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Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are nonsteroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.
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Primary localized cutaneous amyloidosis (PLCA) is characterized by extracellular deposition of pathological fibril aggregation of proteins in the skin without systemic involvement.Macular amyloidosis, lichen (papular) amyloidosis, and nodular amyloidosis are three different subtypes of PLCA. Although the pathological mechanism of PLCA has not yet been clarified, it is assumed that a nucleus formation of amyloid fibril is formed due to repeated external stimulation, such as subcutaneous injection, which often poses diagnostic challenges. Herein, we present a 54-year-old Korean male patient with cutaneous localized amyloidosis which occurred after repeated local insulin injections, and discuss the relationship between insulin therapy in patients with diabetes mellitus and dermal amyloid deposition.
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Background@#The exact definition of sensitive skin is not established yet. Since its high prevalence and significant influence on quality of life, it has become an important topic of research. Among various ingredients, conditioned media from umbilical cord blood-derived mesenchymal stem cells (UCB-MSC-CM) can be a promising source for the treatment of sensitive skin. @*Objective@#We evaluated the efficacy and safety of UCB-MSC-CM on patients with sensitive skin. @*Methods@#We designed a randomized, single blinded, prospective, split-face comparison study and enrolled thirty patients. All patients underwent nonablative fractional laser over the entire face before UCB-MSC-CM or normal saline was applied. Each facial area was randomly assigned to undergo treatment with either UCB-MSC-CM or normal saline. We performed three sessions at two-week intervals, and final results were assessed on six weeks after the last session. As an outcome measure, we evaluated a five-point global assessment scale, transepidermal water loss (TEWL), erythema index (EI) and Sensitive Scale-10. Twenty seven subjects were included in final analysis. @*Results@#The treated side exhibited greater improvement compared to the untreated side based on a five-point global assessment scale. TEWL, EI of the treated side were significantly lower than those of the untreated side throughout study period. Sensitive Scale-10 was significantly improved after treatment. @*Conclusion@#The application of UCB-MSC-CM resulted in improved skin barrier function and reduced inflammatory responsiveness, which could provide beneficial effect on sensitive skin.
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Epithelioid blue nevus (EBN) is a rare variant of blue nevus characterized by large polygonal pigmented melanocytes. As EBN was first described in patients with Carney complex, familial lentiginosis, and low-grade multi-organ neoplasia syndrome, sporadic cases without such clinical features have been reported and debated as having considerable histopathological overlap with animal-type melanoma. A 34-year-old male presented with a well-defined, 2.0-×1.8-cm-sized, dome-shaped, grayish mass on the anterior aspect of the left ankle. A complete surgical resection of the lesion was performed. Histopathological findings revealed a well-circumscribed round tumor in the reticular dermis. Heavily pigmented epithelioid melanocytes were admixed with the collagen bundles. The lesion was diagnosed as EBN. A follow-up period of 9 months showed no evidence of recurrence or metastasis.Here, we report a sporadic case of EBN, which is rare in the Korean population.
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Pilomatricoma is a common benign tumor that originates from hair matrix cells. Bullous pilomatricoma (BP) is a rare variant that often occurs on the upper extremities. A 23-year-old male presented with a cyst on the left upper arm for 6 months. He received the BNT162b2 (Pfizer) mRNA COVID-19 vaccine in the same location approximately 6 months prior to presentation. The lesion appeared 1 week after inoculation and gradually enlarged.Physical examination revealed a 2.5-×2.0-cm-sized, pinkish cystic nodule on the left upper arm. The lesion was excised, and histopathological examination showed a well-circumscribed nodule composed of basophilic cells and eosinophilic shadow cells. Finally, the patient was diagnosed with BP. The exact cause of BP formation following vaccination is yet to be determined; however, this report presents the possibility of BP occurrence in individuals with chronic skin lesions at the site of vaccination.
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Cutaneous metastases from renal cell carcinoma (RCC) present as rapidly growing erythematous or purple-round nodules. An 88-year-old male presented with a solitary, deep-seated firm mass on his left forearm that had persisted for 3 years. Ultrasonography revealed an hypervascular mass with rich vessels. Magnetic resonance imaging revealed a 1.6×1.6×3.3 cm sized, high T2-weighted signal intensity mass at brachioradialis muscle. Histopathologic examination revealed cells with atypical, pleomorphic, oval to spindle-shaped nuclei, and clear cytoplasm with an alveolar pattern within an unencapsulated, lobulated mass. Immunohistochemical analysis showed that the tumor cells were positive for PAX8, CD10, epithelial membrane antigen, and vimentin. Ultrasonography of the urinary tract revealed a lesion suspected to be RCC, which was thought to be the primary tumor. As our patient showed peculiar clinical symptoms and the primary tumor was later diagnosed as a metastatic lesion inversely, we report a rare case of metastatic RCC with an intramuscular mass on the forearm.
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Background@#Psoriasis is a chronic inflammatory autoimmune disease. Some studies have demonstrated a relationship of psoriasis with vitamin D (Vit D) deficiency or serum lipid levels. @*Objective@#We aimed to compare serum levels of Vit D and lipids in patients with active psoriasis and control subjects. Additionally, we analyzed the relationship of disease severity with serum Vit D and lipid levels. @*Methods@#A total of 243 patients were retrospectively analyzed. Statistical data were evaluated, and the values were considered significant at p＜0.05. @*Results@#Statistically significant difference in Vit D levels between the psoriasis (n=117) and the control groups (n=126) was not found. In addition, an association between Vit D levels and the disease severity, using the psoriasis area and severity index (PASI) was not observed. The proportion of overweight patients (body mass index [BMI]≥ 23 kg/m2 ) was higher in the psoriasis group than in the control group, and there was a significant relationship between the increase in PASI and the serum triglycerides (TG) levels (p＜0.05). @*Conclusion@#The psoriasis and control groups did not show a statistical difference in serum Vit D levels. In the subgroup analysis of cases with normal BMI, excluding the underlying disease, no significant difference in Vit D levels between the two groups was observed. However, the association of psoriasis with factors, such as BMI and TG, was found to be significant; hence, these could be therapeutic targets in patients with psoriasis to improve their quality of life. Controlled and well-designed studies are required in the future.
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Background@#Cosmetic units are designated based on their similarity in topographic anatomy, texture and color, solar exposure, hair density, and sebaceous features. The difference of such features in facial port-wine stain (PWS) cases can affect the response to pulsed dye laser (PDL) treatment. @*Objective@#To evaluate the response of facial PWS to PDL treatment based on the underlying cosmetic units. @*Methods@#A retrospective study was conducted on 18 patients with facial PWS who received PDL treatment. For clinical assessment, three dermatologists evaluated the photographs taken before each treatment session. The response grade was assigned according to the quartile grading scale. The lesion was classified based on the underlying cosmetic units. @*Results@#The cheek was the most (50%) commonly involved area. All PWS (6/6) confined to one cosmetic unit showed a marked improvement compared with 16% PWS (2/12) affecting two or more units (p＜0.05). Patients with PWS within one cosmetic unit required fewer treatment sessions to achieve marked improvement. @*Conclusion@#PWS confined to a single cosmetic unit than that located in two or more units responded better to PDL treatment. Before PDL treatment for facial PWS, age, initial lesion size, as well as the number of cosmetic units affected by the lesion should be considered.
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Granuloma annulare (GA) is a common non-infectious granulomatous disease. Generalized GA is the second most common variant of GA. It is often associated with recalcitrant disease progression despite treatment. The lesion of generalized GA typically presents widespread papules that coalesce to form annular plaques over the whole body.We report a case of a patient with disseminated papules and coalescing annular plaques, primarily involving the intertriginous area and mimicking tinea corporis or cruris. Histopathological findings confirmed the lesion as GA. This case underscored the unusual clinical presentation of generalized GA. A case of GA localized to the intertriginous area has rarely been reported. Given the recalcitrant nature of the disease, dermatologists should consider generalized GA as a differential diagnosis in patients with an annular lesion involving the intertriginous area. Thus, we report this as an atypical case of generalized GA localized to the intertriginous area.
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no abstract available.
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Background@#Cyclosporine is an effective drug for the treatment of psoriasis. Nonetheless, little is known about the factors associated with its effectiveness. @*Objective@#This study aimed to analyze the factors affecting the treatment efficacy of cyclosporine in patients with psoriasis. @*Methods@#‘Good treatment response’ and ‘treatment failure’ were each defined as achievement of 75% improvement in the psoriasis area and severity index and failure to achieve 50% improvement in the psoriasis area and severity index, respectively. The factors affecting good treatment response were investigated by comparing the group that achieved psoriasis area and severity index 75 to the not achieved group. Similarly, we also analyzed the factors affecting treatment failure and the time required to achieve psoriasis area and severity index 75. @*Results@#In total, 78 patients (63 males and 15 females) were analyzed. Age of onset, body surface area, accompanying hypertension, accompanying psoriatic arthritis, induction phase mean dose, and cumulative dose showed a relationship with good treatment response. Body surface area, initial dose, and accompanying hypertension were correlated with treatment failure. The mean time taken to achieve psoriasis area and severity index 75 was 6.70±3.17 weeks and it did not correlate with any factor. @*Conclusion@#In patients with psoriasis vulgaris, maintaining an adequate mean dose in the induction phase may be necessary for successful treatment with cyclosporine, especially in the patients with early-onset psoriasis, severe psoriasis, or accompanying psoriatic arthritis. In addition, a sufficiently high start dose may be needed to prevent treatment failure, particularly in patients with severe psoriasis vulgaris.
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Background@#Cyclosporine is an effective drug for the treatment of psoriasis. Nonetheless, little is known about the factors associated with its effectiveness. @*Objective@#This study aimed to analyze the factors affecting the treatment efficacy of cyclosporine in patients with psoriasis. @*Methods@#‘Good treatment response’ and ‘treatment failure’ were each defined as achievement of 75% improvement in the psoriasis area and severity index and failure to achieve 50% improvement in the psoriasis area and severity index, respectively. The factors affecting good treatment response were investigated by comparing the group that achieved psoriasis area and severity index 75 to the not achieved group. Similarly, we also analyzed the factors affecting treatment failure and the time required to achieve psoriasis area and severity index 75. @*Results@#In total, 78 patients (63 males and 15 females) were analyzed. Age of onset, body surface area, accompanying hypertension, accompanying psoriatic arthritis, induction phase mean dose, and cumulative dose showed a relationship with good treatment response. Body surface area, initial dose, and accompanying hypertension were correlated with treatment failure. The mean time taken to achieve psoriasis area and severity index 75 was 6.70±3.17 weeks and it did not correlate with any factor. @*Conclusion@#In patients with psoriasis vulgaris, maintaining an adequate mean dose in the induction phase may be necessary for successful treatment with cyclosporine, especially in the patients with early-onset psoriasis, severe psoriasis, or accompanying psoriatic arthritis. In addition, a sufficiently high start dose may be needed to prevent treatment failure, particularly in patients with severe psoriasis vulgaris.
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Subject(s)
Humans , Aluminum , Hyperpigmentation , Incidence , Korea , Lentigo , Neodymium , Pigmentation , Prospective Studies , Qi , Single-Blind Method , YttriumABSTRACT
Cutaneous Müllerian cyst (CMC) is a rare benign cystic lesion that typically occurs on the lower extremity of young females shortly after puberty. They have been widely regarded as Müllerian heterotopias due to the morphological similarities of the cyst lining cells to the epithelium of the fallopian tubes. A 16-year-old female presented with a two-year history of a solitary, subcutaneous mass involving the left ankle. She had no specific symptoms associated with the skin lesion. However, the lesion had been growing in size. Histopathological findings revealed cystic structures lined by pseudostratified ciliated cuboidal to columnar cells, accompanying intraluminal papillary projection. The immunohistochemical staining profiles, including positive staining for estrogen and progesterone receptors, were characteristic of the fallopian tube epithelium. After being surgically removed, the lesion was cured without recurrence. Based on her typical presentation and histopathological findings, we present this patient as a case of CMC.
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Background@#Patients with undifferentiated masses on the finger are frequently encountered in the clinic. However, dermatology literature is scarce regarding these tumors. @*Objective@#To investigate the clinical characteristics of digital benign tumors. @*Methods@#We retrospectively reviewed clinical photographs and medical records of 139 patients who visited Kangbuk Samsung Hospital for digital tumors confirmed by skin biopsy between January 2013 and August 2019. @*Results@#The mean patient age was 47.6 years and the male-to-female ratio was 1：1.27. The most common digital tumor was mucous cysts, accounting for 32.37% of the total number, followed by pyogenic granuloma (29.49%) and Masson’s hemangioma (7.19%). The most common digital tumors on the volar and dorsal surfaces were pyogenic granuloma (54.09%) and mucous cyst (55.12%), respectively. @*Conclusion@#Our study demonstrates that various digital tumors can occur. Further studies with larger patient groups are needed to better understand the incidence or site predilection of digital tumors.
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No abstract available.
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Wolf's isotopic response is defined as the occurrence of a new skin disorder at the site of another unrelated skin disease that has already healed. In most cases of isotopic response, the initial dermatosis is herpes infection, and the most frequent second dermatoses are granulomatous reactions. Various interpretations of this phenomenon have been attempted. However, the exact mechanism has not been identified yet. Herein, we report a case in which the secondary disease was segmental vitiligo that appeared over the same dermatomes of herpes zoster. A 71-year-old woman presented with well-defined, depigmented patches on the left chest and back. She had been diagnosed with herpes zoster on the same dermatomes and treated with an antiviral agent 3 years ago. Histological examination showed decreased basal melanin pigments and melanocytes. Consequently, the patient was diagnosed with segmental vitiligo based on the clinical and histological findings.
Subject(s)
Aged , Female , Humans , Herpes Zoster , Melanins , Melanocytes , Skin , Skin Diseases , Thorax , VitiligoABSTRACT
Barraquer-Simons syndrome is a rare acquired lipodystrophy characterized by gradually symmetric subcutaneous fat loss in a craniocaudal distribution, often associated with hypocomplementemia and nephropathies. Facial cosmetic treatment in this disorder has not been fully described in the literature. We present a patient with Barraquer-Simons syndrome with emphasis on early cosmetic intervention with autologous fat grafting and its long-term efficacy. At the follow-up 37 months after the last fat grafting, preservation of the grafted fat was noted while lipodystrophy progressed in the trunk regions. Autologous fat grafting is suggested for the correction of facial dysmorphism in this type of lipodystrophy.