Intralesional Cryosurgery for the Treatment of Earlobe Keloid / 대한피부과학회지

Keloids are benign cutaneous lesions that result from excessive collagen synthesis and deposition. Earlobe keloids are commonly seen as a complication of earlobe piercing and infection. Many different treatment modalities are available; however, therapeutic results are often unsatisfactory. Cryosurgery either used as monotherapy or in combination has been used successfully. However, keloids may require multiple sessions to achieve significant improvement and have a high rate of recurrence. Compared to conventional cryosurgery, intralesional cryosurgery has advantages of proper freezing of the deep layer of the lesion and a less harmful effect on the superficial layers. Herein, we present three cases of earlobe keloid effectively treated with intralesional cryosurgery.

Two Cases of Eruptive Pseudoangiomatosis / 대한피부과학회지

Eruptive pseudoandiomatosis (EPA) is a rare, self-limiting exanthem, which is characterized by numerous erythematous angioma-like papules surrounded by a pale halo. We report two cases of EPA, which developed in adulthood. The first patient, a 50-year-old female, had erythematous angioma-like papules surrounded by a pale halo on the face and arms. The second patient, a 34-year-old female, had lesions on the upper and lower extremities. The histological features included dilated blood vessels with plump endothelial cells, but there was no evidence of frank vascular proliferation or vasculitis.

The Effects of Treponema pallidum on Human Dendritic Cells

Cell mediated immune responses play a prominent role in syphilis, which is caused by Treponema pallidum. The role of dendritic cells (DC) in the syphilitic infection is not well understood in human. In the present study, we studied interaction of T. pallidum with DC, generated from human peripheral blood mononuclear cells with GM-CSF and IL-4. After adding T. pallidum for 16 hours to immature DC at culture day 7, the change of surface antigens on DC was monitored by flow cytometry, the amount of IL-12 in culture supernatant of DC was measured by ELISA and T cell stimulatory capacity of DC was checked in mixed lymphocyte reaction (MLR). We have observed an efficient phagocytosis of T. pallidum by electron microscopy as early as 2 hours after addition of T. pallidum to DC. Interaction of DC with T. pallidum resulted in increased surface expression of CD83 which was proportionally increased according to the number of T. pallidum. Expressions of CD80, CD86 and HLA-DR on DC were slightly increased. The amount of IL-12 in the culture supernatant of DC was increased (1, 099pg/ml) after the addition of T. pallidum. T. pallidum-infected DC also displayed enhanced T cell stimulatory capacity in MLR. As seen from the above, we observed phagocytosis of T. pallidum by DC as early as 2 hours after addition of T. pallidum to DC and found that T. pallidum can stimulate DC maturation which mean that DC modulate an protective immune response during T. pallidum infection.

Increased Expression of Intracellular HLA-DM but Not on the Surface of Blood Monocyte-derived Dendritic Cells During Maturation

Cutaneous dendritic cells (DCs), Langerhans cells (LCs) and dermal dendritic cells (DDCs), are present in an immature state. The maturation of DCs is crucial for initiating an immune response. Since HLA-DM has an important role for antigen presentation, an increase in HLA-DM expression according to the maturation of blood monocyte-derived dendritic cells (MoDCs), which have similar characteristics with DDCs, is expected. Therefore, the aim of this study was to determine whether or not HLA-DM expression in MoDCs is related to maturation at each culture day (from day 0 to day 13) by flow cytometry. This was compared with the functional changes related to the maturation of MoDCs. MoDCs were generated by culturing human peripheral blood monocytes in the presence of GM-CSF and IL-4 for 7 days, which were followed by subsequent treatment with a cytokine cocktail (GM-CSF, IL-4, IL-1beta, TNF-alpha, IL-6 and PGE2) for the maturation of MoDCs. The intracellular HLA-DM was expressed in the immature MoDC. A sudden 3 to 8 fold increase in the intracellular HLA-DM expression was observed after treatment with a cytokine cocktail. HLA-DM was weakly expressed on the surface of the immature MoDC, but it seemed to be decreased with maturation. This study indicated that the intracellular HLA-DM expression increased, but not on the MoDC surface during maturation. This was despite the fact that HLA-DM expression was noted not only on the surface but also in the intracellular in the MoDC.

Analysis of methods for the generation of dendritic cells from human peripheral blood monocytes

Dendritic cells (DC) are highly efficient antigen-presenting cells that initiate the primary immune response. Several laboratories have developed culture systems for human DC from peripheral blood monocytes. Most of these studies have used fetal calf serum (FCS) containing culture conditions that are inappropriate for human application. GM-CSF and IL-4 were used to make immature DC. The monocyte-conditioned medium (MCM) was used to induce the final maturation of DC. Using the previously described methods, the quality of MCM has unpredictable variations. Therefore using a defined cocktail of growth factors for the generation of mature DC would be advantageous for experimental as well as clinical purposes. In this study, it is suggested that combinations of both GM-CSF/IL-4 or GM-CSF/IL-13 could be used as the first-step culture to produce immature DC, and that cytokine cocktail (GM-CSF, IL-4, IL-1beta, TNF-alpha, IL-6, PGE2) was as efficient as MCM for the second step-culture to produce fully maturated DC. Here, we have generated an easily reproducible culture system for DC that allows for the generation of large amounts of immature and mature DC, and we also now have established the method in a FCS-free system that is suitable for clinical use.

A Case of Cutaneous Chylous Reflux / 대한피부과학회지

The term cutaneous chylous reflux refers to the back flow of chyle from its normal route and the discharge of chyle from the skin. Primary chylous reflux suggests the absence of an apparent etiology and may be due to malformations of mesenteric lymphatics. On the other hand, secondary chylous reflux is the result from irradiation, neoplasm, trauma and infection with filariasis. Here we report a case of primary cutaneous chylous reflux that has a unique clinical feature.

A Case of Squamous Cell Carcinoma Arising in Nevus Sebaceus / 대한피부과학회지

Various types of appendage tumors develop secondarily within lesions of nevus sebaceus. A syringocystadenoma papilliferum is the most common benign tumor while basal cell carcinoma is the most common malignant tumor developed within a nevus sebaceus. However, a squamous cell carcinoma rarely develops within a nevus sebaceus, although it may be aggressive. We report a case of a 44 year-old man who had a fingertip-sized hemorrhagic crusted mass in a 3x4cm sized nevus sebaceus which had developed since birth on the right occipital scalp. This mass has rapidly enlarged into 1x2cm sized growth in the past 4 months. Histopathologic examination of the lesion showed that infiltrative squamous cell carcinoma with good or moderate differentiation indicatied the lesion of nevus sebaceus. Wide excision of squamous cell carcinoma including the whole lesion of nevus sebaceus was performed. Three months later, squamous cell carcinoma recurred in the same part of the scalp. Another wide excision of the recurrence was performed, but recurred again in the same part with invasion into the muscle layer. The recurrence is currently being treated by radiotherapy.

Detection of Antibodies to Human Keratinocytes in Vitiligo by Western blotting / 대한피부과학회지

BACKGROUND: It has been reported that immunological mechanisms may play an important role in the pathogenesis of vitiligo. Cellular degeneration in vitiligo is not limited to melanocytes but includes keratinocytes and probably whole epidermal melanin units. OBJECTIVE: The purpose of this study was to demonstrate the presence of anti-keratinocyte antibodies and the relationship between the level of antibodies and activity of the disease. METHODS: We analyzed the level of anti-keratinocyte antibodies in 13 patients with non-active, segmental vitiligo and 7 patients with active, non-segmental vitiligo by Western blotting. RESULTS: Using the Western blot method, we demonstrated the occurrence of anti-keratinocyte antibodies with keratinocyte cytoplasm. Anti-keratinocyte antibodies were more reactive in patients with active, non-segmental vitiligo than in those with non-active, segmental vitiligo. CONCLUSION: These results may be a secondary phenomenon to keratinocyte damage with concurrent occurrence of melanocyte destruction. However, the level of these antibodies may represent the acitivity of vitiligo.

A Case of Alopecia Universalis in a Gravida / 대한피부과학회지

A 33-year-old woman began to have diffuse hair loss with the onset of pregnancy, and it rapidly developed into alopecia universalis within 2 months af a mid-trimester termination at 20 weeks of gestation. Two months after completion of the depilation, white terminal hair started to regrow and repigmentation began after another 2 months. The hair loss was aggravated immediately after the termination and the regrowing pattern coincided with that of alopecia areata.

A Case of Sjogren's Syndrome with Recurrent Annular Erythema on the Face / 대한피부과학회지

Sjogren's syndrome has been considered to be an autoimmune disease affecting various organs including salivary and lacrimal glands. It occurs most commonly in middle-aged women, and less than 20 cases with primary Sjogren's syndrome have been reported in children. An 11-yim-old boy presented with recurrent annular erythema on the face that had been present for 2 years. A schirmers test showed a positive result. ANA was detected at a dilution of 1:640. Anti-Ro/SSA and anti-La/SSB antibodies were also detected. On histological examination, lymphocytes were infiltrated in the periappendegeal areas as well as the papillary and reticular dernis. The skin findimg is uncommon in children, but has become a characteristic feature of childhood Sjogrens syndrome with anti-Ro and/or anti-La antibodies.

The Effect of TCA Chemical Peel on Acne Scars / 대한피부과학회지

BACKGROUND: Trichloroacetic acid(TCA) chemical peel has been used for variable skin lesions. However, the effect of TCA chemical peel on acne scars has not been studied. OBJECTIVE: The object of this study is to evaluate the effect of TCA chemical peel on atrop hic acne scars. METHOD: Twenty three patients with atrophic acne scars, who were treated with TCA chemical peel were included. The patieits were interviewed for evaluation of the therapeutic efficacy of TCA chemical peel regarding the number of treatment and satisfaction rates. RESULTS: Those who received treatment for more than 6 times with good or excellent results were 13 out of 15 patients, whereas, those who received treatment for 4 times with good or excellent results were 4 out of 7 patients Thus, chemical peel on acne scars showed that the more often the treatment was carried out, the better the therapeutic effect. There was no significant complication. CONCLUSION: TCA chemical peel is safe and effective for the treatment of atrophic acne scars.