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Syringocystadenoma papilliferum (SCAP) and apocrine hidrocystoma (AH) are benign apocrine neoplasms that usually occur separately. SCAP arises predominantly in head and neck, while AH typically develop in periorbital area. We report a case of a 68-year-old male with an asymptomatic erythematous papulonodule that occurred on his back 3 years ago. Histologic examination showed cystic invagination extending from the epidermis into the dermis with some papillary projections. The invaginated portion was lined by epithelial bilayer composed of cuboidal and columnar cells, and decapitation secretion was observed in the inner epithelial layer. In the deep dermis, multiple cystic spaces with variable sizes were observed, and these cysts also presented double layers of the epithelium and decapitation secretion.According to such histologic features, the coexistence of SCAP and AH within a single lesion was demonstrated. The patient was recommended to completely remove the remaining lesion after punch biopsy, but he refused further surgical management. Herein, we report an unusual case of complex apocrine tumor with a rare composition in an atypical site.
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We analyzed 1,079 forensic autopsies conducted in 2021 by the National Forensic Service Daejeon Institute from the Jungbu province in the central part of South Korea, for their manner and cause of death. Among the manner of death (n=1,079), 45.3% (n=489) were categorised as unnatural, 39.5% (n=426) as natural, and 15.2% (n=164) were unknown. Among the unnatural deaths (n=489), 40.7% (n=199) were accidents, 36.8% (n=180) were suicides, 14.1% (n=69) were undetermined, and 8.4% (n=41) were homicides. The major causes of unnatural deaths (n=489) were by trauma, causing 34.4% (n=168), poisoning causing 26.8% (n=131), and asphyxia causing 17.2% (n=84). The major cause of death by trauma (n=168) was falling at 46.4% (n=78), and by asphyxia (n=84) was strangulation at 76.2% (n=64). Among natural deaths (n=426), heart disease was the major cause at 49.8% (n=212) followed by vascular disease at 16.7% (n=71). In future, a time-series statistical analysis on the manner and causes of death in Jungbu province may provide insight and allow for more advanced interpretations about both healthcare and public safety.
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The areola is a rare location for squamous cell carcinoma (SCC) because sunlight exposure, the main risk factor for SCC, is unusual on it. Acantholytic SCC (ASCC) is a rare histologic variant of SCC, characterized by pseudoglandular appearance with acantholytic tumor cells. A 59-year-old male presented a painful erythematous papule on his right areola. He had a history of psoralen ultraviolet A phototherapy for psoriasis in his 20s. Biopsy revealed an epithelial tumor and pseudoglandular structures with acantholytic tumor cells. In immunohistochemistry, cytokeratin 5/6, epithelial membrane antigen, and p63 were positive, while cytokeratin 7, carcinoembryonic antigen, S-100, and estrogen and progesterone receptors were negative. Periodic acid-Schiff stain was negative. Ki-67 labeling index was 79.7%. The final diagnosis was ASCC of the areola. After wide local excision, recurrence have not been reported. Here, we report a case of ASCC on the areola, focusing on its rare histologic variant and uncommon location.
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no abstract available.
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Background@#Herpes zoster (HZ) is a neurocutaneous disease caused by reactivation of the varicella zoster virus after primary infection. In Korea, it is recommended that all adults aged ＞60 be vaccinated against HZ. However, breakthrough infection with HZ can occur infrequently in vaccinated individuals. @*Objective@#This study aimed to investigate the effects of the HZ vaccine on the clinical manifestations and courses of HZ in immunocompetent elderly individuals aged 60 years and older. @*Methods@#Among 848 immunocompetent HZ patients, 52 were vaccinated and 796 were unvaccinated. From this cohort, we chose 156 unvaccinated patients through a 1:3 propensity score matching analysis using three parameters;age, sex, and involved dermatome. We subsequently compared the clinical manifestations and courses between the vaccinated (n=52) and unvaccinated (n=156) groups. @*Results@#The vaccinated group had a lower peak numeric rating scale pain score and a lower rate of consultation with the pain control clinic than the opposite. Additionally, mild skin lesions without vesicles were more frequent in the vaccinated group than in the opposite. The vaccinated group had a shorter duration of total follow-up, shorter antiviral treatment period, lower admission rate, and shorter hospital stay than the opposite. Although postherpetic neuralgia occurred more frequently in the unvaccinated group than in the unvaccinated group, the incidences of other HZ-related complications showed no significant difference between the two groups. @*Conclusion@#Despite the possibility of breakthrough infection, the HZ vaccine should be recommended in the elderly as it can weaken the clinical features and course of the disease.
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Background@#Fever and skin eruption are common manifestations in patients; however, assessing them can be challenging because of the wide range of differential diagnosis. @*Objective@#We aimed to obtain tips that could assist in differential diagnoses in patients with fever and skin eruption through the analysis of clinical features. @*Methods@#Medical records of hospitalized patients who had fever and skin eruption were examined from January 2010 to December 2019. @*Results@#The patients of the adverse drug reaction group were older (p=0.024), and they had underlying diseases (p＜0.001), whole body skin eruption (p=0.018), elevated alanine aminotransferase (p=0.027). The autoimmune disease group was associated with longer total fever and skin eruption duration (p=0.049, 0.037), leukocytosis (p=0.015), and neutrophilia (p=0.006). Infectious erythema group was associated with targetoid lesions (p=0.003). @*Conclusion@#Clinicians should examine patients with fever and skin eruption, considering that there may be various causes. This can be assisted by delicate skin exam and laboratory tests.
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Background@#Bacterial skin soft-tissue infection is a common clinical manifestation in dermatology. The treatment of bacterial skin infections is often challenging due to antibiotic resistance, including methicillin resistance. @*Objective@#The aim of this study was to investigate the isolation rate of bacteria, antibiotic susceptibility, clinical features, and factors associated with treatment response in bacterial skin infections. @*Methods@#We retrospectively reviewed the medical records of patients who underwent ordinary bacterial skin cultures of the site of superficial skin infections between 2010 and 2019. @*Results@#A total of 1,298 patients were included in the study. The most commonly isolated bacteria were Staphylococcus aureus (31.3%), followed by coagulase-negative staphylococci (22.0%) and Pseudomonas species (4.2%). The methicillin-resistance rate of S. aureus was 22.7%. Crusted lesions (p=0.025), treatment with steroids (p=0.035), duration over 7 days (p=0.009), and isolation of Pseudomonas (p＜0.001) or other uncommon species (non-Staphylococcus, Streptococcus, and Pseudomonas species, p＜0.001) were significantly associated with treatment response. @*Conclusion@#The methicillin-resistance rate of S. aureus was similar to that of the past 5 years, but the mupirocin-resistance rate significantly increased. Lesions with crust or those that were treated with steroids showed good treatment responses, but longer disease durations of over 7 days and skin infections caused by Pseudomonas or other uncommon species were poor prognostic factors that should receive more attention.
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Atypical fibroxanthoma (AFX) is a rare fibrohistiocytic tumor usually observed on ultraviolet light-exposed areas of the body, such as the face or scalp in elderly individuals. Despite its clinically benign course, AFX presents with malignant features on histopathological evaluation. A 12-year-old male adolescent presented with a 3-month history of an asymptomatic, skin-colored, oval-shaped nodule on his right thigh. Histopathological examination showed a dermal tumor adjacent to the epidermis, without epidermal invasion. The tumor was composed of numerous pleomorphic spindle cells and large atypical histiocytes with abundant vacuolated cytoplasm and pleomorphic nuclei. Immunohistochemical analysis revealed tumor cells, which were immunopositive for vimentin, CD68, CD10 and immunonegative for desmin, pan-cytokeratin antibody (AE1/AE3), and S-100. Therefore, the patient was diagnosed with AFX. We report a rare case of AFX that occurred on the thigh (an unusual site) in an adolescent (an uncommon age group). Immunohistochemical analysis is important in patients with suspected AFX, regardless of the patient’s age and site of lesion, for accurate diagnosis to differentiate this condition from other diseases with a similar presentation.
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Purpose@#Previous studies have reported the difference in nutritional status between South and North Korean infants and young children (IYC). Clear understanding on the nature of such differences is essential for planning food and nutrition policies and programs to prepare for a possible re-unification of the two Koreas in future. This study was undertaken to yield valid statistics comparing the nutritional status between North and South Korean IYC. @*Methods@#Raw data obtained from the 2017 Korean National Growth Chart and the 2013–2017 Korea National Health and Nutrition Examination Survey were analyzed to determine the comparable statistics that include weight for age z-score (WAZ), height for age z-score (HAZ) and weight for height z-score (WHZ), with data reported in the Survey Findings Report of the 2017 DRP Korea Multiple Indicator Cluster Survey. The average weight and height by gender and month were estimated for North Korean IYC and calculated for South Korean IYC. SPSS analysis was applied to evaluate the acquired statistics and compare the nutritional status of South and North Korean IYC. @*Results@#WAZ, HAZ and WHZ of North Korean IYC were observed to be lower than values obtained for South Korean IYC as well as the median values of World Health Organization Child Growth Standards across all ages. Similar patterns were observed for average height and weight.The nutritional status of North Korean IYC revealed a prevalence of highly underweight (9.3%), stunting (19.1%) and wasting (2.5%) values, and was determined to be significantly lower than values obtained for South Korean IYC (0.8%, 1.8%, and 0.7%, respectively). @*Conclusion@#This study has yielded valid statistics that compare the nutritional status of North and South Korean IYC. Results of this study confirm the prevalence of nutritional status difference between South and North Korea.
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Background@#Bacterial skin soft-tissue infection is a common clinical manifestation in dermatology. The treatment of bacterial skin infections is often challenging due to antibiotic resistance, including methicillin resistance. @*Objective@#The aim of this study was to investigate the isolation rate of bacteria, antibiotic susceptibility, clinical features, and factors associated with treatment response in bacterial skin infections. @*Methods@#We retrospectively reviewed the medical records of patients who underwent ordinary bacterial skin cultures of the site of superficial skin infections between 2010 and 2019. @*Results@#A total of 1,298 patients were included in the study. The most commonly isolated bacteria were Staphylococcus aureus (31.3%), followed by coagulase-negative staphylococci (22.0%) and Pseudomonas species (4.2%). The methicillin-resistance rate of S. aureus was 22.7%. Crusted lesions (p=0.025), treatment with steroids (p=0.035), duration over 7 days (p=0.009), and isolation of Pseudomonas (p＜0.001) or other uncommon species (non-Staphylococcus, Streptococcus, and Pseudomonas species, p＜0.001) were significantly associated with treatment response. @*Conclusion@#The methicillin-resistance rate of S. aureus was similar to that of the past 5 years, but the mupirocin-resistance rate significantly increased. Lesions with crust or those that were treated with steroids showed good treatment responses, but longer disease durations of over 7 days and skin infections caused by Pseudomonas or other uncommon species were poor prognostic factors that should receive more attention.
ABSTRACT
Atypical fibroxanthoma (AFX) is a rare fibrohistiocytic tumor usually observed on ultraviolet light-exposed areas of the body, such as the face or scalp in elderly individuals. Despite its clinically benign course, AFX presents with malignant features on histopathological evaluation. A 12-year-old male adolescent presented with a 3-month history of an asymptomatic, skin-colored, oval-shaped nodule on his right thigh. Histopathological examination showed a dermal tumor adjacent to the epidermis, without epidermal invasion. The tumor was composed of numerous pleomorphic spindle cells and large atypical histiocytes with abundant vacuolated cytoplasm and pleomorphic nuclei. Immunohistochemical analysis revealed tumor cells, which were immunopositive for vimentin, CD68, CD10 and immunonegative for desmin, pan-cytokeratin antibody (AE1/AE3), and S-100. Therefore, the patient was diagnosed with AFX. We report a rare case of AFX that occurred on the thigh (an unusual site) in an adolescent (an uncommon age group). Immunohistochemical analysis is important in patients with suspected AFX, regardless of the patient’s age and site of lesion, for accurate diagnosis to differentiate this condition from other diseases with a similar presentation.
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Purpose@#Previous studies have reported the difference in nutritional status between South and North Korean infants and young children (IYC). Clear understanding on the nature of such differences is essential for planning food and nutrition policies and programs to prepare for a possible re-unification of the two Koreas in future. This study was undertaken to yield valid statistics comparing the nutritional status between North and South Korean IYC. @*Methods@#Raw data obtained from the 2017 Korean National Growth Chart and the 2013–2017 Korea National Health and Nutrition Examination Survey were analyzed to determine the comparable statistics that include weight for age z-score (WAZ), height for age z-score (HAZ) and weight for height z-score (WHZ), with data reported in the Survey Findings Report of the 2017 DRP Korea Multiple Indicator Cluster Survey. The average weight and height by gender and month were estimated for North Korean IYC and calculated for South Korean IYC. SPSS analysis was applied to evaluate the acquired statistics and compare the nutritional status of South and North Korean IYC. @*Results@#WAZ, HAZ and WHZ of North Korean IYC were observed to be lower than values obtained for South Korean IYC as well as the median values of World Health Organization Child Growth Standards across all ages. Similar patterns were observed for average height and weight.The nutritional status of North Korean IYC revealed a prevalence of highly underweight (9.3%), stunting (19.1%) and wasting (2.5%) values, and was determined to be significantly lower than values obtained for South Korean IYC (0.8%, 1.8%, and 0.7%, respectively). @*Conclusion@#This study has yielded valid statistics that compare the nutritional status of North and South Korean IYC. Results of this study confirm the prevalence of nutritional status difference between South and North Korea.
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Hand-foot-mouth disease (HFMD) is a viral infection that occurs commonly in children. It is characterized by vesicles with surrounding erythema on the extremities and mouth. Most common pathogens are Coxsackievirus A16 and Enterovirus 71. HFMD caused by Coxsackievirus A6 is uncommon and accompanied by more extensive and atypical eruptions. A 42-year-old man presented with erythematous papules and vesicles on the right hand which occurred 7 days prior to presentation. The rash spread extensively with high fever, chills, headache, and myalgia. He also had whitish ulcer-like lesions on the oral mucosa with swallowing difficulty. One day after hospitalization, he developed arthralgia on his shoulders, pelvis, knees, and fingers. The biopsy specimen showed an intraepidermal blister with reticular degeneration, epidermal necrosis, and neutrophilic infiltration. There were no inclusion cells or giant cells. The serum antibody titer of Coxsackievirus A6 showed a significant increase, at 64 times. He was diagnosed with HFMD caused by Coxsackievirus A6.
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Objectives@#This study was conducted to examine the status of foodservice management, with special interest on sanitary and nutritional food service in elderly day care centers. @*Methods@#A total of 79 employees who managed foodservice facilities in elderly day care centers were included in the survey. The contents of the questionnaire consisted of general characteristics, importance and performance of sanitary and nutrition management, the reasons for poor performance, factors necessary for improvement, and the employee's demand for support. Data analysis was conducted using the SPSS v25.0. @*Results@#Sanitary management showed an average importance score of 4.84 ± 0.40 and a performance score of 4.70 ± 0.61 (t-value: 8.260). The item with the lowest performance score was personal sanitary management (4.58 ± 0.71). In nutrition management, the average importance score was 4.52 ± 0.68, and the performance score was 4.20 ± 1.00 (t-value: 9.609). There were significant differences between the average score of importance and performance in both areas. As a result of an Importance-Performance Analysis, items that were recognized as important but had relatively low performance was “personal hygiene”, “ventilation” and “food storage”. Also in the nutritional management area, “menu planning for disease management” and “checking the saltiness in the soup” etc. had very low performance with low importance recognition. The items shown in the “low priority” quadrant were those that required professional management skills. In the areas that demanded support in foodservice management, education about sanitary and safe institutional food service had the highest score (4.42 ± 0.74), and all other items showed a demand of 4 points or more. @*Conclusions@#Foodservice managers recognize the importance of foodservice facility management but performance is relatively low. Institutional support is, therefore, needed to improve performance. For items with low importance, it seems necessary to improve awareness of the necessity of these items and to provide education in this regard. To gradually improve foodservice management, continuous provision of education and training in these areas are of great importance.
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Objectives@#This study examined the results of the restandardization of the Korean Personality Assessment Inventory (PAI). The Korean PAI was first standardized in 2001 and then restandardized in 2019 to establish new normative data. On the other hand, differences may exist in the results of the restandardized version considering the time interval, which may include cultural and social differences. Thus, differences between the results of the Korean PAI administered in 2001 and 2019 must be examined to confirm its new normative data followed by restandardization. @*Methods@#Data from 2212 adults who administered the original Korean PAI in 2001 and 1263 adults who administered the Korean PAI in 2019 were collected. The study compared the reliability and mean scores. In addition, the mean scores of the Korean PAI administered in 2019 were converted to T-scores adapted to the normative data of 2001. The collected data was analyzed using a t-test and comparing the T-scores. @*Results@#The internal consistency reliability showed a similar pattern in both versions, but the differences among the mean scores and T-scores appeared to be significant. @*Conclusion@#The significant differences between the scores of the Korean PAI administered in 2001 and 2019 reflect the result of the restandardization. Therefore, the restandardized version of the Korean PAI may bring more precise information that can be adapted to the contemporary era.
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Kawasaki disease is an acute inflammatory syndrome affecting middle-sized arteries. It is diagnosed when a fever lasts longer than 5 days, and four out of the five diagnostic criteria are satisfied. Some skin lesions are not included in the criteria, but are associated with Kawasaki disease. They can be helpful when the patient has an incomplete presentation. Herein, we report a Kawasaki patient who presented with simultaneous orange-brown chromonychia on all 20 nails and black crusted lips.
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Bee pollen is a mixture made by worker bees and consists of pollen, nectar, and salivary secretions. Due to its abundant nutritional and medicinal effects, people are consuming bee pollen increasingly these days. By the way, some of the elements of bee pollen, such as pollen and fungus, can cause allergic reactions. Anaphylaxis is the most common symptom and other symptoms such as bronchospasm, abdominal pain and urticaria can occur. But localized cutaneous bee pollen allergy has never been reported. A 29-year-old man presented with erythematous vesicular patches on the lower abdomen 3 months ago. The skin biopsy specimen showed a subcorneal pustule filled with eosinophilic microabscess, perivascular eosinophilic infiltration, and epidermal spongiosis. He was diagnosed with skin allergy caused by bee pollen. He stopped ingesting bee pollen and was treated with oral antihistamines and a topical steroid. We report this case because of its unique clinical and histological appearance.
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Background@#The hair pull test is a quick and easy examination to monitor hair loss. It was recently studied in a large group consisting primarily of Caucasians. Considering the ethnic differences in hair and follicles characteristics, hair pull test results could differ in Asians, including Koreans. @*Objective@#To determine the normal hair pull test value in Koreans and which factors influenced the results. @*Methods@#After the participants (n=102) completed a questionnaire, the experimenter performed the hair pull test on five parts of the scalp including the vertex, right parietal, left parietal, occipital, and frontal areas in two different methods. @*Results@#The normal hair pull test value among the Koreans in this study was less than 1. The results were not affected by tugging (p=0.628) or site (p=0.934). No significant differences in results were observed regardless of time since the last washing (p=0.319) or brushing (p=0.851). However, participants over 50 years of age (p=0.035), those who washed their hair less than once daily (p=0.000), and those who never used a dryer (p=0.037) showed significantly increased values, with normal values of less than 2, while those who washed their hair before sleep showed significantly lower values (p=0.027). @*Conclusion@#The normal hair pull test value in Koreans was less than 1, less than that in Caucasians. Age, number of washings per day, and the use of a dryer affected the hair pull test results. Therefore, care must be taken when interpreting the results.
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Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse drug reaction that is difficult to predict. It is characterized by fever, skin rash, and internal organ involvement that usually manifests 2∼6 weeks after use of the culprit drug. The antihyperglycemic agent sitagliptin is commonly used for treating diabetes mellitus, and sitagliptin-induced DRESS syndrome has not been previously reported in Korea. Herein, we report a case of DRESS syndrome after sitagliptin use; these observations may contribute to the timely diagnosis of sitagliptin induced DRESS syndrome and help reduce associated complications or morbidities.
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Cutaneous pseudolymphoma is a heterogeneous group of benign reactive T- or B-cell lymphoproliferative diseases of the skin that simulate cutaneous lymphomas histologically and, sometimes, clinically. Thus far, only a few cases of pseudolymphomas showing atypical clinical manifestations have been reported. A 10-month-old boy presented with multiple flesh-colored, yellowish erythematous disseminated papules on the face, abdomen, and arms. The cutaneous lesions morphologically resembled molluscum contagiosum, Langerhans cell histiocytosis, or juvenile xanthogranuloma. Punch biopsy and immunohistochemistry studies were performed, and the lesion was identified as a cutaneous B-cell pseudolymphoma. Most of the lesions were cleared within a month with systemic corticosteroids and oral antihistamine administration. In this report, we present an interesting rare case of infantile cutaneous B-cell pseudolymphoma mimicking many other dermatological diseases in addition to a cutaneous lymphoma.