Giant Acquired Digital Fibrokeratoma Occurring on the Left Great Toe

Acquired digital fibrokeratoma is an uncommon, benign fibrous tumor which usually occurs in adults as a solitary lesion. The most frequent locations are fingers and toes and the size of the tumor is generally small, around 3~5 mm. An 18-year-old female presented with a solitary, skin-colored, round and protruded nodule of the left great toe. The size of nodule was 2.5x1.6x1.4 cm. Histopathologic examination revealed typical findings of acquired digital fibrokeratoma. Herein, we report a giant acquired digital fibrokeratoma.

Steatocystoma Multiplex Confined to the Scalp with Concurrent Alopecia

Steatocystoma multiplex (SM) is an uncommon disorder of the pilosebaceous unit characterized by the development of numerous sebum-containing dermal cysts which rarely involves the scalp. Here, we report a case of a 50-year-old man with multiple cystic nodules and alopecic patches on his scalp. On histopathological examination, the folded cyst was found to be lined by stratified squamous epithelium, while flattened sebaceous gland cells were identified in the cystic wall. Pigment casts were present in the hair papillae and perifollicular regions, suggesting trichotillomania as a possible cause of the observed alopecia. This case appears to represent an unusual clinical manifestation of SM.

Vitiligo Coexistent with Nevus Depigmentosus: This Was Treated with Narrow-Band UVB and These Lesions Were Followed Using the Mexameter(R), a Pigment-Measuring Device

Nevus depigmentosus (ND) is a congenital, non-progressive, hypopigmented lesion that is usually stable throughout an affected individual's lifetime. The clinical features of vitiligo are similar to those of ND, but the two diseases have different treatment responses and prognoses. We report here on a rare case of vitiligo that was coexistent with ND. Both conditions were treated with narrow-band UVB. An 11-year-old boy presented with two distinct types of hypopigmented lesions, one on the forehead and the other on his back. The first was a hypopigmented patch with leukotrichia, and it was incidentally discovered 3 months before the child was examined at our clinic and it had rapidly increased in size. The second hypopigmented patch was detected at birth and it had slowly been increasing in size. The hypopigmented lesion on the child's forehead was diagnosed as vitiligo, and the one on his back as ND. Once- or twice-weekly narrow-band UVB treatment was initiated. Improvements in the two lesions were assessed with clinical photography and using a Mexameter(R) (Courage-Khazaka Electronic, Germany), which is a pigment-measuring device.

Retronychia, a Proximal In-growth of the Nail Plate / 대한피부과학회지

Retronychia is a process of a nail embedding itself into the proximal nail fold due to an incomplete shedding of the nail, and this usually occurs after physical trauma. Retronychia causes persistent paronychia and defective nail growth on the patients. Simple avulsion of the superimposed nail is curative. A 17-year-old man presented with tender erythema and swelling on the proximal nail fold of the right 3rd and 4th fingers for 2 months after an operation that was performed due to metacarpal bone fracture. The second patient was a 25-year-old male who presented with a 1-month history of persistent paronychia on his right great toe after blunt trauma. For both patients, simple avulsion of the damaged nail was curative and underlying new nails were revealed. We report here on two cases of retronychia that could be easily overlooked and such cases have not been previously reported in the Korean dermatologic literature.

Fibroepithelioma of Pinkus Resembling Seborrheic Keratosis on the Thigh / 대한피부과학회지

Fibroepithelioma of Pinkus (FEP) is an uncommon variant of basal cell carcinoma and this typically appears as single or multiple nodular lesions on the lower back of the elderly. We report here on a case of a 59-year-old woman who presented with an asymptomatic erythematous sessile plaque on the lateral side of her right thigh, and she'd had this lesion for 8 years. Histologic examination showed anastomosing strands of basaloid cells extending from the overlying epidermis into the dermis. The tumor cells with large, oval nuclei and relatively little cytoplasms were grouped in a palisade pattern at the periphery of the tumor mass. The tumor was completely excised with a clear resection margin. The patient showed no recurrence for 10 months. For an elderly patient with a long-standing nodule found anywhere on the body, performing a skin biopsy should be considered to exclude malignancy, including FEP.

A Case of Linear Lichen Planus Pigmentosus

Lichen planus pigmentosus (LPP) is chronic pigmentary disorder that shows diffuse or reticulated hyperpigmented, dark brown macules on the sun-exposed areas such as the face, neck and other flexural folds. Clinically, it is different from classical lichen planus because LPP has a longer clinical course and it manifests with dark brown macules. In case of LPP, involvement of the scalp, nail or mucosal area is rare. The histopathological findings of the lesions show an atrophic epidermis, the presence of melanophages and a vacuolar alteration of the basal cell layer with a sparse lymphohistiocytic lichenoid infiltration. Although there have been a few reports of LPP, there have only 3 cases of linear LPP along the lines of Blaschko in the Korean dermatologic literature. Our patient had lesions on the neck and chin with a linear pattern. In this report, we describe a very rare case of LPP with a linear distribution related to Blaschko's lines on the neck and chin areas.

A Case of p-ANCA-Positive Propylthiouracil-Induced Pyoderma Gangrenosum

Propylthiouracil is a common medication used in patients with hyperthyroidism; it can cause perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) in some patients with Graves' disease. This antibody has been associated with various forms of vasculitis and neutrophilic dermatosis. Herein, we report a patient who presented with cutaneous manifestations of pyoderma gangrenosum with simultaneous development of p-ANCAs during PTU therapy for Graves' disease.

A Case of Superficial Acral Fibromyxoma Occurring after Trauma in a Childhood Patient / 대한피부과학회지

Superficial acral fibromyxoma is a rare, distinctive soft tissue neoplasm most often located in the periungal region of the fingers and toes. This tumor was recently recognized as a distinct clinicopathological entity and since then quite a few cases have been reported. These tumors are composed of stellate and spindle cells arranged in a loose form, with a fascicular growth pattern, and occur mostly in middle-aged adults. However in our case, the lesion developed in 9-year-old male, who had a history trauma. Although the exact pathogenesis of superficial acral fibromyxoma has not yet been clarified, it is possible that the fibroblast hyperplasia in the lesion could be triggered by trauma. We suggest this case which occurred in a 9-year-old patient, triggered by trauma, is a peculiar and interesting event.

Inflammatory Disseminated Superficial Porokeratosis / 대한피부과학회지

Inflammatory disseminated superficial porokeratosis is an unusual pruritic variant of disseminated superficial porokeratosis, and this was first described by Kanzaki in 1992 as eruptive pruritic papular porokeratosis. Since the first report, 8 cases of inflammatory disseminated superficial porokeratosis have been reported in English language dermatologic literature and only one case has been reported in the Korean dermatologic literature. The condition is clinically characterized by an acute pruritic exacerbation of disseminated superficial porokeratosis, which had been asymptomatic for several years. Usually the skin lesions show improvement after several months, leaving brownish atrophic lesions. Histopathologic examination reveals the cornoid lamella with an infiltration of eosinophils and lymphocytes in the upper dermis. Herein, we report on an 81-year-old Korean man with inflammatory disseminated superficial porokeratosis, and this was clinically and histopathologically diagnosed.

A Case of Eruptive Vellus Hair Cyst Involving the Face, Trunk, and Extremities / 대한피부과학회지

Eruptive vellus hair cyst (EVHC) is a benign epithelial tumor. Clinically, it usually presents as grouped or scattered yellowish to reddish-brown papules. It predominantly appears on the anterior part of the chest and extremities. Facial involvement is uncommon and 4 cases with facial involvement have been reported in the Korean dermatologic literature. However, involvement of the face coexistent with involvement of the trunk and extremities has never been reported in the Korean dermatologic literature. Herein, we report on a 10-year-old girl with multiple asymptomatic papules on her face, back and upper arms. To the best of our knowledge, this is the first report of EVHC that involves not only the face, but also the trunk and extremities in the Korean dermatologic literature.

A Case of Invasive Aspergillosis with Skin Involvement in a Renal Transplant Recipient / 대한피부과학회지

Aspergillosis is the second most common opportunistic fungal infection in immunocompromised patients yet skin involvement very rarely occurs. Herein, we report on a 22-year-old female renal transplant recipient who presented with multiple subcutaneous nodules. The biopsy and the culture of her cutaneous lesions confirm the diagnosis of invasive aspergillosis with skin involvement. Invasive aspergillosis should be included in differential diagnosis of immunocompromised patient with multiple subcutaneous nodules.

Surgical Excision and Postoperative IPL Epilation for Preventing Recurrence of Pilonidal Sinus / 대한피부과학회지

Pilonidal sinus (PS) is one of follicular occlusion tetrad, and this is a chronic inflammatory disease that's characterized by a sinus or cyst with entrapped hair in the midline of the sacral region. The exact pathogenesis of PS remains unknown, but hair insertion may be the essential cause of the disease. PS is usually treated by surgical excision, marsupialization or incision and curettage. However, these surgical options often exhibit high recurrence rate, and especially for hirsute patients. Laser epilation has recently been recommended as an effective postoperative adjunctive therapy for PS and this treatment may reduce recurrence of PS. We report here on a 37-year-old male patient with PS, and the PS was treated by surgical excision and postoperative intense pulsed light (IPL) epilation.

A Case of Cutaneous Endometriosis Combined with Epidermal Cyst in the Cesarean Section Scar / 대한피부과학회지

Endometriosis is the abnormal growth of endometrial glands and stroma outside the uterine cavity. Cutaneous endometriosis is a very rare form of extrapelvic endometriosis, and this most commonly occurs at the site of a previous abdominal or pelvic procedure such as hysterectomy, laparoscopy, episiotomy and cesarean section. The classic symptom is a painful nodule that becomes bigger and tenderer during menstruation. Because cutaneous endometriosis is unfamiliar to dermatologists, it can be easily misdiagnosed as other skin tumors. We present here a case of cutaneous endometriosis combined with epidermal cyst, and this developed in the cesarean section scar of a 28-year-old woman.

A Case of Lichen Spinulosus Arising at the Site of Antecedent Seborrheic Dermatitis / 대한피부과학회지

Lichen spinulosus (LS), a disorder of keratinization, is characterized by 1 to 3 mm sized follicular keratotic papules with a central horny spine that are grouped into large patches. Involved lesions were symmetrically distributed over extensor surfaces of the arms and legs, back, chest, face and neck. Although the exact etiology is unknown, several factors such as atopic dermatitis, infections and genetic components have been proposed as playing a role in LS. Additional associations reported in the literature include Crohn's disease, Hodgkin's disease, HIV infection, administration of omeprazole, and seborrheic dermatitis. Herein, we report a case of wide spread lichen spinulosus occurring on a preexisting seborrheic dermatitis lesion in a 50-year-old woman.

A Case of Acute Generalized Exanthematous Pustulosis Induced by Hydroxychloroquine / 대한피부과학회지

Hydroxychloroquine, an 4-amino-quinoline, has been used widely for the treatment of lupus erythematosus due to its anti-inflammatory and immuno-modulatory activities, as well as for the treatment of malaria. A 37-year-old woman who was suspected as lupus erythematosus and treated with hydroxychloroquine for 3 weeks was seen with exfoliated annular patches and pustules on the trunk, neck, and extremities. Histological examination showed subcorneal and spongiform neutrophilic pustules with perivascular lymphocytes, eosinophils and neutrophils infiltrations. The patient had been treated with systemic steroid and antihistamine. The pustular lesions had improved 2 weeks later without recurrence. The causative drug was confirmed by a positive patch test.

A Clinical Study of Skin Diseases on the Nipple and Areola / 대한피부과학회지

BACKGROUND: Nipple and areola diseases of the breast cause cosmetic, sexual and functional problems, and these problems are important to most patients, so awareness of these disease entities is invaluable. Still, there has been insufficient clinical investigation of these conditions. OBJECTIVE: This study was performed to investigate the epidemiological aspects of nipple and areola diseases that were confirmed by biopsies, and we wanted to highlight the clinical features of dermatoses of the nipple and areola. These disease features were then compared between the patients who visited the Departments of Dermatology and General Surgery. METHODS: We retrospectively reviewed the data of 80 patients with nipple and areola lesions and these lesions were confirmed by biopsy at Maryknoll Hospital between March 1989 and August 2007. 37 patients visited the Department of Dermatology and 43 patients visited the Department of General Surgery. RESULTS: The ratio of males to females was 6:74. The ratio of the males to females seen at the Department of Dermatology was 6:31. In contrast, that of the patients seen at the Department of General Surgery was 0:43. The most frequent nipple and areola skin diseases were fibroadenoma, intraductal papilloma, accessory breast and nipple eczema in the decreasing order of frequency. The most frequent nipple and areola skin diseases seen at the Department of Dermatology were nipple eczema, soft fibroma, hyperkeratosis of the nipple and areola, Paget's disease and invasive ductal carcinoma in the decreasing order of frequency. In contrast, the most frequent nipple and areola skin diseases seen at the Department of General Surgery were fibroadenoma, intraductal papilloma, accessory breast, phyllodes tumor and subareolar abscess. Of the 80 cases, 49 had papules or nodules, 15 had patches or plaques, 10 had vesicles, erosions or ulcers and 6 had nipple discharge. Of the 37 cases seen at the Department of Dermatology, 15 had patches or plaques, 14 had papules or nodules and 8 had vesicles, erosions or ulcers. In contrast, of the 43 cases seen at the Department of General Surgery, 35 had papules or nodules, 6 had bloody or serous nipple discharge, and 2 had vesicles, erosions or ulcers. CONCLUSION: We retrospectively studied 80 cases of nipple and areola skin diseases. This study suggests that various conditions, including dysembryoplasia, inflammatory dermatoses, hyperkeratoses and neoplasm, can affect the nipple and areola and show different characteristics according to the Hospital Department they are seen at. The patients with symptoms of patches or plaques tend to visit the Department of Dermatology. In contrast, patients with symptoms of papules or nodules tend to visit the Department of General Surgery. Further investigation with a large group of patients is necessary to better understand the epidemiology of nipple and areola skin diseases.

A Clinical Study of Skin Diseases on the Nipple and Areola / 대한피부과학회지

BACKGROUND: Nipple and areola diseases of the breast cause cosmetic, sexual and functional problems, and these problems are important to most patients, so awareness of these disease entities is invaluable. Still, there has been insufficient clinical investigation of these conditions. OBJECTIVE: This study was performed to investigate the epidemiological aspects of nipple and areola diseases that were confirmed by biopsies, and we wanted to highlight the clinical features of dermatoses of the nipple and areola. These disease features were then compared between the patients who visited the Departments of Dermatology and General Surgery. METHODS: We retrospectively reviewed the data of 80 patients with nipple and areola lesions and these lesions were confirmed by biopsy at Maryknoll Hospital between March 1989 and August 2007. 37 patients visited the Department of Dermatology and 43 patients visited the Department of General Surgery. RESULTS: The ratio of males to females was 6:74. The ratio of the males to females seen at the Department of Dermatology was 6:31. In contrast, that of the patients seen at the Department of General Surgery was 0:43. The most frequent nipple and areola skin diseases were fibroadenoma, intraductal papilloma, accessory breast and nipple eczema in the decreasing order of frequency. The most frequent nipple and areola skin diseases seen at the Department of Dermatology were nipple eczema, soft fibroma, hyperkeratosis of the nipple and areola, Paget's disease and invasive ductal carcinoma in the decreasing order of frequency. In contrast, the most frequent nipple and areola skin diseases seen at the Department of General Surgery were fibroadenoma, intraductal papilloma, accessory breast, phyllodes tumor and subareolar abscess. Of the 80 cases, 49 had papules or nodules, 15 had patches or plaques, 10 had vesicles, erosions or ulcers and 6 had nipple discharge. Of the 37 cases seen at the Department of Dermatology, 15 had patches or plaques, 14 had papules or nodules and 8 had vesicles, erosions or ulcers. In contrast, of the 43 cases seen at the Department of General Surgery, 35 had papules or nodules, 6 had bloody or serous nipple discharge, and 2 had vesicles, erosions or ulcers. CONCLUSION: We retrospectively studied 80 cases of nipple and areola skin diseases. This study suggests that various conditions, including dysembryoplasia, inflammatory dermatoses, hyperkeratoses and neoplasm, can affect the nipple and areola and show different characteristics according to the Hospital Department they are seen at. The patients with symptoms of patches or plaques tend to visit the Department of Dermatology. In contrast, patients with symptoms of papules or nodules tend to visit the Department of General Surgery. Further investigation with a large group of patients is necessary to better understand the epidemiology of nipple and areola skin diseases.

A Case of Giant Cell Tumor of the Tendon Sheath withHistologic Findings Similar to Those of Fibroma of the Tendon Sheath / 대한피부과학회지

Giant cell tumor of the tendon sheath and fibroma of the tendon sheath are similar benign neoplasms occurring near or within joints. The cells of giant cell tumor of the tendon sheath may be related to synovial cells, monocytes, and osteoclasts, whereas those of fibroma of the tendon sheath show myofibroblastic differentiation. But some authors consider these tumors to be different stages of the same pathologic process; fibroma of the tendon sheath is probably one end of the morphological spectrum of regression of giant cell tumor of the tendon sheath. We report a case of giant cell tumor of the tendon sheath with histologic findings similar to that of fibroma of the tendon sheath and suggest some fibroma of the tendon sheaths are indeed the end sclerosing stage of giant cell tumor of tendon sheaths.

A Case of Cytophagic Histiocytic Panniculitis Involving the Extrapleural Fat / 대한피부과학회지

Cytophagic histiocytic panniculitis gap (CHP) was described in 1980 as a chronic histiocytic disease of the subcutaneous tissue and associated with systemic manifestations such as fever, serositis, and hepatosplenomegaly. The current concept of CHP is that it represents a spectrum of lymphoproliferative disorders that induce secondary histiocytic cytophagocytosis. The pathogenesis of hemophagocytosis in CHP is unknown but may be related to histiocyte reaction to an abnormal cytokine milieu brought about by disordered T-cell function. In most cases the disease follows a fulminant course, but in some patients the disease seems limited to the skin and subcutaneous tissue and follows a more benign, chronic course. We report a case of cytophagic histiocytic panniculitis which had a long chronic course over 16 years, but recently became aggravated with the involvement of the extrapleural fat tissue and was treated with combination chemotherapy.

Multiple Eccrine Hidrocystomas Treated with Botulinum Toxinand Fine Needle Electrocoagulation / 대한피부과학회지

Multiple eccrine hidrocystomas are benign cysts of eccrine duct and occur mainly in middle aged women with numerous translucent papules on the central face. The treatment of multiple eccrine hidrocystomas is difficult because of their numbers and location. We propose a combined therapeutic method of botulinum toxin and electrosurgery for widely spreading eccrine hidrocystomas. Botulinum toxin inhibits sweating by temporarily blocking the release of acetylcholine from cholinergic neurons that innervate sweat glands. Electrosurgical energy is transmitted along cystic fluid and destructs cystic walls. A 62-year-old woman presented with multiple translucent papules on the face and was diagnosed with multiple eccrine hidrocytomas. Electrocoagulation was performed at a low power setting on the whole face and botulinum toxin was injected intradermally for microcystic lesions on the whole face except upper eyelids. The condition was controlled successfully for 4 months. We think that botulinum toxin and fine needle electrocoaglation are effective treatments for multiple eccrine hidrocytomas.