Therapeutic Effect of Topical Application of Linoleic Acid and Lincomycin in Combination with Betamethasone Valerate in Melasma Patients

Melasma is an acquired symmetric hypermelanosis characterized by irregular lightto gray-brown macules and patches on sun-exposed areas. Many therapeutic agents are available but are unsatisfactory. Recently, it has been demonstrated that lincomycin (LM) and linoleic acid (LA) can inhibit melanogenesis in vitro. Our purpose was to investigate the clinical efficacy of topical application of LM and LA in combination with betamethasone valerate (BV) in melasma patients. Fortyseven Korean female adults with clinically diagnosed melasma were enrolled in a 6-week, double-blind, randomized clinical trial. Patients were treated with one application of the vehicle (group A), 2% LM mixed with 0.05% BV (group B), or 2% LM mixed with 0.05% BV and 2% LA (group C) on the face every night. Determination of efficacy was based on the Melasma Area and Severity Index (MASI) score and objective assessment (no effect, mild, moderate, or excellent) at intervals of 2 weeks until the end of the study at 6 weeks. After 6 weeks, in comparison with the pre-treatment MASI score, the average MASI score of group C decreased to 68.9%, compared with 98% in group A (p<0.05) and 85.4% in group B. There was no statistically significant difference between group A and group B. Seven patients (43.7%) in group C revealed more than moderate improvement in objective assessment, compared with none in group A and two patients (12.5%) in group B. There were no significant side effects. Topical application of linoleic acid is considered to be effective in the treatment of melasma patients.

Antimelanogenic effects of Arbutin / 대한피부과학회지

BACKGROUND: Arbutin is a glycosylated hydroquinone found at high concentration in certain plants capable of surviving extreme and sustained dehydration. It has been suggested as an inhibitory compound of melanogenesis. OBJECTIVE: The purpose of this study was to investigate the effect of arbutin on melanogenesis in cultured human melanocytes and to evaluate the effectiveness of arbutin in patients with melasma. METHODS: I. In vitro study:we examine the cell number, SRB assay, tyrosinase activity, and melanin contents of cultured human melanocytes in control(absence of arbutin) and experimental groups (presence of 10(-5) M, 10(-4) M, and 10(-3) M arbutin). II. In vivo study:6 patients with melasma applied a 3 % arbutin solution twice daily for 8 weeks. Clinical response to treatment was evaluated by patients' subjective assessment and MASI(Melasma Area and Severity Index) score after 8 weeks of treatment. RESULTS: I. In vitro study 1. The number of melanocytes was decreased in groups treated with 10(-5) M, 10(-4) M, 10(-3) M arbutin for 2 days and 10(-4) M, 10(-3) M arbutin for 7 days. 2. On SRB assay, the proliferation of melanocytes was decreased in groups treated with 10(-5) M, 10(-4) M, 10(-3) M arbutin for 2 days and for 7 days. 3. Tyrosinase activity was decreased in groups treated wtih 10(-4) M, 10(-3) M arbutin for 2 days and 10(-5) M, 10(-4) M, 10(-3) M arbutin for 7 days. 4. The melanin contents were decreased in group treated with 10(-3) M arbutin for 7 days. II. In vivo study 1. On patients'subjective assessment, one showed moderate improvement, one showed mild improvement, and the other four showed no change. 2. On MASI score, there was less than 10% improvement in all 6 patients. 3. Side effects were not found in all 6 patients. CONCLUSION: Although arbutin showed an inhibitory effect on cell proliferation, tyrosinase activity, and melanin synthesis in cultured human melanocytes, there was no significant effect of depigmentation in the patients with melasma.

A Case of Trichoblastoma Arising from Nevus Sebaceus / 대한피부과학회지

Nevus sebaceus is a hamartoma of the skin with the potential to develop benign and maligmant neoplasms. Trichoblastoma is a benign neoplasm that consists of follicular germinative cells. We report a case of trichoblastoma arising from nevus sebaceus in a 22-year old female, who showed a dome-shaped, solitary nodule within yellowish hairless plaque on the occipital area. Histopathologic findings revealed tumoral lobules of basaloid cells affecting the full thickeness of the dermis. Some lobules had at their centers cystic cavities filled with large amounts of melanin. Tumoral lobules of the deeper part of the neoplasm were surrounded by hyalinized collagen bundles with immature fibroblast. The overall architectures was reminiscent of hair bulbs.

Two Cases of Systemic Candidiasis in Very Low Birth Weight Infants / 대한의진균학회지

Reports of systemic candidiasis in neonates have been noted with major advances in neonatal care permitting the frequent survival of low birth weight infants. We experienced 2 cases of systemic candidiasis associated with skin involvement in very low birth weight infants. One case presented with abdominal distension and an erythematous maculopapular eruption on trunk, buttock, and lower extremities. Culture of peritoneal fluid grew Candida of albicans. In another case, a diffuse erythematous patch was noted on the back and buttock. Culture of blood sample grew Candida of albicans. Despite the treatment with intravenous fluconazole, clinical status of the patients continued to remain unstable, and they died.

Plasma Histamine Levels in Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Although there is evidence to support histamine involvement in atopic dermatitis, the role of histamine in pathogenesis of atopic dermatitis and the development of pruritus have been discussed controversially. OBJECTIVE: The purposes of this study were to investigate the plasma histamine levels in patients with atopic dermatitis of different severity and to evaluate the correlation between plasma histamine levels and other parameters of atopy, such as, basophil counts, eosinophil counts, and total IgE levels. METHODS: We measured plasma histamine levels, serum total IgE levels, peripheral basophil counts, and peripheral eosinophil counts in twenty patients with atopic dermatitis and in seventeen normal control subjects. RESULTS: 1. There was no significant difference in plasma histamine levels between patients with atopic dermatitis and normal control subjects. 2. A comparison of atopic dermatitis patients with increased plasma histamine levels and those with normal histamine levels revealed no difference regarding age, sex, and serum IgE levels; however, the group with increased plasma histamine levels was associated with other atopic disease, more commonly. 3. There were no correlation between the clinical severity of atopic dermatitis, seveirty of itching in patients with atopic dermatitis and the plasma histamine levels. 4. Plasma histamine levels in atopic dermatitis were correlated with basophil counts and eosinophil counts. However, there was no correlation between the plasma histamine levels and the serum total IgE levels. CONCLUSION: There was no significant difference of plasma histamine levels between patients with atopic dermatitis and normal control subjects. However, further investigations for measurement of histamine level after stimulation with variety of different substance may lead to clarification of evidence for histamine release in atopic dermatitis.

A Case of Juvenile Xanthogranuloma Associated with Neurofibromatosis / 대한피부과학회지

Neurofibromatosis is a systemic hereditary disorder with varied manifestations in bone, soft tissue, the nervous system, and skin. Neurofibromatosis is characterized by cafe au lait macules, neurofi- bromas, Lisch nodules, optic gliomas, bony dysplasia, intertriginous freckling, and autosomal inheritance. Juvenile xanthogranuloma(JXG) is a benign, self-healing disorder of infants, children, and occa- sionally adults, characterized by yellowish papulonodular lesions located in the skin and other organs and consisting of an infiltrate of histiocytes with a progressively greater degree of lipidation in the absence of metabolic disorders. In 1954 Normland reported the first case of a JXG in a child with numerous cafe au lait macules. Royer, in 1958, reported the triple association of JXG, neurofibromatosis, and leukemia. It is estimated that children with neurofibromatosis and JXG have a higher risk for leukemia than do patients with neurofibromatosis who do not have JXG. In patients with both JXG and neurofibromatosis, long-term follow-up is required because of the additional association with leukemia. We report a case of JXG associated with neurofibromatosis.

A Case of Dermal Melanocytosis with Various Morphological Forms / 대한피부과학회지

Dermal melanocytosis is characterized by the presence of ectopic melanocytes in the dermis and shows several morphological forms, including the mongolian spot, the blue nevus, the nevus of Ota, the nevus of Ito, and dermal melanocyte hamartoma. A 30-month-old boy had a gray blue patch on the left deltoid region, upper back, sacral area, the entire length of the right arm, and right hand. There was a bluish speckled patch on the right palm. The lesions were present at birth, and no appreciable change in appearance had occurred. He also had blue to brownish pigmentation on the right side of his face with dark bluish pigmentation of the right sclera. His Mental and physical development had been normal. The histopathological examination revealed dendritic dermal melanocytes, mainly in the upper and mid dermis. Clinically and pathologically, the patient was diagnosed as having Ota nevus, Ito nevus, mongolian spot, and dermal melanocyte hamartoma. To our knowledge, dermal melanocytosis with 4 different morphological forms in a patient has not previously been reported. We report this unique case of dermal melanocytosis with various morphological forms.

Juvenile Generalized Pustular Psorasis Treated with Etretinate and Methotrexate / 대한피부과학회지

A case of generalized pustular psoriasis in a 12 year-old girl is described. She had generalized pustular eruptions on erythematous base, presenting lake of pus, yellowish brown crusts and denudation associated with high fever and chills. With the administration of oral etretinate at a dose of 0.8mg/kg/day for 1 week, rapid and dramatic remission was achieved. About 3 months after her discharge, there developed another wave of new pustules with fever. She was again placed on etretinate therapy. However, there was no expected response as before with developing new pustules continuously. At that time, we tried combination therapy with etretinate and methotrexate. the pustules and erythema began to remit, with eventual clearing of the skin in 6 weeks.