skin lesions of systemic disease (8.8%). CONCLUSION: Inpatient dermatology consultations not only improve the quality of patient care but also can provide opportunities for residency education and experience with clinical dermatology.

The Effects of Adipose Tissue-Derived Mesenchymal Stem Cells on the Formation ofEpidermis and Basement Membrane in Artificial Skin Models / 대한피부과학회지

BACKGROUND: There is an increasing need for making a more ideal artificial skin model. OBJECTIVE: To evaluate the effects of adipose tissue-derived mesenchymal stem cells (ATMSC) on the formation of epidermis and basement membrane in artificial skin models. METHODS: ATMSC were isolated from lipo-aspirated fat tissues, and their phenotypes were confirmed by cell surface markers. Three kinds of artificial skin models were made using three different dermal substitutes. The dermal substitutes in the three models contained fibroblasts only, fibroblasts together with ATMSC or ATMSC only. The formation of epidermis and basement membrane was evaluated by immunohistochemical stains and transmission electron microscopy. RESULTS: Among the three models, the model with both fibroblasts and ATMSC in the dermal substitute showed the most excellent formation of epidermis and, especially, basement membrane. In this model, the basement membrane proteins, laminin and type IV collagen, were expressed most apparently at the dermo-epidermal junction and, lamina lucida, lamina densa and anchoring fibrils were most evidently observed under transmission electron microscopy. Whereas, the model with only ATMSC did not show keratin 1 expression, suggesting that the 'skin-type' stratified squamous epithelium was not formed well. CONCLUSION: ATMSC together with fibroblasts can be used effectively in constructing artificial skin models.

A Case of Multiple Cylindromas / 대한피부과학회지

Cylindroma is an adnexal tumor which is mostly observed on the scalp. It usually occurs as a solitary lesion rather than multiple lesions. Histopathologically, the tumor is composed of numerous islands of basaloid cells which fit together like pieces of a jigsaw puzzle with surrounding hyaline sheaths. In Korea, there have been two reports of solitary cylindroma in the dermatologic literature, but no report of multiple cylindromas. We herein report a case of multiple cylindromas. A 34-year-old woman presented with three erythematous papules on her scalp, which developed four to five years before. Histopathologic findings on all papules revealed the typical appearance of cylindroma.

Two Cases of Pellagra in Alcoholics / 대한피부과학회지

Pellagra is a chronic wasting disorder characterized by 3 clinical distinct symptoms; dermatitis; dementia; and diarrhea. It results from a marked cellular deficiency of water-soluble vitamin B3, also called niacin. Dermatitis begins as an erythema and shows bilateral symmetrical eruption at cutaneous sites of solar exposure. Herein we report 2 cases of pellagra in chronic alcoholics.

A Case of Cutaneous T Cell Lymphoma Presenting as Papuloerythroderma of Ofuji / 대한피부과학회지

Papuloerythroderma of Ofuji (PEO) is an uncommon entity of unknown etiology, characterized by coalescing erythematous papules sparing skin folds. A number of cases have described the association of this disorder with malignant with pathology, mainly with cutaneous T cell lymphoma. Such reports give rise to the suggestion that PEO may be a precursor of lymphoma or a form of cutaneous T cell lymphoma. We report a case of PEO, which was diagnosed as cutaneous T-cell lymphoma only 2 months after the development of skin lesions, and rapidly progressed. This case suggests the presence of a variant of cutaneous T cell lymphoma with clinical feature of PEO, which is different from mycosis fungoides or S zary syndrome.

Clinical Observation of Sarcoidosis / 대한피부과학회지

BACKGROUND: Sarcoidosis is a systemic noncaseating granulomatous disorder of unknown origin, which can involve any organs including the skin. OBJECTIVE: The purpose of this study is to investigate the clinical characteristics of sarcoidosis in patients in Seoul and Gyeonggi-do. METHODS: A total of 62 patients with sarcoidosis, where sarcoidosis was confirmed by histopathologic examinations at seven university hospitals in Seoul and Gyeonggi-do from 2000 to 2006, were enrolled in this study. The clinical characteristics were analyzed by a thorough review of medical records, histopathologic and radiologic examinations. RESULTS: Man to woman ratio was 1 : 1.48 and 42% of the patients were in their fifth decade. The most frequent chief complaints were cutaneous symptoms (37%), followed by respiratory symptoms (31%). The most frequently involved organs were intrathoracic organs (84%), followed by the skin (37%), peripheral lymph nodes (13%), bones (11%), spleen (8%) and eyes (5%). The most common cutaneous lesion was subcutaneous nodule (74%), followed by papule (13%). Extremities (65%) were the most frequent sites of cutaneous lesions. Systemic organ involvements were observed in 70% of patients with cutaneous sarcoidosis. Among them, the most frequently involved organs were intrathoracic organs (81%), followed by bones (25%), eyes (19%), and peripheral lymph nodes (19%). CONCLUSION: The results were generally similar with the previous domestic reports. Compared with the foreign reports, cutaneous involvement was more frequent and ophthalmic involvement was less frequent. Subcutaneous nodule was the most frequent cutaneous lesion which seems to be a unique feature of this study.

A Case of Black Hairy Tongue following the Use of Psychotropic Agents / 대한피부과학회지

Black hairy tongue is a benign skin condition characterized by dark brown or black patches on the tongue, due to hypertrophied filiform papillae. Although the cause of the disease is uncertain, there are several predisposing factors such as poor oral hygiene, smoking and medication. Herein, we report a case of black hairy tongue that developed after the use of psychotropic agents

Study of Causative Organisms in Pitted Keratolysis / 대한의진균학회지

BACKGROUND: Pitted keratolysis is a superficial bacterial infection which usually affects the pressure bearing areas of the feet. Some bacterial organisms were identified as etiologic agents, including Corynebacterium species, Micrococcus species and Dermatophilus congolensis. However, in Korea, studies to prove the causative organisms have not been performed. OBJECTIVE: We performed this study to identify causative organisms of pitted keratolysis in Korea. METHOD: Twelve normal healthy men and 27 pitted keratolysis patients were enrolled. We cultured the scraped specimens of the stratum corneum and identified the cultured organisms. We compared the cultured organisms of pitted keratolysis group with those of control group. We also compared the distribution of cultured organisms in pitted keratolysis with and without tinea pedis. RESULT: Micrococcus species and Corynebacterium species were identified in pitted keratolysis group much more frequently than in normal control group. In most cases of pitted keratolysis combined with tinea pedis, the identified organisms were Micrococcus species. CONCLUSION: Micrococcus species and Corynebacterium species are thought to be the major causative organisms of pitted keratolysis in Korea. Micrococcus species might play a certain antagonistic role, especially in patients of pitted keratolysis with tinea pedis.

Pulsed Intravenous Immunoglobulin Therapy in Livedo Vasculitis: Report of Two Cases / 대한피부과학회지

Livedo vasculitis is a chronic dermatosis characterized by recurrent painful ulceration of the lower limbs, which heals to leave atrophie blanche. The precise pathophysiology is not known. Antiplatelet, anticoagulant, fibrinolytic therapies and anabolic steroids have been reported to be helpful in this syndrome. However, no consistent benefit has been demonstrated with any treatment modality. Recently, pulsed intravenous immunoglobulin therapy has been reported to be effective in some refractory cases. We herein report two cases of recalcitrant livedo vasculitis which were effectively treated with pulsed intravenous immunoglobulin therapy. These were the first trials carried out in Korea.

A Case of Extramammary Paget's Disease of the Axilla / 대한피부과학회지

Extramammary Paget's disease is a rare cutaneous neoplasm mostly observed on the genital and perineal areas. In Korea, there has only been one report of extramammary Paget's disease occurring in the axilla. We herein report a case of extramammary Paget's disease of the axilla, confirmed by biopsy and immunohistochemical studies.