Endovenous Laser Treatment of Varicose Veins: Long-Term Results / 대한피부과학회지

PURPOSE: It is necessary to eliminate the highest point of reflux originating at the saphenofemoral junction (SFJ) and the great saphenous vein (GSV) to treat varicose veins. Minimal invasive alternatives in the treatment of varicose veins due to the SFJ and GSV incompetence have been tried over the years, resulting in various degrees of success depending on the method. Recently, endovenous laser occlusion using a diode laser has been introduced, with initial successful clinical reports. The present study was conducted to evaluate long-term follow-up results of endovenous laser treatment for closing the incompetent GSV at its junction with the femoral vein. METHOD: Forty limbs (thirty one patients) with reflux at the SFJ into the GSV were treated with 810nm or 940nm diode laser energy, administered endovenously through a bare-tipped laser fiber (600micrometer). The parameters were 12~15 W in a continuous mode, with a pulse of laser energy every second. A duplex doppler ultrasound (DDUS) was used to mark the location of the GSV from the knee to the SFJ. Vein access was achieved by using either the stab wound Mueller hook approach or ultrasound-guided needle puncture. Exact placement of the fiber was determined by direct observation of the aiming beam through the skin or ultrasound confirmation. Where necessary, a standard ambulatory phlebectomy was performed to remove remaining varicosities. Clinical and duplex evaluation was carried out at regular intervals (1, 3, 6, 12 months) following the initial treatment. RESULTS: Successful occlusion of the GSV, defined as absence of flow on the DDUS, was noted in 39 of 40 GSV (97.5%) during the last visit. Recanalization of GSV occurred in two limbs, 3 and 6 months after treatment. The GSV junction of 7 limbs had remained closed for 2 years. Side effects were minimal, with 21 limbs showing significant purpura, 6 limbs developing palpable fibrous cord and 4 limbs showing transient hyperpigmentation within less than 2 weeks to one month after treatment. CONCLUSION: Long-term results obtained from treatment of 40 limbs with endovenous laser treatment demonstrate a recurrence rate of less than 6% after 29 months of follow-up. These results are comparable or superior to those available for treatment of GSV reflux, including surgery, US-guided sclerotherapy, and radiofrequency ablation. Endovenous laser treatment appears to offer the benefit of lower rates of complication and the avoidance of general anesthesia.

A Case of SAPHO Syndrome in a Palmoplantar Pustulosis Patient / 대한피부과학회지

SAPHO syndrome is characterized by sternocostoclavicular osteoarthritis and hyperostosis in the anterior chest wall, and skin changes such as palmoplantar pustulosis and acne. Despite the higher frequency of psoriasis in this syndrome, its inclusion in the psoriatic arthropathy spectrum is not yet clearly established to date. According to a familial series of the SAPHO syndrome, both sacroiliac and sternoclavicular joints could be involved. We report a case of SAPHO Syndrome in a palmoplantar pustulosis patient who had on associated osteoarticular manifestation. A 47-year-old woman had been treated for palmoplantar pustulosis for 15 months. Pain and tenderness then developed abruptly on the chest and neck, and multiple erythematous papules and pustules broke our over the whole body. Laboratory tests were negative for serum RA factor and ANA, and positive for HLA-B27. An X-ray showed a hyperostosis, osteolytic and osteosclerotic lesions in the costo-sterno-clavicular junction. 99mTc isotope scan showed the typical "Bull's head sign" in the anterior chest wall due to increased uptake in the manubrium and both sternoclavicular joints.

A Case of Chilblain Lupus Erythematosus Associated with Antibodies to SSA/Ro / 대한피부과학회지

Chilblain lupus erythematosus (CLE) is a subtype of lupus erythematosus. It is characterized by cutaneous lesions located on the fingers, toes, nose, ears, elbows, heels and knees and is induced or aggravated by exposure to a cold or damp climate. Various laboratory alterations including antinuclear antibody (ANA), anti-dsDNA antibody, anti-SSA/SSB antibody, rheumatoid factor, and cryoglobulin have been reported in CLE patients. Especially, SSA/Ro antibodies may be especially associated with CLE. Approximately 20% of patients presenting with CLE later develop systemic lupus erythematosus (SLE). A 28-year-old man diagnosed with SLE presented with a 2-year history of pruritic erythematous plaques on the ears and dorsa of his hands and feet. The lesions developed or were aggravated the cold weather. In the summer, they were reported to improve, but they did not heal. ANA anti- SSA/SSB antibodies, and anti-dsDNA antibodies were found to be present. He was treated with a topical steroid and advised to avoid the cold.

Results of Photopatch and Patch Tests in 35 Korean Patients with Chronic Actinic Dermatitis and Clinical Importance of These Findings / 대한피부과학회지

BACKGROUND: Chronic actinic dermatitis (CAD) is a rare disease worldwide. It has been defined on the basis of three criteria: 1) clinical - a persistent eczematous eruption on sun- exposed area with possible extension into non-exposed areas, 2) photobiological - a reduction in the minimal erythema dose to UVB irradiation, and possibly longer wavelengths, and 3) histologic - an appearance consistent with chronic eczema, with or without the presence of lymphoma-like changes. However, only a few clinicohistopathologic and photobiological analyses of CAD have been undertaken in Korea. OBJECTIVE: To explore photoallergens and/or allergens causing or thought to be associated with CAD in Korean patients, and to compare the photopatch or patch test results in Korea with those from other countries. METHODS: Thirty-five Korean patients with CAD were enrolled for this study. Photopatch tests were carried out by applying two sets of the Scandinavian photopatch series to each patient. Two days after application, the photopatch tests were analysed, and one set of the photoallergens was irradiated with 50% of the MED-UVA. Both sets of photoallergens were examined 2 days later. A European standard series was used to assess the patch tests. At two and four days after application, patch tests were analysed. RESULT: Twenty-seven of the 35 patients (77.1%) who had photopatch tests showed positive responses; balsam of Peru, promethazine HCl, perfume mix, fentichlor, chlorhexidine digluconate, and chlorpromazine HCl were the common photoallergens that elicited a positive response. Twenty-one of the 35 patients (70%) showed allergy to nickel, chrome, and/or ammoniated mercury. Noticeably, photoallergens such as balsam of Peru, perfume mix, cobalt, and captan revealed positive reactions in the patch tests, too. CONCLUSION: In 77.1% and 74.3% of CAD patients, photoallergens and allergens were identified, respectively. Among them, 57.1% showed positive reactions including both photopatch and patch tests. After the most frequent photoallergens, perfume and spices, and phenothiazines or related antihistamines ranked next and were found to be a unique characteristic to Korea. Photopatch and patchtests are the method for detecting photoallergens and allergens as important initiating agents and are the diagnostic tool for the epidemiologic study of CAD.

A Case of ALK-Negative Systemic Anaplastic Large Cell Lymphoma

No abstract available.

Effects of Topical Cyclosporin-A in the Treatment of Alopecia Areata / 대한피부과학회지

BACKGROUND: Alopecia areata(AA) is believed to be an autoimmune disease in which a mononuclear cell infiltrate develops in and around anagen hair follicles. There is no clearly superior therapy in the treatment of AA, especially AA with atopic dermatitis and alopecia universalis. The theory of autoimmune pathogenesis of alopecia areata suggests a potential therapeutic effect of cyclosporin-A(CsA). OBJECTIVE: The purpose of this study is to evaluate the effectiveness of CsA in the treatment of AA. METHOD: 12 patients with severe or refractory AA were treated with DPCP for at least 12 months. They showed resistance to treatment using DPCP. CsA was made up as a 0.01M, 0.005M solution in an ethanol preparation. 1cc of 0.01M CsA solution was applied on the Lt. side scalp and 1cc of 0.005M CsA solution was applied on the Rt. side scalp. The drug was applied once per week. Response to treatment was evaluated as follows: complete recovery, more than a 80% extent of hair regrowth; marked recovery, hair regrowth of 60% to 80%, moderate recovery, hair regrowth of 40% to 60%; slight recovery, hair regrowth of 20% to 40%; no response, hair regrowth of 0% to 20%. RESULT: The Six patients with focal type AA showed a moderate recovery. Of the six patients with alopecia totalis, 4 patients showed a moderate recovery, two patients showed no response. CONCLUSION: Topical CsA therapy is recommended in severe and refractory AA.

A Case of Chromoblastomycosis Treated with Terbinafine / 대한의진균학회지

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by pigmented or dematiaceous fungi that are implanted into the dermis from the external environment. The vast majority of infections are caused by Fonsecaea pedrosoi and Cladosporium carrionii. Several drugs, such as itraconazole, amphotericin B, terbinafine, have been tried with variable success and various therapeutic techniques, including radiotherapy, cryosurgery, electrodesiccation and surgical excision, can be applied as a further treatment. So far, there are five cases filed as chromoblastomycosis in Korea. Four of them are reported from the southern part of the Korea. Intralesional injection or occlusive dressing of Amphotericin B, and oral administration of intraconazole have been used for the treatment in reported cases. Now, we report firstly a case of chromoblastomycosis treated with terbinafine. A 54-year-old Korean teacher had 10 x 5.5 cm sized dark purple colored plaque with crusts 4 years earlier as a linear plaque after an injury by the thorns of wooden chair. A skin biopsy revealed pseudoepitheliomatous hyperplasia and dermal infiltration of mixed inflammatory cells and Touton type multinucleated giant cells with numerous sclerotic cells. Several clusters of sclerotic bodies were observed also within the giant cells. On the fungus culture, the colony showed slowly growing dark-brown colored heaped appearance in 4 weeks. Isolated fungus was identified as Fonsecaea pedrosoi. Because of partial response to 10 months' itraconazole treatment, the treatment regimen was changed to terbinafine 500 mg/d with marked improvement after 4 months.

Ambulatory Phlebectomy Using the Tumescent Anesthesia / 대한피부과학회지

BACKGROUND: Ambulatory phlebectomy is a cosmetically elegant outpatient procedure for the removal of varicose veins. One of the keys to its success is the ability to perform the procedure under local anesthesia. Tumescent anesthesia is applied in dermatologic surgery and now being expanded for use in phlebectomy. OBJECTIVE: To evaluate the efficacy and safety as well as advantages of 0.1% tumescent anesthesia with epinephrine in ambulatory phlebectomy. METHODS: Twenty-two patients(twenty-seven legs) without reflux at the SFJ were treated with ambulatory phlebectomy using the tumescent(0.1%) technique. In all patients, we monitored blood pressure, heart rate, and O2 saturation before, during, and after procedure. All patients were asked to rate the pain, both intraoperatively and postoperatively. They visited in hospital to record complications at one day, one week, and various monthly intervals (1, 3, 6, 12 months) following the initial treatment. RESULTS: The volume of anesthetic fluid ranged from 90 to 650ml, with an average of 320.7ml of fluid. Blood pressure, heart rate, and O2 saturation measured did not significantly change before, during, or after procedure. The average reported intraoperative pain for all interviewees was from 0 to 2. For postoperative pain, patients reported pain rate less than one. During operation, significant surgical blood loss is eliminated. There were minimal hematoma, purpura, and hyperpigmentation after operation. CONCLUSION: 0.1% Tumescent anesthesia provides a very safe, comfortable technique of anesthetizing patients for ambulatory phlebectomy and may decrease the incidence of complications.

Ambulatory Phlebectomy Using the Tumescent Anesthesia / 대한피부과학회지

BACKGROUND: Ambulatory phlebectomy is a cosmetically elegant outpatient procedure for the removal of varicose veins. One of the keys to its success is the ability to perform the procedure under local anesthesia. Tumescent anesthesia is applied in dermatologic surgery and now being expanded for use in phlebectomy. OBJECTIVE: To evaluate the efficacy and safety as well as advantages of 0.1% tumescent anesthesia with epinephrine in ambulatory phlebectomy. METHODS: Twenty-two patients(twenty-seven legs) without reflux at the SFJ were treated with ambulatory phlebectomy using the tumescent(0.1%) technique. In all patients, we monitored blood pressure, heart rate, and O2 saturation before, during, and after procedure. All patients were asked to rate the pain, both intraoperatively and postoperatively. They visited in hospital to record complications at one day, one week, and various monthly intervals (1, 3, 6, 12 months) following the initial treatment. RESULTS: The volume of anesthetic fluid ranged from 90 to 650ml, with an average of 320.7ml of fluid. Blood pressure, heart rate, and O2 saturation measured did not significantly change before, during, or after procedure. The average reported intraoperative pain for all interviewees was from 0 to 2. For postoperative pain, patients reported pain rate less than one. During operation, significant surgical blood loss is eliminated. There were minimal hematoma, purpura, and hyperpigmentation after operation. CONCLUSION: 0.1% Tumescent anesthesia provides a very safe, comfortable technique of anesthetizing patients for ambulatory phlebectomy and may decrease the incidence of complications.

A Case of Actinic Lichen Planus / 대한피부과학회지

Actinic lichen planus is a particular subtype of lichen planus with a distinct photodistribution. This disease has been variously named lichen planus in subtropical countries, such as lichen planus subtropicus annularis, lichen planus tropicus, summertime actinic lichenoid eruption, and lichenoid melanodermatitis. It is a disorder seen most frequently in Africa, the Middle East, and the Indian subcontinent, favoring Asians. This disease presents in the spring or summer and is frequently quiescent during the winter. A 61-year-old man with unusual lichenoid photosensitive eruption is presented. The lesions developed during the late spring, appearing on both dorsa of hands, wrists, and lower legs. We report a case of actinic lichen planus with a review of the literature.

Sentinel Lymph Node Biopsy and Staging of Melanoma Using Lymphoscintigraphy and Gamma-probe / 대한피부과학회지

BACKGROUND: In malignant melanoma, the regional nodal status is acknowledged as the most powerful indicator of prognosis. Sentinel lymph node status was formally adopted in 2002 AJCC melanoma staging system. However, there has been no clinical study on sentinel lymph node evaluation, especially using lymphoscintigraphy and gamma probe in melanoma patients in Korea. OBJECTIVE: Our purpose was to assess the usefulness of lymphoscintigraphy and intraoperative gamma probe for the detection of sentinel lymph node in melanoma patients. METHODS: In eight malignant melanoma patients (7 stage I/II, 1 stage III), a lymphoscintigraphy with 99mTc-radiocolloids were injected peritumoral area and the identified first lymph node was considered to be a sentinel node. Once the sentinel lymph node was identified using a hand-held gamma probe for intraoperative mapping, it was excised. And the sentinel node was examined by routine hematoxylin-eosin and immunohistochemical stain (HMB45, S-100). RESULTS: Sentinel nodes were identified in 8 patients all using lymphoscintigraphy and intraoperative gamma probe. Nine sentinel nodes were found in 8 patients, and sentinel lymph node biopsies showed micrometases in 5(55.5%). The location of sentinel nodes was that 3(33.3%) were located in axilla, and 6(66.6%) in groin. The case that had melanoma on back revealed dual lymphatic pathway with 2 sentinel nodes on axilla and inguinal area. CONCLUSIONS: We conclude that preoperative lymphoscintigraphy and intraoperative gamma-probe guided sentinel lymph node biopsy is useful for acute staging and prediction of prognosis for melanoma patients.

A Case of Type IIa Hyperlipoproteinemia and Coronary Artery Disease Associated with Xanthoma Tendinosum / 대한피부과학회지

We report a case of type IIa hyperlipoproteinemia with xanthoma tendinosum associated with coronary artery disease in a 51 year-old male. Multiple hard nodules appeared firstly on both achilles tendon area 30 years ago and the lesions gradually spread to the dorsa of hands and feet. On past history, he had been diagnosed as unstable angina with atherosclerosis of three vessels in coronary arteries, 2 years ago. His family history revealed nothing contributory. Serum lipid profile including lipoprotein electrophoresis showed an increase in total cholesterol and LDL-cholesterol with increased beta-lipoprotein fraction, which suggested type IIa hyperlipoproteinemia. Histopathologic finding of a nodule from the dorsum of right hand showed many foamy histiocytes and cholesterol clefts in the dermis. Most of the xanthoma cells were mononuclear, but many Touton type giant cells were seen also. He died suddenly of heart failure with unstable angina.

A Case of Onychomycosis due to Aureobasidium pullulans after Trauma / 대한의진균학회지

Aureobasidium pullulans is classified among dematiaceous fungi, characterized by the production of melanin pigments. It is widely distributed throughout the environment. It has occasionally been infected on the skin and nails of humans. We report a case of onychomycosis due to Aureobasidium pullulans developed in an 49-year-old female after trauma.