The Study on The Nature of Fibrous Materials Extracted from Follicular Skin Lesions / 대한피부과학회지

BACKGROUND: Comedo extractor is in general used for the management or diagnosis of the follicular cutaneous disorders such as acne and folliculitis. During observing such extracted materials, we happened to discover the extraordinary thread-like fibrous materials. OBJECTIVE: We tried to clarify the nature of these fibrous materials. METHODS: The extracted materials from 20 patients with follicular cutanous disorders including 10 acne vulgaris and 10 pityrosporum folliculitis and 10 normal persons were investigated by pKOH, Masson trichrome for collagen fiber, Gomori's reticulum for reticulum fiber, acid orcein for elastic fiber, periodic acid-Schiff for fungal element and alcian blue for mucin. And we performed above mentioned special stainings in two biopsy specimens. RESULTS: Most of the extracted fibrous materials were reticulum fibers(95%) and some of them were elastic fibers(35%). And we observed the reticulum fibers and elastic fibers taken off from the pilosebaceous follicle on the histopathologic study. CONCLUSION: The fibrous materials extracted from follicular lesions were reticulum fibers or elastic fibers. And the observed presence of elastic fibers and reticulum fibers might result from tissue necrosis produced by leukocytes during the inflammatory phase of pilosebaceous follicles.

A Study On Prevalence of The Elevated Transaminase(AST, ALT) and Hepatitis B, C Viral Markers in Dermatologic Patients / 대한피부과학회지

BACKGROUND: Recently, in dermatologic area, the number of skin biopsy for diagnosis and treatment has been increased and the dermatosurgery which should give patients satisfaction developed widely. As the frequency of direct contact with patients increases, we must recognize and prevent infectious diseases such as hepatitis B and C. Also, because drugs which may affect function of liver were used in many medical clinics and shops, we have more chance of evaluating liver function before the treatment. OBJECTIVE: We investigated the prevalence and associated diseases of the patients with elevated transaminase (AST,ALT), positive of hepatitis B surface antigen and anti-HCV Ab. And we tried to study the causes of elevated transaminase. METHOD: All the 1704 outpatients who visited the dermatologic clinic of Pusan National University Hospital from March 1996 to February 1999 were enrolled. AST and ALT level were assessed by kinetic method and elevated group comprised the subjects with AST and ALT levels exceeding the upper limit of normal for our laboratories (AST >40IU/L or ALT >37IU/L). HBsAg and anti-HCV Ab were tested by enzymeimmunoassay(EIA) and medical records were reviewed. RESULTS: The prevalence of elevated transaminase was 13.6% and the peak age was the sixth decade. Most common associated disease categories were drug druption, eruption & urticaria. The prevalence of positive hepatitis B surface antigen was 9.7% and the peak age was the fourth decade (42.4%). Associated diseases of antigen positive patients were lichen planus, urticaria, cryoglobulinemia, etc. The prevalence of positive anti-HCV Ab was 3.4% and the sixth decade was the peak incidence of age distribution. The diseases such as urticaria, erythema nodosum, psoriasis, alopecia, and so on were investigated in the patients. Common suspected causes of elevated transaminase(AST, ALT) were hepatotoxic drug and viral hepatitis. Conclusion: Increased hepatic parenchymal enzyme was investigated in a high percentage of studied patients. Also, the prevalence of HBV and HCV infection in dermatologic patients were relatively higher than that of reported normal Korean people. Therefore dermatologists should recognize these facts and be careful in dermatologic procedure.

A Case of AIDS-associated Kaposi's Sarcoma / 대한피부과학회지

Kaposi's sarcoma(KS) occurs in four distinct subsets: classic, African-endemic, iatrogenic immunosuppressive drug-associated, and AIDS-associated KS. Only two cases of AIDS-associated KS have been reported in Korea. The pathogenesis remains unclear but, suggested the relevance to the association of virus infection with KS, especially human herpesvirus-8. We report a case of an AIDS-related KS that human herpesvirus-8 DNA is present in the KS tissue. The patient was diagnosed with AIDS in 1993 and had complained of disseminated erythematous to purplish colored papulonodules on the face, neck, chest and back for 5months. He was treated with systemic cytotoxic chemotherapy, but died due to septic condition.

Two Cases of Subungual Squamous Cell Carcinomas / 대한피부과학회지

Subungual squamous cell carcinoma is a rare malignant tumor arising on the nail bed and it has resemblance to a variety of inflammatory skin diseases and cutaneous tumors. The diagnostic biopsy is essential but it is often delayed because of patients' reluctance, technical difficulties, or lack of awareness by physicians and inappropriate treatment is given for other suspected conditions, especially fungal or bacterial infections and for warts. We report two rare cases of subungual squamous cell carcinoma and emphasize the need of diagnostic biopsy on the subungual lesions that have resistance to the conventional treatments.

Apoptosis and Expression of bcl-2, p53, and Ki-67 in Mycosis Fungoides / 대한피부과학회지

BACKGROUND: Mycosis fungoides(MF) is a form of cutaneous T cell lymphoma with clonal differentiation of helpr' T cell. It has a patch, plaque, and tumor stage. But pathogenetic factors controlling the development and progression of MF are still unclear. Apoptosis plays a major role in developmental biology and homeostasis. The bcl-2 oncogene prolongs ce11 life by inhibiting apoptosis. The mutant pS3 gene induces apoptosis indirectly. Ki-67 antigen is the cell proliferation marker. Recently, it has been shown that the relationships among them are important in the tumorigenesis of the various tumors. OBJECTIVE: The aim of this study was to examine the expression of these genes and apoptotic rate and clarify the relationship among them in the development and progression of MF. METHODS: The eighteen specimens from 8 patients with MF and 10 specimens from benign lymphocytic infiltrating diseases including 5 lichen planus, 3 lupus erythematosus, and 2 contact dermatitis were included. We performed immunoperoxidase staining(LSAB technique) using monoclonal antibodies including bc1-2, p~53, and Ki-67(MIB1). We used ApoptaqTM(Oncor) in situ labelling kit for detecting apoptotic cell.

A Clinical Study of 381 Patients with Childhood Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo, the pigmentary disorder of the skin and hair, affects patients of various ages from neonates to old adults. According to the onset age, vitiligo is classified as adult or childhood type. Previous clinical studies on childhood vitiligo are rare in Korea. OBJECTIVE: Our purpose was to evaluate the clinical characteristics of childhood vitiligo. METHOD: A clinical investigation was made of 381 outpatients with childhood vitiligo (between 6months and 15years of onset) who had visited the Department of Dermatology, Pusan National University Hospital from January 1988 till December 1997. Results : The results a summarized as follows 1. The subjects consisted of 206(54.1%) females and 175(45.9%) males. 2. The mean age of onset was 7.7 years(males : 8.0, female 7.5). 3. The mean duration of the disease was 2.6 years(male : 2.5, female : 2.7). 4. Familial history was obtained in 30 cases(7.9%) and the most common precipitating factor was trauma(40.0%). 5. Both vulgaris(43.3%) and segmental type(30.4%) were common clinical types in the classification of Ortone et at. Trigeminal distribution(53.4%) was the most common segmental types in Koga's classification. 6. The most common site of initial involvement was the face and neck(52.2%) 7. The most common degree of depigmented lesion was within 5%(84.5%). 8. The progression of vitiligo was present in 68.2% of patients and the incidence of poliosis was 11.5%. 9. Koebner phenomenon was present in 12 cases(3.1%). 10. The most common associated diseases were acne and halo nevus (18.0%). Conclusion : Childhood vitiligo is relatively unique in the clinical findings such as the clinical type(high incidence of segmental type), precipitating factor(trauma is the main factor), depigmented area(small involvement in the extent of the lesion) and the progression of the disease.

Two Cases of Generalized Granuloma Annulare Controlled by Hydroxychloroquine / 대한피부과학회지

We report the clinical evolution of two male patients with generalized granulama annulare(GGA) who were controlled with hydroxychloroquine. In the first case, a 3-year-old boy was treated with systemic steroid, and in the second case, a 68-year-old man was treated with prednisolone, niacin, and retinoic acid. But, remission and recurrence of the skin lesions were repeated. A good clinieal response was achieved in both cases after administration of hydroxychloroquine without side effects or any signs of recurrence. Hydroxychloroquine may be helpful to treat the GGA that have side effects to the systemic corticosteroid or resistence to other therapeutic modalities.

A Case of pseudoglucagonoma Syndrome Treated with Medium-chain Triglyceride / 대한피부과학회지

Necrolytic migratory erythema is a rare, distinctive, necrotizing cutaneous eruption usually associated with glucagonoma, an alpha-cell tumor of the pancreas. Other clinical features include ane- mia, diabetes mellitus and weight loss. However, it also occurrs without the pancreatic glucagonoma. So this rare condition is called pseudoglucagonoma syndrome, and has been described in association with chronic hepatic diseases, malabsorption with villous atrophy, chronic pancreatitis, celiac sprue, hypoproteinemia and odontogenic infection. We report a case of pseudoglucagonoma syndrome induced by malnutrition without glucagonoma. A 28-year-old Korean female was referred to our department complaining of multiple erythematous, desquamative, crusted and erosive patches on the extremities, and diffuse scalp alopecia for 5 years. She also had perianal erosion, angular cheilitis without glossitis, amenorrhea, axillary and pubic hair loss, and weight loss. Six years previously she had had Whipples operation for a pancreatic solid and papillary neoplasm. The laboratory data showed hypoalbuminemia, essential fatty acid deficiency, diabetes mellitus and slightly high levels of zinc and glucagon. A skin biopsy showed irregular acanthosis, epidermal edema and pallor, dyskeratosis, areas of superficial epidermal necrosis and vascular dilatation of the papillary dermis. The patient improved dramatically after intravenous hyperalimentation and oral intake of mediurn chain triglyceride. For 2.5 years she has taken medium-chain triglycerides without any other treatment, and no side effects on recurrence has been observed.