A case of IgA nephropathy in a patient with Behcet's disease / 대한내과학회지

Behcet's disease is a multisystem disorder characterized by oral and genital ulcers, uveitis, and skin lesions. Renal involvement has rarely been observed in Behcet's disease. However, pathological reports have revealed various lesions, especially, amyloidosis, focal and segmental glomerulonephritis with crescents, and IgA nephropathy. A 49-year old female with Behcet's disease was admitted to evaluate proteinuria and microscopic hematuria, and renal biopsy showed IgA nephropathy (subclass V). Immunohistology revealed mesangial deposits of IgA and staining for C3. We report a case of IgA nephropathy which was diagnosed by renal biopsy in a patient with Behcet's disease.

Antinuclear Antibodies in Patients with Behcet's Disease / 대한피부과학회지

BACKGROUND: Behcet's disease has features consistent with an immunopathogenic mechanism, but the autoreactivity in pathogenesis is unclear. OBJECTIVE: This study was to investigate the association of antinuclear antibodies (ANA) with Behcet's disease. METHODS: The patients in this study were diagnosed at Severance Hospital Behcet's Disease Specialty Clinic from May, 1998 to May, 2002. We evaluated the frequency, titers and immunofluorescence patterns of ANA in patients with Behcet's disease, and compared the frequency with a healthy control group. According to the positivity of ANA, we compared the frequency of minor symptoms to investigate the association of the severity of disease with ANA. RESULTS: 1. Of the 554 cases of Behcet's disease, 46 cases (8.3%) were ANA positive, however, of the 271 cases of healthy control group, only 5 cases (1.8%) were ANA positive. (p=0.0003) 2. In ANA titers 38 cases (82.6%) showed low titer (1: 40+, 1: 160-), 5 cases (10.9%) intermediate titer (1: 160+, 1: 640-), and 3 cases high titer (>1: 640+). There was no significant difference in intermediate and high titers between complete (17.9%) and incomplete type (14.3%). 3. In immunofluorescence patterns of ANA, 17 cases (37%) were speckled pattern, 5 cases (10.9%) homogeneous pattern, 3 cases (6.5%) centromere pattern, 2 cases (4.3%) nucleolar pattern and 19 cases (41.3%) unknown pattern. 4. Of 508 cases with negative ANA patients, 272 cases (53.5%) had minor symptoms, however, of 46 cases with positive ANA patients, 14 cases (30.4%) had minor symptoms (p=0.0027). CONCLUSION: From this study ANA was more prevalent in Behcet's disease. However, it was not related to severity of disease and most of them were low titer. ANA, herein, might play a minor role in pathogenesis of Behcet's disease.

Development of an Integrated Information System for the Management of Behcet's Disease / 대한의료정보학회지

As internet technology rapidly improves, clinical services are increasingly computerized in most hosptials. In order to effectively support patient care and clinical researches, information technologies are widely utilized to integrate clinical databases and disseminate information. However, most hospital information systems in Korea are still independently implemented and not fully integrated due to lack of standardization and security measure. In order to meet increasing demand for better patient care and upgrading clinical research, there is a need for a development and sharing of integrated clinical information system with a common database including clinical data collected from various hospitals. The purpose of this study was to develop a web-based clinical information system for management of Behcet's disease by constructing an integrated database with treatment data, test results, and patient demographic data in collaboration with several hospitals. Specifically, current treatment procedure for Behcet's disease was analyzed first and enhanced treatment procedure as well as a web-based clinical information system for management of Behcet's disease was proposed using a structured systems analysis and literature review on the shared clinical information systems. Expected benefits of the system include an improvement of consistency in patient management and reduction of duplicate prescriptions and test orders. In addition, this system can help improve communication among clinics and tertiary hospitals by sharing common clinical database. In a long run, the share system can also help reducing hospital expenditures by reducing duplicate investment on high cost equipments by sharing them among hospitals.

Behcet's Disease: The First Mongolian Case in Literature Showing HLA B51, MICA Gene Type *5/*6

Behcet's disease is a chronic multi-systemic disease of unknown origin that includes mucocutaneous, ocular, cardiac, vascular, renal, gastrointestinal, neurologic and cutaneous involvement. The disease is spread throughout the world, but it is most prevalent in the eastern Mediterranean region-along the Silk Road-, and in Japan, China, and Korea. Recently, we treated a Mongolian patient who had complete-type Behcet's disease. As far as we know, this case is the first report of a Mongolian with Behcet's disease in the English literature. HLA typing in this patient revealed A2, A24; B51, B35; Cw4, Cw7; DR9, DR11. Study of the MICA genetype showed *5, *6 positive. Our data provided adequate evidence, from an epidemiological aspect, to support the belief that Behcet's disease is most prevalent along the old Silk Road.

Tufted Angioma:Clinicopathologic Surveys and the Response to Intralesional Steroid

BACKGROUND: Tufted angioma is an uncommon slowly progressive vascular tumor found typically in infants and young children with characteristic histologic findings, so called "cannonball" appearance. OBJECTIVE: The purpose of this study was aimed to investigate the clinical and histopathological characteristics of tufted angioma and the response to intralesional steroid. METHODS: Clinical information of 10 patients with tufted angioma diagnosed in Severance hospital and Pundang CHA hospital from 1983 to 1999 was obtained from the medical records and clinical follow-ups. We re-evaluated 10 biopsy specimens obtained from them with routine H&E staining. RESULTS: Five male and five female patients were included. In 9 patients the lesion appeared before 2 months of age. Four had a lesion at birth. The thigh was the most common site. The clinical symptoms were diverse, but characteristically tenderness was present in most cases. In all the patients the lesions had a tendency to spread progressively. Microscopically, numerous, distinct, variably sized, tightly packed capillary and endothelial cellular lobules were scattered in the dermis. There were characteristic semilunar spaces adjacent to the capillary tufts. Six patients received intralesional triamcinolone. This treatment was found to be effective in 5 patients who experienced remarkable improvement. The improved cases had similar histologic findings which were composed of cellular mass more than lumen formation. We classified our specimens into two categories, one with more cellular mass and the other with more lumen formation in relative proportion. The former was different from the latter in that it had more solid appearance and more definite margin. And we realized that it was useful to divide into these two categories since its response to treatment could be different. CONCLUSIONS: Tufted angioma is a relatively uncommon disease with characteristic histopathologic findings. It seems not to regress spontaneously. So early treatment is required to pre-vent further spreading up to the extent. We treated 6 patients with intralesional injection of triamcinolone and 5 patients experienced marked improvement which had more cellular mass more than lumen formation histopathologically.

A Case of Palisaded Encapsulated Neuroma of the Lower Lip / 대한피부과학회지

Palisaded encapsulated neuroma(PEN) is a rare intraneural neuroma. It usually occurs as a solitary, asymptomatic, skin-colored papule, and commonly affects the butterfly area of the face of middle-aged adults. However, it rarely involves oral mucosa including lip and should be differentiated from mucosal neuromas which generally occur as multiple small nodules of the lips and the anterior part of the tongue. We report a case of PEN occurring on the lower lip in a 33-year-old male. Histopathologically, it appeared as a well-circumscribed, encapsulated round nodule in the dermis. The nodule was composed of well-developed fascicles of wavy spindle cells separated by a loose matrix. Nuclear palisades were ill defined. On immunohistochemical staining, most tumor cells of the nodule were positive for S-100 protein and about 30% of tumor cells were positive for neural filament, but the capsule was negative for them. Epithelial membrane antigen was focally and discontinuously reactive on the capsule of the nodule.

A Case of Type V Hyperlipoproteinemia with Xanthoma Eruptivum / 대한피부과학회지

We report a case of type V hyperlipoproteinemia with xanthoma eruptivum in a 30-year-old male. He had diffuse erythematous yellowish papules on both extremities and the buttock. The laboratory findings showed the increased cholesterol and the triglyceride. Serum electrophoresis showed an increase in pre-beta and chylomicron, suggesting type V hyperlipoproteinemia. The biopsy specimen of an erythematous yellowish colored papule on the right knee showed many aggregates of foam cells without Touton giant cells.

A Case of Multinucleate Cell Angiohistiocytoma / 대한피부과학회지

Multinucleate cell angiohistiocytoma is a rare benign fibrohistiocytic vascular condition with distinctive histologic features. It tends to occur more frequently in middle-aged women, to favor the extremities, and to appear as grouped reddish-brown papules. We describe a case of solitary multinucleate cell angiohistiocytoma that appeared as a papule on the upper lip of a 24-year-old man.

Clinical Observation of Cutaneous Malignant Tumors and Premalignant Lesions over 15 Years (1982-1996) / 대한피부과학회지

No abstract available.

Clinical Analysis of 14 Cases of Pyoderma Gangrenosum / 대한피부과학회지

BACKGROUND: Pyoderma gangrenosum is a rare disease in which a painful nodule or pustule breaks down to form a progressive enlarging ulcer. Until now, only 8 cases of pyoderma gangrenosum have been reported in Korea. Therefore, we thought it necessary to perform a clinical analysis of pyoderma gangrenosum in Korea with a review of literature. OBJECTIVE: Our purpose was to find the clinical features of pyoderma gangrenosum in Korea. METHODS: Fourteen cases with pyoderma gangrenosum were investigated by reviewing medical records. Results There were 6 males and 8 females. The onset age was between 4 years and 65 years, and most(9 cases) had developed the condition between the ages of 20 and 60. Thirteen cases involved the extremities and 3 cases had whale body involvement, Seven cases(50%) had multiple lesions. All cases had pain at the lesional sites. Two cases were classified as the bullous type and the others were ulcerative in nature. The histological fmdings were non-specific. Dense inflarnmatory infiltrates composed of lymphocytes and predominant neutrophils were found in the epidermis and dermis associated with ulceration. Two cases were treated only with systemic steroids, and 2 cases with dapsone and steroids, 2 cases with colchicine and steroids, and 1 case with steroids, dapsone and colchicine. One case was treated with colchicine and anti-Tbc drug, 1 case with dapsone, 3 cases with antibotics, 1 case with the anti-Tbc drug and 1 case with anti-cancer drugs. Systemic disease was present in 5D% of the cases. The associated diseases were Behcets disease(3 cases), tuberculosis(2 cases), systemic lupus erythematosus(1 case), pancytopenia(1 case), iron deficiency anemia(1 case), acute leukemia(1 case), and colon adenoma(1 case). Recurrence developed in 2 cases and positive pathergy reactions were observed in 3 cases. CONCLUSION: Pyoderma gangrenosum was eccompanied with systemic disease in 50% of the cases and the most common therapeutic drugs were steroids. It is therefore impartant to detect the presence of any underlying disease and to treat this alongside pyoderma gangrenosum.

T Lymphocyte Subsets and Binding of T lymphocyte to Human Dermal Microvascular Endothelial Cells in Behcet's Disease / 대한피부과학회지

BACKGROUND: Behcets disease represents a polysymptomatic, recurrent vasculitis' with a chronic course. Its etiology and pathogenesis still remains unclear. Several immunological abnormalities have been described in this disease and altered cell mediated immunity especially has been suggested to play an important role in the pathogenesis. Recently, suppressor-inducer (naive, CD4-CD45RA+ ) and helper-inducer (memory, CD4-CD45RO+) human T cell subsets have been identified by their relevant monoclonal antibodies. It has heen suspected that human dermal microvascular endothelial cells(HDMEC) are an important part in the pathogenesis of Behcets disease. However, there was no report for HDMEC-T lymphocyte adhesion in Behcets disease, OBJECTIVE: We have investigated the subpopulation differences in CD4- T lymphocytes and the adhesiveness of T lymphocytes to cultured HDMEC in the presence of IL-1 alpha, or TNF-alpha using T lymphocytes isolated from normal human subjects and Behcets disease patients respectively. METHODS: T lymphocyte subsets were evaluated by the two-color immuno-fluorescence flow cytometric analysis using anti CD4-, CD8-, CD45RA- and CD45RO monoclonal antibodies. The binding assay of T lymphocytes to HDMEC was performed before and after stimulating HDMEC with IL-l alpha or TNF-alpha. RESULTS: 1. The number of CD4- T cells and the CD4+ to CD8+ ratio decreased in patients with Behcets disease compared to normal controls. 2. In the CD4+ T cell subpopulation, there was a significant decrease in the CD4+CD45RA+cell number with a slight increase in the CD4+ CD45RO+ cell number. 3. After stimulating HDMEC with IL-la and TNF-a, the degree of T lymphocyte-HDMEC adhesion generally increased in an E:T ratio dependent, manner in patients with Behcets disease compared to normal controls. 4. Increased binding of CD4+ CD45RA+ naive T lymphocytes and CD4+CD45RO+ memory T lymphocytes to HDMEC was induced after stimulation with IL-1 alpha and TNF-alpha in both patients and normal controls. The increasing rate was higher in Behcets disease patients than in normal controls. There was no difference in T lymphocyte-HDMEC adhesion between memory and naive T lymphocytes. CONCLUSION: From these findings it can be postulated that the decrease in the CD4+CD45RA+ count may lead to the inactivation of CD8 suppressor cells resulting in abnormal immune suppression shown in Behcets disease. Proinflammatory cytokines may also play an integral role in the pathogenesis of Behcet's disease by activating endothelial cells increasing the interaction between T lymphocytes and endothelial cells. Increasing the interaction between T lymphocytes and HDMEC may be indirect evidence of activation of cell-mediated immunity.

A Case of Skin Tag like Preaxial Polydactyly / 대한피부과학회지

Polydactyly is the most common congenital anomaly of the upper limb. Polydactyly is classified as preaxial polydactyly(thumb), central polydactyly(index, middle and ring fingers), and postaxial polydactyly(little finger) by the site of the extra digit. A 3-day-old female newborn had a 1.5 * 1.0cm sized flesh color ed pedunculated sac like mass on the proximal phalanx of her right thumb since birth. A roentgenogram on the hand revealed no bony abnormalities of the digit and the mass contained no bony structures. The stalk of the mass was cut by the CO2 laser. On histopathological examination, a cartilage structure was found in the loosely arranged, edematous dermis and the overlying epidermis was flattened. The clinical and histological findings support the diagnosis of preaxial polydactyly. We report this interesting case of preaxial polydactyly with a review of the literature.

Systemic Scleroderma in Childhood / 대한피부과학회지

The onset of systemic scleroderma in the first. decade of lif occurs in less than 1.5% of instances. Systemic sclerodrma in childhood have been characterized by less severe visceral involvement and a benign course We report a boy, aged 7 years, with a history of Raynaid; phenomenon and dysphagia. He had a mask-like face, flexion contracture of hands and knee joints, digital pitting scars, ichthyosiform skin change on leg and hyperpigrnented induration on all extremities and trunk. Antinuclear antibodies were positive in nucleolar type and Scl-70 antiocy was also present. On radiologie study, the pattern of reflux esophagitis and resorption of the listal ends of all phalanges were nated. Histopathological findings were compatible with sclerodma. He was treated with Penicillamine-D and oral corticosteroic with good improvernent.

A Clinical Study of 32 Patients with Sweet' s Syndrome / 대한피부과학회지

BACKGROUND: The clinical study of Sweets syndrome has never been reported in Korea. OBJECTIVE: The purpose of this study was to elucidate the clinical observations and associated diseases of Sweets syndrome. METHODS: During a 5-year-period from Jan. 1990 to Dec. 1994, 32 patients were evaluated in regard to age incidence, sex ratio, location of skin lesions, and associated diseases. RESULTS & CONCLUSIONS : 1, The age distribution was in the range of 21-70 years. Most patients were between 31 to 40 years of age. There were 12 male patients and 20 female giving a sex distribution of 1.7: 1 ratio in favor of the fernale. 2. The most cornmon site of iavolvement was the arm(37.5%). 3. ESR was increased in 21 patients(65.6%) and leukocytosis was present in 13 patients(40.6) 4. The most common associated disease was Behcets disease(31.2%). 5. Steroids were used mos frequently for treatment of Sweets syndrome with 12 patients(37.5%). Recurrence occurred in 7 patients(21.9%). The results show that the iniidence of Sweets syndrome in men in Korea is not as rre as was previously thought and tfiat there are many associated diseases especially Behcets disease.

Wegener' s Granulomatosis / 대한피부과학회지

Wegener's granulomatosis is a systemic necrotizing vasculitis of unknown cause. The disease is characterized by the involvement of the upper airway, the lung, and the kidney. Skin lesions are frequent and the most common lesion is purpura distributed on the limbs and trunk. A 34-year-old female showed recurrent purpuric macules on the both lower extremities and buttocks. The patient. showed nasal septal perforation with saddle nose deformity and C-ANCA positivity. Histopathologic findings of purpuric lesion revealed the features of necrotizing vasculitis. The histologic specimen from the nasal cavity showed chronic inflammation with granuloma formation and kidney showed focal necrotizing glomerulonephritis. Therefore, we treated the patient with prednisolone and cyclophosphamide having diagnosed Wegener's granulomatosis.

Regional Morphological Study on the Development of the Human Embryonic and Fetal periderm / 대한피부과학회지

BACKGROUND: Morphologic characteristics of the human embryonic and fetal periderm according to body region are not very clearly defined. OBJECTIVE: We have tried to Clarify the sequential development of periderm regionally. METHOD: Skin samples were obtained from 12 human embryos and fetuses ranging from 4 to 23 estimated gestational ages(EGA) and divided regionally into scalp, face, back. abdomen, thigh and sale. Specimens were observed by scainning with an electron microscope. RESULTS: Human embryonic end fetal periderm show distinct morphologic changes as follows along its own sequence of development flattened surface, elevated surface, fiormation of incomplete bleb. single bleb stage, multiple-complex bleb stage, formation of regressinjg bieb. Then towards the end of the second trimester, most of thieperidermal cells are completely regressed. Regional variation in peridermal development is not evide!nt during the embryonic period, but earlier development is apparent in the sole, face and scalp especially in the sole compared to other areas during the late first snd second trimester after EGA 9 weeks. CONCLUSION: The periderm, which can be seen only in embryonic and fetal epidermis, shows distinct sequential developmental changeis with regional variation.

Immunohistochemical Demonstration of the Skin Basement Membrane Antigens by the AMex ( Acetone , Methyl Benzoate and Xylene ) Method / 대한피부과학회지

BACKGROUND: Preservation of antigen determinants while retaining morphological detail is prerequisite for high quality immunohistochemistry. Conventional formalin fixation and paraffin embedding procedures are useful in preserving tissue architecture and cytologic detail. However, they destroy the antigenicity of many proteins is tissue samples. On the other hand, fresh frozen section preserve the antigenicity of most proteins, but vield poor morphological preservation. OBJECTIVE: The purpose of this study is to evaluate the AMeX method as to the ability to preserve both antigenicity and morphologic details of the skin basement membrane zone so that precise localization of antigens can be attained in immunohistochemistry. METHODS: Tissues were fixed in acetone at -20degrees C over night, then cleared in methyl benzoate and xylene, consecutively, and embedded in ordinary paraffin at 58-60degrees C. Sections made from this paraffinembedded tissue were stained with hematoxylin and eosin for a morphologic study and immunolabelled with antibodies against major basement membrane antigens to evaluate antigenic preservation. The staining intensity and preservation of the morphology by the AMeX method were compared with conventional formalin processed tissues and frozen tissues. RESULTS: Morphological preservation of the AMeX method-processed sections was good throughout the epidermis, basement membrane, and dermis, and as good as that of routinely formalin-fixed paraffin-embedded sections. Frozen sections usually revealed revealed various degrees of damage by ice crystal formation throughout the epidermis to the dermis. The AMeX method-processed sections showed better or same antigenic preservation comparing the frozen sections when the sections were immunolabelled with specific monoclonal antibodies. But, when the sections were immunolabelled with patient's sera, the AMex method showed less antigenic preservation than the frozed sections. The anti-type IV collagen monoclonal antibody exhibited immunoreactivity only conventional formalin-fixed paraffin-embedded skin sections, but the intensity of the staining was weaker than the AMeX processed sections and the frozen sections. CONCLUSION: The AMeX method can be utilized for the demonstration of skin basement membrane antigens and is superior to the fresh-frozen method in that the histologic figures are more distinct and antigencity can be preserved for a long time.

A Case of Esophageal Ulcerations in Behcet's Disease / 대한소화기내시경학회지

Trminal ileum and cecum are the most frequently involved portions of the gastrointestinal tract in Behqet's disease. Esophageal involvement in Behqet's disease is very uncommon and only a few cases have previously been reported. We have observed a case with this disease. A 25-year-old female patient who was diagnosed as having Behqet's disease 7 years before had dysphagia and weight loss of about 10 kg for 4 months. Esophagogastroduodenoscopic examination revealed diffuse ulceration and mucosal nodularities in esophagus which suspected esophageal cancer. But repeated biopsies showed lymphocytic infiltration around vessels in ulcerative lesions. She was treated with conservative managements.

Cyclosporine in the treatment of psoriasis / 대한피부과학회지

BACKGROUND: Psoriasis is belived to be a disorder of keratinocyte hyperproliferation mediated by T helper cells. Cyclosproine is one of the immunosuppressants and there have been several studies showing the benefcial effects of cyclosporine on psoriasis. OBJECTIVE: To evaluate the clinical efficacy, tolerability, and adverse effects of cyclosporine, a randomized open uncontrolled multicenter study was conducted in 15 university hospitals in Korea. METHOD: There were 68 total trial cases and among them 16 patients dropped out from the study. The reported reasons for stopping the use of the medication under study prematurely were lack of cooperation(seven cases), adverse effects(six cases), the ineffectiveness of the medication(two cases), and another(one case). The drug was administered for 18 weeks to 52 patients. The initial dosage of the drug was 2.5mg/kg/day which was maintained or increased to 4mg/kg/day or 5mg/kg/day according to the PASI score reduction rate at the 6th and 12th week. The PASI score was measured and Iaboratory tests and observation of adverse events were done. RESULTS: At the end of therapy PASI score reduction rate of more than 66% occured in 40 patients (76.9%). The PASI score was significantly reduced from 20.0 to 5.4 after treatment for 18 weeks. The social disability score was significantly decreased. Pruritus and nail involvement were also significantly decreased. The change of systolic and diastolic blood pressure were statistically not significant. The 30% increase of serum creatinine level compared to the baseline was observed in six patients(11.5%) at the 6th week, three patients(5.8%) at the 12th week, five patients(9.6%) at the 18th week, but no patients showed an increase above the normal range.The increase of serum total bilirubin and SGOT was observed in six patients(11.5%) and one patient(1.9%0, respectively. The clinical adverse events reported during the study were gastrointestinal trouble(seven cases, 13.5%), hypertrichosis(two cases, 3.8%), generalized weakness(two cases, 3.8%0, paresthesia(one case, 1.9%), hypertension(one case, 1.9%), disturbance of erection(one case, 1.9%). The overall assessment of efficacy and tolerability by investigator and patients were mostly good or very good. CONCLUSION: Generally cyclosporine was well accepted and tolerated and low dose cyclosporine therapy-2.5mg/kg/day to 5mg/kg/day-is an effective therapeutic modality for the treatment of psoriasis.

The change of langerhans cells,la+kerationocytes and thy-1+dendritic epidermal cell in allergic contact dermatitis and irritant contact dermatitis / 대한피부과학회지

BACKGROUND: Langerhans cells (LC), keratinocytes and Thy-1+ dendritic epidermal cells(DEC) are epidermal cells which are known to have important roles in inflammatory or immunologic skin disorders. Allergic contact dermatitis(ACD) is a prototype of a delayed hypersensitive reaction in which LC, keratinocytes and T lymphocytes play an important role. The role of LC in ACD is well known, but the role of Thy-1+ DEC is not yet fully revealed. Futhermore, the mechanism of irritant contact dermatitis(ICD) is not known and more study is required on the interaction between these epidermal cells in ICD. OBJECTIVE: The aim of this study is to observe the changes of these cells in ACD and ICD and to discuss their possible roles in the disease precess. MEHTODS: We evoked ACD with DNFB and ICD with croton oil in BALB/c mice and observed the morphologic changes of LC, Ia+ keratinocytes, and Thy-1+ DEC by immunoperoxidase staining when the inflammation was at its peak and at the resolution state. RESULTS: 1. In the control group, LC were evenly distributed and their average number was 1147+/-132/mm*. Thy-1+ DEC were slightly bigger than LC and showed uneven distribution. The average number of Thy-1+ DEC was 57+/-69/mm* Ia+ keratinocytes did not appeared. 2. On the 1st day of DNFB challenge, the number of LC was significantly decreased and their size and dendritic processes were increased when compared to those of the control group. Most of the keratinocytes showed Ia antigen expression on their surfaces. 3. On the 12th day of DNFB challenge, no significant changes in the number and morphologyof LC were noted when compared to the cotrol group, Ia+ keratinocytes were not observed. 4. there were no significant changes in the number and morphology of Thy-1+ DEC in ACD on the 1st and 12th day after DNFB challenge. 5. On the 2nd day after croton oil application, the number of LC was significantly decreased but the morphology not significantly changed. Ia+ keratinocytes were not observed. 6. On the 20th day after croton oil application, the number of LC was significantly increased but the morphology was not significantly changed. Ia+ keratinocytes were not observed. 7. There were no significant changes in th number and morphology of Thy-1+ DEC in ICD on the 2nd and 20th day after application of croton oil. Ia+ keratinocytes were not observed. CONCLUSION: In can be deduced that the LC have important roles in the mechanisms of both ACD and ICD reactions. Ia+ keratinocytes have an important role mainlyin the inflammatory precess of ACD. In addition, since the changes of the number of Langerhans cells in ACD and ICD showed different time courses and Ia+ keratinocytes appeared only in ACD, we hypothesized that different pathways of inflammation exist in ACD and ICD, and different cytokines may be responsible. It is probable that Thy-1+ DEC does not have any significant role in the inflammatory process of both ACD and ICD.