Syringomas Treated by Intralesional Insulated Needles without Epidermal Damage

Syringoma is a benign adnexal tumor derived from intradermal eccrine ducts; it predominantly occurs in women at puberty or later in life. Although syringoma is a common benign neoplasm, there have been no effective therapies for its removal. Conventional therapies for syringomas, including surgical excision, electrodessication, chemical peeling, topical atropine or tretinoin, cryosurgery, and laser therapy, can lead to cosmetic defects such as hyperpigmentation or scarring due to epidermal damage. In contrast, treatment using intralesional insulated needles, which are insulated at the point of epidermal contact, has been shown to result in good cosmetic outcomes due to selective destruction of dermal lesions. This could be an effective and highly satisfying treatment for syringomas. We herein present 2 patients with syringomas treated with intralesional insulated needles.

Two Cases of Linear Scleroderma 'En Coup de Sabre' Treated with Polymethylmethacrylate Microspheres (PMMA-NewPlastic(R)) / 대한피부과학회지

Localized scleroderma is a disease of unknown origin and is characterized by circumscribed sclerotic skin changes. When occurring in a linear pattern, it is called linear scleroderma. 'En coup de sabre' is a subtype of linear scleroderma which is characterized by band-like, ivory-colored depressions on the frontoparietal scalp region. Several treatment modalities have been used. However, they have not been effective or safe. We report our experience of two patients with 'en coup de sabre' on the forehead, who were treated successfully with polymethylmethacrylate microspheres (PMMA-NewPlastic(R)).

Clinical Evaluation of Pressure Alopecia / 대한피부과학회지

BACKGROUND: Pressure alopecia is the loss of hair following a prolonged immobilization, probably due to pressure-induced local ischemia. It is most commonly observed after surgical procedures under general anesthesia. Most of the studies or reports of pressure alopecia deal with postoperative cases. OBJECTIVE: This study was undertaken to investigate and understand the clinical manifestations, course and histopathological characteristics of pressure alopecia in various circumstances. METHOD: 27 patients with pressure alopecia, who had visited the Department of Dermatology at Busan Paik Hospital between 1998 and 2004, were examined clinically and histopathologically. RESULTS: The ratio of males to females was 4: 5, and the mean age of patients was 36+/-22 years. The cause of pressure alopecia were classified into 5 groups: open heart surgery, craniectomy, other surgeries, long-term bed rest, and the miscellaneous causes including wearing of hair prosthesis and group punishment. The most commonly involved site was the occipito-parietal area. Histopathological examination showed upper dermal edema and fibrosis, follicular fibrosis, melanin pigments, hair follicles in telogen and catagen stages, perifollicular lymphocytic infiltration and vascular change. The mean operation time was 8.1+/-7.2 hours in the patients with temporary alopecia and 17.8+/-7.6 hours in those with permanent alopecia. The mean operation time of the patients with temporary alopecia was shorter than those with permanent alopecia (p<0.05). CONCLUSION: This study revealed several causative factors of pressure alopecia including surgery, long-term bed rest, and miscellaneous causes. Therefore, close observation of the pressure site and changing the position of the patient's head at regular intervals are essential during the various surgical and nonsurgical treatments to prevent pressure alopecia.

A Case of Bowen's Disease with Modified Phenol Peel (Exoderm(R)) / 대한피부과학회지

We report a case of Bowen's disease in a 63-year-old male patient who presented with a 15x10cm-sized, large erythematous, scaly plaque on his back. Histopathologic examination revealed Bowen's disease. The skin lesion was improved after treatment with modified phenol peeling. Modified phenol peeling of Bowen's disease can be an alternative method of therapy for those lesions which are too large for excision and primary closure.

A Case of Neurofibromatosis with Giant Pigmentation, Diffuse Neurofibromas and a Pigmented Neurofibroma / 대한피부과학회지

A 31-year-old man presented with an erythematous tumor within a giant pigmentation on the left arm, which was partially covered with hairs and had a few subcutaneous nodules within it. Also he had a bluish tumor on the left palm, multiple tumors and cafe au lait spots on the upper trunk. Histologic examination from the tumor, pigmentation and subcutaneous nodules on the left arm, and the tumors on the upper trunk and left palm all revealed neurofibromas. Interestingly, the rare types of the neurofibromas, diffuse and pigmented neurofibroma were included in these.

A Clinical Study of Androgenetic Alopecia / 대한피부과학회지

BACKGROUND: Androgenetic alopecia (AGA) is one of the most common type of alopecia among all men and women after puberty. The number of patients with AGA appears to be gradually increasing. OBJECTIVES: The purpose of this study was to investigate the clinical status such as age, family history, and type of patients with AGA and to review recent Korean literature. METHODS: 1500 patients with AGA who had visited the Department of Dermatology, Busan Paik Hospital, Inje University School of Medicine during the last 7 years (from May 1997 through December 2003) were examined through the clinical records. RESULTS: 1) There were 1162 male and 338 female patients being most prevalent in the third decade in both sexes. 2) In males AGA, Norwood-Hamilton's type II was the most common. 3) In females AGA, Ludwig's type I was the most common. 4) There was a family history of baldness in 62.9% of relatives in male patients and 48.8% in female patients. 5) The largest number of patients with AGA first visited our department when they had had 1-5 year's history of AGA in both sexes. 6) In the management of male AGA, oral finasteride only or with topical medications was the most common (72.4%) treatment modality. 7) In the management of female AGA, topical minoxidil solution only or with other topical medications was the most common (78.7%) treatment modality. CONCLUSIONS: The proportion of young patients with mild types appears to be high among AGA patients. It might be largely due to psychological stress in social situations.

A Case of Darier's Disease Complicated by Eczema Herpeticum / 대한피부과학회지

Eczema herpeticum is a herpes simplex virus (HSV) infection with disseminated skin involvement superimposed on a pre-existing dermatosis such as atopic dermatitis, neurodermatitis, pemphigus vulgaris and Darier's disease. We report a case of eczema herpeticum by HSV-1 infection confirmed by polymerase chain reaction in a 20-year-old man associated with Darier's disease.

Expressions of Cytokeratin and Ki-67 in the Development of the Pilomatricoma / 대한피부과학회지

BACKGROUND: Pilomatricoma (PM) is benign follicular tumor composed of the basophilic cells, transitional cells, shadow cells, squamoid cells and keratin filaments/amorphous debris. At present, PM is assumed to differentiate toward hair-forming cells of hair follicles but definite direction is not clear. OBJECTIVES: This study was made in order to investigate the pathways of cell differentiation associated with sudden keratinization in PM. METHODS: In the present study, 19 cases of human PM was histopathologically examined and classified into 4 groups according to the chronological stages. RESULTS: In the chronological stages according to Kaddu's classification, there were 2 cases of early lesion, 6 cases of fully developed lesion, 7 cases of early regressive lesion and 4 cases of late regressive lesion. The basophilic cells changed into the shadow cells or amorphous debris through the transitional cells moving toward the exterior of the PM, as well as toward the interior. As keratinization occurs, some inner basophilic cells which had been located in marginal areas of keratinization lost their tight cell-cell bonding. These cells showed edematous/vesicular and squamoid changes. High molecular weight cytokeratin was expressed in a linear pattern in some early and fully developed lesions. There were fewer layers of basophilic cells between the stroma and squamoid cells/amorphous debris than between the stroma and shadow cells. Ki-67 was expressed strongly both basal and overlying basophilic cells. Apoptotic bodies were detected in most transitional cell layers and some amorphous debris zones. CONCLUSIONS: The present study suggests dual pathways of cell differentiation in PMs. In the sudden keratinization pathway, the basophilic cells, transtional cells, shadow cells, and squamoid cells are suddenly keratinized, and the basophilic cells become early the transitional cells or squamoid cells. Cytoplasmic expressions of Ki-67 and cytokeratin in the basophilic cells show that the basophilic cells differentiate toward the innermost layer of the outer root sheath cells.

Clinicopathological Observation in Trichotillomania and Pathologs after Hair Plucking in Rabbits / 대한피부과학회지

BACKGROUND: Trichotillomania appears as incomplete alopecia due to patients own repeated manipulations of the hair. But there are few available clinicopathologic data in Korea. OBJECTIVE: The purpose of this study was to evaluate the clinicopathological feature of trichotillomania and the experimental pathologic findings after hair plucking in rabbits. METHOD: Through retrospective study on patients who were diagnosed as trichotillomania from 1988 to 1997 at the Department of Dermatology in Pusan National University Hospital, we observed the clinical and histopathological findings in 20 cases of trichotillomania as well as histopathologic changes of hair follicle and associated structure after hair plucking in rabbits with 4 days interval. RESULTS: 1. The mean age of onset was 15.7 years and female were 12 cases(60%). 2. The school age(between 7 and 18 years) was most common as 15cases(75%) 3. Among initial sites of involvement, parietal region was the most common(10 cases, 55%), followed by frontal(5 cases, 25%), temporal(2 cases, 10%), and occipital(2 cases, 10%) region. 4. Some patients complained pruritus(25%), chronic headache(10%) and had onychophagia (20%), trichophagia(5%) and thumb sucking(5%). 5. Many patients were not typical in history, and 14 cases(70%) denied hair-plucking history. 6. Results of twelve patients with psychiatric consultation revealed obsessive disorder(4 cases, 33%), social phobia(2 cases, 17%) and dysmorphic disorder(1 case, S%). 7. The most common presumptive triggering factor was mental stress related to school work(5 cases, 25%). 8. The characteristic findings of histopathologic examination in 20 cases were empty hair follicles without perifollicular infiltration(100%) and increased catagen hair(90%) with normal anagen hair(85%), trichomalacia(40%). 9. In experimental hair plucking of rabbit, soon after hair plucking, dilated empty root sheaths, perifollicular hemorrhage were observed. These findings are similar in trichotillomania. Catagen evolution, sebaceous proliferation and hyperplasia at 4th day, prominent bulge region at 8th day, growing epithelial sheaths into deep dermis at 12th day, many anagen hair at 20th day were observed. CONCLUSION: Trichotillomania was more frequent in young than adolescent and female than male. Histopathologically, the most characteristic finding was increased catagen hair without perifollicular inflammation. In hair follicle regeneration of rabbit after plucking, all hair follicles changed into catagen and telogen stage simultaneously and new hair growth was observed.

A Study of Cellular and Humoral Immunity in Patients with Herpes Zoster / 대한피부과학회지

BACKGROUND: It seems that herpes zoster is caused by reactivation of the varicella-zoster virus and its incidence is increasing. The reactivation of the varicella zoster virus is thought to be associated with the disturbance of the state of immunity in patients with herpes zoster. OBJECTIVE: The purpose of this study was to elucidate the state of immunity in patients with herpes zoster in its acute phase(less than 7 days). METHODS: 1. Thirty patients with acute phase herpes zoster matched by age and sex against a control group, were checked for Helper/Inducer T cell(CD4), Suppressor/Cytotoxic T cell(CD8), NK cell, B cell and activated T cell by three color flow cytometric analysis. 2. Forty patients with herpes zoster measured delayed cutaneous hypersensitivity by means of Multitest' CMI. 3. Thirty patients with herpes zoster measured Ig G, M, A by means of N-antisera method.

A Case of Multiple Agminated Spitz Nevi Showing Desmoplastic Changes

We report a case of multiple agminated Spitz nevi in a 16-year-old boy who presented with multiple nodules on the right side of his face. His past history revealed that there had been erythematous and brown colored papules on the same site at the age of four. At that time one lesion was excised and histopathological findings showed fairly well circumscribed spindle and epithelioid cell nests consistent with a Spitz nevus. Twelve years later, he presented with multiple agminated brown to black colored nodules on the face. Microscopic evaluation revealed nevus cells diffusely distributed throughout the dermis showing no or little junctional activity. In addition, these cells were embedded in a strikingly desmoplastic stroma which consisted of acellular collagen fiber. Immunohistochemical staining for S-100 protein was positive. To our knowledge this is the first report of multiple agminated Spitz nevi in Korea.