ABSTRACT
BACKGROUND: The efficacy of tumescent liposuction in the treatment of axillary osmidrosis has been widely established. But there have been few studies that have conducted a comparative analysis according to the level of dermal curettage with respect to the efficacy and safety. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy and complications of tumescent liposuction according to the degree of dermal curettage. METHODS: From September 2004 through August 2009, a total of 33 patients with axillary osmidrosis (66 axillae) were included in this study. Twelve patients (24 axillae) were treated by tumescent liposuction with dermal curettage at the level of the mid-dermis (the classical technique group), and the other 21 patients (42 axillae) were treated by tumescent liposuction with dermal curettage at the level of the dermo-subcutis junction (the modified technique group). The preoperative and postoperative disease severity was measured as 0, 1, 2 and 3. The improvement of symptoms was graded by the patient as excellent, good, fair and poor. We also evaluated the postoperative complications, including skin necrosis, scar, hematoma, sensory disturbance and infection. Biopsies of the axillary skin were performed in 7 patients to confirm the level of dermal curettage and the reduction of apocrine glands after treatment. RESULTS: The follow-up ranged from 6 to 60 months. Six months after treatment, 95.8% (23/24) of the axillae in the classical technique group and 95.2% (40/42) of the axillae in the modified technique group had reduced disease severity below 1. Among the 12 patients treated with the classical technique, 11 (91.7%) had excellent to good results, while 95.2% (20/21) of the patients treated with the modified technique had excellent to good results by the patients' own grading. The complications included skin necrosis, scar and hematoma. In the classical technique group and the modified technique group, the incidence of skin necrosis was 12.5% (3/24) and 2.4% (1/42), respectively, the incidence of scar formation was 4.2% (1/24) and 0%, respectively, and the incidence of hematoma was 8.3% (2/24) and 0%, respectively. The postoperative histologic examinations confirmed that the dermal curettage level was at the mid-dermis in the classical technique and at the dermo-subcutis junction in the modified technique. Interestingly, the histologic examination from the classical technique group revealed vacuolar alteration of keratinocytes and partial separation of the dermo-epidermal junction. CONCLUSION: The efficacy of the modified technique is compatible with that of the classical technique, but the modified technique offers fewer complications. So, the modified technique may improve the cosmetic outcome without reducing the treatment efficacy for the patient with axillary osmidrosis.
Subject(s)
Humans , Apocrine Glands , Axilla , Biopsy , Cicatrix , Cosmetics , Curettage , Follow-Up Studies , Hematoma , Incidence , Keratinocytes , Lipectomy , Necrosis , Postoperative Complications , Skin , Treatment OutcomeABSTRACT
A number of conditions can cause melanonychia striata, but its main importance is that it may indicate the presence of a subungual melanoma. A biopsy of the nail matrix can be performed to rule out melanoma, but nail matrix boipsies sometimes result in a permanent nail deformity. Since the incidence of melanoma in children is quite small, there is some controversy as to whether this procedure should routinely be performed in the pediatric age group. We report a 7-year-old boy with melanonychia striata resulting from a congenital melanocytic nevus.
Subject(s)
Child , Humans , Male , Biopsy , Congenital Abnormalities , Incidence , Melanoma , Nevus, PigmentedABSTRACT
Contrary to general perception, thin acral lentiginous melanoma can metastasize. Sentinel lymph node metastases are found in a significantly greater proportion of patients with thin melanoma showing histological evidence of regression. In these cases, metastatic melanoma within lymph nodes may stimulate an immune response, resulting in regression of the primary lesion. However, a small number of thin acral lentiginous melanoma without regression also metastasize. We report a case of thin acral lentiginous melanoma with lymph node metastasis showing regression.
Subject(s)
Humans , Lymph Nodes , Melanoma , Neoplasm MetastasisABSTRACT
BACKGROUND: The risk of squamous cell carcinoma (SCC) is significantly increased in chronic cutaneous ulcers. Moreover, if the proliferating epithelium of the ulcer margin shows pseudoepitheliomatous hyperplasia, it can be very difficult to discriminate between the two diseases. Enzymes such as matrix metalloproteinases (MMPs) are thought to be implicated at all stages of tumorigenesis. OBJECTIVE: We investigated the expression patterns of epithelial MMP-7 and MMP-13 in chronic ulcers and SCCs by an immunohistochemical technique and the usefulness in differentiating these two entities. METHODS: Formalin-fixed and paraffin-embedded tissues obtained from 16 chronic ulcers and 12 SCC patients were studied using an immunohistochemical staining method for MMP-7 and MMP-13. RESULTS: MMP-7 and MMP-13 were expressed by the malignant tumor cells of 4 (33.3%) and 9 SCC samples (75%), respectively, while they were absent from the proliferating epithelium of chronic ulcers. CONCLUSION: Our results suggest that epithelial expression of both MMP-7 and MMP-13 have a specificity in differentiating the benign epithelial proliferation of chronic ulcer from malignant tumor cells, but MMP-13 seems to be a more sensitive and useful marker due to the lower sensitivity of MMP-7 in SCCs.
Subject(s)
Humans , Carcinogenesis , Carcinoma, Squamous Cell , Epithelium , Hyperplasia , Matrix Metalloproteinases , Sensitivity and Specificity , UlcerABSTRACT
BACKGROUND: Genital skin diseases are common, yet there has been insufficient clinical investigation of these conditions. OBJECTIVE: This study was performed to investigate the epidemiological aspects of genital skin diseases, and to highlight the clinical features of common dermatoses of the genitalia. METHOD: We retrospectively reviewed data of 84 patients biopsied for genital skin lesions at Maryknoll Hospital between September 1991 and August 2004. RESULTS: The ratio of males to females was 2: 1 (56: 28). The most frequent genital skin diseases present were lichen simplex chronicus, condyloma accuminata, irritant contact dermatitis, lichen sclerosus et atropicus and calcinosis cutis in decreasing order of frequency. Of the 84 cases, 42 had patches or plaques, 36 had papules or nodules and 16 had vesicles, erosions or ulcers. CONCLUSION: Our results were similar to other studies in some cases and different from others in other cases. Further investigation with a larger group of patients is necessary to better understand the epidemiology of genital skin diseases.
Subject(s)
Female , Humans , Male , Calcinosis , Dermatitis, Contact , Epidemiology , Genitalia , Lichen Sclerosus et Atrophicus , Neurodermatitis , Retrospective Studies , Skin Diseases , Skin , UlcerABSTRACT
Methazolamide is a sulfonamide derivative and carbonic anhydrase inhibitor used to lower intraocular pressure in glaucomatous eyes. Stevens-Johnson syndrome (SJS)-toxic epidermal necrolysis (TEN) associated with methazolamide treatment has been reported in Korean and Japanese patients. We report two cases of SJS-TEN associated with methazolamide treatment. The result of HLA typing of our two patients was a positive reaction for HLA-B59, which is specific to Koreans and Japanese. This suggests a possible relationship between genetic background and SJS-TEN associated with methazolamide treatment. Therefore, methazolamide should be prescribed with caution to Korean or Japanese patients.
Subject(s)
Humans , Asian People , Carbonic Anhydrases , Histocompatibility Testing , Intraocular Pressure , Methazolamide , Stevens-Johnson SyndromeABSTRACT
Nodular morphea, also known as keloidal morphea, is a rare variant of scleroderma, characterized by the presence of nodular lesions resembling keloids. Histological findings are highly variable; from characteristics of hypertrophic or keloid scarring to those of scleroderma or mixed form. A 13-year-old girl was presented with asymptomatic brown or ivory colored mottled sclerotic patch with purple colored firm papules in a linear distribution on her right thigh for 2 years. She was healthy, otherwise. Histopathological findings showed morphea on patch lesion and keloid on nodular lesion.
Subject(s)
Adolescent , Female , Humans , Cicatrix , Keloid , Scleroderma, Localized , ThighABSTRACT
Lichen planus(LP) and lupus erythematosus(LE) may occur infrequently as an overlap syndrome. The term comprises a heterogenous group of patients who have clinical, histological and/or immunopathological characteristics of both diseases at the same time. We report a case of LP/LE overlap syndrome in a 42-year-old man who has had a red to violet colored patch with atrophy and telangiectasia on the left arm for 2 years. The biopsy of the left arm showed histological features consistent with LP and LE at the same lesion. Direct immunofluorescence also showed features consistent with LP and LE at the same lesion.
Subject(s)
Adult , Humans , Arm , Atrophy , Biopsy , Fluorescent Antibody Technique, Direct , Lichen Planus , Lichens , Telangiectasis , ViolaABSTRACT
Blastomycosis-like pyoderma is an uncommon vegetating tissue reaction, often secondary to a bacterial infection occurring in patients with a compromised immune system. We describe a clinically blastomycosis-like pyoderma on the right ankle and knee in a patient with iatrogenic Cushing syndrome, hypertension, hypercholesterolemia and congestive heart failure.