A Case of Palisaded Neutrophilic and Granulomatous Dermatitis Associated with an Initial Presentation in Ankylosing Spondylitis

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an inflammatory dermatosis associated with systemic immune-mediated diseases such as rheumatoid arthritis, systemic sclerosis, lupus erythematosus, and ulcerative colitis. Histologically, serial development of leukocytoclastic vasculitis is shown from an early stage, which can progress to palisading granuloma in the fully developed stage and to fibrosis in the final stage. A 32-yearold man presented with ankylosing spondylitis showing multiple erythematous papules on his fingers, elbows, knees, and left auricle. Histologic examination from his skin lesion revealed a perforating palisading granuloma with leukocytoclastic vasculitis, which was consistent with PNGD. Therefore, this study reported a case of PNGD accompanied by ankylosing spondylitis as an initial presentation.

Clinicoepidemiological Features of Melasma in Korean Patients at Five University Hospitals: A Cross-sectional Multicenter Study / 대한피부과학회지

BACKGROUND: Melasma is a common acquired hyperpigmentation disorder that predominantly affects the face. It frequently occurs in women with darker skin types and severely impacts quality of life. OBJECTIVE: To characterize the clinicoepidemiological features and triggering or aggravating factors of melasma in Korean patients. METHODS: This cross-sectional study was conducted at the dermatology clinics of five university hospitals in Korea. Between January 2011 and August 2012, 411 patients with melasma completed a questionnaire about the clinical and aggravating factors associated with their melasma. RESULTS: The study population consisted of 400 women and 11 men aged 22~73 years (mean age, 42.8±9.92 years). Triggering or aggravating factors were sun exposure (68.4%), pregnancy (27.0%), and emotional stress (24.8%). Interestingly, 61.1% of patients complained of sensitive/inflammatory features such as erythema, itching, and a stinging sensation. Dryness was the most common aggravating factor, followed by erythema/redness and itching/stinging. Concomitant pigmentary disorders included post-inflammatory hyperpigmentation in 15.1% of patients, followed by pigmented contact dermatitis, and acquired bilateral nevus of Ota-like macules. CONCLUSION: It is well known that sun exposure and hormonal changes are the most common triggers of melasma; however, sensitive/inflammatory features may aggravate melasma in East Asian patients. Therefore, these individual and racial differences should be considered in the prevention and treatment of melasma.

A Case of Anagen Effluvium Induced by INH (Isonicotinic Acid Hydrazide) / 대한피부과학회지

We report a case of a 30 year-old woman who presented with acute scalp hair loss induced by isonicotinic acid hydrazide gap (INH). Considerable hair loss started within 4 weeks of INH administration. There was no evidence of dermatitis, allergic reaction, or any other cause for the hair loss. INH was discontinued, and the hair loss stopped within 4 weeks, with new hair growth seen. There was complete recovery of hair loss after 12 weeks of alopecia. Medication-induced hair loss is an occasional adverse effect of many drugs, however hair loss induced by INH has been reported in only 1 case. The complete recovery from anagen effluvium is difficult to explain, but it could have been due to the early discontinuance of INH.

A Case of Isolated Plantar Collagenoma / 대한피부과학회지

Collagenoma is a hamartomatous lesion consisiting of proliferation of normal collagen tissue. We report herein a rare case of isolated plantar collagenoma without associated abnormalities. A 50-year-old male presented with an asymptomatic, 1.5x1.5cm sized, firm, dome-shaped tumor on his left sole. There were no associated cutaneous or systemic findings. Histopathologically, the lesion consisted of thick collagen fibers, which was compatible with collagenoma.

A Case of Bednar Tumor / 대한피부과학회지

A Bednar tumor is a rare pigmented subtype of dermatofibrosarcoma protuberans (DFSP). The clinical and histopathological findings of Bednar tumors are identical to DFSP, except for the presence of melanin-containing cells within the lesion. We present a case of a Bednar tumor on the left anterior chest of a 58-years-old woman. It was presented as an asymptomatic, firm, hyperpigmented 1.8x2.7cm sized nodule with surrounding erythematous patch which had been present for over 35 years. The tumor was treated by wide local excision of the lesion. There has been no evidence of recurrence during a 1 year follow-up period.

A Case of Diabetic Thick Skin Syndrome / 대한피부과학회지

The diabetic thick skin syndrome is a common disease in the children of diabetes mellitus. But, it has not been reported in Korea. It is characterized by the stiff joints of hands and the indurated skin of both hands and arms. The simple screening test is prayer sign that patient is unable to bring fingers together because of contractures of proximal and distal interphalangeal joints. We present an 11-year-old Korean child with stiff joints of both hands and waxy, indurated skin of both hands and forearms that had been increasing in extent for the last 4 years.

A Case of Multiple Yrichilemmal Cysts All Over the body / 대한피부과학회지

A case of multiple trichilemmal cysts (TC) is presented. TC is known to be a kind of keratinous cyst with lining cells showing trichilemmal keratinization. About 90% of TC occur on the scalp. They are multiple in 70%, however, only 10% of the patients have been reported to have more than ten cysts. Therefore multiple TC on any other sites than scalp seem to be rare. A 37-year-old man presented with a twenty year duration of twelve nodular lesions on the back, chest, buttock, thigh, neck and scalp. All lesions were completely excised and microscopically examined, and showed histopathology compatible with TC.

A Case of Wells' syndrome / 대한피부과학회지

Wells' syndrome, also called eosinophilic cellulitis, is characterized by recurrent cutaneous swellings, which resemble acute bacterial cellulitis, distinctive histopathological changes, dermal eosinophilic infiltration and characteristic flame figure. A 53-year-old woman developed pruritic, erythematous, and edematous plaques on chest, abdomen, back and both upper arms. Histology of the plaques revealed a diffuse infiltration of eosinophils and flame figure in the dermis without granulomatous and vasculitic process, consistent with the diagnosis of Wells' syndrome.

A Case of Generalized Subcutaneous Fat Necrosis of Newborn / 대한피부과학회지

Subcutaneous fat necrosis of newborn is an uncommon disorder characterized by firm subcutaneous plaques and nodules usually appearing shortly after birth. A female newborn with brain death developed diffuse hardening of trunk, extremity, cheek and buttock in the first 5 weeks of the life. A clinical diagnosis of sclerema neonatorum was made. But histologic examination revealed patchy areas of fat necrosis with crystallization, infiltration of histologic cells and several multinucleated giant cells containing needle-shaped clefts. Calcium deposits were also demonstrated within the necrotic area. So, we diagnosed this case as subcutaneous fat necrosis of newborn with generalized hardening of the skin.

A Case of Congenital Midline Cervical Cleft Associated with Congenital Cardiac Anomaly / 대한피부과학회지

Congenital midline cervical cleft is a rare congenital anomaly of the ventral neck. Less than 100 cases have been reported in the literature. This anomaly is part of a spectrum of midline branchiogenic syndromes resulting from abnormal migration of cells derived from the branchial arches. It presents as a small skin tag superiorly with a linear, ventrically oriented atrophic patch. We present a case of congenital midline cervical cleft associated with congenital cardiac anomaly.

Spitz Nevus in a Giant Speckled Lentiginous Nevus / 대한피부과학회지

Speckled lentiginous nevus is circumscribed patch of hyperpigmentation with smaller, darker pigmented macules or papules within the patch. The background shows histologic features of lentigo simplex. The speckled areas show junctional or compound nevus. Association of speckled lentiginous nevus with multiple spitz nevi was rarely reported. We report a case of multiple spitz nevi arising in a giant speckled lentiginous nevus.

Distribution and Recognition of Skin Diseases in Rural Areas / 대한피부과학회지

BACKGROUND: In many epidemiologic reports of distribution of skin diseases, the outpatients of university hospitals have been the target groups of the analysis. But there has been no epidemiologic study of dermatoses in the field of rural area. OBJECTIVE: The purposes of this study were to investigate the distribution of skin diseases in rural areas and to evaluate the rural population's concept of skin disease and the attitude to their skin problems. METHOD: We analysed the results of interview and responses of questionnaires from 481 residents who visited the local public health centers and the free clinics in the rural areas of Kyonggi-Do and Ulsan city. RESULTS: The results of the study are summarized as follows : 1. Of 481 residents, there were 328 females and 153 males. The mean age was 56.6 years old. The residents over 50 years old formed 73.2 percent of total population. 2. The common dermatoses were tinea pedis, onychomycosis, xerosis, seborrheic keratosis, chloasma, pruritus, hand eczema, contact dermatitis, lentigo, seborrheic dermatitis in order of frequency. 3. The cutaneous fungal infection was the most common dermatoses in each study population. 4. To treat skin diseases, 51.2% of the residents visited the drug store initially. 5. The major reason of not taking dermatological care in the rural population was customary habit. 6. The 39.5% of 238 respondents have used self-treatments, and 15.5% of 90 respondents have experienced side effects of self-treatments. 7. On the question about the negative concepts of dermatoses, 61.7% of 462 respondents agreed to the statement that dermatoses look unclean. 8. Half of the 463 respondents thought that dermatologic medicine was harmful. The 50.6% of the 328 respondents had no specific reason, and 34.1% experienced gastrointestinal trouble. 9. The most favorite type of dermatologic medicine was topical agent, which was preferred especially by the group of respondents using nonmedical service including drug store. CONCLUSION: The distribution of the skin diseases in rural areas was similar to other reported results except the high frequency of cutaneous fungal infection. This research could be a basis on the following epidemiologic studies of the skin diseases in rural areas. It is also suggested that the educational program to improve understanding of skin diseases should be performed in the rural areas.

A Case of Cytomegalovirus Induced Purpura in a Bone Marrow Transplant Recipient / 대한피부과학회지

Cytomegalovirus(CMV) infection is very common in organ transplant recipients and other conditions such as lymphoproliferative disorders or acquired immunodeficiency syndrome. However, CMV rarely causes skin manifestations. We describe a leukemic patient with CMV induced purpuras which developed during cyclosporin therapy after a bone marrow transplantation. A biopsy revealed several foci of large irregular-shaped endothelial cells with large, basophilic intranuclear inclusions in the papillary dermis. Laboratory examination disclosed positive blood culture for CMV and polymerase chain reaction study performed with the skin sample revealed positive CMV DNA. Early intravenous gancyclovir made improvement of the skin lesions and negative conversion of viral antigenemia.