Changes in Skin Color after Smoking Cessation / 가정의학회지

This study was performed to assess changes in skin color over 1 month after smoking cessation. The study population consisted of 49 men who participated in a smoking cessation program from March 2010 to June 2010 at a public health centre in Yangsan, South Korea. Thirty-four men who stop smoking completely were included in our study. Instrumental evaluations of skin color were performed using Mexameter (MX 18; Courage and Khazaka Electronic GmbH) at the beginning of the study and at 1-week and 4-week follow-up visits. Skin color was evaluated by measurement of 2 main color bases-melanin and haemoglobin-with the results expressed as melanin index (MI) and erythema index (EI). Both MI and EI were significantly reduced at the 4-week follow-up visit on all 7 sites measured. We anticipate that desirable effects on skin color after smoking cessation will play a positive role in maintaining smoking abstinence in routine clinical practice.

Clinical Character istics of Itch in Patients with Adult and Childhood Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Itch is an essential feature of atopic dermatitis (AD). Active AD cannot be diagnosed without a history of itch. There has been no previous study delineating the different characteristics of itch according to age. OBJECTIVE: We wanted to characterize and compare the clinical patterns and the sensory and affective dimensions of itch in adult and childhood AD patients. METHODS: A face-to-face structured questionnaire based on the McGill pain questionnaire was given to 90 patients with AD. The patients were classified into two groups: adult AD patients (> or =15 years old) and childhood AD patients (<15 years old). RESULTS: Eighty-eight percent of the total AD patients experienced itch everyday. This itch was mostly aggravated during the summer and at night in both groups of AD patients. The antecubital fossae, popliteal fossae and neck were the major sites of involvement with itch. More patients perceived the characteristics of itch as crawling, burning and tickling rather than stinging, stabbing and pinching. The majority of AD patients answered that sweat and hot climate aggravated the itch and medications and cold climate alleviated the itch. However, compared with the childhood patients, more adult patients experienced the aggravation of itch by exposure to dust, and the itch was alleviated by taking medications and by concentrating on work. A burning sensation with itch was more frequently reported by the adult patients when compared to that of the childhood patients. CONCLUSION: This study highlights the detailed description and characteristics of itch in adult and childhood AD patients. The proper management of itch according to age may be prerequisite to improve AD patients' quality of life.

Clinical Character istics of Itch in Patients with Adult and Childhood Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Itch is an essential feature of atopic dermatitis (AD). Active AD cannot be diagnosed without a history of itch. There has been no previous study delineating the different characteristics of itch according to age. OBJECTIVE: We wanted to characterize and compare the clinical patterns and the sensory and affective dimensions of itch in adult and childhood AD patients. METHODS: A face-to-face structured questionnaire based on the McGill pain questionnaire was given to 90 patients with AD. The patients were classified into two groups: adult AD patients (> or =15 years old) and childhood AD patients (<15 years old). RESULTS: Eighty-eight percent of the total AD patients experienced itch everyday. This itch was mostly aggravated during the summer and at night in both groups of AD patients. The antecubital fossae, popliteal fossae and neck were the major sites of involvement with itch. More patients perceived the characteristics of itch as crawling, burning and tickling rather than stinging, stabbing and pinching. The majority of AD patients answered that sweat and hot climate aggravated the itch and medications and cold climate alleviated the itch. However, compared with the childhood patients, more adult patients experienced the aggravation of itch by exposure to dust, and the itch was alleviated by taking medications and by concentrating on work. A burning sensation with itch was more frequently reported by the adult patients when compared to that of the childhood patients. CONCLUSION: This study highlights the detailed description and characteristics of itch in adult and childhood AD patients. The proper management of itch according to age may be prerequisite to improve AD patients' quality of life.

Primary Cutaneous Epithelioid Hemangioendothelioma on the Back / 대한피부과학회지

Epithelioid hemangioendothelioma (EHE) is an uncommon vascular neoplasm that is considered to be a low-grade malignancy with a severity between an angiolymphoid hyperplasia with eosinophilia and an epithelioid hemangiosarcoma. The appearance of cutaneous EHE is extremely rare and only about 20 cases have been reported in the Korean and English literatures. A 70-year-old man presented with an approximately 1-year history of an isolated painful subcutaneous nodule of the back. A histopathologic examination revealed nests and cords of epithelioid eosinophilic cells in hyalinized stroma with intracytoplasmic vacuoles. Tumor cells were strongly positive for the endothelial cell markers CD31 and CD34, and we didn't find any metastatic lesions under radiologic examination. On the basis of these findings, the diagnosis of primary cutaneous EHE was made. To our knowledge, cutaneous EHEs were reported in only 2 cases in the Korean literature, and that of the trunk has not been published previously. Moreover, there is no meta-analytic study about cutaneous EHE. So, we report here a rare case of EHE of the back and review the relevant literature.

Multiple Eccrine Hidrocystomas Treated with Botulinum Toxin Type-A / 대한피부과학회지

Eccrine hidrocystomas are benign tumors of the sweat glands that arise from cystic dilatation of the excretory sweat ducts. They may be solitary or multiple. Multiple lesions are observed as small papulonodules having prominent surfaces with a translucent intense bluish dome, localized predominantly to periorbital and malar areas. The diagnosis of multiple eccrine hidrocystomas is clinical, and surgery is the treatment of choice in the case of a single lesion. However, the treatment of multiple eccrine hidrocystomas is challenging and the outcome of conventional therapies varies. Botulinum toxin type-A (BTA) causes chemodenervation at the cholinergic nerve terminal of eccrine glands; accordingly our patient was given intradermal injections of BTA and the result was successful. Herein, we report a case of multiple eccrine hidrocystomas treated successfully with BTA; we believe that BTA can be a novel treatment option for this condition.

Mybacterium chelonae Infection Occurring at the Site of Bee Sting Therapy / 대한피부과학회지

Mycobacterium chelonae is a rapidly growing atypical mycobacterium found in soil and water. In a healthy person, it causes cutaneous infection after an invasive procedure or surgery. Herein, we present a case of a 52-year-old man with multiple erythematous plaques and nodules on the back and left arm, and these occurred at the site of bee sting therapy by a herbal medical doctor. The histologic findings showed a granulomatous infiltration composed of numerous neutrophils, lymphocytes, eosinophils, histiocytes and multinucleated giant cells. Acid fast bacilli were detected by Ziehl-Neelsen stain and Mycobacterium chelonae infection was confirmed by an INNO-LiPA mycobacteria kit. The patient was treated with 1 g of clarithromycin and 200 mg of doxycycline for 6 months and his condition improved considerably.

An Open, Randomized, Comparative Clinical and Histological Study of Imiquimod 5% Cream Versus 10% Potassium Hydroxide Solution in the Treatment of Molluscum Contagiosum

BACKGROUND: Although molluscum contagiosum (MC) resolves spontaneously, there are several reasons to treat this dermatological disorder. OBJECTIVE: To evaluate the safety and efficacy of 5% imiquimod cream versus 10% potassium hydroxide (KOH) solution in treating MC, and to propose the mechanism of cure by observing the histological findings. METHODS: Imiquimod or KOH were applied by the patient or a parent 3 days per week until all lesions cleared. The number of MC lesions was counted and side effects were evaluated at 5 points during the treatment (the initial visit, week 2, week 4, week 8, and week 12). Histological changes were compared between 2 patients of each group, before and after the 2 weeks of application. RESULTS: In both group, the mean lesion counts decreased all through to week 12, and the reduction in number of lesions were statistically significant in both groups (p <0.005). Over 40% of each group developed local side effects, and no systemic side effects were noted in either group. Before treatment, histological findings showed little or no dermal infiltrates. After treatment, specimens showed dense lymphocytic infiltrates, especially T cells, around the lesions which had resolved. CONCLUSION: Both 10% KOH solution and 5% imiquimod cream are effective and safe treatment of MC.

The Efficacy of Topical Calcineurin Inhibitors for Treating Lichen Striatus / 대한피부과학회지

BACKGROUND: Lichen striatus is a well-known, acquired, self-healing, linear inflammatory dermatosis. The therapeutic approach that is usually adopted is topical steroid, even though the prolonged use of this may lead to several side-effects, and particularly cutaneous atrophy. OBJECTIVE: The purpose of this study was to evaluate the efficacy of topical calcineurin inhibitors for the treatment of lichen striatus. METHODS: Twenty nine patients received topical application of calcineurin inhibitors twice a day up to the marked disappearance of the cutaneous lesions. RESULTS: Six (20.7%) of 29 patients achieved a complete response after a mean treatment period of 2.5 months. A good response was observed in 8 patients (27.6%) and a partial response was seen in 8 patients (27.6%). Of the 29 patients, 22 patients (75.9%) had more than a 50% response without any severe adverse effects. No significant differences in the therapeutic responses were found with regard to the patients' ages, the duration of the disease and the length of the treatment periods. CONCLUSION: Our results show that topical calcineurin inhibitors may well represent a useful therapeutic alternative for the treatment of lichen striatus.

Assessment of the Quality of Life in Patients with Varicose Veins for Evaluation of Treatment Effect / 대한피부과학회지

BACKGROUND: Varicose veins are the most common venous condition of the lower extremities. Treatment for varicose veins varies from surgery to minimally invasive techniques such as radiofrequency endovenous occlusion (RFEO), ambulatory phlebectomy (AP), sclerotherapy and endovenous laser treatment (EVLT). However, there is no method to assess the quality of life (QOL) of patients with varicose veins and the effect of treatment on the QOL. OBJECTIVE: The purpose of this study was to assess the QOL of patients with varicose veins and to evaluate the effect of treatment on the QOL. METHOD: A total of 72 patients with varicose veins were interviewed with the Aberdeen varicose vein questionnaire (AVVQ), was asked 25 questions relating to the symptoms and concerns of their condition. Follow-up was done with questionnaires again, 8 weeks after treatment. RESULTS: The results obtained are summarized as follows: 1. Of the 32 patients the distribution of age was 40-49 years of age (37.5%), followed by 50-59 years of age (27.8%) and 30-39 years of age (19.4%). The mean age was 47.7 years old. 2. 30 patients (41.8%) had suffered with varicose veins for less than 5 years, and 24 patients (33.3%) for 6-10 years. 3. According to the CEAP classification, the most common type of varicose vein was the C1AEPAS (31.9%). 4. Treatment method of varicose veins were sclerotherapy in 60 patients (83.3%), AP in 10 patients (13.9%), and RFEO in 2 patients (2.8%). 5. AVVQ scores correlated with symptoms and concern scores, and also with the clinical grade. 6. After treatment, AVVQ scores demonstrated a highly significant increase. CONCLUSION: This study confirms that varicose veins have a significant impact on the overall QOL, and that QOL shows a significant improvement after treatment. Therefore, assessment of QOL in patients with varicose veins can be a valid measure for the evaluation of treatment effect.

A Study on Utilization of Alternative Medicine for Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Alternative medicine - sometimes called complementary or supplementary medicine - may be defined as forms of therapy or examination that have no scientific basis and whose effect or diagnostic reliability has not been demonstrated by scientific methods. Recently, alternative medicine has been used in various chronic diseases including atopic dermatitis (AD) and has attracted attention in the mass media. Several studies on the use of alternative medicine in patients with AD have been performed in western countries, however only a few studies have been conducted in Korea. OBJECTIVE: The purpose of this study was to investigate the use of alternative medicine in AD patients. METHOD: A total of 100 patients with AD were enrolled on the study, and interviewed with a questionnaire about their past history of AD and the use of alternative medicine. RESULTS: The results obtained are summarized as follows: 1. 84 out of 100 patients (84.0%) reported previous or current use of more than one type of alternative medicine. 2. The most common type of alternative medicine used was herbal remedies (73.8%). Spa and bath therapies (47.6%), health food preparations (39.3%) and diet therapy (25.0%) were also commonly used. 3. The frequency of alternative medicine used was related to onset and severity of AD. 4. The most common reason for using alternative medicine was `I wish to try everything' (60.2%), and the most common source of information on alternative medicine was relatives and friends who did not have the disease (41.4%). 5. The therapeutic effect of alternative medicine was found to be excellent in 25.3% of patients, but no change was seen in 58.6% of patients. 6. The most common side effect of alternative medicine was aggravation of symptoms. Other side effects included urticaria, diarrhea, fever and chills. 7. The average monthly cost for alternative medicine was 210, 000 won/person. CONCLUSION: The use of various types of alternative medicine in patients with AD is very common. However, these tend to be used impulsively and without caution or adequate knowledge. Therefore, dermatologists need to be aware of the benefits and adverse effects of alternative medicines.

A Case of Tufted Angioma Arising within a Nevus Flammeus / 대한피부과학회지

Tufted angioma is an uncommon, slowly-progressive vascular tumor, found typically in infants, young children and sometimes at birth or during adulthood. It shows a characteristic histopathologic finding, the so-called "cannonball" appearance. Various tumors can be developed in the nevus flammeus, such as pyogenic granuloma, basal cell carcinoma, squamous cell carcinoma, giant proliferative hemangioma and lymphangioma circumscriptum. Tufted angioma can be also accompanied with nevus flammeus and the coexistence of tufted angioma and nevus flammeus is a very rare condition. We report a case of tufted angioma arising within nevus flammeus in the left axilla of a 47 year-old female.

A Clinical Analysis of Surgical Treatment for Axillary Osmidrosis by the Bipedicle Flap Method and CO2 Laser / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is caused by excessive secretion of apocrine sweat, which causes foul odor and extreme social embarrassment. Axillary osmidrosis can be treated by a number of methods, but surgery is the treatment of choice. OBJECTIVE: The purpose of this study was to evaluate clinical results of surgical treatment for axillary osmidrosis by the bipedicle flap method and CO2 laser. METHODS: December 1995 and December 2002, 53 patients with axillary osmidrosis were treated by the bipedicle flap method and with CO2 laser. Post-operative complications and convalescent time in the patients (106 axillae) were then of evaluated. Among them, 37 patients were followed up for a minimum 6 months, and the patients were asked to complete a questionnaire on their family history, aggravation factors, association with wet ear wax or palmoplantar hyperhidrosis, degree of satisfaction, decreased sweating, decreased axillary hair, tension on motion, and scarring. RESULTS: Follow-up ranged from 6 to 84 months (mean: 41months). Thirty one (83.8%) out of 37 patients were satisfied or partially satisfied with the results. Six (16.2%) out of 37 patients were dissatisfied. Post-operative complications were seen in 27 (25.5%) out of 106 axillae. The average convalescent time was 18 days. CONCLUSION: Based on the long-term evaluation, this bipedicle flap method and CO2 laser treatment were found to be effective for axillary osmidrosis.

A case of Linear IgA Bullous Dermatosis Probably Caused by Vancomycin / 대한피부과학회지

Linear IgA bullous dermatosis (LABD) is an uncommon acquired autoimmune subepidermal bullous disease characterized by the linear deposition of IgA at the basement membrane zone. Although LABD is most often idiopathic, drug-induced LABD may, occur in rare occasions. We report a case of vancomycin-induced LABD in a 70-year-old woman with septic arthritis on the right knee.

Two Cases of Early Stage Mycosis Fungoides Treated with Acitretin and Narrow Band UVB Phototherapy / 대한피부과학회지

Early stage mycosis fungoides (MF) has been treated with skin directed therapies including topical steroids, phototherapy (UVB), photochemotherapy (PUVA), topical nitrogen mustard, or total skin electron beam therapy. Recently, several studies have been reported that treat early-stage MF with narrow band UVB (NBUVB), which is an effective and convenient modality compared to other alternatives. Herein, we describe two cases of early stage MF treated with NBUVB. During the remission induction therapy, oral acitretin combined with NBUVB was used for several weeks to clear the MF, followed by treatment with only NBUVB for maintenance.

A Case of Fibroadenoma Arising in the Accessory Breast Tissue of the Axilla / 대한피부과학회지

Accessory breast tissue of the axilla is one of the varieties of supernumerary breast tissue, which is observed after puberty. The tissue is capable of developing identical pathophysiologic changes as normal breast tissue. The pathologic findings of the accessory breast tissue were classified as normal breast tissue, cystic disease, chronic mastitis, atypical ductal hyperplasia, and fibroadenoma. Among these, the fibroadenoma is relatively uncommon. We have experienced a case of fibroadenoma arising in the accessory breast tissue of the axilla. A 28-year-old woman had a 8-month history of 1.5x1.3cm and 1.1x1.2cm sized firm nodules, deeply located in subcutaneous tissue on the left axilla. The size of the lesion was constant. However, she complained of mild tenderness at every premenstrual period. The histopathologic finding of the lesion revealed the typical features of fibroadenoma with accessory breast tissue.

An Unusual Case of Porokeratotic Eccrine Ostial and Dermal Duct Nevus on the knee and the perianal region / 대한피부과학회지

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare, benign congenital hamartoma involving the eccrine sweat duct. Histologically, the distinctive feature of PEODDN is the existence of keratinous plugs that represent cornoid lamellae overlying dilated infundibula of eccrine ducts. Lesions are typically asymptomatic papules or plaques that are located on the distal extremities, including palms, fingers and soles. We report a case of a 7-year old girl with PEODDN who exhibited lesions on the left knee and the perianal region.

Itraconazole Pulse Therapy in Childhood Onychomycosis / 대한의진균학회지

BACKGROUND: Although in managing childhood onychomycosis, it is reported that continuous therapy of itraconazole is effective and safe, pulse therapy seems to be preferred to enhance patient's compliance and tolerability. Still, there is a relatively limited data regarding clinical characteristics and efficacy of itraconazole pulse therapy in childhood onychomycosis. OBJECTIVE: The purpose of this study was to evaluate the clinical characteristics of childhood onychomycosis and efficacy of itraconazole pulse therapy in childhood onychomycosis. METHODS: The study has been processed from 1999 August to 2003 April regarding total 28 patients, age under 14 years old. Clinical evaluation was performed on the bases of age, sex, site, clinical type, risk factors and existence of other concomitant fungal infections. Diagnosis was confirmed by KOH mount and fungal culture. Fungal slide culture was performed to identify the causative organism. Itraconazole was administered 5mg/weight (kg) 2 pulses for finger nail infection and 3 pulses for toe nail infection. Then the follow up was done as scheduled, and we evaluated clinical improvement and adverse effect regularly at every visit. RESULTS: Twenty five patients (male 16, female 9; mean age 8.7 years) completed the follow-ups. 6 patients (24%) had lesions on the finger nail and 19 patients (76%) on the toe nail. Studied clinical type were distolateral subungual onychomycosis (DLSO) and whitish superficial onychomycosis (WSO), but predominantly DLSO; 3 patients on the finger nail and 18 on the toe nail, 21 (84%) totally presenting the most commonly involved. Tinea unguium and tinea pedis-related family history was found in 18 patients (72%). Other concomitant fungal infections were found in 21 patients (84%). As causative organism, only Trichophyton (T.) rubrum was identified in 17 patients (68%). Clinical cure rate was 84%, while treatment failure was 16%. CONCLUSION: Childhood onychomycosis showed similar clinical chracteristics with adulthood and itraconazole pulse therapy was effective for childhood onychomycosis.