Squamous Cell Carcinoma Originating from Frostbite-induced Osteomyelitis / 대한피부과학회지

Squamous cell carcinoma commonly originates from recalcitrant wound sites, including burn scars, pressure sores, stasis ulcers, osteomyelitis, and sites of frostbite. A 62-year-old male was referred to the dermatology department for skin necrosis of his right great toe and walking difficulty. He had a history of smoking, drinking alcohol, and frostbite of his right great toe 9 years prior, which deteriorated into osteomyelitis due to poor care. Although a skin biopsy was recommended before amputation, the two procedures were performed simultaneously due to a lack of toe function due to severe osteolysis. Biopsy of the amputated toe tip showed many lobules consisting of atypical keratinocytes with hyperchromatic nuclei, and severe dermal pleomorphism. After evaluation for distant metastasis, including a (99m) Tc-MDP bone scan, 18F-FDG positron emission tomography scan, computed tomography, and ultrasound, no metastasis was detected.

Comparison between Famciclovir and Valacyclovir for the Treatment of Herpes Zoster in Adults / 대한피부과학회지

BACKGROUND: Famciclovir and valacyclovir are antiviral agents commonly used to treat herpes zoster. These medications not only reduce the time to complete cessation of zoster-associated pain, but also aid in the healing of the herpes zoster skin lesions. However, only few studies have compared these antiviral agents. OBJECTIVE: We conducted a randomized clinical trial to evaluate the extent of pain relief and wound healing, and the rate of postherpetic neuralgia associated with these drugs during 4 weeks of treatment. METHODS: The study included 69 immunocompetent adult inpatients diagnosed with herpes zoster randomly divided into 2 groups based on the antiviral agent administered. Patient age, date of visit from rash onset, and rash severity at baseline were recorded. Famciclovir or valacyclovir were administered orally for 7 days. Patients reported pain levels through a visual analog scale (VAS) score, and pain durations were assessed on days 1, 3, and 7, and at weeks 2, 3, and 4. Crust formation and reepithelialization times of skin lesions were also recorded. RESULTS: VAS scores, pain durations, ratios of patients undergoing postherpetic neuralgia, and skin lesion healing rates did not differ significantly between the 2 groups. However, rash severity independently correlated with the extent of pain experienced. CONCLUSION: Famciclovir and valacyclovir are comparable to each other in resolving zoster-associated pain, postherpetic neuralgia, and zoster wound healing. Early antiviral treatment before expansion of the skin lesion would be helpful for rapid relief of herpes zoster pain.

An Analysis of Surgical Results of Punch Incision and Elliptical Excision in Removal of Epidermal Cysts from the Head and Neck / 대한피부과학회지

BACKGROUND: The removal of epidermal cysts from the head and neck can sometimes be challenging for dermatologists, due to the associated cosmetic effects. Punch incision is an alternative method to the traditional elliptical excision for the removal of epidermal cysts. It is simple to perform with commonly available instruments, and easy to learn. However, there is currently no randomized study directly comparing the long-term results of these two methods in Korea. OBJECTIVE: The purpose of this study was to evaluate the usefulness of punch incision as compared to elliptical excision for the removal of epidermal cysts, and to identify the characteristics of the lesions most suitable for punch incision. METHODS: We conducted a prospective randomized study. A total of 109 patients with non-infected epidermal cysts on the head and neck were randomly assigned to treatment with either punch incision or elliptical excision, between January 2012 and January 2013. Statistical analysis was performed to compare the differences between the two procedures with respect to the demographic data of the patients; size and location of the lesions; operative time; complications; recurrence; cosmetic results; and patient satisfaction. RESULTS: The mean operative time for the punch incision group was significantly shorter than for the elliptical excision group (p0.05). CONCLUSION: Punch incision requires less time than elliptical excision, and is associated with superior cosmetic results. Regardless of different demographic characteristics, duration, location, and size, any epidermal cyst on the head and neck can be effectively treated with punch incision. Thus, we suggest that punch incision may be a useful method for removing epidermal cysts of the head and neck.

Acquired Ectopic Nail as a Complication after Excision of Epidermal Cyst / 대한피부과학회지

No abstract available.

The Effect of Light Emitting Diode on Acute Pain and the Inhibitory Effects of Postherpetic Neuralgia in Patients with Herpes Zoster / 대한피부과학회지

BACKGROUND: Acute pain and postherpetic neuralgia often interfere with life quality severely. Light emitting diode (LED) has been proposed as one of the effective therapeutic tools for pain reduction. However, little has been published in the Korean medical literature about the effect of LED on acute pain and the inhibitory effects of postherpetic neuralgia (PHN) in patients with herpes zoster. OBJECTIVE: The purpose of this study was to evaluate the efficacy of LED on acute pain and the inhibitory effects of PHN in patients with herpes zoster. METHODS: Sixty patients who were hospitalized for herpes zoster were evaluated according to their age, sex, associated disease, nature of pain, interval between diagnosis, therapy, and PHN. The patients were randomly placed into either a LED group treated with I.V acyclovir, analgesics and LED or a control group treated with I.V acyclovir and analgesics alone. The severity of pain was evaluated by patients themselves using a visual analogue scale (VAS) and a verbal rating scale (VRS) at one week intervals. The occurrence of PHN was assessed at 4 weeks after the initial development of the characteristic skin lesion of herpes zoster. RESULTS: The average days required for pain relief was significantly shorter in the LED group than the control group. The average weeks needed to reduce pain from 100 to 50 in the VAS, implicating relief of acute pain, were 1.4 weeks in the LED group and 1.8 weeks in the control group (p0.05). CONCLUSION: LED is an effective method which can be used to relieve acute herpes zoster pain quickly; however, LED cannot reduce the onset of PHN effectively.

Multiple Trichoepithelioma Improved by Intralesional Bleomycin Injection / 대한피부과학회지

Multiple trichoepithelioma is a benign adnexal neoplasm characterized by the presence of many small papules that appear predominantly on the face. Clinical improvement have been demonstrated after several treatments such as carbon dioxide laser, cryotherapy, dermabrasion, and argon laser. However, these destructive methods have various disadvantages. We report a case of multiple trichoepithelioma treated with an intralesional bleomycin injection. Fewer lesions without scars and cosmetic improvements were observed. Bleomycin is a cytotoxic antitumor antibiotic that can be injected intralesionally by transcutaneous administration and displays excellent results for treating malignancies including skin tumors. We believe that intralesional bleomycin injection is an effective treatment option for this condition, and an easy method to conduct at the outpatient clinic.

A Case of Dermatomyositis with Acute Interstitial Pneumonitis Manifested as Antisynthetase Syndrome / 대한피부과학회지

Dermatomyositis is a systemic inflammatory disease affecting the skin, skeletal muscle, and occasionally, other organs, such as the lung. Interstitial lung disease (ILD) is a serious lung complication, which can occur in patients with dermatomyositis. It affects the prognosis of the disease and requires a more aggressive therapeutic approach. Interstitial lung disease (ILD) may be associated with systemic inflammatory disorders and autoantibody production. In particular, anti Jo-1 antibody has long been recognized as an important predictive factor in systemic manifestations of ILD in dermatomyositis. We report here a case of a 42 year old woman with cutaneous lesions typical of dermatomyositis, showing clinical features of antisynthetase syndrome, which showed rapid progression to acute respiratory distress syndrome.

Association between Palmoplantar Pustulosis and Cigarette Smoking in Korean / 대한피부과학회지

BACKGROUND: Palmoplantar pustulosis (PPP), a skin disease, is characterized by chronically recurring sterile pustules on the palms and the soles. Although the etiology of PPP is unknown, it is interesting to note high prevalence of tobacco use in these patients. It would seem that there may be a relationship between PPP, autoimmune disease and alterations of thyroid function. However, this fact was never verified among Korean. OBJECTIVE: This study aims to explore smoking as a risk or exacerbation factor for PPP in Korean patients with PPP, and confirm the relationship between PPP and other factors, including thyroid disease. METHODS: We studied a total of 109 patients (M:F=38:71) with ages ranging from 20 to 70 years, diagnosed with PPP. A control group was matched according to gender and age: 109 patients with other dermatologic problem. Patients were interviewed about tobacco use, and thyroid disease, and autoimmune diseases. The data were analyzed to determine whether there was any association between PPP and various factors. RESULTS: The proportion of PPP patients using tobacco was much higher than that of the control group (p<0.05). Smoking was more strongly associated with PPP among women. Although there was no association between the quantity of cigarettes smoked daily and the severity of PPP, there was a dose-dependent correlation between the pack*year and the severity of PPP (p<0.05). Furthermore, 14 patients had been diagnosed with thyroid disease. In addition, all of them were smokers. CONCLUSION: There was significant association between PPP and smoking. However, the impact of giving it up in the clinical course of the disease remains to be established. In addition, it would seem that there may be a relationship between PPP and alteration of thyroid function.

Ulcerative Necrobiosis Lipoidica Improved by Hydroxychloroquine / 대한피부과학회지

Necrobiosis lipoidica (NL) is a chronic granulomatous skin disease of unknown etiology, which can be seen in patients with diabetes mellitus. Typical lesions of NL appear on the pretibial skin as painful yellow-brown inflammatory plaques with raised borders and atrophic centers. Ulceration occurs in approximately 35% of cases, leading to increased risk of secondary bacterial infection and scarring. Although there have been many proposed therapies for ulcerative NL, the response to treatment is often met with limited success. Here, we report a case of a 19-year-old girl with ulcerative NL, which showed improvements with oral hydroxychloroquine, an antimalarial agent.

Clinical Study of Motor Paresis in In-patients with Herpes Zoster / 대한피부과학회지

BACKGROUND: Although herpes zoster primarily affects afferent sensory neurons, it may complicated by motor nerve involvement in 0.5% to 5% of cases. However herpes zoster-induced muscle paresis is still under-recognized by dermatologists, and there has been insufficient clinical investigation of these conditions. OBJECTIVE: This study was conducted to investigate the clinical aspects of motor nerve involvement of herpes zoster. METHODS: We retrospectively reviewed the data of 711 patients with herpes zoster who had been admitted to our hospital in the departments of dermatology, ophthalmology, otorhinolaryngology, neurology, neurosurgery and rehabilitation medicine between 2005 and 2010. RESULTS: Among the 711 patients with herpes zoster, 15 patients had motor paresis (2.1%). 11 patients (73.3%) had facial nerve palsy including one patient who had accompanying vagus nerve palsy. Besides, one case of trochlear nerve palsy, one case of hypoglossal nerve palsy, one case of upper limb paresis and one case of lower limb paresis were noted. Associated underlying diseases were observed in nine patients (60.0%). Duration of motor weakness ranged from 1 month to 4 years. Twelve patients (80.0%) achieved complete recovery. CONCLUSION: In our patient population, the incidence of motor involvement of herpes zoster was higher in cranial nerves, especially the facial nerve, than in spinal nerves. Although motor nerves are usually involved in relation to dermatome, cranial nerve palsy may occur regardless of its dermatome because of complicated anatomical association. The majority of cases recovered completely without any complications. Further prospective investigation with a large group of patients is necessary to better understand the epidemiology of motor nerve involvement of herpes zoster.

A Case of p-ANCA-Positive Propylthiouracil-Induced Pyoderma Gangrenosum

Propylthiouracil is a common medication used in patients with hyperthyroidism; it can cause perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) in some patients with Graves' disease. This antibody has been associated with various forms of vasculitis and neutrophilic dermatosis. Herein, we report a patient who presented with cutaneous manifestations of pyoderma gangrenosum with simultaneous development of p-ANCAs during PTU therapy for Graves' disease.

Surgical Excision and Postoperative IPL Epilation for Preventing Recurrence of Pilonidal Sinus / 대한피부과학회지

Pilonidal sinus (PS) is one of follicular occlusion tetrad, and this is a chronic inflammatory disease that's characterized by a sinus or cyst with entrapped hair in the midline of the sacral region. The exact pathogenesis of PS remains unknown, but hair insertion may be the essential cause of the disease. PS is usually treated by surgical excision, marsupialization or incision and curettage. However, these surgical options often exhibit high recurrence rate, and especially for hirsute patients. Laser epilation has recently been recommended as an effective postoperative adjunctive therapy for PS and this treatment may reduce recurrence of PS. We report here on a 37-year-old male patient with PS, and the PS was treated by surgical excision and postoperative intense pulsed light (IPL) epilation.

Calciphylaxis Treated with Phosphate Binder Sevelamer Hydrochloride in a Patient Who Was Operated on for Parathyroidectomy / 대한피부과학회지

Calciphylaxis is a rare, but serious disorder that is usually observed in patients with renal disease and secondary hyperparathyroidism. It is characterized by the ischemic necrosis of the skin, the underlying tissue and other organs, as well as rapid vascular calcification. Prompt diagnosis and management is required because the intractable skin necrosis sometimes causes lethal sepsis. Sevelamer hydrochloride is an ion-exchanging resin that binds phosphates in the gut without increasing the calcium load. Treatment with it may lead to less vascular calcification and better survival for patients with chronic renal disease. Herein we present a case of calciphylaxis with renal failure and the patient improved after treatment with sevelamer hydrochloride therapy.

A Case of Cutaneous Endometriosis Combined with Epidermal Cyst in the Cesarean Section Scar / 대한피부과학회지

Endometriosis is the abnormal growth of endometrial glands and stroma outside the uterine cavity. Cutaneous endometriosis is a very rare form of extrapelvic endometriosis, and this most commonly occurs at the site of a previous abdominal or pelvic procedure such as hysterectomy, laparoscopy, episiotomy and cesarean section. The classic symptom is a painful nodule that becomes bigger and tenderer during menstruation. Because cutaneous endometriosis is unfamiliar to dermatologists, it can be easily misdiagnosed as other skin tumors. We present here a case of cutaneous endometriosis combined with epidermal cyst, and this developed in the cesarean section scar of a 28-year-old woman.

Effects of L-Arginine and N-Nitro-L-Arginine Metheylester Treatment on Vasodilation of Propofol in Rat Thoracic Aortic Rings / 대한마취과학회지

BACKGROUND: Propofol decreases arterial blood pressure. This has been ascribed to vasodilation and decreased cardiac output occurring separately or in combination. This study investigated the relaxant effects of propofol and the effects of L-arginine and L-NAME on the vasodilation of propofol in rat thoracic aortic rings. METHODS: Isolated aortic rings were precontracted with phenylephrine (0.01 micrometer -10 micrometer) cumulatively and 10 minutes before the precontracted phenylephrine treatment, propofol was added cumulatively (1 micrometer-10 micrometer). The effects of L-NAME and L-arginine were evaluated by applying L-NAME (10 micrometer) and L-arginine (10 micrometer) after added propofol and before precontracted phenylephrine. RESULTS: A low concentration of propofol (1 micrometer) did not reduce phenylephrine-induced contraction but a high concentration of propofol (over 10 micrometer) reduced it significantly. Propofol also relaxed rat thoracic aortic rings in an endothelium independent manner. The L-NAME and L-arginine treatment did not affect the propofol-induced relaxation. CONCLUSIONS: Propofol was shown to have a biphasic vasoactive effect on rat thoracic aorta rings. The vasodilation effect of propofol was not related to the production of nitric oxide.