Treatment of Molluscum Contagiosum in Children by Topical Imiquimod Cream Therapy / 대한피부과학회지

BACKGROUND: There are numerous therapeutic options for molluscum contagiosum (MC) and these may be broadly subdivided into surgical procedures (curettage, squezzing), chemical application (silver nitrate, cantharidin) and immunological therapies (imiquimod). However, in young children it is quite difficult to treat the condition due to pain associated with these procedures. Therefore, physicians need to consider more tolerable treatment options in pediatric patients. OBJECTIVE: We evaluated 20 children with MC for clinical effectiveness and side effects of imiquimod application. METHODS: Twenty children with MC were asked to apply 5% imiquimod cream three times per week at nights every other day for between 8~12 weeks. RESULTS: Nine of the 20 patients (45%) achieved complete clearance after a mean treatment period of 6.9 weeks. Partial clearance was observed in 10 patients (50%) and no response in 1 patient (5%). No patients dropped out due to adverse effects. Twelve children (60%) reported erythema and five children (25%) reported itching. CONCLUSION: Therapy with imiquimod cream was found to be effective, safe and painless in the treatment of MC in children. However, large-scale, double-blind, controlled prospective studies are needed to confirm the effectivenss of Imiquimod cream.

Two Cases of Eczematoid Reactions following BCG Vaccinations / 대한피부과학회지

The adverse effects of BCG vaccination span diversely from systemic to local reactions. However, the adverse effects of BCG vaccination on the skin are rare and these can appear as non-specific or specific skin reactions. We experienced two cases of non-specific skin reaction, which occurred on a vaccine-injected site. Eczematous lesions with the clinical and pathological findings have not previously been report in the English dermatologic literature. Herein, we present two interesting cases of non-specific skin reactions from dermatological complications of BCG vaccination.

A Case of Linear Lupus Panniculitis in Child / 대한피부과학회지

Lupus panniculitis is an uncommon clinical variant of cutaneous lupus erythematosus. The cutaneous lesions of lupus panniculitis are characterized by subcutaneous nodules or plaques. The overlying skin can often appear unchanged, but may also be associated with discoid lupus erythematosus and appear erythematous, atrophic, telangiectatic or poikilodermatous. The mean age of incidence is between 30~40 years, and children are rarely affected. Furthermore, a linear distributions of the lesions has rarely been reported. We herein describe a case of 8-year-old girl with linear lupus panniculitis on the face, and propose that the possibility of this disease be considered in cases where linear subcutaneous nodular lesions occur in children or young adults.

A Clinicopathologic Study on Eccrine Tumors / 대한피부과학회지

BACKGROUND: Various eccrine tumors are rather common diseases in clinicians. However, data on the clinicopathologic features of eccrine tumors in Korea are limited. OBJECTIVE: The purpose of this study was to investigate the clinicopathologic characteristics of eccrine tumors in Korea. METHODS: Two hundred and sixty five cases of eccrine tumors, seen from 2002 to 2004 in Korea, were retrospectively analyzed clinically and histopathologically. RESULTS: The most common eccrine tumors identified within Koreans were syringoma (61%), followed by eccrine poroma (13%), eccrine hidrocystoma (9%), and nodular hidradenoma (6%). Moreover, eccrine tumors were usually found to occur in middle-aged woman as multiple asymptomatic skin-colored papules. The most common site of occurrence was the face (45%), followed by the neck (9%), scalp (5%), foot (5%), abdomen (4%), and vulvar (3%). CONCLUSION: The results of this study will be useful and fundamental data on eccrine tumors for clinicians and pathologists.

A Case of Palmoplantar Lichen Planus / 대한피부과학회지

Lichen planus is an inflammatory disorder that affects the skin, mucous membrane, nails and hair. According to the literature, lichen planus on the palms and/or soles occurs rarely and does not usually have classical clinical features. We report a case of lichen planus in a 26-year-old man, who presented with papules on his palms and soles.

A Case of Palmoplantar Lichen Planus / 대한피부과학회지

Lichen planus is an inflammatory disorder that affects the skin, mucous membrane, nails and hair. According to the literature, lichen planus on the palms and/or soles occurs rarely and does not usually have classical clinical features. We report a case of lichen planus in a 26-year-old man, who presented with papules on his palms and soles.

Pruritus and Nerve Growth Factor in Psoriasis / 대한피부과학회지

BACKGROUND: Many patients with psoriasis also suffer with pruritus. However, the literature on pruritus in psoriasis is sparse. OBJECTIVE: This study was undertaken to examine the expression of nerve growth factor (NGF) and its receptor (NGF-R) in psoriatic lesions, with or without pruritus, using a confocal laser scanning microscope. METHOD: A skin biopsy was obtained from 10 psoriatic patients with pruritus, 10 psoriatic patients without pruritus and 10 normal control subjects. Immunofluorescence staining and confocal laser scanning microscopy were performed. RESULTS: The psoriatic lesions with pruritus showed an increase in the expression of NGF and NGF-R compared with the psoriatic lesions without pruritus. NGF was expressed in the entire epidermis, but NGF-R was expressed in the basal cell layer only. The psoriatic lesions without pruritus showed an increase in the expression of NGF compared with the normal controls. There was no difference between the psoriatic lesions without pruritus and normal controls in the expression of NGF-R. CONCLUSION: These results indicate that possible pruritogenic factors in psoriasis are neurogenic factors including NGF, and provide the groundwork for further studies to clarify the mechanism involved in pruritus of psoriasis.

Wells' Syndrome Associated with Esophageal Squamous Cell Carcinoma / 대한피부과학회지

Wells' syndrome or eosinophilic cellulitis is a recurrent inflammatory dermatosis, characterized clinically by acute dermatitis resembling cellulitis. The histopathologic findings show diffuse dermal eosinophilic infiltration and characteristic `flame figures'. The etiology and pathogenesis are unknown, however, various associated disorders such as hematological diseases, infections, arthropod bites, drugs, and surgery have been documented. Wells' syndrome has previously been reported in only 4 cases of non-hematological malignancy. A 57-year-old man with esophageal squamous cell carcinoma developed recurrent, mildly tender, urticarial plaques on the trunk and left forearm. A skin biopsy specimen revealed histopathologic findings compatible to Wells' syndrome. Skin lesions resolved with systemic corticosteroids therapy without recurrence until now. We report a case of Wells' syndrome associated with esophageal squamous cell carcinoma

The Clinical Effect of 5% Imiquimod Cream in the Treatment of Verruca Plana / 대한피부과학회지

BACKGROUND: Despite numerous therapeutic options, the treatment of verruca plana remains unsatisfactory for both patients and physicians. Imiquimod, a novel topical immune response modifier, has been successfully used for the treatment of external anogenital warts. OBJECTIVE: The purpose of this study was to investigate the efficacy of imiquimod in treatment of verruca plana. METHOD: Fifteen patients with verruca plana were treated with 5% imiquimod cream that was self-applied 3 times a week and left in place overnight. Assessment for responses and side effects was performed every 2 weeks until clinical cure or up to 12 weeks. RESULTS: 10 of 15 (66.7%) patients achieved a excellent result (>75% improvement), and 11 (73%) patients achieved a good result (>50% improvement). With regard to the location of the lesions, 10 of 12 (83%) patients with lesions on the face and neck achieved a clear result (>95% improvement), but only 2 of 7 (28%) patients with lesions on the extremities achieved a clear result. Local inflammatory reactions were the most common adverse events, however, they were generally mild and transient. CONCLUSION: 5% imiquimod cream, applied by the patient, is an effective treatment modality for verruca plana.

Central Trichoptilosis Associated with Trichorrhexis Nodosa and Pili Torti

A 12-year-old girl presented with a 1-week duration of hair loss associated with splitting of the hair ends and whitish dots on the occipital hairs. On microscopic examination, a longitudinal splitting of the hair shaft with reconstitution of the normal hair distal to the fracture, nodular swellings, with the appearance of broomsticks pushed into one another, at the site of whitish swellings, and the flattening and twisting of the hair shaft around the long axis were demonstrated. Minor trauma to injury-prone hair is a common cause of hair shaft defects, however the reports with the combined conditions are insufficient in the literature. We describe a patient with central trichoptilosis associated with localized trichorrhexis nodosa and pili torti.

Erythema Nodosum Probably Induced by Kerion Celsi

A 6-year-old girl visited us with a 4-week history of inflammatory, pustular, tender patches and plaques on the scalp, and a 3-day history of multiple, erythematous, indurated, tender, subcutaneous nodules on both pretibial areas. A swab was taken from the scalp lesion and colonies of Tiichophyton mentagrophytes grew on culture. The histopathological findings of the leg nodule were consistent with erythema nodosum. The patient was treated with oral itraconazole and deflazacort, combined with topical potassium permanganate solution. Erythema nodosum regressed two weeks later and the kerion of the scalp regressed six weeks after starting the treatment, leaving residual scarring alopecia. The patient was diagnosed as erythema nodosum probably induced by kerion celsi, that has not been reported in the Korean literature.

A Case of Locally Invasive Basal Cell Epithelioma Presented as a Subcutaneous Mass / 대한피부과학회지

Basal cell epithelioma(BCE) is the most common malignant tumor of the skin, and locally invasive neoplasm, rarely metastatic, yet capable of significant local destruction and disfigurement. Radiotherapy has been reported to have high local cure rate and good cosmetic results in the treatment of BCE, and therefore may be an alternative treatment when excision is not functionally or cosmetically feasible, especially in the high risk areas. We report a 73-year-old female with locally invasive BCE presented as a subcutaneous mass on the left nasolabial fold area.

A Case of Carcinoma en Cuirasse from Thyroid Cancer / 대한피부과학회지

A 52-year-old male had presented with painful swelling on the left shoulder. The lesion had progressed to involve the left chest, neck, and arm, and 3 months later, evolved into brown to light purplish hard plaque mimicking the feature of scleroderma. A skin biopsy findings were consistent with metastatic carcinoma, and neck MRI and thyroid sonogram revealed primary thyroid cancer of left lobe. The patient's condition was carcinoma en cuirasse, an uncommon clinical feature of metastatic skin cancer. Skin metastasis of thyroid cancer is rare, and to our knowledge, there is not any documented case of carcinoma en cuirasse from thyroid cancer. We present a case of carcinoma en cuirasse from thyroid cancer.

Pruritus Associated with Psoriasis / 대한피부과학회지

BACKGROUND: Pruritus has been reported to be a common symptom of many psoriatic patients, although the significance of this complaint has often been overlooked by dermatologists. OBJECTIVES: This study was aimed to explore the prevalence and various related clinical characteristics of pruritus associated with psoriasis in Korean patients. METHODS: Questionnaire data from 131 psoriatic patients were analyzed and psoriasis severity was determined by PASI score evaluation. RESULTS: Pruritus was a symptom of psoriasis in 83% of patients. It involved usually on the areas of active psoriatic lesion and appeared mainly at night. The severity and extent of psoriasis in pruritic patients were significantly (p<0.05) higher than those of non-pruritic patients. The presence and intensity of pruritus did not depend on sex, age, duration of disease, family history of psoriasis, smoking, and alcohol habits. Pruritus tended to be prolonged during the period of exacerbation. Sixty-five (59.6%) patients had an experience of Koebner's phenomenon due to scratching. Important daily factors that were found to exacerbate the itch were emotional stress, hot baths, sweating, and so on. The factors to improve the itch were emotional relief, cold baths, and hot baths. The patients who answered that pruritus significantly affects quality of life were 76.3%. CONCLUSION: Pruritus is a very common clinical feature of psoriasis, and its intensity correlates with the clinical severity of psoriasis. The attempt to relieve the symptoms of pruritus may improve the overall quality of life of patients with psoriasis.

A Case of Abdominal Protrusion Caused by Herpes Zoster / 대한피부과학회지

Segmentally distributed cutaneous eruptions along with sensory change and pain are frequently seen in herpes zoster. Occasionally it affects motor nerves in the segments corresponding to the involved sensory dermatomes, causing a flaccid paralysis. Motor weakness following herpes zoster infection has been well documented, with about half of the cases involving the cranial nerves and the other half involving the extremities. Interestingly, myotomal paresis involving the thoracic segment is unusual. We report a case of segmental herpes zoster paralysis presenting as an abdominal protrusion.

A Case of Sebaceous Epithelioma / 대한피부과학회지

Sebaceous epithelioma is a rare skin appendage tumor with sebaceous differentiation and appears as yellow papules, nodules, or plaques, most commonly in areas with large numbers of sebaceous glands, such as the face. Histopathologically, sebaceous epitheliomas are composed of circumscribed nodules consisting predominantly of basaloid cells and foci of sebaceous differentiation. We report a case of sebaceous epithelioma which appeared as a yellowish to erythematous patch on the forehead in a 55-year-old woman.

A Case of Purpura Annularis Telangiectodes (Majocchi's disease) / 대한피부과학회지

Purpura annularis telangiectodes is an uncommon pigmented purpuric eruption that is seen more commonly in young adult females, and it is one of the subgroups of pigmented purpuric dermatoses. Clinically, the disease is characterized by symmetrical telangiectatic, purpuric, annular patches with a predilection for the lower extremities and buttock. We report a case of purpura annularis telangiectodes (Majocchi disease) on the lower extremities of a 31-year-old male patient.

A Case of Giant Cell Tumor of Tendon Sheath on the Palm / 대한피부과학회지

A 36-year-old female presented with a 5-month history of an indurated asymptomatic nodule on the left palm. A skin biopsy was done and the histopathological findings were consistent with those of a giant cell tumor of tendon sheath (GCTTS). A GCTTS occurs in the tendon sheath of digits or in the joints of the extremities, and most commonly involves the distal fingers. However, palmar involvement of this tumor is unusual. We present a case of GCTTS on the palm.

A Case of Sister Mary Joseph's Nodule / 대한피부과학회지

A metastatic umbilical carcinoma from internal malignancy is known as Sister Mary Joseph's nodule. A 56-year-old man presented with a progressively enlarging umbilical nodule. Skin biopsy was done and the patient was diagnosed as metastatic adenocarcinoma of umbilicus. Search for the primary tumor revealed gastric adenocarcinoma with metastasis to perigastric lymph node, portal vein and intrahepatic duct. Sister Mary Joseph's nodule, a rare form of cutaneous metastasis, generally carries very poor prognosis. We describe a case of Sister Mary Joseph's nodule preceding a diagnosis of gastric cancer with review of the literature, and emphasize the importance of careful evaluation of any umbilical nodule.

A Clinical Study on The Labial Diseases / 대한피부과학회지

BACKGROUND: Diseases of the lips are common, however the clinical investigations of the labial lesions are not sufficient. OBJECTIVE: The purpose of this study was to investigate the epidemiological aspects of the labial diseases with the brief review of the common labial diseases. METHODS: We retrospectively reviewed the data on 117 patients biopsied for the labial lesions at Sanggye Paik Hospital between August, 1989 and May, 2003. RESULTS: The ratio of male to female was 1: 1.54(46: 71). The general age distribution was relatively even, however the age distribution was quite different in each disease. The frequent labial diseases were mucocele, pyogenic granuloma, actinic cheilitis, Fordyce's condition, hemangioma, squamous cell carcinoma, verruca, venous lake, etc., in order of frequency. Vascular disorders and the diseases associated with ultraviolet radiation, such as actinic cheilitis and squamous cell carcinoma, are relatively frequent. Among 117 cases, 29 cases(24.8%), 78 cases(66.7%), and 9 cases(7.7%) involved upper lip, lower lip, and both lips, respectively. And the frequency of the diseases varied according to the locations. CONCLUSION: The result of our study was different from others and we consider the discrepancy resulted from the regional and racial difference. Further investigations of a wider and larger nature are necessary to understand the epidemiology of labial diseases.