A Case of Localized Lymphedema of the Vulva Mimicking a Fibrous Tumor / 대한피부과학회지

Lymphedema refers to inflammation that occurs in a part of the body owing to impaired lymphatic transport. Lymphedema arises as a consequence of a malformation or malfunction of the lymphatic system. It commonly occurs on the face, vulva, and penis and can cause superficial lesions known as lymphangiectasia. Common presenting symptoms include pain, pruritus, oozing of lymphatic fluid, sexual dysfunction, and infection. Prolonged lymphedema can lead to fibrosis and epidermal hyperplasia with verrucous hyperkeratosis. In rare cases, the lymphedema may mimic a skin tumor. We report the case of a 69-year-old woman who presented with erythematous oozing papules and hard nodules on the vulva, which mimicked a fibrous tumor.

Primary Cutaneous Nodular Amyloidosis in Both Lip Angles / 대한피부과학회지

Primary cutaneous nodular amyloidosis is a rare variant of primary cutaneous amyloidosis and manifests as nodular, light-chain, amyloid deposits that are localized to the skin. The pathogenesis of the disease is still unclear. It usually originates in the lower extremities, face, scalp, and genitals and presents clinically as waxy, yellowish erythematous colored nodules. Histological characteristics include diffuse homogenous eosinophilic deposits in the dermis or subcutaneous regions along with interspersed plasma cells. We report a case of a 72-year-old man who presented with fissured, erythematous, waxy nodules on the bilateral lip angles. To the best of our knowledge, this is the first case report of primary cutaneous nodular amyloidosis of the lip angles in Korean dermatological literature.

Observational Study in Drusen Patients with Epiretinal Membrane after Vitrectomy and Membrane Peeling

Purpose@#To observe results in drusen patients with epiretinal membrane after a vitrectomy and membrane peeling. @*Methods@#This retrospective, observational study included drusen patients diagnosed with epiretinal membrane after vitrectomy with membrane peeling. Twenty eyes had epiretinal membrane with drusen (group 1) and 112 eyes had epiretinal membrane without drusen (group 2). At the 6 month follow-up, central foveal thickness and changes in best-corrected visual acuity (BCVA) were evaluated. In Group I, the results with drusen size 65 μm were compared. The largest drusen size change was measured and compared according to the existence of preoperative intraretinal cysts or ellipsoid zone disruption. @*Results@#Preoperatively and at 6 months postoperatively, the average size of the largest drusen was 198.23 ± 27.34 and 192.23 ± 26.12 μm, respectively, and there was no significant change during the follow-up period. Group I patients with intraretinal cysts and ellipsoid zone disruption experienced low BCVA during the preoperative period; the BCVA had improved postoperatively at 6 months, but with limitations. @*Conclusions@#Postoperatively at 6 months, no significant change was observed in the largest drusen size after vitrectomy and membrane peeling. Thus, drusen patients with epiretinal membrane, as well as intraretinal cysts or ellipsoid zone disruption can expect an extended recovery period and slow BCVA improvement.

Observational Study in Drusen Patients with Epiretinal Membrane after Vitrectomy and Membrane Peeling

Purpose@#To observe results in drusen patients with epiretinal membrane after a vitrectomy and membrane peeling. @*Methods@#This retrospective, observational study included drusen patients diagnosed with epiretinal membrane after vitrectomy with membrane peeling. Twenty eyes had epiretinal membrane with drusen (group 1) and 112 eyes had epiretinal membrane without drusen (group 2). At the 6 month follow-up, central foveal thickness and changes in best-corrected visual acuity (BCVA) were evaluated. In Group I, the results with drusen size 65 μm were compared. The largest drusen size change was measured and compared according to the existence of preoperative intraretinal cysts or ellipsoid zone disruption. @*Results@#Preoperatively and at 6 months postoperatively, the average size of the largest drusen was 198.23 ± 27.34 and 192.23 ± 26.12 μm, respectively, and there was no significant change during the follow-up period. Group I patients with intraretinal cysts and ellipsoid zone disruption experienced low BCVA during the preoperative period; the BCVA had improved postoperatively at 6 months, but with limitations. @*Conclusions@#Postoperatively at 6 months, no significant change was observed in the largest drusen size after vitrectomy and membrane peeling. Thus, drusen patients with epiretinal membrane, as well as intraretinal cysts or ellipsoid zone disruption can expect an extended recovery period and slow BCVA improvement.

Visual and Structural Differences in Idiopathic Epiretinal Membrane According to the Presence of Retinoschisis

PURPOSE: To present differences in visual acuity and macular structure before and after surgery in patients with idiopathic epiretinal membrane (ERM) according to the presence of retinoschisis. METHODS: This retrospective observational study included 324 eyes with idiopathic ERM, that underwent pars plana vitrectomy with ERM and internal limiting membrane peeling, and were followed for more than 6 months. Subjects were classified into two groups according to the presence of retinoschisis using preoperative optical coherence tomography (OCT; group 1, ERM with retinoschisis; group 2, ERM without retinoschisis). Preoperative and postoperative macular structure changes and surgical outcomes were compared. RESULTS: Group 1 included 61 eyes, and group 2 included 263 eyes. Group 1 had a significantly higher preoperative and final postoperative best-corrected visual acuity compared with group 2 (p = 0.01, p = 0.02). Preoperative disorganization of retinal inner layers (DRIL) was significantly less in group 1 than group 2 (p = 0.01). Preoperative central macular thickness was not significantly different between the two groups. However, postoperative central macular thickness was significantly lower in group 1 than group 2 (p = 0.02, p = 0.01, p < 0.01). The ratio of the inner or outer layer in the total retinal thickness before surgery was significantly smaller in group 1 than in group 2 (p = 0.02, p = 0.04). CONCLUSIONS: Preoperative visual acuity was better and the occurrence of DRIL was less in idiopathic ERM with retinoschisis than without retinoschisis. Postoperative visual and structural outcome was better in idiopathic ERM with retinoschisis than without retinoschisis. Retinoschisis may have played a role in reducing the tractional force given to the inner and outer retina.

Therapeutic Effect of Glucosamine on an Atopic Dermatitis Animal Model

BACKGROUND: Recent studies have reported that glucosamine (GlcN) showed therapeutic effects in allergic diseases such as asthma and rhinitis, and its mechanisms include the suppression of T helper type 2 immune responses and the nuclear factor-κB pathway. OBJECTIVE: We aimed to investigate the effect of GlcN on atopic dermatitis (AD) in an animal model. METHODS: Twenty-five BALB/c mice were divided into five groups (groups A~E). Group A was the phosphate-buffered saline (PBS)-treated group without AD induction. Group B was the PBS control group with AD induction. Groups C to E were the AD induction groups, which were treated with three different doses of GlcN (10 mg, 20 mg, and 40 mg, respectively). Histopathological examination was performed after GlcN administration. Interleukin (IL)-4, IL-13, and IL-17 cytokine levels were measured by enzyme-linked immunosorbent assay using skin biopsy specimens. Serum total immunoglobulin E (IgE) concentrations were measured before and after administration with GlcN or PBS. RESULTS: Clinical dermatitis scores decreased with increasing GlcN dose (p<0.001). Concentrations of tissue IL-13 and IL-17 decreased after GlcN administration (each group: p=0.002 and p<0.001, respectively), but the concentrations of tissue IL-4 did not show differences across groups. Serum IgE levels tended to be lower after GlcN administration (p=0.004). Histopathological scores were not significantly different among groups B~E (p=0.394). CONCLUSION: GlcN improved AD symptoms and decreased tissue IL-13, IL-17, and serum total IgE levels in an animal model.

Therapeutic Effect of 308-nm Excimer Laser on Alopecia Areata in an Animal Model

No abstract available.

A Case of Immunoglobulin A Pemphigus: Intraepidermal Neutrophilic Dermatosis Type / 대한피부과학회지

Immunoglobulin A (IgA) pemphigus is a rare variant of an autoimmune bullous disease with IgA antibodies. IgA pemphigus is divided into 2 major subtypes: the subcorneal pustular dermatosis (SPD) type and intraepidermal neutrophilic (IEN) dermatosis type. We documented a case of an 18-year-old woman with recurrent generalized blisters and pustules that were especially severe in the intertriginous areas. Some half-and-half blisters and coalesced pustules in an annular pattern with crusts were simultaneously observed. A biopsy specimen from one of the half-and-half blister lesions showed intraepidermal separation with multiple neutrophils. Direct immunofluorescence staining revealed lace-like intercellular deposition of IgA in the entire epidermis. IgA antibody deposits were also observed in the patient's serum. The eruptions cleared with systemic steroids and colchicine 0.6 mg for 1 week, and the patient remained in partial remission at the 8-month follow-up. Herein, we report a case of IEN-type IgA pemphigus, clinically mimicking SPD with half-and-half blisters.

Pseudoangiosarcomatous Squamous Cell Carcinoma of the Face / 대한피부과학회지

No abstract available.

Squamous Cell Carcinoma on the Fingers of Orthopedic Surgeon Induced by Occupational Radiation Exposure

No abstract available.

Two Cases of Congenital Hemangioma / 대한피부과학회지

Congenital hemangioma (CH) is a fully formed benign vascular tumor at the time of birth and do not proliferate in postnatal life. CH must be differentiated from infantile hemangioma. CH has three subtypes that are recognized based on their natural history: Rapidly involuting congenital hemangioma (RICH), non-involuting congenital hemangioma (NICH), and partially involuting congenital hemangioma (PICH). It is important to distinguish RICH from NICH because RICH spontaneously regresses but NICH does not. Herein, we report two patients diagnosed with RICH and NICH, respectively. We presented the clinical features as well as ultrasonographic and histologic findings to distinguish congenital from infantile hemangioma.

A Case of Cutaneous Larva Migrans Improved by Oral Ivermectin / 대한피부과학회지

No abstract available.

Intraoperative Foveal Traction in Patients with Epiretinal Membrane

PURPOSE: To determine influences of intraoperative foveal traction during membrane peeling in idiopathic epiretinal membrane (ERM) surgery. METHODS: This retrospective observational study included 46 eyes of 46 patients with idiopathic ERM who underwent pars plana vitrectomy with ERM and internal limiting membrane peeling from February 2015 to September 2015. The presence of intraoperative foveal traction during membrane peeling was reviewed using video records. The main outcome measures were best-corrected visual acuity (BCVA), central foveal thickness (CFT), foveal contour, and photoreceptor inner segment/outer segment junction disruption using optical coherence tomography at baseline and at 1, 3, 6, and 12 months after surgery. RESULTS: Group 1 (ERM with intraoperative foveal traction) included 22 eyes, and group 2 (ERM without intraoperative foveal traction) included 24 eyes. Preoperatively, convex pattern ERM was observed more often in group 1. Group 1 had a significantly thicker CFT and a lower BCVA compared to group 2 at baseline and during the first 6 months, but the final postoperative BCVA and CFT were not significantly different between the groups at 12 months. Among 22 eyes, 12 eyes (54.5%) were restored to flat or concave ERM patterns at an average of 5.4 months after surgery in group 1, and 18 out of 24 eyes (75%) recovered at 2.4 months (p < 0.01) in group 2. CONCLUSIONS: Preoperative thick CFT and convex pattern ERM indicated a high possibility of intraoperative foveal traction in idiopathic ERM surgery. There were no differences in long-term BCVA and restoration of foveal configuration according to foveal traction during membrane peeling.

Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

PURPOSE: To investigate the clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation. METHODS: We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o'clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications. RESULTS: Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-corrected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients. CONCLUSIONS: Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.

Intravitreal Aflibercept Monotherapy for Treating Submacular Hemorrhage Secondary to Neovascular Age-related Macular Degeneration

PURPOSE: To evaluate the effects of intravitreal aflibercept injection in the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration (nAMD). METHODS: This retrospective, observational study included patients diagnosed with nAMD with submacular hemorrhage treated with intravitreal aflibercept monotherapy. A total of 54 eyes of 54 patients were treated with an initial series of three monthly intravitreal aflibercept injections followed by as-needed injections. At the 6 month follow-up, changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and submacular hemorrhage area (SMH) were evaluated. RESULTS: The mean preoperative BCVA was 0.79 ± 0.59 logMAR, which improved significantly to 0.53 ± 0.46 logMAR at 3 months and 0.48 ± 0.50 logMAR at 6 months (p < 0.001, in both). The CMT significantly decreased in all eyes: preoperative, 454.4 ± 131.5 µm, to 242.6 ± 39.7 µm at 6 months. The SMH was also reduced in all eyes: preoperative, 6.4 ± 4.8 disc areas (DAs) to 0.8 ± 1.4 DAs at 6 months. Ten eyes were diagnosed with typical nAMD (18.5%) and 44 eyes were diagnosed polypoidal choroidal vasculopathy (81.5%). There was no significant difference at 6 months in the visual outcomes of the subgroups. CONCLUSIONS: Intravitreal aflibercept monotherapy is well-tolerated as a treatment in maintaining or improving vision in patients with SMH secondary to nAMD.

An Atypical Erythromelalgia on the Chest

No abstract available.

Comparison of Optical Coherence Tomography Characteristics among Three Subtypes of Exudative Age-related Macular Degeneration

PURPOSE: To compare the characteristics of optical coherence tomography in eyes with treatment-naïve typical neovascular age-related macular degeneration (typical nAMD), polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP). METHODS: One hundred fifty-three eyes newly diagnosed with exudative AMD were retrospectively collected. All study eyes were classified into three subtypes: typical nAMD, PCV, and RAP. Subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). Central macular thickness (CMT) and other OCT features including intraretinal cystoid fluid and subretinal fluid were also evaluated in all eyes. SFCT, CMT and other OCT features were compared among the three subtypes of exudative AMD. RESULTS: Seventy-four eyes with typical nAMD, 55 eyes with PCV, and 24 eyes with RAP were included. SFCT was significantly thickest in PCV and thinnest in RAP (p < 0.001). RAP showed the thickest CMT and the highest frequency of intraretinal cystoid fluid (p = 0.004, p < 0.001, respectively). CONCLUSIONS: In patients with exudative AMD, different characteristics of OCT were observed according to the three subtypes. Identification of OCT characteristics could help differentiate the subtypes of exudative AMD.

Change in Subfoveal Choroidal Thickness after Patterned Panretinal Photocoagulation in Patients with Diabetic Retinopathy

PURPOSE: To evaluate changes in subfoveal choroidal thickness (SFCT) after patterned panretinal photocoagulation (PRP) using pattern scan laser (PASCAL) in patients with diabetic retinopathy. METHODS: This study included 39 patients (50 eyes) treated with patterned PRP using PASCAL and who were followed for at least 3 months. Patients were classified into 2 groups according to severity: severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. SFCT was measured by enhanced depth imaging of spectral-domain optical coherence tomography. The change in SFCT was analyzed at 1 and 3 months after PRP. RESULTS: SFCT was 270.42 ± 61.44 µm before PRP, 264.52 ± 60.78 µm at 1 month, and 255.74 ± 56.89 µm at 3 months after PRP. Significant change of SFCT was found at 3 months after PRP. Central macular thickness was 275.56 ± 50.61 µm before PRP and increased to 295.18 ± 52.80 µm and 293.10 ± 57.24 µm at 1 and 3 months post-treatment, respectively. There were no significant differences between groups in SFCT at baseline or in the amount of change in SFCT after PRP. CONCLUSIONS: SFCT significantly decreased after patterned PRP using PASCAL.

Short-Term Efficacy of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

PURPOSE: To evaluate the short-term effect of intravitreal aflibercept (Eylea(R); Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA and Bayer, Basel, Switzerland) on the visual outcomes and retinal anatomic changes of patients with polypoidal choroidal vasculopathy (PCV). METHODS: Intravitreal Eylea(R) was injected into 16 eyes of 16 patients with PCV in this retrospective case study. After therapy, the patients were followed up for over 3 months. Changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) using optical coherence tomography (OCT) and abnormal vasculature on indocyanine green angiography (ICGA) were evaluated. RESULTS: The mean log MAR BCVA was 0.75 +/- 0.60 at baseline, 0.74 +/- 0.60 and 0.71 +/- 0.63 at 1 and 2 months, respectively (p > 0.05) and 0.57 +/- 0.53 at 3 months (p < 0.05) after treatment. The mean CFT was 379 +/- 130 microm at baseline, 281 +/- 92 microm, 247 +/- 54 microm, and 231 +/- 51 microm at 1, 2, and 3 months, respectively, after treatment (p < 0.05). Complete resolution was 43%, 55%, and 50% at 1, 2, and 3 months, respectively in pigment epithelial detachment (PED), 67%, 83%, and 92% at 1, 2, and 3 months, respectively in subretinal fluid (SRF) and 33%, 60%, and 60% at 1, 2, and 3 months, respectively in intraretinal fluid (IRF) using OCT. The polypoidal lesions in ICGA decreased in 12 of 14 eyes (86%). CONCLUSIONS: Intravitreal injection of Eylea(R) with PCV reduced CFT due to decreased retinal PED, SRF, IRF and occluded effectively the polypoidal lesion leaking. Compared with baseline, mean BCVA at the 3-month follow-up was significantly improved.

Baseline Predictors of Visual Acuity and Retinal Thickness in Patients with Retinal Vein Occlusion

This study investigated the baseline predictors of best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6 months in patients with treatment-naive branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). This multicenter, interventional case series included 208 BRVO and 123 CRVO patients with follow-up period of 6 months or more. Outcome measures of BCVA (logMAR) included absolute change from baseline and a gain or loss of > or = 0.3 from baseline. Outcome measures of CRT included absolute change from baseline and a measurement of or = 400 microm at 6 months. Univariate and multiple regression analyses were done to find baseline predictors. For BRVO, younger age, worse baseline BCVA, and shorter duration of symptom were associated with more gain in BCVA. For CRVO, worse baseline BCVA was associated with more gain in BCVA. For CRT outcomes, higher baseline CRT predicted greater decrease at 6 months in both BRVO and CRVO. Younger age and better baseline BCVA were associated with an increased likelihood of measurement of a or = 400 microm at 6 months. In conclusion, several baseline factors including age, symptom duration, and baseline BCVA and CRT are associated with BCVA and CRT outcomes at 6 months, which may help to predict disease course for RVO patients.