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Background@#Dermatofibromas (DF) are fibrohistiocytic tumors of unknown etiology, and multiple DF (MDF) are relatively rare. MDF have been reported in the setting of autoimmune diseases, human immunodeficiency virus infection, or comorbidities treated with immunosuppressive drugs. @*Objective@#The present study investigated whether underlying conditions with impaired immune function are associated with MDF. @*Methods@#A total of 338 patients with DF was enrolled. We divided patients into two groups as MDF and solitary DF (SDF) groups. We retrospectively reviewed patient medical records and classified all patients by underlying diseases. Statistical significance of SDF and MDF for each conditions was analyzed. @*Results@#The demographics and comorbidities were compared between MDF group (n=82) and SDF group (n=256). Among underlying conditions, systemic lupus erythematosus (SLE) (odds ratio, 10.397; 95% confidence interval, 2.743∼39.404; p＜0.001) was significantly associated with MDF over SDF. Vitiligo and post status of kidney transplant were related more highly to MDF (p=0.014; p=0.014, respectively) than to SDF. Presence of overall comorbidities, autoimmune diseases, and immunosuppressive drug use were associated with DF number (p＜0.001;p＜0.001; p＜0.001, respectively). @*Conclusion@#We propose an association between MDF and comorbidities, especially SLE and immunosuppressant use. MDF lesions seem to be impacted by compromised immune function. This is of significance since it is essential to search for associated conditions in patients presenting with MDF in dermatologic clinical settings.
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Inflammatory acquired Blaschko-linear dermatoses (IABLD) are a continuous concept involving diseases such as lichen striatus, blaschkitis, and atopic dermatitis. However, atopic dermatitis that showed increase in severity along Blaschko lines is rarely reported on its own. Herein, we report a rare case of atopic dermatitis with secondary prurigo nodularis along Blaschko lines, which may be valuable in broadening the concept of IABLD. A 28-year-old male presented with multiple, pruritic, brownish nodules on the left lower extremity along Blaschko lines for 3 to 4 years. The patient had atopic dermatitis since childhood. Histopathologic findings revealed compact orthohyperkeratosis, hypergranulosis, spongiosis, and irregular acanthosis in the epidermis. Fibrosis with vertically arranged collagen fibers and perivascular lymphohistiocytic infiltration were shown in the upper dermis. We diagnosed the case as secondary prurigo nodularis along Blaschko lines, accompanied by the preceding atopic dermatitis. We hypothesized that the patient’s underlying atopic dermatitis increased in severity along Blaschko lines, and prurigo nodularis occurred due to frequent scratching. The lesions improved with topical methylprednisolone cream, oral antihistamines and intralesional triamcinolone injection.
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Warty dyskeratoma (WD) is an uncommon skin tumor that histologically presents as focal acantholysis and dyskeratosis and is a common finding among acantholytic diseases such as Darier’s disease. WD most commonly occurs on the head or neck of adults as an isolated papule or nodule. To our knowledge, only 6 cases of WD in the genital area have been previously reported in the literature, and no case have occurred on the scrotum to date.We report the first case of multiple WD that occurred on the scrotum successfully treated with 0.025% tretinoin cream. A 55-year-old male presented with asymptomatic, multiple, 0.1∼0.2-cm-sized, skin-colored papules on the scrotum for the previous 6 months. A skin punch biopsy and human papillomavirus (HPV) polymerase chain reaction test were performed for a clinical suspicion of genital warts or bowenoid papulosis. The histopathologic examination showed cup-shaped epidermal invaginations with central keratotic plug. Prominent villi, acantholytic clefting and corps ronds were also shown. The patient tested negative for HPV and was diagnosed with WD with typical pathologic findings. The patient was treated with 0.025% tretinoin cream for 2 weeks, and the lesions decreased in both size and number.
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Background@#As the use of laser therapy for skin lesions has increased significantly, laser treatment is performed in many cases without an accurate diagnosis. @*Objective@#This study aimed to analyze cases in which skin lesions recurred or remained after laser treatment by investigating the clinicopathological diagnosis. @*Methods@#We retrospectively analyzed the patients who visited the Seoul Saint Mary’s hospital from January 2011 to December 2020, the clinical records of 518 cases of patient who had a history of laser treatment and underwent histopathological examination. @*Results@#The number and proportion of patients who visited the hospital showed a steadily increasing trend for 10 years. In 187 patients, the time between laser treatment and hospital visits was ＞1 year. The most common site of lesions was the face (66.2%), especially the cheek (29.3%) and nose (12.2%). Final diagnosis of the lesion yielded 59 cases (11.4%) of premalignant diseases and 55 cases (10.6%) of malignant tumors, and the rate increased with increasing age. The most common malignant tumor was basal cell carcinoma (69.1%), followed by squamous cell carcinoma (14.5%) and malignant melanoma (12.7%). @*Conclusion@#In this study, we found that laser treatment for premalignant and malignant tumors is not rare. This study emphasizes that indiscriminate laser treatment should be avoided, and an accurate diagnosis and proper medical treatment by an experienced dermatologist are needed.
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no abstract available.
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Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.
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Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.
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Extraskeletal osteochondroma is a rare, benign, bone tumor of the soft tissue that generally affects the soft tissue of the hands and feet, followed by the trunk, and is rarely reported in the head and neck area. A 41-year-old female presented with an asymptomatic, skin-colored, palpable nodule on the neck that had been slowly growing over an unknown period of time. An ultrasound examination revealed a 0.9-cm-sized, dense, calcified lesion in the skin layer on the left side of the neck. Calcinosis cutis, pilomatricoma, and other benign tumors were clinically suspected, and a tumor excision was performed. The histological examination showed encapsulated round nodules composed of mature hyaline cartilage, which gradually changed into mature bone tissue. Extraskeletal osteochondroma was diagnosed by pathological examination. Here, we report an interesting case of extraskeletal osteochondroma in an unusual location.
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Leprosy is an infectious disease caused by Mycobacterium leprae. Patients usually present with hypopigmented or erythematous plaques with central hypoesthesia or tenderness, and necessitate a differential diagnosis with eczema, granuloma annulare, sarcoidosis, syphilid, mycosis fungoides, erythema nodosum, and skin cancer. A 93-year-old woman presented with asymptomatic erythematous plaques and subdermal nodules on the face and extremities for 6∼ 7 months, and the lesions were suspicious for skin cancer. Histopathologic examination revealed diffuse infiltration of foamy histiocytes separated by a grenz zone. Acid-fast bacilli were seen in Ziehl−Neelsen stain with clumps called globi. Based on clinical and histopathological findings, she was finally diagnosed with lepromatous leprosy.The patient was diagnosed with leprosy at an advanced age; thus, we report the case in which dermatologists should consider leprosy as well as skin cancer in the elderly patients with unusual erythematous nodules, despite decreasing prevalence of leprosy.
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OBJECTIVES: Adolescence involves a number of developmental processes, as well as unique psychological characteristics and behaviors. An increased rate of internet and game addictions, school violence, and suicide may either represent aspects of adolescence or a psychopathological phenomenon. There is an urgent need to develop software programs that can prevent and resolve adolescent behavioral problems. We applied the mentalization theory to interpret and find solutions for problems faced by adolescent characters in literature. METHODS: In Joan Rowling's novel “Casual Vacancy,” Sukhvinder is a girl with problems representative of those encountered by modern adolescents; she is a victim of bullying and engages in self-mutilation. We targeted her problematic behaviors as representative of a prementalized state. RESULTS: Born into an upper-class English family with Pakistani origins, Sukhvinder, unlike her siblings, fails her parents' expectations. Whenever she faces a psychological crisis, she regresses into the teleological mode (the most primitive pre-mentalization stage) and regains her sense of self by cutting herself. After her friend's suicide, however, she begins to communicate with her parents and moves toward mentalization. CONCLUSION: By analyzing Sukhvinder's behavior, we assessed patterns of attachment, empathy, and mentalization, and identified corrective approaches for problematic behaviors. We believe that the presented interpretation may serve as a foundation for the development of models for understanding adolescent deviant behaviors.
Subject(s)
Adolescent , Female , Humans , Adolescent Behavior , Bullying , Empathy , Internet , Parents , Siblings , Suicide , ViolenceABSTRACT
BACKGROUND: P-phenylenediamine (PPD) has been identified as the most frequent contact sensitizer of hair dye and the clinical characteristics of hair dye contact allergy (HDCA) are diverse. OBJECTIVE: The purpose of this study was to identify the clinical characteristics of HDCA and to assess the relationships between HDCA, exposure time to PPD and PPD positivity. METHODS: We analyzed 105 patients with patch test-confirmed hair dye allergy who presented between July 2009 and March 2015. Clinical symptoms, signs, associated skin diseases, involved ACD area, and patterns of hair dye use were obtained by reviewing medical records and by interview. RESULTS: HDCA was more common in women and in individuals aged more than 50 years. Pruritus was the most common symptom; erythematous macules and patches were the most frequently observed clinical signs. The most common site of HDCA was the face and non-specific eczema and urticaria were frequently observed with HDCA. Exposure time to hair dye, represented as frequency and duration, showed a positive correlation with the area affected by hair dye allergy (p < 0.001). Hair dye allergy was identified in most patients (80%) before diagnosis by patch test. However, only 28.6% of all patients stopped using hair dye, even after the diagnosis was confirmed. CONCLUSION: The extent of hair dye allergy involvement was related to exposure time to hair dye. For effective treatment of HDCA, it is important to properly educate patients with HDCA about the clinical manifestations of HDCA and to keep away from allergens.
Subject(s)
Female , Humans , Allergens , Dermatitis, Allergic Contact , Diagnosis , Eczema , Hair Dyes , Hair , Hypersensitivity , Medical Records , Patch Tests , Phenylenediamines , Pruritus , Skin Diseases , UrticariaABSTRACT
Osteoblastoma is a rare benign tumor, representing less than 1% of all bone tumors. Most cases occur in the vertebrae and in the long bones. Intranasal or paranasal osteoblastoma is particularly rare and only one case of osteoblastoma in the inferior turbinate has been reported in the world literature. Treatment is intralesional curettage or en bloc resection. Since the tumor is benign, conservative surgery is curative in about 80-90% of the cases. Concha bullosa is an abnormal pneumatization of the intranasal turbinates and inferior concha bullosa is a very rare condition. We report an unusual case of osteoblastoma occurring together with inferior concha bullosa. The tumor and inferior concha bullosa were removed by endoscopic submucosal inferior turbinoplasty, with favorable results. Related articles are reviewed and brief discussions are presented in regards to the case findings.
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No abstract available.