ABSTRACT
It is important to differentiate violaceous to dusky red papules and plaques that widely persist on the trunk and extremities because there are dermatoses that could be fatal, such as lupus erythematosus, dermatomyositis, drug eruptions, and graft-versus-host disease.Dyskeratotic cells only in the upper epidermis and horny layer are not well known, but it is a distinctive histopathological pattern of atypical type of rash of adult-onset Still’s disease (AOSD). AOSD rash is a transient salmon-colored rash that occurs and disappears with fever; however, an atypical type of rash called “persistent dermal plaque” or “persistent pruritic eruptions” has also been reported. It occurs and persists even after fever subsides.Herein, we describe a case with necrotic dyskeratotic cells in the upper epidermis and horny layer without AOSD symptoms lasting for five years.
ABSTRACT
Background@#Angiosarcoma (AS) and Kaposi sarcoma (KS) are rare malignant and borderline malignant vascular tumors that may first present to a dermatologist. There are few Korean studies that particularly focus on their survival due to low incidence. @*Objective@#To investigate the survival and prognostic factors among patients with AS and KS, in addition to their clinical features. @*Methods@#Between 2000∼2021, medical records of 26 AS and 26 KS patients at a single center were analyzed retrospectively. Additionally, we calculated the disease specific survival (DSS) and overall survival (OS) of two diseases. @*Results@#The mean age of patients with AS was 72.9 years and 67.3 years for KS. The most common tumor location was the scalp in patients with AS (80.8%) and the foot (65.4%) in those with KS. In patients with AS, 1-year DSS and OS rates were 36.0% and 34.6%, respectively. Five-year DSS and OS rates were 24.0% and 20.2%, respectively. In patients with KS, the 1-year DSS and OS rates were 96.2% and 84.6%, respectively. The 5-year DSS and OS were 91.6% and 58.0%, respectively. Patients who were older or had larger lesions than average had decreased DSS and OS in AS. Among the patients with KS, immunosuppressed status, including human immunodeficiency virus infection, showed reduced OS. @*Conclusion@#Apart from confirming grave survival of AS and favorable survival of KS, patient’s age and size of lesion affect survival outcomes in patients with AS. Otherwise, immunosuppressed status affects survival outcomes in patients with KS.
ABSTRACT
The Department of Dermatology at Kyungpook National University School of Medicine, initially the Dermatology Department of the Private Daegu Medical Training School in 1924, commemorated its 100th anniversary in 2023.Throughout its rich history, the department has been dedicated to advancing contemporary dermatology and enhancing the well-being of local communities through exceptional research, education, and social contributions.Initially tasked with the diagnosis, treatment, and education of patients with dermatological and urological disorders, the department evolved over time. In 1958, it separated from the Urology Department to focus solely on the diagnosis, research, and education of dermatological disorders. In 1962, Dr. Soon Bong Suh became the inaugural Chief of the Dermatology Department, marking the foundation of the Kyungpook National University School of Medicine’s Dermatology Department. Our legacy of pioneering contributions extends to dermatophytic diseases, which account for a large proportion of skin disorders in Korea, where we have excelled in basic research and treatment. These achievements have played a crucial role in the advancement of dermatophytic diseases.Subsequently, we have demonstrated expertise in blistering diseases and dermatopathology, making substantial contributions to the diagnosis and treatment of refractory skin conditions. Recently, we have been at the forefront of research and interventions for chronic inflammatory skin conditions that cause significant distress in many individuals, including atopic dermatitis and psoriasis. Our influence has also extended to severe and refractory skin disorders, including skin cancer and vascular anomalies. Striving to stay contemporary, our achievements now encompass aesthetics, including acne, pigmentation, and laser treatments. Our accomplishments have garnered widespread recognition nationwide, engendering high expectations for future advancements.
ABSTRACT
Methotrexate (MTX) is commonly employed in the management of chronic inflammatory skin diseases. We report the case of a 73-year-old man who presented with a persistent cough lasting for 1 month. He had an 11-year history of psoriasis and had received MTX (10.0 mg/wk) over the past 21 months. High-resolution chest computed tomography revealed diffuse ground-glass opacities and bronchiectasis affecting both lung fields. Based on clinical and radiological assessments, the patient was diagnosed with MTX-induced interstitial pneumonia. Notably, significant clinical and radiological improvement was observed 1 month after the discontinuation of MTX and corticosteroid administration. Although some reports have demonstrated lung toxicity in patients receiving high-dose MTX therapy, cases of adverse pulmonary effects following low-dose treatment in patients with psoriasis are rare.This case report underscores the rarity of interstitial pneumonia in a patient with psoriasis undergoing MTX treatment in Korea.
ABSTRACT
Lymphomatoid papulosis (LyP) is a relatively uncommon CD30＋ lymphoproliferative disorder with a good prognosis. However, it is important to be cautious because 4%∼25% of the cases are accompanied by secondary lymphoma. LyP is divided into subtypes of infiltrate-descriptive categories based on the histological findings. Classically, LyP shows a patchy, wedge-shaped, dermal infiltrate of small to intermediate-sized lymphocytes, with atypical lymphoid cells and a variable mixture of neutrophils, histiocytes, and eosinophils. Follicular LyP (type F LyP), which was recently described and is not yet included as an official subtype in the World Health Organization classification, shares these characteristics, although its infiltrate is folliculocentric. Variable folliculotropism, follicular dilation, rupture, and mucinosis can occur. This entity is commonly misdiagnosed and is possibly underreported because its histopathologic features can masquerade as more common follicular-based entities. Herein, we report the case of follicular type LyP, which has not been reported in in Korean dermatology literature.
ABSTRACT
Dermatofibrosarcoma protuberans (DFSP) is a relatively rare, slow-growing dermal spindle cell tumor characterized by high local recurrence rates and a low risk of metastasis. It starts as an erythematous indurated papule or plaque where firm nodules subsequently arise, forming typical ‘protuberant’ morphology. However, atypical DFSP presentations, which are difficult to diagnose clinically, have been reported. In this study, we describe three patients diagnosed with diversely atypical DFSP, which were pigmented, hemangioma-like, and cystic DFSP variants. Among them, two patients were misdiagnosed with other diseases, resulting in delayed treatment, with much larger resections needed to achieve local control or avoid recurrence. Therefore, dermatologists should pay attention to these diverse clinical variants of DFSP.
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Background@#In addition to vascular endothelial cells, vascular smooth muscle cells (VSMCs) are subject to continuous shear stress because of blood circulation. The angiogenic properties of VSMCs in extracranial arteriovenous malformations (AVMs) may exceed those of normal blood vessels if the body responds more sensitively to mechanical stimuli. This study was performed to investigate the hypothesis that rapid angiogenesis may be achieved by mechanical shear stress. @*Methods@#VSMCs were obtained from six patients who had AVMs and six normal controls. The target genes were set to angiopoietin-2 (AGP2), aquaporin-1 (AQP1), and transforming growth factor-beta receptor 1 (TGFBR1). Reverse-transcriptase polymerase chain reaction (RT-PCR) and real-time PCR were implemented to identify the expression levels for target genes. Immunofluorescence was also conducted. @*Results@#Under the shear stress condition, mean relative quantity values of AGP2, AQP1, and TGFBR1 in AVM tissues were 1.927±0.528, 1.291±0.031, and 2.284±1.461 when compared with neutral conditions. The expression levels of all three genes in AVMs were higher than those in normal tissue except for AQP1 under shear stress conditions. Immunofluorescence also revealed increased staining of shear stress-induced genes in the normal tissue and in AVM tissue. @*Conclusions@#Shear stress made the VSMCs of AVMs more sensitive. Although the pathogenesis of AVMs remains unclear, our study showed that biomechanical stimulation imposed by shear stress may aggravate angiogenesis in AVMs.
ABSTRACT
Background@#Although particulate matter likely provokes inflammatory reactions in those with chronic skin disorders like atopic dermatitis, no study has examined the relationship between particulate matter and psoriasis exacerbation. @*Objective@#This study evaluated possible associations between particulate matter and hospital visits for psoriasis patients in 7 major cities in South Korea. @*Methods@#We investigated the relationship between psoriasis and particulate matter. To do this, we used psoriasis patient data from the Korean National Health Insurance Service database. In addition, PM 10 and PM 2.5 concentration data spanning a 3-year time frame were obtained from the Korea Environment Corporation. @*Results@#A pattern analysis generated by the sample cross-correlation function and time series regression showed a correlation between particulate matter concentration and the number of hospital visits by psoriasis patients. However, the prewhitening method, which minimizes the effects of other variables besides particulate matter, revealed no correlation between the two. @*Conclusion@#This study suggests that particulate matter has no impact on hospital visit frequency among psoriasis patients in South Korean urban areas.
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Background@#Cutaneous malignant melanoma (CMM) develops mainly in the elderly, although it is often seen in young patients and in clinical practice. However, there are few studies on the clinical features of young patients with CMM in Korea. @*Objective@#To investigate the clinical characteristics of young Korean patients with CMM. @*Methods@#We retrospectively reviewed the medical records of patients with CMM between January 2009 and June 2019 and compared the clinical features of CMM in patients aged 10∼39 and 50∼79 years. @*Results@#Of the 341 patients with CMM, only 22 (6.5%) were between the age of 10∼39 and 250 (73.3%) were aged 50∼79. Acral lentiginous melanoma (ALM) was the most common clinical subtype in both groups (45.5% and 71.2%, respectively). Subungual melanoma was more common in age 10∼39 years (27.3% vs. 17.2%), whereas ALM except subungual melanoma was more common in age 50∼79 years (18.2% vs. 54.0%). Superficial spreading melanoma (31.8%) was also a significant subtype observed in age 10∼39 years (p＜0.001). Frequently involved locations in age group 10∼39 were fingers (27.3%) and trunk (22.7%), but feet (40.8%) were common in age group 50∼79 (p=0.009). There were no differences in mean Breslow thickness, lymph node metastases, or staging of CMM (p＞0.05). @*Conclusion@#Compared with elderly patients, CMM in patients aged 10∼39 showed differences in the location of the lesion and clinical subtype. Therefore, a misdiagnosis can be prevented when a young patient has suspected CMM on the finger or trunk.
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Background@#Venous malformations (VMs) are the most common type of vascular malformations. Intramuscular venous malformations (IMVMs) are lesions involving the muscles, excluding intramuscular hemangiomas. The purpose of this study was to compare clinical outcomes between patients with IMVMs who were treated with sclerotherapy and those who were treated with surgical excision. @*Methods@#Of 492 patients with VMs treated between July 2011 and August 2020 at a single medical center for vascular anomalies, 63 patients diagnosed with IMVM were retrospectively reviewed. Pain, movement limitations, swelling, and quality of life (QOL) were evaluated subjectively, while radiological outcomes were assessed by qualified radiologists at the center. Complication rates were also evaluated, and radiological and clinical examinations were used to determine which treatment group (sclerotherapy or surgical excision) exhibited greater improvement. @*Results@#Although there were no significant differences in pain (P=0.471), swelling (P=0.322), or the occurrence of complications (P=0.206) between the two treatment groups, the surgical treatment group exhibited significantly better outcomes with regard to movement limitations (P=0.010), QOL (P=0.013), and radiological outcomes (P=0.017). Moreover, both duplex ultrasonography and magnetic resonance imaging showed greater improvements in clinical outcomes in the surgical excision group than in the sclerotherapy group. @*Conclusions@#Although several studies have examined IMVM treatment methods, no clear guidelines for treatment selection have been developed. Based on the results of this study, surgical excision is strongly encouraged for the treatment of IMVMs.
ABSTRACT
Background@#Oral propranolol has recently been introduced as a successful treatment for infantile hemangioma (IH).Though, there are limited reports on this treatment including large number of Korean patients with IH covering a long-term powder and solution formulation period. @*Objective@#We investigated the effectiveness and side effects of two different formulations of oral propranolol treatment in patients with IH at a Korean tertiary university hospital. @*Methods@#From June 2011 to October 2019, 375 patients were treated with powder- or solution-type oral propranolol starting at 1 mg/kg/day and increasing up to 3 mg/kg/day. Drug effectiveness was evaluated on four scales through sequential photographs by two dermatologists. Side effects were recorded on a medical chart. @*Results@#Overall, the mean improvement scale was 2.61±0.73 at 3 months after treatment initiation. The scale was higher for solution-type than for powder-type oral propranolol at the 3-month follow-up (2.71±0.79 vs. 2.54±0.67, p＜0.05). The patients’ mean duration of treatment was 8.56±5.85 months, which was shorter for solution-type than for powder-type oral propranolol (6.0 vs. 10.69 months, p＜0.05). Among the total number of patients, 22 reported mild side effects, including loose stools and noticeable sleep disturbance, and few serious side effects such as grunting, while two patients required medical intervention. @*Conclusion@#The patients in our study were effectively treated for IH with oral propranolol without significant side effects and had a shorter treatment duration with solution-type oral propranolol than with powder-type oral propranolol.
ABSTRACT
An 83-year-old man presented with an intermittently bleeding fixed nodule on the left side of the chest for 2 months. Due to the clinical suspicion of metastatic cancer or a ruptured epidermal cyst, a punch biopsy was performed, which revealed granulation tissue. During surgical excision, a connection between the granulation tissue and the deeper structure was confirmed. Based on the clinicopathological findings, a cutaneous fistula was suspected;a detailed history revealed that he had experienced blunt chest trauma in a motorcycle accident 2 months before. Subsequent chest computed tomography showed soft tissue infiltration in the left sixth rib. Finally, the patient was diagnosed with a cutaneous fistula and underwent resection of the left sixth rib and costal cartilage. Cutaneous fistulae rarely occur in the chest. In cases where a recalcitrant inflammatory nodule is observed on the chest, the patient’s trauma history and ordinary medical history should be evaluated to rule out a cutaneous fistula.
ABSTRACT
Background@#Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to manage. The ear is the second most common site of extracranial AVM. However, studies regarding the management of this condition remain lacking. The purpose of this study was to share managing experiences in our center and to investigate the treatment effect through a retrospective analysis of cases. @*Methods@#Among 265 patients with AVM treated in our vascular anomalies center between January 2008 and January 2021, 10 patients with auricular AVM were included in the study to investigate the lesion distribution, clinical stage, and treatment methods by performing a retrospective evaluation. @*Results@#Among 10 patients, five patients had AVMs distributed in the upper half of the ear, one patient in the lower half of the ear, and four patients in whole ear, respectively. Seven patients had Schobinger stage II, and three had stage III. One patient received surgical treatment only, four patients received sclerotherapy only, and five patients received both surgical treatment and sclerotherapy. The posttreatment status was checked as controlled in two patients, improved in seven patients, persistent in one patient. There were no worsening patients. @*Conclusion@#Auricular AVM is a disease that is difficult to manage by one specific department, thus requiring a collaborative management effort from multidisciplinary team.
ABSTRACT
Background@#Only a few studies have tried to assess factors relevant to the satisfaction of the participants in atopic dermatitis (AD) educational programs. More systematic modeling of this issue is needed. @*Objective@#To examine the benefit of a conjoint educational program for AD on patients and caregivers in a clinical setting. @*Methods@#In a half-day educational program called “AD school”, 831 people (493 patients and 338 family members) participated for 8 years. Various educational and entertaining programs were provided. The on-site survey was administered to measure participants’ satisfaction and perception of the benefit. We applied structural equation modeling to identify the relations among satisfaction and perception. @*Results@#A total of 209 family survey data was obtained and analyzed. The survey items were grouped into four categories. The categories were classified as individual education, group education, fun activity, and overall satisfaction (fun, benefit, intention to re-join and recommend to others). According to the model that we built, comprehensive group education was demonstrated to be the most relevant factor affecting overall satisfaction. @*Conclusion@#Our holistic approach would allow dermatologists to improve the efficacy of the conjoint educational program for AD.
ABSTRACT
Nevus comedonicus is a very rare skin disorder characterized by the presence of comedo-like dilated pores with keratinous plugs, rarely resulting in painful recurrent inflammatory nodules or cysts. It presents as localized or extensive form. It displays unilaterally or bilaterally segmental distribution. Histopathologically, it is characterized by keratin-filled epidermal invagination with bulbous proliferation of keratinocytes. The condition may be caused by fibroblast growth factor receptor 2 mutation. Although it may be controlled by a variety of therapeutic modalities, it is difficult to achieve complete resolution. We report a case of extensive nevus comedonicus with inflammatory nodules and cysts controlled with adalimumab.
ABSTRACT
Background@#Oral propranolol has recently been introduced as a successful treatment for infantile hemangioma (IH).Though, there are limited reports on this treatment including large number of Korean patients with IH covering a long-term powder and solution formulation period. @*Objective@#We investigated the effectiveness and side effects of two different formulations of oral propranolol treatment in patients with IH at a Korean tertiary university hospital. @*Methods@#From June 2011 to October 2019, 375 patients were treated with powder- or solution-type oral propranolol starting at 1 mg/kg/day and increasing up to 3 mg/kg/day. Drug effectiveness was evaluated on four scales through sequential photographs by two dermatologists. Side effects were recorded on a medical chart. @*Results@#Overall, the mean improvement scale was 2.61±0.73 at 3 months after treatment initiation. The scale was higher for solution-type than for powder-type oral propranolol at the 3-month follow-up (2.71±0.79 vs. 2.54±0.67, p＜0.05). The patients’ mean duration of treatment was 8.56±5.85 months, which was shorter for solution-type than for powder-type oral propranolol (6.0 vs. 10.69 months, p＜0.05). Among the total number of patients, 22 reported mild side effects, including loose stools and noticeable sleep disturbance, and few serious side effects such as grunting, while two patients required medical intervention. @*Conclusion@#The patients in our study were effectively treated for IH with oral propranolol without significant side effects and had a shorter treatment duration with solution-type oral propranolol than with powder-type oral propranolol.
ABSTRACT
An 83-year-old man presented with an intermittently bleeding fixed nodule on the left side of the chest for 2 months. Due to the clinical suspicion of metastatic cancer or a ruptured epidermal cyst, a punch biopsy was performed, which revealed granulation tissue. During surgical excision, a connection between the granulation tissue and the deeper structure was confirmed. Based on the clinicopathological findings, a cutaneous fistula was suspected;a detailed history revealed that he had experienced blunt chest trauma in a motorcycle accident 2 months before. Subsequent chest computed tomography showed soft tissue infiltration in the left sixth rib. Finally, the patient was diagnosed with a cutaneous fistula and underwent resection of the left sixth rib and costal cartilage. Cutaneous fistulae rarely occur in the chest. In cases where a recalcitrant inflammatory nodule is observed on the chest, the patient’s trauma history and ordinary medical history should be evaluated to rule out a cutaneous fistula.
ABSTRACT
Background@#Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to manage. The ear is the second most common site of extracranial AVM. However, studies regarding the management of this condition remain lacking. The purpose of this study was to share managing experiences in our center and to investigate the treatment effect through a retrospective analysis of cases. @*Methods@#Among 265 patients with AVM treated in our vascular anomalies center between January 2008 and January 2021, 10 patients with auricular AVM were included in the study to investigate the lesion distribution, clinical stage, and treatment methods by performing a retrospective evaluation. @*Results@#Among 10 patients, five patients had AVMs distributed in the upper half of the ear, one patient in the lower half of the ear, and four patients in whole ear, respectively. Seven patients had Schobinger stage II, and three had stage III. One patient received surgical treatment only, four patients received sclerotherapy only, and five patients received both surgical treatment and sclerotherapy. The posttreatment status was checked as controlled in two patients, improved in seven patients, persistent in one patient. There were no worsening patients. @*Conclusion@#Auricular AVM is a disease that is difficult to manage by one specific department, thus requiring a collaborative management effort from multidisciplinary team.
ABSTRACT
Background@#Only a few studies have tried to assess factors relevant to the satisfaction of the participants in atopic dermatitis (AD) educational programs. More systematic modeling of this issue is needed. @*Objective@#To examine the benefit of a conjoint educational program for AD on patients and caregivers in a clinical setting. @*Methods@#In a half-day educational program called “AD school”, 831 people (493 patients and 338 family members) participated for 8 years. Various educational and entertaining programs were provided. The on-site survey was administered to measure participants’ satisfaction and perception of the benefit. We applied structural equation modeling to identify the relations among satisfaction and perception. @*Results@#A total of 209 family survey data was obtained and analyzed. The survey items were grouped into four categories. The categories were classified as individual education, group education, fun activity, and overall satisfaction (fun, benefit, intention to re-join and recommend to others). According to the model that we built, comprehensive group education was demonstrated to be the most relevant factor affecting overall satisfaction. @*Conclusion@#Our holistic approach would allow dermatologists to improve the efficacy of the conjoint educational program for AD.
ABSTRACT
Nevus comedonicus is a very rare skin disorder characterized by the presence of comedo-like dilated pores with keratinous plugs, rarely resulting in painful recurrent inflammatory nodules or cysts. It presents as localized or extensive form. It displays unilaterally or bilaterally segmental distribution. Histopathologically, it is characterized by keratin-filled epidermal invagination with bulbous proliferation of keratinocytes. The condition may be caused by fibroblast growth factor receptor 2 mutation. Although it may be controlled by a variety of therapeutic modalities, it is difficult to achieve complete resolution. We report a case of extensive nevus comedonicus with inflammatory nodules and cysts controlled with adalimumab.