An Unusual Case with Membranous Lipodystrophy in a Hypertensive Patient with Transepidermal Elimination

Membranous lipodystrophy represents a peculiar type of fat necrosis that is present in patients with various types of skin disease. It is characterized by the presence of microcysts and macrocysts and is lined by amorphous eosinophilic material with a crenelated arabesque appearance. These findings have been associated with lupus erythematosus, diabetes mellitus, erythema nodosum, trauma, etc. We report a case of a 43-year-old woman who had a red to purple asymptomatic indurated plaque, approximately seven cm in diameter and on the left arm. She was a chronic hepatitis B antigen carrier and had hypertension for four years. Histopathology of the biopsied lesion showed transepidermal elimination of altered collagen and elastic fibers, as well as membranous lipodystrophy changes. There were hypertensive vascular changes including lymphohistiocytic infiltration around the vascular wall, swelling of endothelial cells, increased thickness of the vascular walls, and narrowing of the lumen. We report a case showing transepidermal elimination with membranous lipodystrophy. We carefully suggest that the secondary phenomenon of transepidermal elimination was associated with membranous lipodystrophy and degenerate connective tissues.

A Case of the Sign of Leser-Trelat Associated with Bladder Cancer / 대한피부과학회지

The sign of Leser-Trelat refers to the sudden appearance and rapid increase in size and number of seborrheic keratosis. It is considered to be a sign of internal malignant tumors. A 60-year-old male who had received chemotherapy for bladder cancer showed multiple rice to bean-sized dark brownish papules on the scalp and trunk. Skin lesions had suddenly appeared 4 months ago, and he had been diagnosed with transitional cell carcinoma of bladder cancer. The lesions had rapidly increased in number and size. The histopathologic finding of the skin lesions revealed seborrheic keratosis.

The Clinical and Histopathological Study of Ota's Nevus / 대한피부과학회지

BACKGROUND: Ota's nevus, characterized by the presence of melanocytes in the dermis, has been familiar among dermatologists, but the etiology, the pathophysiology, the clinical and histological classification are not entirely clear. To understand and elucidate them, more clinical studies and researches are necessary. OBJECT: The aim of this study was to document the clinical and histopathological features of Ota's nevus. METHODS: We examined 299 patients with Ota's nevus who visited the dermatology clinic in Korea from February 1993 to August 2003. Among them, 188 patients were biopsied. All the specimens were stained with hematoxylin and eosin. We examined the age & sex distribution, age of onset, seasonal variation, associated skin diseases, aggravating factors and color. We clinically classified Ota's nevus into 4 types according to Tanino's classification and histologically into 5 types based on the pattern of pigmentation. RESULTS: 1. The ratio of male and female was 1: 3. 2. The peak age of onset was at birth (28.4%) and puberty (24.8%). 3. Seasonal variation was observed with distinct aggravation in the summer (60%). 4. The associated diseases were 9 cases of persistent mongolian spot, 6 cases of nevus flameus, 4 cases of blue nevus, 3 cases of vitiligo, 3 cases of nevus of Ito, 2 cases of atopic dermatitis, 2 cases of psoriasis, 2 cases of cafe au late macules and 2 cases of contact dermatitis. 5. The aggravating factors were sunlight (35.8%), emotional stress (21.0%), menstruation (12.6%), cold exposure (9.5%), pregnancy (9.5%), fatigue (9.5%) and chemical agents (2.1%). 6. The color of lesions were blue black (36.8%), brown (34.8%), dark brown (16.1%) and slate (11.0%). 7. All cases were classified according to Tanino's METHODS: type Ia (23.1%), type Ib (20.1%), type II (26.7%), type III (9.4%), type IV (20.7%). 8. The histological subtypes of Ota's nevus were classified as: the superficial type (35.6%); the middermis type (5.9%), the superficial-middermis type (18.6%); the mid-lower dermis type (2.7%); the diffuse type was composed of the superficial dominant type (19.7%), the middermis dominant type (4.8%), the dispersed (true diffuse) type (12.2%) and the deep dominant type (0.5%). 9. In the relation between histological types and the color of the lesion: the superficial type had 31 cases of brown color, 15 cases of blue black color, 11 cases of dark brown color and 9 cases of slate color; the middermis type had 6 cases of blue black color and 2 cases of dark brown color, query number of cases of slate color; the superficial-middermis type had 12 cases of blue black color, 10 cases of dark brown color, 7 cases of brown color and 6 cases of slate color: the mid-lower dermis type had 3 cases of blue black color; for the diffuse type, the superficial dominant type had 13 cases of brown color, query number of cases of blue black color and 7 cases of dark brown color; the mid-dermis dominant type had 4 cases of brown color, query number of cases of dark brown color, the dispersed type had 14 cases of blue black color and 5 cases of brown color; the deep dominant type had 1 case of blue black color. CONCLUSION: The histological reclassification of Ota's nevus may be very useful in making a therapeutic prognosis of the disease.

Two Cases of Inverted Wart / 대한피부과학회지

Human papilloma virus (HPV), an established causative organism of viral warts, has recently been isolated from several mucocutaneous tumors with different clinical features. HPV could also be found in epidermoid cysts and inverted plantar warts. We report two cases of inverted wart developed on the back and neck. The inverted wart in this report may represent a variant of viral warts in human.

Clinical and Histopathological Features in Inverted Follicular Keratosis / 대한피부과학회지

BACKGROUND: Inverted follicular keratosis has distinctive histopathological features and is infrequently encountered by dermatologists. To date, the pathogenesis of inverted follicular keratosis has not been elucidated. Many authors have suggested several theories for the nature of inverted follicular keratosis including verruca vulgaris with squamous eddies, irritated seborrheic keratosis and distinctive follicular tumors. There are no comprehensive studies about the clinical and histopathological features of inverted follicular keratosis in Korea. OBJECTIVE: The purpose of this study was to analyze the clinical features and histopathological findings of inverted follicular keratosis with literature review. METHODS: We studied 14 patients with inverted follicular keratosis for clinical features including the duration of the disease, the location and size of the lesions, the clinical impressions at the first visit and we made a record of the patients' age and sex, histopathological findings. RESULTS: Eight of the 14 patients were male and the ages ranged from 40 to 83 years(mean 59.3 years). The lesions were situated on the face(5/14), scalp(3/14), abdomen(2/14), hand(2/14), buttocks(1/14), shin(1/14). The average size of the lesions was 1.38cm. Seborrheic keratosis was the most common clinical diagnosis(6/14), followed by verruca vulgaris(4/14), cutaneous horn(1/14), melanoma(1/14), soft fibroma(1/14) and pigmented nevus(l/14). Solid and nodular types were the most common histopathological type(7/14), followed by keratoacanthoma-like type(5/14), filiform or wart like type(2/14). CONCLUSION: Inverted follicular keratosis have unusual clinical and histopathological features. We recommend that verrucous plaque lesions should be diagnosed correctly by histopathologic examination and it may be helpful to avoid inappropriate therapeutic approach.

Tactile-like Corpuscles and Fatty Cell Infiltration in Neurofibroma / 대한피부과학회지

Neurofibroma is one of the major benign nerve sheath tumor characterized by proliferation of Schwann cells, fibroblasts, perineural fibroblasts, and axons. It can be seen as a solitary lesion or in the context of neurofibromatosis. It has been occasionally reported that tactile-like corpuscle is found in neurofibroma and there is only one report about fatty change in neurofibroma. We present an unusual case of neurofibroma occurring in the occipital scalp of a 66-year-old woman, which has tactile-like corpuscles and fatty cell infiltration.

The Figural Character of the Palm Lines in Koreans / 대한피부과학회지

BACKGROUND: Three main elements make up the complete study of palmistry: chiromancy, chirognomy, and dermatoglyphics. Throughout the world, research on palmistry is continuing. Since the early 20th century, many medical researchers all over the world have been using dermatoglyphics to conduct tests and trials in many areas of medical research, with some of their findings published every so often. In contrast, developments in palmistry techniques using skin patterns have been rarely publicized, especially in Korea. OBJECTIVE: This study investigated the character of the palm lines of Koreans according to age. METHODS: This study involved 140 cases of healthy men and women. They were divided into seven groups according to age, with each group having 20 cases. Features of main lines (life line, head line, and heart line) were observed according to age. We classified the features of main lines into three types: type 1 (the feature that head line and life line start with one line), type 2 (the feature that head line and life line start with two separate lines), and simian crease. RESULTS: 1. The most prevalent type is type 1 (left palm-73.6%, right palm-77.1%), followed by type 2 (left palm-21.4%, right palm-19.37%). Simian crease was observed in 3.6 percent of the cases. 2. Characteristic past history could not be detected from the palm lines. 3. About 50 percent of the type 2 cases showed either right or left hand having the type 2 figure. On the other hand, those with the simian crease had it on both left and right hand. 4. No difference in palm lines was detected for each age group. CONCLUSION: The character of the palm lines of Koreans was investigated. There was no significant difference in character according to age.

The Effects of Change in Epidermal Calcium Gradient on Keratinocyte Differentiation / 대한피부과학회지

BACKGROUND: The cornified cell envelope(CE) which is formed during the terminal differentiation of keratinocytes, is a specialized structure which forms a structurally and functionally complete permeability barrier. OBJECTIVE: The purpose of our study is to investigate the effects of changes in the calcium ions on keratinocyte differentiation, especially in the expression of CE protein. METHODS:The permeability barrier of hairless mice was disrupted by tape-stripping and then exposed to the air or occluded with a water-vapor impermeable membrane, and iontophoresis was done without permeability barrier perturbation. Skin specimens were prepared for ion capture cytochemistry and immunohistochemistry with anti-K5, anti-K10, anti-K6, anti-involucrin and anti-loricrin. RESULTS: The calcium gradient which disappeared after tape-stripping was restored at 36 h after tape-stripping with air exposure and at 60 h after tape-stripping with occlusion. The change in calcium ions produced by both positive and negative iontophoresis showed recovery at 6 h. Expression of basal K5 showed a slight decrease and expression of suprabasal K10 showed an increase at 12 h with air exposure after tape-stripping, tape stripping with occlusion, and iontophoresis. Expression of K6 appeared at 12 h after tape-stripping and then in the whole epidermis at 36 h with air exposure after tape-stripping and tape stripping with occlusion and focally appeared in the stratum granulosum and stratum spinosum after iontophoresis. Expression of involucrin was increased at 12 h with air exposure after tape-stripping and iontophoresis and was extended to the lower spinous layers in tape-stripping with occlusion. Expression of loricrin in air exposure after tape-stripping, tape-stripping with occlusion and iontophoresis was similar to that of normal skin. CONCLUSION: The changes in calcium ions without permeability barrier perturbation are related to the expression of CE protein. It is thought that calcium ions in the epidermis have an important role in the terminal differentiation of keratinocytes.

The Effects of Change in Epidermal Calcium Gradient on Keratinocyte Differentiation / 대한피부과학회지

BACKGROUND: The cornified cell envelope(CE) which is formed during the terminal differentiation of keratinocytes, is a specialized structure which forms a structurally and functionally complete permeability barrier. OBJECTIVE: The purpose of our study is to investigate the effects of changes in the calcium ions on keratinocyte differentiation, especially in the expression of CE protein. METHODS:The permeability barrier of hairless mice was disrupted by tape-stripping and then exposed to the air or occluded with a water-vapor impermeable membrane, and iontophoresis was done without permeability barrier perturbation. Skin specimens were prepared for ion capture cytochemistry and immunohistochemistry with anti-K5, anti-K10, anti-K6, anti-involucrin and anti-loricrin. RESULTS: The calcium gradient which disappeared after tape-stripping was restored at 36 h after tape-stripping with air exposure and at 60 h after tape-stripping with occlusion. The change in calcium ions produced by both positive and negative iontophoresis showed recovery at 6 h. Expression of basal K5 showed a slight decrease and expression of suprabasal K10 showed an increase at 12 h with air exposure after tape-stripping, tape stripping with occlusion, and iontophoresis. Expression of K6 appeared at 12 h after tape-stripping and then in the whole epidermis at 36 h with air exposure after tape-stripping and tape stripping with occlusion and focally appeared in the stratum granulosum and stratum spinosum after iontophoresis. Expression of involucrin was increased at 12 h with air exposure after tape-stripping and iontophoresis and was extended to the lower spinous layers in tape-stripping with occlusion. Expression of loricrin in air exposure after tape-stripping, tape-stripping with occlusion and iontophoresis was similar to that of normal skin. CONCLUSION: The changes in calcium ions without permeability barrier perturbation are related to the expression of CE protein. It is thought that calcium ions in the epidermis have an important role in the terminal differentiation of keratinocytes.

The Effect of Bentonite and Glycolic Acid on the Stratum corneum

BACKGROUND: Bentonite clay, which is a major component of mud pack, has been used for various purposes in cosmetics. Glycolic acid is known to be effective in the treatment of acne. Al-though those products are used widely, information on the mode of action and effects on the skin are little and controversial till now. OBJECTIVE: To investigate whether bentonite alone, or bentonite with glycolic acid in mixed formulation affect the stratum corneum leading to alteration on cutaneous barrier function and whether those products alter the lipid lamellae and desmosomes of corneocytes. MATERIALS AND METHODS: Mud pack-type ointment of bentonite, bentonite and 5% glycolic acid formulation, bentonite and 10% glycolic acid formulation were applied on the volar fore-arm of the five healthy men and flank skin of five 6-8 week old hairless mice. Transepidermal water loss and capacitance were measured. Electron microscopic examination after ruthenium tetroxide postfixation was performed on the flank skin of the mice. RESULTS: Transepidermal water loss(TEWL) increased immediately and normalized 4 to 6 hours later after removal of vapor permeable membrane in both mouse and human. Capacitance did not show any evidence of change in the water content of the stratum corneum. Electron microscopic examination revealed that lipid lamellae and desmosome of corneocytes were not de-graded, but lamellar body secretion and partially electron-lucent material was-increased in 10% glycolic acid and bentonite mixture-treated area. CONCLUSION: Barrier function of stratum corneum is not disturbed by bentonite and glycolic acid formulations at the concentration used. Barrier structures are not disrupted, but lamellar body secretion and partially electron-lucent material was increased by bentonite and glycolic acid formulations at higher concentration.

The Change of Epidermal Calcium Gradient: Confocal Laser Scanning Microscopic Approach / 대한피부과학회지

BACKGROUND: Ion capture cytochemistry(the potassium oxalate pyroantimonate method), semi- quantitatively, and proton probe X-ray microanalysis, quantitatively, have been applied to investigate the epidermal calcium distribution. OBJECTIVE: In this study, we examined the epidermal calcium distribution with confocal laser scanning microscopy(CLSM) in an attempt to evaluate the possibility of another method in epidermal calcium study. METHODS: The change of epidermal calcium distribution after barrier perturbation with tape stripping was investigated with CLSM and was compared to the results of ion capture cytochemistry. RESULTS: The calcium distribution pattern in normal murine epidermis demonstrated by CLSM show a normal calcium gradient, from a low level of calcium ions in the basal and spinous layer, followed by a progressive increase with a level of calcium ions reaching its maximal density within the outer stratum granulosum. Disruption of the epidermal barrier with tape stripping induced an immediate loss of the calcium gradient and the calcium gradient after 36h was almost normalized, in parallel with the recovery of barrier function. CONCLUSION: These results show that calcium gradient in murine epidermis after tape-stripping is restored by 36h and CLSM study can be used as a new method in epidermal calcium study.

A Case of Perforating Pseudoxanthoma Elasticum / 대한피부과학회지

Perforating pseudoxanthoma elasticum is a localized, cutaneous disorder found mostly in obese, multiparous middle-aged women. It is characterized clinically by a slowly enlarging, yellowish, well-defined reticulated plaque usually in the periumbilical area with keratotic papules scattered on its surface, and histologically by transepidermal elimination of altered basophilic calcified elastic fibers, which are short, fragmented, and curled, in the middle portion of the reticular dermis. We present a case of a 36 year-old female who had a skin lesion, which showed chracteristic features consistent with perforating pseudoxanthoma elasticum in her neck region but not in the periumbilical area.

A Case of Seborrheic Keratosis with Focal Acantholysis / 대한피부과학회지

Seborrheic keratosis, a benign tumor is more common in the elderly and composed of epidermal keratinocytes. Seborrheric keratoses are very common in white races and are often of little concern to the patient, being accepted as a harmless and inevitable consequence of aging. This tumor was classified into six histopathological types by Lever; acanthotic, hyperkeratotic, adenoid, irritated, clonal, and melanoacanthoma. In 1978 Tagami and Yamada reported a rare acantholytic variant of seborrheic keratosis. We are reporting a case with seborrheic keratosis showing focal acantholysis.

A Case of Arteriovenous Malformation Arising in the Port-Wine Stain / 대한피부과학회지

Arteriovenous malformation is a vascular anomaly due to the hamartomatous proliferation of the subpapillary vascular plexus which exhibits multiple arteriovenus shunts. Various tumors can be developed in the port-wine stain, such as, pyogenic granuloma, basal cell carcinoma, squamous cell carcinoma, tufted angioma, giant proliferative hemangioma, and lymphangioma circumscriptum. We report a case of arteriovenous malformation arising in the port-wine stain. The pathogenesis of development of arteriovenous malformation in the port-wine stain is still unknown, but may be related to localized exaggerations of ectasia.

A Case of Arteriovenous Malformation Arising in the Port-Wine Stain / 대한피부과학회지

Arteriovenous malformation is a vascular anomaly due to the hamartomatous proliferation of the subpapillary vascular plexus which exhibits multiple arteriovenus shunts. Various tumors can be developed in the port-wine stain, such as, pyogenic granuloma, basal cell carcinoma, squamous cell carcinoma, tufted angioma, giant proliferative hemangioma, and lymphangioma circumscriptum. We report a case of arteriovenous malformation arising in the port-wine stain. The pathogenesis of development of arteriovenous malformation in the port-wine stain is still unknown, but may be related to localized exaggerations of ectasia.

A Case of Congenital Solitary Morphea Profunda

A 4-year-old boy has had a solitary sclerotic depressed plaque on the right anterior chest since birth. The histopathologic findings are consistent with morphea profunda: thickening, hyalinization, and homogenization of collagen bundles in the dermis and subcutaneous tissues, admixture with a prominent lymphocytic and plasma cell infiltrate, and sweat glands en-trapped between the thickened collagen bundles. We report a case of congenital solitary morphea profunda.

The Efficacy and Safety of Isotretinoin in Korean Patients with Mild to Moderate Acne / 대한피부과학회지

BACKGROUND: Oral isotretinoin has been widely used in severe acne patients and is known as a very effective drug. Recently it is being used in any grades and any types of acne. However we have few reports of clinical study about oral isotretinoin in our country. OBJECTIVE: To investigate clinical efficacy, factors influencing the result and side effects of oral isotretinoin in mild to moderate acne patients in Korea, prospectively. NATERIALS AND METHODS: The patients with mild to moderate acne visiting out-patient dermatology clinics of four university hospitals have taken oral isotretinoin 0.3-1.0mg/kg/day over 16 weeks. The clinical improvement was assessed by the scores using photographs before treatment and at 8 weeks, 12 weeks, 16 weeks, 20 weeks after treatment, and by the satisfaction of patients and physicians at the end of treatment. The side effects were recorded and SGOT, SGPT, cholesterol and triglyceride were checked at regular intervals. RESULTS: The grade of acne was much improved proportional to the duration of treatment. The factors showing better results were dosage and duration of oral isotretinoin, older age, more severe acne and severe acne in the past. About 90% of patients and physicians were satisfied with the result at the end of treatment. The side effects, mainly mucocutaneous symptoms were expectable and tolerable in the most cases. The values of SGOT, SGPT, cholesterol and triglyceride were increased after treatment but within normal reference range. CONCLUSION: Oral isotretinoin is a very effective agent in Korean patients with mild to moderate acne. We expect the better result in patients having high dose and long duration of oral isotretinoin, old ages and more severe acne. If we understand it's side effects enough, we can use it very safely.

A Case of Buschke-Lowenstein Tumor That Progressed to Squamous Cell Carcinoma / 대한피부과학회지

Buschke-Lowenstein (B-L) tumor occurs in penis associated with human papillomavirus (HPV). It appears as a exophytic cauliflower-like mass that may be foul smelling and sometimes ulcerated. B-L tumor is predominantly associated with HPV 6, 11 and rarely 16, 18. Because HPV 6, 11 are usually isolated from benign lesions, it has been hypothesized that other cofactors such as immunosuppression, poor hygiene, lack of circumcision, and chronic irritation may be involved. In addition, genomic alternation or subtle amino-acid changes in the HPV 6 E7 protein may play a role in enhancing oncogenic properties of the low-risk virus, HPV 6. We present a case of B-L tumor with squamous cell carcinoma that showed HPV 6 positive and altered p53.

A Clinical Study of Rosacea / 대한피부과학회지

No Abstract Available.

A Case of Isolated Epidermolytic Acanthoma / 대한피부과학회지

No Abstract Available.