New Selective Medium for Rapid Identification of Vibrio vulnificus from Patients with V. vulnificus Sepsis / 대한피부과학회지

BACKGROUND: Vibrio(V.) vulnificus is a halophilic, gram-negative bacillus that causes a fatal sepsis in patients with underlying chronic disease such as liver cirrhosis and alcoholic abuse. Because V. vulnificus infection has a fulminant course and high mortality rate, early recognition and rapid diagnosis with prompt therapy are necessary to improve survival rate. OBJECTIVE: The purpose of this study was to develop a new selective medium for rapid identification of V. vulnificus through color change of medium according to pH from patients suspected of having V. vulnificus sepsis. METHODS: Rapid isolation and identification of V. vulnificus can be possible by modifying the component of PNC(5% peptone, 1% NaCl, and 0.08% cellobiose [pH 8.0]) broth medium. From this PNC broth, a basal broth(5% peptone+1% NaCl+cellobiose) was prepared and used to evaluate additional medium supplements(cellobiose concentration [0.08, 0.2, 0.1%], pH [6.8, 7.5, 8.0] and pH indicator dye [bromthymol blue, thymol blue, phenol red, bromcresol purple, crystal violet, cresol red, and neutral red]). To examine the rapid identification and selectivity of this basal medium according to various conditions, V. vulnificus was tested by using saline and normal human blood containing these bacteria(1, 000 bacteria/ml), respectively at 37degrees C. A positive reaction(V. vulnificus growth) appeared as color change. The selectivity and identification capacity of this new broth was tested by using other 6 Vibrio species and 14 strains of other bacteria. RESULTS: Color change appeared only in the medium including bromthymol blue and thymol blue as a pH indicator dye. It was called the basal medium containing blue dyes as PNCB(peptone, NaCl, cellobiose and blue dye) medium. It took an average time of 4.8hr for becoming aware of yellow color change in PNCB broth after cultivating with saline mixed with V. vulnificus and 6hr in PNCB broth after cultivating with blood mixed with V. vulnificus. One Vibrio species and another 3 bacteria produced color change. So we confirmed that the final composition and pH of PNCB broth medium was 5% peptone, 1% NaCl, 0.2% cellobiose, 0.0004% bromthymol blue and 0.0004% thymol blue [pH 7.5] CONCLUSIONS: PNCB broth could be used as a selective and differential medium for rapid isolation and identification of V. vulnificus in patients with V. vulnificus sepsis.

Finger-Tip Unit in Korean Adults and It's Clinical Application According to Anatomical Sites / 대한피부과학회지

BACKGROUND: Dermatologic patients need advice on how much ointment or cream to apply, in particular topical corticosteroids. The instructions given to patients concerning topical therapy are frequently vague. OBJECTIVE: The aims of this study are to make simple guidelines on the topical application of ointments or creams for patients, parents, doctors and nurses, and to check the accuracy of these guidelines in practice. METHODS: The average height and weight according to the different age groups and sex were measured from Korean standard growth and developement chart. From this chart, their total body surface areas(BSA) were calculated using a standard nomogram. The length of the tips of their index fingers was measured; measuring from the distal skin-crease to the end of the finger. One finger-tip unit(FTU) was defined as the amount of ointment expressed from a tube nozzle with a 5 mm in diameter, covering from the distal skin-crease to the tip of the palmar aspect of the index finger. The average area of abdominal skin covered by one finger-tip unit, and that of one palm were measured by computer scanner(Hurapack scanner, 4C) and image analyzed program(Image Pro. Plus(R) V. 3.0, Micromedical). Each patient then placed his or her right hand lightly, palm side down with the fingers and thumb closed, onto Hurapack scanner 4C. A tracing of the outer edge of the hand was made from the ulnar to radial styloid by photoshop program. The outlined area and enclosed area were measured by an image analyzer. RESULTS: 1. The average length of each finger-tip was 2.48+/-0.2cm in males and 2.24+/-0.13cm in females. 2. The average weight of one FTU was 0.46+/-0.03g in males and 0.40+/-0.02g in females. 3. The average area of palm was 145+/-12.4cm2 in males and 115.9+/-10.1cm2 in females. 4. The average area of abdominal skin covered by one FTU was 278+/-34.4cm2; The average area was 303+/-24.3cm2 in males and 253+/-21.9cm2 in females. 5. The number of FTU of adult male required to treat various anatomical sites was : face and neck, 2.6; trunk and buttock, 10.5; arm and hand, 5; leg and foot, 10. The number of FTU of adult female was : face and neck, 2.8; trunk and buttock, 11; arm and hand, 5.5; leg and foot 11. 6. The number of FTU of children required to treat each anatomical site was variable because of differential growth according to different age. CONCLUSION: The concept of FTU provides convenient means of rapidly assessing the approximate amount of ointment or cream required for the treatment of patients.

A Case of Angiocentric T-cell Lymphoma / 대한피부과학회지

A 40-year-old female patient, known angiocenteric T-cell lymphoma on nasal cavity, was transfered from the department of hemato-oncology for the evaluation of egg sized pinkish-yellow indurated mass with central necrotic tissue on the left medial elbow. Histopathologic findings revealed angiocentric, angioinvasive, and angiodestructive infiltrate containing atypical lymphocytes. The infiltrative cells were positivly stained with antibody to CD45RO, LCA, but not with antibody CD20. The atypical infiltrated perivascular lymphoid cells were positive to Epstein-Barr virus in situ polymerase chain reaction. She was treated with combined chemotherapy and radiation therapy, but she died due to sepsis. We herein report a rare case of angiocentric T-cell lymphoma on the nasal cavity and skin associated with Epstein-Barr virus.

A Case of Cervical Tab / 대한피부과학회지

Cervical tab is one of rare developmental anomalies of the brachial apparatus which appears as firm, protruding papule or nodule on the neck along the line of anterior border of the sternocleidomastoid muscle. A 5 year-old male patient developed a pea sized, movable, semi-solid mass on the lower portion of right sternocleidomastoid muscle area. On microscopic examination, well-marginated oval shaped cartilage was present. Individual cells in the lacunae had ample cytoplasm and eccentric nucleus. Verhoeff-van Gieson stained section of the mass showed cartilage with a rich elastic network in the matrix, most heavily concentrated about the chondrocyte. We report a rare case of cervical tab manifesting as a skin-colored nodule on the sternocleidomastoid muscle area.

Clinicopathologic Studies of 7 Cases with Cutaneous Metastatic Carcinomas from Lung Cancers / 대한피부과학회지

BACKGROUND: Cancer that tends to metastasize to other internal organs also involves the skin with various clinical features. OBJECTIVE: We studied the clinical and histopathological findings of metastatic skin cancer and primary lung cancer. METHODS: We reviewed the clinical features and histopathological findings in 7 patients with metastatic skin cancer from the lung cancer. We performed routine hematoxylin-eosin stain and immunohistochemical staining with monoclonal antibody to cytokeratin, neuron specific enolase, S-100, leukocyte common antigen, and epithelial membrane antigen using the formalin-fixed paraffin embedded skin tissue of cutaneous metastatic and primary lung cancer. RESULTS: All patients are men ranging from 44 to 72 years in age(mean, 63.0 years). Cutaneous lesions were nodule, tumor, and sclerotic plaque. Skin lesions appeared on all parts of body. The neck, chest, and scalp were the most common locations of metastases. Pathologic findings were squamous cell carcinoma in 5 patients, adenosquamous cell carcinoma in 2 patients. We found some different immunophenotypes in cutaneous metastatic lesion and lung cancer. Mean survival time from the diagnosis of lung cancer was 10.4 months, and 8.4 months from the diagnosis of skin metastasis. CONCLUSION: We conclude that patients with cutaneous metastasis of lung cancer reflect progressive, terminal stage, and poor prognosis of the disease.

Combination Therapy with Griseofulvin and Immunotherap (DNCB, DPCP)on Plane Warts / 대한피부과학회지

BACKGROUND: Although several kinds of treatment methods(destructive therapy, immunotherapy, etc) for plane warts have been attempted but there have been no entirely satisfactory treatments, because the plane wants are seen to recur frequently. OBJECTIVE: This study was aimed to evaluate the combination therapy of griseofulvin and immunotherapy(dinitrochlorobenzene=DNCB, diphenylcycloprope none=DPCP) on plane warts. METHOD: Sixteen patients(age range, 9 to 41; mean age, 21.8 years) with VPJ were treated with the combination therapy with griseofulvin(500mg/day) and single contact immunotherapy(DNCB or DPCP).

Chronic Recurrent Folliculitis with Atypical Hyperpigmented Scarring in an AIDS Patient

Bacterial, fungal, and viral infections of the skin with extended skin involvement can occur during the early phase of human immunodeficiency virus infection. A significant reduction in circulating CD4+ lymphocytes in the late stage of the disease may cause tumors of the skin such as Kaposi's sarcoma. A 40-year male patient, a former sailor who had multiple sexual contact with native African women, presented with multiple tender follicular pustules and fibrotic brown patches on both his legs. these had been present for 6 months. The skin lesions were healed leaving brown pigmentation. Laboratory examinations revealed the presence of leukopenia, thromocytopenia and a reversed T4/T8 ratio. The ELISA and Western blot analysis to human immunodeficiency virus were positive. A skin biopsy from a brown patch showed early stages of scar tissue and perivascular hemosiderin deposition. We herein report a case of acquired immunodeficiency syndrome patient with atypical dark brown scarring atrophic patches on the lower legs following purulent bacterial folliculitis. This may have been an early manifestation of Kaposi's sarcoma from a preceding skin lesion.

A Case of Contact Dermatitis due to Garlic / 대한피부과학회지

Garlic is a well known edible plant and has been used as a herbal medicine. It is a member of Liliaceae which contains allylpropyldisulfide, diallyldisulfide and allicin which can induce allergic contact dermatitis or primary irritant dermatitis applied topically. A 53-year-old female patient was presented with vesicles, crust and erythema on her left buttock. She applied crushed raw garlic on the lesion site for the treatment of residual skin lesion following herpes zoster.

A Case of Mycosis Fungoides / 대한피부과학회지

We describe a case of mycosis fungoides (infiltrative plaque type) in an 86-year-old male. He had experienced dark erythematous round plaques on the face, trunk, buttock, upper and lower extremities. Histopathologic findings revealed band-like superficial dermal infiltration of atypical lymphocytes, epidermotropism, and Pautrier's microabscess in the epidermis. The infiltrative cells were positivly stained with CD3, but not with a CD20. He was treated with a topical application of 0.2% carmustine, but he died due to poor general condition and septicemia.

A Case of Prolonged Skin Ulceration Caused by Jellyfish Stings / 대한피부과학회지

A 32-year-old Korean man was stung by a jellyfish on his right lower leg while scuba diving at the Philippine seashore. The stung lesion rapidly became painful, erythematous and swollen. Seven days later, an irregular shaped ulcer developed at the pervious sting site. The histopathological findings showed focal perivascular infiltration of chronic inflammatory cells in the upper and mid dermis, fibrosis and focal necrosis in the subcutis. The patient had been treated with antibiotic ointment, topical application of tetrachlordecanoic acid solution and 800mg pentoxifylline for 2 months. During treatment, leg swelling had recurred intermittently. After 2 months, the lesion healed leaving an erythematous atrophic scar. We report a rare case of delayed cutaneous reactions with prolonged skin ulceration and chronic recurrent swelling due to lymphatic obstruction.

A Case of Linear IgA Bullous Dermatosis / 대한피부과학회지

We describe an 18-year-old male with generalized pruritic, tense annular or polycyalic blistera on normal-appearing skin or erythematous bases. Histopathological fmdings of an iatact early blistering showed subepidermal blistering and papillary neutrophilic gnicroabscesses. A direct immunofluctescent study of a section from the skin adjacent to a lesioti revealed linear deposits of IgA at the dermoepidermal junction. There were no deposits of IgG, lgM, or C3. In 1.0M NaC1 eplit skin, IgA was found to be bound linearly on the epidermal roof. The patient respmded weIl to eteroid and dapsone therapy.