Botulinum Toxin Treatment in a Patient with Frey Syndrome After Upper Thoracic Sympathicotomy / 대한피부과학회지

Frey syndrome is characterized by profuse facial sweating which is provoked by the taste of food. It has been described as a consequence of upper thoracic sympathicotomy. Botulinum toxin injection is a relatively new treatment modality for Frey syndrome. Botulinum toxin type A (Botox , Allergan, USA) had been successfully used to treat Frey syndrome occurring in a 38-year-old patient following thoracic sympathicotomy for palmar hyperhidrosis. A total dose of 100U of botulinum toxin (1.0U/0.1ml/cm2) injection resulted in a 6 months' resolution of sweating, burning, and flushing sensation on eating. During the follow-up period, no systemic side effects were experienced.

Polymerase Chain Reaction and Heteroduplex Analysis Based Detection of Clonal T Cell Receptor Gamma Gene Rearrangements in Paraffin-embedded Tissues of Cutaneous T Cell Proliferative Diseases

BACKGROUND: Recently, the molecular pathologic investigation for clonality in lymphomas has been introduced and has gained a role in the diagnosis of lymphomas. In fact, the clonality test using TCRGR phenomenon has been done by Southern blot analysis (SBA) and polymerase chain reaction (PCR) for molecular pathologic diagnosis of T cell lymphomas. However, it is difficult to perform SBA with paraffin embedded specimens or with samples of small skin biopsies. OBJECTIVE: We investigated the efficacy of PCR amplification of TCR gene in paraffin em-bedded cutaneous T cell lymphomas. METHODS: Iii this study, the clonality was assessed by polymerase chain reaction (PCR) analysis of T cell receptor gamma (TCR) gene from the DNA extracts obtained from paraffin em-bedded tissues (PET) of malignant T cells, B cell lymphomas, and benign cutaneous T cell proliferative disorders. Heteroduple-x-analyses were also performed to rule out the false positives. RESULTS: Among the total of 62 cases analyzed, monoclonality was observed in 4 out of 10 mycosis fungoides, 7 out of 9 cutaneous T cell lymphomas excluding mycosis fungoides, 1 out of 3 angiocentric lymphomas, 2 out of 2 lymphomatosis papulosis, 1 out of 7 large plaque parapsoriasis, and 1 out of 2 T cell lymphomas in other organs. No monoclonality was observed in 9 inflammatory cutaneous diseases, 5 small plaque parapsoriasis, 4 cutaneous B cell lymphomas, and 11 B cell lymphomas in lymph nodes. CONCLUSION: The results suggest that the PCR method and heteroduplex analysis used in this study were not only practical but also efficacious for the diagnosis of cutaneous T cell lymphomas using tissues embedded in paraffins.

Changes in Compound Muscle Action Potentials according to the Dilution Volume of the Botulinum Toxin Type A

OBJECTIVE: To know if changes in compound muscle action potential (CMAP) of human extensor digitorum brevis (EDB) muscle can be enhanced by increase in dilution volume of botulinum toxin type A. METHOD: In 11 healthy volunteers, 2.5 U of botulinum toxin (Botox (R) , Allergen Inc.) in a volume of 0.1 ml normal saline was injected in EDB muscle and the same dose with the dilution volume of 0.5 ml was injected in the opposite side. We measured the pre- and post-injection M-wave amplitude and area of EDB muscle. RESULTS: The mean post/pre injection amplitude ratio of CMAP were 0.49+/-0.21 with the 0.1 ml of dilution volume and 0.40+/-0.12 with the 0.5 ml of dilution volume. The mean post/pre injection area ratio of CMAP were 0.51 0.18 with the 0.1 ml of dilution volume and 0.44+/-0.15 with the 0.5 ml of dilution volume. There was no significant difference between the two dilution volumes. CONCLUSION: Five fold increase in dilution volume did not enhance the paralyzing effect of botulinum toxin type A in human EDB muscles.

A Case of Mycosis Fungoides Rapidly Progressed to the Tumor Stage during Treatment / 대한피부과학회지

Mycosis fungoides(MF) is representative of cutaneous lymphoma and over many years progresses to plaques and tumors steadily. The extent and type of skin lesions at initial diagnosis and the presence of extracutaneous involvement are predictive indicators of survival in MF patients. Patients with limited plaque lesions are the least likely to have extracutaneous involvement and thus have the longest survival similar to the control population. We report a case of 45-year-old woman, who developed multiple subcutaneous nodules in normally appearing skin during photochemotherapy (PUVA). She had been treated with PUVA for the limited pre-mycotic skin lesions (T1 stage), which themselves showed good response to the treatment. She experienced the insidious course of early stage, but thereafter rapidly progressed to the tumor stage unusually during treatment.

A Case of Familial Primary Localized Cutaneous Amyloidosis / 대한피부과학회지

Primary localized cutaneous amyloidosis comprises macular, papular and rare nodular amyloidosis. Macular and papular amyloidosis are considered as different manifestations of the same disease process and can occur in the same patient, which is known as biphasic amyloidosis. Although most cases of primary cutaneous amyloidosis occur sporadically, some cases have been reported to have familial incidence with papular, biphasic or rarely macular amyloidosis. We report a case of a family in which a mother and her son have brown hyperkeratotic pruritic papules on both upper and lower extremities. The skin lesions initially began as macules on the shins in the second or third decade, but gradually spread with increasing papules and pigmentation. They had no kind of manifestation suggesting systemic amyloidosis. A skin biopsy specimen disclosed amyloid deposition in papillary dermis.

A Case of Familial Primary Localized Cutaneous Amyloidosis / 대한피부과학회지

Primary localized cutaneous amyloidosis comprises macular, papular and rare nodular amyloidosis. Macular and papular amyloidosis are considered as different manifestations of the same disease process and can occur in the same patient, which is known as biphasic amyloidosis. Although most cases of primary cutaneous amyloidosis occur sporadically, some cases have been reported to have familial incidence with papular, biphasic or rarely macular amyloidosis. We report a case of a family in which a mother and her son have brown hyperkeratotic pruritic papules on both upper and lower extremities. The skin lesions initially began as macules on the shins in the second or third decade, but gradually spread with increasing papules and pigmentation. They had no kind of manifestation suggesting systemic amyloidosis. A skin biopsy specimen disclosed amyloid deposition in papillary dermis.

Immunohistochemical Analysis of Cutaneous Pseudolymphoma / 대한피부과학회지

BACKGROUND: In the skin, it is often difficult to differentiate lymphomas from reactive lymphoid lesions by light microscopic examination. OBJECTIVE: Our purpose was to determine whether immunologic data obtained from mutine-processed specimens could be used to further objective morphologic interpretations. METHODS: We conducted an immunohistochcmical staining in 44 cases of benign and malignant cutaneous lymphoproliferative lesions using nine antibodies, including anti-CD3, UCHL1, MT1, MT2, L26, MB2, BerH2, 123C3, and MIB1. RESULTS: 1. Immunophenotyping with anti-CD3, UCHL1, MT1, L26, and MB2 was useful for the diagnosis of T cell or B cell lymphoma. However, these antibodies showed a lack of specificity for neoplastic cells, 2. Antibody to CD56, 123C3 showed positivity in 4 cases of angiocentric lymphoma, but negativity in 8 cases showing angiocentric lymphoma-like pathology. 3. Antibody to CD30, BerH2 showed positivity in all 6 cases of CD30 positive large cell lymphoma, but negativity in 6 cases showing diffuse lymphoma-like pathology. 4. Antibody to Ki-67, MIB1 showed positivity in more than 30% of infiltrating cells in 6 cases of angiocentric lymphoma, 4 cases of diffuse B cell lymphoma, and in more than 60% of infiltrating cells in 6 cases of CD30 positive large cell lymphoma. CONCLUSION: These observations suggest that immunostaining may provide useful adjunctive information in distinguishing benign from malignant cutaneous lymphoproliferations in paraffin sections.

Recurrent Annular Erythema in A Patient Presumed to Have Lupus Erythematosus / 대한피부과학회지

Annular erythema associated with lupus erythematosus/ Sjogrens syndrome has recently been described in Orientals. We present a patient with recurrent annular erythema who partially demonstrated features of lupus erythematosus. A 32-year-old man was referred to us for recurrent annular erythema. Laboratory findings revealed mild leukopenia and the presence of antinuclear antibodies at a titer of 320 with a finely speckled pattern on Hep-2 substrates. Anti-Ro/La antibodies were also detected. A skin biopsy specimen revealed the findings of perivascular and periappendageal lymphocytic infiltration without prominent hydropic degeneration of the basal layer. Skin lesions subsided with hydroxychloroquine (400-200mg/day).

Immunohistochemical Staining in the Differential Diagnosis of Trichoblastoma and Basal cell Carcinoma / 대한피부과학회지

BACKGROUND: Trichoblastoma is a benign skin tumor with follicular differentiation which sometimes is difficult to distinguish histologically from basal cell carcinoma (BCC). OBJECTIVE: Our purpose is to investigate the usefulness of the immunostains in the differential diagnosis of trichoblastoma and BCC. METHODS: The authors analyzed 11 trichoblastoma, 8 keratotic BCCs, 9 nodular BCCs, 6 borderline cases. The monoclonal antibodies to bcl-2, CD34, Ki-67, p53 were applied to formalin-fixed paraffin sections in all cases, using a labelled streptoavidin biotin peroxidase complex method. RESULTS: Most nodular BCCs demonstrated diffuse cytoplasm labelling for bcl-2. In contrast, 'peripheral' bcl-2 staining of trichoblastomas was noted in 9 of 11. Keratotic BCCs demonstrated mixed staining pattern for bcl-2. CD34 staining failed to discriminate between trichoblastomas and BCCs. In BCC, Ki-67 positive cells were mainly distributed in the perphery of tumors. CONCLUSION: Immunostain using monoclonal antibodies to bcl-2, CD34, Ki-67, p53 can not differentiate between trichoblastomas and BCCs. But it could be an adjunctive method to establish the definite diagnosis of trichoblastomas and BCCs.

Histological Changes in the Skin with Innate Ageing / 대한피부과학회지

BACKGROUND: It is a popular notion that cutaneous ageing includes two distinct phenomenon; true ageing, a universal presumably inevitable change attributable to the passage of time alone, and photoageing, changes attributable to chronic habitual sun exposure that are neither universal nor inevitable. Numerous investigations with experimental animals, in vitro skin models have been conducted, although, few histological studies to date have attempted to announce fundamental morphological changes with innate ageing. OBJECTIVE: We compared skin derived from the breast of old and young persons using light microscopy to discern structural changes in epidermal and dermal morphology with advancing age. METHODS: The histological, immunohistochemical studies were performed with normal skin sections of thirty donors who were diagnosed with breast cancer. They were classified into three age cohort groups; nine into group I (22 to 38), twelve into group II(40 to 52), and nine into group III(54 to 87). We chose the breast as an area that might closely resemble intrinsically aged skin. This region is relatively shielded from photoageing by its anatomical location. Analysis of data was performed using the Kruskal-Wallis and ANOVA test for dermal parameters based on a 5-point rating scale, and a simple regression test for a positive rate of immunoreactants. Results : 1. Light microscopic appearance of aged skin revealed a more flattened epidermis than young skin. There was no trend for an increase in epidermal melanin content per unit area on Fontana-Masson staining. There was an age-associated decrease in the Ki-67 positive rate(p<0.001), the density of Ki-67 positive cells declined approximately 1.16% per decade in photoprotected skin(p<0.001). The number of S-100 positive cells declined approximately 4.4/mm width along the dermo-epidermal juction per decade in photoprotected skin(p<0.001). The expression of differentiation markers(keratin 1, involucrin, filaggrin, loricrin) were not different among the three age cohort groups. 2. With advancing age, there was an attenuation in the number and diameter of elastic fibers in the papillary dermis and an increase in the number and straightness of the same fibers in the reticular dermis. The collagen fibers are arranged in sparse bundles in disarray, and/or aggregates of loosely woven, straight fibers in the aged skin. There was an apparent, age-related decrease in the stainability of ground substances in the papillary dermis on colloidal iron staining. Conclusions : Our data documents semi-quantitative differences among three groups in intrinsically aged breast skin and provide the framework for future research to evaluate the ageing process.

Palmoplantar Epidermal cyst / 대한피부과학회지

BACKGROUND: Although palmoplantar epidermal cysts have long been associated with develop ment following implantation of an epidermal fragment as a result of a penetrating or blunt injury, the pathogenic mechanism is still not fully understood. Since 1987, many cases have been reported in which human papillomavirus(HPV) could be associated with palmoplantar epidermal cysts. OBJECTIVE: In this study, we evaluated the clinicopathological findings of palmoplantar epidermal cysts and investigated them for the presence of HPV in order to examine the role of HPV in the pathogenesis of this disorder in Korea. METHODS: The clinical, histological, immunohistochemical studies were performed on seven cases of plantar cysts, and two cases of palmar cysts. RESULTS: No previous trauma history was seen. Histopathologically, parakeratotic nuclei, or vacuolar strutures within the keratinous mass in the cyst cavity were found. However, we could not find intracytoplasirnic eosinophilic bodies in the wall, the cyst content, or the overlying epidermis. The dyskeratotic keratinocytes were observed in 3 cases. Papillomavirus common antigens were not detected by immunohissochemical staining. CONCLUSIONS: Palmoplantar epidermal cysts in Korea have some different histological features compared to those of HPV 60-associated cases in Japan and we could not detect the immunohistochemical evidence of HPV infection in our cases.