Genetic Diversity of Dematiaceous Fungi Using Random Amplified Polymorphic DNA / 대한의진균학회지

BACKGROUND: There are three kinds of diseases caused by dematiaceous fungi: chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma. The dematiaceous fungi have been identified and classified by morphological, biochemical and physiological tests. Recently molecular analysis has been introduced to the field of medical mycology. OBJECTIVE: We investigated the genetic diversity of dematiaceous fungi using random amplified polymorphic DNA (RAPD). METHODS: The dematiaceous fungal strains studied were eight clinical isolates of chromoblastomycosis and phaeohyphomycosis agents (3 strains of Fonsecaea pedrosoi, 2 strains of Exophiala dermatitidis, 1 strain of Exophiala jeanselmei, 1 strain of Phialophora verrucosa, 1 strain of Rhinocladiella aquaspersa) and 4 standard strains (F. pedrosoi IFM 4889, E. dermatitidis IFM 4828, P. verrucosa IFM 4928, R. aquaspersa IFM 4930). Total twelve strains of dematiaceous fungi were cultured on Sabouraud's dextrose broth and their DNA were extracted by bead-beating method. RESULTS: The optimal condition for PCR was template DNA 0.025 mg and annealing temperature 39 degrees C. The RAPD analysis using OPA 10 primer (5'-GTGATCGCAG-3') of Operon kit showed different patterns among dematiaceous fungi. But one clinical isolate of F. pedrosoi showed intra-specific variability. CONCLUSION: The RAPD analysis is considered a rapid and reliable method for identification and classification of dematiaceous fungi if the procedure is carefully standardized with adequate primer.

A Case of Basal Cell Carcinoma Arising in Linear Porokeratosis

Porokeratosis are characterized by distinct clinical findings of a keratotic ridge that corresponds to the cornoid lamella on histology and has well defined potential for malignancy. We report a case of basal cell carcinoma(BCC) arising in linear porokeratosis in a 77-yearold man.

A Case of Congenital Constricting Band of the Trunk / 대한피부과학회지

Congenital constricting band of the trunk is a rare malformation with a wide spectrum of associated congenital anomalies. A 3-year-old boy with a congenital constricting band around the waist and anterior thigh and clubfoot deformity is reported. Laboratory test and chest and abdominal X-ray examination were within normal limits and unremarkable. Histopathologic examination revealed compact fibrocollagenous bundles in deep dermis. The compact fibrocollagenous bundles are parallel to the skin surface and have thin wavy nuclei. We think these bundles caused annular constriction on the trunk. We follow up the patient regularly without specific treatment because the constricting band caused no functional impairment and hypertrophic scar had developed at the biopsy site.

A Case of Congenital Smooth Muscle Hamartoma / 대한피부과학회지

Congenital smooth muscle hamartoma usually presents as a well-circumscribed, hypertrichotic, hyperpigmented or skin colored patch or plaque on the trunk or an extremity at birth. Histologically, numerous thick, long, well defined bundles of smooth muscle fibers are scattered throughout the dermis in various directions. We report a case of congenital smooth muscle hamartoma in an 8-month-old female infant who showed hypertrichotic, skin colored plaque on the lumbosacral area since at birth. The pseudo-Darier sign was positive. Histopathologic findings were numerous, well-defined bundles of smooth muscle fibers in the dermis (H and E, Masson-trichrome stain).

A Case of Cutaneous Protothecosis / 대한피부과학회지

Protothecosis is an unusual cutaneous soft tissue infection caused by the Prototheca, which is a genus of the unicelluar, achloric algae. We report a case of cutaneous protothecosis in a 66-year-old female, who showed erythematous, purulent patches and plaques with ulcerations on the right forearm for 2 months. Biopsy specimen revealed the characteristic thick-walled morulalike sporangia in the dermis. Prototheca wickerhamii was isolated in the culture and the biochemical study. Electron microscopic examination showed the thick-walled spores containing dark dense bodies and amyloplasts. After two months of oral itraconazole 200mg/day, skin lesions were improved.

A Case of Infarcted Supernumerary Digit / 대한피부과학회지

The hand is complex embryological organ and the supernumerary digit is one of the most common congenital anomalies of the upper limbs. We report a premature female with congenital grotesque mass on her left hand that was found roentgenographically and histopathologically to be composed of infarcted cartilage structure. The patient had also congenital heart disease. We treated it with total excision.

A Simple Detection Method of the Resistance to the Treatment of Onychomycosis: A Case Report of Aspergillus sydowii Onychomycosis

A 35-year-old housewife was diagnosed with onychomycosis and treated by oral terbinafine, 250mg/day, for 4 months. Clinically all infected nails improved gradually. However, her left great toe-nail was not improved thereafter. At that time the proximal end of the onychomycotic lesion was marked with surgical blade, and terbinafine therapy was continued for four weeks. However, the onychomycotic nail was not improved, and the scratch mark passed by the proximal end of the infected nail. Therefore, we detected the resistance to the therapy and switched the medication to itraconazole 100 mg/day and then another scratch mark was done at the proximal end of the onychomycotic lesion. After another 2 weeks the infected nail went along with the scratch mark distally, and showed clinical improvement. After 8 weeks therapy of itraconazole, she was cured clinically and mycologically. The fungal culture was identified as Aspergillus sydowii.

A Case of Pemphigus Foliaceus Developed During Pregnancy / 대한피부과학회지

Pemphigus foliaceus is characterized by superficial blisters with acantholysis in the upper portion of the epidermis. Pemphigus foliaceus in pregnancy is rare. We report a case of pemphigus foliaceus in a 26-year-old pregnant woman who showed erythematous bullae, erosions and crusts on the whole body for 2 months. She was diagnosed by clinical and histopathological findings, direct immunofluorescent test and immunoblotting analysis. She was treated with prednisolone for 28 days and skin lesions were markedly improved.

A Case of Hypereosinophilic Syndrome Presented with Solitary Cutaneous Nodule / 대한피부과학회지

Idiopathic hypereosinophilic syndrome(HES) is a multisystem disease characterized by unexplained prolonged eosinophilia and evidence of specific organ damage, including skin. Cutaneous involvement occurs in more than 50 percent of patients but cutaneous nodule as the only manifestation of HES is rare. We report a case of hypereosinophilic syndrome in a 39-year-old male, who showed a solitary tender coin-sized erythematous nodule on his right lower abdomen for 2.5 months without evidence of systemic involvement.

Clinical Study of Halo Nevi / 대한피부과학회지

BACKGROUND: There have been few clinical studies of halo nevi. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathologic features of halo nevi and correlation between halo nevi and vitiligo. METHODS: The medical records of 40 patients with halo nevi and biopsy specimens of 30 patients with halo nevi were reviewed. RESULTS AND CONCLUSION: 1.The ratio of male to female patients was 1:1.5. 2.The mean age of the onset was 20.1 years (male : 11.5, female : 25.9). 3.Multiple halo nevi were present in 32.5%(male : 25%, female : 37.5%). 4.The areas in which the lesions developed were head and neck(39.1%), back(32.8%), anterior chest(12.5%), abdomen(10.9%), groin(3.1%), and lower extremity(1.6%) in descending order. 5.The mean duration of each color in central nevus was as follows: black(2.7 years), pink(3.5 years), gray(4.9 years) 6.The most common pathology of the central nevus was intradermal(80%). 7.The halo nevi associated with vitiligo were 21 cases(52.5%) out of 40 patients. Among them, the cases with non-segmental vitiligo were 13(61.9%), the cases with segmental vitiligo were 8(38.1%). 8.Out of the 21 cases with halo nevi associated with vitiligo, the cases with halo nevi prior to vitiligo were 4(19.1%), concurrent onset 12(57.1%) and the cases with halo nevi after vitiligo were 5(23.8%).

The Ivory Colored Hypopigmentation After Autologous Suction Blister Grafts in Vitiligo Lesion May be Caused by the Pretreated Deep Freeze

BACKGROUND: Ivory colored hypopigmentation has been frequently observed in morphea and lichen sclerosus et atrophicus, and also seen after phenol peels, dermabrasion, cryosurgery and post-laser resurfacing. OBJECTIVE: This study was undertaken to investigate the cause of hypopigmentation following autologous suction blister graft (ASBG) in vitiligo patients. METHODS: The ivory lesion and contralateral normal skin were collected by punch biopsies. And the tissues were stained with hematoxylin-eosin, Fontana-Masson, Masson's trichrome, Verhoeff-van Gieson, and S-100 protein to compare the differences between two specimens. RESULTS: H-E and Masson's Trichrome stains showed that compacted hyalinized sclerotic collagens and collapsed, small sized capillaries in the upper dermis were definite in the hypopigmented lesion, whereas norma1 control sites were unremarkable. Elastic fibers were markedly decreased or fragmented in upper dermis of the hypopigmented lesion. Fontanna-Masson stain identified that the lesional epidermis was more hyperpigmented rather than hypopigmented. S-100 stain showed no differences between hypopigmented and contro1 sites. CONCLUSION: The results suggest that the ivory colored hypopigmentation is not caused by the failure of procedure, but by scar formation due to deep freeze; therefore, this kind of complication may be prevented by carefully performing the cryotherapy.

An Epidermoid Cyst with Seborrheic Verruca-like Cyst wall Showing Incidental Acantholysis

A 37-year-old female was presented with an epidermal cyst on her lower back. Histopathologic examination was consistent with an epidermoid cyst with seborrheic verrucalike cyst wall and acantholytic change was also found in the cyst wall. Human papillomavirus(HPV)-specific DNA sequences in paraffin-embedded tissue section were not detected by polymerase chain reaction using HPV consensus primers.

A Case of Subcutaneous Phaeohyphomycosis Caused by Exophiala Jeanselmei / 대한피부과학회지

We report a case of subcutaneous phaeohyphomycosis caused by Exophiala(E,) jeanselmei in a 66-year-old female, who showed a mild tender, 4.5x3.5cm sized, erythematous cystic mass with satellite lesions on the left forearm for 4 months. Histopathologically, suppurative granulomatous inflammation, brownish conidia in a chain and hyphae were observed. Fungal culture grew out the typical black-gray velvety colonies of E. jeanselmei after 2 weeks. The isolate grow well at 25 C, but very poorly at 37 C. No growth could be observed at 40 C. Sporulation adequate for evaluation was present on the malt extract agar. We confirmed E. jeanselmei by colony and microscopic morphology, temperature tolerance and sugar assimilation tests. The patient had been treated with itraconazole for 6 momths. Complete remission was observed.

Presence of Progesterone Receptors in the Granular Cell Layer of Epidermis: Immunohistochemical Localization of Estrogen and Progesterone Receptors

BACKGROUND: Hormones influence various normal biological processes in the skin and hairs. OBJECTIVE: This study was undertaken to investigate the presence of estrogen receptors(ER) and progesterone receptors (PR) in the skin and to assess differences in sex and age. METHODS: We examined seven normal volunteers' skin. The mouse monoclonal antibodies against human ER and PR were used to identify the localization of ER and PR in the frozen tissue sections by using a standard two stage indirect immunoperoxidase technique. RESULTS: The granular layer of epidermis and infundibulum of hair follicle in all the samples showed strong positivity of PR. Although each skin section did not contain all skin appendages, most of the samples showed that eccrine gland duct, inner root sheath of hair follicle stained weakly positive of PR. ER was not demonstrate in all samples epidermis. CONCLUSION: PR was presented in the granular layer of epidermis, infundibulum of hair follicle, eccrine gland duct, and inner root sheath of hair follicle. Therefore, we might suspect that the progesterone probably contributes to the keratinization of the skin because these positively staining sites are prior to complete keratinization layers.

Recurrence of Depigmentation in a Halo Nevus after Autologous Suction Blister Grafting

In this report we will highlight an interesting 3 year case of a halo nevus on the back of a 13-year-old Korean girl. This was a single halo nevus with a central pinkish mole and a depigmented patch, 20 mm in diameter. The patient underwent an autologous suction blister graft on the lesion. The halo nevus was completely repigmented except for the marginal rim. At a 4 month follow-up, a new whitish halo was observed around the central pinkish mole. At this point the central nevus was excised and examined with a H & E stain and an immunohistochemical stain with an anti-Ig G antibody. After the excision of the central mole, repigmentation was completed and this condition persisted at a 3-year-follow-up.

A Case of Varicella in a Full Term Pregnant Woman / 대한피부과학회지

Varicella during pregnancy is a threat to both mother and fetus because of disseminated infection, varicella pneumonia and meningitis etc. And about 10% of babies acquire intrauterine infection, as indicated by the congenital varicella syndrome, neonatal varicella or zoster during infancy. We report a case of varicella in a 30-year-old, 39 weeks and 3 days' gestational age, full-term pregnant woman presented with generalized erythematous papules, vesicles, pustules and umbilicated pustules on the whole body. She was ordered absolute bed rest for delaying the delivery and treated with acyclovir and varicella-zoster immune globulin. However, she delivered a healthy baby which weighed 3,350 gm the next early morning. In our investigation of cord blood after delivery, varicella-zoster IgG and IgM by ELIZA method were negative and varicella-zoster virus DNA by polymerase chain reaction was also negative. The newborn revealed no clinical evidence of skin lesions and anomalies of varicella. So we supposed there was no intrauterine varicella infection.