Analysis of Judicial Precedents on Drug Eruption in South Korea / 대한피부과학회지

Background@#Both medicolegal disputes and the incidence of cutaneous drug eruptions are increasing in Korea. We were unable to find research that surveyed the legal disputes involving drug eruption cases. @*Objective@#This study investigates medical litigation associated with drug eruption cases in Korea. @*Methods@#Judicial precedents on drug eruption cases were searched using the Supreme Court of South Korea’s Written Judgement Management System. General characteristics, results, suspected agents, and recognized negligence were analyzed. @*Results@#From the search results, 50 cases were selected. Of these, 34 cases had severe cutaneous adverse reactions, including Stevens-Johnson syndrome/toxic epidermal necrolysis (n=25, 50.0%), and drug rash with eosinophilia and systemic symptoms syndrome (n=9, 18.0%). Antimicrobial agents (n=17, 34.0%), non-steroidal anti-inflammatory drugs (n=6, 12.0%), and anticonvulsants (n=6, 12.0%) were the most common drugs implicated. Death was reported in 15 patients (30.0%). In this sample, 22 cases (47.0%) were awarded to the plaintiff, and violation of the duty to inform patients of risks was the most common legal issue cited. @*Conclusion@#Clinicians should be aware of and advise patients of the potential for severe adverse reactions that can lead to negative outcomes and medicolegal disputes.

Pancreatic Panniculitis: A Case Report / 이화의대지

Pancreatic panniculitis is a rare skin complication in which subcutaneous fat necrosis occurs in association with pancreatic disorders, most commonly acute or chronic pancreatitis. Erythematous subcutaneous nodules develop on the legs and spontaneously ulcerate or exude an oily substance. A 32-year-old Korean female patient presented with a 2-week-history of tender nodules with erythematous crusts on her left shin. She had a history of alcoholic liver cirrhosis and, 5 weeks earlier, had been diagnosed with acute pancreatitis. The histopathologic findings from a skin biopsy were consistent with lobular panniculitis, without signs of vasculitis, and diffuse fat necrosis. Basophilic calcium deposits were present in the dermis and subcutaneous fat. These findings were suggestive of pancreatic panniculitis. The skin lesion had a chronic course corresponding to repeated exacerbations of the patient’s pancreatitis. Thus, in the differential diagnosis of subcutaneous nodules, clinicians should consider pancreatic panniculitis as a cutaneous manifestation of pancreatic disease.

The Assessment of the Effect and Patient Compliance of Nickel-Restricted Diets in Patients with Nickel Allergy / 대한피부과학회지

Background@#Nickel is one of the leading causes of allergic contact dermatitis. Positive patch tests for nickel suggest the possibility of persistent dermatitis from nickel-plated item usage and nickel-containing food ingestion. Previous studies have suggested the clinical improvement of dermatitis in such patients after a nickel-restricted diet. @*Objective@#This retrospective study aimed to assess the efficacy of nickel-restricted diets in nickel-sensitized patients and evaluate their adherence to nickel-restricted diets. @*Methods@#A review of the records of nickel-sensitized patients from June 1, 2018 to April 30, 2020 with positive patch tests for nickel was conducted. Patients were interviewed in May 2020 to assess the current status of dermatitis and self-reported adherence. @*Results@#A total of 245 patients were identified, and 100 patients were contacted. The degree of nickel sensitivity between patients with localized skin lesions (n=44) and generalized skin lesions (n=56) did not show difference. Twenty-four of 29 patients (82.8%) with good compliance showed improvement, while only 32 of 71 patients (45.1%) with poor compliance showed improvement. The percentage of improved patients in the group with good compliance and that in the group with poor compliance showed a statistically significant difference (p=0.00086). Of the patients with good compliance, those with localized skin lesions showed statistically significant improvement (p=0.0074). @*Conclusion@#To improve patient compliance, revised, simplified, and interventional guidelines for nickel-restricted diet should be implemented along with dermatologists’ encouragement and reassurance of a diet modification.

Focal Acral Hyperkeratosis / 이화의대지

no abstract available

Two Cases of Orofacial Granulomatosis / 대한피부과학회지

Orofacial granulomatosis (OFG) is a rare chronic granulomatous disease of oral mucosa and maxillofacial region that clinically presents recurrent or persistent orofacial swelling. OFG may exist as an integration of the spectrum of various disorders, including Melkersson-Rosenthal syndrome, granulomatous cheilitis, Crohn’s disease, sarcoidosis, infectious diseases and delayed hypersensitivity reaction to food additives, dental materials. Precise etiology is not yet to be elucidated. Herein, we report two rare cases of orofacial granulomatosis who presented similar clinical manifestation of lip swelling but was diagnosed as a sarcoidosis and as a granulomatous cheilitis.

Analysis of Positive Rates for Standard Allergens of Patch Test in Korea with Literature Review / 대한피부과학회지

Background@#Korean standard series (KSS) have not changed for 20 years. Moreover, the Korea Food and Drug Administration has suspended import licensing of Cosmetic series (ChemotechniqueⓇ). Objective: To analyze trends in the positive rates of allergens in patch test using KSS and present a literature review on the comparison of the results those of European baseline series (EBS) and North American Contact Dermatitis Group (NACDG) screening series. @*Methods@#Epidemiologic findings and the positive rate of KSS allergens were analyzed from patients who visited the Department of Dermatology in Ewha Womans University Mokdong Hospital between 1998 and 2018. Literature reviews were conducted on the comparison of the results with those of the 2015∼2016 NACDG, 2013∼2014 ESSCA, and standard antigens in K-camp. @*Results@#The positive rates of KSS allergens from 126 patients in 2018 were compared with those from 184 patients during 1998 to 2007. The top 3 allergens in the two study periods were common; nickel sulfate, cobalt chloride, and potassium dichromate. Remarkably, the positive rates for balsam of Peru and paraben mix increased from 7.1% to 17.5% and from 2.7% to 7.9%, respectively. As compared with the results of NACDG standard series and EBS, KSS lacked fragrance and cosmetic series of allergens, especially fragrance mix II, methyldibromoglutaronitrile, and methylisothiazolinone, and epoxy series of allergens. @*Conclusion@#Our results, especially the increasing trends of balsam of Peru and paraben mix, would be further confirmed in a multicenter study. Additionally, in view of the increase in fragrance and preservative allergens, KSS would need the addition of related allergens.

Quantitative Analysis of Metal Contents in Korean Herbs and Herbal Products to Give Advice for Metal Allergic Patient

BACKGROUND: Herbs have been used worldwide as complementary and alternative medicines. In Korea, herbs for medical purpose are strictly controlled by the Korea Food and Drug Administration (KFDA). But it does not provide standards for metal antigens. OBJECTIVE: This study conducted to identify the metal contents of Korean herbs and herbal products and to give information on counselling metal allergic patient. METHODS: The concentration of three metal allergens with high antigenicity, cobalt (Co), chromium (Cr), nickel (Ni) was quantitatively determined using inductively coupled plasma with a mass spectrometer after nitric acid (HNO₃) digestion. The herbal objects are as follows: 1) ten kinds of herb plants, 2) ten herbal products sold in Korean drugstores, and 3) ten herbal extracts prescribed by Korean herbal doctors. RESULTS: In 30 samples, Ni and Cr were detected in all items. Co was not detected in two drugstore products. CONCLUSION: Although the levels of metal detected in this study were very low relative to international guidelines and KFDA regulations, the herbal preparations contained similar or higher metal levels than known metal-rich foods. It can cause problems when it added to the daily diet and cause deterioration of skin lesions of metal sensitized person.

Primary Cutaneous Intravascular Large B-cell Lymphoma / 대한피부과학회지

No abstract available.

A Case of Epoxy Resin-induced Hand Eczema in a Doll Craftswoman / 대한피부과학회지

No abstract available.

Mucinous Nevus

Mucinous nevus is an uncommon entity classified as either a cutaneous mucinosis or a connective tissue nevus. The condition presents as grouped papules and coalescent plaques growing in a unilateral or zosteriform manner. The key histopathological feature is a band-like deposition of mucin in the superficial dermis. A 34-year-old male presented with grouped gray-brown papules and confluent plaques exhibiting a zosteriform distribution on the right side of the lower back. The lesions had commenced in childhood. Histological examination revealed mucin deposition in the papillary dermis. Thus, we diagnosed a mucinous nevus. To date, only a few reports of such nevi have been reported in the literature. Therefore we report a rare case of mucinous nevus.

Acquired Brachial Cutaneous Dyschromatosis in a Middle Aged Male

Acquired brachial cutaneous dyschromatosis (ABCD) is an acquired disorder of pigmentary change that presents as chronic, asymptomatic, geographic-shaped, gray-brown patches, consisting of mixed hyper and hypopigmented macules on the dorsal aspect of the forearms. We report a case of a 40-year-old male who presented with asymptomatic, multiple brown-colored macules on the outer aspects of both arms. He had no history of hypertension and had never taken angiotensin converting enzyme inhibitors. He also denied chronic sun exposure history. Histologic examination demonstrated epidermal atrophy, increased basal layer pigmentation, and several telangiectatic vessels in the upper dermis. Solar elastosis was not remarkable. The patient's clinical and histopathologic features were consistent with a diagnosis of ABCD. Poikiloderma of Civatte, melasma, acquired bilateral telangiectatic macules and other pigmentary disorders should be considered in the differential diagnosis of ABCD. Herein, we report a case of ABCD in a middle-aged male without hypertension and medication.

Clinical Analysis of Drug Eruptions among Inpatients Seeking a Consultation with the Department of Dermatology / 대한피부과학회지

BACKGROUND: Drug eruptions are common in hospitalized patients. Rapid and accurate diagnosis is essential but often difficult. OBJECTIVE: This study defined the clinical features and causative drugs among inpatients presenting with drug eruptions. METHODS: We retrospectively analyzed the clinical and laboratory data of inpatients who sought consultations with the Dermatology Department for a diagnosis of drug eruptions. RESULTS: A total of 228 patients were diagnosed with drug eruptions, and this study included 139 patients. The highest incidence of drug eruptions was observed in patients in their 50s (22.3%). The most common latent period was up to 1 week (57.6%). The most common drug eruptions were exanthematous eruptions (59.7%), acneiform eruptions (10.8%), and urticaria (9.3%). The most common causative drugs were antibiotics (53.2%), followed by anticancer drugs (19.4%), and contrast media (6.5%). Laboratory abnormalities included eosinophilia (15.8%), abnormal liver function tests (7.9%), leukopenia (4.3%), an elevated serum creatinine level (2.2%), and leukocytosis (0.7%). CONCLUSION: In descending order, the most frequent drug eruptions were exanthematous eruptions, acneiform eruptions, and urticaria, and the most common causative drugs were antibiotics, anticancer agents, and contrast media. Prompt diagnosis and discontinuation of the causative drug are important in this context. Clinicians should be aware of cutaneous adverse drug reactions.

Multiple Eruptive Dermatofibromas in a Healthy Child / 대한피부과학회지

No abstract available.

Superficial Epithelioma with Sebaceous Differentiation Presented as a Yellow Plaque

No abstract available.

A Case of Cutaneous Protothecosis in an Immunocompetent Patient

No abstract available.

Clinical Characteristics of Patients with Chromium Allergy in a Single University Hospital in Korea / 대한피부과학회지

BACKGROUND: Chromium is one of the most common metal allergens that cause allergic contact dermatitis. European regulation of chromium (VI) content in cement was first implemented in 2005, and regulation of chromium in leather in 2015. OBJECTIVE: This clinical study was performed to obtain basic data on subjects with allergic contact dermatitis due to chromium in Korea. We investigated the clinical characteristics of patients with chromium allergy among subjects with contact dermatitis who underwent patch tests. METHODS: Patch test data from June 1998 to January 2014 were retrospectively analyzed (n=975; men=290, women=685). Patients who showed positive reactions to potassium dichromate (chromium [+] group; n=58) and who showed positive reactions to other allergens except potassium dichromate (others [+] group; n=497) were identified and the characteristics of both groups were compared. Patients who only reacted to chromium (only chromium group; n=17) were identified, and their clinical characteristics were investigated. The prevalence of chromium allergy was analyzed in each 4-year period to study the changes over time. RESULTS: The sensitization rate of potassium dichromate was 5.9% (n=58) and women comprised 72.4% (n=42) of the chromium (+) group. Hands and feet were more frequently affected in the chromium (+) group (p=0.002 and 0.019, respectively). Occupational dermatitis was significantly less common in the chromium (+) group. Chromium allergy was the most prevalent in patients in their 50s (8.4%). The only chromium group had significantly more number of patients aged 40 years or older (p=0.004). The prevalence of chromium allergy was 13.5% during 1998~2002, but decreased to 5.4% during 2010~2014. CONCLUSION: The characteristics of patients with chromium allergy suggests that chromium exposure in daily activities, including leather exposure, is more relevant than occupational exposure for most patients. The prevalence of chromium allergy has been decreasing in Korea, which may be an effect of voluntary regulation of chromium content in cement by manufacturers.

Expression of Phosphatase and Tensin Homologue, phospho-Akt, and p53 in Acral Benign and Malignant Melanocytic Neoplasms (Benign Nevi, Dysplastic Nevi, and Acral Melanomas)

BACKGROUND: The role of the phosphatidylinositol-3 kinase signaling pathway in the development of acral melanoma has recently gained evidence. Phosphatase and tensin homologue (PTEN), one of the key molecules in the pathway, acts as a tumor suppressor through either an Akt-dependent or Akt-independent pathway. Akt accelerates degradation of p53. OBJECTIVE: We assessed the expression of PTEN, phospho-Akt (p-Akt), and p53 by immunohistochemistry in benign acral nevi, acral dysplastic nevi, and acral melanomas in the radial growth phase and with a vertical growth component. METHODS: Ten specimens in each group were included. Paraffin-embedded specimens were immunostained with antibodies for PTEN, p-Akt, and p53. We scored both the staining intensity and the proportion of positive cells. The final score was calculated by multiplying the intensity score by the proportion score. RESULTS: All specimens of benign acral nevi except one showed some degree of PTEN-negative cells. The numbers of p-Akt and p53-positive cells were higher in acral dysplastic nevi and melanoma than in benign nevi. P-Akt scores were 1.7, 1.8, 2.6, and 4.4, and p53 scores were 2.0, 2.1, 3.8, and 4.1 in each group. PTEN and p-Akt scores in advanced acral melanoma were higher than in the other neoplasms. CONCLUSION: The expression of PTEN was decreased and the expression of p-Akt was increased in acral melanoma, especially in advanced cases. The PTEN-induced pathway appears to affect the late stage of melanomagenesis. Altered expression of p-Akt is thought to be due to secondary changes following the loss of PTEN.

A Case of Linear Eruptive Collagenoma on the Chest and Neck / 대한피부과학회지

Eruptive collagenoma is a rare acquired type of connective tissue nevus that predominantly consists of collagen. It usually presents as multiple, asymptomatic, firm, flesh-colored or pink nodules or plaques that are symmetrically distributed over the trunk and upper extremities. Four cases of eruptive collagenoma in linear or zosteriform arrangements have been reported in the English literature. A 16-year-old boy presented with multiple asymptomatic erythematous papules and nodules on the left side of his sternal margin and the posterior side of his left neck. A punch biopsy taken from one of the nodules on the chest showed thickened collagen fibers in the dermis. Masson-Trichrome staining revealed an increase in the collagen fibers, which were broad and arranged haphazardly, and the elastic staining indicated a reduction in the elastic fibers in the dermis, which are findings that are consistent with collagenoma. We report a case of eruptive collagenoma that presented in a linear arrangement, which is a rare distribution pattern for connective tissue nevi.

Hemophagocytic Lymphohistiocytosis Manifesting as a Purpuric Patch / 대한피부과학회지

Hemophagocytic lymphohistiocytosis (HLH) is a fatal, systemic inflammatory syndrome that characteristically presents hemophagocytic histiocytes infiltrating into various organs. Common features of HLH are abrupt onset of high fever, malaise, lymphadenopathy, hepatosplenomegaly, and abnormal laboratory findings including pancytopenia, hypertriglyceridemia, hypofibrinogenemia, and high ferritin levels. Cutaneous manifestations, which occur in 6~65% of patients, can develop at any moment in the clinical course of the syndrome. Most skin eruptions in HLH patients are generalized, transient maculopapular rashes. We describe an HLH patient who first manifested cutaneous symptoms as a large purpuric patch on her thigh. A skin biopsy found high levels of hemophagocytic histiocytes.

Clinical Features of Dermatology-Consulted Inpatients: Focus on the Differences between Individual Departments / 대한피부과학회지

BACKGROUND: A variety of dermatological disorders develop in hospitalized patients and the need for dermatological consultations is on the rise. OBJECTIVE: We analyzed 2 years of dermatological consultation data from a tertiary medical center in Korea and compared dermatological problems among individual departments. METHODS: We reviewed 3,102 dermatological inpatient consultations by performing a retrospective chart review. RESULTS: Contact dermatitis (11.4%), drug eruption (9.6%), tinea pedis (5.5%), xerotic eczema (5.3%), and seborrheic dermatitis (5.2%) were the 5 dermatological disorders that were most commonly referred to dermatologists. Patients in the allergy and pulmonology departments had higher rates of drug eruptions. Endocrinology-admitted patients, especially diabetic patients, frequently complained of foot dermatitis. The cardiology, gastroenterology, and hemato-oncology departments referred many patients with purpuric dermatosis to dermatologists. Patients from the surgical departments consulted more frequently consulted contact dermatitis and drug eruptions. The neurology and rehabilitation medicine departments referred more seborrheic dermatitis patients than other departments. Pediatric patients commonly consulted for atopic dermatitis, viral exanthemata, and seborrheic dermatitis. Regardless of department, patients who suffered from severe illness and underwent major surgery developed herpes zoster and cutaneous fungal infections more frequently than other patients. Personal hygiene was closely related to the development of follicular disorders. CONCLUSION: Dermatologists should be familiar with the diverse dermatological complaints of patients admitted to various departments and be actively involved in the diagnosis, treatment, and education of doctors and patients to improve the quality of inpatient care.