A Case of Lupus Panniculitis-Misdiagnosed as Alopecia Areata

We present a 24-year-old woman with systemic lupus erythematosus presented with multiple patches of non-scarring alopecia closely resembling alopecia areata. Scalp biopsy showed a predominantly subcutaneous and dermal lymphocytic infiltrate that surrounded the deep follicular segments and hair bulb. This pattern is capable of producing a temporary hair loss, clinically misdiagnosed as alopecia areata. The clinical history, presence of erythema on bald patches and scalp tenderness as well as the biopsy findings were important clues in diagnosis of lupus erythematosus. We report here a case of lupus panniculitis that presented as multiple bald patches misdiagnosed as alopecia areata.

A Case of Partial Unilateral Lentiginosis with Cafe-au-lait Macules / 대한피부과학회지

Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder that's characterized by multiple lentigines in a unilateral distribution. The lesions often have a segmental pattern with a sharp demarcation at the midline. This is sometimes combined with other disorders such as neurofibromatosis or cafe-au-lait macules (CALMs). The presence of multiple CALMs in the same distribution as the lentigines on a PUL patient makes it difficult to differentiate PUL from segmental neurofibromatosis. We present here a 25-year-old woman with an unusual combination of several caf?-au-lait macules and scattered numerous lentigines involving the left side of the abdomen, flank and back.

A case of type 3 hyperlipoproteinemia associated with generalized tuberoeruptive xanthomas / 대한내과학회지

A 55-year-old female presented with extensive yellowish eruptive plaques over both elbows and the buttocks that she had first noticed 2 years earlier. Yellowish orange discoloration of her palmar creases was noted. Her serum cholesterol and triglyceride were markedly elevated. Lipoprotein electrophoresis showed a broad beta band. On apolipoprotein E genotyping, the arginine at position 158 had been replaced by cysteine in both alleles (E2/E2). Under a diagnosis of type III hyperlipoproteinemia, combined atorvastatin and fenofibrate therapy for 2 months normalized the serum cholesterol and triglyceride levels.

Clinical and Histopathologic Review on 28 Cases of Nodular Fasciitis / 대한피부과학회지

BACKGROUND: Nodular fasciitis presents as a solitary, slightly painful, rapidly growing nodule. It is associated with a reactive, proliferative process of unknown cellular origin and can be misdiagnosed as a sarcoma. OBJECTIVE: Our study was designed to investigate the process and cellular origin of the disease. METHODS: The clinical and histopathologic findings from 28 cases of nodular fasciitis were reviewed. Additional histochemical and immunohistochemical staining was done. RESULTS: The mean age of onset was 29.8 years. A majority of patients with nodular fasciitis had a duration of symptoms of less than 6 months. The upper extremity and face were most frequently involved. Most of the lesions had diameters less than 2 cm. Total excisions were performed in 23 lesions; 3 lesions recurred thereafter. Histopathologically, a subcutaneous plane was most frequently involved. The nodule consisted of numerous large, pleomorphic fibroblasts growing haphazardly in a vascular stroma containing varying amounts of mucoid ground substance, which was confirmed by histochemical stains. In the immunohistochemical stain, most lesions had positive findings for smooth muscle actin (SMA), vimentin and negative findings for CD34 except in a few cases. The stains for desmin and S-100 were negative in all cases. CONCLUSION: It is suggested that nodular fasciitis is associated with a reactive proliferation of myofibroblasts rather than with a sarcomatous process.

A Case of Localized Bullous Pemphigoid Confined to the Face / 대한피부과학회지

Bullous pemphigoid (BP) is a chronic autoimmune subepidermal blistering disease that usually occurs in the elderly. Two types of clinical variants exist. The generalized form typically involves the lower abdomen, groin, thighs and inner arms. The localized forms of BP include (1) mucous membrane pemphigoid or cicatrical pemphigoid, (2) localized scarring pemphigoid or Brunsting-Perry pemphigoid, and (3) localized nonscarring pemphigoid. We report here on a case of localized nonscarring pemphigoid on the face of a 71-years-old man.

A Case of Herpes Zoster Multiplex in Five Disparate Dermatomes / 대한피부과학회지

The skin lesion of herpes zoster is classically limited to single dermatomal area, and most cases of multidermatomal herpes zoster have contiguous skin lesions. Noncontigous multidermatomal herpes zoster is very rare in both immunocompetent and immunocompromised persons. The phenomenon of zoster occurring in two noncontiguous dermatomes has been referred to as zoster duplex unilateralis or bilateralis. We report a case of herpes zoster multiplex in five disparate dermatomes in a 71-year-old woman with non-Hodgkin's lymphoma.

A Case of Black Hairy Tongue following the Use of Psychotropic Agents / 대한피부과학회지

Black hairy tongue is a benign skin condition characterized by dark brown or black patches on the tongue, due to hypertrophied filiform papillae. Although the cause of the disease is uncertain, there are several predisposing factors such as poor oral hygiene, smoking and medication. Herein, we report a case of black hairy tongue that developed after the use of psychotropic agents

A Study of Dermatosis and Characteristics of the skin in the Super-old ages and Centenarians / 대한피부과학회지

The increased aging of the population in the developed world is an accepted fact. Consequently, the number of patients aged 90 years or above (super-old age: from 90 to 99), and centenarians (above 100) will increase in the coming years. The objective was to determine the prevalence and characteristics of skin diseases in the population of super-old ages and centenarians. A total of 50 volunteers, aged from 90 to 106 years, were enrolled on this study. They completed a questionnaire about skin diseases and underwent a cutaneous examination during the period of July 26 to 30, and Aug 23 to 28, 2004. The average age of the volunteers was 96.3 years. 28 volunteers were women and 22 were men. The common diseases were found to be senile lentigo, seborrheic keratosis, idiopathic guttate hypomelanosis, xerosis, telangiectasia, onychomycosis, tinea pedis, and cherry hemangioma. Wrinkle grading of men was less severe than in women. The degree of pigmentation was independent of age and sex. However, activity and pigmentation scale showed a significant statistical correlation. Gray hair and alopecia in men was more severe than in women. As for aging factors, smoking, activity, location, and occupation did not appear to play an important role in wrinkle formation. The incidence of skin disorders increased with age, due to changes in skin structure and lifelong exposure to environmental aggravations. Super-old aged people often have many skin diseases. However, only a small number of volunteers were included in this study. Therefore, further dermatologic studies need to be conducted.

A Case of Cholesterol Embolism / 대한피부과학회지

The occlusion of arterioles by cholesterol microcrystals and subsequent ischemic change give rise to so called "cholesterol embolism". Usually cholesterol emboli are released from atheromatous plaque in great arteries by various provoking factors-by direct physical impacts during the cardiovascular interventions, such as CABG (coronary artery bypass graft) and CAG (coronary angiography), and by intricate biologic processes which weakens fibrous cap of atheromatous plaque, such as thrombolytic and anticoagulant therapy. Herein we report cholesterol embolism occurred in a 71-year old man who has underlying atherosclerosis after cardiovascular surgery and follow-up angiography, and concomitant anticoagulant therapy.

Epstein-Barr Virus Associated Lymphoproliferative Lesion Presenting as a Hydroa Vacciniforme-like Eruption / 대한피부과학회지

BACKGROUND: There have been several reports of patients with a severe hydroa vacciniforme (HV)-like eruption from Asia and Latin America. The cutaneous lesions are present in both sun-exposed and nonexposed areas in these patients unlike true HV. Several patients have died of malignant hematologic malignancies. The latent Epstein-Barr virus (EBV) infection has been detected in the skin lesions of the patients. OBJECTIVE: To describe clinical, histological, immunohistochemical, and molecular pathological features of the patients with EBV associated lymphoproliferative lesion presenting as a HV-like eruption. METHODS: The clinical, histological, and immunohistochemical features of 16 patients were reviewed. The presence of T-cell receptor (TCR)-gamma gene rearrangement was investigated using polymerase chain reaction (PCR) technique. Photoprovocation by repetitive UVA exposure was performed in five patients. In situ hybridization was performed to detect mRNA for EBV in the lesional skin biopsy specimen, lymph node biopsy specimen, mucosal biopsy specimen of stomach, and the skin biopsy specimen of photo-provoked site. PCR was performed to detect DNA for EBV in the skin biopsy specimens of 6 patients and peripheral mononuclear cells of 2 patients. RESULTS: The severity of the skin lesion and the clinical course varied among the patients. Skin biopsy specimens obtained from a papule or a vesicle showed perivascular and periadnexal infiltrate of lymphoid cells with T-cell phenotype. However, clonal TCR-gamma gene rearrangement was not detected in all 8 patients. Papules or vesicles were induced by repetitive UVA exposure in 5 patients. A latent EBV infection was demonstrated in all the tested samples, such as lesional skin, lymph node, gastric mucosa, peripheral blood mononuclear cells, and the photo-provoked lesion. CONCLUSION: EBV associated lymphoproliferative lesion presenting as a HV-like eruption is a novel disease that is not related to classic HV. Repetitive irradiation of UVA can induce the skin lesion in some patients with EBV associated lymphoproliferative lesion presenting as a HV-like eruption.