Association between IL17A/IL17RA Gene Polymorphisms and Susceptibility to Alopecia Areata in the Korean Population

BACKGROUND: Alopecia areata is marked by autoimmune assault on the hair follicle resulting in hair loss. T helper 17 cell subset has important roles in protecting the host against extracellular pathogens, however, also promotes inflammatory pathology in autoimmune disease, and it expresses both interleukin (IL)-17A and IL-17F, which can signal via the IL-17 receptor A. OBJECTIVE: To investigate the significance of IL17A and IL17RA gene polymorphisms in the susceptibility to alopecia areata. METHODS: We conducted case-control association study of 238 alopecia areata patients and 270 matched healthy controls. Allele frequency of total 2 single nucleotide polymorphims in the IL17A gene and 4 single nucleotide polymorphims in the IL17RA gene were studied. The statistical analyses were performed according to onset age, the presence of familyhistory, clinical subtypes, and presence of nail involvement or body hair involvement. RESULTS: One single nucleotide polymorphim (rs879577) of IL17RA gene showed significant difference between alopecia areata patients group and controls group (p= 0.0288). One single nucleotide polymorphim (rs4819554) of IL17RA gene showed significant difference between the early onset and late onset alopecia areata (p=0.0421). CONCLUSION: IL17RA gene polymorphism might contribute to the increased susceptibility to alopecia areata in Korean population, and IL17RA gene polymorphism may be associated with onset age.

A Case of Development of Vitiligo Followed by TNF-alpha Antagonist Treatment for Rheumatoid Arthritis

As the usage of biologics for rheumatic diseases increases, such as rheumatoid arthritis and ankylosing spondylitis, various cutaneous adverse events are also being increasingly reported. We experienced a case of development of vitiligo during a TNF-alpha antagonist therapy in a 22-year-old woman with rheumatoid arthritis. The patient was presented with vitiligo lesions on the dorsum of both hands after 1 month of treatment with etanercept. Vitiligo improved with topical tacrolimus ointment and excimer laser treatment without the discontinuation of etanercept. No clearly defined mechanism for vitiligo induced by TNF-alpha antagonist exits. However, considering that vitiligo is an autoimmune disorder, the development of this skin lesion in association with the TNF-alpha antagonist could be explained by a paradoxical induction of the autoimmune process.

Eccrine Porocarcinoma Presenting with Unusual Clinical Manifestations: A Case Report and Review of the Literature

Eccrine porocarcinoma is a rare neoplasm that originates from the intraepidermal ductal portion of the eccrine sweat gland, and it usually occurs on the pre-existing lesion of benign eccine poroma. Its occurrence is more common in females and elderly persons. We present a case of a 44-year-old man who suffered from eccrine porocarcinoma, which developed on the right scrotum and pelvic area with metastases to the lung, adrenal gland, esophagus, ureter, and distant lymph nodes. Here we report on a unique case of eccrine porocarcinoma that developed primarily on the scrotum, which is an uncommon site, and showed rapid metastasis to the internal organs.

Palmar Digital Vein Thrombosis / 대한피부과학회지

Palmar digital vein thrombosis causing one or more nodules seems to be a relatively rare condition. Only 20 cases of palmar digital vein thrombosis have been reported worldwide in the English language literature. It presents with a painful, firm and blue nodule located at or in close proximity to one of the flexion creases. The etiology remains unknown, but changes in the vessel wall related to the anatomic characteristics of the palmar digital veins may play a role, along with intraluminal stasis. Two patients with blue nodule located in close proximity to flexion creases on the volar side of the finger presented to our hospital. Histological examination showed organizing thrombus within the dilated vessel. We report here on these two cases of palmar digital vein thrombosis.

A Case of Acquired and Localized Hypertrichosis Associated with Chronic Erythema Nodosum / 대한피부과학회지

Chronic erythema nodosum, a variant of erythema nodosum, is characterized by the presence of non-ulcerated lesions located mainly on the legs and by a lack of a migratory tendency. These lesions can persist for years. Hypertrichosis is defined as the excessive growth of hairs and is classified into generalized or localized forms. An acquired and localized hypertrichosis has been associated with Becker's nevus, pretibial myxedema, local inflammation or irritation, orthopedic casts and splints, and topical application of steroids. A 48-year-old Korean female visited our clinic for evaluation of a 2-year history of scattered, erythematous to brownish, tender patches or subcutaneous nodules on both shins. Her skin lesions had waxed and waned under treatment, and after 6 months localized hypertrichosis had appeared on her skin lesions. We report a case of acquired and localized hypertrichosis associated with chronic erythema nodosum.

Giant Dermatofibrosarcoma Protuberans Presenting with Atypical Clinical Course / 대한피부과학회지

Dermatofibrosarcoma protuberans is a slow-growing malignant tumor of soft tissue usually occurring on the trunk or proximal extremities. It commonly affects 20 to 50-year-old persons and measures less than 5 cm in diameter. It starts as an erythematous indurated papule or plaque, and can enlarge over several years. It shows aggressive local invasion but a low rate of distant metastasis. A 63-year-old female presented with a 5-month-history of a rapidly growing cutaneous lesion on the abdomen. Physical examination revealed an 8x10 cm sized, violaceous, polypoid firm mass superimposed on the violaceous to brownish indurated plaque and surrounding nodule. Histopathologic examination showed an infiltrating mass composed of spindle shaped cells that were arranged in a storiform growth pattern within the whole layer of dermis. The cellular mass extended into the subcutaneous fat layer in a honeycomb pattern. The tumor cells were positive for CD-34 stain. Additionally, some areas of tumor showed myxoid change. Magnetic resonance imaging demonstrated a homogenously-enhancing, and protruded mass invading the subcutaneous fat layer. The diagnosis of dermatofibrosarcoma protuberans was established and it was treated by wide local excision. We report a case of giant, polypoid dermatofibrosarcoma protuberans presenting with rapid growth.

The Recognition of Skin Health and Diseases in Dermatologic Outpatients / 대한피부과학회지

BACKGROUND: Social interests and the prevalence of skin disease have increased rapidly along with social development and improvement of life quality. Information on skin diseases and aesthetics are available through the internet and mass media. However, there have been few studies on the value of this information and the treatment-seeking behavior of patients. OBJECTIVE: To evaluate the recognition of skin health and diseases in patients who visit dermatology clinics and to improve the role of dermatologists in the process. METHODS: From March, 2008, to April, 2008, 1901 patients were asked to complete a questionnaire in 62 dermatologic hospitals. The questions covered: purposes of visiting the clinic; duration of skin disease; treatment-seeking behavior; recognition of the prescribed medicine; compliance and common sense about representative skin problems. RESULTS: Patients visited the dermatologic clinic because of skin disease for 67.39% of patients, esthetic treatment in 22.88% of patients, and both in 9.73% of patients. For visits to a dermatology clinic for skin problems, 61.28% of patients visited a clinic but 38.72% did not. Most (81.38%) patients followed the doctor's prescription. Most negative responses to prescribed medicine were due to the internet and mass media or wrong information from pharmacists (52.24%). Moreover, patients who learned about skin diseases and prescription medicines through the internet usually lacked compliance and common sense regarding their skin problems. CONCLUSION: The internet can provide good information about healthy skin and skin diseases, but we have to consider its disadvantages of exaggeration and misbelief. The effects of this tool have been overstated and excessively publicized in comparison to actual established clinical results. Use of the internet may delay diagnosis and decrease compliance. Consequently, dermatologists have to provide correct information to minimize the disadvantages of internet information. Patients who have abnormal skin problems should visit dermatologic clinics to be evaluated and treated appropriately.

A Case of Trichilemmal Cyst of the Finger / 대한피부과학회지

Trichilemmal cysts are cysts of epithelial origin with a distinctive keratinization pattern that simulates that of the human anagen hair follicle between bulge and sebaceous gland and in the sac surrounding catagen hairs. This type of keratinization of the outer root sheath epithelium occurs when it is freed from the internal cover of its inner root sheath. Over 90 percent of trichilemmal cysts occur on the scalp. The others are located on the face, neck and trunk. A 34-year-old female had a solitary, skin-colored nontender subcutaneous nodule on the 5th finger of her right hand. We clinically diagnosed this skin lesion as an epidermal cyst. However, histopathologic examination revealed a stratified squamous epithelium without a granular layer, which corresponded to trichilemmal keratinization. The contents of the cyst consisted ofa homogenous eosinophilic material. The cyst was diagnosed as a trichilemmal cyst.

The Effect of Gromwell (Lithospermum erythrorhizon) Extract on the Stratum Corneum Hydration and Ceramides Content in Atopic Dermatitis Patients

BACKGROUND: A disruption of the balance between the water content of the stratum corneum (SC) and skin surface lipids may lead to the clinical manifestation of dryness of skin in patients with atopic dermatitis (AD). OBJECTIVE: To determine whether supplementation of gromwell (Lithospermum erythrorhizon), one of herbs used in East Asia in remedies for various abnormal skin conditions, may improve the SC level of hydration and ceramides, major lipid in SC in patients with AD. METHODS: A total of 28 subjects with AD were randomly assigned into two groups: either gromwell group received dextrose contained capsules with 1.5 g of gromwell extracts or placebo group received only dextrose contained capsules for 10 weeks. RESULTS: In contrast to no alteration of SC hydration and ceramides in placebo group, the SC hydration in gromwell group was significantly increased in parallel with an increase of SC ceramides. Furthermore, % increase of SC hydration in gromwell group bore a positive correlation with the clinical severity, which suggests that the increase of SC hydration in gromwell group was more effective as AD was more severe. CONCLUSION: Supplementation of gromwell improves SC hydration in parallel with an increase of ceramides in part.

A Case of CD30 (+)/ALK (-) Primary Systemic AnaplasticLarge Cell Lymphoma with Atypical Clinical Features / 대한피부과학회지

Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin's lymphoma, and this tumor is predominantly composed of large lymphoid cells that have a strong expression of CD30. Two major groups of ALCL have been described. The first is a spectrum of CD30+ lymphoproliferative disorders, including primary cutaneous ALCL and lymphomatoid papulosis. The second is systemic nodal ALCL, which can be subdivided into two groups: anaplastic lymphoma kinase (ALK)-positive and ALK-negative. The relative frequency of ALCL in Korea is about 19% of all cutaneous lymphomas. Solitary or multiple large nodular tumoral lesions confined to one body compartment are the most common presentation. We report here on a case of CD30 (+)/ALK (-) primary systemic ALCL in a 77 year-old-male, and the skin lesion manifested as multiple papules, plaques and tumors on the trunk, buttocks and upper and lower extremities.

Treatment of Skin Laxity and Facial Wrinkles with Combinationof Radiofrequency and Infrared Light / 대한피부과학회지

BACKGROUND: A device using radiofrequency and infrared has been used as a nonablative method for producing noninvasive skin tightening. However, the method combining radiofrequency and infrared light has not been used widely for treating both skin wrinkling and tightening. OBJECTIVE: To investigate the efficacy of a new nonablative Korean medical device, AntiLax(TM) (Jeisys Medical, Seoul, Korea), which uses both radiofrequency and infrared light, on facial wrinkling and laxity. METHODS: Thirty-three patients with facial laxity and wrinkles were enrolled in this study. Three patients failed to complete the three treatment sessions spaced 4 weeks apart so, ultimately, 30 patients completed the scheduled procedure. Serial photographs of the patients were obtained during the study period. A final clinical assessment was made 3 months after the last treatment. Punch biopsies of the treatment areas were obtained 1 week before treatment and 1 month after the last treatment in five patients who agreed to undergo skin biopsies. RESULTS: Doctors' assessments of the photographs taken before and 3 months after the treatment observed marked differences in the effect of treatment on skin laxity, according to location, but no differences in the effect of treatment on skin wrinkling, according to location. The efficacy of treatment of both skin laxity and wrinkling increased with the number of treatments. Patient satisfaction scores paralleled the clinical improvements observed. Secondary benefits reported by patients 3 months after treatment included decreased pore size, reduced sebum secretion, and improved skin texture. The side effects were mild and limited to transient erythema, edema, and rare vesicle formation. Histopathologically, there were increased, thickened collagen fibers 1 month after the last treatment, as compared to pretreatment. However, quantitative morphometric methods are needed to evaluate the histological changes objectively. CONCLUSION: Noninvasive radiofrequency combined with infrared light appears to be a safe, effective method for treating skin laxity and facial wrinkles.

Colocalization of Segmental Vitiligo and Alopecia Areata / 대한피부과학회지

Vitiligo has been associated with various disorders including thyroid disease, type I diabetes, alopecia areatal and pernicious anemia. It has been purported to be caused by autoimmune response. Vitiligo and alopecia areata occurring in the same patient has often been found, but colocalization of these two diseases has been rarely reported. It is suggested that this concurrence can result from a nonspecific immune mechanism affecting not only the melanocyte but the epithelium of the hair follicle as well. Thus colocalization can occur due to costimulation of a helper T-cell-mediated immunologic response or through inactivation of a suppressor-mediated response and other composite mechanisms such as neurogenic factors, stress and infection. We report a 17-year-old Korean female who presented with a 1-year history of alopecia and depigmentation on the same site of the left eyebrow. We diagnosed this skin lesion as colocalization of vitiligo and alopecia areata by both clinical and histopathological findings.

A Study on Altered Expression of Serine Palmitoyltransferase and Ceramidase in Psoriatic Skin Lesion

Ceramides are the main lipid component maintaining the lamellae structure of stratum corneum, as well as lipid second messengers for the regulation of cellular proliferation and/or apoptosis. In our previous study, psoriatic skin lesions showed marked decreased levels of ceramides and signaling molecules, specially protein kinase C-alpha (PKC-alpha) and c-jun N-terminal kinase (JNK) in proportion to the psoriasis area and severity index (PASI) scores, which suggested that the depletion of ceramide is responsible for epidermal hyperproliferation of psoriasis via downregulation of proapoptotic signal cascade such as PKC-alpha and JNK. In this study, we investigated the protein expression of serine palmitoyltransferase (SPT) and ceramidase, two major ceramide metabolizing enzymes, in both psoriatic epidermis and non-lesional epidermis. The expression of SPT, the ceramide generating enzyme in the de novo synthesis in psoriatic epidermis, was significantly less than that of the non-lesional epidermis, which was inversely correlated with PASI score. However, the expression of ceramidase, the degradative enzyme of ceramides, showed no significant difference between the lesional epidermis and the non-lesional epidermis of psoriatic patients. This might suggest that decreased expression of SPT protein is one of the important causative factors for decreased ceramide levels in psoriasis.

A Case of Annular Polycyclic Type of Subacute Cutaneous Lupus Erythematosus with Protein Losing Enteropathy / 대한피부과학회지

We present a case of annular polycylic type of subacute lupus erythematosus which fulfilled the criteria of systemic lupus erythematosus and was associated with protein losing enteropathy. A 37-year-old male had erythematous annular rashes with several painful, scattered ulcers and a generalized edematous appearance. Abnormal laboratory findings were hypoalbuminemia, low complement, positive Anti-Ro, La, and ANA in a speckled pattern. Tc-99m human serum albumin scintigraphy revealed extravasation within the small bowel. The histopathologic findings showed vacuolar degeneration, upper dermal edema and cleft with perivascular lymphocytic infiltration. Direct IF revealed granular deposition of IgG along the dermo-epidermal junction. The patient was treated with intravenous steroids and oral hydroxychloroquine.

A Case of Kaposi's Sarcoma Associated with Castleman's Disease / 대한피부과학회지

Castleman's disease, also known as angiofollicular lymphoid hyperplasia or giant lymph-node hyperplasia, is an unusual form of a lymphoproliferative disorder, and is divided clinically into a solitary and a multicentric form. The multicentric form of Castleman's disease is almost always of the plasma cell type. This can coexist with Kaposi's sarcoma in some cases. Kaposi's sarcoma is a multicentric, proliferative, vascular tumor involving cutaneous and visceral tissue. Iatrogenically-developed, immunosuppression-associated Kaposi's sarcoma is usually the result of immunosuppressive therapy. A 61-year-old man diagnosed as the plasma cell type of Castleman's disease, who had been treated with prednisolone for 2 years, was referred to the department of dermatology with numerous skin lesions consisting of confluent, violaceous-colored papules and plaques on his palm and soles. Histologic examination of the cutaneous lesions showed consistency with Kaposi's sarcoma. We report a rare case of Kaposi's sarcoma associated with multicentric Castleman's disease.

A Case of Androgenetic Alopecia Associated with Cushing's Disease / 대한피부과학회지

Cushing's disease is an ACTH-producing pituitary corticotrope adenoma. This pituitary adenoma exhibits an unrestrained ACTH secretion resulting in hypercortisolemia. A 27-year-old female visited us with a 3-year history of diffuse hair loss on the scalp. Her past medical history included recently-developed hypertension and 10 years of increased weight gain and oligomenorrhea. Central obesity, hirsutism, acne, violet striae on the abdomen, lower and upper extremities, and christmas tree-shaped alopecia on the scalp were observed upon physical examination. The secretion of cortisol was not suppressed in both a low and high dose dexamethasone suppression test. A brain MRI detected a pituitary microadenoma in the sella turcica. Based on the clinical and laboratory findings, we diagnosed androgenetic alopecia associated with Cushing's disease. After surgical removal of the pituitary adenoma, the alopecia showed a remarkable improvement. We report a case of Cushing's disease found in a patient with androgenetic alopecia.

A Case of Microvenular Hemangioma Clinically Mimicking Kaposi's Sarcoma / 대한피부과학회지

Microvenular hemangioma is an uncommon aquired vascular tumor, occurring in young to middle-aged adults of both genders. It usually presents as a small, solitary, purple-to-red papule, nodule or plaque on the extremities or trunk. Histologically, the tumor is composed of small branching venules with collapsed lumina and conspicuous pericytes infiltrating the full thickeness of the reticular dermis. Herein, we report a case of microvenular hemangioma, clinically mimicking Kaposi's sarcoma, on the toe of the right foot in a 44-year old male.