ABSTRACT
Cytomegalovirus (CMV) infection is common among immunocompromised hosts; however, its cutaneous manifestation is considered rare in comparison to internal organ involvement. Clinical manifestations of cutaneous CMV infection generally include perioral or perianal ulcerations. On the other hand, autoimmune bullous dermatosis can have bullae and ulcerations similar to those caused by cutaneous CMV infection. Autoimmune bullous dermatosis requires treatment with immunosuppressive agents for relatively long periods, which may cause reduction of immunocompetence. Because of this iatrogenic immunosuppression, patients with autoimmune bullous dermatosis subsequently acquire increased risk for opportunistic infections. However, cases of bullous pemphigoid (BP) complicated by cutaneous CMV infection are rarely reported. Herein, we report the case of an 88-year-old male who had BP and subsequently recalcitrant perianal skin lesions, which were eventually diagnosed as cutaneous CMV infections.
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Background@#Patients with skin barrier dysfunction often coincides with pruritus, creating a ‘vicious cycle’ of dry skin and itching. Recently, Cynanchum atratum (CA) extract and its constituents have demonstrated effects on atopic dermatitis both in vivo and in vitro. @*Objective@#This study aimed to assess the safety and efficacy of a moisturizer infused with CA extract in enhancing epidermal barrier function and reducing pruritus. @*Methods@#A total 36 participants with skin barrier dysfunction with pruritus (mean age: 46.22±12.48 years) applied the CA-containing moisturizer topically twice daily for up to 4 weeks. Treatment efficacy was assessed by the investigator using the erythema scaling induration fissuring (ESIF) scale, transepidermal water loss (TEWL), skin hydration, visual analogue scale (VAS) for pruritus, and overall patient satisfaction assessed via questionnaire. @*Results@#The CA-containing moisturizer demonstrated favorable tolerability, and yielded significant pruritus relief as evidenced by VAS scores after 2 and 4 weeks of application (p＜0.05). Significant decreases in TEWL (p＜0.05) and skin hydration (p＜0.05) were observed after 2 and 4 weeks, indicating enhanced skin barrier function. Moreover, significant relief from pruritus and reductions in ESIF were observed at 2 and 4 weeks of application (p ＜0.05), aligning with the high levels of patient satisfaction was high. @*Conclusion@#The CA-infused moisturizer emerged as a safe and effective intervention for restoring skin barrier function and providing itch relief.
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Background@#Discoid lupus erythematosus (DLE) with alopecia of the scalp can result in permanent hair loss. Therefore, it is important to evaluate skin lesions and establish appropriate treatment plans for scalp DLE with alopecia. @*Objective@#We aimed to investigate the dermoscopic features of scalp DLE with alopecia and to determine the correlation between dermoscopic findings and treatment efficacy. @*Methods@#Thirty-one patients histopathologically diagnosed with scalp DLE and alopecia were included. We reviewed clinical photographs and dermoscopic findings of the patients and evaluated their treatment responses. @*Results@#The most frequent dermoscopic features of DLE with alopecia were follicular keratotic plugs (96.8%), white scales (71.0%), telangiectatic vessels (67.7%), and pigmentation (64.5%); followed by absent follicular openings (48.4%), white structureless areas (35.5%), follicular red dots (16.1%), and perifollicular whitish halo (12.9%). After at least 6 months of treatment, hair regrowth was observed in 22 patients (71.0%). Dermoscopic findings showed that white structureless areas, perifollicular whitish halo, absent follicular openings (especially when the alopecic patch involved ＞25% of the scalp), and moderate to severe telangiectatic vessels were associated with absence of hair regrowth. @*Conclusion@#Dermoscopy is a promising tool for evaluating lesions and predicting therapeutic outcomes in scalp DLE with alopecia. It may contribute to the establishment of appropriate treatment plan by determining whether hair loss is reversible.
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Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by multiple nodules and papules, which are accompanied by intense pruritus. Treatment is challenging and requires a diverse approach. Recently, a few reports have described successful treatment of PN with dupilumab. We report a case of a patient with treatment-resistant PN who was successfully treated with dupilumab. Dupilumab was administered at the standard dose: an initial induction dose of 600 mg, followed by 300 mg every 14 days. Pruritus reduced after 2 weeks and almost completely disappeared after 4 weeks of treatment.
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Intralymphatic histiocytosis (ILH) is a rare cutaneous condition with uncertain pathogenesis. It is characterized by dilated lymphatic vessels that contain histiocytes within their lumina. Although the etiology of ILH remains unknown, it has been associated with various inflammatory and neoplastic diseases, such as rheumatoid arthritis (RA), reaction to metal joint implants and Merkel cell carcinoma, breast cancer and colon cancer. An 83-year-old female presented with an erythematous patch on the left forearm that had appeared six months previous. She had suffered from osteoarthritis (OA) and the cutaneous lesion was located in the vicinity of the affected joint. Skin biopsy from the lesion showed dilated dermal vessels and some ectatic vessels that contained many mononuclear histiocytes. Based on the clinical and histopathological findings, we diagnosed her with ILH with OA. Two sessions of intralesional triamcinolone acetonide injection (5 mg/ml) were administered to treat the skin lesion, which gradually improved over a period of a few months. We here report a rare case of ILH associated with degenerative OA.
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Background@#A direct potassium hydroxide (KOH) smear is used to diagnose onychomycosis despite its broad sensitivity range. For a more accurate diagnosis, histopathologic examination can be used and consistently show high sensitivity. @*Objective@#We investigated the value of histopathologic examination of the nail plate as a diagnostic tool for onychomycosis. We proposed effective routine diagnostic staining to compare sensitivity between periodic acid-Schiff (PAS) and Gomori’s methenamine silver (GMS) staining. @*Methods@#This retrospective study was conducted from January 1, 2019 to May 31, 2020, and included 97 patients who showed negative results on direct KOH smear but had clinical manifestations that implied onychomycosis. We performed nail plate biopsy and PAS or GMS staining to identify fungal hyphae missed in the direct KOH smear. Sensitivity comparison between PAS and GMS was performed in co-stained samples. @*Results@#Among 97 patients with 102 cases, 55 cases (53.9%) of onychomycosis were confirmed by histopathologic examination. A total of 68 patients (70.1%) had a previous medical history of antifungal agents within previous six months. PAS and GMS staining were concurrently performed in 73 cases, and onychomycosis was confirmed in 41 cases. The sensitivity of PAS was 100% (41/41), while that of GMS was 87.8% (36/41); this difference was not significant. @*Conclusion@#This study suggests that histologic examination of the nail plate is an effective tool to diagnose onychomycosis and can be performed with a direct KOH smear. Two staining methods, PAS and GMS, are recommended for concurrent performance to enhance the identification of fungal hyphae.
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Background@#A direct potassium hydroxide (KOH) smear is used to diagnose onychomycosis despite its broad sensitivity range. For a more accurate diagnosis, histopathologic examination can be used and consistently show high sensitivity. @*Objective@#We investigated the value of histopathologic examination of the nail plate as a diagnostic tool for onychomycosis. We proposed effective routine diagnostic staining to compare sensitivity between periodic acid-Schiff (PAS) and Gomori’s methenamine silver (GMS) staining. @*Methods@#This retrospective study was conducted from January 1, 2019 to May 31, 2020, and included 97 patients who showed negative results on direct KOH smear but had clinical manifestations that implied onychomycosis. We performed nail plate biopsy and PAS or GMS staining to identify fungal hyphae missed in the direct KOH smear. Sensitivity comparison between PAS and GMS was performed in co-stained samples. @*Results@#Among 97 patients with 102 cases, 55 cases (53.9%) of onychomycosis were confirmed by histopathologic examination. A total of 68 patients (70.1%) had a previous medical history of antifungal agents within previous six months. PAS and GMS staining were concurrently performed in 73 cases, and onychomycosis was confirmed in 41 cases. The sensitivity of PAS was 100% (41/41), while that of GMS was 87.8% (36/41); this difference was not significant. @*Conclusion@#This study suggests that histologic examination of the nail plate is an effective tool to diagnose onychomycosis and can be performed with a direct KOH smear. Two staining methods, PAS and GMS, are recommended for concurrent performance to enhance the identification of fungal hyphae.
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Pilomatricoma, also known as calcifying epithelioma of Malherbe, is a benign adnexal skin tumor arising from hair matrix cells. Clinically, pilomatricoma typically presents as a firm, bluish or red colored, deep-seated nodule with overlying normal skin. Several variants of pilomatricoma have been described including perforating, extruding, bullous, melanocytic, giant, keratoacanthoma-like, exophytic, lymphangiectatic, familial, anetodermic, and multiple. Among these, an extruding variant has been very rarely reported. A 10-year-old girl presented with a 2-month history of a rapid-growing, solitary, firm, skin-colored to pinkish, pedunculated papule with a central crusted perforation on the left cheek. Based on the clinical and histological findings, we made a diagnosis of exophytic pilomatricoma with perforating figure. She had no signs of recurrence of the lesion for 8 months after removal.
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Fibrofolliculoma is a benign perifollicular connective tissue tumor that usually occurs in the face. Most fibrofolliculoma present as multiple lesions and typically occur with trichodiscomas and acrochordons, constituting the Birt-Hogg-Dube syndrome. Solitary fibrofolliculoma is nonhereditary and unassociated with other cutaneous abnormalities. A 72-year-old man visited our clinic complaining of a solitary umbilicated nodule on the antitragus of the left ear. Skin biopsy from the lesion showed a central dilated follicular infundibulum with anastomosing bands of follicular epithelium extending into the fibrous stroma. The diagnosis of a solitary fibrofolliculoma was made based on the clinical and histopathological findings. No signs of lesion recurrence for 1 year after shave removal were noted. We report a rare case of solitary fibrofolliculoma that occurred on the antitragus of the ear.
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Background/Aims@#Recent studies have shown a cumulative dose-dependent association between the use of hydrochlorothiazide (HCTZ) and skin cancer, including melanoma and non-melanoma skin cancer (NMSC) in Western Europe. However, whether this pattern is present in East Asia countries is unknown. The aim of this study was to examine the association between HCTZ use and the risk of skin cancer among a cohort of hypertensive patients in South Korea. @*Methods@#This was a retrospective, population-based cohort study using the database from the Health Insurance Review and Assessment Service between January 1, 2007 and June 30, 2017 in South Korea. We identified patients diagnosed with melanoma and NMSC in the cohorts of essential hypertensive patients who were treated with HCTZ or antihypertensive agents other than HCTZ. Using Cox proportional hazards regression models, the hazard ratios (HR) for skin cancer associated with HCTZ users were calculated. @*Results@#The risk of melanoma was significantly lower in HCTZ-users compared with non-HCTZ users (HR, 0.85; 95% confidence interval [CI], 0.75 to 0.97; p = 0.016), and the risk of NMSC was lower in the HCTZ users but no statistically significant association was seen (HR, 0.96; 95% CI, 0.91 to 1.02; p = 0.236). High cumulative doses (≥ 50,000 mg) of HCTZ were associated with decreased risk of both NMSC (HR, 0.20; 95% CI, 0.10 to 0.38; p < 0.001) and melanoma (HR, 0.18; 95% CI, 0.04 to 0.70; p = 0.001), respectively. @*Conclusions@#High cumulative use of HCTZ may have a chemopreventive effect against the development of melanoma and NMSC with clear cumulative dose-response and duration-response relationships in South Korea.
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Background@#Acne is a chronic inflammatory disease of the pilosebaceous unit and usually affects adolescents when the peak concentrations of growth hormone, insulin-like growth factor 1, and androgen are demonstrated. The activity of alkaline phosphatase (ALP), which increases physiologically in growing children and adolescents, in the pilosebaceous unit has been reported. However, the correlation between the serum level of ALP and the number of acne lesions has not been studied. @*Objective@#The present cross-sectional study was designed to evaluate the correlation between serum level of ALP and the numbers of non-inflammatory and inflammatory acne lesions in children and adolescents. @*Methods@#For this study, 202 pediatric and adolescent patients clinically diagnosed with acne vulgaris were included. Age, sex, serum level of ALP, number of non-inflammatory acne lesions, number of inflammatory acne lesions, and number of total acne lesions were evaluated. Additionally, the serum level of dehydroepiandrosterone sulfate was evaluated in 117 patients. Multiple regression analysis was performed. Multicollinearity was quantified using the variance inflation factor. @*Results@#In the 202 patients, serum level of ALP was the only independent factor that significantly affected both the number of non-inflammatory acne lesions and of total acne lesions (regression coefficient=0.089 and 0.086, respectively, p＜ 0.001). @*Conclusion@#There was a significant correlation between serum level of ALP and the extent of acne (non-inflammatory acne lesions and total acne lesions).
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Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
ABSTRACT
Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.
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BACKGROUND: Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that alitretinoin is an effective and well-tolerated treatment for CHE. However, there is a relative lack of data on the effectiveness of alitretinoin in elderly patients. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of oral alitretinoin in elderly patients with moderate to severe CHE in Korea. METHODS: We retrospectively investigated 46 CHE patients who were treated with either 10 mg or 30 mg of alitretinoin between June of 2016 and July of 2018. The physician's global assessment (PGA) was used to evaluate treatment efficacy. All adverse events were retrospectively evaluated with respect to laboratory testing, including complete blood cell count, fasting blood chemistry, lipid profile, and liver and thyroid function tests. RESULTS: The mean patient age in this study was 71.0±5.1 years. The treatment period was over eight weeks. A total of 38 of 46 patients (82.6%) exhibited clinical improvement with PGA ratings of ‘clear’ or ‘almost clear.’ There were 13 patients (28.3%) who experienced an adverse effect, with the most common being headache (13.0%) and gastrointestinal symptoms (8.7%) followed by xerosis (6.5%). A total of 13 patients developed or exhibited worsening hypertriglyceridemia (28.3%). CONCLUSION: Alitretinoin can be considered a safe and effective treatment option in elderly patients with moderate to severe CHE.
Subject(s)
Aged , Humans , Blood Cell Count , Chemistry , Eczema , Fasting , Hand , Headache , Hypertriglyceridemia , Korea , Liver , Retrospective Studies , Thyroid Function Tests , Treatment OutcomeABSTRACT
BACKGROUND: The slide-swing skin flap is a combination of transposition and adjacent skin sliding and can be used to close large, round defects with a flap that is smaller than the primary defect to produce aesthetically good results. OBJECTIVE: To evaluate the efficacy and safety of the slide-swing skin flap for various surgical defects caused by skin tumor excisions. METHODS: This retrospective case series, which includes 33 Asian patients between the ages of 25 and 86 years, describes the slide-swing skin flap after primary excision for malignant or premalignant skin conditions. The outcomes were assessed 12 weeks after surgery using the patient and observer scar assessment scale (POSAS). RESULTS: Patients were 25 male and 8 female, and the causes of surgery were various malignant skin tumors including malignant melanoma, dermatofibrosarcoma protuberans, and malignant nodular hidradenoma. Tumors were on the lower limb in eleven patients, back in nine patients, chest in five patients, face in three patients, buttock in three patients and two patients had tumors in other locations. The mean defect size was 3.5×3.1±1.9×2.2 cm (range, 1.4×0.9~9.0×12.0 cm). The mean patient POSAS total score was 9.7±3.0 and mean patient overall opinion score was 1.8±0.7. The mean observer POSAS total score was 11.0±2.7 and mean observer overall opinion score was 1.9±0.5. All flaps survived and postoperative recoveries were uneventful. CONCLUSION: The slide-swing skin flap is highly versatile and can be used to cover various surgical defects, irrespective of size and location, with excellent functional and cosmetic results.
Subject(s)
Female , Humans , Male , Acrospiroma , Asian People , Buttocks , Cicatrix , Dermatofibrosarcoma , Lower Extremity , Melanoma , Retrospective Studies , Skin Neoplasms , Skin , Surgical Flaps , ThoraxABSTRACT
Parry Romberg Syndrome (PRS), also known as idiopathic progressive hemifacial atrophy, is a rare neurocutaneous disorder characterized by loss of skin and subcutaneous fat of face, muscles, and bones causing unilateral atrophy. Most patients require only soft tissue augmentation although syndrome has varying grades of severity. In the majority of reported cases, it has been treated with surgical flap or autologous fat transplantation. However, these treatments need complicated surgical skills which take a lot of time and cost. Herein we report the first case of PRS augmented by hyaluronic acid (HA) filler in a 42-year-old female patient to suggest that HA filler could be a safe, simple, and even rational economic alternative to surgical treatment.
Subject(s)
Adult , Female , Humans , Atrophy , Facial Hemiatrophy , Hyaluronic Acid , Muscles , Neurocutaneous Syndromes , Skin , Subcutaneous Fat , Surgical FlapsABSTRACT
Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis presenting as white papules and atrophic patches in the anogenital region. Extragenital LSA is rare and commonly affects the neck, thighs, and the trunk. A 68-year-old woman presented with a well-demarcated, whitish linear plaque on the forehead that was observed several months prior to presentation. A biopsy specimen showed hyperkeratosis and thinning of the epidermis and homogenization of collagen in the papillary dermis with a subepidermal cleft. Mild periappendageal lymphocytic infiltration and eccrine gland atrophy secondary to thickening of collagen bundles were observed in the deep dermis. Based on the clinical and histopathological findings, this patient was diagnosed with extragenital LSA and concomitant morphea along the Blaschko's lines.