A Clinicopathologic Study of Lichenoid Drug Eruption / 대한피부과학회지

Background@#Lichenoid drug eruption (LDE) is a relatively rare form of cutaneous drug eruption and that resembles lichen planus on a clinical and histological basis. Although there are some studies on histopathological findings of LDE, studies on clinical findings of LDE are limited. @*Objective@#To investigate the clinical and histopathologic findings and prognosis of LDE. @*Methods@#We retrospectively investigated the clinicopathologic findings of LDE patients who visited Kosin University Gospel Hospital between 1990 and 2020. @*Results@#This study included 44 LDE patients (male:female=1.4:1). The most common causative drug was anti-tuberculous drugs (52.3%), followed by 5-fluorouracil (11.4%), and captopril (9.1%). There were pruritic erythematous scaly or lichenoid patches and plaques in all cases. The most frequently involved sites were trunk and extremities. Notably, 15 cases (34.1%) involving the scalp and 3 cases (6.8%) involving the oral mucosa. Treatment modalities included oral, topical corticosteroid, and oral antihistamines. Among 44 cases, 28 patients discontinued the causative agent, and 16 patients continued to use it after diagnosis of LDE. The mean duration of treatment for patients who discontinued or did not discontinue the causative drugs was 4, 10 weeks, respectively. The most commonly observed histopathologic findings were superficial and deep perivascular infiltration of inflammatory cells (100.0%) and eosinophil infiltration (93.2%). @*Conclusion@#LDE can be differentiated from idiopathic lichen planus by clinicopathologic findings. LDE appears to be a mild form of drug eruption in which symptoms can be controlled with conservative treatment, even without the cessation of causative drugs for the treatment of the underlying disease.

Ultraviolet A1 Phototherapy of Mycosis Fungoides

No abstract available.

Ultraviolet A1 Phototherapy of Mycosis Fungoides

No abstract available.

A Case of Recalcitrant Hidradenitis Suppurativa Treated with Secondary Healing and a Split Thickness Skin Graft after Exteriorization / 대한피부과학회지

Hidradenitis Suppurativa (HS) is a chronic relapsing disease that involves the apocrine gland-bearing skin. It results in sinus tract formation, fibrosis and scarring. Many different treatments for HS have been reported, including topical and systemic antibiotics, intralesional steroids, systemic retinoids, hormonal therapies and immnunosuppressive agents, but they all have limited beneficial effects. Surgical treatments, including wide exteriorization with secondary intention, a skin graft and a flap can be effective treatments for recalcitrant HS. We present here the case of a 26-year-old man with recurred inguinal and axillary HS, and this was treated with secondary healing and a split thickness skin graft after exteriorization. Based on our experience, it is suggested that secondary healing and a split thickness skin graft after exteriorization are effective for recalcitrant HS with multiple interconnected tracts and abscesses.

A Case of Botryomycosis at the Excoriation Site in a Patient with Chronic Eczema / 대한피부과학회지

Botryomycosis is a chronic, granulomatous and suppurative infection. The skin is the most frequently affected organ. The most common species is Staphylococcus aureus, followed by Pseudomonas aeruginosa. Clinically, the skin lesions most commonly affect the hands and feet and they can appear as nodules, ulcers, sinuses, fistulae and verrucous plaques. Histopathologic examination reveals grains with surrounding eosinophilic material and inflammatory cells. We report here on a case of botryomycosis at the excoriation site in a 90-year-old female patient with chronic eczema.

Efficacy of Ultraviolet A1 Phototherapy in Recalcitrant Skin Diseases

BACKGROUND: Ultraviolet (UV) radiation has been used for decades to treat a variety of skin diseases. UVA1 was used initially as an effective treatment for acute exacerbated atopic dermatitis. Since then, UVA1 has been attempted for recalcitrant skin diseases. OBJECTIVE: This study examined the efficacy of UVA1 phototherapy in three recalcitrant skin diseases. METHODS: This retrospective study reviewed the efficacy and follow-up of 26 patients with atopic dermatitis (AD), mycosis fungoides (MF) and localized scleroderma (LS). SUPUVASUN 3000 (Mutzhas Co., Munich, Germany) and SELLAMED 3000 (Sellas Medizinische Gerate GmbH, Gevelsberg, Germany) were the UVA1 equipment used. Irradiation was performed in accordance with the disease. Low-dose (20 J/cm2), medium-dose (65 J/cm2) and high-dose regimens (100 J/cm2) of UVA1 therapy were employed. The frequency of the therapy ranged from 3 to 5 times weekly. The therapeutic effectiveness was assessed according to the clinical examination before and after the last treatment. RESULTS: In patients with AD, complete and partial remission was achieved in four (80%) and one (20%) patient, respectively. In patients with MF, complete and partial remission was observed in thirteen (86.7%) and two (13.3%) patients, respectively. In patients with LS, complete and partial remission was observed in three (50%) and three (50%) patients, respectively. CONCLUSION: UVA1 phototherapy is an effective treatment modality for acute exacerbated AD, MF and LS.

Acute Edema Blisters in an Immobilized Patient / 대한피부과학회지

Edema blisters is an acute bullous disease that occurs following acute lower leg edema in patients with heart, renal and liver disease. Most of the affected patients are elderly, immobile and have been hospitalized for a long time. These clinical situations are commonly observed, but this can be misdiagnosed as other bullous diseases, especially friction blisters and bullous pemphigoid. We herein report a case of acute edema blisters in a 74-year-old female who presented with a tense bullae based on an edematous lower leg.

Cowden Syndrome Accompanied by Multiple Sclerotic Fibroma on the Face / 대한피부과학회지

Cowden syndrome (CS) is a rare genodermatosis that is characterized by multiple hamartomatous tumors of an ectodermal, mesodermal and endodermal origin. CS is associated with an increased risk of malignancy and especially breast cancer, thyroid cancer, uterine cancer and renal cell carcinoma. The characteristic features of the disease are mucocutaneous findings, including multiple facial trichilemmomas, oral mucosal papillomatosis and acral keratoses. Multiple sclerotic fibroma is also known to be a clue to diagnose CS. We herein emphasize that multiple sclerotic fibromas of the skin are an important marker of CS, which may also be helpful for making an early diagnosis.

The Efficacy of Photodynamic Therapy with Methyl 5-aminolaevulinate for the Treatment of Viral Wart / 대한피부과학회지

BACKGROUND: Photodynamic therapy (PDT) with methyl 5-aminolaevulinate (MAL) has proven to be useful for the treatment of a wide variety of benign and malignant dermatologic conditions. More recently, this therapeutic modality has emerged as an alternative therapy for viral wart. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of PDT for treating viral warts with using a light-emitting diode (LED) device and MAL. METHODS: Fifteen patients with a total of 34 warts were treated with MAL under an occlusive dressing for 3 hours and this was followed by irradiation with a LED device at a wavelength of 633+/-3 nm and a fluence of 37 J/cm2. The treatment was repeated at 1~2 weeks until all the lesions cleared. The side effects, including pain, hyperpigmentation and pruritus, were recorded on a progress chart. The intensity of pain was assessed by using a 5-point verbal rating scale (VRS). RESULTS: A total of 34 warts from 15 patients (9 males and 6 females) were treated with MAL-PDT. The sites of the lesion were classified as periungal (26%), sole (18%) and others (56%). After an average of 2.15+/-0.61 therapeutic sessions (MAL+PDT) for 34 warts, the number of complete, partial and no responses were 27/34 (79.4%), 7/34 (20.6%) and 0/34 (0%), respectively. The overall complete response rates were 66.7% for the periungal warts, 50% for the sole warts and 94.7% for the others. The pain after the first treatment was more intense and deeper as compared with that after the second treatment. There were no recurrences of the warts that had a complete response during the follow-up period (from 6 to 12 months). CONCLUSION: We suggest that MAL-PDT is an effective and safe alternative therapy for viral warts.

A Case of Pseudolymphoma Syndrome Induced by Vancomycin / 대한피부과학회지

We report here on a case of a patient who experienced fever, skin eruption and lymphadenopathy 1 month after the beginning of vancomycin treatment. Generalized mild pruritic erythematous pin-head to rice-grain sized confluent scaly papules and plaques appeared on the whole body. Skin biopy showed the characteristic findings of pseudolymphoma mimicking mycosis fungoides. The skin lesions and general symptoms improved after discontinuation of vancomycin and starting steroid therapy. The patient was diagnosed with pseudolymphoma syndrome due to vancomycin. Pseudolymphoma syndrome shows clinical features that are different from those of usual drug eruptions, and the histologic findings are similar to mycosis fungoides. Thus, a thorough understanding of the clinical and histologic features of this entity may aid making a diagnosis, establishing treatment plans and determining the prognosis.

A Case of Episodic Angioedema with Eosinophilia / 대한피부과학회지

Angioedema with eosinophilia is classified as the episodic and transient types according to the clinical course, the presence of recurrence and the response to treatment. Episodic angioedema with eosinophilia is characterized by recurrent angioedema, urticaria, periodical weight gain, peripheral eosinophilia and fever. The pathophysiologic mechanism is unknown, but it has been suggested that T-lymphocytes, eosinophils and cytokines may be the causes of this disorder. We report here on a 35-year-old woman with episodic angioedema and weight gain that she experienced about 3 days before the onset of menstruation.

The Inhibitory Effect of Phytoclear-EL1 on Melanogenesis

BACKGROUND: Phytoclear-EL1, an extract from Euphorbia lathyris seeds, has a whitening effect due to inhibition of tyrosinase activity. OBJECTIVE: The purpose of this study was to investigate the inhibitory effect of phytoclear-EL1 on melanogenesis. METHODS: Cultured B-16 melanoma cells and 30 human volunteers were used for in vitro and in vivo studies, respectively. Phytoclear-EL1 was added to the cultured B-16 melanoma cells, and applied to UVB-induced hyperpigmented lesions of human volunteers twice daily for 7 weeks. Changes in the number of B-16 melanoma cells, as well as changes in morphology, melanin content, and tyrosinase activity, were measured and then compared with the normal control and the 10(-3)M arbutin groups. Also, the effect of phytoclear-EL1 on UVB-induced hyperpigmented lesions was examined through subjective and objective measurements. RESULTS: In the in vitro study (p<0.05), the number, melanin content, and tyrosinase activity of cultured B-16 melanoma cells were decreased in the 5microgram/ml phytoclear-EL1 group compared to the control group. On objective assessment with a chromameter, the 0.2% phytoclear-EL1 group had a larger difference in the mean L values before and 7 weeks after applying phytoclear-EL1 as compared to the other groups. On subjective assessment by both the researchers and subjects 7 weeks after applying experimental materials, the 0.2% phytoclear-EL1 group and positive control (3% arbutin) had higher scores than the placebo groups. These results demonstrated that phytoclear-EL1 in vivo and in vitro had an inhibitory effect on melanogenesis. CONCLUSION: Phytoclear-EL1 may be a candidate extract in the control of hyperpigmentary disorders.

A Case of Delayed Hypersensitivity Reaction due to Hyaluronic Acid (Restylane(R)) / 대한피부과학회지

Hyaluronic acid fillers have been proposed as an alternative to other temporary skin fillers for treating facial skin lines and providing soft tissue augmentation. There is no antigenic specificity for species or tissue; thus, these agents have a low potential for allergic or immunogenic reaction. However, there are a few reports about allergic hypersensitivity reactions to hyaluronic acid. We report here on the case of a woman who developed a delayed hypersensitivity reaction to the non-animal stabilized hyaluronic acid filler, Restylane(R).

Efficacy of Photodynamic Therapy with Methyl 5-aminolevulinic Acid and Red Light for Actinic Keratosis / 대한피부과학회지

BACKGROUND: Actinic keratosis (AK) is a pre-cancerous skin lesion that has the potential to progress to squamous cell carcinoma, which generally occurs on long-term sun exposed and cosmetically sensitive areas of the face, scalp, ears and neck. Many treatment options such as surgical excision, electrosurgery, cryotherapy, topical therapy including 5-fluorouracil, imiquimod and diclofenacare are available for AK, but these can be inconvenient and unsatisfactory for patients. Recently, the efficacy of topical photodynamic therapy (PDT) has been demonstrated in a large number of clinical studies over the last several years. OBJECTIVE: The aim of this study was to evaluate the efficacy and adverse effects of methyl 5-aminolevulinic acid (MAL) and red light photodynamic therapy (PDT) in the treatment of actinic keratosis. METHODS: This study included 21 actinic keratosis lesions in 12 patients. After application of commercially available MAL cream (Metvix(R), Galderma, Hertfordshire, U.K.) under occlusion for 3 hours, the lesions were illuminated by red light from a light-emitting diode system (Aktilite lamp(R), PhotoCure ASA, Oslo, Norway). All patients were followed for 3 months after 2 MAL-PDT sessions. Therapeutic effectivenesswas assessed by clinical and histopathological findings. RESULTS: Complete remission was achieved in 18 of 21 lesions (85.7%). The local adverse effects were erythema, pain, burning sensation and edema. CONCLUSION: This study showed that MAL-PDT using red-light is a safe and effective treatment option for AK.

The Clinical, Histopathologic and Mycologic Characteristics of Dermatophytosis Which were Initially Diagnosed by Skin Biopsies / 대한피부과학회지

BACKGROUND: Dermatophytosis is sometimes difficult to definitively diagnose if it has atypical clinical characteristics or the mycological tests are negative. For these cases, skin biopsy will be helpful to diagnose a fungal infection. OBJECTIVE: The purpose of the present study was to evaluate the clinical, histopathologic and mycologic characteristics of dermatophytosis patients who were initially diagnosed by skin biopsies. METHODS: We performed a retrospective study of the clinical characteristics and the histopathologic and mycologic features of 16 patients with dermatophytosis and who were initially diagnosed by skin biopsy. RESULTS: The final diagnosis of dermatophytic infections were tinea incognito (7 cases) and Majocchi's granuloma (9 cases). The main symptoms were pruritus (4 cases) and pain (2 cases). The skin lesions of tinea incognito and Majocchi's granuloma mimicked inflammatory skin disease, lupus vulgaris or deep mycosis. The most common site of involvement was the face. The possible predisposing factors causing tinea incognito and Majocchi's granulomas appeared to be application of steroid ointment (6 cases), physical trauma (2 cases) and diabetes mellitus (1 case). The histopathologic features of tinea incognito revealed the sandwich sign (100%) and neutrophils in the epidermis (71.5%) and dermis (71.5%). Majocchi's granuloma showed rupture of hair follicles (88.9%) and suppurative folliculitis (66.7%). With Periodic acid Schiff and methenamine silver staining, hyphae and spores could be identified on the horny layers, within the hair follicles and/or on the dermis in the biopsy specimens of all the cases. Culture of the causative organisms using dermal fragments and skin scales on Sabouraud media demonstrated Trichophyton rubrum (4 cases), T. mentagrophytes (3 cases) and Microsporum canis (3 cases). Systemic treatment with itraconazole or terbinafine for 2~10 weeks was effective, except for two cases. CONCLUSION: We consider that the histopatholgic findings may be of great help to diagnose a dermatophytosis that has atypical clinical characteristics or negative mycological tests. Fungal culture is also important for making an accurate diagnosis of dermatophytosis.

A Case of Telangiectatic Cutaneous Metastasis from Carcinoma of the Breast / 대한피부과학회지

The incidence of cutaneous metastases of primary tumor has been reported to be rare, as compared with metastasis of other internal organ. Carcinoma of the breast is most common cause of cutaneous metastasis in women. We report here on a case of telangiectactic metastatic breast carcinoma in a 65-year-old female who had violaceous plaques and vesicles over the right side of the neck. Histopathological examinations of the cutaneous lesion revealed aggregations of tumor cells within the dilated blood vessels in the dermis.

Letter to Editor

The Revision of the Article Entitled "A Case of a Cutaneous Angiomyolipoma"

A Case of Primary Cutaneous Anaplastic Large Cell Lymphoma Mimmicking Keratoacanthoma / 대한피부과학회지

Pseudoepitheliomatous hyperplasia with a massive neutrophil infiltrate associated with primary cutaneous anaplastic large cell lymphoma has been rarely reported. Herein we report on a 33-year-old man who presented with multiple asymptomatic erythematous walnut-sized rapidly growing tumors on the axilla, trunk and left inguinal area for 1 month. The histopathologic features showed a keratoacanthoma-like epithelial hyperplasia in the epidermis and several large atypical lymphoid cells with nuclear plemorphism and abundant cytoplasm in the dermis. The atypical cells were obscured by a rich infiltrate of neutrophils and some eosionophils. Immunohistochemical studies confirmed the majority of the large anaplastic cells in the dermis were CD30+ cells. In addition, the expressions of anaplastic lymphoma kinase (ALK) and epithelial membrane antigen (EMA) were negative. There was no evidence of extracutaneous involvement. The patient was diagnosed with primary cutaneous anaplastic large cell lymphoma (ALCL) and he was treated with low dose methotrexate (15 mg/week). We think that this case was challenging both clinically and histologically.

A Case of Keratoacanthoma on the Lower Lip / 대한피부과학회지

Keratoacanthoma is a rapidly growing cutaneous tumor with a histopathologic pattern often suggestive of a squamous cell carcinoma (SCC). It may be viewed as an aborted malignancy which only rarely progresses into an aggressive SCC. It is most likely arising from hair follicle that has the tendency of spontaneous resolution. The diagnosis of keratoacanthoma is based on clinical, histopathologic features and biologic behavior. A 75-year-old woman presented with a 1-month history of a rapidly enlarging exophytic tumor on the lower lip. A biopsy was performed leading to a diagnosis of keratoacanthoma. We report a case of keratoacanthoma on the lower lip, because the mucosal area is an unexpected location.

A Case of Secondary Syphilis Showing a Histological Pattern of Interstitial Granuloma Annulare / 대한피부과학회지

No abstract available.