Transition from Pemphigus Foliaceus to Pemphigus Vulgaris: Case Report with Literature Review

The transition between the main subtypes of pemphigus, pemphigus vulgaris (PV), and pemphigus foliaceus (PF) has rarely been reported. Moreover, the development of PV in a patient with PF is much more unusual than that of PF in a patient with PV. We report a 48-year-old man who presented with cutaneous lesions showing the typical clinical and histological features of PF. Five years later, his skin lesions became extensive and he developed oral erosions. His condition did not respond well to steroids and azathioprine. Histological examination of a vesicle disclosed suprabasal acantholysis in contrast to the subcorneal acantholysis discovered upon initial histological evaluation. Indirect immunofluorescence revealed IgG antikeratinocyte cell surface antibodies at a titer of 1:640. The titer was 1:160 at initial diagnosis. Upon immunoblotting, the patient's serum reacted with 130 kiloDalton (kDa) and 160 kDa proteins, suggesting desmoglein (Dsg) 3 and 1, respectively. We herein report an unusual case of PV that developed from PF during the disease's flare-up.

A Case of Dengue Fever / 대한피부과학회지

Dengue fever is caused by the dengue virus which belongs to the flaviviridae family and is transmitted by mosquitos. It occurs in the tropical climates of central and south america, asia, and africa and is considered one of the most important arthropod-borne viral diseases as regards morbidity and mortality, especially due to its hemorrhagic forms, dengue hemorrhagic fever and dengue shock syndrome. We report a case of dengue fever which presented with typical systemic symptoms and signs such as fever, headache, nausea and characteristic erythroderma (white islands in a sea of red) on travelling Bangladesh.

The Incidence of the Expression of Epstein-Barr Virus in Lymphomatoid Papulosis and Cutaneous CD30+ Anaplastic Large Cell Lymphoma in Korea / 대한피부과학회지

No abstract available.

Cutaneous Metastasis of Choriocarcinoma: A Case Report

Choriocarcinoma is one of the malignant tumors of trophoblastic cells characterized by the secretion of human chorionic gonadotrophin (hCG) (1-3). Cutaneous metastasis is a rare presentation of choriocarcinoma but a poor prognostic sign because it is associated only with widespread disease (3-5). A 52-yr-old female complaining of dyspnea for 2 months, presented with fingertip sized erythematous nodules on the left side of the neck and the right side of the upper back of 1 month duraton. She has suffered from Behcet's disease since 1999. Microscopic examination of a nodule of upper back demonstrated biphasic pattern of cytotrophoblasts and hCG-positive syncytiotrophoblasts, and the typical histologic features of choriocarcinoma. She was referred to the gynecological oncology department. After 17 cycles of combination chemotherapy, the serum hCG level has fallen from 700,000 to under 2.0 mIU/mL and the skin lesions have almost disappeared. However, after 3 months, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed due to elevated serum hCG level (4,447.7 mIU/mL), and she is scheduled to receive post-operative adjuvant chemotherapy.

Antinuclear Antibodies in Patients with Behcet's Disease / 대한피부과학회지

BACKGROUND: Behcet's disease has features consistent with an immunopathogenic mechanism, but the autoreactivity in pathogenesis is unclear. OBJECTIVE: This study was to investigate the association of antinuclear antibodies (ANA) with Behcet's disease. METHODS: The patients in this study were diagnosed at Severance Hospital Behcet's Disease Specialty Clinic from May, 1998 to May, 2002. We evaluated the frequency, titers and immunofluorescence patterns of ANA in patients with Behcet's disease, and compared the frequency with a healthy control group. According to the positivity of ANA, we compared the frequency of minor symptoms to investigate the association of the severity of disease with ANA. RESULTS: 1. Of the 554 cases of Behcet's disease, 46 cases (8.3%) were ANA positive, however, of the 271 cases of healthy control group, only 5 cases (1.8%) were ANA positive. (p=0.0003) 2. In ANA titers 38 cases (82.6%) showed low titer (1: 40+, 1: 160-), 5 cases (10.9%) intermediate titer (1: 160+, 1: 640-), and 3 cases high titer (>1: 640+). There was no significant difference in intermediate and high titers between complete (17.9%) and incomplete type (14.3%). 3. In immunofluorescence patterns of ANA, 17 cases (37%) were speckled pattern, 5 cases (10.9%) homogeneous pattern, 3 cases (6.5%) centromere pattern, 2 cases (4.3%) nucleolar pattern and 19 cases (41.3%) unknown pattern. 4. Of 508 cases with negative ANA patients, 272 cases (53.5%) had minor symptoms, however, of 46 cases with positive ANA patients, 14 cases (30.4%) had minor symptoms (p=0.0027). CONCLUSION: From this study ANA was more prevalent in Behcet's disease. However, it was not related to severity of disease and most of them were low titer. ANA, herein, might play a minor role in pathogenesis of Behcet's disease.

Therapeutic Effects of Narrow-band UVB Phototherapy in the Treatment of Vitiligo / 대한피부과학회지

BACKGROUND: Recently, narrow-band UVB phototherapy is introduced for vitiligo treatment. It is easier to be applicable because of no need for topical and/or systemic photosensitizers, and comparably or more effective than PUVA without systemic side effects. Moreover, it is more safely applicable to children and pregnant women. However, to date, there is not so large series of clinical reports about its use in vitiligo treatment as to evaluate therapeutic effects. OBJECTIVE: This study was to evaluate the effects of narrow-band UVB phototherapy for vitiligo in various aspects of clinical parameters. METHODS: Treatment of patients in this study with narrow-band UVB was started between November 2001 and November 2002. Narrow-band UVB phototherapy was given as monotherapy once or twice a week. The starting dose was 280-300mJ/cm2, with dose increments at each subsequent treatment. RESULTS: 78 patients were able to be evaluated in this study. Their ages ranged from 3 to 67 years (mean, 33.7 years). 69 patients had Fitzpatrick skin type IV, 5 had skin type III and 4 had skin type V. 36 of the 78 patients (46.2%) achieved more than 75% repigmentation (grade 4). The better repigmentation grade, the shorter vitiligo duration (p=0.0464). Compared with other sites, lesions on the hands and feet showed poorer improvement(grade 1: 10/13 and 4/4 respectively, p= 0.0015). Adverse effects were limited and transient. CONCLUSION: Narrow-band UVB therapy is an effective and safe therapy for vitiligo. Long-term adverse and therapeutic effects compared to other treatment modalities remain to be determined.

Halo Dermatitis Around a Compound Nevus / 대한피부과학회지

Halo dermatitis was first described as a halo-shaped eczematous change around a nevocellular nevus. However, other cases developed around various kinds of lesions including seborrheic keratosis or lentigo were reported later on, so it is now considered not to be specific for melanocytes or nevus cells. It has never been reported to be associated with regression of central lesion, in contrast to halo nevus. We report a case of halo dermatitis developed around a compound nevus in a 20-year-old male patient. On histopathologic examination, the central lesion was a compound nevus and the surrounding lesion was consistent with chronic eczematous dermatitis.

A Case of Majocchi's Granuloma in a Renal Transplant Recipient / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism usually associated with Majocchi's granuloma is Trichophyton rubrum, however, other dermatophytes may be the causative agent. We presented a 29-year-old female, who underwent kidney transplantation for end stage renal disease 3 years earlier, had an erythematous nodule on her left lower leg for 6 months. Histology showed suppurative granulomatous inflammatory cellular infiltrates in the dermis. Many septate hyphae were noted within the granulomatous tissue stained with PAS. A fungal culture from biopsy specimen revealed T. rubrum. The cutaneous lesion treated with terbinafine 250 mg daily and 10 weeks later, there was a marked improvement in the lesion.