Prevalence of Fungal Infection on Foot in Diabetic Patients and Correlation between Diabetic Ulcer and Fungal Infection on Foot / 대한피부과학회지

OBJECT: The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. METHODS: A total of 21, 693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. RESULTS: 13, 271 patients had certain kinds of foot problem, accounting for 61.2% of 21, 693 diabetics examined. Of these, fungal foot disease were found in 10, 403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6, 496 (29.9%), onychomycosis in 7, 783 (35.9%), and coexistence was in 3, 883 (17.9%). Foot deformity was in 1, 346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1, 051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5, 486 patients paid a visit to the department of dermatology. Of these, 4, 519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2, 272 males and 2, 247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3, 847 patients (70%) and onychomycosis was proven mycologically in 3, 276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3, 885(70.8%) and tinea pedis was found in 3, 209 (58.5%), most commonly involving the soles. CONCLUSION: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.

Tufted Angioma:Clinicopathologic Surveys and the Response to Intralesional Steroid

BACKGROUND: Tufted angioma is an uncommon slowly progressive vascular tumor found typically in infants and young children with characteristic histologic findings, so called "cannonball" appearance. OBJECTIVE: The purpose of this study was aimed to investigate the clinical and histopathological characteristics of tufted angioma and the response to intralesional steroid. METHODS: Clinical information of 10 patients with tufted angioma diagnosed in Severance hospital and Pundang CHA hospital from 1983 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated 10 biopsy specimens obtained from them with routine H&E staining. RESULTS: Five male and five female patients were included. In 9 patients the lesion appeared before 2 months of age. Four had a lesion at birth. The thigh was the most common site. The clinical symptoms were diverse, but characteristically tenderness was present in most cases. In all the patients the lesions had a tendency to spread progressively. Microscopically, numerous, distinct, variably sized, tightly packed capillary and endothelial cellular lobules were scattered in the dermis. There were characteristic semilunar spaces adjacent to the capillary tufts. Six patients received intralesional triamcinolone. This treatment was found to be effective in 5 patients who experienced remarkable improvement. The improved cases had similar histologic findings which were composed of cellular mass more than lumen formation. We classified our specimens into two categories, one with more cellular mass and the other with more lumen formation in relative proportion. The former was different from the latter in that it had more solid appearance and more definite margin. And we realized that it was useful to divide into these two categories since its response to treatment could be different. CONCLUSIONS: Tufted angioma is a relatively uncommon disease with characteristic histopathologic findings. It seems not to regress spontaneously. So early treatment is required to pre-vent further spreading up to the extent. We treated 6 patients with intralesional injection of triamcinolone and 5 patients experienced marked improvement which had more cellular mass more than lumen formation histopathologically.

Narrow-band UVB as a Tool of Vitiligo Treatment / 대한피부과학회지

BACKGROUND: Many modalities of treatment for vitiligo have been elucidated and yet the treatment of vitiligo remains to be a challenge. OBJECTIVES: The purpose of this article is to review our results and experiences with narrow-band ultraviolet B phototherapy for vitiligo. METHOD: We studied 9 patients with vitiligo who received narrow band UVB phototherapy for 6 months in our department. This is a retrospective analysis of our experiences and results. RESULTS: Nine patients were able to be evaluated for the purpose of this analysis. Their ages ranged from 6 to 68 years(mean, 18.4 years). Six patients of 9 patients achieved more than 75% repigmentation with a mean of 25 sessions of phototherapy. The remaining three patients had 50%, 40% and 30% repigmentation after 44, 40, and 45 sessions of phototherapy, respectively. Adverse effects were mild. CONCLUSION: Narrow-band UVB is a useful and well-tolerated therapy for vitiligo in comparsion with other therapies.

Proliferating Nodules Within a Congenital Melanocytic Nevus: Proper criteriae for surgical removal in infantile periods

Congenital melanocytic nevus(CMN) constitute a well-known risk factor in the development of malignant melanoma, but melanoma developing in newborn and infants are extremely rare. We describe a case of proliferating nodules within CMN at the age of 13 months. Like our case it is difficult to manage the proliferating lesions within CMN in infants. So we carefully suggest the indications of preventive excision when proliferating lesions occur within CMN as follows; 1) preventive excision is postponed until the age of two when the proliferating lesions are slowly growing, 2) surgical excision is needed when the lesions are rapidly growing exceeding 1 cm in size even though it is before the age of two.

A Case of multiple cutaneous neurofibromas treated by CO2 laser / 대한피부과학회지

Multiple Cutaneous neurofibromas are the most common skin manifestation of Von Recklinghausen neurofibromatosis(NF-1). The CO2 laser is presented as a useful tool for the removal of large numbers of small- or medium-sized cutaneous neurofibromas. Its advantages include high patient satisfaction with the rapid removal of hundreds of neurofibromas, with minimal morbidity and an enhanced appearance. We report a case of multiple cutaneous neurofibromas treated by CO2 laser in a 40 year-old man whom we eliminated 288 cutaneous neurofibromas out of 788 in total. After 3 months of follow up, the lesions were healed with slight erythemas and minimal scars.

A Case of Acquired Periungual Fibrokeratoma / 대한피부과학회지

We report herein a case of acquired periungual fibrokeratoma occuring beneath the proximal nail fold. A 0.5 X 0.3 cm sized, firm nodule was found beneath the proximal nail fold and at its distal portion longitudinal ridging of nail plate was found. Histopathological finding showed marked hyperkeratosis and acanthosis in the epidermis and thick collagen bundles were predominantly oriented in the direction of longitudinal axis of the tumor.

A Case of Primary Cutaneous Adenoid Cystic Carcinoma / 대한피부과학회지

We report a case of primary cutaneous adenoid cystic carcinoma in a 39-year-old male patient. It was a slightly erythematous hard nodule on left chin and composed of cribriform and tubular masses of basaloid cells. Lumina formed by neoplastic cells contained mucin and hyalin, and similar constituents were located between neoplastic cell masses and adjacent dermis. Immunohistochemically, the neoplastic cells stained only focally with S-100 protein and negative with carcinoembryonic antigen(CEA). Therapy should employ wide surgical excision that extends well beyond the clinical confines of the neoplasm.

A Case of Aneurysmal Fibrous Histiocytoma / 대한피부과학회지

Aneurysmal fibrous histiocytoma(AFH) is a histologic variant of dermatofibroma. The importance of the recognition of AFH as a variant of dermatofibroma lies in the differential diagnosis because the histologic appearance of AFH is very similar to dermatofibrosarcoma protuberans and other vascular malignancies, such as Kaposi's sarcoma and angiosarcoma. A 32-year-old man was seen for a nodular mass on the right popliteal fossa of 4 years' duration. The excisional biopsy specimen showed a relatively well circumscribed tumor mass in the dermis. In addition to compact storiform proliferation of spindle cells, there were multiple, irregular, blood-filled, aneurysmal tissue spaces that were devoid of lining of endothelial cells. Also, deposition of hemosiderin was prominent, particularly in the periphery of the aneurysmal spaces. Immunohistochemical stain for CD34 were negative to most tumor cells. After excisional therapy, there was no evidence of recurrence during the period of ten months' follow-up.

A Case of Branchial cleft fistula / 대한피부과학회지

Congenital branchial anomalies are developmental defects resulting from incomplete obliteration of branchial clefts, arches and pouches, and usually found as cysts, fistulas and sinuses. The sinus or fistula is usually noted during infancy and young childhood due to recurrent infection. We have experienced a case of branchial cleft fistula in a 12-year-old male. It was a skin colored, nontender nodule which had mucus secreting from a small opening pore. We performed complete surgical removal and histopathologically the lumen was lined by pseudostratified columnar cells and the stroma was composed of aggregates of lymphocytes with many germinal centers. So we finally diagnosed it as branchial cleft fistula of second type branchial anomaly.

Two Cases of Deep Vein Thrombosis Associated with Behcet's Disease / 대한피부과학회지

In Behcet's disease(BD), there is a marked increase in vascular complication. Venous thrombosis is a major feature of the disease, although arterial thrombosis is rarely described. In Behcet's disease, thrombosis occurs in 20 to 30% of patients. We present two cases of Behcet's disease admitted to our hospital whose chief complaint was progressive increases in swelling and pain in their legs. In the first case, routine coagulation tests and sero-immunological tests were within normal limits, however, protein C and S activity were significantly decreased in the patient. So these findings suggest that auto-immune acquired protein S deficiency may be involved in the pathogenesis of thrombotic events in BD.

A Case of Erosive Adenomatosis of the Nipple / 대한피부과학회지

We present a case of erosive adenomatosis of the nipple in a 22-year-old woman. The clinical features of erosive adenomatosis of the nipple are similar to Paget's disease in that it has erythematous erosions with oozing and fissured crusts on one nipple. However, histologic findings are characteristic, consisting of dilated tubular structures that are lined by a peripheral layer of cuboidal cells and a luminal layer of columnar cells showing secretary properties into the lumen. The clinical course is benign, so simple mastectomy is enough for treatment.

Sweet's Syndrome Associated with Acute Erythema Nodosum

A 44-year-old man had Sweet's syndrome (acute febrile neutrophilic dermatosis), accompanied by erythematous tender subcutaneous nodules resembling erythema nodosum(EN). The EN-like lesions histologically showed a septal panniculitis with predominantly neutrophilic in-filtrates. The association of Sweet's syndrome with EN seems to be uncommon and only a few cases have been reported until the present. We describe a patient with Sweet's syndrome associated with acute EN.

Prurigo Pigmentosa:A Report of 5 Cases with a Review of the Korean Literature

Prurigo pigmentosa(PP) is a rare dermatosis with an unknown cause characterized by intensely pruritic papules that resolve with reticulate pigmentation. It is a disease entitity commonly reported in Japan but seemingly rare in other parts of the world. We report 5 cases that clinically and histopathologically fulfilled the characterisitics of PP and were treated with dapsone resulting in significant clinical improvement.

Four Cases of Pigmentary Dermacation Lines of Pregnancy with Erythema

Pigmentary dermarcation lines are boundaries between more deeply pigmented skin and areas of lighter pigmentation. We report 4 cases of pigmentary demarcation lines of pregnancy associated with erythema which developed in the third trimester of pregnancy and were symmetrically located in the buttock and posteromedial portion of the lower extremities. After delivery, the erythema disappeared within 3-7 days, followed by slow resolution of the brownish pigmentation.

Jellyfish Sting / 대한피부과학회지

Stings due to jellyfish, sea anemones, and corals are the most common envenomations encountered with humans in the marine environment. The first case was a 36-year-old female who presented with multiple whiplike linear, dark reddish bullous eruptions on the right forearm after she was stung by a jellyfish in the Philippines 15 days previously. The patient was treated with oral antibiotics for 10 days, but severe pruritus persisted and new papular lesions developed on her hand. Antibiotic therapy was discontinued and oral and topical corticosteroid therapy was applied instead. The skin lesions disappeared without recurrence after about 4 weeks. The second case was a 29-year-old male who visited our department with linear, reddish patches and necrotizing blisters on both the arms, left thigh, and trunk after he was stung by a jellyfish in Thailand. We treated him with oral and topical corticosteroids for 10 days and the lesions cleared. We describe two typical cases of jellyfish sting that are rare in Korea.

A Case of Acute Generalized Exanthematous Pustulosis / 대한피부과학회지

Acute generalized exanthematous pustulosis(AGEP) is a disease entity caused mostly by drugs or viral infections. Clinically it manifests as generalized erythema, erythema multiforme and amicrobial pustules with fever. Histologically, AGEP is composed of neutrophilic subcorneal and spongiform pustules. A 70-year-old female, with no personal or family history of psoriasis, was given medication including diltiazem for hypertension. Fourteen days after taking the medications, pustular eruptions appeared on the face and rapidly spread to the trunk and limbs. A Laboratory examination revealed neutrophilic leukocytosis and an elevated erythrocyte sedimentation rate. The skin biopsy showed subcorneal and spongiform pustules. We report here a case of AGEP probably due to diltiazem.

Clinical Analysis of 14 Cases of Pyoderma Gangrenosum / 대한피부과학회지

BACKGROUND: Pyoderma gangrenosum is a rare disease in which a painful nodule or pustule breaks down to form a progressive enlarging ulcer. Until now, only 8 cases of pyoderma gangrenosum have been reported in Korea. Therefore, we thought it necessary to perform a clinical analysis of pyoderma gangrenosum in Korea with a review of literature. OBJECTIVE: Our purpose was to find the clinical features of pyoderma gangrenosum in Korea. METHODS: Fourteen cases with pyoderma gangrenosum were investigated by reviewing medical records. Results There were 6 males and 8 females. The onset age was between 4 years and 65 years, and most(9 cases) had developed the condition between the ages of 20 and 60. Thirteen cases involved the extremities and 3 cases had whale body involvement, Seven cases(50%) had multiple lesions. All cases had pain at the lesional sites. Two cases were classified as the bullous type and the others were ulcerative in nature. The histological fmdings were non-specific. Dense inflarnmatory infiltrates composed of lymphocytes and predominant neutrophils were found in the epidermis and dermis associated with ulceration. Two cases were treated only with systemic steroids, and 2 cases with dapsone and steroids, 2 cases with colchicine and steroids, and 1 case with steroids, dapsone and colchicine. One case was treated with colchicine and anti-Tbc drug, 1 case with dapsone, 3 cases with antibotics, 1 case with the anti-Tbc drug and 1 case with anti-cancer drugs. Systemic disease was present in 5D% of the cases. The associated diseases were Behcets disease(3 cases), tuberculosis(2 cases), systemic lupus erythematosus(1 case), pancytopenia(1 case), iron deficiency anemia(1 case), acute leukemia(1 case), and colon adenoma(1 case). Recurrence developed in 2 cases and positive pathergy reactions were observed in 3 cases. CONCLUSION: Pyoderma gangrenosum was eccompanied with systemic disease in 50% of the cases and the most common therapeutic drugs were steroids. It is therefore impartant to detect the presence of any underlying disease and to treat this alongside pyoderma gangrenosum.

A Case of Fibrolipoma

Fibrolipoma is an uncommon variant of lipomas which shows a distinct pathologic findings with both component of mature adipose cells and broad bands of dense fibrous connective tissue. A 30-year-old woman developed an 5×7cm sized, indurated, ill-defined, subcutaneous mass on the right axilla. Microscopically, the tumor contained broad bands of dense connective tissue with mature adipose tissue scattered throughout the mass, but it did not show encapsulation. The lesion was excised and she showed no evidence of recurrence after 6 months of follow-up.

A Case of Aplasia Cutis Congenita, Type V

Aplasia cutis congenita is a congenital localized or widespread absence of the skin. We report a case of aplasia cutis congenita, type V, in a 6-day-old male infant born with the stellate and linear skin lesions covered by granulation tissue and soft capsule with slightly elevated erythematous edges on the trunk and lower extremities without any associated family history. The patient had amniotic bands and were diagnosed as aplasia cutis, type V. The patient received conservative treatment such as antiseptic dressing and prophylactic systemic antibiotics with healing of the ulcer.

Systemic Scleroderma in Childhood / 대한피부과학회지

The onset of systemic scleroderma in the first. decade of lif occurs in less than 1.5% of instances. Systemic sclerodrma in childhood have been characterized by less severe visceral involvement and a benign course We report a boy, aged 7 years, with a history of Raynaid; phenomenon and dysphagia. He had a mask-like face, flexion contracture of hands and knee joints, digital pitting scars, ichthyosiform skin change on leg and hyperpigrnented induration on all extremities and trunk. Antinuclear antibodies were positive in nucleolar type and Scl-70 antiocy was also present. On radiologie study, the pattern of reflux esophagitis and resorption of the listal ends of all phalanges were nated. Histopathological findings were compatible with sclerodma. He was treated with Penicillamine-D and oral corticosteroic with good improvernent.