Comparative Histopathologic Study of Drug eruption and Rubella / 대한피부과학회지

BACKGROUND: Dermatologists frequently see morbilliform rash in the clinic, drug eruptions and viral eruptions. Due to close clinical similarities, it is difficult to differentiate them. OBJECTIVE: The purpose of this study was to review the histopathologic differences between drug eruption and viral eruption. METHOD: In this study, 13 patients diagnosed as rubella and 13 patients diagnosed as drug eruption in Department of Dermatology, Presbyterian Medical Center from 1995 to 1997 were included. We reviewed the epidermal changes such as vacuolopathy, dyskeratotic cells, spongiosis and exocytosis and dermal changes by light microscopy. RESULTS: 1. Vacuolopathy of basal layer was observed in 92.3% of patients in both diseases. 2. Dyskeratotic cells, spongiosis and exocytosis were observed significantly highly in drug eruption. 3. Perivascular lymphohistiocytic infiltration was mild in both diseases, but eosinophilic infiltration was significantly higher in drug eruption(84.6%) than viral eruption(15.4%). 4. Atypical lymphocytes were observed in both diseases. 5. Red blood cell extravasation was observed only in viral eruption. 6. Perivascular edema was significantly higher in drug eruption(76.9%) than viral eruption(38.4%) CONCLUSION: There were statistically significant differences in dyskeratotic cells, spongiosis, dermal eosinophilic infiltration and Red blood cell extravasation. Considering these observation, histopathologic findings may be helpful in differentiating between drug eruption and viral eruption.

A Case of Phakomatosis Pigmentovascularis Type I a With Multiple Pyogenic Granulomas Developed in Pregnancy / 대한피부과학회지

Phakomatosis pigmentovascularis(PPV) was first described in 1947 as a distinctive association of vascular and pigmentary nevi by Ota et al. Hasegawa et al subclassified the disorder into eight types and type I a is characterized by the coexistence of nevus flammeus and nevus pigmentosus et verrucous, which is not associated with systemic organ involvement. PPV type I a is relatively rare and a case with multiple pyogenic granulomas developed in pregnancy, is not reported yet. We present a case of PPV type I a with multiple pyogenic granulomas developed in pregnancy within nevus flammeus in a 29-year-old female.

A Case of Cutaneous Manifestations Associated With Hydroxyurea Therapy / 대한피부과학회지

Hydroxyurea is an antitumor agent that has attained an important role in the management of myeloproliferative syndromes. Its mechanism of action is not fully understood, but it appears to affect DNA synthesis and genetic control of cell replication by inhibiting the conversion of ribonucleotides in deoxyribonucleotides. Cutaneous side effects such as xerosis, hyperpigmentation, nail changes, skin ulceration, alopecia, and palmoplantar keratoderma may occur, especially with long-term treatment. We report a case of 65-year-old chronic myelogenous leukemia(CML) patient showing various cutaneous manifestations after receiving long-term hydroxyurea therapy.

A Case of Median Raphe Canal of the Penis / 대한피부과학회지

Median raphe canal is an uncommon disease and represents a defect abnormality of the male genitalia. It occurs along the ventral median raphe from the glans penis to the anus. Histologically the canal is lined by stratified squamous epithelium which dose not communicate with the urethra. Surgical excision is the treatment of choice. Recently we observed a 25-year-old male patient who had had a median raphe canal located in the ventral aspect of penis.

A Case of Angiosarcoma on the Scalp in a Teenage Girl / 대한피부과학회지

Angiosarcoma is a rare and highly malignant vascular tumor of endothelial cell origin. Cutaneous angiosarcoma usually occurs on the scalp and face of the elderly person, frequently in the sixth and seventh decade. Unusually, we experienced a case of angiosarcoma of the scalp in a 12-year-old girl. The patient had a solitary, well-demarcated 0.7X0.7cm sized, non-tender, blue-violaceous to gray-black colored, crusted papule on the vertex for 2 months. She was treated by wide surgical excision only but no recurrence in the last eight years after excision.

A Case of Multiple Verruciform Xanthoma of Oral Cavity and Gastrointestinal tract / 대한피부과학회지

Verruciform Xanthoma(VX) is a rare disease of unknown etiology that is typically solitary and predominantly located within the oral cavity. It is usually not associated with other lesions or metabolic abnormalities. Histologic features include acanthosis with uniform elongation of the rete ridges and xanthomatous cells that lie in are and typically confined to the papillary dermis. We report a rare case of multiple verruciform xanthoma that occurs in oral cavity and gastrointestinal tract simultaneously.

Four Cases of Cutaneous Sinus Tract of Dental Origin / 대한피부과학회지

The most common cause of chronic cutaneous sinus tract in the face and neck is chronically draining dental infection. The diagnosis is easily confirmed by dental examination and dental roentgenogram of the involved area, but this disease is frequently misdiagnosed and incorrectly treated in dermatologic department. We report four cases of cutaneous sinus tract of dental origin. First patient had a painful nodule with chronically draining pus and a dimple on the left cheek. Second patient had a dimple with draining bloody fluid on the right chin. Third patient had a pea-sized papule with draining serous fluid on the left chin. Fourth patient had a fluctuant erythematous plaque with draining pus and a dimple on the left buccal area. In all four patients radiologic examination of the maxillary and mandibular regions demonstrated radioluency at the apex of tooth consistent with periapical abscess.

A Clinical and Histopathologic Study of Rubella / 대한피부과학회지

BACKGROUND: Although rubella is a mild exanthematous viral infection and its incidence has been greatly decreased after effective vaccination, epidemics of rubella has been noted at 5- to 7-year intervals. But there has been few report about the clinical and histopathologic study of rubella in Korean literatures. OBJECTIVE: The purpose of this study was to review the clinical and histopathologic characteristics of rubella of 1996 outbreak. METHODS: We reviewed the clinical features and histopathologic findings in 50 patients diagnosed as rubella in Department of Dermatology, Presbyterian Medical Center from January 1996 through to May 1996. RESULTS: 1. The male-female ratio was 1: .17. The age distribution was 13-32 years and 72% of patients were aged 16-25 years. 2. Erythematous maculopapular rash on whole body was developed in all patients. Eighty two percent of the patients had fever and lymphadenopathy, and 36% of the patients had petechiae of soft palate. The main prodromal symptoms were sore throat(50%), headache(34%), and upper respiratory symptoms(22%), as order of frequency. 3. Positive serologic test for rubella IgM antibody was 79.5%. 4. The most common abnormal laboratory finding was leukopenia(58%), and followed by positive ASO(34%), the presence of atypical lymphocytes(21%), and thrombocytopenia(8%). 5. Histologically, epidermal changes were mild to moderate vacuolopathy(92.3%), the presence of dyskeratotic cells(30.8%), spongiosis(23.1%), and exocytosis(15.4%). Dermal findings were mild superficial perivascular lymphohistiocytic infiltration(100%), upper dermal edema(53.8%), perivascular edema(38.4%), pigmentary incontinence(30.8%), and the presence of extravasated RBC(23.1%). Eosinophil infiltration(15.4%) and the presence of large nucleated lymphocytes(92.3%) were also observed. Conclusions: According to the results of our study about rubella outbreak in 1996, clinical signs and symptoms were similar to those of previously described. Histologically, superficial perivascular dermatitis with mild to mederate vacuolar interface change was a main feature and large nucleated lymphocytes were frequently noted.

A Case of Toxic Epidermal Necrolysis Due to Contact of Paraquat(Gramoxone(R)) / 대한피부과학회지

Occasionally, erythema multiforme has been reported to occur in association with allergic contact dermatitis to various substances including paraquat(Gramoxone(R)). In these cases the erythema multiforme has ranged from mild localized exanthem to life-threatening toxic epidermal necrolysis. We report a case of toxic epidermal necrolysis developed from erythema multiform due to contact of paraquat.

A Case of Lentigo Maligna Melanoma / 대한피부과학회지

Lentigo maligna melanoma(LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM evolved from lentigo maligna(LM). A 71-year-old female presented with a longstanding irregular brown patch containing two black papules on the left cheek which developed 8 months ago. Histopathologic findings were consistent with LM and LMM. We performed a wide excision and dufourmental flap for reconstruction with no recurrence for 30 months. Sun exposure has been known as the most important etiologic factor for the development of malignant melanoma including LMM and the incidence has an increasing tendency. Thus, skin biopsy is recommended in the evaluation of a longstanding irregular brown patch on the face to prevent LMM.

Expression of Fas and Fas Ligand in Various Skin Diseases / 대한피부과학회지

BACKGROUND: Fas and Fas ligand (FasL) are cell surface proteins that mediate apoptosis. Fas and FasL are expressed in normal epidermal cells, but are different in the expression patterns in epidermal layers. OBJECTIVE: The purpose of this study was to evaluate the expression of Fas and FasL in various skin diseases including non-tumorous diseases and tumors. METHOD: We performed immunohistochemical staining for Fas and FasL with monoclonal or polyclonal antibodies using frozen skin tissues from 29 patients. RESULTS: 1. In normal skin, Fas and FasL were expressed as intercellular and intracellular patterns. Fas was expressed in the basal and spinous layers, and FasL was expressed in the upper spinous and granular layers. 2. In psoriasis vulgaris and lichen planus, FasL expression was proportional to the degree of epidermal hyperplasia, such a relationship was not found in Fas expression. 3. In verruca vulgaris and herpes zoster, the upregulation of Fas and FasL expression was observed in lesional epidermis. 4. In skin tumors, Fas and FasL expression were observed in most tumor cells of Bowen's disease, keratoacanthoma, and squamous cell carcinoma. In basal cell carcinoma, FasL was expressed strongly and diffusely in the infiltrating tumor cells, but Fas was not expressed at all. CONCLUSION: Fas and FasL play an important role in the differentiating process of the epidermis by coordinate expression between them. In non-tumorous conditions and skin tumors, Fas and FasL might function as essential mediators of cellular turnover in pathogenesis of the skin diseases.

Expression of Fas and Fas Ligand in Various Skin Diseases / 대한피부과학회지

BACKGROUND: Fas and Fas ligand (FasL) are cell surface proteins that mediate apoptosis. Fas and FasL are expressed in normal epidermal cells, but are different in the expression patterns in epidermal layers. OBJECTIVE: The purpose of this study was to evaluate the expression of Fas and FasL in various skin diseases including non-tumorous diseases and tumors. METHOD: We performed immunohistochemical staining for Fas and FasL with monoclonal or polyclonal antibodies using frozen skin tissues from 29 patients. RESULTS: 1. In normal skin, Fas and FasL were expressed as intercellular and intracellular patterns. Fas was expressed in the basal and spinous layers, and FasL was expressed in the upper spinous and granular layers. 2. In psoriasis vulgaris and lichen planus, FasL expression was proportional to the degree of epidermal hyperplasia, such a relationship was not found in Fas expression. 3. In verruca vulgaris and herpes zoster, the upregulation of Fas and FasL expression was observed in lesional epidermis. 4. In skin tumors, Fas and FasL expression were observed in most tumor cells of Bowen's disease, keratoacanthoma, and squamous cell carcinoma. In basal cell carcinoma, FasL was expressed strongly and diffusely in the infiltrating tumor cells, but Fas was not expressed at all. CONCLUSION: Fas and FasL play an important role in the differentiating process of the epidermis by coordinate expression between them. In non-tumorous conditions and skin tumors, Fas and FasL might function as essential mediators of cellular turnover in pathogenesis of the skin diseases.

Mask Phenomenon; Five Cases of Unusual Facial Purpura / 대한피부과학회지

Purpura is discoloration of the skin and mucous membranes due to extravasation of red blood cells and may be due to a variety of factors, but it is sometimes difficult to identify the exact cause. Some forms of purpura can frighten the patient and puzzle the physician. Mask phenomenon is an unusual purpura of the relatively loose tissues of the face and neck occuring after prolonged coughing, vigorous vomiting, valsalva's maneuver, parturition, or any other exertion that raises intrathoracic or abdominal pressure. This occurs with acute onset and fades within twenty-four to seventy-two hours spontaneously. A work-up for a coagulation or platelet defect is usually not required. We herein describe five cases of mask phenomenon(unusual facial purpura).

Mask Phenomenon; Five Cases of Unusual Facial Purpura / 대한피부과학회지

Purpura is discoloration of the skin and mucous membranes due to extravasation of red blood cells and may be due to a variety of factors, but it is sometimes difficult to identify the exact cause. Some forms of purpura can frighten the patient and puzzle the physician. Mask phenomenon is an unusual purpura of the relatively loose tissues of the face and neck occuring after prolonged coughing, vigorous vomiting, valsalva's maneuver, parturition, or any other exertion that raises intrathoracic or abdominal pressure. This occurs with acute onset and fades within twenty-four to seventy-two hours spontaneously. A work-up for a coagulation or platelet defect is usually not required. We herein describe five cases of mask phenomenon(unusual facial purpura).

A Case of Subcutaneous Sweet's Syndrome in MYelodysplastic Syndrome Showing Nuelear Segmentation Anomalies of Neutrophils / 대한피부과학회지

We encountered a case of Sweet's syndrome associated with myelodysplastic syndrome in a 60-year-old woman. The clinical presentation strongly suggested Sweet's syndrome. A skin biopsy specimen taken from her skin lesion on the leg showed an infiltration of numerous neutrophils in the subcutis instead of the dermis which is the main area of neutrophilic infiltration in Sweet's syndrome. Among infiltrating cells, many neutrophils(8%) showed nuclear segmentation anomalies, that is, hyposegmentation(pseudo-Pelger-Huet anomaly) or hypersegmentation. Peripheral blood neutrophils had similar anomalies. This subcutaneous variant of Sweet's syndrome, Sweet's panniculitis, is rare and nuclear segmentation anomalies of neutrophils are probably a good clue to underlying myelodysplastic syndrome.

A Case of Transient Acrodermatitis Enteropathica in a Full-Term Breast-Fed Infant / 대한피부과학회지

We herein report a case of transient acrodermatitis enteropathica in a 3-month-old, breast-fed, full-term infant. The patient was presented with a 2-month history of diarrhea and crusted erythema- tous patches on the periorificial area. Similar lesions were seen in his siblings. His serum zinc level and the zinc level in his mother's breast milk were markedly reduced. Diarrhea and skin lesions disappeared promptly with oral zinc supplementation and did not recur when zinc was discontinued after three weeks. Our case indicates that even full-term infants, who feed excl-usively on mothers milk, run a risk of developing zinc deficiency, if the concentration of zinc in the breast milk is very low.

A Case of Glomangiomyoma / 대한피부과학회지

Glomus tumor shows histologically characteristic three components of glomus cells, vascular structures, and spindle-shaped smooth muscle cells. It is classified into solid glomus tumor, glomangioma and glomangiomyoma according to relative proportions of components. Glomangiomyoma, the least frequent type of glomus tumor, has its overall histopathologic pattern identical to common solid glomus tumor or glomangioma. In contrast to the foregoing types, however, it has an important number of spindle-shaped smooth muscle cells, which blend with the glomus cells. A 49-year-old woman presented with 2-year history of painful bluish red nodule beneath nail plate of right 4th finger. We made a diagnosis of glomangiomyoma by virtue of routine histopathologic examinations and immunohistochemical stains such as vimentin, smooth muscle actin and desmin.

Cutaneous Infection Caused by Fusarium verticillioides in a Patient with Diabetes Mellitus and Liver Cirrhosis / 대한의진균학회지

Fusarium species, which are common soil saprophytes, have been implicated as a pathogen causing a variety of opportunistic infections such as keratitis, onychomycosis, burn wound infection or disseminated systemic infections in immunocompromised hosts. We report a case of cutaneous infection caused by F. verticillioides in a 59-year-old man, with a long history of diabetes mellitus and alcoholic liver cirrhosis. He presented with a few papules and fluctuant cutaneous nodules on both forearms traumatized by woodstick 4 months ago. The diagnosis of F. verticillioides infection was established by histopathologic examination and finding of tissue cultures.