Retinoid Induces the Degradation of Corneodesmosomes and Downregulation of Corneodesmosomal Cadherins: Implications on the Mechanism of Retinoid-induced Desquamation

BACKGROUND: Topical retinoids induce skin fragility. As corneodesmosomes are important adhesion structures in the epidermal cohesion, an effect of retinoids on corneodesmosomes has been suspected. OBJECTIVE: The aim of this study was to investigate the effect of retinoid on the expression of corneodesmosomal components including desmoglein (DSG) 1, desmocollin (DSC) 1, corneodesmosin (CDSN) and kallikrein (KLK)s. METHODS: 2% all-trans-retinol or ethanol was applied to the back of hairless mice for five days, and the structure of the stratum corneum was examined by transmission electron microscopy. The cultured human keratinocytes were treated with all-trans-retinoic acid (RA) in low or high calcium media for 24 hours. RESULTS: Topical retinol increased corneocyte detachment and degradation of corneodesmosomes. RA significantly decreased DSG1 and DSC1 expression at the mRNA and protein levels in keratinocytes that were cultured in both low- and high-calcium media. On the other hand, CDSN mRNA levels did not decrease in low-calcium media or increase in high-calcium media after RA treatment. KLK5 and KLK7 expression did not increase after RA treatment. CONCLUSION: Our results indicate that DSG1 and DSC1 downregulation by RA could be related to the increased degradation of corneodesmosomes and consequent desquamation induced by retinoids.

Epidermal Hyperplasia and Elevated HB-EGF are More Prominent in Retinoid Dermatitis Compared with Irritant Contact Dermatitis Induced by Benzalkonium Chloride

BACKGROUND: 'Retinoid dermatitis' is a retinoid-induced irritant contact dermatitis (ICD). The mechanism of retinoid dermatitis may be different from that of other ICDs. However, it remains uncertain how topical retinoid induce ICD. OBJECTIVE: We compared several aspects of contact dermatitis induced by topical retinol and benzalkonium chloride (BKC) on hairless mice skin. METHODS: 2% retinol or 2.5% BKC was applied to hairless mice and transepidermal water loss (TEWL), ear thickness, histologic and immunohistochemical findings were compared. We also compared mRNA expression of inflammatory cytokines, epidermal differential markers, cyclooxygenases (COXs) and heparin binding epidermal growth factor like growth factor (HB-EGF). RESULTS: Topical application of 2% retinol and 2.5% BKC increased TEWL and ear thickness in similar intensity. Epidermal hyperplasia was more prominent in retinol treated skin. Proliferating cell nuclear antigen, involucrin and loricrin expression were higher in retinol-treated skin than in BKC-treated skin. Filaggrin, however, was more expressed in BKC-treated skin. The mRNA expression of IL-8, TNF-alpha, COX-2, involucrin, loricrin and filaggrin were increased in both retinol- and BKC-treated skin in similar intensity. HB-EGF was more significantly increased in retinol-treated skin. CONCLUSION: Elevated HB-EGF and epidermal hyperplasia are more prominent features of retinoid dermatitis than in BKC-induced ICD.

Two Cases of Acute Leukopenia Induced by Colchicine with Concurrent Immunosuppressants Use in Behcet's Disease

Colchicine-induced leukopenia usually occurrs in intentional or accidental overdoses or inappropriate use in combination with intravenous and oral colchine; however, there have been several reports of hematologic toxicity in short-term and small-dose colchicine medication courses. We present two cases of leukopenia induced by colchicine use concurrent with immunosuppressants in Behcet's disease. We postulate that the mechanism of colchicine-induced leukopenia might be the destruction of circulating leukocytes and an inhibition of leukocyte production by the immediate and direct toxic effect of colchicine on idiosyncrasies unique to each patient. The concurrently administered immunosuppressant might decrease the threshold for hematologic toxicity of colchicine in the leukocytes and their precursor cells.

Two Cases of Anti-p200 Pemphigoid / 대한피부과학회지

Anti-p200 pemphigoid is a recently defined subepidermal immunobullous disease. Most anti-p200 pemphigoid patients show the clinical features of bullous pemphigoid, dermatitis herpetiformis and linear IgA disease. It is characterized by the binding of circulating IgG autoantibodies to the dermal side of 1 M NaCl split skin, and by reactivity of these autoantibodies to a unique 200-kD antigen on immunoblot of dermal extract. On immunoelectron microscopic examination, these autoantibodies deposit at the lamina lucida-lamina densa interface. Herein, we report two cases of anti-p200 pemphigoid, as well as their favorable response to treatment with systemic corticosteroid, colchicine and dapsone.

Anticonvulsant Hypersensitivity Syndrome Associated with Epstein-Barr Virus Reactivation

We describe a 59-year-old female with severe anticonvulsant hypersensitivity syndrome (AHS) associated with Epstein- Barr virus (EBV) infection. The causative drug was speculated to be carbamazepine. Recurrent EBV infection was demonstrated by the presence of anti-EBV early antigen IgM antibodies and anti-EBV nuclear antigen IgG antibodies. To our knowledge, only one case of drug hypersensitivity syndrome (DHS) associated with EBV has been reported in the English- language literature. Our case is the second report of EBV-associated DHS, which suggests that EBV infection may contribute to the pathogenesis of AHS in a few patients.

Syringoma: A Clinicopathologic and Immunohistologic Study and Results of Treatment

The purpose of our study was to describe clinical and histopathological features of sixty one patients with histological diagnosis of syringoma over four year period in our dermatology clinic in Korea. Female:male ratio was 6.6:1 with onset of age during 2nd and 3rd decades in more than half of the patients in our study. The most frequently involved site was eyelids (43 cases, 70.5%) and the most common color of lesion was skin-color (30 cases, 49.2%). In 34 cases, characteristic tad-pole appearances (55.7%) were observed. Basal hyperpigmentation was observed more frequently in brown-colored lesion (p=0.005). Fibrosis was observed more frequently in erythematous lesion (p=0.033). Keratin cyst was observed less frequently in genital involved group (p=0.006). We also performed immunohistochemical stain for the presence of progesterone receptor (PR) and estrogen receptor (ER) in fifty six cases with negative results.

Treatment of Molluscum Contagiosum with High Dose Cimetidine Therapy / 대한피부과학회지

BACKGROUND: Molluscum contagiosum is often a difficult problem for dermatologists to treat. Cimetidine is a H2 histamine receptor antagonist that has been used mainly to treat peptic ulcer disease. The use of cimetidine in the treatment of molluscum contagiosum has been reported previously using a dose of 40 mg/kg/day, and has the advantage of being painless and easy to administer, especially for recurrent, extensive, facial and eyelid lesions. OBJECTIVE: The purpose of this study was to evaluate the clinical effects of high dose cimetidine therapy for molluscum contagiosum. METHODS: Twenty patients with molluscum contagiosum were treated using high dose cimetidine therapy (14 females, 6 males; age range 2~16 years). RESULTS: Of the 20 patients who completed the study, 12 patients (60%) showed complete remission, 3 patients (15%) showed partial remission and 5 patients (25%) showed no response. Five out of 8 patients with atopic dermatitis showed complete remission and one showed partial remission. Of the 12 patients without atopic dermatitis, 7 showed complete remission and 2 showed partial remission. CONCLUSION: High dose cimetidine therapy is an effective treatment modality for molluscum contagiosum, and has no severe adverse effects.

A Case of Cutaneous Alternariosis in Liver Transplant Patient / 대한의진균학회지

A case of cutaneous alternariosis is reported in a 61-year-old female who underwent liver transplantation one year earlier. The infection manifested as a crusted papule about 1 cm in diameter on the right knee. Histological examination with silver methenamine and periodic acid-Schiff diastase revealed fungal spores and hyphae with chronic granulomatous inflammation. Biopsy fragments inoculated on Sabouraud-glucose agar with chloramphenicol produced colonies which were identified as Alternaria species on the basis of macroscopic and microscopic characters. Complete excision and treatment with 250 mg/day oral terbinafine for one month resulted in a satisfactory course with no signs of local recurrence over follow-up period of one year.

Analysis of Increased Xerosis in Intensive Care Unit Patients

BACKGROUND: Xerosis is commonly seen in patients in intensive care units (ICU), and is sometimes accompanied by itching sensation and dermatitis. However, xerosis in ICU patients is often missed by doctors who are trained to attend to the more serious conditions that can become life-threatening. OBJECTIVE: The purpose of this study is to evaluate xerosis of ICU patients objectively, by measuring hydration levels of the skin. METHOD: To investigate hydration levels of the skin in ICU patients, a corneometer was used to measure the skin's capacitance. The experimental group consisted of 106 ICU patients, while the control group was made up of 53 outpatients visiting the dermatology department. RESULTS: ICU patients showed decreased skin surface hydration, and its level was inversely correlated with the duration of ICU admission. However, no correlation between age and skin surface hydration was observed in either the ICU patients or the control group. The actual humidity of the ICU was 5% lower than that of the outpatient dermatologic clinic. The severity of systemic diseases can also influence the development of xerosis. CONCLUSION: The decreased skin surface hydration in ICU patients correlated with the prolonged ICU stay, which seemed to be associated with the dry environment of the ICU or the severity of the systemic diseases causing dry skin. The increased incidence of xerosis in ICU patients can be explained by the decreased skin surface hydration.

Transition from Pemphigus Foliaceus to Pemphigus Vulgaris: Case Report with Literature Review

The transition between the main subtypes of pemphigus, pemphigus vulgaris (PV), and pemphigus foliaceus (PF) has rarely been reported. Moreover, the development of PV in a patient with PF is much more unusual than that of PF in a patient with PV. We report a 48-year-old man who presented with cutaneous lesions showing the typical clinical and histological features of PF. Five years later, his skin lesions became extensive and he developed oral erosions. His condition did not respond well to steroids and azathioprine. Histological examination of a vesicle disclosed suprabasal acantholysis in contrast to the subcorneal acantholysis discovered upon initial histological evaluation. Indirect immunofluorescence revealed IgG antikeratinocyte cell surface antibodies at a titer of 1:640. The titer was 1:160 at initial diagnosis. Upon immunoblotting, the patient's serum reacted with 130 kiloDalton (kDa) and 160 kDa proteins, suggesting desmoglein (Dsg) 3 and 1, respectively. We herein report an unusual case of PV that developed from PF during the disease's flare-up.

A Case of Herpetic Folliculitis / 대한피부과학회지

Although herpetic skin infections are very common, herpetic folliculitis is not often reported in the literature. It has varied presentations, some of which are clinically atypical requiring histopathological confirmation of follicular involvement. We report a case of herpetic folliculitis which developed on the left shoulder of a 36-year-old man with painful erythematous grouped papules, but without vesicles. On histopathologic examination of a papular lesion, viral cytopathologic changes such as ballooning degeneration and giant cell formation, were observed within the follicular epithelium, thus we could diagnose this case as a viral folliculitis. The patient was treated with an antiviral agent, and the lesions subsided within several days.

Cutaneous Metastasis of Choriocarcinoma: A Case Report

Choriocarcinoma is one of the malignant tumors of trophoblastic cells characterized by the secretion of human chorionic gonadotrophin (hCG) (1-3). Cutaneous metastasis is a rare presentation of choriocarcinoma but a poor prognostic sign because it is associated only with widespread disease (3-5). A 52-yr-old female complaining of dyspnea for 2 months, presented with fingertip sized erythematous nodules on the left side of the neck and the right side of the upper back of 1 month duraton. She has suffered from Behcet's disease since 1999. Microscopic examination of a nodule of upper back demonstrated biphasic pattern of cytotrophoblasts and hCG-positive syncytiotrophoblasts, and the typical histologic features of choriocarcinoma. She was referred to the gynecological oncology department. After 17 cycles of combination chemotherapy, the serum hCG level has fallen from 700,000 to under 2.0 mIU/mL and the skin lesions have almost disappeared. However, after 3 months, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed due to elevated serum hCG level (4,447.7 mIU/mL), and she is scheduled to receive post-operative adjuvant chemotherapy.

Percutaneous hepatic arterial catheterization for infusion chemotherapy in treatment of primary hepatoma

Chemotherapy offers palliative treatment to patient with advanced nonresectable hepatoma. The usefulness of systemic chemotherapy is limited becaused of serious side reaction and low concentration of drug at tumor. Butthis problem may be overcome by intraarterial infusion. Nonsurgical percutaneous hepatic arteiral catheterizationwas done in 21 patients with primary hepatoma, and infusion chemotherapy was done in 19 patients who were successful in catherization. The results were as follows; 1. Selective catheterization of hepatic artery proper,common hepatic artery, and celiac artery were seccessful in 4, 9 and 4 patients, respectively. The success rate ofselective catheterization is 80.9% including celiac artery among 21 patients with hepatoma. 2. Simple catherization method was applied in 14 patients, and catheter exchange and Loop methods were applied in 2 and 1patient respectively. 3. Complications related to catheterization, such as infection and bleeding on punctured site, intimal injury and dislodgement of catheter were not serious. 4. Drugs were well tolerated without serioustoxicity or complication. 5. 3 patients showed objective response and median survival time of treated patients is 2.5 months.