A Case of Cystic Basal Cell Carcinoma / 대한피부과학회지

Cystic basal cell carcinoma is an uncommon histologic variant of basal cell carcinoma. Degeneration of tumor cells causes cystic space, in which mucin is secreted from the adjacent tumor cells. We report a case of cystic basal cell carcinoma with prominent cystic formation occurring in a 52-year old women on the right cheek.

A Case of Jellyfish Dermatitis / 대한피부과학회지

Jellyfish dermatitis was characterized by purpuric papules or tiny vesicles arranged linearly with a color ranging from pink to red to brown. A 24-year-old woman presented with multiple whiplash-like erythematous lesions of 5-hours duration on both legs after contact with a jellyfish at a Korean seashore.

A Statistical Study of Dermatoses in the Suwon Area and Southern Area of Kyonggi(1995-2001) / 대한피부과학회지

BACKGROUND: There has been no statistical study of dermatoses in the Suwon area and southern area of Kyonggi province which has been rapidly developing in the last 7 years. OBJECTIVE AND METHODS: We evaluated the recent distributions of dermatoses in the Suwon area and southern area of Kyonggi and compared them with the previous reports of other provinces of Korea. Fifty two thousand, one hundred fifty three new outpatients who visited the Ajou University Hospital from 1995 to 2001 were analysed statistically. RESULTS: The study results are summarized as follows: Among the 52, 153 outpatients, the total number of male patients were 24, 005(46.0%) and female patients were 28, 148(54.0%). The frequency of age groups are as follows; the age groups were the 3rd decade(22.0%), 4th decade(20.4%), 1st decade(18.7%), 5th decade(11.5%), 2nd decade(11.1%), 6th(8.5%), 7th(5.4%), 8th and above(2.4%). The distributions of dermatoses as disease groups were eczema(28.6%), dermatophytosis(8.7%), erythema urticaria and drug eruption(8.1%), disease of skin appendages(7.9%), viral infection(7.3%), etc. Those dermatoses which demonstrated a tendency to increase annually were seborrheic dermatitis, hyperpigmentary disorders, verruca, and alopecia areata. The incidence of dermatophytosis, in particular, decreased during the study period. Seasonal distribution showed that those diseases occurring the most frequently during the summer were dermatophytosis, allergic contact dermatitis, urticaria, verruca, and vitiligo. The incidence of atopic dermatitis and nevocellular nevi increased during the winter season. Acne vulgaris was the disease occurring frequently during summer and winter. Sexual distribution of dermatoses showed that hyperpigmentary disorder, nevocellular nevi, benign epidermal tumor, acne, allergic contact dermatitis, and irritant contact dermatitis were more frequent in females, and dermatophytosis, seborrheic dermatitis, alopecia were more frequent in males. Age distribution was as follows; atopic dermatitis, vitiligo and verruca was the most frequent in the 1st decade. Acne vulgaria was the most frequent in the 2nd decade and 3rd decade. Hyperpigmentary disorder and seborrheic dermatitis were the most frequent in the 4th decade. Hyperpigmentary disorder was the most frequent in the 5th decade and herpes zoster in 6th, 7th and 8th decade and above. CONCLUSION: In contrast to an earlier published report from Seoul, the infectious dermatoses, especially parasitic infestation, showed a tendency to decrease and nevocellular nevi, hyperpigmentary disorder and alopecia showed a tendency to increase. The distribution pattern of the skin disease did not differ from other provinces of Korea in general.

A Case of Actinomycosis Presenting as an Oral Ulcer in a Healthy Child / 대한의진균학회지

Actinomycosis is a chronic suppurative and granulomatous bacterial infection most commonly presenting as an abscess, soft tissue swelling, or mass in the cervicofacial region. Although the organisms often invade soft tissues through damaged oral mucosa, actinomycosis presenting acutely as a superficial oral ulcer is extremely rare. We report a case of actinomycosis in a 6-year-old boy who presented a painful ulcer on the right buccal mucosa. Histopathologic examination showed sulfur granules and granulation tissue with mixed inflammatory infiltrate in the dermis. The granules contained numerous Gram-positive filamentous organisms consistent with actinomycosis. We propose that actinomycosis should be kept in mind in the diagnosis of oral ulcerations.

A Case of Heterotopic Brain Tissue in the Scalp / 대한피부과학회지

Heterotopic brain tissue is defined as displaced neuroglial tissue that has no connection with the central nervous system. As there is no communication with underlying structures, serious anomalies rarely occur. A 6-year-old Korean male presented an erythematous, non tender nodule measuring 1.5X1.5X0.5cm on right parietal scalp since birth. The lesion was covered with thickened alopetic skin. There was no neurologic defect. The mass was not connected with intracranial structures on a magnetic resonance imaging.

The Motile Properties of Vimentin Intermediate Filament in B16 Melanoma Cells / 대한피부과학회지

BACKGROUND: Intermediate filaments as well as microtubule and microfilament are major components of cytoskeleton of human cells. Melanocytes have vimentin intermediate filament, which have not been well investigated as other cytoskeletons, especially in their function. OBJECTIVE: The purpose of this study was to observe the motile characteristics of vimentin intermediate filament in living B16 melanoma cells. METHODS: The motile properties of vimentin intermediate filament have been studied in living B16 melanoma cells using green fluorescent protein(GFP). cDNA expressing GFP-vimentin fusion protein was cloned and transfected into living B16 melanoma cells. Living cells were observed under fluorescent microscope and confocal microscope. Time-lapse images were collected and analysed. RESULTS: GFP-vimentin is incorporated into the endogenous vimentin networks. Time-lapse observations of vimentin fibrils demonstrate that they are constantly changing their configurations. Intersecting points of vimentin fibrils, or foci, frequently move towards or away from each other, indicating that the fibrils can lengthen or shorten. Fluorescence recovery after photobleaching shows that bleach zones across fibrils rapidly recover their fluorescence. During this recovery, bleached zones frequently move, indicating translocation of fibrils. Short filamentous structures('squiggle') are also seen actively translocating. Melanosomes also are changing their position back-and-pro constantly. They are co-localized very well with kinesin molecules in B16 melanoma cells. CONCLUSION: The vimentin intermediate filament and melanosomes in B16 melanoma cells have very active movement, which seem to have close relation with kinesin motor proteins.

A Case of Lichen Striatus: Multinucleated Giant Cells / 대한피부과학회지

Lichen striatus is a self limited, papulosquamous disorder with a linear distribution. The linearity has been shown to correspond in many cases to the pattern of Blaschkos lines. Lichen striatus can usually be identified by clinical features and histology. However, the histologic features are diverse and some are nonspecific. We present the rare case of lichen striatus which shows multinucleated giant cells in upper dermis with microscopy.

A Case of Primary Cutaneous Plasmacytoma / 대한피부과학회지

Primary cutaneous plasmacytoma is a rare cutaneous B cell lymphoma characterized by monoclonal proliferation of mature plasma cells in the skin without systemic involvement. Although a significant proportion of patients, especially with multiple lesions, went on to develop systemic disease with a poor prognosis, the abnormal clone of plasma cells may arise in the skin and never progress to multiple myeloma involving the bone marrow in a number of patients. We report a case of primary cutaneous plasmacytoma and review data published in the literature. A 19-year-old man developed multiple 0.2 to 0.5cm sized erythematous grouped papules on his posterior neck for 4 years. Histopathologic examination represented superficial and deep interstitial and nodular dense infiltration of plasma cells showing monoclonal expression of immunoglobulin lambda light chain. F-18 FDG coincidence PET(CoDe-PET) scan and serum electrophoresis were within normal limit. Any systemic disease has not developed for 6 months after diagnosis.

A Case of Microscopic Polyangiitis with Acute Myocardial Infarction

Microscopic polyangiitis is a systemic small-vessel vasculitis, which may involve multiple organs, but cardiac involvement is relatively rare. We report a case of microscopic polyangiitis with multiple organ involvement, in which myocardial infarction was the early manifestation of the disease. A 53-year-old man presented with sudden papulovesicular eruptions and swellings on the face, posterior neck, dorsa of both hands and fingers, and with diffuse erythematous patches on the back. He had suffered from renal dysfunction, arthralgia, and hypertension for more than 8 years. He had been admitted to the department of cardiology for acute myocardial infarction and had suffered from recurrent gastrointestinal bleeding, renal failure, acute pancreatitis and sepsis during the admission. Histopathologically, small-vessel leukocytoclastic vasculitis with out granuloma was seen. Direct immunofluorescence showed no immune deposite. A high serum level of P-ANCA was detected by ELISA.

A Case of Granuloma Faciale Treated with Co2 Laser / 대한피부과학회지

Granuloma faciale is a rare disease of unknown origin characterized by single or multiple cutaneous nodules usually occurring on the face. A narrow grenz zone of normal dermis is usually observed between the epidermis and the dense dermal polymorphous infiltrates. We report a case of granuloma faciale in a 40-year-old male patient with erythematous plaque on his nose. The skin biopsy specimen showed a dense dermal accumulation of inflammatory cells, including neutrophils, eosinophils, monocytes, and lymphocytes. The infiltrate was distributed diffusely throughout the involved dermis and it focally involved the thinned and flattened epidermis. There is deposition of fibrinoid material within and around the affected lood wessels. The lesion was treated with CO2 laser effectively.

Koebner phenomenon developed on skin grafts and flaps but not on graft donor site in a psoriasis patient / 대한피부과학회지

The Koebner phenomenon describes the appearance of new isomorphic lesions on otherwise normal-looking skin in response to trauma. A 42-year-old male presented erythematous macules and patches with silvery scales on left leg, right knee, and surgical wounds including skin grafts, flaps, and donor sites for flaps, but not on the donor site for split thickness skin graft. He had received surgical treatment for electrical burns on both arms 4 months before the skin lesions developed. The mechanisms of the phenomenon is not clear yet. We present evidence that local factors may be important in the development of the Koebner phenomenon.

Malignant Melanoma on Congenital Melanocytic Nevus

Congenital melanocytic nevi are considered to be precursors of malignant melanoma. Although the risk of malignant melanoma with medium and small congenital melanocytic nevi is uncertain, it is important to notice the possibility of malignant transformation in those lesions. We describe a 62-year-old woman who had had a brown soft verrucous tumor on her right lower back since birth. She first noticed a black nodule in the center of the tumor 5 years before which had ulcerated 3 months prior to presentation without healing. A biopsy specimen revealed malignant melanoma arising from a congenital melanocytic nevus.

Intramuscular Lipoma of the Frontalis Muscle

Intramuscular lipomas are benign soft-tissue mesenchymal tumors which rarely occur in the region of the head. These tumors present as slow-growing, generally painless masses and are easily misdiagnosed initially as epidermal inclusion cysts. We describe a 44-year-old woman who presented with an intramuscular lipoma of the frontalis muscle.

A Case of Sjogren's Syndrome with Recurrent Annular Erythema on the Face / 대한피부과학회지

Sjogren's syndrome has been considered to be an autoimmune disease affecting various organs including salivary and lacrimal glands. It occurs most commonly in middle-aged women, and less than 20 cases with primary Sjogren's syndrome have been reported in children. An 11-yim-old boy presented with recurrent annular erythema on the face that had been present for 2 years. A schirmers test showed a positive result. ANA was detected at a dilution of 1:640. Anti-Ro/SSA and anti-La/SSB antibodies were also detected. On histological examination, lymphocytes were infiltrated in the periappendegeal areas as well as the papillary and reticular dernis. The skin findimg is uncommon in children, but has become a characteristic feature of childhood Sjogrens syndrome with anti-Ro and/or anti-La antibodies.

Two Cases of Multiple Pilomatricoma / 대한피부과학회지

Pilomattiaoma, aften called calcifying epithelioma of Malherbe, is a benign tumor originating from the outer root sheath cell of the hair follicle and extending into the hair matrix, Pilomatricoma usually occurs as a single, asymptomatic dermal or subcutaneous nodule. Multiple lesions are quite unueuel, comprising only 2-3.5% of cases. We report two patients with multiple pilomatricoma.

Two Cases of Bullous Pemphigoid Showing the Characteristics of Herpes Gestationis Autoantibodies / 대한피부과학회지

Bullous pemphigoid(BP) and herpes gestationis(HG) are subepidermal bullous diseases which show clinical and immunological similarities. Both diseases show immune deposits along the basement membrane zone and their autoantibodies bind a common antigenic site within the non-collagenous stretch of the 180 kDa BPAG2 ectodomain. Besides its association with pregnancy, HG has some characteristic features that distinguish it from BP. The serum of patients with HG often contains an IgG that avidly fixes complement, and showes IgG1 subclass predominance. We report here two cases of non-pregnant young women presenting clinical and histological features of bullous pemphigoid or herpes gestationis. The immunopathology, IgG subtyping and immunoblotting studies showed that the autoantibodies in the patients were the characteristic ones of herpes gestationis. The patients might be a subtype of BP that have characteristics of autoantibodies of HG patients.

Antineutrophil Cytoplasmic Antibodies (ANCA) in Patients with Behcet's Disease / 대한피부과학회지

BACKGROUND: Antineutrophil cytoplasmic antibodies(ANCA) are autoantibodies against cytoplasmic constituents of neutrophils, and have been detected in patients with idiopathic necrotizing glomerulonephritis, crescenteric glomerulonephritis, Wegener's granulomatosis, and polyarteritis nodosa. The induction of ANCA may result in neutrophil mediated vascular injury. In Behest's disease mucosal and cutaneous lesions are often characterized by small vessel vasculitis. So the endothelial cell damage probably mediated by polymorphonuclear leukocytes has been regarded as an important pathophysiological mechanism in the disease. However, the literature has not showed the presence of ANCA in the disease, and it has been generally accepted that ANCA cannot be incriminated as a contributing factor to the abnormalities of neutrophils in Behcet's disease. OBJECTIVE: We examined the presence of ANCA in sera of 7 patients with Behest's disease. METHOD: We examined clinical and laboratory findings of 61 patients with Behest's disease, who also had cutaneous manifestations due to vascular disorders. ANCA were demonstrated in the sera of the patients by the indirect immunofluorescence method. RESULT: We found ANCA in the sera of 7 patients with complete or incomplete types of Behcet's disease. CONCLUSION: We do not yet know the meanings of the ANCA that were detected in Behest's disease. Moreover, we cannot retort against previous reports showing that ANCA were meaningless in Behest's disease in the aspects of pathophysiology. However, it is clear that ANCA can be detected in patients with Behcet's disease, so it is necessary to investigate more about ANCA in Behest's disease.

Scanning Electron Microscopic Examination of Dermatophytes / 대한의진균학회지

BACKGROUND: It is important to understand the morphologic characteristics for the identification of a microorganism. Electron microscopy has contributed a great deal to the field of mycology. Scanning electron microscope (SEM) has become a useful tool to study three-dimensional images of fungi. Vacuum dessicator aqueous fixation is a useful sample preparation technique for SEM examination of fungal specimens without surFace distortions. OBJECTIVE: This study was done to observe the three-dimensional structures of dermatophytes preserving their natural growth characteristics. METHODS: Trichophyton rubrum, T. mentagrophytes, Microsporum canis, M. gypseum, and Epidermophyton floccosum were isolated and cultured on Sabourd agar, corn meal agar, or rice agar plate. Vacuum dessicator aqueous fixation was utilized as p preparation technique for SEM examinations of fungi. RESULTS: Vacuum dessicator aqueous fixation led us to examine the aerial mycelia including conidia of the dermatophytes under SEM. The five species of dermatophytes showed their own characteristic structures especially on microconidia and macroconidia. CONCLUSION: The use of ultrastructural research has made it possible to identify the species of fungi and can be expanded and improved along with the development of SEM and specimen preparation techniques.

Epidemiological and clinical features of Behcet's disease in Korea

Behcet's disease occurs with a high prevalence in the Far East including Korea. In this report we inspected 1,155 patients with Behcet's disease and collected information concerning the clinical and epidemiologic features of Behcet's disease in Korea. In summary, patients in their 30s were the most common, with the most common age of onset in the 20s; the sex ratio was 0.63:1 with female predominance; according to revised Shimizu's classification, the order of frequency of the different types was incomplete (38.2%), suspected (25.4%), possible (20.3%) and complete (16.1%); oral ulcers were the most frequent major symptom (97.5%) and the most common initial symptom (78.5%); erythema nodosum-like lesion (55.3%) was the most common type of skin lesion; a seasonal aggravation of the disease was observed in 21.3% of patients; and the most common type of childhood onset Behcet's disease was suspected type.

Pedunculated Lipofibroma

A 45-year-old woman had a bean-sized, asymptomatic, soft nodule on the right buttock for 4 years. Histopafhologic evaluation revealed acanthosis and a central core of adipose tissue with thin papillary and reticular dermis containing eccrine glands. Staining with alcian blue showed a slight increase of mucopolysaccharides in the reticular dermis. We made the diagnosis of pedunculated lipofibroma as a solitary form of nevus lipomatosus superficialis.