ABSTRACT
A 75-year-old male was diagnosed with idiopathic pulmonary fibrosis and treated with pirfenidone. He presented with an erythematous thick scaly patch on his face, neck, and both hands and arms. He had a history of significant exposure to sunlight without using sunscreen. All lesions were restricted to sun-exposed areas and appeared one month ago.Histopathological examination revealed necrotic keratinocytes, epidermal spongiosis, liquefaction degeneration of the basal layer, interface dermatitis, solar elastosis, and upper dermal perivascular lympho-histiocytic infiltration. Based on clinical and histopathological findings, the skin lesion could be diagnosed as photosensitive drug eruption induced by pirfenidone. Pirfenidone was discontinued for a month, and the patient was treated with oral and topical corticosteroids. Consequently, the skin lesion almost fully cleared, leaving mild postinflammatory hyperpigmentation. Although there are many reports of photosensitivity reactions to pirfenidone, dermatologists are still not familiar with this drug. Through this case presentation, clinicians should be aware of the potential phototoxic effects of pirfenidone and provide the necessary precautionary information to patients who take pirfenidone.
ABSTRACT
Background@#Psoriasis imposes a significant treatment burden on patients, particularly impacting well-being and quality of life (QoL). The psychosocial impact of psoriasis treatments remains unexplored in most patient populations. @*Objective@#To assess the impact of adalimumab on health-related QoL (HRQoL) in Korean patients with psoriasis. @*Methods@#This 24-week, multicenter, observational study, assessed HRQoL in Korean patients treated with adalimumab in a real-world setting. Patient-reported outcomes (PROs) including European Quality of Life-5 Dimension scale (EQ-5D), EQ-5D VAS, SF-36, and DLQI were evaluated at week 16 and 24, versus baseline. Patient satisfaction was assessed using TSQM. @*Results@#Among 97 enrolled patients, 77 were assessed for treatment effectiveness. Most patients were male (52, 67.5%) and mean age was 45.4 years. Median baseline body surface area and Psoriasis Area and Severity Index (PASI) scores were 15.00 (range 4.00~80.00) and 12.40 (range 2.70~39.40), respectively. Statistically significant improvements in all PROs were observed between baseline and week 24. Mean EQ-5D score improved from 0.88 (standard deviation [SD], 0.14) at baseline to 0.91 (SD, 0.17) at week 24 (p=0.0067). The number of patients with changes in PASI 75, 90, or 100 from baseline to week 16 and 24 were 65 (84.4%), 17 (22.1%), and 1 (1.3%); and 64 (83.1%), 21 (27.3%), and 2 (2.6%), respectively. Overall treatment satisfaction was reported, including effectiveness and convenience. No unexpected safety findings were noted. @*Conclusion@#Adalimumab improved QoL and was well-tolerated in Korean patients with moderate to severe psoriasis, as demonstrated in a real-world setting. Clinical trial registration number (clinicaltrials.gov: NCT03099083).
ABSTRACT
Background@#The use of biologics for psoriasis treatment has increased and is now a major treatment option.Nevertheless, real-world data on the safety of biologic administration in psoriasis is insufficient, especially in Korea. @*Objective@#To compare the frequency of adverse events in patients treated with adalimumab, ustekinumab, secukinumab, and guselkumab. @*Methods@#Patients treated with adalimumab, ustekinumab, secukinumab, and guselkumab between March 2018 and June 2019 were enrolled in this study. Demographic data were collected at the time of enrolment. Serial interviews were conducted at 12, 36, and 52 weeks. The occurrence of adverse events and psoriasis area severity index (PASI) scores were investigated at each visit. @*Results@#A total of 241 patients were enrolled, and 212 (88.0%) completed the study. The frequencies of adverse events did not differ significantly among the classes of biologics (p=0.597). The most common reason for dropout was loss of efficacy, followed by serious adverse events. Five cases of severe adverse events were reported;however, no class-specific tendency was observed (p＞0.999). The most common adverse event was pruritus, followed by nasopharyngitis, injection site erythema, urticaria, folliculitis, and alopecia. Guselkumab and secukinumab showed superior efficacy regarding PASI 75. @*Conclusion@#This study suggests that adalimumab, ustekinumab, secukinumab, and guselkumab are effective and safe for the treatment of moderate to severe psoriasis. Most adverse events were relatively mild and self-limiting, and severe adverse events mostly occurred during the induction phase.
ABSTRACT
Background@#Omalizumab is a very important drug for the treatment of chronic urticaria. Although omalizumab’s therapeutic efficacy has been demonstrated, data on real-world experiences in Korea, especially regarding chronic inducible urticaria (CIndU), are limited. This study attempted to compare the efficacy of omalizumab in Korean chronic spontaneous urticaria (CSU) and CIndU patients. @*Methods@#Fifty-two CSU and 29 CIndU patients were included and Urticaria Activity Score 7 (UAS7) at baseline, week 4, and week 12 was assessed retrospectively. @*Results@#Omalizumab 150 mg significantly decreased UAS7 in both patients with CSU and CIndU with only one dose (P < 0.001). The significant decrease in the UAS7 scores of both groups of patients continued from weeks 4 to 12. Although there was no significant difference in treatment efficacy between the two groups, the symptoms of patients with CSU tended to improve faster; furthermore, the number of antihistamines administered daily reduced more significantly in this patient group (P = 0.047). Additionally, the decrease in the UAS7 score between baseline and week 12 and the response rate were higher in patients with CSU. @*Conclusion@#Omalizumab may be slightly more effective against CSU than against CIndU. Regarding the CIndU subtypes, dermatographic urticaria was associated with the greatest reduction in the UAS7 score, and patients with this condition showed the highest response rate, indicating the best effect of omalizumab. The duration of chronic urticaria was greater in non-responders than in responders (P = 0.025). Conversely, baseline immunoglobulin E levels were significantly higher in responders (P = 0.039).
ABSTRACT
Background@#Folliculitis decalvans and dissecting cellulitis are types of primary neutrophilic cicatricial alopecia characterized by permanent hair loss. Clinicopathological differentiation is poorly described in literature. @*Objective@#This study aimed to determine the clinicopathological distinction between folliculitis decalvans and dissecting cellulitis. @*Methods@#A retrospective review was conducted in 45 patients diagnosed with dissecting cellulitis and folliculitis decalvans between 2011 and 2021. We reviewed the clinical features using electronic medical records, clinical photographs, and histopathologic features. @*Results@#Clinically, middle-aged men with folliculitis decalvans showed polytrichia (80%) and papulopustules (55%), while young men with dissecting cellulitis had deeply seated nodules (84%). Histopathologically, follicular plugging was more frequently observed in dissecting cellulitis (80%) than in folliculitis decalvans (50%). There was a difference in the depth of inflammation between the two types. @*Conclusion@#A difference in clinical manifestations was observed according to the depth of inflammation. These findings may contribute to the differential diagnosis of primary neutrophilic cicatricial alopecia.
ABSTRACT
Background@#Digital mucous cysts (DMCs) are benign, occurring mainly on the fingers but rarely on the toes.Although the exact cause of DMC has not been identified, it is classified into two different types based on its pathogenesis and location. Surgical and nonsurgical procedures, including aspiration, sclerotherapy, steroid injection, cryotherapy, and CO 2 laser, can be used to treat DMC. @*Objective@#This study aimed to compare treatment response based on DMC type and evaluate its efficacy in surgical and nonsurgical (sclerotherapy) treatments. @*Methods@#We retrospectively reviewed the electronic medical records of patients with DMC who visited our dermatology department between January 2010 and November 2020. @*Results@#This study enrolled 39 patients having a mean age of 59.2 years. The proportion of female patients (21/39, 53.8%) was more than male (18/39, 46.2%). The DMC occurrence was more frequent in the fingers (32/39, 82.1%), especially in the index and middle fingers than in the toes (7/39, 17.9%). In sclerotherapy, DMC in the distal interphalangeal joint (DIPJ) required more treatment than that in the proximal nail fold (PNF) (p＜0.05). The number of treatments using sclerotherapy was higher compared to that of surgical treatments (p＜0.05). @*Conclusion@#The DIPJ type of DMC patients was more difficult to treat using sclerotherapy than the PNF type.Moreover, surgical treatment has a better response than sclerotherapy.
ABSTRACT
Friction melanosis (FM) is an acquired pigmented disease that is caused by recurrent mechanical stress. There is no previous report explaining the presence of tiny brown-colored particles confined to the corneal layer. We describe a case of a rare form of FM of the finger that showed a relatively transient clinical course. A 17-year-old Korean female presented with a 5-month history of an asymptomatic localized hyperpigmented patch on the tip of the right index finger. The dermoscopic examination revealed homogenous globular pattern, which favored pigmentation over hemorrhage. Histopathologically, hyperkeratosis and acanthosis with lymphohistiocytic infiltration of the superficial dermis were noted on hematoxylin and eosin staining; however, there was neither a definite increase in melanophages in the upper dermis nor melanocytic proliferation in the basal layer. Per high-power field, multiple brown-colored tiny particles were scattered in the corneal layer. The particles were not dyed by Fontana-Masson stain, iron stain, and S-100. We questioned the patient about the presence of irritation and found that she had bought new shoes at the time of the onset. She was habituated to placing her fingers in her shoes while wearing them because they were slightly tight. The lesion disappeared spontaneously a week after the cause of friction was eliminated.Altogether, we encountered a rare form of FM that occurred in a rare location with a transient clinical course. Further cases on pigmentation restricted to finger tips might reveal the origin of the particles.
ABSTRACT
Background@#Psoriasis and seborrheic dermatitis are difficult to distinguish if the lesion is localized to the scalp. @*Objective@#To validify the use of langerin and CD1a as markers of Langerhans cells to distinguish scalp psoriasis from seborrheic dermatitis. @*Methods@#We retrospectively evaluated 25 seborrheic dermatitis cases and 17 psoriasis cases diagnosed at a tertiary medical center in Korea from 2010 to 2019. The histopathological features and expression of CD1a and langerin were analyzed by dermato-pathologists. @*Results@#Hyperkeratosis, parakeratosis, and the presence of neutrophils in the parakeratotic mound were observed more frequently in the psoriasis group than in the seborrheic dermatitis group (p=0.016, p=0.027, and p=0.021, respectively). Other features examined did not show statistically significant differences. Dermal expression of langerin occurred more frequently in the psoriasis group than in the seborrheic dermatitis group (76.5% vs. 36.0%, p=0.010). Additionally, stronger CD1a dermal expression was observed in the psoriasis group than in the seborrheic dermatitis group (p=0.049), although the difference in overall dermal CD1a expression regardless of strength was not significant. In contrast, the epidermal expressions of CD1a and langerin did not show significant differences. Similarly, the follicular expressions of CD1a and langerin did not demonstrate significant differences. @*Conclusion@#In this retrospective study, histopathological findings that favored psoriasis over seborrheic dermatitis included hyperkeratosis, parakeratosis, and the presence of neutrophils in the parakeratotic mound. The use of Langerhans cells, CD1a, and langerin as markers could help distinguish scalp psoriasis from seborrheic dermatitis.
ABSTRACT
Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.
ABSTRACT
A 10-year-old boy presented with a 1-day history of multiple painful erythematous skin lesions on his upper and lower extremities. He was admitted to the Department of Pediatrics with persistent right lower abdominal pain and diarrhea. Punch biopsy of a skin lesion on his lower leg showed necrotizing granulomatous vasculitis with septal panniculitis consistent with polyarteritis nodosa, and our differential diagnosis included cutaneous manifestations of Crohn’s disease. Abdominal ultrasonography revealed distended colonic loops suggestive of inflammatory bowel disease. Upper and lower gastrointestinal endoscopy revealed lesions involving the duodenum, cecum, colon, and rectum. He developed multiple perianal fistulas during hospitalization. Additional laboratory tests revealed positive results for anti-saccharomyces cerevisiae and antinuclear antibodies. Based on his clinical presentation and laboratory findings, he was diagnosed with Crohn’s disease associated with cutaneous polyarteritis nodosa. We report a rare case of a child who presented with cutaneous polyarteritis nodosa as an extraintestinal manifestation of Crohn’s disease.
ABSTRACT
Background@#Psoriasis and seborrheic dermatitis are difficult to distinguish if the lesion is localized to the scalp. @*Objective@#To validify the use of langerin and CD1a as markers of Langerhans cells to distinguish scalp psoriasis from seborrheic dermatitis. @*Methods@#We retrospectively evaluated 25 seborrheic dermatitis cases and 17 psoriasis cases diagnosed at a tertiary medical center in Korea from 2010 to 2019. The histopathological features and expression of CD1a and langerin were analyzed by dermato-pathologists. @*Results@#Hyperkeratosis, parakeratosis, and the presence of neutrophils in the parakeratotic mound were observed more frequently in the psoriasis group than in the seborrheic dermatitis group (p=0.016, p=0.027, and p=0.021, respectively). Other features examined did not show statistically significant differences. Dermal expression of langerin occurred more frequently in the psoriasis group than in the seborrheic dermatitis group (76.5% vs. 36.0%, p=0.010). Additionally, stronger CD1a dermal expression was observed in the psoriasis group than in the seborrheic dermatitis group (p=0.049), although the difference in overall dermal CD1a expression regardless of strength was not significant. In contrast, the epidermal expressions of CD1a and langerin did not show significant differences. Similarly, the follicular expressions of CD1a and langerin did not demonstrate significant differences. @*Conclusion@#In this retrospective study, histopathological findings that favored psoriasis over seborrheic dermatitis included hyperkeratosis, parakeratosis, and the presence of neutrophils in the parakeratotic mound. The use of Langerhans cells, CD1a, and langerin as markers could help distinguish scalp psoriasis from seborrheic dermatitis.
ABSTRACT
Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.
ABSTRACT
Benign cephalic histiocytosis is a rare subtype of non-Langerhans cell histiocytosis of unknown etiology. It usually occurs in infants and children and resolves spontaneously. A 14-month-old infant presented with multiple papules on his face, trunk, as well as upper and lower extremities. Histopathological examination of a biopsy specimen showed diffuse proliferation of histiocytes in the dermis with scattered lymphocytes and eosinophils. Immunohistochemical evaluation showed cells that were immunonegative for S-100 and CD1a but strongly immunopositive for CD68.Benign cephalic histiocytosis usually affects the head and neck areas and rarely spreads to other sites. Some reports in the available literature have described an association between juvenile xanthogranuloma and neurofibromatosis type 1; however, the association, if any, between benign cephalic histiocytosis and neurofibromatosis type 1 is unclear. We report a rare case of benign cephalic histiocytosis in a patient with a family history of neurofibromatosis type 1.
ABSTRACT
A 31-year-old Korean man presented with a 6-month history of a painful nodule on his neck. Excisional biopsy was performed for diagnosis and treatment. Histopathological evaluation of the resected specimen revealed well-demarcated vascular proliferation with adipose tissue in the dermis, and the patient was diagnosed with cutaneous angioleiomyoma with fat modulation. To our knowledge, angioleiomyomas most commonly occur on the extremities, and the head and neck are rarely involved. Few cases of cutaneous angioleiomyomas of the neck have been reported in the literature. We report a rare case of cutaneous angioleiomyoma of the neck.
ABSTRACT
A 70-year-old female was referred for brown-to-gray colored papules and nodules on her lower legs. She had been diagnosed with diffuse large B-cell lymphoma (DLBCL) in her stomach, and myelodysplastic syndrome (MDS) by bone marrow biopsy. Three years after complete remission of DLBCL, she experienced DLBCL recurrence in her small bowel and was hospitalized. MDS had been stationary, but during the treatment of DLBCL, her laboratory findings suggested signs of leukemia. Bone marrow biopsy was done, and acute monoblastic leukemia (AMoL) was diagnosed. After 1 cycle of chemotherapy for AMoL, skin lesions developed, and her skin biopsy showed cutaneous T-cell lymphoma (CTCL). Terminal deoxynucleotidyl transferase staining and CD123 staining were negative, and bone marrow re-biopsy conducted after the skin lesion developed still showed monoblastic proliferation. Whether the CTCL represented with an AMoL lineage switch could not be completely proved due to the absence of molecular or clonal marker evaluations, but the possibility of coexistence of three different malignancies was higher. During treatment, a neutropenic fever developed, and the patient died due to sepsis. We herein report a rare case of CTCL accompanied by AmoL and DLBCL.
ABSTRACT
Wolf’s isotopic response refers to the occurrence of a novel skin disease at the site of a preceding treated or untreated skin disease. Although the most common preceding skin disease was found to be herpes zoster (HZ), HZ-related dermatological phenomena are not well known in the literature. We report a case of HZ granulomatous dermatitis in a 77-year-old female with a previous history of hypertension, diabetes mellitus, chronic kidney disease, and HZ. She presented with a 3-month history of a pruritic skin lesion on her right thigh. The location of the lesion was consistent with a previous HZ site. Histopathological examination revealed lympho-histiocytic infiltration in the superficial dermis, forming a granulomatous structure. Based on clinical and histopathological findings, we made a diagnosis of granulomatous dermatitis at a previous HZ site. We assumed that the lesion arose from an isotopic response of Wolf. The patient was treated with topical steroids for 3 months and showed clearance of the lesion and symptom. We suggest that treatment should be based on the individual disease, which in our case was topical steroid.
ABSTRACT
A 10-year-old boy presented with a 1-day history of multiple painful erythematous skin lesions on his upper and lower extremities. He was admitted to the Department of Pediatrics with persistent right lower abdominal pain and diarrhea. Punch biopsy of a skin lesion on his lower leg showed necrotizing granulomatous vasculitis with septal panniculitis consistent with polyarteritis nodosa, and our differential diagnosis included cutaneous manifestations of Crohn’s disease. Abdominal ultrasonography revealed distended colonic loops suggestive of inflammatory bowel disease. Upper and lower gastrointestinal endoscopy revealed lesions involving the duodenum, cecum, colon, and rectum. He developed multiple perianal fistulas during hospitalization. Additional laboratory tests revealed positive results for anti-saccharomyces cerevisiae and antinuclear antibodies. Based on his clinical presentation and laboratory findings, he was diagnosed with Crohn’s disease associated with cutaneous polyarteritis nodosa. We report a rare case of a child who presented with cutaneous polyarteritis nodosa as an extraintestinal manifestation of Crohn’s disease.
ABSTRACT
Background@#Accuracy in histological subtyping of basal cell carcinoma (BCC) is crucial for determining the appropriate treatment modality. Previous studies have assessed the concordance rateof punch biopsy and excision in subtyping BCC however, they did not calculate this rate according to the BCC location or in Asian populations. @*Objective@#This study compared the concordance rate of punch biopsy and excision for each BCC location. @*Methods@#This study included 192 patients who underwent both punch biopsy and excision. BCC subtypes identified by punch biopsy and excision were compared to calculate the concordance rate. The differences in the rates of misdiagnosis according to the BCC location were also determined. @*Results@#The overall concordance rate of punch biopsy and excision was 78.1% (150/192). The proportion of aggressive type was higher for excision than for punch biopsy. The false-positive rate, defined as the rate of misidentified nonaggressive type, was 19.7% (26/132) and was highest for nodular-type BCC. Additionally, most discrepancies occurred in BCCs located in the face, especially in the H-zone. @*Conclusion@#Owing to the inconsistencies in the results of punch biopsy and excision and the high false-positive rate of punch biopsy, dermatologists should be aware of the possibility of an aggressive type BCC even if it is identified as anonaggressive type in punch biopsy. Moreover, more aggressive treatment should be considered in cases of BCCslocated on the face, especially in the H-zone, as the discrepancy rate is higher.
ABSTRACT
A 62-year-old female, with previous history of asthma andhypertension, presented with generalized hyperpigmentedskin lesion, found a year ago. Physical examination revealedbrown colored lichenified and sclerotic patches on the lowerabdomen and flexural areas of extremities. Punch biopsywas performed and histopathological examination revealedhyperkeratosis, follicular plugging and thinning in epidermis.In dermoepidermal junction, cleft like space separating atrophicepidermis and dermis was seen. Also, lichenoid lymphocyticinfiltration was observed in mid-dermis. Based onclinical and histopathological findings, a diagnosis of generlaizedlichen sclerosus et atrophicus (LSA) was made.Other laboratory examinations were unremarkable. As thereis no standard treatment for LSA, the patient received varioustreatments including topical steroid, tacrolimus and narrow-band ultraviolet B therapy. The skin lesion has softenedand its color improved after treatment. LSA is defined as infrequentchronic inflammatory dermatosis with anogenitaland extragenital manifestations. Generalized type is rare andgenital involvement is the most frequent and often the onlysite of involvement. We report this case as it is an uncommontype of LSA with generalized hyperpigmented and scleroticskin lesion in a postmenopausal female patient.
ABSTRACT
Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural locations, including cutaneous site. The skin lesion presents as a circumscribed nodule or tumor, mainly on the head and neck. A 41-year-old male presented with 6 months history of nail lesion without symptom on the left third finger. The lesion is slightly yellowish discoloration with subungual erythematous nodule and distal onycholysis. Biopsy specimen from the nail lesion showed the spindle cells form patternless pattern with hypercellular and hypocellular area. And small blood vessels and dilated vascular spaces were present. The result of special stain for specimen showed that positive for CD34, Bcl-2, and CD99 but negative for S-100, FactorXIIIa, and smooth muscle action. Recognition of this uncommon location of SFT is important because of possible confusion with other subungual tumors, including glomus tumor, fibroma and other fibrohistiocytic tumors like dermatofibrosarcoma protuberans, superficial acral fibromyxoma and cellular digital fibroma. Here in, we report a case of SFT of subungual region. We think this case is interesting because of uncommon location and may be helpful to more understand the character of this disease.