Clinicopathologic Study of 37 Cases of Xanthelasma Palpebrarum; Clinical Significance of Xanthelasma Palpebrarum in Hyperlipidemiae and Cardiovascular Diseases / 대한피부과학회지

BACKGROUND: Xanthelasma palpebrarum is the most common cutaneous xanthoma. Although xanthelasma is a type of xanthoma, a half of patients in most series are known to be normolipemic. OBJECTIVE: This study is an attempt to elucidate the clinical and pathologic features of xanthelasma in Korea and to know the clinical significance of xanthelasma, especially suggested role as a marker for hyperlipidemiae and increased risk for cardiovascular diseases. METHOD: Thirty seven cases of xanthelasma were clinially and pathologically analyzed. Incidence of abnomal lipid profiles and cardivascular diseases were compared with those of control group using logistic regression statistics. RESULTS: 1. The incidence of xanthelasma was 0.09% of the total number of dermatologic patients. 2. The ratio between male and female was 1: 1.8 and the mean age was 52.4 years (range;17-71 years). 3. Clinically, it typically presented as yellow or orange papules on the inner canthus of both upper eyelids. 4. The incidences of abnormal lipid profiles(hyperlipidemia and dyslipoproteinemia) are 42.4-44.0%. The levels of total cholesterol and low density lipoprotein-cholesterol were increased significantly. The incidence of the cardiovascular diseases was 16.2%, which was not statistically different from that of control group. 5. Histopathologic findings of 23 cases showed masses of foam cells in the upper dermis accompanied with sparse inflammatory cells and few giant cells. CONCLUSION: Xanthelasma seems to help to identify persons with abnormal lipid profiles which are risk factors of cardiovascular diseases and we recommand examination of lipid profiles in patients with xanthelasma.

Two cases of Cutaneous Larva Migrans / 대한피부과학회지

Cutaneous larva migrans(CLM) is a creeping cutaneous eruption that results from skin invasion by the larval form of nematodes. We experienced two patients who had typical clinical findings of CLM. One patient had a history of contact with possibly contaminated fertilizer by the larva of nematotes. The other had a history of travelling to the endemic tropical areas. We report herein two cases of CLM with the literature review of the previous CLM cases in Korea.

Two Cases of Acquired Fibrokeratoma Occuring on the Prepatellar Area and the Nail Bed / 대한피부과학회지

Aquired fibrokeratoma is a rare, benign tumor which occurs most frequently on the fingers. Because of the digital predilection, a term of digital fibrokeratoma has been frequently used. We present here two cases of acquired fibrokeratoma occurring on the prepatellar area and the proximal nail bed which are unusual sites of this lesion. A skin-colored, hyperkeratotic tumor with finger-like projection was found on the prepatellar area of a 29-year-old man and a round pedunculated nodule was found on the proximal nail bed of second finger of a 74-year-old woman. Histopathologic examination revealed typical features of acquired fibrokeratoma.

A Case of Mucormycosis Involving the Skin in Renal Transplant Recipient / 대한피부과학회지

Mucormycosis is a rare and opportunistic infection usually associated with hematologic diseases, diabetes mellitus, renal failure, solid tumors, and organ transplantations. We present here a considered case of disseminated mucormycosis in renal transplant recipient. A 60-year-old man who had undergone second kidney transplantation for a month visited emergency room due to 5 day history of cough with spiking fever and abnormal mental status and vital signs were rapidly deteriorated. Septic shock was suspicious. He was admitted to ICU and treated with broad spectrum antibiotics and antiviral agents, but there was no improvement. A few days later, several large hemorrhagic blisters and purpura occurred on the face, trunk, and both lower extremities. The histopathologic examination from skin specimen revealed large, broad, nonseptate hyphae branched at right angles in the dermis and blood vessels, which was consistent with mucormycosis. But the skin culture for fungus was negative. He had had no skin trauma history and evidence. So we considered the disseminated mucormycosis from unknown primary origin. He died of progressive respiratory failure before antifungal treatment.

A Case of Chilblain Lupus Erythematosus / 대한피부과학회지

Chilblain lupus erythematsus is a rare special subtype of chronic cutaneous lupus erythematosus characterized erythematous acral skin lesion induced by cold, damp climate. Approximately, only 20% of the patients presenting with chilblain lupus erythematosus later develop systemic lupus erythematosus(SLE). We present here a case of chilblain lupus erythematosus, associated with a development of SLE later. A 29-year-old female patient has had violaceous and erythematous papules on the ear, dorsal hands and finger tips for 10 years and these lesions have been aggravated by winter. She has been diagnosed as a suspicious SLE for 3 years and then was treated with oral prednisolone and hydroxychloroqine.

A Case of Clear Cell Sarcoma Developing Early Systemic Metastasis / 대한피부과학회지

Clear cell sarcoma is a rare malignant soft tissue neoplasm with unknown oringin. It is slow growing tumor , but uncommonly, it shows rapidly progressive course. In Korea, there has been rare case of clear cell sarcoma, especially with systemic metastasis. We herein present a case of clear cell sarcoma rapidly progressing with systemic metastasis. She had a deep seated nodule on left heel and inguinal and abdominal lymphadenopathy at the initial presentation. While chemotherapy, acute renal failure occurred and it was suspicious from abdominal ultrasono that both kidneys were invaded with clear cell sarcoma. She died with repiratory failure.

A Case of Bilateral Mondor's Disease / 대한피부과학회지

Mondor's disease is an uncommon superficial thrombophlebitis, usually of thracoabdominal wall. The exact cause is unclear, but it is suggested that the trauma, strenous exercise, breast surgery are often associated. Clinically, it is characterized by a palpable, tender, linear cutaneous groove and it is always almost unilateral. We report a case of bilateral Mondor's disease. 49 year old female presented a cord like subcutaneous lesion on right thoracoabdomial wall. She had a history of strenous exercise for several weeks. Histologic exam reveals thrombophlebitis. A week later, the patient had another same linear subcutaeous lesion on left abdomen.

A Comparative Study between Adolescent Acne and Post-adolescent Acne

BACKGROUND: The prevalence of patients over the age of 25 years with acne has significantly increased over the past 10 years. Several etiologic factors such as genetic factor, hyperandrogenism, stress, and cosmetics have been studied. OBJECTIVES: The purpose of this study is to evaluate the differences between adolescent acne and post-adolescent acne, based on the clinical features, asoociated diseased and aggravating factors of 327 acne patients. METHODS: 327 consective patients, first visited to our hospital with clinical facial acne between March 2000 and February 2001, were enrolled. 220 adolescent patients(AP) were under the age of 25 and post-adolescent patients(PP) were over age of 25. RESULTS: 1. In the face, cheeks and forehead in adolescents, chin and cheeks in post-adolescents were predilection sites. The predominant type was a comedonal type in adolescents and a papulopustular type in post-adolescents(P<0.05). Severity of inflammatory type was not different between two groups. Familial factors were important in both groups, but more frequently found in post-adolescents with persistent acne(P<0.05). 2. Rosacea, chloasma, and hyperandrogenic features such as hirsutism and androgenetic alopecia were more frequently observed in post-adolescents. Seborrheic and atopic dermatitis were more frequent in adolescents. Four patients had all the features of chloasma, acne, rosacea, seborrheic dermatitis and hirsutism. 3. Aggravation by weason especially summer, sweating, stress, and cosmetics was more frequent in adolescents. In PP, acne was more frequently aggravated by sunlight, foods and menstrual period. CONCLUSION: Post-adolescent acne was mainly a papulopustular type predominantly located on the chin and cheeks with mild to moderated severity, and family history and hyperandrogenism were strong etiologic factors in persistent acne. Aggravating factors were not significantly different between two group, which suggested cosmetics and stress might not be important in post adolescent acne.

A Case of Granuloma Faciale Showing Unusual Histopathological findings

Granuloma faciale is an uncommon localized form of small-vessel vasculitis characterized by single or multiple lesions on the face in middle-aged whites, especially males. Histopathological examination demonstrates a dense polymorphous cellular infiltrate consisting of neutrophils, eosinophils, lymphocytes and histiocytes in the upper two thirds of the dermis. A characteristic subepidermal Grenz zone separates the infiltrate from the epidermis. We report a case of granuloma faciale, showing interesting evidence of palisaded granuloma-like pattern in the serial biopsy specimen at 3-year interval.

Lichen Sclerosus et Atrophicus of the Face / 대한피부과학회지

Lichen sclerosus et atrophicus is a benign, chronic inflammatory dermatosis with multifactorial origin. It is most common in the vulvar and perianal areas, but it may involve any other area, rarely face, oral mucosa, and palm and sole. Especially, lichen sclerosus et atrophicus on face is more difficult in diagnosis due to atypical location and may be confused with morphea, discoid lupus erythematosus, vitiligo, and atophic scar. We, herein, present a case of facial lichen sclerosus et atrophicus with central brownish atrophic change in a 21-year-old man. The lesion showed atypical clinical feature and unusual location. But histologic examination revealed typical features of lichen sclerosus et atrophicus.

Clinicopathological study of 30 Cases of Cutaneous Mastocytosis / 대한피부과학회지

BACKGROUND: Mastocytosis is characterized by accumulation of mast cells in various organs, most frequently, in skin. Cutaneous mastocytosis is a relatively rare disease in outpatient clinics and the clinicopathological study has not been done yet in Korea. OBJECTIVE: The aim of this study is to analyze the clinicopathological features of cutaneous mastocytosis. In addition, we examined CD117 expression in the skin biopsy specimens immuno histochemically. METHODS: Thirty cases of cutaneous mastocytosis were collected from 1990 to 1999 in Asan Medical Center. Clinical records, photographs, and biopsy slides were reviewed. In each biopsy specimen, CD117 was stained by immunoperoxidase method. RESULTS: Among 30 cases, 29 cases were childhood type urticaria pigmentosa(76.7%) or masto cytoma(20.0%) and only 1 case occurred after 16 years of age. The incidence showed a peak under 1 year old (70.0%) and males affected 2.3 times as much as females. The trunk and distal extremities are the most common site of urticaria pigmentosa and mastocytoma, respectively. CD117 was strongly positive in all cases of urticaria pigmentosa (both child and adult type) and mastocytoma. CONCLUSION: Urticaria pigmentosa of infantile onset was the most common, followed by infantile mastocytoma. Systemic reactive manifestations are rare in cutaneous mastocytosis. The strong expression of CD117 was seen regardless of the type of cutaneous mastocytosis.

The Effect of High-Dose Intravenous Immunoglobulin for the Treatment of Toxic Epidermal Necrolysis / 대한피부과학회지

BACKGROUND: Toxic epidermal necrolysis(TEN) is the most dramatic and life-threatening cutaneous drug reaction. However, specific and effective treatment for TEN have not yet been identified. Recently several reports suggested that high dose intravenous immunoglobulin(IV Ig) treatment has produced good results in patients with TEN. OBJECTIVE: To analyze the efficacy and side effects of IV Ig in treatement of TEN. METHODS: Ten patients with clinicopathological diagnosis of TEN were treated with IV Ig(1.6-3.4g/kg), and clinical efficacy and side effects were observed. RESULTS: Nine patients were healed and one died of sepsis. Interruption of further epidermal detachment occurred after an average 3 days from the onset of IV Ig therapy. Complete wound healing occurred after an average of 14.3 days. The side effects of IV Ig including headache, myalgia, nausea, transient neutropenia, and coombs positive hemolytic anemia were observed in 4 patients but normalized after cessation of IV Ig therapy. Three of them showed complete healing of detached skin but died with aggravation of underlying disease. CONCLUSION: IV Ig therapy represents a safe and very effective treatment for TEN. Furthermore, intensive care for underlying diseases is also very important for reducing the mortality rate in patients with TEN.

A Case of Tinea Incognito Presented as Folliculitis / 대한피부과학회지

Tinea incognito has been used to describe a dermatophyte infection modified by topical or systemic corticosteroid treatment. Lesions are often atypical appearing and the diagnosis is frequently delayed or missed even though by skilled dermatologists. We present here a 70-year-old female patient who had been treated with topical steroid ointment for the erythematous papules on the face and scalp under the diagnosis of contact dermatitis. Initially the lesions were regarded as a folliculitis, but a potassium hydroxide (KOH) preparation showed many fungal hyphae. A fungal culture grew Trichophyton rubrum.

Invasive Aspergillosis with Skin and Thyroid Gland Involvement / 대한피부과학회지

Invasive aspergillosis is the second most prevalent opportunistic mycosis and usually occurs in the immunocompromised patients. The most common involved organs are the lung, brain, heart, kidney, thyroid gland, intestinal organ, and skin in descending order. Among them, thyroid gland involvement is not so common, and clinical appearances of hyperthyroidism or hypothyroidism are also rare. We present a case of invasive aspergillosis with skin and thyroid gland involvement in a patient with renal transplantation, who had symptoms of hyperthyroidism and elevated T4 level.