Comparison of Therapeutic Effect of High Dose Corticosteroid Pulse Therapy and Combination Therapy of Cyclosporine with Low Does Corticosteroid for Severe Alopecia Areata / 대한피부과학회지

BACKGROUND: Severe alopecia areata (AA) is difficult to treat. Treatment modalities such as topical and systemic immune modulators, corticosteroids and topical sensitizers have been tried. Among them, encouraging RESULTS have been reported with high dose pulse corticosteroid therapy. OBJECTIVE: The aim of this study was to determine the effectiveness of a high dose corticosteroid pulse therapy in patients with severe AA compared with a group treated with oral cyclosporine with low dose corticosteroid. METHODS: A total of 105 patients with severe AA were treated with high dose corticosteroid pulse therapy and 41 patients those were treated with oral cyclosporine (3~5 mg/kg/day) with low dose methylprednisolone (2.5~5 mg/day). RESULTS: Therapeutic effect of high dose corticosteroid pulse therapy was better in shorter disease duration (6~12 months, 52.6%;>13 months, 37.3%) and less extensive type (AA multiplex, 80.0%; alopecia totalis, 41.2%; alopecia universalis, 27.8%). Therapeutic effect of oral cyclosporine with low dose corticosteroid therapy was better in less extensive type (AA multiplex, 75.0%; alopecia totalis, 41.2%; alopecia universalis, 25.0%). Disease duration did not significantly affect treatment response. High dose corticosteroid pulse therapy was more effective method (65.7%) than combination regimen of oral cyclosporine with low dose methylprednisolone (46.3%), especially in the case of shorter disease duration (p<0.05). CONCLUSION: High dose corticosteroid pulse therapy might be a more effective therapy for severe AA than other treatments, especially when in the acute stage (<6 months).

A Case of Diffuse Neurofibroma of the Scalp

A neurofibroma is a benign tumor of the peripheral nerve sheath characterized by proliferation of Schwann cells, perineural cells, and endoneurial fibroblasts. Different types of neurofibromas can be identified, including localized, plexiform, and diffuse types. Neurofibromas can involve any site on the body skin. The diffuse variant is rare and occurs primarily in children and young adults. It involves the skin and subcutaneous tissue in a plaque-like fashion on the head and neck regions. We present a case of a 10-year-old boy who had a diffuse neurofibroma on the scalp.

A Case of Linear Epidermal Nevus Associated with Multiple Trichilemmal Cysts / 대한피부과학회지

Epidermal nevi are harmatormas that are the result of developmental malformations of the epidermis, and these lesions present with a variety of clinical and histological characteristics. Some tumors can arise in epidermal nevi because epidermal nevi develop from multipotent germinative cells. We report here on a 57-year-old woman who had epidermal nevi arranged in a linear pattern since childhood. Her epidermal nevi were located in her left chest, arm and shoulder, upon which multiple trichillemal cysts seemed to develop after several years. We think that this patient with linear epidermal nevi associated with multiple trichilemmal cysts is a rare and distinctive case.

A Clinical Study of Androgenic Alopecia (VII) / 대한피부과학회지

BACKGROUND: Androgenic alopecia (AGA) is characterized by the local and gradual transformation of terminal scalp hair into vellus hair, which has a shorter and thinner shaft. It is the most common form of hair loss in people with a genetic predisposition for baldness. OBJECTIVE: The aim of this study was to evaluate the prevalence, AGA type, family history, co-morbidity diseases, stress factors and endocrine factors of AGA patients. METHODS: We examined a total of 432 male and female AGA patients who visited for two years at the Department of Dermatology, School of Medicine, Chung-Ang University. RESULTS: There were 2.06 times more men (291 patients) than women (141 patients) among the study subjects. Most of the men were in their twenties (108, 37.1%), however, most of the women were in their forties (42, 29.7%). In the 291 male patients, Norwood class IIIv was dominant (120 patients, 41.2%). In the 141 female patients, Ludwig class I was dominant (87 patients, 61.7%). 219 (75.2%) of the 291 male patients and 81 (73.6%) of the 141 female patients had a family history of AGA. 224 (76.9%) of the 291 male patients and 101 (53.4%) of the 141 female patients had a co-morbidity disorder. The most common among these disorders in both the male and female patients was seborrheic dermatitis. Stress factors were observed in 162 (55.6%) of the 291 male patients and in 78 (55.3%) of the 141 female patients. The most common stress factor in both the male and female patients was work tasks. The serum testosterone levels was increased in 51 (17.5%) of the 291 male patients and in 20 (14.1%) of the 141 female patients. CONCLUSION: Most of the study results are compatible with those of our previous study. Yet the following results were different: (1) the number of female AGA patients in their forties is increasing; and (2) stress was found to be associated with AGA in both the male and female patients.

A Clinical Study of Androgenic Alopecia (VII) / 대한피부과학회지

BACKGROUND: Androgenic alopecia (AGA) is characterized by the local and gradual transformation of terminal scalp hair into vellus hair, which has a shorter and thinner shaft. It is the most common form of hair loss in people with a genetic predisposition for baldness. OBJECTIVE: The aim of this study was to evaluate the prevalence, AGA type, family history, co-morbidity diseases, stress factors and endocrine factors of AGA patients. METHODS: We examined a total of 432 male and female AGA patients who visited for two years at the Department of Dermatology, School of Medicine, Chung-Ang University. RESULTS: There were 2.06 times more men (291 patients) than women (141 patients) among the study subjects. Most of the men were in their twenties (108, 37.1%), however, most of the women were in their forties (42, 29.7%). In the 291 male patients, Norwood class IIIv was dominant (120 patients, 41.2%). In the 141 female patients, Ludwig class I was dominant (87 patients, 61.7%). 219 (75.2%) of the 291 male patients and 81 (73.6%) of the 141 female patients had a family history of AGA. 224 (76.9%) of the 291 male patients and 101 (53.4%) of the 141 female patients had a co-morbidity disorder. The most common among these disorders in both the male and female patients was seborrheic dermatitis. Stress factors were observed in 162 (55.6%) of the 291 male patients and in 78 (55.3%) of the 141 female patients. The most common stress factor in both the male and female patients was work tasks. The serum testosterone levels was increased in 51 (17.5%) of the 291 male patients and in 20 (14.1%) of the 141 female patients. CONCLUSION: Most of the study results are compatible with those of our previous study. Yet the following results were different: (1) the number of female AGA patients in their forties is increasing; and (2) stress was found to be associated with AGA in both the male and female patients.

A Case of Faun Tail Naevus Treated by Intense Pulsed Light

A faun tail is abnormal lumbar hypertrichosis that is characterized by a wide, often triangular or lozenge-shaped patch of coarse hair, and this hair is usually several inches long. Faun tail is a rare entity. A 36-year-old male presented with a triangular shaped hair tuft with terminal hair on the lumbosacral area, and he'd had this unusual hair since birth. There were no neurologic signs or abnormality on his spine X-ray. The MRI scan showed disc degeneration and loss of lodordosis. We report here on a rare case of faun tail, which was a form of localized hypertrichosis on the lumbosacral area, and this was successfully treated with intense pulsed (IPL) light.

A Case of Faun Tail Naevus Treated by Intense Pulsed Light

A faun tail is abnormal lumbar hypertrichosis that is characterized by a wide, often triangular or lozenge-shaped patch of coarse hair, and this hair is usually several inches long. Faun tail is a rare entity. A 36-year-old male presented with a triangular shaped hair tuft with terminal hair on the lumbosacral area, and he'd had this unusual hair since birth. There were no neurologic signs or abnormality on his spine X-ray. The MRI scan showed disc degeneration and loss of lodordosis. We report here on a rare case of faun tail, which was a form of localized hypertrichosis on the lumbosacral area, and this was successfully treated with intense pulsed (IPL) light.

Ocular Abduction Palsy in a Patient with Herpes ZosterOphthalmicus and This was Improved by Short-term Use of Steroid / 대한피부과학회지

Herpes zoster ophthalmicus involving the first division of the fifth cranial nerve produces various clinical manifestations. Among them, external ocular motor palsy is a rare and uncomfortable complication, but it is generally transient and self-limited. This palsy can have a neural, vascular ormuscle origin. We report here on a case of ocular abduction palsy in a patient with herpes zoster ophthalmicus, and this palsy cleared up after treatment with systemic steroid for two weeks.

A Case of Early Stage Mycosis Fungoides that was Successfully Treatedwith a Combination Therapy of PUVA and Interfernon-gamma / 대한피부과학회지

Early stage mycosis fungoides (MF) is known to be responsive to various topical and systemic therapies such as corticosteroids and ultraviolet light radiation, photochemotherapy with psoralens and whole-body electron beam irradiation. However, these treatments have all revealed a high relapse rate. Thus, we suggest that more invasive therapy, including PUVA combined with interferon-gamma, is one of the possible treatments for early MF because this treatment displays a reduced relapse rate. We report here on a case of early stage MF (Stage Ib) that was successfully treated with PUVA (total dose: 105.7 J/cm2) and intravenous administration of recombinant human interferon-gamma (total 5.4x10(6) IU), and the patient has been without relapse 1 year after treatment.

A Case of Drug Eruption with Localized ExfoliativeDermatitis Induced by Imatinib Mesylate / 대한피부과학회지

Imatinib mesylate (Gleevec(R), formerly known as STI571) is a protein-tyrosine kinase inhibitor that inhibits the bcr-abl tyrosine kinase created by the Philadelphia chromosome abnormality in patients with chronic myeloid leukemia (CML). Between 7 to 21% of the patients treated with imatinib mesylate have been reported to develop adverse cutaneous reactions. However, exfoliative dermatitis related to imatinib mesylate is rare and there is only one previously reported case of this in the Korean literature. We report here on a woman with localized exfoliative dermatitis that developed after administering imatinib mesylate for treating her CML.

A Case of Actinic Cheilitis Treated by Topical Photodynamic Therapywith Methyl Aminolevulinate / 대한피부과학회지

Actinic cheilitis is a pathologic condition affecting mainly the lower lip caused by long term exposure of the lips to UV radiation in sunlight. Analogous to actinic keratosis of the skin, actinic cheilitis is considered as a precancerous lesion and may develop into squamous cell carcinoma. Photodynamic therapy (PDT) is a treatment modality involving the use of a photosensitizing agent, oxygen, and light of a specific wavelength to produce controlled cell death. Photodynamic therapy (PDT) using the new highly selective photosensitizer methyl aminolevulinate (MAL) (Metvix(R), Galderma, U.K.) is a promising new treatment modality for premalignant and malignant skin lesions. We report a case of actinic cheilitis treated with PDT using MAL, with satisfactory outcome in both clinical and pathological aspects.

A Case of Milia en Plaque Induced by Physical Stress / 대한피부과학회지

Milia en plaque is designated as an atypical subtype of milia which is characterized by a group of milia on an erythematous base. It usually arises spontaneously in predisposed persons without any apparent causative factor and commonly occurs on the periauricular area. Histopathologic finding is consistent with milia and treatment is not established. We report a case of milia en plaque produced by physical stress in the right arm.

A Case of Cutaneous Hodgkin's Disease Presented with a Maculopapular Rash / 대한피부과학회지

Hodgkin's disease (HD) is a lymphoproliferative disorder that presents as a clinically asymptomatic mass or painless lymph node swelling. Cutaneous HD is a very rare manifestation in patients with HD. A 66-year-old man complained of a maculopapular rash waxing and waning for one year. A painful mass had developed on his left axilla 7 weeks prior to presenting. The biopsy specimens of both skin and lymph node revealed Hodgkin's lymphoma with atypical lymphoid cells and Reed-Sternberg cells. We report a case of cutaneous involvement of HD, which had been presented as a maculopapular rash for one year.

A Clinical Study of Androgenetic Alopecia (VI) / 대한피부과학회지

BACKGROUND: Androgenetic alopecia is the most common form of hair loss in people with a genetic predisposition. It is characterized by the miniaturization of terminal hair follicles and the formation of vellus-like follicles. OBJECTIVE: The aim of this study was to evaluate the prevalence, clinical manifestation, genetic and endocrine factor, and associated diseases of Korean patients with androgenetic alopecia. METHODS: We studied 789 Korean men and women with androgenetic alopecia. A detailed history was taken and their hormonal values were measured. A pelvic ultrasound scan was performed to check for abnormalities the ovaries and uterus of 56 women with androgenetic alopecia. RESULTS: The number of men was 1.9 times more (520) than that of women (269). Most of them were in their twenties (male 223; 42.8%, female 85; 31.5%). In the 520 male patients, Norwood class IIIv was dominant (161 patients; 30.9%). In the 269 female patients, Ludwig class I was superior (218 patients; 81%). 395 (75.9%) of male patients and 198 (73.6%) of female patients had a family history of androgenetic alopecia. The most common associated disorder was seborrheic dermatitis (male 407; 78.2%, female 155; 57.6%). And others included atopic dermatitis, hypertension, thyroid disease, etc. Serum testosterone levels were increased in 92 (17.6%) of the male patients and in 36 (13.3%) of the female patients. Abnormal pelvic ultrasound findings were observed in 10 (18%) of 56 female patients, and the conditions were ovarian cysts (8.9%), Uterine myoma (5.4%), uterine mass (2%), endometrial mass (2%). CONCLUSION: Androgenetic alopecia is a disease that has genetic and familial tendency and is associated with the androgen level. The number of androgenetic alopecia patients was increasing and type IIIv was most common in the male patients. The pelvic ultrasound showed an increased rate of abnormal findings in the female patients with androgenetic alopecia, but ultrasound is not an appropriate routine test to evaluate.

Two Cases of Basal Cell Carcinomas Treated by Topical Photodynamic Therapy with Methyl Aminolevulinate / 대한피부과학회지

Topical photodynamic therapy (PDT) via topical 5-aminolevulinic acid (ALA) is potentially useful for the treatment of basal cell carcinoma. However, as a photosensitizer used in PDT, methyl aminolevulinate (MAL) can replace ALA, because MAL has more advantages than ALA. We treated two patients with basal cell carcinoma using MAL-PDT. Topical MAL-PDT may be a safe and effective treatment modality for basal cell carcinoma.

A Case of Tinea Incognito Presented like Furunculosis / 대한의진균학회지

Tinea incognito is a dermatophytosis of atypical clinical character due to the absence of classic features of ringworm. It is caused by prolonged use of topical or systemic corticosteroids, sometimes prescribed as a result of incorrect diagnosis. We report a case of tinea incognito presented like furunculosis on the chin. The patient had been treated with topical and oral corticosteroid under the impression of atopic dermatitis for 3 years for the eczematous lesion on the face and trunk. Mycologic studies including KOH mount and fungus culture were positive for hyphae and colonies of Trichophyton rubrum. Skin biopsy showed fungal hyphae in follicular keratinous plug and diffuse dermal and perifollicular inflammation. The lesion was treated with terbinafine systemically and cured 3 months later.

A Case of Head and Neck Dermatitis Treated with Itraconazole / 대한의진균학회지

Head and neck dermatitis is a variant of atopic dermatitis often seen in young adults. Pityrosporum is a normal skin commensal. Thus, its importance as a pathogen of atopic dermatitis was neglected in the past. It was found, however, that the treatment of head and neck dermatitis with an antifungal agent results in clinical improvement. At present, although the pathogenesis of atopic dermatitis has not yet been fully elucidated, Pityrosporum is considered one of the triggers of head and neck dermatitis. The case of an 18-year-old male who had a history of head and neck atopic dermatitis with erythematous xerotic patches accompanied by a yellowish colored crust and oozing on the facial area is reported herein. The lesion was treated with itraconazole monotherapy for four weeks, after which its condition improved.

A Case of Pseudoangiomatous Spindle Cell Lipoma on the Abdomen / 대한피부과학회지

Spindle cell lipoma is a benign, subcutaneous neoplasm typically located on the neck, back and shoulder of men. Pseudoangiomatous spindle cell lipoma is a rare variant of spindle cell lipoma that is characterized by non-vascular branching spaces. A 64-year old man presented with 2 masses on the abdomen. Although 1 tumor had a very low fat component, it could be histologically diagnosed as pseudoangiomatous spindle cell lipoma due to CD 34 positive spindle cells, ropey collagen and blood vessels. We report a case of pseudoangiomatous spindle cell lipoma on the abdomen, which was diagnostically difficult due to a scanty fat component.

Two Cases of Doughnut-shaped Warts Following Cryosurgery / 대한피부과학회지

Warts are benign proliferations caused by human papillomavirus (HPV) that commonly involve the skin and other epithelial tissues. Many therapeutic modalities are available for the treatment of warts. We report 2 cases of doughnut-shaped warts following cryosurgery with liquid nitrogen. Our cases demonstrate that, after removal, relapse of warts within a few weeks is frequent and probably due to sub-clinical or latent HPV infections surrounding the warts. Our cases suggest that we should be aware of possible recurrence and that adjuvant therapy, such as immune response modifiers with potent antiviral activities, should be used to reduce the incidence of wart recurrence after cryosurgery.

A Case of Anal Erosion Treated with Chamomile and Myrrh Extracts / 대한피부과학회지

Anal disorders are common and more than one half of the population will experience one at some time during their lives. Anal erosion and fissures can cause discomfort, severe pain, bleeding and inflammation. In the acute phase of anal erosion, with bowel habit management and topical emollient, lesions can be improved. Chamomile and Myrrh are known for centuries to have several effects and have anti-inflammatory, sedative, antibacterial and antifugal properities. Here, We report a case of anal erosion treated with Chamomile and Myrrh extracts (Ad-Muc(R)). Our case indicates that Chamomile and Myrrh extracts might play a role in the management of anal erosion and fissure.