A Case of Pompholyx after Intravenous Immunoglobulin Therapy / 대한피부과학회지

Intravenous immunoglobulin therapy has been used to treat various immune-mediated diseases. Its utility in dermatology continues to expand, including treatment for autoimmune blistering disease, graft-versus-host disease, and dermatomyositis. It is generally considered safe, and serious adverse effects such as anaphylaxis, renal tubular necrosis or aseptic meningitis rarely occur. Furthermore, adverse skin reactions very rarely occur, but can include urticaria, pruritus, eczema, alopecia, lichenoid dermatitis or pompholyx. We describe a case of a 48-year-old man who developed vesicular eczema on his palms and soles after administration of intravenous immunoglobulin therapy for encephalomyelopathy.

Possible Apoptotic Mechanisms in the Vesiculation Process of Pemphigus, Bullous Pemphigoid, and Epidermolysis Bullosa Acquisita / 대한피부과학회지

BACKGROUND: Apoptosis, or programmed cell death, may participate with pathogenesis of intercellular detachment and loss of cell-matrix interaction. Autoimmune bullous dermatoses is an entity charaterized by bullous lesions of the skin and mucosa, and autoantibodies to the specific tissue components. OBJECTIVE: The purpose of this study was to investigate the induction of apoptosis in the lesional skin of pemphigus vulgaris (PV), pemphigus foliaceus (PF), bullous pemphigoid (BP), and epidermolysis bullosa acquisita (EBA). METHODS: Hoechst 33342 (bisbenzimide) staining and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) staining was performed to determine the induction of apoptosis in the lesional skin of each disease. RESULTS: In PV and PF, typical findings of apoptosis were observed in the lesional epidermis showing acantholysis. However, in BP and EBA, no apoptosis of the epidermis was observed. CONCLUSION: These results suggest that apoptosis is only associated with acantholysis of the epidermal keratinocytes, one of many components of pathogenesis in bullous disease, in patients with pemphigus.

Application of Confocal Laser Scanning Microscopy to the Differential Diagnosis of Bullous Pemphigoid and Epidermolysis Bullosa Acquisita / 대한피부과학회지

BACKGROUND: The differential diagnosis of bullous pemphigoid (BP) and epidermolysis bullosa acquisita (EBA) presents some difficulties since both diseases have overlapping clinical and histological features, as well as immunopathological findings. Confocal laser scanning microscopy (CLSM) has been developed and has shown to be a promising tool for dermatological investigations, giving a higher degree of resolution and available co-localization analysis. OBJECTIVE: The purpose of this study was to evaluate whether the new technique of CLSM could reliably identify and differentiate the binding sites of disease specific-autoantibodies (Abs) at the basement membrane zone (BMZ), with the sera from BP and EBA. METHODS: An indirect immunofluorescence (IF) assay was performed to localize the binding sites of circulating Abs from 5 cases of both BP and EBA, as well as the sites of 3 BMZ markers (integrin beta4, laminin-5, and type IV collagen). To facilitate identification and topographic differentiation between the two groups, patients' Abs were labeled with fluorescein isothiocyanate, whereas the BMZ markers were labeled with Texas red. The tissue specimens were observed under both conventional IF microscopy and CLSM. RESULTS: Owing to superposition of antigens and marker labels, double immuno-labeled sections under IF microscopy revealed limitations for the differentiation of patient's sera from BMZ markers even with high magnification (x1,000). However, CLSM was able to eliminate much of the antigen overlap. In BP, the circulating autoantibody' deposits were recognized on the epidermal side of laminin-5 and type IV collagen, and codistributed with integrin beta4. On the other hand, the binding of autoantibodies in EBA was on the dermal side from that of integrin beta4, laminin-5 and type IV collagen. These spatial relationships are compatible with their known microstructural locations. CONCLUSION: Our study indicates that CLSM examination may provide more precise localization of the antigens in BP and EBA than conventional IF microscopy. CLSM would not only be an efficient tool to identify circulating anti-BMZ autoantibodies for diagnosis and differential diagnosis of blistering diseases, but also a great addition to examining tissue specimens in patients who do not have detectable circulating Abs.

Two Cases of Cellular Phone Dermatitis / 대한피부과학회지

In recent years, cellular phones have become one of lifes necessities. In proportion to the number of cellular phones in use, the number of reported cellular phone dermatitis cases has increased. Chromate and nickel sulfate are thought to be the allergen of cellular phone dermatitis, but direct qualitative analysis of cellular phones has not yet been carried out. We report 2 cases of cellular phone dermatitis which were suspected to be caused by a contact allergy to nickel. Patch tests were performed and showed a positive reaction to cobalt chloride and nickel sulfate. Direct qualitative analysis by a scanning electron microscope-energy dispersive X-ray analyzer of the cellular phones of the patients showed peaks for nickel and chrome.

Clinical Features and Predilection Sites of the Lesions Observed in Chronic Cutaneous Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: The typical clinical feature of chronic cutaneous lupus erythematosus (CCLE) is 'discoid erythema'; however, several different clinical variants exist such as hypertrophic LE, LE profundus, chilblain LE, tumid LE and so on. The heterogeneity-spectrum of the lesional morphology of the cutaneous lesions and the predilection sites of the lesions of twenty Korean patients with CCLE were examined and tried to compare to those of CCLE patients of Caucasian origin. METHODS: Clinical examinations of twenty patients with CCLE were carried out by dermatologists to define the morphologic characteristics of cutaneous lesions and the anatomic predilection sites of the lesions. RESULTS: The most common cutaneous lesion-morphology noted in Korean patients with CCLE was classic discoid erythema. Three cases had concurrent cutaneous lesions of other clinical variants of CCLE. The predilection sites of all lesions were the face (cheeks) and head (frontal area). These clinical findings observed among this group of patients are similar to those features seen in people of Caucasian origin. CONCLUSION: The most frequent clinical feature of CCLE was discoid erythema and the predilections sites of the lesions found were the face and the scalp; indicating that the morphological heterogeneity-spectrum of cutaneous lesions and the predilection sites observed in Korean patients of CCLE seem to have no remarkable differences when compared with Caucasian cases with the same diagnoses.

A Case of Hailey-Hailey Disease Improved with Topical Tacrolimus Ointment / 대한피부과학회지

A 45-year-old woman presented with a six-month history of Hailey-Hailey disease, which was recalcitrant to many dermatologic therapies including systemic antibiotics, dapsone, and topical corticosteroids. We precribed tacrolimus (0.1%) ointment for application to the lesions twice a day and examined weekly for the efficacy; the lesions were much improved after 6 weeks of treatment.