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Squamous cell carcinoma in situ (SCCIS) is a precancerous lesion that usually appears as a well-demarcated erythematous scaly plaque, histopathologically characterized by atypical full-thickness disarrangement and pleomorphic atypical keratinocytes. Extramammary Paget disease (EMPD) is an intraepidermal tumor that usually affects skin in the genital region, histopathologically identified by large cells with pale and vacuolated cytoplasm, called Paget cells, in the epidermis. An 84-year-old female presented with an asymptomatic solitary scaly erythematous plaque on her back first noticed 10 years prior. A keratotic mass was noted immediately adjacent to the plaque. A biopsy was performed; one specimen showed atypical full-thickness disarrangement and pleomorphic keratinocytes with negative CK7 staining in the epidermis, and another specimen showed Paget cells above the basal layer with positive CK7 staining in the epidermis. Based on these findings, the patient was diagnosed with SCCIS coexisting with EMPD. The patient underwent wide surgical excision of the lesion with reconstruction, and is being monitored without recurrence.
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Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory papulosquamous disease of the skin. Its exact pathogenesis and incidence are not yet known. Clinically, it presents as palmoplantar keratoderma, hyperkeratotic follicular papules, and plaques. PRP can be diagnosed by histopathological examination, and the characteristic histopathological features include alternating orthokeratosis and parakeratosis, hypergranulosis, psoriasiform acanthosis with short and broad rete ridges, thick suprapapillary plates of the epidermis, and superficial perivascular inflammatory cell infiltrates. There are six subtypes of PRP based on clinical manifestations and age of onset. PRP is known to respond to acitretin, and treatment with other medications such as isotretinoin, methotrexate, and biologics results in symptomatic improvement. We present two cases of patients who developed type 2 and type 4PRP following treatment with cyclosporine.
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Pleomorphic sarcoma is a mesenchymal neoplasm and divided into several groups based on histologic differentiation features, including stroma and infiltrated cells. Undifferentiated pleomorphic sarcoma is a rare type of pleomorphic sarcoma. It is called pleomorphic dermal sarcoma when the origin of tumor is the skin. The term of this tumor is confusing, and it has been changed continuously. In histopathologic study, it presents as well circumscribed tumor in which several pleomorphic and atypical cells are mixed. Herein, we report a rare pleomorphic dermal sarcoma showing characteristics of myxoinflammatory fibroblastic sarcoma
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Background@#The European Academy of Allergy and Clinical Immunology guideline for the management of urticaria published in 2018 recommends adding omalizumab as a third-line therapy. However, data on the potential predictive factors of a successful response to omalizumab are limited in Korea. Therefore, this study aimed to perform a retrospective clinical analysis of the effects of omalizumab in a Korean population of patients affected by chronic spontaneous urticaria (CSU). @*Objective@#To investigate factors affecting the effect of omalizumab treatment and identify factors related to its clinical response. @*Methods@#We retrospectively reviewed the clinical records of patients with CSU treated with omalizumab at the single-center dermatology department from February 2018 to August 2020. Omalizumab was administered at a single dose of 150 mg every 4 weeks. Clinical treatment response was assessed using the urticaria activity score summed over 7 days (UAS7) after the fourth, sixth, and 12th omalizumab injections. @*Results@#Twenty-six patients were enrolled in this study. The mean UAS7 at baseline was 16.9 (range, 4∼28). Treatment was completed in seven patients (26.9%). Three patients (11.5%) discontinued treatment because of poor treatment response. Symptoms improved in all patients at the fourth injection (UAS7=3.9, range 0∼10). The second administration of omalizumab showed that the lower the body mass index (BMI), the better the response to treatment (p＜0.05), and a similar trend after an additional injection. @*Conclusion@#The symptoms improved after omalizumab treatment in most patients. Those with a lower BMI and higher total immunoglobulin E levels during long-term treatment showed significantly better treatment responses.
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Background@#A large number of patients present with multiple papular skin lesions at the outpatient department of dermatology. In practice, however, the clinical presentation and skin histology has often been difficult to classify as a specific disease group. @*Objective@#The purpose of this study was to analyze the clinical and histopathologic characteristics in patients at a single center with papular eruptions that looked clinically similar to lichen nitidus. Finally, we propose a new disease category with the series of characteristics we found. @*Methods@#We retrospectively reviewed and analyzed the medical records, clinical photographs, and histopathologic slides of 22 patients who underwent skin biopsies for the diagnosis of lichen nitidus-like papular lesions. @*Results@#There were 16 men (72.7%) and 6 women (27.3%) included with a mean age at onset of 13.3 years. There were 17 children (77.3%) and 5 adults (22.7%). Eleven patients (50%) had pruritic symptoms. Fifteen patients (68.2%) had generalized eruptions. The localized eruptions predominantly involved the upper extremity (31.0%), especially the dorsum of the hands (14.1%). The most frequent histopathologic changes were superficial perivascular inflammatory cell infiltration (100%) and epidermal acanthosis (95%). @*Conclusion@#Our study was an overall review of flat or dome-shaped papular eruptions. The data are expected to contribute to the identification of the characteristics of this cutaneous disease that has been difficult to categorize.
ABSTRACT
Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
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Objectives@#Currently, patients’ consent is essential to use their medical records for various purposes; however, most people give their consent using paper forms and have no control over it. Healthcare organizations also have difficulties in dealing with patient consent. The objective of this research is to develop a system for patients to manage their consent flexibly and for healthcare organizations to obtain patient consent efficiently for a variety of purposes. @*Methods@#We introduce a new e-consent model, which uses a purpose-based access control scheme; it is implemented by a blockchain system using Hyperledger Fabric. All metadata of patient records, consents, and data access are written immutably on the blockchain and shared among participant organizations. We also created a blockchain chaincode that performs business logic managing patient consent. @*Results@#We developed a prototype and checked business logics with the chaincode by validating doctors’ data access with purpose-based consent of patients stored in the blockchain. The results demonstrate that our system provides a fine-grained way of handling medical staff ’s access requests with diverse intended purposes for accessing data. In addition, patients can create, update, and withdraw their consents in the blockchain. @*Conclusions@#Our consent model is a solution for consent management both for patients and healthcare organizations. Our system, as a blockchain-based solution that provides high reliability and availability with transparency and traceability, is expected to be used not only for patient data sharing in hospitals, but also for data donation for biobank research purposes.
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The safety and efficacy of Poly-L-lactic acid (PLLA) as an injectable facial volumizer for the treatment of lipoatrophy and facial rejuvenation has been widely proven. We experienced a remarkable case of deep-seated nodules on both the cheeks of 57-year-old female 18-months after administration of PLLA filler injection for cosmetic purpose and performed a skin biopsy. With hematoxylin and eosin stain, the nodule showed non-caseating granulomas consisting of histiocytes with central foreign bodies in the dermis. This case report represents the late-onset foreign body reaction due to PLLA facial injections.
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Cutaneous warts are caused by the infection of keratinocytes with human papillomavirus (HPV). Hyperpigmentation is a common condition in which patches of skin become darker than the normal surrounding skin. We report a case of a 56-year-old man who presented with an asymptomatic pinkish and brownish plaque accompanied by progressive pigmentation on the left sole. The lesion was located where the patient had undergone wide excision and skin graft for stage Ib acral lentiginous melanoma three years earlier. Recurrent melanoma (nodular and acral lentiginous type) was suspected, and skin biopsies of the nodular lesion and lentiginous pigmented lesion were performed. The patient was diagnosed with plantar warts with hyperpigmentation by skin biopsy. In this case, damage to the skin barrier at the melanoma site and repeated surgery may have increased the risk of developing verruca and progressive pigmentary changes.
ABSTRACT
Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
ABSTRACT
Cutaneous warts are caused by the infection of keratinocytes with human papillomavirus (HPV). Hyperpigmentation is a common condition in which patches of skin become darker than the normal surrounding skin. We report a case of a 56-year-old man who presented with an asymptomatic pinkish and brownish plaque accompanied by progressive pigmentation on the left sole. The lesion was located where the patient had undergone wide excision and skin graft for stage Ib acral lentiginous melanoma three years earlier. Recurrent melanoma (nodular and acral lentiginous type) was suspected, and skin biopsies of the nodular lesion and lentiginous pigmented lesion were performed. The patient was diagnosed with plantar warts with hyperpigmentation by skin biopsy. In this case, damage to the skin barrier at the melanoma site and repeated surgery may have increased the risk of developing verruca and progressive pigmentary changes.
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Subject(s)
Humans , Commerce , Computer Communication Networks , Computer Security , Confidentiality , Electronic Health Records , Health Information Exchange , Logic , Methods , Politics , Privacy , ProxyABSTRACT
OBJECTIVES: Home-based nursing care services have increased over the past decade. However, accountability and privacy issues as well as security concerns become more challenging during care provider visits. Because of the heterogeneous combination of mobile and stationary assistive medical care devices, conventional systems lack architectural consistency, which leads to inherent time delays and inaccuracies in sharing information. The goal of our study is to develop an architecture that meets the competing goals of accountability and privacy and enhances security in distributed home-based care systems. METHODS: We realized this by using a context-aware approach to manage access to remote data. Our architecture uses a public certification service for individuals, the Japanese Public Key Infrastructure and Health Informatics-PKI to identify and validate the attributes of medical personnel. Both PKI mechanisms are provided by using separate smart cards issued by the government. RESULTS: Context-awareness enables users to have appropriate data access in home-based nursing environments. Our architecture ensures that healthcare providers perform the needed home care services by accessing patient data online and recording transactions. CONCLUSIONS: The proposed method aims to enhance healthcare data access and secure information delivery to preserve user's privacy. We implemented a prototype system and confirmed its feasibility by experimental evaluation. Our research can contribute to reducing patient neglect and wrongful treatment, and thus reduce health insurance costs by ensuring correct insurance claims. Our study can provide a baseline towards building distinctive intelligent treatment options to clinicians and serve as a model for home-based nursing care.
Subject(s)
Humans , Asian People , Certification , Computer Security , Delivery of Health Care , Electronic Health Records , Health Information Exchange , Health Personnel , Health Smart Cards , Home Care Services , Home Health Nursing , Information Dissemination , Insurance , Insurance, Health , Methods , Nursing , Nursing Care , Privacy , Social ResponsibilityABSTRACT
BACKGROUND: The occurrence of cutaneous malignant tumors has been increasing worldwide due to changes in various environmental factors. OBJECTIVE: Our study aimed to analyze the overall tendency of clinical characteristics in single-center patients with cutaneous malignant tumors according to sex, age, duration, size, anatomic site, treatment, and concomitant diseases. METHODS: We retrospectively reviewed the medical records and clinical photographs of 319 patients diagnosed with cutaneous malignant tumors (basal cell carcinoma, squamous cell carcinoma, melanoma, lymphoma, Paget's disease, metastatic skin cancer, mycosis fungoides, angiosarcoma, dermatofibrosarcoma protuberans, Kaposi sarcoma, malignant fibrous histiocytoma, Merkel cell carcinoma) and 109 patients diagnosed with premalignant tumors (Bowen's disease) between January 2007 and January 2017. RESULTS: The average annual incidence of malignant cutaneous tumors was 2.4%. In total, 158 males (36.9%) and 270 females (63.1%) were included with a mean age of onset of 66 years. Among the malignant tumors, basal cell carcinoma (30.8%) was the most common, while the incidences of squamous cell carcinoma (18.9%), melanoma (6.3%), and lymphoma (4.4%) were also high. The predominantly involved anatomic sites were the face (67.3%), trunk (11.5%), and legs (10.9%). Most cases involved solitarily existing tumors (77.3%), and pruritus (21.7%) was the most common accompanying symptom. Among the 69.6% of patients who received treatment for their tumors, the most common method was surgical removal. No significant increase in concomitant diseases or environmental factors was detected. CONCLUSION: Our study is meaningful as an overall and recent review of various types of cutaneous malignancies that provides preliminary data for further large-scale nationwide studies.