Transepidermal Elimination of Nevus Cells in Acral Lentiginous Nevus / 대한피부과학회지

Pigmented lesions of palmar and plantar skin may cause diagnostic problems, because some features of benign lesions in these sites may raise the suspicion of melanoma if considered alone. Transepidermal elimlnation is a mechanism by which a substance is eliminated through the epidermis, and it is apt to be confused with a feature of melanoma that tumor cells are located at all layers of the epidermis. We report a case of transepidermal elimination of nevus cells in acral letiginous nevus which needs a differential dignosis of melanoma.

A Case of Pulmonary Infarction Probably Related with Henoch-Schönlein Purpura

We report a case of pulmonary infarction probably related with Henoch-Schönlein purpura, which presented with purpura on both lower extremities in a 27-year-old woman. The purpura had developed 4 days previously and it had no itching or tend'erness. She complained of mild fatigue, chest tightness, but no dyspnea or hemoptysis. On routine examination, chest radiography showed a poorly defined nodular opacity on the left lung field, and it was diagnosed by a follow up chest CT as a pulmonary infarction secondary to pulmonary vasculitis.

Frequencies of HLA-DRB1 Alleles in Korean Patients with Pemphigus / 대한피부과학회지

BACKGROUND AND OBJECTIVES: Pemphigus is an autoimmune bullous disease of the skin and mucous membranes. There are two major types of pemphigus, namely pemphigus vulgaris(PV) and pemphigus foliaceus(PF) which can be classified by the specificity of the autoantibodies against the epidermal desmosomal antigens in this disease. Like many other autoimmune diseases, pemphigus is also considered to be strongly associated with certain HLA alleles; some alleles can be detected with higher frequencies as compared with those found in ethnically matched populations. At this time, we tried to find out if there were certain HLA class II allele(s) associated significantly with Korean patients of pemphigus. PATIENTS AND METHODS: Thirty patients with pemphigus (fifteen of PV and fifteen of PF), and one hundred healthy Korean controls were enrolled in this study. For the genotyping of HLA class II alleles in DRB1 loci, genomic DNAs prepared from buccal epithelia were amplified by polymerase chain reactions with nucleotide sequence-specific primers. Each allele of thirteen different generic types belonging to the DRB1 loci were used to identify the existence of each allele in both patient and control groups on gel electrophoreses. RESULTS: In PV, there was a significantly increased frequency of HLA-DRB1*01 alleles than from the findings observed in the controls(pc=0.0013, RR:5). In patients with PF, there was a significant degree of association with HLA-DRB1*01(pc=0.00013, RR:5.5) when compared with that in normal controls. However, no allele of negative association with a significantly low frequency in the patient group was detected in both types of the disease. CONCLUSION: It can be suggested that DRB1*01 alleles may be susceptibility genes in Korean patients with PV, and DRB1*01 alleles could contribute to the autoimmune reactivity in patients with PF. This data shows different patterns in the frequency of each DRB1 allele in patient groups compared with those found in patients of other ethnic backgrounds.

The Incidences of Malassezia in Steroid Acne and Other Acneiform Eruptions / 대한의진균학회지

BACKGROUND: Steroid acne is a folliculitis that can result from a systemic or topical administration of steroid and has been described as showing similar clinical pictures to Malassezia folliculitis, but there have been few reports about the incidence of Malassezia in steroid acne and other acneiform eruptions. OBJECTIVE: Our purpose was to describe the incidences of Malassezia in acneiform eruptions and to discuss about the relationship between clinical steroid acne and Malassezia folliculitis. METHODS: The history, clinical features, direct microscopy, histopathological analysis, and therapeutic results of 125 cases with steroid acne or other acneiform eruptions were described and compared. RESULTS: Over 80% of patients with acneiform eruption receiving systemic steroid revealed significant numbers of Malassezia in the lesional follicle. CONCLUSION: Steroid acne and other acneiform eruptions showing discrete follicular papules and/or pustules localized to the upper trunk or acneiform facial skin lesions associated with multiple acneiform lesions on the body in the summer period should be suspected as Malassezia folliculitis.

A Case of Trichoadenoma / 대한피부과학회지

Trichoadenoma is a rare cutaneous tumor that was first described by Nikolowski in 1958. It usually occurs as a single tumor on the face and its size varies from 3 to 50mm in diameter. It may arise any time during adult life. This tumor is less mature than trichofolliculoma and more differentiated than trichoepithelioma, and it is considered as a benign tumor with differentiation toward the infundibular portion of the pilosebaceous canal. In this report, we describe a 61-year-old women who developed trichoadenoma on the left shoulder of 3 years duration. The lesion was asymptomatic and had grown slowly. Histopathological findings showed numurous horn cysts with central keratinous material and solid tumor islands reaching to the deep dermis. Immunohistochemical studies showed negative findings for eccrine differentiation.

A Case of Arteriovenous Hemangioma showing Darier's Sign / 대한피부과학회지

We experienced a case of arteriovenous hemangioma showing Dariers sign on the forehead of a 43-year-old man. He presented with a single, 1 * 1.5cm sized, violaceous, asymptomatic nodule with a history of an intermittent wheal at the lesional site. This skin lesion showed Dariers sign clinically and proliferation of mast cells histopathologically with the punch biopsy specirnen suggesting urticaria pig- mentosa. Howerer, we could diagnose it as a arteriovenous hemangioma on complete excision, as the specimen showed arteriovenous proliferation with increased mast cells in a perivascular pattern. This case showed confusing clinical signs and showed the importance of complete excision for the diagnosis of a small skin tumor especially when a vascular proliferating tumor is suspected.

Q-switched ruby laser in the treatment of nevus of Ota

The purpose of this study is to evaluate the efficacy of Q-switched ruby laser in the treatment of nevus of Ota, a pigmented lesion on the face. The Q-switched ruby laser has been shown to remove tattoos without scarring. With this in mind, the nevus of Ota with pigmented cells in the dermis could be effectively treated with Q-switched ruby laser. Eighty patients (19 men, and 61 women) with nevus of Ota on the face were enlisted to be tested in evaluating the efficiency of Q-switched ruby laser therapy. The age of patients ranged from 1 to 62 years. The energy fluence used varied from 6 to 8.5 J/cm2. Treatment intervals ranged from 4 to 16 weeks, and the number of treatment sessions varied between 1 to 9 visits. During a 2-year follow-up period, more than fifty percent removal of nevus-pigment was noted in 64 of the 80 patients. Transient hyperpigmentation was noted in 32 patients lasting for 2 to 6 months after treatment; transient hypopigmentation was seen in 3 cases which recovered within one year. No patients had permanent textural or pigmentary changes or scarring. Q-switched ruby laser therapy appears to be an effective and safe modality for the treatment of nevus of Ota.

Q-Switched Ruby Laser in the Treatment of Nevus of Ota

BACKGROUND: The Q-switched ruby laser has recently shown that it can remove tattoos with-out scarring. Therefore the Q-switched ruby laser is expected to be effective in the treatment of nevus of Ota, which contains pigmented cells in the dermis. OBJECTIVE: The purpose of this study is to evaluate the efficacy of Q-switched ruby laser in the treatment of nevus of Ota. METHODS: Twenty-five patients (6 men, 19 women) with nevus of Ota on the face were treat-ed. The age of the patients ranged from 3 to 62 years. The energy fluence used varied from 6 to 8.5 J/cm². Treatment intervals ranged from 1 to 3 months, and the number of treatments ranged from 2 to 9. Photographs were taken of all patients before and on every return visit. The photographs were then compared with each other. After completion of treatment, we evaluated some parameters including the extent of pigment-free area within the skin lesions (score 0-4), degree of lightening in the remaining skin lesions (score 0-3), and patient's own or their parents' opinions on the result of treatment (score 0-3). The scores of the above three parameters were added and the resulting scores were designated as excellent (score 9-10), good (score 7-8), moderate (score 5-6) and poor (score 0-4). RESULTS: Excellent treatment response (score 9-10) was obtained in 6 of the 25 patients. In all patients disappearance of pigmentation on a 40 percent or larger area was seen. One month after completion of treatment, the remaining lesion size was less than 40 percent of the original lesion in 21 (84.0%) patients. The degree of lightening in the remaining lesion was marked (score 3) in 22 (88%) patients. No scarring was noted following treatment. Transient hyperpigmentation was noted in 7 patients, and transient hypopigmented areas were noted in one patient. CONCLUSION: Q-switched ruby laser appears to be an effective and safe modality for the treatment of nevus of Ota.

Congential Self-Healing Histiocytosis

A case of congenital self-healing histiocytosis was studied with S-100 antibody and electron microscopy. Many tumor cells were positive for S-100 protein and a few contained Birbeck´s grandles and dense bodies. A pathlogic fracture was first noticed on the seventh day. The lesions involuted spontaneously by the end of a weeks

Cutaneous Manifestations and Nail Changes in Diabetes Mellitus / 대한피부과학회지

BACKGROUND: At least 30 per cent of diabetics, which is said to comprise over 3% of general population in Korea, have one or more cutaneous complications during the course of the disease. These skin changes may be the consequences of microangiopathy, arteriosclerosis, direct metabolic disturbances and/or the sequelae of chronic therapy. OBJECTIVE: We tried to observe certain cutaneous and nail changes in diabetics and to relate them with systemic complications, blood sugar level and duration of diabetes. METHODS: During the period of 12 months from March, 1992 to February, 1993, a total of 1858 outpatients diagnosed as diabetes mellitus at Eulji General Hospital were examined. RESULTS: The cutaneous manifestations are observed in 79.5% of diabetics examined and cutaneous infections are the most prevalent(52.3%). Pruritus(p<0.01), anogenital pruritus(p<0.01), peripheral dedema(p<0.05) are more common in females and infections, shin spots, finger pebbles(p<0.01) are more common in males. Systemic complications are observed in 50.7% and the cutaneous manifestations are observed more frequently in patients with systemic complications(p<0.05). Shin spots, diabetic foot, peripneral edema diabetic bullosis are observed frequently associated with systemic microangiopathic complications such as retinopathy, nephropathy and neuropathy(p<0.01). There is a significant correlation between blood sugar level and fungal infections and anogenital pruritus(p<0.01). The frequencies of shin spots, diabetic foot and diabetic bullosis increase with the length of time diabetes has been present. Nail changes are observed in 39.6% of diabetics and onychomycosis is the most frequent(34.5%). CONCLUSION: It is suggested that cutaneous shgns especially fungal infections in diabetics are on the increase in Korea. A variety of skin conditions are encountered with diabetes mellitus and the dermatologist may be able to make a significant contribution in the control of diabetes mellitus by identifying skin signs and conditions as diabetic complications.

It's clinical analysis and autoantibodies / 대한피부과학회지

BACKGROUND: Vitiligo is riot quite a rare diseasep; it has about 1% prevalence. The cause of vitiligo is not clear, however, in recent studies an autoimmune origin is freqluei itily mentioned. OBJECT: We tried to an lyze some clinical features of vitiligo and relate them with the presence of autoantibodies. MEHTODS: A total of 381 vitiligo patients was included for the analysis of clinical features. A laboratory study included rhumatoid factor, antinuclear antibocoly, antithyroglobulin antibody and antimicrosome antibody. Some 62 patients were examined for opl thmologic changes. RESULTS: One hundred and one(26.5%) of 381 patients exam ned showed at least one of the autoantibodies tested. Twenty nine pateints showed 2 different aitintibodies. The age at aonset of vitiligo in the autoantibody positive group was 6.6 years later than that of the autoantibody negative group. Autoimmune and/or endocrine diseases were more frequinty found among aut.oantibody positive patients. These diseas s included hyperthyroidism, diabetes me litus and alopecia areata. One patient revealed retinal hypoigmentation and showed no autoantibcidics. CONCLUSION: About 9% of vitiligo patients who were autoantiocyte positive had clinical evidence of diseases associated with the autoantibody. However, it is prudent. to xpect that more patients with t.he autoantibody may develop later systemic autoimmune diseases or endocrinopathies. A long term follow-up of these patients seem:, to be very important.

A Case of Linear IgA Bullous Dermatosis

This paper deals with a case of linear IgA bullous dermatosis (LABD). The patient was a 58-year-old woman who had multiple pruritic vesicles on the trunk, buttocks, thighs, tongue and buccal mucosa. A biopsy of a lesion revealed subepidermal vesicles. Direct immunofluorescence examination of the perilesional skin showed a linear deposition of IgA along the basement membrane zone (BMZ). Indirect immunofluorescence examination, using NaCl split skin as substrate, showed antiBMZ IgA antibodies bound only to the epidermal side. The skin lesions responded well to oral dapsone therapy.

A Case of Linear IgA Bullous Dermatosis

This paper deals with a case of linear IgA bullous dermatosis (LABD). The patient was a 58-year-old woman who had multiple pruritic vesicles on the trunk, buttocks, thighs, tongue and buccal mucosa. A biopsy of a lesion revealed subepidermal vesicles. Direct immunofluorescence examination of the perilesional skin showed a linear deposition of IgA along the basement membrane zone (BMZ). Indirect immunofluorescence examination, using NaCl split skin as substrate, showed antiBMZ IgA antibodies bound only to the epidermal side. The skin lesions responded well to oral dapsone therapy.

Balanitis Circumscripta Plasmacellularis

A 79-year-old man with balanitis circumscripta plasmacellularis(BCP), presenting as an erythematous constricting band of the inner surface of the prepuce encircling the penile shaft is described. The biopsy specimen of the lesion showed, in addition to the typical histologic findings of BCP, increased fibrosis and decreased amount of elastic fibers which correlate well with our clinical observations. Electron microscopic examination revelaed no viral particles or elastic fibers. Immunohistologically, IgG was found to be the major immunoglobulin class in the plasma cellular inf iltrate.

Treatment of uncomplicated male gonococcal urethritis with enoxacin / 대한피부과학회지

No abstract available.

A Case of Squamous Cell Carcinoma and Bowen's Disease Associated with Superficial Disseminated Porokeratosis

We describe the clinical and pathologic observation of a 50-year-old man with superficial disseminated porokeratosis who developed a squamous cell carcinoma on the dorsum of his right thumb and Bowens disease on his right upper arm. The tumors were surrounded by lesions of superficial disseminated porokeratosis and were thought to develop from the dysplastic epidermal cells located under the comoid lamellae.

Treatment of Gonorrhoea

Because of increasing resistance of circulating N. gonorrhoeae and frequent failures in the treatment of gonorrhoea, intensive work on gonorrhoea has become of paramount importance. During January 1980-April 1984, at the Choong-Ku VD Clinic in Seoul, 3,340 male patients with uncomplicated gonococcal urethritis were treated with various treatment regimens. Diagnosis of gonorrhoea and declaration of a treatment failure were made on the basis of positive urethral culture. In 1984, the prevalence of Penicillinase Producing N. gonorrhoeae (PPNG) was about 30%, The pretreatment minimun inhibitory concentration of various antibiotics were quite high. Even for non-PPNG urethritis standard penicillin regimens gave unsatisfactory results. For PPNG urethritis, only spectinomycin, cefoperazone and cefotaxim-probenecid regimens gave satisfactory results. No spectmomycin resistant strain of N. gonorrhoeae has been found since 1982 at the Choong-Ku VD Clinic. As an agent of single drug therapy, spectinomycin seems to be one of the most cost effective drugs in the treatment of uncomplicated gonorrhoea in men.

Epidermolysis Bullosa Acquisita

A 40-year-old woman had a pruritic, vesiculobullous eruption of her face for 6 weeks with no evidence of systemic disease. A biopsy showed subepidermal blisters and dermal infiltrates of neutrophilic inflammatory cells. Direct immunofluorescence demonstrated thick linear deposits of IgG and C3 along the basement membrane zone. The cleavage plane was identified to be just beneath the lamina densa. Using Western immunoblots, the patient's IgG autoantibodies were found to recognize type VII proeollagen. Moderate starting doses of systemic prednisolone gave a good response for this patient with an early inflammatory form of epidermolysis bullosa acquisita.

Clinical Features of Early Lesions in Pemphigus / 대한피부과학회지

Among 13 patients with pemphigus : 8 of pemphigus vulgaris(PV), 4 of pemphigus foliaceus(PF), l of pemphigus erythematosus(PE), we have examined the sites of early lesions and the clinical appearances of the skin lesions. The most common site of the early lesions in PV was the oral mucosa, however, in PF and PE the face was affected first. The clinical appearances of the early lesions were flaccid bullae, erythematous papules and eczematoid patches. Clinicians should be aware of these clinical features of pemphigus for a more precise diagnosis and better management.

Prevalence of PPNG in Seoul , Korea ( 1987 ) / 대한피부과학회지

The prevalence of PPNG among pretreatment isolates at a VD Clinic in Seoul has been studied and reported annually since 1981. In 1987, 649 strains of N. gonorrhoeae were isolated, among which 339(52.2%) were PPNGs. The prevalence of PPNG in Seoul is still increasing.