Assessment of the Quality of Life in Patients with Varicose Veins for Evaluation of Treatment Effect / 대한피부과학회지

BACKGROUND: Varicose veins are the most common venous condition of the lower extremities. Treatment for varicose veins varies from surgery to minimally invasive techniques such as radiofrequency endovenous occlusion (RFEO), ambulatory phlebectomy (AP), sclerotherapy and endovenous laser treatment (EVLT). However, there is no method to assess the quality of life (QOL) of patients with varicose veins and the effect of treatment on the QOL. OBJECTIVE: The purpose of this study was to assess the QOL of patients with varicose veins and to evaluate the effect of treatment on the QOL. METHOD: A total of 72 patients with varicose veins were interviewed with the Aberdeen varicose vein questionnaire (AVVQ), was asked 25 questions relating to the symptoms and concerns of their condition. Follow-up was done with questionnaires again, 8 weeks after treatment. RESULTS: The results obtained are summarized as follows: 1. Of the 32 patients the distribution of age was 40-49 years of age (37.5%), followed by 50-59 years of age (27.8%) and 30-39 years of age (19.4%). The mean age was 47.7 years old. 2. 30 patients (41.8%) had suffered with varicose veins for less than 5 years, and 24 patients (33.3%) for 6-10 years. 3. According to the CEAP classification, the most common type of varicose vein was the C1AEPAS (31.9%). 4. Treatment method of varicose veins were sclerotherapy in 60 patients (83.3%), AP in 10 patients (13.9%), and RFEO in 2 patients (2.8%). 5. AVVQ scores correlated with symptoms and concern scores, and also with the clinical grade. 6. After treatment, AVVQ scores demonstrated a highly significant increase. CONCLUSION: This study confirms that varicose veins have a significant impact on the overall QOL, and that QOL shows a significant improvement after treatment. Therefore, assessment of QOL in patients with varicose veins can be a valid measure for the evaluation of treatment effect.

Clinicopathological Study of 12 Cases of Erythromelanosis Follicularis Faciei et Colli / 대한피부과학회지

BACKGROUND: Erythromelanosis follicularis faciei et colli(EFFC) is an infrequently diagnosed disorder. This condition consists of the clincal triad of well-demarcated erythema, hyperpigmentation, and follicular plugging on the face and neck. The etiology of EFFC remains obscure, and therapy for EFFC is only moderately successful. OBJECTIVE: The aim of this study is to examine the clinical and histopathologic findings of erythromelanosis follicularis faciei et colli and suggest the new treatment method of erythema by 585nm flashlamp-pumped dye laser. METHODS: We evaluated 12 patients of erythromelanosis follicularis faciei et colli. Among them, we made a trial of 585nm flashlamp-pumped dye laser in erythema of EFFC on 11 cases. RESULTS: The results were as follows; 1. The mean age of onset and that of the first visits made by patients was 12.1 and 18.9 years, respectively, and there was a male predominance. 2. Histologic features revealed hyperpigmentation in basal layer, perivascular and periadnexal lymphocytic infiltration, and vessel dilatation in upper dermis in all specimens. Follicular plugging(62.5%), hyperkeratosis without parakeratosis(55.6%), enlarged hair follicle containing lamellar body(25.0%), and sebaceous gland hypertrophy(22.2%) were also observed. 3. Electron microscopic studies showed abnormal melanosomes, such as a stippled appearance of the periphery of a melanosome and a large number in the cytoplasm of basal cells. 4. 585nm flashlamp-pumped dye laser treatment with fluences that ranged from 6.5-7.5J/cm2 was given on 1 time. In 2 cases, results were achieved in fair improvement of erythema. Hyperpigmentation occurred in 2 cases(2/11) . CONCLUSION: Characteristically, EFFC affects adolescent males predominantly. The histologic features, although nondiagnostic, correlate with the clinical features. We suggest the new treatment modality, 585nm flashlamp-pumped dye laser, for the treatment of erythema in EFFC. EFFC, which can cause significant cosmetic problems to patients, maybe much more common than recognized. However, it is not well known, may be because the small number of cases have been reported in the literature. It can be helpful to understand the pathogenesis and improve treatment modalities when it will be recognized by more physicians and patients.

A Case of the Pterygium due to Lichen Planus Limited to the Nails / 대한피부과학회지

Patients with lichen planus may present with nail changes. The nail changes often present are ridging, longitudinal grooving and splitting of the nail plate, and atrophy of the nail. Pterygium formation is to be rare. Lichen planus limited to the nails without skin or mucous membrane involvement is rarely reported in the literature. A case of pterygium due to lichen planus limited to the nails in a 32-year-old man is reported.

The Study on The Nature of Fibrous Materials Extracted from Follicular Skin Lesions / 대한피부과학회지

BACKGROUND: Comedo extractor is in general used for the management or diagnosis of the follicular cutaneous disorders such as acne and folliculitis. During observing such extracted materials, we happened to discover the extraordinary thread-like fibrous materials. OBJECTIVE: We tried to clarify the nature of these fibrous materials. METHODS: The extracted materials from 20 patients with follicular cutanous disorders including 10 acne vulgaris and 10 pityrosporum folliculitis and 10 normal persons were investigated by pKOH, Masson trichrome for collagen fiber, Gomori's reticulum for reticulum fiber, acid orcein for elastic fiber, periodic acid-Schiff for fungal element and alcian blue for mucin. And we performed above mentioned special stainings in two biopsy specimens. RESULTS: Most of the extracted fibrous materials were reticulum fibers(95%) and some of them were elastic fibers(35%). And we observed the reticulum fibers and elastic fibers taken off from the pilosebaceous follicle on the histopathologic study. CONCLUSION: The fibrous materials extracted from follicular lesions were reticulum fibers or elastic fibers. And the observed presence of elastic fibers and reticulum fibers might result from tissue necrosis produced by leukocytes during the inflammatory phase of pilosebaceous follicles.

The Efficacy and Safety of Short-term Therapy with Itraconazole Melt-Extrusion Tablet in The Hyperkeratotic Type of Tinea Pedis and/or Tinea Manus / 대한의진균학회지

BACKGROUND: The many antifungal agents have been used in fungal infections. In usual trial agents, itraconazole still remains difficult to absorption in gastrointestinal tract. OBJECTIVE: The purpose of this study is to evaluate the clinical efficacy and adverse reactions of short-term itraconazole melt-extrusion tablet increased in hyperkeratotic type of tinea pedis and/or tinea mauns. METHODS: From November 1998 to February 1999, a total of 60 patients with palmoplantar type of tinea pedis and/or tinea manus at Department of Dermatology of 5 general hospital, were enrolled in a subject group for the study. Itraconazole melt-extrusion tablet was administered, 200mg twice daily, in one week. Clinical symptoms and signs with mycological findings were assessed. RESULTS: Fifty-six patients (male 33, female 23; mean age 36.1+/-10.7; mean duration 6.5+/-4.8) completed the follow-ups. Direct KOH smear examination was positive in all them. Decrease in initial percentages of patients showing symptoms at the last follow-up 2 months after starting therapy: for scale, from 100% to 85.4%; for ertyema, from 91.1% to 10.7%; for hyperkeratosis from 100% to 32.3%; for pruritus, from 82.1% to 10.7%. Mycologic cure rate was 92.9% at the last follow-up. Overall clinical responses evaluated at the last follow-up were 'cured' in 6 pathients(10.7%), 'markedly improved' in 38 patiendts(67.9%), making a clinical response rate of 78.6%. During therapy, transient epigastria pain and indigeastion developed in 5 patients(8.9%). CONCLUSION: With these results, itraconazole melt-extrusion table is considered an effective and safe treatment modality for hyperkeratotic type of tinea pedis and/or tinea manus.

A Case of Multiple Endocrine Neoplasia type 3 With Multiple Mucosal Neuroma / 대한피부과학회지

Multiple endocrine neoplasi~a type 3 is a rare, heritable or sporadic, multiple neoplastic disorder that is charracterized by thyroid medullary careinoma, pheochromocytoma, multiple mucosal neuroma, and marfanoid habitus. The most important disorder of the syndrome is mucosal neuroma that is an early diagnostic sign of multiple endocrine neoplasia type 3. Early diagnosis of MEN type 3 determines prognosis of the disease. We present a case of multiple endocrine neoplasia type 3 of the sporadic pattern in a 27-year-old man who had typical medullary thyroid carcinoma, mucosal neuroma, marfanoid habitus, and megacolon.

Apoptosis and Expression of bcl-2, p53, and Ki-67 in Pilomatricoma / 대한피부과학회지

BACKGROUND: Pilomatricoma is a benign epidermal appendage tumor with differentiation toward hair matrix cells. Histologically, pilomatricoma comprises masses of immature basophilic cells, few transitional cells, and clusters of shadow cells. The mechanism leading to the formation of shadow cells is still unknown. OBJECTIVE: The aim of this study is to examine the expression of p53, bcl-2, Ki-67, and apoptotic rate for the investigation of the cell turnover and cell differentiation within pilomatricoma. METHODS: Immunohistochemical staining(LSAB technique) using monoclonal antibodies including bcl-2, p53, and Ki-67(MIB-1) is performed on skin biopsy specimens of pilomatricoma, and TUNEL staining for detecting apoptotic cells is also performed. RESULTS: The expression of Ki-67 and bcl-2 is noted in basal basophilic cells more than overlying basophilic cells. The p53 protein is observed to be alike on basal and overlying basophilic cells. But apoptotic cells are only expressed in transitional cells. CONCLUSION: The result of this study suggests that high proliferative area, such as basal basophilic cells manifested by over-expression of Ki-67 and bcl-2, is regulated by the p53 protein inducing apoptosis. Thereafter, basophilic cells may progress to shadow cells through apoptotic transitional cells by the action of p53 protein.