A Case of Impetigo Herpetiformis Occurring In Puerperium / 대한피부과학회지

Impetigo herpetiformis is a rare, severe dermatologic disorder occurring predominantly in the third trimester of pregnancy. Rarely, it may present during the puerperium, and this suggests that impetigo herpetiformis should be included in the differential diagnosis of puerperal fever, particularly in those cases associated with dermatoses. We report a 32-year-old woman who developed impetigo hermpetiformis during puerperium. She was a primigravida and did not have a previous history of psoriasis. Three days after parturition she developed a severely pruritic pustular rash composed of erythematous patches first presented in both axilla. The patient showed rapid improvement with oral prednisolone 40 mg/day for 5 days, and the lesions healed in 10 days. Follow-up for 12 months revealed no recurrence.

A Case of Transformation of Mycosis Fungoides to Large Cell Lymphoma / 대한피부과학회지

Cutaneous T cell lymphoma (mycosis fungoides/Sezary syndrome) is a clonal malignacy of helper (CD4+) T lymphocytes usually first detected in the skin. In 8-55% of mycosis fungoides, the malignant T cell clone undergoes, cytologic transformation characterized by pleomorphic, large cells with prominent nucleoli, resulting in the morphologic appearance of a large cell lymphoma. The prognosis of large cell transformation of mycosis fungoides is poor; so detection of cytologic transformation is important to decide further treatment. We report a case of 22-year-old mycosis fungoides patient who developed large cell transformation during photochemotherapy (PUVA).

A Case of Sarcoidosis Showing Various Cutaneous Manifestations / 대한피부과학회지

Sarcoidosis is a chronic idiopathic disorder characterized by the accumulation of noncaseating granulomas. We report a case of sarcoidosis with various cutaneous manifestations in a 42-year old female. On cutaneous examination, there were multiple papules on the posterior neck and anterior chest, subcutaneous nodules along an old scar of the right scapular area, violaceous nodule with satellite lesions and subcutaneous nodule on the right knee. Histopathology revealed noncaseating granulomas in all 5 specimens. She was treated with oral prednisolone leading to an excellent clinical response within 3 months of treatment, and remains well without recurrence for follow-up period of 20 months. .

Hypopigmentation Occurred After Er: YAG Laser Resurfacing / 대한피부과학회지

BACKGROUND: Hypopigmentation is one of the complications developed after laser resurfacing. There have been few data about hypopigmentation developed after Er: YAG laser resurfacing, especially in darker skin. OBJECTIVE: The objective of this study was to assess the clinical and histopathologic features of hypopigmentation developed after Er: YAG laser resurfacing. METHODS: One hundred and ninety patients have been included in this study. Ninety seven patients were treated with short pulsed Er: YAG laser, 2mm spot sized handpiece at the setting of 12.5-15.0J/cm2. Fifty two patients were treated with variable pulsed Er: YAG laser, 5mm spot sized handpiece at the setting of 7.0-7.5J/cm2 and 7msec pulse duration. Forty one patients were treated with dual mode Er: YAG laser, 4mm spot sized scanner at the setting of 17.5J/cm2 ablation mode and 3.15J/cm2 coagulation mode. Incidence, time of onset, duration of hypopigmentation were evaluated throughout the medical charts and serially checked photographs. Skin biopsy was performed in four patients at the hypopigmentation site for histopathologic and electron microscopic examinations with informed consents. RESULTS: Hypopigmentation was observed in twenty six patients; eight in short pulsed Er: YAG laser, eight in variable pulsed Er: YAG laser, ten in dual mode Er: YAG laser. According to the time of onset of hypopigmentation, twelve patients developed hypopigmentation within one month, five patients in two months, three patients within three months, three patients within four months, two patients within five months, and one patient within six months. Twenty out of twenty six patients recovered skin coloration within six months, and two patients within twelve months. On the other hand, four patients had persisted hypopigmentation for more than one year. Melanosome appeared to be decreased but melanocytes appeared to be present in normal numbers on the histopathologic and electron microscopic examinations. CONCLUSION: Although hypopigmentation is one of the frequent complicaions of Er: YAG laser resurfacing, it is temporary in most cases. Thermal damage due to long pulse duration of laser seems to be a very important factor in inducing hypopigmentation.

Study of Dermatofibromas Using Immunohistochemical Staining / 대한피부과학회지

BACKGROUND: Dermatofibromas are common benign tumors which occur in the skin. They have been divided into "fibrous" lesions, composed entirely or almost entirely of fibroblasts and collagen, and "cellular" lesions composed to a significant degree of phagocytic cells with the appearance of histiocytes. A cellular variant characterized by increased cellularity, storiform arrangement, larger size, and location in the deep dermis, often with extension into the superficial subcutaneous tissue may be difficult to differentiate from dermatofibrosarcoma protuberans. There is an incessant controversy over the histogenesis of dermatofibromas, although many authors consider that these tumors derive from primitive mesenchymal cells. The recent development in immunohistochemical staining technology and ultrastructural study revealed various cellular proliferation in the lesion, including fibroblast, histiocyte and myofibroblast. OBJECTIVE: Our purpose was to study by immunohistochemistry the differences between fibrous and cellular dermatofibromas and to find the relationship between the myofibroblast and the histogenesis of dermatofibroma. METHODS: We will select 36 cases of dermatofibromas which include 27 fibrous and 9 cellular types. We have studied the immunophenotype of 36 dermatofibromas using antibodies against vimentin, smooth muscle actin, desmin, CD34, factor XIIIa, CD68 and MMP 11. RESULTS: All dermatofibromas were positive for vimentin, smooth muscle actin, and factor XIIIa, but negative for desmin and CD34. All cellular type were positive for CD68, but 24/27 of the fibrous type were positive for CD68. MMP 11 was positive in 6/9 of the cellular type and 25/27 of the fibrous type. The degree of staining for vimentin, factor XIIIa, CD68, and MMP 11 was not different in both types. But the degree of staining for smooth muscle actin in the fibrous type was higher than in the cellular type. CONCLUSION: The differences in the degree of staining for smooth muscle actin and the positivity for CD68 suggest the possibility of a different differentiation of dermatofibroma between cellular and fibrous types. The prominent vimentin and smooth muscle actin immunoreactivity and desmin non-reactivity may suggest that the myofibroblast may play a role, in part, for developing dermatofibromas. Further investigations with ultrastructural study using electron microscopy and double/triple immunohistochemical staining would be necessary.

A Case of Tuberculosis Verrucosa Cutis / 대한피부과학회지

We report a case of tuberculosis verrucosa cutis in a 39-year-old male patient, who presented verrucous plaque on the dorsum of right third finger. Seven months ago, he had a cut with paper and skin lesion developed. Histopathologic features revealed parakeratosis, irregular acanthosis in the epidermis and inflammatory cellular infiltrates and tuberculoid granulomas in the dermis. AFB- positive bacilli were demonstrated. He has been treated with isoniazid, rifampicin, ethambutol, and pyrazinamide for 4 months till now and the skin lesion has been markedly improved.

A Case of Congenital Triangular Alopecia in Infancy / 대한피부과학회지

Congenital triangular alopecia is an uncommon nonscarring form of alopecia. It presents with isolated alopecic patch at the frontotemporal area of the scalp. Although previously considered congenital, this condition usually is discovered after 2 years of age and, more recently, is thought to be acquired. We report a case of congenital triangular alopecia in a 12 month old female who had the lesion since birth.

In Vitro Effects of 1,25-Dihydroxyvitamin D3 on the Production of Interleukin-1alpha by Ultraviolet B Irradiation in Cultured Human Keratinocyte Cell Line HaCaT Cells / 대한피부과학회지

BACKGROUND: Keratinocyte-derived interleukin-1(IL-1)alpha is one of the key cytokines in initiation of cutaneous inflammation. Release of IL-1alpha from human keratinocytes may be induced by proinflammatory stimuli including ultraviolet B(UVB) irradiation, and subsequently, keratinocyte-derived IL-1alpha may exert numerous paracrine and autocrine effects. 1,25-dihydroxyvitamin D3(1,25(OH)2D3) is involved in the regulation of keratinocyte proliferation and differentiation and is also recognized to have immunoregulatory properties such as an antiinflammatory effect. OBJECTIVE: The purpose of this study was to investigate the in vitro effects of 1,25-(OH)2D3 on the production of IL-1alpha by UVB irradiation in cultured human keratinocyte cell line HaCaT cells. RESULTS: are summerized as follows; 1. The vialility of cultured HaCaT cells measured by MTS assay at 24 hours after UVB irradiation was significantly reduced at the doses of above 100 mJ/cm2 of UVB(p<0.05). 2. The secretion of IL-1alpha by HaCaT cells was significantly increased at the doses of above 30 mJ/cm2 of UVB(p<0.05). UVB irradiation could not influence on the secretion of IL-1beta by HaCaT cells. 3. At the concentrations of 10-8M and 10-6M of 1,25(OH)2D3, the production of IL-1alpha by HaCaT cells(48 hours after 100 mJ/cm2 UVB irradiation) was significantly inhibited in both culture supernatants and cell lysates(p<0.05). CONCLUSION: UVB irradiation increased the production of IL-1alpha by HaCaT cells and this stimulatory effect on the production of IL-1alpha induced by UVB irradiation was suppressed by 1,25-(OH)2D3. Calcipotriol(MC-903) had similar suppressive effect on the production of IL-1alpha induced by UVB irradiation in HaCaT cells to that of 1,25(OH)2D3.

A Case of Verrucous Hyperplasia in An Amputee / 대한피부과학회지

Chronic dermatological problems associated with lower limb amputation sites include local maceration, intertrigo, blistering and ulceration, contact dermatitis, tissue atrophy, verrucous hyperplasia, lichenification, callosities, epidermoid cyst formation, and malignant neoplasia. A 60 year-old male was presented with a verrucous oozing eruption of the amputation stump of the left leg. He had been involved in a railroad logging accident 30 years before, resulting in the loss of the left lower limb. He were a below-knee prosthesis (patellar-tendon hearing). We diagnosed him as verrucous hyperplasia by clinical and histological findings and then referred him to the division of rehabilitation for a refitting of his prosthesis, after which his eruption cleared two months later.

A Case Of Lymphangioma Circumscriptum: Magnetic Resonance Imaging (MRI) in Diagnostic Evalutaion

A 21-year-old male visited our clinic with an erythematous plaque studded with papulovesicules on the right thigh and calf which had been noticed at 3 months after birth. Moving the limb caused intermittent pain. He was diagnosed with lymphangioma circumscriptum which involved muscle layers after checking the skin biopsy and magnetic resonance imaging (MRI). Partial removal of mass resulted in relieving pain on motion.

A Case of Extramammary Paget's Disease on the Scalp

We treated a case of extramammary Paget's disease that affected the scalp of a 45-year-old female. It is extremely rare that the disease arises in areas other than the anogenital region and the axillae. The lesion was a round erythematous oozing crusted hairless patch. Histopathologically, many pagetoid cells were found within the epidermis and dermis. The cytoplasms of these cells stained with alcian blue at pH 2.5, CEA, EMA and low-molecular-weight-cytokeratin. The patient underwent a wide local excision. We used a mapping technique to reveal the distribution of microscopically involved lesions.

A Case of Primary Cutaneous Mucinous Adenocarcinoma / 대한피부과학회지

We report a case of primary cutaneous mucinous adenocarcinotna in a 64-year-old female. The tumor was about 2cm in size, forminga round dome-shaped alopecic scalp mass which had gradually increased in size over about 5 years, Histalogic examination revealed that the tumor was divided into numerous compartments by strands of fibrous tissue. In each compartment, abundant amounts of pale-staining mucin surrounded nests or cords of moderately anaplastic epithelial cells. We couldn't find any evidence of internal neoplasms as a source of metastasis. We resected the tumor with approximately a 1 cm margin and then performed a split thickness skin graft.

A Case of Generalized Pustular Psoriasis / 대한피부과학회지

We present a case of generalized pustular psoriasis in a 47-year-old female who was treated with cyclosporine and methotrexate. She developed generalized pustular eruptions after irregular therapy of steroid and etretinate for severe psoriasis. Treatment with cyclosporine and a steroid supplement produced much improvement, but during the tapering of cyclosporine there was aggravation with pusutules and fever. She was placed on methotrexate therapy. The pustules and erythema began to remit, and eventual clearing of the skin lesions was achieved in 4 months after introduction of methotrexate.

Incidence of Antithyroid Antibodies in Vitiligo Patients

BACKGROUND: Vitiligo is considered as an autoimmune disorder due to the generation and presence of autoantibodies directed against melanocyte antigens in the patients sera. Previous studies have revealed an increased incidence of organ-specific autoantibodies in vitiligo patients. A number of studies have demonstrated an increased frequency of thyroid autoantibodies in vitiligo patients and vitiligo is commonly seen in patients with clinical thyroid diseases. OBJECTIVE: The aim of this study is to investigate the incidence of antithyroid antibodies in vitiligo patients and to correlate the presence of these antibodies with factors such as sex, age, activity of the disease, duration of the disease and the type of vitiligo. Another aim of this study is to compare the incidence of abnormal thyroid function in those who have antithyroid antibody and those who don't. METHODS: One hundred and fifty seven vitiligo patients who visited vitiligo clinic in Samsung medical center from January of 1995 to November of 1996 were enrolled in this study. Detection and titration of antithyroid antibodies were performed by immunoradiometric assay. RESULTS: Among 157 patients tested, 17(10.8%) patients had antithyroglobulin antibodies and 10(6.4%) patients had antimicrosomal antibodies. Five patients had both antibodies. Statistically meaningful data are as follows; 1) Antimicrosomal antibody appeared less frequently in patients of childhood-onset. 2) Antithyroglobulin antibody was detected more frequently in active disease. Fifty nine out of 157 patients were examined for thyroid function. Four out of 22 patients with antithyroid antibody had abnormal thyroid function. None out of 37 patients without antithyroid antibody had abnormal thyroid function. CONCLUSION: The incidence of antithyroid antibodies according to onset age and activity is contradictory to previous reports, therefore large scaled study will be necessary to draw a conclusion.