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Background@#Dermatofibromas (DF) are fibrohistiocytic tumors of unknown etiology, and multiple DF (MDF) are relatively rare. MDF have been reported in the setting of autoimmune diseases, human immunodeficiency virus infection, or comorbidities treated with immunosuppressive drugs. @*Objective@#The present study investigated whether underlying conditions with impaired immune function are associated with MDF. @*Methods@#A total of 338 patients with DF was enrolled. We divided patients into two groups as MDF and solitary DF (SDF) groups. We retrospectively reviewed patient medical records and classified all patients by underlying diseases. Statistical significance of SDF and MDF for each conditions was analyzed. @*Results@#The demographics and comorbidities were compared between MDF group (n=82) and SDF group (n=256). Among underlying conditions, systemic lupus erythematosus (SLE) (odds ratio, 10.397; 95% confidence interval, 2.743∼39.404; p＜0.001) was significantly associated with MDF over SDF. Vitiligo and post status of kidney transplant were related more highly to MDF (p=0.014; p=0.014, respectively) than to SDF. Presence of overall comorbidities, autoimmune diseases, and immunosuppressive drug use were associated with DF number (p＜0.001;p＜0.001; p＜0.001, respectively). @*Conclusion@#We propose an association between MDF and comorbidities, especially SLE and immunosuppressant use. MDF lesions seem to be impacted by compromised immune function. This is of significance since it is essential to search for associated conditions in patients presenting with MDF in dermatologic clinical settings.
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Inflammatory acquired Blaschko-linear dermatoses (IABLD) are a continuous concept involving diseases such as lichen striatus, blaschkitis, and atopic dermatitis. However, atopic dermatitis that showed increase in severity along Blaschko lines is rarely reported on its own. Herein, we report a rare case of atopic dermatitis with secondary prurigo nodularis along Blaschko lines, which may be valuable in broadening the concept of IABLD. A 28-year-old male presented with multiple, pruritic, brownish nodules on the left lower extremity along Blaschko lines for 3 to 4 years. The patient had atopic dermatitis since childhood. Histopathologic findings revealed compact orthohyperkeratosis, hypergranulosis, spongiosis, and irregular acanthosis in the epidermis. Fibrosis with vertically arranged collagen fibers and perivascular lymphohistiocytic infiltration were shown in the upper dermis. We diagnosed the case as secondary prurigo nodularis along Blaschko lines, accompanied by the preceding atopic dermatitis. We hypothesized that the patient’s underlying atopic dermatitis increased in severity along Blaschko lines, and prurigo nodularis occurred due to frequent scratching. The lesions improved with topical methylprednisolone cream, oral antihistamines and intralesional triamcinolone injection.
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Warty dyskeratoma (WD) is an uncommon skin tumor that histologically presents as focal acantholysis and dyskeratosis and is a common finding among acantholytic diseases such as Darier’s disease. WD most commonly occurs on the head or neck of adults as an isolated papule or nodule. To our knowledge, only 6 cases of WD in the genital area have been previously reported in the literature, and no case have occurred on the scrotum to date.We report the first case of multiple WD that occurred on the scrotum successfully treated with 0.025% tretinoin cream. A 55-year-old male presented with asymptomatic, multiple, 0.1∼0.2-cm-sized, skin-colored papules on the scrotum for the previous 6 months. A skin punch biopsy and human papillomavirus (HPV) polymerase chain reaction test were performed for a clinical suspicion of genital warts or bowenoid papulosis. The histopathologic examination showed cup-shaped epidermal invaginations with central keratotic plug. Prominent villi, acantholytic clefting and corps ronds were also shown. The patient tested negative for HPV and was diagnosed with WD with typical pathologic findings. The patient was treated with 0.025% tretinoin cream for 2 weeks, and the lesions decreased in both size and number.
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Background@#As the use of laser therapy for skin lesions has increased significantly, laser treatment is performed in many cases without an accurate diagnosis. @*Objective@#This study aimed to analyze cases in which skin lesions recurred or remained after laser treatment by investigating the clinicopathological diagnosis. @*Methods@#We retrospectively analyzed the patients who visited the Seoul Saint Mary’s hospital from January 2011 to December 2020, the clinical records of 518 cases of patient who had a history of laser treatment and underwent histopathological examination. @*Results@#The number and proportion of patients who visited the hospital showed a steadily increasing trend for 10 years. In 187 patients, the time between laser treatment and hospital visits was ＞1 year. The most common site of lesions was the face (66.2%), especially the cheek (29.3%) and nose (12.2%). Final diagnosis of the lesion yielded 59 cases (11.4%) of premalignant diseases and 55 cases (10.6%) of malignant tumors, and the rate increased with increasing age. The most common malignant tumor was basal cell carcinoma (69.1%), followed by squamous cell carcinoma (14.5%) and malignant melanoma (12.7%). @*Conclusion@#In this study, we found that laser treatment for premalignant and malignant tumors is not rare. This study emphasizes that indiscriminate laser treatment should be avoided, and an accurate diagnosis and proper medical treatment by an experienced dermatologist are needed.
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Background@#Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients’ quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. @*Objective@#These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. @*Methods@#A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. @*Results@#Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. @*Conclusion@#These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
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no abstract available.
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Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.
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Background@#Cutaneous warts tend to recur despite of various treatment modalities. However, previous studies provided few data on their reinfection rate. @*Objective@#In this study, we investigated the reinfection rate along with the incidence and prevalence rates of cutaneous warts. @*Methods@#We conducted a nationwide, cross-sectional population-based study using the Korean National Health Insurance Service database from January 2006 through December 2016. Patients who visited outpatient clinics with an International Classification of Disease-10 code of viral warts (B07) were included. The reinfection rate was calculated as a percentage of patients with an initial visit in 2010 and subsequent visits for cutaneous warts with at least a six-month interval from last visit until 2016. @*Results@#From 2006 to 2016, the overall incidence and prevalence rates of cutaneous warts increased from 2.99 to 7.69 per 1,000 population and from 3.45 to 10.94 per 1,000 population, respectively. The overall reinfection rate of cutaneous warts was 30.9%. The reinfection rate of males and females was 31.6% and 30.0%, respectively. Children under ten years old had the highest reinfection rate (34.3%). @*Conclusion@#These results demonstrate that the reinfection rate of cutaneous warts is the highest in male children under ten years old. Therefore, these patients should be monitored closely after treatment.
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Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.
ABSTRACT
Background@#Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients’ quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. @*Objective@#These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. @*Methods@#A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. @*Results@#Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. @*Conclusion@#These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
ABSTRACT
Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.
ABSTRACT
Background@#Cutaneous warts tend to recur despite of various treatment modalities. However, previous studies provided few data on their reinfection rate. @*Objective@#In this study, we investigated the reinfection rate along with the incidence and prevalence rates of cutaneous warts. @*Methods@#We conducted a nationwide, cross-sectional population-based study using the Korean National Health Insurance Service database from January 2006 through December 2016. Patients who visited outpatient clinics with an International Classification of Disease-10 code of viral warts (B07) were included. The reinfection rate was calculated as a percentage of patients with an initial visit in 2010 and subsequent visits for cutaneous warts with at least a six-month interval from last visit until 2016. @*Results@#From 2006 to 2016, the overall incidence and prevalence rates of cutaneous warts increased from 2.99 to 7.69 per 1,000 population and from 3.45 to 10.94 per 1,000 population, respectively. The overall reinfection rate of cutaneous warts was 30.9%. The reinfection rate of males and females was 31.6% and 30.0%, respectively. Children under ten years old had the highest reinfection rate (34.3%). @*Conclusion@#These results demonstrate that the reinfection rate of cutaneous warts is the highest in male children under ten years old. Therefore, these patients should be monitored closely after treatment.
ABSTRACT
Background@#Ultrasonography is an effective noninvasive imaging modality for the diagnosis of subcutaneous masses. To date, few studies have reported skin ultrasonography using deep convolutional neural networks (DCNNs).We investigated the accuracy of DCNNs for the diagnosis of epidermal cysts, lipomas, and other subcutaneous masses. @*Objective@#The purpose of this study was to evaluate whether DCNNs could diagnose subcutaneous masses with ultrasonographic images at level of competence comparable to dermatologists. @*Methods@#We created a dataset of 1,361 skin ultrasonography images obtained from 202 patients diagnosed with epidermal cysts, lipomas, and other subcutaneous masses, to train the DCNNs using ResNet18. Performance was compared with another set of 93 ultrasonographic images (24 epidermal cysts, 25 lipomas, and 44 other subcutaneous masses) from open-access articles. @*Results@#The DCNNs yielded 87.10% classification accuracy and 86.10% F1-scores. The area under the curve, sensitivity, and specificity were 0.92 (95% confidence interval [CI] 0.86∼0.98), 75.00%, and 98.55% for epidermal cysts; 0.93 (95% CI 0.88∼0.98), 80.00%, and 94.12% for lipomas; and 0.97 (95% CI 0.93∼1.00), 97.73%, and 85.71% for other subcutaneous masses, respectively. Analysis using gradient-weighted class activation mapping revealed that the DCNNs could detect specific ultrasonographic findings of epidermal cysts and lipomas. @*Conclusion@#We propose that DCNNs combined with ultrasonography may aid in the diagnosis of subcutaneous masses in outpatient settings.
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Extraskeletal osteochondroma is a rare, benign, bone tumor of the soft tissue that generally affects the soft tissue of the hands and feet, followed by the trunk, and is rarely reported in the head and neck area. A 41-year-old female presented with an asymptomatic, skin-colored, palpable nodule on the neck that had been slowly growing over an unknown period of time. An ultrasound examination revealed a 0.9-cm-sized, dense, calcified lesion in the skin layer on the left side of the neck. Calcinosis cutis, pilomatricoma, and other benign tumors were clinically suspected, and a tumor excision was performed. The histological examination showed encapsulated round nodules composed of mature hyaline cartilage, which gradually changed into mature bone tissue. Extraskeletal osteochondroma was diagnosed by pathological examination. Here, we report an interesting case of extraskeletal osteochondroma in an unusual location.
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Leprosy is an infectious disease caused by Mycobacterium leprae. Patients usually present with hypopigmented or erythematous plaques with central hypoesthesia or tenderness, and necessitate a differential diagnosis with eczema, granuloma annulare, sarcoidosis, syphilid, mycosis fungoides, erythema nodosum, and skin cancer. A 93-year-old woman presented with asymptomatic erythematous plaques and subdermal nodules on the face and extremities for 6∼ 7 months, and the lesions were suspicious for skin cancer. Histopathologic examination revealed diffuse infiltration of foamy histiocytes separated by a grenz zone. Acid-fast bacilli were seen in Ziehl−Neelsen stain with clumps called globi. Based on clinical and histopathological findings, she was finally diagnosed with lepromatous leprosy.The patient was diagnosed with leprosy at an advanced age; thus, we report the case in which dermatologists should consider leprosy as well as skin cancer in the elderly patients with unusual erythematous nodules, despite decreasing prevalence of leprosy.
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A 40-year-old man presented with pruritic, multiple, variable-sized, erythematous umbilicated papules on the trunk and both extremities for 4 months. He was diagnosed with Hodgkin's lymphoma (stage IIA) after histopathologic examination of a neck mass that developed a month ago. A punch biopsy was performed on his right lower leg. Histological examination showed transepidermal elimination of the degenerated collagen. Masson's trichrome staining was performed to distinguish collagen fibers from the muscular tissue; using Masson's stain, the collagen appeared as a bluish color crossing from the dermis to the epidermis. The diagnosis of acquired reactive perforating collagenosis was made. The skin lesions showed much improvement after 6 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy. Acquired perforating disorders are a group of cutaneous disorders that occur in adults with chronic kidney disease or diabetes mellitus. Cases of acquired perforating disorders associated with Hodgkin's lymphoma have been rarely reported in the English literature. To our knowledge, this is the first case of acquired reactive perforating collagenosis in a Korean patient with Hodgkin's lymphoma.