Novel Photopneumatic Therapy for the Treatment of Rosacea

BACKGROUND: Rosacea is a common skin condition, but the currently available treatments are not satisfactory. OBJECTIVE: We wanted to assess the efficacy and safety of photopneumatic therapy (PPx), which delivers pneumatic energy and broadband light (400~1,200 nm), for the treatment of erythematotelangiectatic rosacea. METHODS: Twenty two patients with erythematotelangiectatic rosacea were treated 3~5 times with PPx. Three independent dermatologists evaluated the efficacy of PPx by comparing the photographs taken before and after treatment. Patient self-assessment was also done by interviews. RESULTS: The photographic assessment by the dermatologists of the improvement showed that >50% improvement occurred in 64% (14/22) of the patients. The specific categories of improvement were as follows: poor (75% improvement), 3 patients. Based on the patients' self-assessment, 20 patients (91%) acknowledged an improvement. CONCLUSION: PPx is an effective and safe treatment option for erythematotelangiectatic rosacea.

Alterations of Cell Cycle Regulation and Apoptosis Related Factors in Skin Tumors / 대한피부과학회지

BACKGROUND: Tumor growth and progression is dependent on a variety of factors including; increased cell survival, i. e. resistance to undergo apoptosis, increased proliferation, and the inability to undergo growth arrest or differentiation. The cyclins are a growing group of proteins that form the regulatory subunits in complexes with a specific catalytic protein kinase(cyclin-dependent kinase(CDK)) partner. Tumor suppressor gene such as Rb, p53 and cell cycle regulatory proteins such as p16, p27, WAF1(p21, or Cip 1) also act as a regulator of cyclin and CDK. Apoptosis regulatory proteins such as bcl-2, bcl-x act as a blocking protein of apoptosis and Ki-67 is frequently used as a marker for cell proliferation. OBJECTIVE: The purpose of this study was to investigate the alterations of cell cycle regulation and apoptosis in skin tumors. METHODS: We compared expressions for cyclin A, cyclin E, WAF1, Ki-67, p53, p27, Rb, bcl-2 and bcl-x in paraffin embedded samples from 5 normal adult skin tissues, 10 basal cell epithelioma, 10 squamous cell carcinoma, 10 Bowen's disease, 5 keratoacanthoma and 5 solar keratosis by immunohistochemical staining method. RESULTS: The stainings of the tumors showed some differences from normal tissues in expression of antigens according to the differentiation state and nature of tumors. CONCLUSION: These results support an important role for cell cycle and apoptosis regulatory proteins in the regulation of growth and differentiation of malignant keratinocyte in these cutaneous neoplasms. Aberrant expression of such proteins may participate in the multistep process of carcinogenesis.

Two Cases of Linear Focal Elastosis

We report two cases of linear focal elastosis. They are a 16-year-old girl and a 14-year-old boy who had had asymptomatic, several, yellow-red, slightly elevated, palpable, striae-like lesions on their middle and lower back since their early childhood. Light microscopic examinations of skin biopsy specimens demonstrated dermal thickening and focal increases of thin wavy fibers in the upper and mid-dermis but no changes in the epidermis. Verhoeff-van Gieson stains for elastic fiber revealed aggregated, clumped, curled, or fragmented elastic fibers.

Clinical and Histopathological Study of Cellulitis / 대한피부과학회지

BACKGROUND: Cellulitis is a suppurative inflammation involving particularly the subcutaneous tissue. There has been no data about its clinicopathologic features in Korea. OBJECTIVES: The purpose of this study was to investigate the clinicopathologic characteristics of cellulitis and to assess the yield rate of special stainings (Brown-Brenn, Gram) for organisms. METHODS: We reviewed the medical records and histologic sections of 45 patients who had been diagnosed as cellulitis in the Department of Dermatology, Chungbuk National University Hospital from January 1992 to August 1998. RESULTS: The results were as follows. 1. The sex ratio of male to female was 1.5:1 and average age was 43 years old. 2. The lower extremity was the most frequently involved site of cellulitis with a frequency of 53.4%. 3. Erythema, tenderness, local heating, swelling, and pain were almost always presenting clinical manifestations. 4. Diabetes mellitus was the most frequent underlying systemic disease. 5. The route of infection was suspected in 25 cases(55.6%). Tinea pedis was strongly suspected in 7 cases(28.0%), and followed by insect bite in 5 cases(20.0%), herpes zoster in 4 cases(16.0%), and trauma in 2 cases(8.0%). 6. The main complications were orthopedic problems including bursitis, osteomyelitis, and septic arthritis. 7. Microorganisms were isolated in 20 of 43 tissue cultures(46.5%). 8. It is important to suspect Escherichia coli as a causative organism if blistering cellulitis occurs, especially in patients with underlying systemic disease. 9. The most frequent histopathologic findings were perivascular lymphohistiocytic infiltrations in both dermis and subcutaneous fat simultaneously without vasculitis. 10. Special stainings(Brown-Brenn or Gram) were worthy to try, especially in the neutrophilic dominant cellulitis. 11. First-generation cephalosporin was chosen as primary antibiotics in 31 cases, and there was no difference in clinical course between its monotherapy and combined therapy. 12. Twenty percent of cases experienced recurrences. Lower extremity was most common site of recurrence(63.6%). CONCLUSION: Diabetes mellitus and tinea pedis were so closely bound up with cellulitis that control of those diseases is important in view of the clinical course of cellulitis. Special stainings(Brown-Brenn or Gram) were worthy to try, especially in the neutrophilic dominant cellulitis.

A Case of Woolly Hair

We report a case of woolly hair. Woolly hair is found frequently in most blacks but is unusual in individuals of non-negroid origin. A 12-year-old female patient visited our clinic complaining of a hair abnormality. It had been tightly curled, fine, light brown, short and easily broken since birth. On scanning electron microscopy, many of the hairs showed damaged cuticles with cuticular splintering, and most hair shafts were round to oval on cross sectional examination.

Nitric Oxide Synthase Expression and Apoptosis in Psoriasis / 대한피부과학회지

BACKGROUND: Nitric oxide(NO) is generated from L-arginine by NO synthase(NOS). Three types of NOS are currently known:inducible(iNOS), neuronal(nNOS) and endothelial(eNOS). NO has been found to be important in a number of different physiological processes. Of particular relevance to the skin are the roles of NO in vasodilatation, inflammation, immunomodulation and in oxidative damage to cells and tissues. NO exhibits contradictory effects in the regulation of apoptosis. The proapoptotic effects seem to be linked to pathophysiological conditions, where high amounts of NO are produced by iNOS. In contrast, the continuous release of eNOS inhibits apoptosis. Psoriasis is a common chronic skin disease, but the cause of psoriasis is not definitely known until now. OBJECTIVE: To investigate the role of NO in psoriasis pathogenesis, such as inflammatory infiltration, dermal vessels dilatation, apoptosis, we performed this study. METHODS: Ten cases of psoriasis and 5 cases of normal skin for immunohistochemical with antibodies to iNOS, PCNA, bcl-2, p53 and TUNEL stainings, and 5 cases of psoriasis and 2 cases of normal skin for western blot with antibody to iNOS were investigated. RESULTS: The results were summarized as follows.1. Immunohistochemical staining with iNOS showed positive reactions in 9 cases(90 %) of psoriasis, 4 cases among them were strong positive staining, but all cases of normal skin were negative.2. Labelling index of PCNA staining was 24.4+2.5%, 2.4+0.7% in psoriasis, normal skin, respectively.3. All cases of psoriasis and normal skin were negative in p53 staining, but squamous cell carcinoma as positive control was positive.4. Bcl-2 staining showed focal positivity in 5(50%) cases of psoriasis, but diffuse positivity in epidermal basal layer of normal skin.5. TUNEL staining showed positivity in 7(70%) cases of psoriasis, but all of normal skin were negative.6. Western blot with anti-iNOS showed positive 130 kDa band in psoriatic, but not in normal skin tissues. CONCLUSION: The results suggested that NO was considered to play a role in psoriasis pathogenesis, including apoptosis, dermal vessels dilatation and inflammatory infiltration.

A Considered Case as Primary Cutaneous Mucormycosis / 대한의진균학회지

Mucormycosis is an invasive fungal infection, caused by members of the order Mucorales, that usually occurs in immunocompromised individuals. It manifests itself in a variety of ways and rarely may be confined to the cutaneous tissues. We report a case of primary cutaneous mucormycosis associated with longstanding diabetes mellitus and liver cirrhosis. A 53-year-old woman was presented because of cutaneous discoloration and bullae on the both lower extremities. Cutaneous lesions consisted of necrotic blackish discoloration with bullae and ill-defined margins with extending nature. A biopsy specimen from the cutaneous lesion revealed large, broad, nonseptate hyphae branched at right angles. Our patient was successfully treated with intravenous administration of amphotericin B and surgical debridement of necrotic tissue.

A Case of Nodular Amyloidosis

A 38-year-old male patient visited our clinic complaining of three skin lesions on the scalp. There were yellowish to brownish, waxy, non-tender, walnut-sized nodules. Hematoxylin and eosin staining revealed amorphous pinkish material deposits in the dermis. The Congo red stain and Dylon stain under polarizing microscopy showed yellow-green birefringence and the immunoglobulin-lambda light chain stain showed a positive reaction. An electron microscopic examination revealed filaments with uniform diameter(6 to 10nm) that were straight and neither branched nor anastomosed. Based on the clinical, histopathological, immunohistochemical and electron microscopical findings, the skin lesions were diagnosed as nodular amyloidosis.

Cutaneous Manifestations in Sepsis Caused by Methicillin-Resistant Staphylococcus aureus / 대한피부과학회지

Sepsis refers to the systemic response to serious infection. Patients with sepsis usually manifest fever, tachycardia, tachypnea, leukocytosis, and a localized site of infection. Methicillin-resistant Staphylococcus aureus(MRSA) is a gram-positive, nonmotile, aerobic, catalase- positive coccus, which is resistant to all the B -lactam antibiotics. Cutaneous manifestations in sepsis are maculopapules, nodules, petechiae, ecchymoses, purpurae, pustules, vesiculobullae, hemorrhagic bullae and ulcers. When MRSA is identified in blood cultures and skin tissue cultures, the skin lesions can be considered as cutaneous manifestations in sepsis caused by MRSA. We report two cases with erythematous pustules, petechiae, hemorrhagic bullae and maculopapules caused by MRSA sepsis. MRSA grew in blood cultures and skin tissue cultures.

A Case of Trichilemmal Carcinoma

Trichilemmal carcinoma is a rare tumor that is located predominantly on sun-exposed skin of the elderly. It is thought to be related to the external root sheath of the hair follicle and the malignant counterpart of a trichilemmoma. We report a case of trichilemmal carcinoma in a 88-year-old woman who had a 10 year history of a single, dark brown tumor on the right preauricular region. In her past medical history, it had been excised twice at a private clinic without a histopathological evaluation and recurred 2 years later. Histopathological findings showed atypical clear cells resembling those of the outer root sheath. Tumor cells showed PAS-positive cytoplasm. Immunohistochemistry revealed positive high molecular weight cytokeratin expression. To our knowledge, this is the second case of trichilemmal carcinoma in the Korean literature. (Ann Dermatol 100) 175178, 1998).

An Immunohistochemical Stain in Paget's Disease / 대한피부과학회지

BACKGROUND: Generally, there are few problems in the diagnosis of Paget's disease(PD) using the H&E stain. However, the differentiation of PD from the clonal type of Bowens disease and superficial spreading melanoma in situ that shows pagetoid spreading of tumor cells, may present diagnostic difficulties. In addition, the specia1 stains used for demonstrating the presenee of Pagets cells, such as PAS and mucicarmim, are non-specific and not always sensitive. So, inenunohistochemical stains with monoclonal antibodies against various antigens may be helpful for differentiating PD from ather morphologically similar skin lesions. OBJECTIVE: The purpose of this study was to investigate the diagnostic accuracy of immunohisto- chemical staining for diagnostic use in PD. METHODS: Immunohistochemical stains used in the biotin streptavidin amplificxl technique with monoclonal antibodies to several low rnolecular weight cytokeratin(CK)s, EMA and CEA, were performed on formalin-fixed, paraffin-embedded tissue. Twelve cases of PD(10 cases of extranmmmary PD and 2 cases of mammary PD), five cases of superficial spreading melanoma in situ and five cases of Bowens disease were investigated. RESULTS: The results were as follows. 1. Positive reactions with variable intensity using CK7, CKS, CK19 were seen in all cases(100%) of PD and the. staining intensity tor CK7 or CK19 was stronger than that of CKS. 2. Of the 12 cases of PD, both CK18 and CAM5.2 staining showed positivity in 11 cases(92%). 3. EMA and CEA staining showed positivity in 10(83%) and 9(75%) of 12 cases, respectively. 4. Some Pagets cells were negative for CK8, CK18 and EMA, although other positive cells were observed in the same sections. 5. All antigens were consistently negative in all cases of Bowens disease and superficial spreading melanoma in situ. CONCLUSION: The results show that moaoclonal antibodies to low molecular weight CKs are more sensitive than EMA or CEA in the demonstration of Pagets cells. Moreover, among the low molecular weight CK series, CK7 and CK19 are most useful for their high sensitivity and intensity.

A Case of Bednar Tumor / 대한피부과학회지

No abstract available.

A Case of Dopamine Gangrene / 대한피부과학회지

Dopamine, a sympathomimetic agent, is one of the drugs used to improve cardiac output and blood pressure in advanced cardiac life-support in the context of conditions such as shock and heart failure. It is available only for intravenous use. We report a case of dopamine gangrene which has never been reported in Korean medical literature. Four gangrenous lesions developed in both forearms and the left leg of a 72-year-old man during a 7-day infusion of dopamine 3 microgram per kg per minute as treatment for septic shock, which corresponded to the injection sites. The gangrenous lesions healed up spontaneously leaving scars after administration of dopamine was discontinued.

Skin Manifestations of Patients with Liver Cirrhosis / 대한피부과학회지

BACKGROUND: The high level of susceptibility of patients with liver cirrhosis (LC) to septicemic infection is thought to be due to decreased reticuloendothelial function and irnpairment of several components of cell mediated and humoral immunity. It is well known that LC may cause many characteristic skin changes including jaundice, spider angioma, palmar erythema, xanthelasrna and nail changes such as clubbing and white nails. OBJECTIVE AND METHODS: During a 7 month period frorn April to October 1995, 100 patients who had been diagnosed as having LC were evaluated for the duration of their LC, the associated diseases they had apart from LC and various skin manifestations. Also, we performed the tuberculin test in 20 patients with LC and evaluated the correlation of the tuberculin test with severity of LC divided into 3 groups according to the Childs classification. RESULTS: The results are summarized as follows ; 1. The most frequent duration of LC was under 5 years (74%). 2. The most common associated disease of patients with LC was upper GI bleeding including esophageal varix (24 cases). Also, diabetes mellitus (13 cases) and hepatic coma (11 cases) were observed. 3. Jaundice (82 cases) was the most frequent skin rnanifestation of patients with LC. In addition, vascular changes (81 cases) and various nail changes (69 cases) were observed. Onychomychosis was the most common nail change of patients with LC. 4. 60% of the patients who were given the tuberculin test showed anergy, and the frequency of anergy increased in proport on to the severity of LC. However, it was not significant statistically (p> 0.05 ). CONCLUSIONS: Some of the skin manifestations help in the diagnosis of LC. Also, increased frequency of tuberculin test anergy in proportion to the severity of LC is thought to be related to decreased cell mediated immunity, although statistically it is not significant.

Immunohistochemical Findings of p53, PCNA, and bcl-2 in the Tumor and Epidermis Overlying and Adjacent to Non-melanoma Skin Cancers / 대한피부과학회지

BACKGROUND: In both normal tissue development and malignant cell growth, the maintenance of cell numbers reflects a balance between cell proliferation and cell death. Excessive growth may result from uncontrolled cellular proliferation or limited cell death. The growth process of squa mous cell carcinorna(SCC) has recently been reported to differ from that of basal cell carcinoma (BCC). Several reports have suggested that the normal-appearing, overlying epidermis might be a proliferative and be a precursor lesion of BCC. SCCs occur in burn scars, chronic ulcers, and chronic sinus but the najority of SCCs are actinic in origin. It is possible to develop subsequent. skin cancer from the normal-appearing epidermis adjacent to SCC due to chronic sun-exposure. OBJECTIVE: The purpose of this study was to investigate growth dynamics of non-melanorna skin cancers and characteristics, including the carcinogenic property, of the normal appearing epidermis overlying and acljacent to non rnelanoma skin cancers. METHODS: We compared expressions for p53, PCNA, bcl 2, and TGF-alpha in 21 BCCs and 8 SCCs by irnmunohistochi.mical staining with a labelled strept,avidin biotin complex(LSAB) method. RESULTS: The results were as follows. 1) Expressions for p53 and PCNA within the tumor remarkably increased and the distribution pattern of expression for p53 was not always consistent with that for PCNA. 2) An expression the bcl-2 was increased in half of the BCCs, but not in all of the SCCs. 3) The epidermis overlying the BCC showed increased expressions for p53, PCNA, and TGF-alpha. 4) The epidermis adjacent to the SCC showed increased expressions for p53, and PCNA in a few of cases. CONCLUSION: We suggest that a neoplastic transformatiqn in BCC is caused by extended cell survival rather than increased cell proliferation, but in SCC it is caused by other mechanisms, and that the proliferativ activity in the epiderrnis overlying BCC is different from the normal epidermis and maybe repr'sents carcinogenic activity of the epidermis.

A Case of Infantile Myofibromatosis / 대한피부과학회지

Infantile myofibromatosis is an uncornmon, benign, self-limiting, localized or generalized process, probably of hamartomatous origin, which consists to a large degree of cells having the characteristics of myofibroblasts and sometimes of pericytes. Both solitary and multicentric forms occur. Most lesions are present at birth or in early infancy, and some are familial in origin. A female newborn presented with a firm, round, red colored, 3 x 3 cm sized tumor with central necrosis on the left chest. Histological examination revealed well-circumscribed nodules consisting of short bundles of plump, spindle shaped cells displaying staining characteristics intermediate between fibroblasts and smooth muscle cells. The tumor was immunoreactive for actin but did not stain for desmin. A Follow-up examination at the age of 3 months revealed a moderate degree of spontaneous regressior of the lesion.

A Case of Nail - Patella - Elbow Syndrome / 대한피부과학회지

Nail-patella-elbow syndrome is a relatively rare autosomal dominant disorder characterized by nail and skeletal defects, especially of the patella. The principal manifestations include hypoplastic or absent patellae, dysplastic finger-nails, dislocated radial heads with limited elbow motion, and often iliac horns. A less common but not infrequent manifestations are hereditary nephropathy and hyperpigmentation of the pupillary margin of the iris ("Lester iris"). A 17-year-old man was presented with abnormalities of both the 1st and 2nd finger-nails since birth. He had triangular lunulae and hypoplastic nail plates. Two months ago, the diagnosis of subluxation of both elbow joints was made as limitation of motion and radiologic findings of both knee joints revealed hypoplastic patellae. Routine laboratory studies were all within normal limits. The patient's father had triangular lunulae and hypoplastic nail plates on both 1st finger-nails. We report a case of nail -patella syndrome with the review of literature.

The Study on the Effect of Six Soaps on Cutaneous Irritation Measured by Noninvasive Technique / 대한피부과학회지

BACKGROUND: Soaps are the most widely used body cleanser and sometimes cause irritation of the skin. OBJECTIVE: Our purpose was to compare the skin irritancy of 6 soaps using noninvasive techniques. METHODS: The skin responses to patch test with 6 soaps were measured by visual scoring, evaporimeter and corneometer. RESULTS: The results are summarized as follows. 1. F soap was shown to cause the least irritancy measured by visual scoring and corneometer. But using evaporimeter, there were no differences in irritancy between the 6 soaps. 2. Through correlation analysis, we found that the evaluation of the evaporimeter was closely related to visual measurement. CONCLUSION: Soap irritancy can be measured by noninvasive techniques, such as the evaporimeter, corneometer, laser doppler flowmetry and visual scoring. Further study of evaluation after short and repeat contacts with soap are needed.

The Effectiveness and Remission Time of Retinoid - Modified Ingram Therapy for Psoriasis / 대한피부과학회지

BACKGRUOND: Although treatment with etretinate or modified Ingram method is effective for psoriasis, both regimens have limitations beeause of the risk of long-term toxicity. OBJECTIVE: We performed retinoid-modified Ingram combination therapy expecting greater therapeutic efficacy and less side effect. METHODS: Thirty three plaque-form psoriasis patients were included. Pretreatment with etretinate for 1 to 2 weeks was followed by modified Ingram therapy in combination with etretinate. RESULTS: l. Among 33 patients, clearing was shown in 26 patients(78.8%), 4 patients(12.1%) was improved, and 3 patients(9.1%) showed failure. The number of cleared patient was 13/15 (86.7% ) in moderate group, and 13/18 (72.2%) in severe group. 2. In cleared patients, the mean numbers, duration, and total dose of UVB therapy reaching grade 4 were 11.9, 24.5 days, 1348.5 mJ/cm in trunk, and 13.5, 29.1 days, 1733.3 mJ/cm in extremities. Their differences between trunk and extremities were not statistically significant (p>0.05). 3. In cleared patients, the mean numbers, duration, total dose of phototherapy, and total close of etretinate reaching grade 4 in severe group were not significantly higher than them in moderate group (p>0.05). 4. There were some side effects of etretinate such as cheilitis, dry mouth, and side effects of modified Ingram therapy such as erythema, pruritus. But there was no discontinuation of therapy due to side effect. 5. In 22 patients who were followed up at least,one year, the mean remission time was 149 months in moderate group and 6.9 months in severe group. CONCLUSION: Our study suggests that retinoid-modified Ingram regimen is effective and tolerable in the treatment of psoriasis, especially in severe group.

The Effectiveness and Remission Time of Retinoid - Modified Ingram Therapy for Psoriasis / 대한피부과학회지

BACKGRUOND: Although treatment with etretinate or modified Ingram method is effective for psoriasis, both regimens have limitations beeause of the risk of long-term toxicity. OBJECTIVE: We performed retinoid-modified Ingram combination therapy expecting greater therapeutic efficacy and less side effect. METHODS: Thirty three plaque-form psoriasis patients were included. Pretreatment with etretinate for 1 to 2 weeks was followed by modified Ingram therapy in combination with etretinate. RESULTS: l. Among 33 patients, clearing was shown in 26 patients(78.8%), 4 patients(12.1%) was improved, and 3 patients(9.1%) showed failure. The number of cleared patient was 13/15 (86.7% ) in moderate group, and 13/18 (72.2%) in severe group. 2. In cleared patients, the mean numbers, duration, and total dose of UVB therapy reaching grade 4 were 11.9, 24.5 days, 1348.5 mJ/cm in trunk, and 13.5, 29.1 days, 1733.3 mJ/cm in extremities. Their differences between trunk and extremities were not statistically significant (p>0.05). 3. In cleared patients, the mean numbers, duration, total dose of phototherapy, and total close of etretinate reaching grade 4 in severe group were not significantly higher than them in moderate group (p>0.05). 4. There were some side effects of etretinate such as cheilitis, dry mouth, and side effects of modified Ingram therapy such as erythema, pruritus. But there was no discontinuation of therapy due to side effect. 5. In 22 patients who were followed up at least,one year, the mean remission time was 149 months in moderate group and 6.9 months in severe group. CONCLUSION: Our study suggests that retinoid-modified Ingram regimen is effective and tolerable in the treatment of psoriasis, especially in severe group.