A Case of Disseminated Cutaneous Nocardiosis due to Nocardia brasiliensis Diagnosed by Fine Needle Aspiration Biopsy and 16S Ribosomal RNA Sequencing / 대한피부과학회지

Nocardiosis is a rare, life-threatening infection in the immunocompromised host. The causative bacteria are members of the genus Nocardia and are filamentous gram-positive bacilli that usually infect the lung, skin, and central nervous systems. Cutaneous nocardiosis presents as a disseminated infection or as a primary infection resulting from inoculation. Isolation of Nocardia from clinical specimens and identification of species is difficult and needs the expertise of a microbiologist. These infections are particularly important because of the associated high risk of dissemination. Hence, prompt identification of this organism is crucial. Herein we report a case of disseminated nocardiosis caused by N. brasiliensis in a 64-year-old man diagnosed by fine needle aspiration (FNA) and 16S ribosomal RNA sequencing. The patient was treated with trimethoprim plus sulfamethoxazole, imipenem, and amikacin with an improvement of symptoms.

A Case of Myxoid Neurothekeoma on the Hand / 대한피부과학회지

Neurothekeoma is a benign dermal soft tissue tumor that is probably of nerve sheath origin. It usually presents as a slow-growing, solitary papule or nodule that is mainly located on the head and neck or upper extremities except for the hand. There are three histologic subtypes - myxoid, mixed and cellular type - depending on the amount of myxoid stroma. Immunohistochemical markers such as S-100, glial fibrillary acidic protein, nerve growth factor receptor, NK1C3 (CD57) and Ki-M1p can be applied to the tumor cells to distinguish among thesethree subtypes of neurothekeoma. Only one case has been previously reported on the hand in Korea. Herein, we report a rare case of myxoid neurothekeoma on the hand with a review of the related literature.

A Case of Esophageal Adenocarcinoma Metastasized to the Scalp

Cutaneous metastases from internal malignancies are, occurring in 0.5% to 9% of cases. Lung, breast, and colorectal cancers are common primary tumors that metastasize to the skin; cutaneous metastasis usually occurs on the chest wall and abdomen as asymptomatic nodular patterns. Esophageal cancer is not nearly as common as breast, lung, and colorectal cancers, and esophageal cancer rarely metastasizes to the skin. Cutaneous metastasis of esophageal cancer is rare and metastasis to the scalp is extremely rare. Only a few cases of cutaneous metastases of esophageal cancer have been reported in Korea. Most of the cases involved cutaneous metastases arising from esophageal squamous cell carcinoma; however, there have been several reports describing cutaneous metastases from esophageal adenocarcinomas. Herein, we describe a case of metastatic skin cancer that originated from esophageal adenocarcinoma.

Surgery and Perioperative Intralesional Corticosteroid Injection for Treating Earlobe Keloids: A Korean Experience

BACKGROUND: The aesthetic implications of ear keloids, which affect people of all races, are serious and the treatment of earlobe keloids is known to be difficult. The high rate of recurrence following excision alone has led to investigating various types of adjuvant therapy, including intralesional corticosteroid injection. OBJECTIVE: We evaluated the efficacy of excision combined with perioperative intralesional triamcinolone acetonide injection for treating earlobe keloids of Korean patients. METHODS: From 1997 to 2006, eighteen keloids on the earlobes of fifteen Korean patients were treated. The patient age ranged from 15 to 32 years (mean age: 24 years). All the patients were female and the keloids occurred after ear piercing. Preoperative intralesional triamcinolone acetonide (TA) injection was administered twice at a 1-month interval. Postoperative intralesional TA injections were given every 1 month for several months, depending on the patient's clinical progress. RESULTS: The follow-up period ranged from 4 to 42 months (mean: 18.5 months). After the surgery, TA intralesional injections were given 2 to 13 times (mean: 5.2 times). Of the treated keloids, eleven showed good results (61.1%) and three recurred (16.6%). No complications from the TA intralesional injection were observed. CONCLUSION: Among the various treatments for earlobe keloids, we suggest that excision with corticosteroid intralesional injection can be used as the first line therapy when considering its effect and economic advantage.

Two Cases of Nevoid Basal Cell CarcinomaSyndrome in One Family

The nevoid basal cell carcinoma syndrome, or Gorlin-Goltz syndrome, is an autosomal dominant multiple system disorder with high penetrance and variable expressions, although it can also arise spontaneously. The diagnostic criteria for nevoid basal cell carcinoma syndrome include multiple basal cell carcinomas, palmoplantar pits, multiple odontogenic keratocysts, skeletal anomalies, positive family history, ectopic calcification and neurological anomalies. We report a brother and sister who were both diagnosed with nevoid basal cell carcinoma syndrome.

A Case of Eccrine Angiomatous Hamartoma with Unusual Lipomatous Involvement / 대한피부과학회지

Eccrine angiomatous hamartoma (EAH) is a benign, uncommon cutaneous lesion, often localized to the distal extremities of children. It usually presents as a solitary, asymptomatic lesion that appears as a nodule or plaque, but sometimes it can occur as multiple lesions. Varying degrees of hyperhidrosis and pain have been reported. The histological feature is characterized by a proliferation of eccrine sweat glands and angiomatous channels. Occasionally, other elements are involved, such as mucin-secreting cells, adipose tissue, bony structures, apocrine glands or hair structures. We describe a case of eccrine angiomatous hamartoma with unusual lipomatous involvement.

Two Cases of Secondary Erythromelalgia Associated with Essential Hypertension / 대한피부과학회지

Erythromelalgia is a rare clinical syndrome characterized by redness and painful episodes of the feet and hands, which is triggered by heat or exercise. A 22-year-old male soldier presented with paroxysmal redness of the both feet associated with pain and tenderness upon heat stimulation, including wearing military shoes for periods of over 30 minutes. He had been treated of essential hypertension with dichlorothiazide and had a familial medical history of essential hypertension with his mother and brother. A 21-year-old male soldier also presented with paroxysmal redness of both feet and hands associated with pain and tenderness upon heat stimulation. By searching for the underlying or combined diseases of the erythromelalgia, he was also found to have essential hypertension. Herein, we report two cases of secondary erythromelalgia associated with essential hypertension.

A Clinical Study of Molluscum Contagiosum in Adults / 대한피부과학회지

BACKGROUND: Molluscum contagiosum is a common cutaneous viral infection of the skin. Although molluscum contagiosum generally affects young children, the incidence in adults is rising. OBJECTIVE: The purpose of our investigation was to describe the clinical characteristics of 28 adults with biopsy-proven molluscum contagiosum. METHODS: We reviewed the medical records and clinical photographs of 28 patients who were diagnosed with molluscum contagiosum from June 2000 to May 2007. Personal and clinical information such as onset, age, gender distribution, clinical manifestations, associated diseases, pathologic characteristics and treatment modalities were investigated. RESULTS: Of the 28 patients, 19 (67.9%) were men and 9 (32.1%) were women. The average age of onset in men and women were 39.4 and 46.4 years, respectively and the overall average age of onset was 41.7 years. The most common clinical finding was a typical umblicated papule in 10 (35.7%) of the 28 cases. The atypical presentations including giant molluscum, chickenpox-like lesions, prurigo-like lesions and verruca-like lesions were also seen. The most common affected site was the genital area, followed by the head and neck, extremities and trunk. Except for the 21 asymptomatic patients, 7 patients complained of pruritus. Seropositive ELISA assays for HIV was found in 1 patient. Five patients were under immunosuppressive conditions such as HIV infection, sarcoidosis, taking immunosuppressant drugs after liver transplantation, chemotherapy for breast cancer and chemotherapy for gastric cancer. Molluscum bodies were confirmed in all patients through histologic findings. Molluscum extraction was mainly used as a treatment of molluscum contagiosum. CONCLUSION: In Korean literature, this is the first clinical study of molluscum contagiosum occurring in adults. Molluscum contagiosum in adults shows atypical clinical features, so it can be misdiagnosed as other diseases. We suggest that dermatologists should perceive clinical findings of molluscum contagiosum in adults and perform proper investigation and management.

A Case of Eruptive Xanthoma Associated withType IV Hyperlipoproteinemia and Koebner Phenomenon / 대한피부과학회지

Type IV hyperlipoproteinemia is characterized by increased blood levels of the triglyceride form of the fat that makes up very low-density lipoproteins (VLDL). Eruptive xanthomas have been frequently observed in type I and V hyperlipoproteinemias but rarely observed in patients with type IV hyperlipoproteinemia. The Koebner phenomenon is the development of the isomorphic skin lesions in persons with certain skin diseases after an injury has occurred on skin of normal appearance. Although this response can develop in psoriasis, lichen planus, verruca etc., it has seldom been associated with eruptive xanthoma. We report a case of eruptive xanthoma with type IV hyperlipoproteinemia and Koebner phenomenon in a 28-year-old Korean male.

Generalized Eczema-like Eruption in a Patient Treated with Interferon Alpha-2b and Ribavirin for Chronic Hepatitis C / 대한피부과학회지

The combination of interferon alpha with ribavirin is currently recommended in the treatment of hepatitis C virus (HCV) infection. Commonly reported cutaneous reactions include localized reactions such as injection site inflammation and necrosis and worsening of other skin disorders, including psoriasis, lichen planus, vitiligo, or systemic lupus erythematosus. However, generalized eczematous reactions have been reported to occur uncommonly in patients treated with interferon and ribavirin, however such a case has not been described in the Korean literature. Herein, we describe a 49-year old female showing generalized eczema-like eruption after treatment of interferon alpha-2b and ribavirin for chronic HCV infection.

A Case of Linear IgA Bullous Dermatosis Probably Caused by Captopril / 대한피부과학회지

Linear IgA bullous dermatosis (LABD) is a rare autoimmune subepidermal bullous disease characterized by a linear pattern of IgA deposition along the basement membrane zone. The etiology of LABD is unknown but a minority of cases are drug-induced. Although vancomycin is the agent most commonly implicated in the pathogenesis of drug-induced LABD, association with other agents including phenytoin, piroxicam, captopril, diclofenac sodium and cyclosporine have also been reported. We describe a case of linear IgA bullous dermatosis which probably developed after captopril treatment in a 51-year-old male patient with infective endocarditis.

A Case of a Follicular Hybrid Cyst

Various cutaneous cysts such as epidermal cysts, trichilemmal cysts, vellus hair cysts, steatocystoma, or pilomatricoma can arise from a different part of the pilosebaceous unit, namely the infundibulum, isthmus, sebaceous ducts, and bulbar or inferior portion. Rarely, a hybrid cyst that includes two or more components of a cystic lesion arising from the pilosebaceous unit can develop. The pathogenesis of this unusual disease is not yet known. We report a case of a follicular hybrid cyst which showed combined histologic features of both an epidermal cyst and pilomatricoma, and discuss the possible pathomechanism of the development of this hybrid cyst with a review of the literature.

A Case of Histiocytoid Sweet's Syndrome with Myelodysplastic Syndrome / 대한피부과학회지

Sweet's syndrome is an acute febrile neutrophilic dermatosis that occurs with malignant disease, mainly myeloid hemopathies, in about 20% of cases. When associated with myelodysplasia, clinical and histologic features of Sweet's syndrome can be atypical; however its significance is still debated. We encountered a case of Sweet's syndrome associated with myelodysplastic syndrome in a 63-year-old woman. The clinical presentation strongly suggested Sweet's syndrome but, histopathologic examination showed dense histiocytic infiltration with prominent upper dermal edema and little neutrophil infiltration. In the evaluation for atypical histopathology and laboratory abnormalities, she was diagnosed with myleodysplastic syndrome by peripheral blood smear and bone marrow biopsy. Histiocytoid Sweet's syndrome is a currently accepted concept and probably has a close relation with underlying myeloid hemopathies.