A Case of Toenail Onychomycosis Caused by Trichosporon asahii / 대한피부과학회지

We report the first case of toenail onychomycosis caused by Trichosporon asahii in a 60-year old Korean man. The patient presented with a typical distal subungual onychomycosis. Direct microscopic examination of scrapings on the potassium hydroxide(KOH) preparation revealed fungal elements. On modified dermatophyte agar, the colony was white color and wrinkled, folded with furrows and convolutions and microscopic morphology showed long rectangular arthroconidia and lateral blastoconidia of trichosporon species. The fungus was identified as T. asahii using API 20C AUX (bioMerieux S.A., l'Etolile, France) kit.

Prevalence and Risk Factors of Tinea Pedis in Workers of Shipbuilding Industry / 대한산업의학회지

OBJECTIVES: Recently,tinea pedis has been reported to be a type of occupational dermatoses because of its high prevalence in specific working conditions.Although there is no doubt that the environment surrounding work places, the usual habits of workers etc are intimately related to this skin conditions, there is some controversy as to whether or not this condition is a real occupational illness and what is the exact cause of the high prevalence of this illness is. In this study, the prevalence of tinea pedis in workers from the shipbuilding industry was investigated andthe risk factors of this disease were evaluated. This study also aimed to verify whether or not tinea pedis is one of the occupational diseases. METHODS: The results of interviews, questionnaires and clinical findings from 1,419 workers who visited the occupational health center for an annual routine check for their health state were analyzed. RESULTS: Among the 1,419 workers, 778 workers (54.8%)had tinea pedis. By simple logistic regression analysis,the prevalence of tinea pedis was found to be affected by some variables, including the job category, the types of work,the kinds of footwear, whether or not they were using communal baths in the work places, and a family history of tinea pedis.In contrast, by multiple logistic regression analysis,only utilization of the communal baths in the work places and a family history of tinea pedis turned out to be statistically significant risk factors. CONCLUSIONS: In this study, the major factors contributing to the high prevalence of tinea pedis are the use of communal baths in the workplace and a positive family history. However, the wearing of safety shoes was not statistically significant. Therefore, tinea pedis could not be confirmed to be an occupational disease. On the basis of these results, a solution to the environmental hygiene of communal baths and the personal hygiene of individuals needs to be improved in order to prevent tinea pedis.

A Case of Fixed Cutaneous Type Sporotrichosis with Many Fungal Elements on Histopathologic Examination / 대한피부과학회지

We report a case of fixed cutaneous type sporotrichosis with atypical histopathologic findings in a 18-year-old male patient, who presented with a 1-year history of a 4x3 cm sized, crusted, erythematous plaque and several small erythematous papules on the left knee. The histopathologic findings showed pseudoepitheliomatous hyperplasia, abscess formation, chronic granulomatous inflammation and many PAS-positive fungal spores and hyphae in the dermis. Sporothrix schenckii was identified with fungal culture of biopsy specimen. The lesions improved with three pulses of itraconazole 400mg daily for a week per month.

Cutaneous Cytomegalovirus Infection Presenting as Perianal Ulcers

A 68-year-old Korean woman was consulted to the department of dermatology to evaluate ulcerated lesions on the perianal area, which developed about 3 weeks after a cadaveric renal trans-plantation. Histopathologic examination showed large atypical cytomegalic cells in the upper dermis. Polymerase chain reaction(PCR) study revealed positive cytomegalovirus(CMV) deoxyribonucleic acid(DNA) from the skin tissue. We herein present a case of cutaneous CMV infection presenting as perianal ulcers.

Succesful Treatment of Pruritus in Pregnancy with Broadband UVB Phototherapy

A 31-year-old pregnant woman with pruritus in pregnancy was described; she presented with a one-week history of generalized pruritus at gestational age 6 weeks without primary skin lesion. She had no dermatologic problem before pregnancy. Her pruritic symptom was not con-trolled with conventional emollient and topical corticosteroids. Broadband Ultraviolet B(UVB) phototherapy successfully improved her pruritus. UVB phototherapy also worked well after recurrence of pruritus at pregnancy 23rd week. We report herein a case of pruritus in pregnancy successfully treated with broadband UVB phototherapy.

A Case of Punctate Porokeratosis / 대한피부과학회지

We report a case of punctate porokeratosis in a 50-year old Korean man. The patient had multiple small keratotic papules and pits on his both palms and soles for more than 20 years. Histopathologic exam showed a typical cornoid lamella and loss of granular cell layer and mild vacuolar degeneration of epidermis under the cornoid lamella. The final diagnosis was the punctate porokeratosis, a rare form of porokeratosis.

A Case of Type V Hyperlipoproteinemia with Xanthoma Eruptivum / 대한피부과학회지

We report a case of type V hyperlipoproteinemia with xanthoma eruptivum associated with diabetes mellitus. An 18-year-old female patient presented with multiple, erythematous papules on the trunk, buttocks, and both extremities and multiple orange-yellow colored, conglomerated nodules on the elbows and knees. Laboratory examination showed increased serum blood glucose, cholesterol and triglyceride. Lipoprotein electrophoresis showed increased pre-beta and chylomicron bands. Analysis of lipoprotein revealed increase of very low density lipoprotein (VLDL) and triglyceride levels in the plasma. A skin biopsy from the papule on the trunk revealed a xanthoma. We diagnosed the patient as type V hyperlipoproteinemia. After 10 months of treatment with insulin and gemfibrozil, the serum levels of cholesterol and triglyceride were reduced to normal level. The skin lesions showed marked improvement without scar.

A Clinico-Pathological Study of Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: Squamous cell carcinoma(SCC) may occur anywhere on the skin and on mucous membranes with squamous epithelium. OBJECTIVE: The purpose of this study was to investigate the clinico-pathological characteristics of SCC. METHODS: A total of 62 patients with SCC were enrolled in this study. Six cases with metastatic SCC were included. The hospital charts and histopathological slides of the patients with SCC diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: 1. The male and female ratio was 1.8:1. The mean age at diagnosis was 61.5 years in male patients and 71.8 years in female patients. 2. Most commonly involved sites were the face(41.8%). Upper extremities, trunk, lower extremities, genitalia and scalp were followed in decreasing order. The proximal nail fold was involved in 3 case of primary cutaneous SCC and 1 cases of metastatic SCC. 3. Six cases(9.7%) of metastatic SCC were included. Lung cancer(83.3%) was the most common cause of metastatic SCC in this study. Interestingly, one case presented with SCC of the proximal nail fold revealed metastatic SCC from the lung. 4. The possible causative diseases of primary cutaneous SCC were actinic keratosis(12.5%), burn scar(8.9%), immune suppression(8.9%) owing to kidney transplantation and chemotherapy, arsenical keratosis(7.1%), Bowen's disease(5.4%), trauma(5.4%), osteomyelitis(3.6%), and porokeratosis(1.8%). The causes of 25 cases(44.6%) were undetermined. 5. Histopathological differentiation of the primary cutaneous SCC was performed as follows: 29 cases(51.8%) of well-differentiated, 11 cases(19.6%) of moderately-differentiated, 8 cases(14.3%) of poorly-differentiated, 6 cases(10.7%) of acantholytic, and 2 cases(3.6%) of verrucous SCC. 6. Metastatic rate of primary cutaneous SCC was 16.1%. Metastasis of SCC from osteomyelitis (100%) and burn scar(40%) or trauma(33.3%) and that of poorly differentiated SCC(37.5%) were more common. Regional lymph nodes(55.6%), skin(44.4%), and lung(33.3%) were common metastatic organs.

Two Cases of Subcutaneous Panniculitis-like T-cell Lymphoma / 대한피부과학회지

Subcutaneous panniculitis-like T-cell lymphoma(SPTCL) is a rare subtype of cutaneous T-cell lymphoma and needs to be differentiated from benign causes of panniculitis and other cutaneous T-cell lymphomas involving subcutis, especially nasal type NK/T-cell lymphoma(NKTL) involving the panniculus. We report herein two cases of SPTCL which was distinguished from nasal type NKTL by the following findings; CD8+, CD56-, Ebstein Barr virus RNA- and clonal T cell receptor gene arrangement.

A Case of lupus vulgaris diagnosed with polymerase chain reaction / 대한피부과학회지

Lupus vulgaris is the most common form of cutaneous tuberculosis showing various clinical manifestations. Because AFB staining and culture are often negative, diagnosis can be difficult. Polymerase chain reaction with high sensitivity and specificity may improve the diagnostic panel for cutaneous tuberculosis. We report a case of lupus vulgaris in a 5 year-old girl. The presence of Mycobaterium tuberculosis DNA in a skin biopsy demonstrated by polymerase chain reaction led to the diagnosis of lupus vulgaris.

A case of Norwegian scabies / 대한피부과학회지

An atypical form of scabies is crusted or Norwegian sacbies, which is often seen in the physically or mentally handicapped, immunocompromised, and institutionalized persons. The characteristic skin lesions in this form are gross scaling and hyperkeratotic plaque, especially on the hands, feet, scalp, face, and pressure bearing areas with varying degrees of pruritus. We report a case of Norwegian scabies in a 81 year old patient with a chronic obstructive pulmonary disease using systemic steroid.