A Case of Tufted Angioma Showing a Good Response to Interferon-alpha / 대한피부과학회지

A 13-month-old boy had irregularly shaped, erythematous to dusky red, slightly raised patches and plaques on the left antecubital fossa and arm for 7 months. The lesions were firm and tender. Histopathologically the lesion consisted of small, circumscribed, angiomatous tufts and lobules with a cannonball appearance scattered throughout dermis, a characteristic feature of tufted angioma. For 15 weeks, interferon-a intralesional injections have been performed and the lesions showed an improvement.

Three Cases of Lichen Striatus with Onychodystrophy / 대한피부과학회지

Lichen striatus is an uncommon unilateral inflammatory linear papular dermatosis of uncertain etiology. It most commonly affects the extremities and has a self-limiting course. Nail involvement in lichen striatus is a very rare reported finding and is a cause of a deformity of the nail plate. It tends to have a more prolonged course for cutaneous eruptions than disease limited only to the skin. Characteristic histopathological features are important to differentiate this condition from other linear lesions that may interfere with nail growth. Three cases of lichen striatus with onychodystrophy are presented herein.

Classification of Vitiligo Based on its Clinical types / 대한피부과학회지

BACKGROUND: Vitiligo is a distressing skin condition in which acquired destruction of melanocytes causes depigmented patches of various shapes & sizes by as yet unclear mechanisms. Its classification is as varied and unresolved as the theories on its pathogenesis, the most plausible of which are autoimmune, neurohumoral and self-destruction theories. OBJECTIVE: Our purpose was to devise a classification scheme which would correlate well with the disease course and prognosis. METHOD: We classified vitiligo into 3 types(symmetric: type 1, segmental; type 2, localized; type 3) based on different proposed pathogenetic mechanisms and analyzed the differences between these types in the clinical manifestations of 502 Korean cases. RESULTS: 1. There were 203 males(40.4% ) and 299 females(59.6%). 2. The most frequent clinical type was the symmetric type(49.8%), followed by the localized type(34.1%) and the segmental type(16.1%). 3, The male-to-female ratio was highest in type 2, but not significantly so. 4. Poliosis and halo nevus were associated in 22.3% and 3.8%, respectiuely. 5. The mean age at the first visit was 32.7 years(male, 29.2 years, female; 27.5 years), and there was a significant difference between the clinical types(type 1; 41.0 years, type 2; 20.5 years, type 3; 26.2 years). 6. The mean age of onset was 25.6 years(male; 23.0 years, female; 27.5 years), and there was a significant difference between the clinical types(type 1; 31.3 years, type 2; 15.7 years, type 3; 22.1 years). 7. A family history of vitiligo was observed in 11.2% of patients, whose sisters were most frequently affected, and there was no significant difference between the clinical types. 8. Associated diseases were seen in 12.1% of the patients, the frequency of which was significantly higher in type 1 vitiligo. 9. Abnormal laboratory findings were found in 14.7% and were significantly more common in type 1 vitiligo. CONCLUSIONS: The 3 types differ significantly in the mean age at the first visit, the mean age of onset, disease association and abnormal laboratory findings. Type 1 develops by autoimmune mechanisms, as shown by the continuous progression and the close association with other diseases and abnormal laboratory findings, Types 2 and 3 have a different disease course, becoming stationary after initial progression, Thus, the 3 clinical types classified by the authors are thought to be useful in predicting the course and prognosis of vitiligo and in determining the appropriate therapy. For a more optimal classification, further study on the pathogenesis of vitiligo seems to be in order.

A Clinical Study of PUVA-Induced Complication in Vitiligo Patients / 대한피부과학회지

BACKGROUND: Oral of topical psoralen photochemotherapy is the most popular arid efficacious treatment, available for repigmentation of vitiliginous patches. However this therapy is often used for prolonged periods and various types of pigmentary changes can be observed and sometimes, may be carcinogenic. The safety of PUVA therapy has been an issue of debate. OBJECTIVE: The purpose of the study was to describe in more detail the complications of PUVA treatment and to investigate a possible relation with multiple factors. PATIENTS AND METHOD: We studied 137 vitiligo patients who received PUVA therapy(using oral 8-MOP) for more than six months in our department between March 1990 and June 1996. RESULT: The results are summarized as follows 1. Among 137 cases of vitiligo, the numbers of male and female patients were 40(29.2%) and 97(70.8%) respectively. The mean age at the start of PUVA was 39 years and the mean duration of treatment was 31 months. There were no patients with skin type I and II. Forty cases had skin type III, 68 skin type IV, 29 skin type V. 2. Acute side effects were nausea(35.8%), pruritus(32:8% ), erythema(30.7%), headache(21.2 %), dizziness(18.8%), burning sensation(16.8%), fatigue(8.8%) and the Koebner phenomenon(1.5 %). These are all reversible and disappear on discontinuation of treatment. 3. PUVA-induced pigmentary changes were PUVA lentigines(39 cases;26.3%), hypopigmented confetti macules(36 cased;26.3%), mottling(31 cases,22.6%), nail pigmentation(8 cases,5.8%) and PUVA keratosis(7cases;5.1%) 4. The mean cumulative UVA dose was 1833J/cm and the mean number of treatments was 171. In the high-dose group and the patients who had the most number of treatments, we observed an increased number of patients with PUVA lentigiens and mottling. However, no relationship was observed between the development of PUVA-induced pigmentary changes and sex or age at the start, of PUVA or in relation to skin type. 5. We did not see any patients with melanoma, nonmelanoma skin cancer or systemic cancer. CONCLUSION: Long term exposure to PUVA significantly increases chronic clinical side effects of PUVA. Therefore carefuI clinical follow-up of patients who receive long term PUVA therapy in necessary. This risk shoud be considered in selection of treatment.

The Transmittance of UVA and UVB on Human Epidermis / 대한피부과학회지

BACKGROUND: Ultraviolet light induces sunburn, ageing of the skin, pigmentation and even promotes skin cancers. As there has been a recent decrease in the ozone layer surrounding the earth, increasing attention has been given to the effects of ultraviolet light on the skin. Through human epidermis, ultraviolet light is reflected, scattered, absorbed or transmitted. In caucacians, the rate of transmitted ultraviolet light A from the epidermis to the dermis is 50% and the rate of transmitted ultraviolet light B is below 10%. OBJECTIVE: The purpose of this study was to evaluate the transmittance of UVA and UVB on Korean normal epidermis. METHODS: Pure epidermis was obtained from normal human epidermis by suction of blisters in 12 patients with vitiligo. All specimens were irradiated respectively with UVA and UVB and the amount of transmitted energy was measured. RESULTS: 1. The transmittance of UVA energy density by normal epidermis was 47.7+11.2% of irradiated UVA energy. 2. The transmittance of UVB energy density by normal epidermis was 32.4+3.4% of irradiated UVB energy. CONCLUSION: UVA energy transmission through normal epidermis of Korean is less than those of Caucacians but UVB energy transmission through nor mal epidermis of Korean is more than those of Caucacians. It is suggested that this could be an important basic data to study for photoaging and photoprotection in Korean population.

A Case of Bullous Systemic Lupus Erythematosus Presenting as Bullous Eruption / 대한피부과학회지

We describe a 19-year-old girl showing typical laboratory and clinical features of bullous systemic lupus erythematosus(BSLE). Clinically she has suffered from recurrent vesiculobullous skin eruptions for 7 years. The bullous eruption has not been known as the initial manifestation of SLE until she was diagnosed as SLE. These cutaneous lesions have waxed and waned with oral prednisolone with or without dapsone. Bullous SLE should be considered in the differential diagnosis of children presenting with generalized bullous eruptions.

Maximal Tension of Human Epidermis Prepared from Suction Blisters

BACKGROUND: Epidermis is directly exposed to various external stimuli and protects internal structures. Most studies about skin tension focused on the dermis, and epidermal tension has not been able to attract interest because dermis much thicker than epidermis and dermal collagen fibers play a predominant role in the skin tension. However, circumstances which involve only the epidermis are often shown, and thus it is necessary to study the mechanical property of the epidermis. OBJECTIVE: The purpose of this study is to quantify the role of the epidermis as a mechanical barrier. METHODS: Human epidermal sheets were obtained from suction blisters in 14 patients with vitiligo during epidermal grafting. Maximal tension, that is the power required to break the epidermal sheets, was measured by tensiometer. RESULTS: The maximal tension of the epidermis ranged from 40.0 g/cm² to 84.5g/cm² with a mean values of 56.1g/cm² and did not differ significantly according to the age or anatomical sites. CONCLUSION: The barrier function of epidermis is important and the results are expected to be used as the basic information for other studies about the mechanical property of the epidermis. In addition, this will be important data in developing an artificial skin whose mechanical property is similar to that of the human skin.

Autologous Epidermal Graft Using Suction Blister in Leg Ulcers

Regardless of the any cause leg ulcers are painful and inconvenient to patients and present clinical and economic problems due to their chronicity. Conventional skin grafts, cultured allogenic epidermis, and cultured autologous epidermis have been used for the treatment of leg ulcers. In a twenty-year-old woman with leg ulcers, autologous pure epidermal sheets were obtained from the lower chest by means of suction blisters and grafted to the leg ulcers. All lesions were healed completely in 20 days after grafting. The donor sites showed slight postinflammatory hyperpigmentations without scars. The autologous epidermal graft using suction blisters appears to be a useful method for the treatment of leg ulcers, with no immunologic rejection, no need for cultivation and anesthesia, no desiccation, and no scars on the donor sites.

UVA Blocking Effect of Epidermal Melanin in Patients with Vitiligo

BACKGROUND: Ultraviolet light induces sunburn, aging of the skin, disorders of pigment and even promotes skin cancers. Melanin is known to have a protecting role in the skin by blocking ultraviolet light. OBJECTIVE: The purpose of this study was to evaluate UVA blocking effect of epidermal melanin and to compare UVA blocking effect among different anatomical sites. METHODS: From 20 vitiligo patients who had undergone an epidermal graft, we obtained epidermis of normal and vitiliginous skin and measured transmitted UVA energy density. RESULTS: The vitiliginous epidermis, devoid of melanin, blocked lower amount of UVA energy than the normal epidermis. 11.6% of irradiated UVA energy was blocked by epidermal melanin. No significant differences were observed in UVA blocking effect among different anatomical sites in normal and vitiliginous epidermis. CONCLUSION: Epidermal melanin has some UVA blocking effect. No significant differences were found in UVA blocking effect among different anatomical sites despite the differences in the density of melanin pigment among different sites of the body.

Two Cases of Primary Cutaneous Cryptococcosis / 대한피부과학회지

We report two cases of primary cutaneous cryptococcosis that is a very rare disease. One patient was a 45 year-old female, who had had an erythematous hard nodule on dorsum of right wrist for ten months, The other patient was a 53-year-old male, who had had itching and burning erythematous rashes on left auricle for ten months. Histopathologic examination showed typical spores with capsules, Other physical examination and laboratory findings were within nomal limit. Our patients were successfully treated with excision and combination of amphotericin B and 5-fluoro-cytosine.

A Case of Friction Melanosis / 대한피부과학회지

Friction melanosis is frequently developed in thin, young woman, on thc covered skin of spinc, rib, elbow, knee and tibia. These lesions range from brown to rcddish-brown in color, appear in either band shapes or reticular patterns, and exhibit no overt syrnptoms. They do not show any inflamatory changes, and the skin remains smooth. According to histopathological findings, the main changcs arc perivascular melanophages on the papillary derrnis and upper dermis, and also increased melanin granules on the basal layer. The following case concern a relatively thin 20-year-o1d female patient. She had a syrwptoniless brown color changcs above the ribs of back, growing in dircction of the ribs for a period of three years. This change was band shaped, but there were no signs of inflammatory reaction, leaving the skin smooth. A biopsy was performed on the relevant tissue, and clinical-histopathological analysis was resulting in diagnosis of friction melanosis.

A Case of Multiple Trichoepithelioma / 대한피부과학회지

A 33-year-old man had multiple, dome shaped, pin-head sized, hard papules on the center of face and pigeon's egg sized hard tumors on the left upper arm and the trunk. The histopathological findings of the skin biopsy specimens from face and left upper arm showed tumor islands composed of basophilic cells of the same sppearance as basalioma cells, arranged in a lacelike and solid aggregates, without horn cysts.