Tuberculoid-type Leprosy Mimicking Tinea Corporis / 대한피부과학회지

A 59 year-old man developed a large, reddish, well-defined, scaly patch on his submental area 37 years before visiting our department; the patch showed central atrophy and was enlarged. He was erroneously treated for tinea corporis at private clinics for 5 years before the correct clinicopathological diagnosis of tuberculoid-type leprosy was made. We report this case to suggest that dermatologists should play an important role in the diagnosis and treatment of leprosy, and that they should pay careful attention while diagnosing new cases of leprosy.

Pincer Nail Deformity Treated with Widening of the Nail Bed / 대한피부과학회지

Pincer nail deformity is a nail deformity characterized by a transverse overcurvature of the nail plate, which increases along the longitudinal axis. Many conservative and surgical treatment modalities have been reported. Conservative methods can be difficult to use in cases of severe deformity because of their high recurrence rate. Therefore, surgical techniques, including nail matricectomy or correction of the nail bed, have been preferred in these cases. Matricectomy is generally considered as the surgical treatment of pincer nail deformity because of low recurrence rate in the field of dermatology. However, poor cosmetic results (e.g. narrowing of nail plate) are frequently observed. We present here a case of pincer nail deformity in the left great toe in a 57-year-old man who was treated successfully with widening of the nail bed without matricectomy. This method is an effective surgical technique preserving the nail matrix for the correction of pincer nail deformity.

The Differential Expression of Lysyl Oxidase in Keratoacanthoma and Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: Because keratoacanthoma (KA) and squamous cell carcinoma (SCC) are very similar with respect to clinical and histological features but are different with respect to prognosis and treatment, it is necessary to differentiate these two diseases. A number of recent studies have been attempted to differentiate these two diseases using immunohistochemical stains; however, the results obtained using these approaches were inconsistent. OBJECTIVE: The purpose of this study was to examine the expression pattern of polyclonal antibody to lysyl oxidase (LOX) on KA and SCC using an immunohistochemical staining method, and to evaluate the ability of this method in distinguishing these two diseases. METHODS: The expression of LOX in 10 cases of KA and 10 cases of SCC, which were confirmed by histopathologic examination, and 10 cases of normal human skin as a control, were evaluated using an immunohistochemical staining method. We divided the degree of immunohistochemical staining into three classifications --high density, low density, and no density-- based on the level of the expression of LOX in the epidermis and the tumor. Evaluation of the immunohistochemical staining was performed by two dermatologists and one pathologist. RESULTS: The rates of high, low, and no density in KA were 50%, 50%, and 0%, respectively. The rates of high, low, and no density in SCC were 40%, 10%, and 50%, respectively. The rates of high, low, and no density in the control group were 70%, 30%, and 0%, respectively. CONCLUSION: Because the degree of LOX expression in KA and SCC was very diverse, it could not be reliably used as a differential stain for the two diseases. But interestingly, no LOX expression was observed in SCC. This suggests that if expression of LOX is absent, there is a high probability of being diagnosed with a malignant skin tumor rather than a benign skin tumor.

Painful Nodular Chancre of the Lower Lip / 대한피부과학회지

No abstract available.

Syringoid Eccrine Carcinoma on the Dorsum of Hand / 대한피부과학회지

No abstract available.

Eccrine Poroma Presenting as Pedunculating Mass on the Flank / 대한피부과학회지

Eccrine poroma is a benign neoplasm, arising from the eccrine sweat duct. It generally occurs in middle aged individuals and is most commonly found on the sole or the sides of the foot, followed by the hands and fingers. It presents as a solitary, soft or a rather firm consistent, sessile or often slightly pedunculating, tumor. A 47-year-old woman presented with a 2.5x1.5 sized brownish to erythematous pedunculating mass on the left flank. According to histopathologic finding and immunohistochemical staining (epithelial membrane antigen), the final diagnosis was consistent with eccrine poroma. We report here on an interesting case of eccrine poroma presenting as pedunculating mass on the flank, which is an unusual location.

Malignant Fibrous Histiocytoma on the Face / 대한피부과학회지

Malignant fibrous histiocytoma (MFH) is an aggressive soft-tissue sarcoma that most commonly occurs in the skeletal muscle of the extremities or retroperitoneum of the middle and late adulthood. We present a case of a 65-year-old woman who was presented with an asymptomatic erythematous nodule with central erosion on left temporal area. She was diagnosed with MFH, and then underwent Mohs micrographic surgery and flap coverage. No sign of metastatic recurrence was noted during the 6 month follow-up period.

Classic Type Ehlers-Danlos Syndrome with Cutis Laxa-like Histopathologic Findings / 대한피부과학회지

Ehlers-Danlos syndrome is a connective tissue disorder that is characterized by hyper-extensible skin, hyper-mobile joints, fragile tissues, bleeding diathesis and poor healing of wounds with "cigarette paper" scar formation. Cutis laxa is also a disease of the elastic fibers of the connective tissue and characterized by loose skin folds over all parts of the body, a prematurely aged appearance, a hooked nose with a short colummella and umbilical/inguinal hernias. We report here on two patients who showed the symptoms of Ehlers-Danlos syndrome with histopathologically reduced and distorted elastic fibers, which is usually seen in cutis laxa.

Crusted Scabies Misdiagnosed as a Cutaneous Side Reaction due to Allopurinol in a Patient with Acquired Perforating Dermatosis / 대한피부과학회지

Crusted (Norwegian) scabies is a clinical variant of human infestation with Sarcoptes scabiei, and is characterized by extensive, heavily crusted skin lesions. It usually affects immunocompromised patients. The diagnosis is commonly missed, and can lead to mismanagement. Here we report a case of crusted scabies misdiagnosed as a cutaneous side reaction due to allopurinol in a 48 year old male patient with acquired perforating dermatosis who had been treated with allopurinol for about 20 weeks. The lesion showed pruritic, excessive hyperkeratotic scaly crusts and fissures on the hands, and on pelvic, genital and inguinal areas. His skin lesions disappeared after treatment with 10% crotamiton cream for 2 weeks.

Aeromonas hydrophila Sepsis Mimicking Vibrio vulnificus Infection

Aeromonas hydrophila is a facultatively anaerobic, asporogenous gram-negative rod that has often been regarded as an opportunistic pathogen in hosts with impairment of a local or general defense mechanism. A 68-year-old alcoholic woman presented with shock and gangrene on the right arm. At first, her clinical presentations were severe painful erythematous swelling that worsened within a few hours with development of gangrene, edema, and blisters. Bullous fluid and blood cultures yielded A. hydrophila. Histopathological findings of sections obtained from the vesicle revealed subepidermal vesicles; necrosis of the epidermis, papillary dermis, and subcutaneous fat; and massive hemorrhage in the subcutis. Despite all efforts to save the patient, she died 8 hours after admission. Clinical features of A. hydrophila sepsis resemble those of Vibrio vulnificus sepsis. Therefore, in addition to the case report, we compared the cultural, biochemical, and morphological differences between A. hydrophila and V. vulnificus for facilitation of early and accurate identification of the causative agent.

Clinical Comparison of In-patients with Drug-induced Hypersensitivity Syndrome between the Departments of Dermatology and Internal Medicine / 대한피부과학회지

BACKGROUND: Because more severe patients tend to be admitted to the Department of Internal Medicine, drug-induced hypersensitivity syndrome may be underestimated by the dermatological evaluation of only in-patients. OBJECTIVE: The purpose of this study was designed to compare the clinical features of in-patients with drug-induced hypersensitivity syndrome in the Departments of Dermatology and Internal Medicine. METHODS: Between January 2000 and September 2010, we retrospectively reviewed the medical records of 10 in-patients in the Department of Dermatology and 11 in-patients in the Department of Internal Medicine in drug-induced hypersensitivity syndrome. RESULTS: The average age of onset was older in the internal medicine group than the dermatology group. The most common causative agent in the dermatology group was carbamazepine. The most common causative agents in the internal medicine group were carbamazepine, anti-tuberculosis, and allopruinol. The average latent period was longer in the internal medicine group than the dermatology group. The most common morphological feature in the dermatology group was maculopapular eruption, but in the internal medicine group was exfoliative dermatitis. Abnormal laboratory findings in drug-induced hypersensitivity syndrome were more severe in the internal medicine group than the dermatology group. The average treatment period was longer in the internal medicine group than the dermatology group. CONCLUSION: Our study suggests that in-patients of the internal medicine in drug-induced hypersensitivity syndrome are more severe than in-patients ofthe dermatology. Therefore, it is important that dermatologists recognize the concept of this syndrome much more widely.

Frequently Relapsing Secondary Cutaneous Diffuse Large B-cell Lymphoma in the Skin / 대한피부과학회지

We report a case of cutaneous diffuse large B cell lymphoma in a 66-year-old male who had a 5-year history of diffuse large B cell lymphoma on the left inguinal lymph node. The patient visited our clinic for the first time for relief of a non-tender well-defined erythematous hard nodules on the left foot and left thigh that had been present form 6 months and 1 month, respectively. Histologic examination revealed diffuse dense infiltration of large neoplastic lymphocytes with scanty cytoplasm and large nuclei. They showed a positive reaction to CD20 and CD79a, suggesting a B cell lineage. The patient was diagnosed with secondary cutaneous diffuse large B cell lymphoma. After 1 month of radiation therapy, complete remission was achieved. Five and seven months later, the patient returned foe relief of non-tender red-to-brown hard nodules on the left and right thigh, respectively. Histologic examination and immunohistochemical stain prompted the same diagnosis as previously. After radiotherapy and chemotherapy, the skin lesion was nearly resolved, and no evidence of extracutaneous involvement has been noted since.

Unilateral Acanthosis Nigricans on Non-flexural Area / 대한피부과학회지

Unilateral acanthosis nigricans (AN) is an exceedingly rare disorder, probably viewed as a nevoid disorder and sometimes called nevoid AN, which is characterized by hyperkeratosis, papillomatosis and moderate acanthosis. The lesions of unilateral AN are distributed unilaterally and morphologic features are similar to other forms of AN. It is not associated with a syndrome, endocrinopathy, drugs or cancers. Here we describe a case of unilateral AN in a 16 year-old Korean man who presented with a broad ashy brown hyperpigmented, confluent hyperkeratotic plaque on the right posterior thigh.

Localized Cutaneous Infection due to Scedosporium apiospermum / 대한의진균학회지

Scedosporium(S) apiospermum is the asexual stage of Pseudallescheria boydii. The organism has been isolated from polluted water, soil, sewage and potted plants in a hospital with low virulence. This ubiquitous fungus causes not only mycetoma, but also infections of variety of body sites including the skin. Localized skin infection without grain production due to this organism is much rarer than mycetoma. Infection may occur via direct inoculation and usually affects the extremities. We report a case of localized cutaneous infection due to S. apiospermum which occurred in a 79-year old female. She presented multiple erythematous papulopustules on the right wrist. Culture isolation for definitive diagnosis showed S. apiospermum. The patient was treated successfully with oral itraconazole 200 mg daily for 4 weeks.

Axillary Hidradenitis Suppurativa Treated with a Split Thickness Skin Graft after Wide Excision / 대한피부과학회지

Hidradenitis suppurativa is a chronic, relapsing suppurative disease of the apocrine sweat glands that principally affects the axillary and anogenital regions. The etiology of this disorder remains unknown. As conservative treatment usually does not prevent recurrence, surgical treatment is the method of choice, particularly for advanced case. We report a 25-year-old male patient who presented with a 7-year history of abscesses with foul-smelling discharge from his axilla. After failed medical therapy, he was referred for surgery. We performed a wide excision of the axilla with a split thickness skin graft after 1 week. The patient has been doing well, and there has been no relapse for about ayear after the operation.

Erythrokeratodermia Variabilis with Congenital Deaf-Mutism / 대한피부과학회지

Erythrokeratodermia variabilis is a rare genodermatosis characterized by the coexistence of randomly occurring, transient, erythematous patches and hyperkeratosis of the skin. A 25-year-old Uzbekistanian female with congenital deaf-mutism presented with well demarcated geographic hyperkeratotic patches and bizarre erythema on the whole body surface except the face, hands and feet from birth. The histopathological examination revealed marked hyperkeratosis, moderate acanthosis in the epidermis and vascular dilatation with a perivascular infiltration of inflammatory cells in the upper dermis. Herein we report on a rare case of erythrokeratodermia variabilis with congenital deaf-mutism which was rapidly improved by administering acitretin.

Correction of Pincer Nail Deformity Using Dermal Grafting

Pincer nail deformity is characterized by excessive curvature and distortion of the nail in the transverse dimension, and particularly at the distal part of the nail plate. This deformity leads to pinching off and loss of soft tissue in the affected digit, causing severe pain. Many treatment methods have been proposed; however, an effective long-term method preserving the nail matrix has not yet been established. We present here a case of pincer nail in the left thumb in a 49-year-old woman who was treated successfully with dermal grafting under the nail bed. We describe the surgical method and the treatment results. To the best of our knowledge, this is the first report in the Korean medical literature on the use of dermal grafting for the treatment of pincer nail deformity.

Condyloma Lata of the Tongue / 대한피부과학회지

Condyloma lata is one of the cutaneous manifestations of secondary syphilis. They are extremely infectious, moist papules that are commonly seen on patients with secondary syphilis. Condyloma lata commonly affects the intertriginous skin, and especially that of the genitalia, the perianal area and axilla, which all suffer from heat, moisture and friction. However, they are rarely seen on the tongue. A 19-year-old male patient presented with multiple erythematous papules and plaques on the tongue. But he did not have any other cutaneous eruption. Histopathological findings revealed irregular epidermal hyperplasia and perivascular inflammatory cell infiltration with lymphocytes and plasma cells in the dermis. The VDRL and TPHA test were both positive.

Extensive Cornifying Darier's Disease without a Family History / 대한피부과학회지

Darier's disease is an uncommon inheritable genodermatosis that is characterized by recurrent waxy, hyperkeratotic papules that usually occur over the seborrheic areas. The characteristic histopathological changes are acantholysis leading to the formation of lacunae and dyskeratosis with corps ronds and grain, which are diagnostic clues of the disease along with the typical clinical features. A 50-year-old Korean male patient presented with an extensive involvement of whitish thick hyperkeratotic fissures, verrucoid plaques with oozing and foul odor over the skin for about 30 years. We report here on an unusual case of extensive cornifying Darier's disease in a patient who has no family history of this disease.

Successful Treatment of Steatocystoma Multiplex with OK-432 Sclerotherapy / 대한피부과학회지

Steatocystoma multiplex is a hamartomatous malformation of the pilosebaceous junction and this manifests as multiple, asymptomatic, yellowish or skin-colored cystic papules and nodules located most commonly on the upper anterior portion of the trunk, upper arms and axillae. Various treatment methods such as radical excision, simple surgery, CO2 laser, cryotherapy, needle aspiration and oral retinoids have been reported, but there is currently no standard treatment. OK-432 is a biological preparation consisting of lyophilized powder containing Streptococcus pyogenes Su strain cells (group A, type3) that were treated with benzylpenicillin potassium. This has been used for sclerotherapy in patients with lymphangioma. We herein report on a case of 36-year-old female with steatocystoma multiplex on the trunk and axillary area. She was successfully treated with intralesional infusion of OK-432 after aspiration of the oily contents without recurrence or any complications such as scarring, atrophy and skin necrosis. We suggest that this sclerotherapy is a cosmetically acceptable treatment option for the multiple lesions of steatocystoma multiplex.