Botulinum Toxin Type A for Facial Wrinkles and Benign Masseter Hypertrophy in Korean Patients / 대한피부과학회지

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.

Differential Expression of TGF-beta Isoforms During Differentiation of HaCaT Human Keratinocyte Cells: Implication for the Separate Role in Epidermal Differentiation

The three mammalian isoforms of transforming growth factor-beta (TGF-beta1, beta2, beta3) are potent regulators of cell growth, differentiation, and extracellular matrix deposition. To study their role in skin differentiation, we investigated the expression of TGF-beta isoforms on cell growth and differentiation induction of the human keratinocyte cell line, HaCaT by elevating the Ca2+ concentration. An ELISA and RT-PCR assay revealed secreted TGF-beta 1 protein and TGF-beta1 mRNA were increased during calci-um-induced differentiation. In contrast, major differences were seen for TGF-beta 2 and TGF-beta 3 mRNA which were decreased during differentiation, but TGF-beta 2 and TGF-3beta protein were not evident on an ELISA. These results suggest different functions for each TGF-beta isoforms in epidermal differentiation, such that TGF-beta 1 is associ-ated with the more differentiated state, and TGF-beta 2 and TGF-beta 3 may be associ-ated the more proliferated state.

5 Cases of Solitary Mastocytoma

We report five cases of solitary mastocytoma. All patients were under one year of age and diagnosed as solitary mastocytoma based on clinicopathologic findings. Skin lesions were found on the right forearm, left hand, left leg, left elbow and left shoulder. They resolved themselves spontaneously resolution within 2 or 3 years.

Three Cases of Flagellate Pigmentation from Intravenous Bleomycin / 대한피부과학회지

Bleomycin is an antitumoral antibiotic derived from Streptomyces verticillus in 1965. The drug has been used with a varying success in the treatment of squamous cell carcinomas and malignant lymphomas. The cutaneous toxicities of bleomycin include hyperpigmentation, sclerosis, gangrene, nail changes and erythema. Linear streaks appear to be a characteristic eruption induced by bleomycin. We report three cases of flagellate pigmentation from intravenous bleomycin. Three patients were suffering from uterine cervical carcinomas and were treated with chemotherapy with a VBP (vincristine, bleomycin, cisplatire) regimen. During or after their courses of chemotherapy, dark brownish skin lesions developed on the body surface of these patients. A Light microscopic study of each specimen showed increased pigmentation of the basal layer and an electron microscopic study showed a slightly increased number of melanosomes in keratinocytes.

Comparative Study of Infiltrating Cells of Early and Late Psoriatic Lesions using Immunohistochemical Staining / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic relapsing disease characterized by epidermal hyperproliferation and epiderrnal and dermal inflammatory cell infiltration. The etiology of this disease is still unclear. Recently, there has been growing interest in the probable role of a T cell mediated immune response in the pathogetiesis of psoriasis. The infiltrating cells in psoriatic lesions have been iden- tified by monoclonal ant~ibodies and T cells were found to be the major infiltrating type. OBJECTIVE: This stud was done to investigate the difference of cellular infiltration and adhesion molecule exg!ressions between early and late skin lesions of psoriasis using immunohistochernical studies. Methpds : Patients with psoriatic lesions were divided into two groups. The early gr oup were defined as having skin lisions that had lasted for about 4 weeks, and late group were defined as having skin lesions that had lasted for more than 8 weeks. Then biopsy specirnens were stained using monoclonal antibidies for CD4, CD8, CD1, LFA-1, and ICAM l. RESULTS: 1. CD4 positive cells,vere tly increased in both the early and late groups compared with CD8 positive cells. Z. CD8 positive cells were significantly increased in the late g~roup compared with the early group. 3. CDl-posit,ive dendri!ic cells were more nurnerous in the late group than the early group. 4. There were no significant differences between the early and late group with regard to numbers of LFA-1 positive (ells. 5. ICAM-1 were more strongly expressed on epidermal keratinocytes in the late than the early group. CONCLUSION: CD4-positive cells are important in early and late psoriatic lesions and CD8 positive cells playi more important role in late than early lesions. ICAM-1 and LI'A-1 play a role in cell adhesion of infiltrating cells and lymphocytic rnigration to the epidermis.

Comparative Study of Infiltrating Cells of Early and Late Psoriatic Lesions using Immunohistochemical Staining / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic relapsing disease characterized by epidermal hyperproliferation and epiderrnal and dermal inflammatory cell infiltration. The etiology of this disease is still unclear. Recently, there has been growing interest in the probable role of a T cell mediated immune response in the pathogetiesis of psoriasis. The infiltrating cells in psoriatic lesions have been iden- tified by monoclonal ant~ibodies and T cells were found to be the major infiltrating type. OBJECTIVE: This stud was done to investigate the difference of cellular infiltration and adhesion molecule exg!ressions between early and late skin lesions of psoriasis using immunohistochernical studies. Methpds : Patients with psoriatic lesions were divided into two groups. The early gr oup were defined as having skin lisions that had lasted for about 4 weeks, and late group were defined as having skin lesions that had lasted for more than 8 weeks. Then biopsy specirnens were stained using monoclonal antibidies for CD4, CD8, CD1, LFA-1, and ICAM l. RESULTS: 1. CD4 positive cells,vere tly increased in both the early and late groups compared with CD8 positive cells. Z. CD8 positive cells were significantly increased in the late g~roup compared with the early group. 3. CDl-posit,ive dendri!ic cells were more nurnerous in the late group than the early group. 4. There were no significant differences between the early and late group with regard to numbers of LFA-1 positive (ells. 5. ICAM-1 were more strongly expressed on epidermal keratinocytes in the late than the early group. CONCLUSION: CD4-positive cells are important in early and late psoriatic lesions and CD8 positive cells playi more important role in late than early lesions. ICAM-1 and LI'A-1 play a role in cell adhesion of infiltrating cells and lymphocytic rnigration to the epidermis.

A Case of Squamous Cell Carcinoma Arising in Giant Porokeratosis

We report a case of squamous cell carcinoma arising in giant porokeratosis in an 88-year-old woman. She had a 20 × 12 cm sized erythematous scaly patch with central ulceration on the right parietal area. On histopathologic examination, a skin biopsy specimen from the peripheral ridge of erythematous lesion revealed porokeratosis, and a specimen from the central ulceration showed well differentiated squamous cell carcinoma.

Cutaneous Ulcer Due to Candida Infection / 대한의진균학회지

Cutaneous ulcers due to candida infection are very rare condition, occurring almost in immunocompromised host or occurring as cutaneous manifestation of systemic candidal infection. A 52-year-old woman presented with cutaneous ulcer on dorsum of left hand which had lasted for about 15 days. Bacterial culture showed nonpathogenic organism, Enterobacter cloacae. Mycologic studies including KOH mount and fungus culture were positive for pseudohyphae and colonies of Candida species. A biopsy specimen from the center of ulcer revealed numerous spores and fungal hyphae in the upper dermis and necrotic epidermis. Bacterial culture and fungus culture of patient's serum and urine were negative. Initial treatment with antibiotics had no effectiveness for 2 weeks. After then we treated with antifungal drug, itraconazole 100mg/day. After 6 weeks of antifungal therapy, the skin lesion was much improved. We report this case, because it showed cutaneous ulcer due to candida infection but had neither systemic candidal infection nor clinical sign of immunosuppression.