A Case of Solitary Adult Type Myofibroma in Eyelid / 대한피부과학회지

Solitary myofibroma is an uncommon myofibroblastic neoplasm, presenting as an asymptomatic nodule of the skin, which mainly occurrs in adults. It was thought to be the adult counterpart of infantile myofibromatosis. Although it has histopathological similarity to infantile myofibromatosis, it shows a discrete clinicopathological entity compared with infantile form on the basis of its much later onset, superficial location, invariable solitary occurrence and uniformly benign behavior. A-45-year-old woman had a skin lesion on the right upper eyelid for 2 years, which was a solitary, painless nodule with eyelid retraction. The excised tumor was diagnosed as myofibroma by light microscopy and immunohistochemistry.

A Case of Epithelioid Sarcoma / 대한피부과학회지

Epithelioid sarcoma is a rare soft tissue neoplasm of uncertain origin and occurs most commonly on the distal extremities of young adult males. It usually presents as a slowly growing dermal or subcutaneous nodule, however it is characterized by multiple recurrences and metastases. Its slowly growing pattern and confusing histopathologic findings often result in inaccurate or delayed diagnosis. We describe a 38-year-old female of epithelioid sarcoma on the hand, emphasizing that clinicians should consider the possibility of this disease in case of nodular or ulcerated lesion of the extremities, especially distal upper extremities.

A Case of Fibrous Hamartoma of Infancy / 대한피부과학회지

Fibrous hamartoma of infancy (FHI) is an uncommon benign fibrous proliferation, usually presenting as a single nodule. A 17-month-old male patient had an asymptomatic fingertip-sized subcutaneous nodule on the right side of the back for 6 month. Histopathologic findings showed the typical feature of FHI, that is well defined intersecting fibrous trabeculae, small immature cells within loosely textured areas, and mature adipose areas in the lower dermis and subcutaneous layer. Immunohistochemically, vimentin positivity was present in both the trabecular and loosely textured areas, but desmin was not present in any components which is positive usually only in trabecular areas. The lesion was excised without recurrence. We experienced and report an uncommon case of fibrous hamartoma of infancy in a 17-month-old male patient.

A Case of Extensive Nevus Comedonicus / 대한피부과학회지

Nevus comedonicus(NC) is an uncommon skin disorder, which appears as linear groups of open comedones clinically. A 56-year-old male patient presented a painful walnut-sized erythematous nodule with pus-like discharge on the right posterior aspect of the neck. He has extensive comedone like lesions on the right side of the body after his birth and has suffered from recurrent infections. Histopathologic finding showed the typical features of nevus comedonicus, wide and deep invagination of the epidermis filled with keratin plugs. He was treated with incision, pus drainage and systemic antibiotics. We report a case of extensive nevus comedonicus.

Treatment of Molluscum Contagiosum with Topical Tretinoin Therapy / 대한피부과학회지

BACKGROUND: Conventional treatment of molluscum contagiosum(MC) has been surgical curettage. This treatment is painful and not feasible in widespread lesions, particularly in infants and children. OBJECTIVE: We evaluated 30 children with MC for the clinical effectiveness and advantage of treatment with topical tretinoin therapy. METHODS: Thirty children with MC visited our clinic were asked to apply the tretinoin cream to each individual lesion, and followed up for 8 to 12 weeks. During these periods the assessment of therapeutic response was performed on a biweekly basis. RESULTS: Fifteen(50%) of 30 patients achieved complete clearance after a mean treatment period of 4.7 weeks. Partial clearance were observed in 5(16.7%) and no response in 1 children(3.3%). No patient dropped out because of the adverse effects. Twenty one children(66.7%) reported a mild itching and/or erythema, stinging, and temporary hyperpigmentation. CONCLUSION: Therapy with treatinoin cream was found to be effective, safe, and painless in the treatment of MC in children.

Cytokine Expression and Cellular Phenotype in Skin Lesions of Borderline Lepromatous Leprosy during Multiple Drug Therapy / 대한피부과학회지

BACKGROUND: Distinct patterns of T cell cytokine production have been shown to influence the outcome of infection. There will be plethora of dynamic changes of T cells and their cytokine production after starting drug therapy in leprosy skin lesions. OBJECTIVE: To determine dynamics of cytokine expression, T cell and macrophage populations in the lesions taken serially in early part of World Health Organization-Multiple Drug Therapy in BL patients. METHODS: Cytokine mRNA expression of TNF-alpha, IFN-gamma, IL-4 and IL-10 in BL skin lesion was detected by RT-PCR analysis. To determine cellular phenotypes of infiltrated cells, immunohistochemical staining method was performed using antibodies to CD4, CD8, CD56, CD57, CD 68, gammadelta-TCR , and S-100 protein. RESULTS: TNF-alpha mRNA, initially showed no consistent change, increased 6 months after MDT. IFN-gamma and IL-10 mRNA showed decreasing tendency initially, but failed to show any consistent increase or decrease after 6 months. IL-4 mRNA was not detected in our patients. In reactional states, mRNA expression of TNF-alpha, IFN-gamma, IL-10 was increased in 2 patients but decreased in 1 patient compared to baseline. Ratio of TNF-alpha positive cells decreased during MDT compared to baseline(p<0.05), but ratio of cells expressing IFN-gamma showed no significant change after MDT. Only CD68 positive cells decreased after MDT(p<0.05). CONCLUSION: Variable treatment induced changes in cellular patterns and cytokine expression within BL lesion observed in this study suggest that complex mechanism of immune systems - including cytokine regulation and defect in macrophages - may exist and be involved in the pathogenesis of leprosy.

A Histopathologic Study of Alopecia Using Transverse Sections / 대한피부과학회지

BACKGROUND: Conventional vertical sections of scalp biopsy specimens are often inadequate for the diagnosis of alopecia. Alternatively, a better approach can often be provided with the use of transverse sections continues, which is readily available and continues to grow in popularity. OBJECTIVE: The purpose of this study was to compare the histopathologic findings of transverse and vertical sections of scalp biopsy specimens in various types of alopecia. METHODS:A total of 27 scalp biopsy specimens obtained during the past 16 months for the evaluation of alopecia was processed for either transverse or vertical section, or for both. With these sections a quantitative morphologic study was done by counting a variety of follicular structures, and any specific histopathologic changes were recorded. RESULTS: Diagnostic features that were better seen in vertical sections included quantitative morphologic changes of a variety of follicular structures such as total number of follicles, catagen and telogen hairs, vellus hairs and follicular stele, as were anagen-telogen ratios and terminal-vellus ratios. Other histopathologic findings that were better demonstrated in transverse sections included peribulbar inflammatory infiltrate for alopecia areata, miniaturization for androgenetic alopecia, trichomalacia and pigment cast for trichotillomania, and fat atrophy for pressure alopecia. In some cases, especially for scarring alopecia, vertical sections also allowed for useful adjunctive diagnostic information such as follicular destruction, dermal fibrosis and sclerosis, and interface change. CONCLUSION: Transverse sections of scalp biopsy specimens provided many useful information in histopathologic diagnosis of alopecia. But, in some cases of scarring alopecia, vertical sections provided more diagnostic findings. To overcome the diagnostic limitation of transverse sections, therefore, observing both transverse and vertical sections at a time could be an alternative way of enhancing diagnostic yield of alopecia.

A Histopathologic Study of Alopecia Using Transverse Sections / 대한피부과학회지

BACKGROUND: Conventional vertical sections of scalp biopsy specimens are often inadequate for the diagnosis of alopecia. Alternatively, a better approach can often be provided with the use of transverse sections continues, which is readily available and continues to grow in popularity. OBJECTIVE: The purpose of this study was to compare the histopathologic findings of transverse and vertical sections of scalp biopsy specimens in various types of alopecia. METHODS:A total of 27 scalp biopsy specimens obtained during the past 16 months for the evaluation of alopecia was processed for either transverse or vertical section, or for both. With these sections a quantitative morphologic study was done by counting a variety of follicular structures, and any specific histopathologic changes were recorded. RESULTS: Diagnostic features that were better seen in vertical sections included quantitative morphologic changes of a variety of follicular structures such as total number of follicles, catagen and telogen hairs, vellus hairs and follicular stele, as were anagen-telogen ratios and terminal-vellus ratios. Other histopathologic findings that were better demonstrated in transverse sections included peribulbar inflammatory infiltrate for alopecia areata, miniaturization for androgenetic alopecia, trichomalacia and pigment cast for trichotillomania, and fat atrophy for pressure alopecia. In some cases, especially for scarring alopecia, vertical sections also allowed for useful adjunctive diagnostic information such as follicular destruction, dermal fibrosis and sclerosis, and interface change. CONCLUSION: Transverse sections of scalp biopsy specimens provided many useful information in histopathologic diagnosis of alopecia. But, in some cases of scarring alopecia, vertical sections provided more diagnostic findings. To overcome the diagnostic limitation of transverse sections, therefore, observing both transverse and vertical sections at a time could be an alternative way of enhancing diagnostic yield of alopecia.

Rosacea: Clinical Study of 67 Cases

BACKGROUND: Rosacea is a chronic skin disease which primarily affects the face. There have been many basic and clinical studies on rosacea in the West, but little in Korea. OBJECTIVE: This study was to investigate clinical features of rosacea in Korea and to compare them with those in the West. METHODS: During a 20-month period, 67 patients diagnosed as having rosacea were examined for their clinical presentations by means of personal interview. RESULTS: Erythema and telangiectasia were found in almost all of the 67 patients. Comparing with the results in the West, flushing and telangiectasia were more common whereas papules, pustules, and rhinophyma were less common with no case of ocular complaints or migraine. CONCLUSION: Because early detection and treatment is necessary to prevent the progression of rosacea, it is important to realize that rosacea is not uncommon in Korea and to recognize its somewhat different clinical manifestations from those in the West.

Clinical and Histopathological Study of Benign Melanocytic Neoplasms on the Palm and Sole / 대한피부과학회지

BACKGROUND: The incidence of malignant melanoma in oriental countries is lower than that in western countries. But recently the incidence of malignant melanoma and related death rate are increasing in the world. Malignant melanoma on the palm and sole is known to have worse prognosis and sometimes radical surgery such as amputation is necessary. It is important to exclude malignant melanoma when pigmented patch is encountered, and biopsy is necessary in most cases. But histopathological features of benign melanocytic neoplasms occurring at palm or sole are known to be confusing, because they can resemble the features of malignant melanoma. But there has been no report on this item in Korean dermatological literature, to our knowledge. OBJECTIVE: We investigated the histopathological features of benign melanocytic neoplasms on the palm and sole with their clinical features. MATERIALS AND METHODS: A total of 23 benign melanocytic neoplasms that had been excised from the palm and sole at Inje University Sanggye Paik Hospital and Seoul National University Hospital between July 1991 and April 1998 were evaluated. The retrospective analysis of the clinical manifestation was performed. Histologically, hematoxylin and eosin stained tissue sections were reviewed with the following criteria: symmetry, circumscription, lentiginous hyperplasia, anastomosing rete ridges, pagetoid spread, papillary dermal fibroplasia, lymphocytic infiltrate, pigment in the dermis and the stratum corneum, cytologic atypia, and mitotic activity. RESULTS: Five patients were male and eighteen were female; the mean age was 27.6 years with a peak incidence in the fourth decades. Six lesions had asymmetric, irregular and geographic borders. The diameter of the lesions varied; 3 cases were larger than 9 mm in maximum diameter. Clinically, we suspected 7 cases to be malignant melanoma before biopsy. Histological diagnoses of 23 benign melanocytic neoplasms were as follows: 12 junctional nevi, 3 compound nevi, 1 intradermal nevus, 2 lentigines, 3 benign melanocytic hyperplasias, and 2 congenital melanocytic nevi. Microscopic findings showed single melanocytic proliferation at the dermo-epidermal junction in 17 cases(73.9%), lentiginous hyperplasia in 8 cases, upward migration of melanocytes in 8 cases(34.7%), and ill-defined lateral circumscription in 6 cases(26.0%). Mitotic figures and cytologic atypia were not present. Pigments were variously seen in the stratum corneum in all cases and conspicuous amounts of melanin where the melanocytes upwardly migrated were found in 8 cases. CONCLUSION: There has been a report that the diameter of lesions is very important in differential diagnosis of malignant melanoma when a pigmented lesion is present on the palm and sole and 9mm is the critical maximum diameter. But we encountered 3 cases of benign melanocytic neoplasm which were larger than 9mm in their diameters. We think 9mm is not a reliable critical diameter in the differential diagnosis of malignant melanoma. Histological analysis showed some features resembling malignant melanoma, such as single melanocytic hyperplasia, upward migration of melanocytes in epidermis, ill-defined lateral margin, abundant pigments in the stratum corneum, and lymphocytic infiltration in dermis. There was no case with cytological atypia or mitoses and we think this is an important feature to be studied in the future in the differentiation of malignant melanoma.

A Case of Eosinophilic Panniculitis Associated With Superior Sagittal Sinus Thrombosis

Eosinophilic panniculitis is characterized by a prominent infiltration of numerous eosinophils in subcutaneous fat, and has been identified in patients with a variety of associated clinical conditions. A case of eosinophilic panniculitis in a 20-year-old woman with a history of atopic dermatitis is reported. She later developed superior sagittal sinus thrombosis, and we stress the importance of systemic evaluations in patients with eosinophilic panniculitis.

Three Cases of Secondary Membranous Lipodystrophy / 대한피부과학회지

Membranous lipodystrophy is a peculiar type of fat necrosis, present in patients with various types of skin diseases. It is charaeterized by the presence of microcysts and macrocysts lined by amorphous eosinophilic material with a crenelated arabesque appearance and microgranules in the subcutis with massive fat necrosis. The eosinophilic lining and microgranules stain positively with periodic acid-Schiff, are resistant to diastase, and also stain with Sudan black B. We report three cases of subcutanous membranous lipodystrophy in patients with erythema induratum, posttraumatic panniculitis and morphea with typical clinical and histopathologic findings.

Excision of Hemangioma and Sculpturing of the Lip using a CO2 Laser / 대한피부과학회지

BACKGROUND: Massive bleeding, inability to identify important landmarks and structures, and necessity for a blood transfusion have been the usual problems of hemangioma excision. OBJECTIVE: We introduce a CO2 laser excision technique as a surgical method for the treatment of hemangioma of the lips and demonstrate its benefits. METHODS: In 4 patients with nevus flammeus of hemiface and accompanying hemangioma of the lips, excision of the hemangioma was performed using a focused beam from a CO2 laser under local anesthesia. RESULTS: Excellent to good results were achieved with minimal blood losses in all patients. No or minimal post-operative pain and edema and no significant complications were observed. CONCLUSION:The CO2 laser excision technique is recommended since it renders less textural change, greater volume reduction, hemostasis and an overall good cosmetic outcome than defocused modes or conventional scalpel surgery.

Comparison of the Sebum Excretion Rate and Follicular Density in Young Women With and Without Acne / 대한피부과학회지

BACKGROUND: Acne, one af the commonest dermatological disorders, is a disease of the pilosebaceous unit, and the primarily involved site is the face, where this structure exists in maximal density. Among the many etiologieal factors of acne, changes in the kinetics of sebum secretion in acne patients have been described, but there is no report to compare follicular density and the sebum excretion rate in different facial regions between normal and acne patients. OBJECTIVES: The purpose of this study was to compare the sebum output and follicular density in different regions of the face in women with and without acne and to evaluate the differences between the two groups. METHODS: We studied 10 normal and 14 acneic women aged 19-27. Follicular density was determined by light microscopy counting pilosebaceous units on cyanoacrylate follicular biopsy specimens. The sebum excretion rate was calculated by an image analyzer with a sebum print on Sebutape. RESULTS: 1. Follicular density was not significantly different between the normal and acne group. The number of follicles decreased from the central to the lateral aspect of the face with the highest value being on the nose tip and the lowest on the lateral forehead. 2. The total sebum excretion rate and the number of actively secreting follicles showed different patterns in the two groups. There was a decreased value in the acne group in some central regions of face. In addition, central to lateral declining pattems, shown in the normd group, were not apparent in the acne group. 3. The follicular sebum excretion rate showed large variations in both groups, without apparent central to lateral declining patterns. The confluence of adjacent follicles seemed to produce falsely low or high values compared with previous studies. CONCLUSION: Sebum production is influenced both by the number of active follicles and their individual capacity to excrete sebum, and the total sebum excretion rate was lower than normal in low grade acne in this study. Obstruction of the outflow of sebum and regression of sebaceous glands due to comnlones may account for it.

A Case of Unilateral Keratosis Follicularis of Linear Distribution / 대한피부과학회지

Unilateral keratosis fotlicularis has the same histological features of classic Darier's diseases and is considered to be a localized variant of Darier's disease. Unlike classic Darier's disease, it is not related to family history but with a later age of onset, unilateral and linear lesions. Lack of solar aggravation and increased irritation from sweating also characterize this disease. A 45-year-old female presented with scaly follicular papules in a linear distribution limited to one side of her lower extremity. There was no family history or other signs of Darier's disease elsewhere in the body. Histopathological features were typical of acantholytic dyskeratosis. The condition was aggravated during the summer and regressed with residual pigmentation after topical application of corticosteroid and tretinoin.