The Two Cases of Multifocal Fixed Drug Eruption Caused by Diclofenac / 대한피부과학회지

Fixed drug eruption (FDE) is a drug-induced disorder that may appear as patches or bullae. It recurs at the same sites as those involved in exposure to the same drug (causative drug). We encountered two cases of generalized FDE, and both patients had a history of diclofenac exposure before the onset of skin lesions. In the first case, an 82-year-old female patient presented with multiple erythematous patches on the trunk and lower extremities. In the second case, a 71-year-old male patient developed multiple bullae on violaceous patches on the trunk and extremities. The findings of histopathologic examinations were indicative of the diagnosis of FDEs. Although diclofenac is commonly used as a non-steroidal inflammatory drug, diclofenac-induced generalized FDE occurs rarely and has not been reported in Korea. With reuse of causative drugs, the size and number of lesions tend to increase. Therefore, early diagnosis of FDE is important, and avoidance of repeated exposure to drugs should be educated.

Extraintestinal Cutaneous Manifestations in Inflammatory Bowel Disease: Survey and Literature Review / 대한피부과학회지

Background@#Inflammatory bowel disease (IBD) is a chronic, relapsing, inflammatory disease of the gastrointestinal tract. IBD tends to coincide with several cutaneous symptoms and signs; previous studies have suggested a link between IBD and immune-mediated skin diseases (ISDs) such as psoriasis, rosacea, and atopic dermatitis. However, there is a paucity of reports on extraintestinal cutaneous manifestations in patients with IBD from Asia and Korea. @*Objective@#We examined the prevalence of cutaneous manifestations in IBD patients and investigated the possible association between IBD and various dermatoses in a Korean tertiary care hospital. @*Methods@#Detailed questionnaires were administered to 120 patients diagnosed with IBD treated at the gastrointestinal center of our hospital. We also extracted their medical records retrospectively to obtain additional information about both their cutaneous manifestations and IBD, including disease duration and treatment course. A literature review on the prevalence of psoriasis in IBD patients was performed to clarify the association between those diseases. @*Results@#Crohn’s disease and ulcerative colitis were noted in 58 and 62 cases, respectively. Reactive skin lesions including aphthous stomatitis, erythema nodosum, and pyoderma gangrenosum were found in 12 cases (10%). ISDs such as psoriasis, rosacea, and atopic dermatitis were present in 3.3%, 21.7%, and 12.5% of cases, respectively. Other dermatoses including herpes zoster, xerosis, and skin fungal infection were also detected. @*Conclusion@#The prevalence of cutaneous manifestations in IBD is similar to that reported previously in Asian patients. Future investigations on the associations between skin diseases and IBD are needed to understand the pathogenesis and immunologic background of their comorbidities.

Clinicopathologic Features and Prognostic Factors of Primary Cutaneous Melanoma: a Multicenter Study in Korea

BACKGROUND: Malignant melanoma is a cutaneous malignancy with a high mortality rate and high potential for metastases. Detailed information on the clinicopathologic characteristics and prognostic factors of cutaneous melanoma is currently limited in Korea. This study aimed to identify the epidemiological and clinicopathologic characteristics of primary cutaneous melanoma in Korean patients, and to assess which prognostic variables could influence both the development of metastases in primary cutaneous melanoma and overall survival (OS). METHODS: A total of 261 patients diagnosed with primary cutaneous melanoma in seven medical centers between 1997 and 2017 were retrospectively investigated with regard to clinical presentation, localization of the tumor, histopathologic subtype, and survival time. RESULTS: The nodular histologic subtype, ulceration, and Breslow thickness were significantly associated with the development of metastasis; and overweight and obesity (body mass index > 23) were significantly associated with increased Breslow thickness. The location of the metastases appeared to influence OS: brain metastases were associated with the highest risk of death, followed by gastrointestinal, lung, and extra-regional lymph node metastases. CONCLUSION: In this study, tumor thickness, nodular histologic subtype, and ulceration predicted metastatic spread of primary cutaneous melanoma. In addition, OS was associated with the location of metastases. Obesity was related to the prognosis of primary cutaneous melanoma. Clinicians should bear these findings in mind when forming a diagnosis because of the risk of a poor prognosis.

A Case Report of Hailey–Hailey Disease Treated with Alitretinoin

No abstract available.

Association between Homocysteine Levels and Psoriasis: A Meta-Analysis

BACKGROUND: Psoriasis is a multifactorial disease associated with an increased risk for metabolic syndrome and cardiovascular diseases. Elevated levels of homocysteine (Hcy) are a marker of cardiovascular risk. Several studies have evaluated the associations between psoriasis and Hcy levels; however, the results remain inconclusive. OBJECTIVE: We performed a systematic review of the literature and a meta-analysis to better understand the relationship between psoriasis and Hcy. METHODS: Five scientific databases (MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science) were searched to identify relevant studies. A review of 307 publications identified 16 studies that directly assessed plasma levels of Hcy in psoriasis patients. RESULTS: A total of 16 studies including 2,091 subjects were included in the meta-analysis. Hcy levels were significantly higher in psoriasis patients relative to healthy controls (weighted mean difference [WMD], 3.30; 95% confidence interval [CI], 1.58∼5.02; I²=82.1%). Subgroup analyses revealed that patients with higher mean psoriasis area severity index (PASI) scores (PASI>10) had significantly higher Hcy levels compared to healthy controls (WMD, 4.17; 95% CI, 1.18∼7.16; I²=88.3%), whereas patients with lower mean PASI scores (PASI ≤10) had not (WMD, 0.76; 95% CI, −1.84∼3.35; I²=72.2%). CONCLUSION: This meta-analysis found that psoriasis patients, in particular those with PASI >10, had significantly higher Hcy levels compared to healthy controls. Further research is needed to determine the association between Hcy levels and psoriasis severity.

Treatment of Hidradenitis Suppurativa Patient with Klinefelter Syndrome by Adalimumab

Hidradenitis suppurativa (HS) is a chronic, inflammatory and painful skin disease with recurrent nodules and tracts involving the intertriginous regions. It is known that the patient with HS shows an increased risk of metabolic disorders such as diabetes, metabolic syndrome and autoimmune diseases. Klinefelter syndrome (KS) is a sex chromosomal disorder occurring in males due to an abnormality of sexual differentiation, characterized by 47, XXY karyotype. Also, KS is related with somatic comorbidities such as metabolic syndrome, autoimmune and rheumatologic disorders as HS is. We report a HS patient with KS who shows a big improvement while on tumor necrosis factor-alpha inhibitor treatment.

Clinical and Statistical Analysis of Patients with Anaphylaxis Visiting the Emergency Room of a Tertiary Hospital / 대한피부과학회지

BACKGROUND: Understanding the epidemiology of anaphylaxis is imperative for appropriate diagnosis and treatment, but the prevalence reportedly varies and only a few studies have compared the clinical features of anaphylaxis with the underlying causes in Korea. OBJECTIVE: This study aimed to investigate the etiology and clinical features of anaphylaxis. METHODS: We retrospectively reviewed the medical records of 319 anaphylaxis patients who visited our emergency room and extracted information on the causes, clinical characteristics, and subsequent outpatient visits. RESULTS: Food, drugs, and environmental factors were common causes of anaphylaxis. Statistically significant differences (p<0.001) were observed between children (<18 years of age) and adults (≥18 years of age), with food and drugs identified as the most common causes, respectively. Clinical characteristics of the patients were compared according to the common causes of anaphylaxis. Cutaneous symptoms were observed more frequently in food-induced cases (n=137, 95.1%) compared to drug-induced (n=73, 77.7%) and bee sting-induced (n=18, 78.3%) cases (p<0.001), whereas neurological symptoms were observed more frequently in drug-induced (n=37, 39.4%) and bee sting-induced (n=11, 47.8%) cases than in food-induced (n=18, 12.5%) cases (p<0.01). Drug-induced (n=44, 46.8%) and bee sting-induced (n=11, 47.8%) cases were more severe than food-induced cases (n=32, 22.2%). Out of the 319 assessed patients, only 25, 14, and 14 patients were referred to the pediatrics, allergy, and dermatology departments, respectively, after visiting the emergency room. CONCLUSION: Clinical characteristics of anaphylactic patients differed according to the underlying cause, but these findings are presumably influenced by factors determining the severity of anaphylaxis. We found that subsequent follow-up care in other departments to identify the cause of anaphylaxis was inadequate for most patients.

A Case of Generalized Granuloma Annulare in a Pediatric Patient / 대한피부과학회지

No abstract available.

A Rare Case of Dystrophic Calcification in the Masseter Muscle / 대한피부과학회지

No abstract available.

A Case of Hyperpigmented Mycosis Fungoides with CD8 Positive Cells / 대한피부과학회지

Mycosis fungoides (MF) represents the prototype of cutaneous T-cell lymphoma, which is defined as clonal expansion of skin-homing T lymphocytes. The natural history of MF is characterized by an indolent progression through patch, plaque, tumor, and visceral stages; however, this progression is not necessarily seen in all patients. Classically, the atypical lymphocytes in MF are CD3/CD4 positive with a loss of CD7. However, fewer than 5% of cases of MF present with a cytotoxic/suppressor CD8 positive phenotype, which presents with a variety of clinical features, including granulomatous, folliculotropic, poikilodermatous, hypopigmented, and hyperpigmented MF. Different immunophenotypic variants have been reported in MF but seem to lack any specific behavior and prognosis. Herein, we report a rare case of hyperpigmented MF with CD8 positive cells.

A Case of Papular Elastorrhexis: Differential Diagnosis with Eruptive Collagenoma / 대한피부과학회지

Papular elastorrhexis is a rare entity, possibly a form of connective tissue nevi, characterized by asymptomatic white papules on the trunk and extremities first appearing during childhood or adolescence. Histopathologically, the elastic fibers are decreased and may appear in thin and fragmented forms. This rare condition has clinical and histological findings that overlap with those of other connective tissue nevi, making diagnosis a challenge for dermatologists. Herein we report the case of a 27-year-old Korean female presenting with asymptomatic 2~5 mm sized whitish papules on both extremities and showing histopathologic findings of increased layers of collagen fibers and decreased and fragmented elastic fibers in the dermis.

Two Cases of Acne Keloidalis Nuchae Developed in Patients with Metabolic Syndrome / 대한피부과학회지

No abstract available.

Bullous Pilomatricoma: A Case Report / 대한피부과학회지

No abstract available.

A Case of Adult-onset Xanthogranuloma on the Skin of the Third Toe / 대한피부과학회지

No abstract available.

Increased Prevalence of Left-sided Skin Cancer: A Systematic Review and Meta-analysis / 대한피부과학회지

BACKGROUND: Based on trends demonstrated in the United States, a very insignificant number of people have shown a predisposition to left-sided skin cancer. However, to date, no systematic review or meta-analysis has demonstrated the predominance of left-sided skin cancers over right-sided skin malignancies. OBJECTIVE: We systematically reviewed and meta-analyzed all data pertaining to locations of skin cancers. METHODS: All data were pooled using the Mantel-Haenszel method (random-effects weighting); an inverse variance model featuring fixed-effects weighting was applied to explore the robustness of modeling. Heterogeneity was evaluated using the I2 test. Dichotomous outcomes with respect to the prevalence of left- and right-sided skin cancers are presented as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Nine studies were included in our evaluation. Our study sample included: 182,840 patients with malignant melanoma (MM), 1,419 patients with basal cell carcinoma (BCC), and 331 patients with squamous cell carcinoma (SCC). Meta-analyses of pooled observational data revealed greater prevalence of left-sided MM compared to right-sided MM (RR 0.91, 95% CI 0.89~0.92, p<0.01), while left-sided SCC was more prevalent than right-sided SCC (RR 0.83, 95% CI 0.71~0.97, p=0.02). However, right-sided BCC was more prevalent than left-sided BCC (RR 1.07, 95% CI 0.95~1.19, p=0.26). CONCLUSION: Observational studies vary greatly in terms of design, methodological quality, and types of patients studied. Of note, only a few studies analyzing BCC and SCC were included in our present meta-analysis. Additionally, a selection and reporting bias could have affected our results. Our meta-analysis suggests that both MM and SCC demonstrate a left-side bias, but BCC does not.

Increased Prevalence of Left-sided Skin Cancer: A Systematic Review and Meta-analysis / 대한피부과학회지

BACKGROUND: Based on trends demonstrated in the United States, a very insignificant number of people have shown a predisposition to left-sided skin cancer. However, to date, no systematic review or meta-analysis has demonstrated the predominance of left-sided skin cancers over right-sided skin malignancies. OBJECTIVE: We systematically reviewed and meta-analyzed all data pertaining to locations of skin cancers. METHODS: All data were pooled using the Mantel-Haenszel method (random-effects weighting); an inverse variance model featuring fixed-effects weighting was applied to explore the robustness of modeling. Heterogeneity was evaluated using the I2 test. Dichotomous outcomes with respect to the prevalence of left- and right-sided skin cancers are presented as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Nine studies were included in our evaluation. Our study sample included: 182,840 patients with malignant melanoma (MM), 1,419 patients with basal cell carcinoma (BCC), and 331 patients with squamous cell carcinoma (SCC). Meta-analyses of pooled observational data revealed greater prevalence of left-sided MM compared to right-sided MM (RR 0.91, 95% CI 0.89~0.92, p<0.01), while left-sided SCC was more prevalent than right-sided SCC (RR 0.83, 95% CI 0.71~0.97, p=0.02). However, right-sided BCC was more prevalent than left-sided BCC (RR 1.07, 95% CI 0.95~1.19, p=0.26). CONCLUSION: Observational studies vary greatly in terms of design, methodological quality, and types of patients studied. Of note, only a few studies analyzing BCC and SCC were included in our present meta-analysis. Additionally, a selection and reporting bias could have affected our results. Our meta-analysis suggests that both MM and SCC demonstrate a left-side bias, but BCC does not.

Permanent Makeup Removal from Murine Skin Using 1,064-nm Q-switched Nd:YAG Laser and 694-nm Q-switched Ruby Laser: Comparing the Degree of Removal Following Irradiation at Different Time Points after Application / 대한피부과학회지

BACKGROUND: Q-switched lasers have made it possible to remove tattoos without leaving unsightly scars. OBJECTIVE: Tobdetermine the optimal time for permanent makeup removal using Q-switched Nd:YAG and ruby lasers, we compared the degree of removal and associated histological changes following irradiation at different time points. METHODS: Using black ink and a permanent makeup machine, we performed 108 separate permanent makeup applications on rat skin. The 1,064-nm Q-switched Nd:YAG laser (QSNDL) and 694-nm Q-switched ruby laser (QSRL) were used to irradiate the permanent makeup on the day of its application and also 3, 5, 7, 14, and 21 days later. We assessed changes in pigmentation over time at each irradiated site using Mexameter® measurements and skin biopsies. RESULTS: The Mexameter® analysis demonstrated no significant differences in pigment removal among irradiations with QSNDL or QSRL on the day of permanent makeup application or at 3, 5, 7, 14, and 21 days later. Histological analysis demonstrated that permanent makeup pigment migrated from the epidermis to the superficial and mid dermis over time. QSNDL more effectively removed pigment throughout the epidermis and dermis compared to QSRL. CONCLUSION: For maximum pigment removal efficacy, the melanin index results suggest that laser treatment should be performed on the day permanent makeup is applied. However, from the histological perspective, permanent makeup should be removed approximately 1 week later, at which point the crusts have peeled off and the wound repair process is almost complete. In this study, histological analysis suggested the superiority of treatment with QSNDL to that with QSRL.

Comparison of Thermal Damage and Wound Repair in Rat Skin after Bipolar Fractional Radiofrequency and CO₂ Laser Treatment / 대한피부과학회지

BACKGROUND: Several studies have described the use of bipolar fractional radiofrequency (FRF) treatment not only to reverse aging or restore photo-damaged skin but also to treat acne and acne-related scarring with a low downtime and few potential complications. However, few histological studies have been conducted to identify the precise mechanism responsible for the success of bipolar FRF treatment. OBJECTIVE: To compare thermal tissue damage and wound repair after exposure to bipolar FRF and ablative CO₂ laser treatment. METHODS: We irradiated the skin of an albino rat (Sprague-Dawley, 200∼250 g) using a CO₂ laser and a bipolar FRF device. Biopsy specimens of the irradiated skin were collected on the first, third and fourteenth day after treatment. For histological analysis, the skin samples were stained with hematoxylin and eosin, Masson's trichrome, and Verhoeff-van Gieson stain. RESULTS: Immediately after bipolar FRF treatment, the skin samples showed coagulated columns in the dermis forming a pyramidal zone of sublative thermal injury. Three days after treatment, they showed re-epithelialization with minimal crust formation. Compared to the ablative CO₂ laser, bipolar FRF treatment showed lower epidermal disruption and more extensive dermal remodeling, with a rapid tissue repair response to the damage. CONCLUSION: With bipolar FRF treatment, wound repair is rapid with minimal recovery time and pigmentary complications. The bulk impact of coagulation and residual heating occurring deep within the dermis causes significant collagen contracture and remodeling, leading to effective improvement in skin texture and wrinkles, acne scars, and dyschromia in all skin types.

Comparison of Thermal Damage and Wound Repair in Rat Skin after Bipolar Fractional Radiofrequency and CO₂ Laser Treatment / 대한피부과학회지

BACKGROUND: Several studies have described the use of bipolar fractional radiofrequency (FRF) treatment not only to reverse aging or restore photo-damaged skin but also to treat acne and acne-related scarring with a low downtime and few potential complications. However, few histological studies have been conducted to identify the precise mechanism responsible for the success of bipolar FRF treatment. OBJECTIVE: To compare thermal tissue damage and wound repair after exposure to bipolar FRF and ablative CO₂ laser treatment. METHODS: We irradiated the skin of an albino rat (Sprague-Dawley, 200∼250 g) using a CO₂ laser and a bipolar FRF device. Biopsy specimens of the irradiated skin were collected on the first, third and fourteenth day after treatment. For histological analysis, the skin samples were stained with hematoxylin and eosin, Masson's trichrome, and Verhoeff-van Gieson stain. RESULTS: Immediately after bipolar FRF treatment, the skin samples showed coagulated columns in the dermis forming a pyramidal zone of sublative thermal injury. Three days after treatment, they showed re-epithelialization with minimal crust formation. Compared to the ablative CO₂ laser, bipolar FRF treatment showed lower epidermal disruption and more extensive dermal remodeling, with a rapid tissue repair response to the damage. CONCLUSION: With bipolar FRF treatment, wound repair is rapid with minimal recovery time and pigmentary complications. The bulk impact of coagulation and residual heating occurring deep within the dermis causes significant collagen contracture and remodeling, leading to effective improvement in skin texture and wrinkles, acne scars, and dyschromia in all skin types.

Permanent Makeup Removal from Murine Skin Using a 1064 nm Q-switched Nd:YAG Laser: Comparison of the Degree of Removal When Irradiated at Various Time Points after Application / 대한피부과학회지

BACKGROUND: Various Q-switched (QS) lasers, such as ruby, alexandrite or neodymium:YAG (Nd:YAG) lasers, are used to remove tattoos and permanent makeup. To our knowledge, there has been no indication or guideline published for the optimal time for laser-mediated tattoo removal. OBJECTIVE: To set a guideline for the optimal irradiation time for tattoo and permanent makeup removal via 1064 nm QS Nd:YAG (QSND) laser, we compared the degree of tattoo removal and skin histologic changes when the irradiation was employed at different time points. METHODS: Rat skin was marked with 54 artificial permanent makeup marks with black ink using a permanent makeup machine. The marks were irradiated with a 1064 nm QSND laser on the application day, and 3 days, 5 days, 1 week, 2 weeks, and 3 weeks after application. Pigmentation changes were checked over time using a Mexameter(R) and skin biopsy. RESULTS: There was no significant difference in the degree of pigment removal as examined by Mexameter(R) on the day of makeup application compared to 3 days, 5 days, 1 week, 2 weeks, and 3 weeks after application. Histopathologically, the permanent makeup pigments seemed to move from epidermis to superficial and mid dermis with time. The pigments were relatively well removed throughout the epidermis and dermis when the laser was employed 7 days after tattoo application, compared to laser irradiation on the day of application, as viewed histologically. CONCLUSION: Laser removal of permanent makeup is effective on the day of application, as determined by testing pigment levels. However, based on histopathology, it is recommended to use lasers to remove permanent makeup about a week after application, since the wound repair process is almost complete at that time.