The Long Term Efficacy and Relapse Rate of Itraconazole Pulse Therapy Versus Terbinafine Continuous Therapy for Toenail Onychomycosis: a 96-week follow-up study / 대한의진균학회지

No abstract available.

A Case of Pyoderma Gangrenosum Treated with Topical Tacrolimus and Oral Cyclosporin / 대한피부과학회지

Pyoderma gangrenosum is a chronic inflammatory skin disease, characterized by the recurring destructive and painful skin ulcers. Although the mainstay of therapy is the systemic administration of high doses of corticosteroids, many other treatment modalities have been widely used. Recently, there have been several reports of the successful treatment of pyoderma gangrenosum using topical tacrolimus. We report a successful treatment of pyoderma gangrenosum with combination therapy of topical tacrolimus and systemic cyclosporin.

Study of The Ideal Method in Cryotherapy of Wart / 대한피부과학회지

BACKGROUND: Cryotherapy of warts with liquid nitrogen is the most widely used method of treatment by dermatologist , but little is known about its ideal method. OBJECTIVE: This study is to investigate the ideal methods in cryotherapy of warts. METHODS: 127 cases of viral warts were studied. These warts consisted of three groups of verruca vulgaris, palmoplantar wart, and periungual wart. 104 cases were treated with a Cry-Ac(R) spray, 23 cases with a cotton wool bud. Using either technique, liquid nitrogen was applied until ice-ball formation had spread from the center to include a margin of 2-4 mm around each wart. Treatment was done at 2-week or 3-weekly intervals and with two to six freeze thaw cycles. The endpoint of the study was complete clearance of all warts. RESULT: Each cure rate for treatment interval is 70.0% for 2-weekly treatment, and 71.6% for 3-weekly treatment. The rate of pain and blister with a shorter interval is higher. Each cure rate for freeze thaw cycles is 73.7% for 2 cycles, 70.4% for over 3 cycles. The morbidity for blister is higher in over 3 cycles than 2 cycles. Cure rates were 70.2% in the spray and 73.9% in the cotton wool bud. CONCLUSION: This study shows no significant benefit of the trial beyond 2 freeze-thaw cycles. We suggest that 3-weekly treatment is the optimal treatment and cryotherapy is equally effective when treated with a spray or a cotton wool bud.

Surgical Treatment of Subungual Glomus Tumor / 대한피부과학회지

BACKGROUND: Glomus tumor is a small encapsulated tumor that is derived from the subcutaneous glomus body. Treatment of subungual glomus tumor is the complete removal of the tumor. However, the surgical method is not familiar to us. OBJECTIVE: The aim of this study is to introduce surgical treatment results of subungual glumus tumor in dermatologic surgery clinic of Seoul National University Hospital and Seoul City Boramae Hospital from 1995 to 2002. METHOD: We reviewed the medical records and checked clinical aspects, surgical methods and results. RESULTS: All patients, 10, were female. Pain was elicited by contact in 80% and occurred spontaneously in 60%. Temperature hypersensitivity occurred in 50%. 90% of tumors were located in fingers. 70% of tumors revealed just blue or erythermatous discoloration of nail plate. Nail deformity was found in 30%. Post-operative mild distal nail splitting had developed in 2 cases. In 8 cases nails showed normal growth. Nobody complained of a recurrence of pain. CONCLUSION: Careful dissection and complete removal of the tumor almost offered permanent relief and it is thought that appropriate education of surgical skills should be needed and offered.

Molecular Biological Approaches to the Study of Dermatophytes / 대한의진균학회지

Dermatophytes are keratinophilic fungi responsible for superficial infections called dermatophytoses and composed of three anamorphic genera, Trichophyton, Microsporum and Epidermophyton. The identification of these species by mycological methods is sometimes difficult and time-consuming. Moreover, suitable methods for subtyping of these species are not established yet. Therefore, several approaches using molecular biological methods have been proposed to identify dermatophyte species and to clearly define their taxonomic and phylogenetic relationship to the teleomorphs and to other dermatophyte species. For identification, distinction among isolates to the species level was easily performed using molecular biological methods, particularly for atypical isolates. In contrast, in all but a few cases, distinction between dermatophyte strains failed. The development of new techniques to reveal molecular polymorphisms in dermatophytes is required.

Antifungal Susceptibility Testing in Three-dimensional Keratinocyte Culture Model / 대한피부과학회지

BACKGROUND: Standardization of antifungal susceptibility testing for dermatophytes is important and several variables, such as inoculum size, length and temperature of incubation, media, and end point determination has recently been established. However, a more improved test model which can evaluate bioavailability and has clinical relevance is still needed. OBJECTIVE: We performed antifungal susceptibility testing by using three-dimensional keratinoctyte culture model, living skin equivalent (LSE), as an in vitro model. METHODS: LSE was prepared and various concentrations of antifungals were added to media. Microconidia of Trichophyton mentagrophytes was inoculated onto LSE and incubated for 6 days at 35 degrees C. RESULTS: Inhibition of fungal proliferation and invasion were observed at 0.1microgram/ml of terbinafine, 0.01 microgram/ml of itraconazole solution, 0.1 microgramg/ml of itraconazole powder, and 10 microgram/ml of fluconazole, respectively. CONCLUSION: Our culture model is similar to in vivo situation and the results were relatively well accordant to those of other previous studies. Our LSE model is considered as a promising in vitro system for evaluating the activity and safety of antifungal agents. However, further study using more various species of dermatophytes and more strains is still needed.

Identification of Dermatophytes by Mycological Tests and Random Amplified Polymorphic DNA analysis / 대한피부과학회지

BACKGROUND: Dermatophytes are usually identified based on their characteristic morphologies and physiological tests. However, identification is often delayed and problematic for atypical isolates. Recently, random amplified polymorphic DNA(RAPD) analysis was successfully performed for the identification of dermatophyes. OBJECTIVE: This study was performed to identify clinical isolates which could not be identified previously. The causes of unidentification were analysed and the merits and demerits of RAPD analysis were evaluated. METHODS: Thirty-six clinical isolates and 14 standard strains were included in this study. Seven mycological studies were performed and RAPD analysis was done by using primer OPAO-15 (5'-GAAGGCTCCC-3'). RESULTS: Based on the results of 7 mycological tests, 28 strains were confirmed as follows: 24, T. rubrum; 2, T. mentagrophytes; 2, T. raubitschekii. Four were considered as atypical strains of T. rubrum, and another 4 as non-dermatophytic moulds. This results were confirmed by RAPD analysis. CONCLUSION: RAPD analysis was useful for the identification of dermatophytes, especially the atypical strains. However, non-dermatophytic mould could not be identified by RAPD analysis. RAPD analysis was considered as a supplementary method to the conventional mycological studies for the identification of dermatophytes.

Nucleotide Sequence of Internal Transcribed Spacer 1 of Trichophyton mentagrophytes Isolated from Human and Animals / 대한피부과학회지

BACKGROUND: Trichophyton mentagrophytes is a complex species and 3 perfect states, Arthroderma benhamiae, A. vanbreuseghemii, and A. simii have been described. In Korea and Japan, all of the isolates of T. mentagrophytes of which the perfect states determined were known as A. vanbreuseghemii till recently. However, in Japan, one isolate from a monkey was reported as A. simii and several strains from rabbits or patients were A. benhamiae. Therefore, it is necessary to confirm the existence of A. simii or A. benhamiae in Korea. OBJECTIVES: We performed this study to determine the teleomorphs of 19 strains of T. mentagrophytes isolated from Korean patients infected from pets and 4 from the skin lesions of rabbits. METHODS: DNA sequences of internal transcribed spacer 1 (ITS1) area of the 23 isolates and 3 reference strains were determined and matched with the data registered in GenBank nucleotide sequence database. RESULTS: The sequencing data of 22 isolates were very similar to those of A. vanbreuseghemii and 1 to T. mentagrophytes var. interdigitale respectively. CONCLUSION: Although all of the clinical isolates were related with A. vanbreuseghemii in this study, the possibility of the existence of A. simii and A. benhamiae in Korea is still high and further study is needed.

A Case of Phthiriasis Occurring on the Scalp of a Child / 대한피부과학회지

Phthiriasis is a sexually transmitted disease by Phthirus pubis(pubic or crab louse) and usually affect the pubis in adult. Infestation of the eyelashes and scalp occurs rarely and mainly in children. In children, infestation may be transmitted by close contact with infected family, infected towel or other materials, or rarely by sexual abuse. So, careful examination is needed to find out familial source. We report a case of phthiriasis occuring on the scalp of a 16 month-old child whose mother has phthiriasis on the pubis and both axilla.

Identification and Subtyping of Trichophyton rubrum by Molecular Biological Methods / 대한의진균학회지

BACKGROUND: Trichophyton rubrum is one of the major pathogens causing dermatophytoses on human. The identification of this species by mycological methods are sometimes difficult and time-consuming. Moreover, suitable methods for subtyping of this species are not established yet. OBJECTIVE: This study was performed to identify and subtype T. rubrum by molecular biological methods. METHODS: Total 65 clinical isolates of T. rubrum were included and classified according to the results of 8 mycological tests. Their identification were done by random amplified polymorphic DNA (RAPD) analysis. Subtyping of this species was performed by analyzing the DNA band patterns produced by amplifying the non-transcribed spacer (NTS) area of ribosomal DNA. RESULTS: The 65 strains of T. rubrum could be classified into 5 phenotypic varieties according to the results of mycological tests. All clinical isolates produced identical band pattern with those of standard strains of T. rubrum by RAPD analysis. Amplification of NTS area produced 13 PCR patterns. CONCLUSION: The confirmative identification of T. rubrum could be done by RAPD analysis regardless of their phenotypic variations. Subtyping of T. rubrum was successfully performed by amplifying NTS area but these PCR patterns were not correlated with their phenotypic characteristics.

Effect of Glycolic Acid on Collagen Gene Expression in Cultured Human Skin Fibroblasts

BACKGROUND: Glycolic acid is currently reported to have beneficial effects on the photoaged skin. These effects may be through the modulatory action of glycolic acid in the production of dermal extracellular matrix proteins of fibroblast. OBJECTIVE: The aim of this study was to investigate the specific effect of glycolic acid on the collagen and elastic fiber gene expression in vitro. METHODS: Human skin fibroblasts were cultured from normal skins of excised specimens and glycolic acid (75 µg/ml) was treated. After 24 hours of treatment, six each cell lines were processed for extraction of RNA and subjected to Northern analysis. RESULTS: Type I collagen mRNA expression was significantly increased in the glycolic acid-treated fibroblasts. Elastin mRNA expression did not show any significant change. CONCLUSION: These results suggested that glycolic acid induced the increase of type I collagen mRNA expression and had the specific biologic effect on fibroblast.

Four Cases of Cutaneous Fistula of Dental Origin / 대한피부과학회지

Cutaneous fistula of dental origin is the most common type of cutaneous fistula that is formed on the face and neck. This lesion can be a diagnostic challenge to clinicians who are not familiar with cutaneous fistula since many patients with cutaneous fistula of dental origin do not have any complaints such as toothache. Diagnostic errors may result in multiple excisions, biopsies, and ineffective long-term antibiotic therapy. However, if the lesion could be suspected of being of dental origin, the diagnosis can be easily confirmed by radiologic examinations. We report four cases of cutaneous fistula of dental origin. All four patients had a characteristic cutaneous findings with chronically draining, fixed, erythematous papule on their nasolabial fold or submental region. Ultrasonography, fistulography or plain roentgenography were needed to confirm the diagnosis of cutaneous fistula originating from dental problems.

Two Cases of Acral Lentiginous Melanoma in situ Presenting a Melanonychia / 대한피부과학회지

Black or brown pigmentation of the nail plate commonly results from melanin produced by melanocytes in the matrix secondary to inflammatory dermatoses or systemic medications. It can also be caused by a benign pigmented nevus in the matrix or malignant melanoma. We report two cases showing black discoloration of the finger nail which were histologically found to be acral lentiginous melanoma in situ. It follows that melanoma, when the cells are separated from the dermis by a basement membrane zone, will have a good prognosis. Total resection for the lesion, including the nail matrix and nail bed with a free margin of 0.5 to 1.0cm, may be adequate.

Prevalence of Tinea Pedis in Korean Soldiers in a Battalion / 대한피부과학회지

BACKGROUND: It has been widely accepted that the prevalence of tinea pedis in soldiers may be higher due to their occlusive army boots and communal baths. OBJECTIVE: Our study was designed to investigate the prevalence of tinea pedis in Korean soldiers monthly throughout the year by the ranks of the soldiers and also to verify whether tinea pedis is one of the occupational diseases in Korean soldiers. METHODS: We examined the feet of soldiers in a battalion monthly throughout the year. On those with suspected skin lesions, microscopic examinations along with fungus cultures were performed in July, 1996. RESULTS: Average prevalence of tinea pedis throughout the year was 51.5% on clinical examination. The highest prevalence was 74.0% in August and the lowest in February by 36.7% . The prevalence of tinea pedis by rank was 38.3%(18/47) in the new private group, 61.7%(29/47) in the private group, 84.8%(67/79) in the private 1st class group, 72.4%(55/76) in the corporal group and 70.9%(39/55) in the sergeant group in July, 1996. Dermatophytes were demonstrated microscopically in 59.1%(123/208) of the specimens examined. Cultures were positive in 93 cases, i.e., from 44.7% of those examined. CONCLUSION: The major factor contributing to the highest prevalence of tinea pedis in August among the months of the year seems to be the hot and damp weather conditions(especially in July and August). Considering the fact that the prevalence of tinea pedis in winter season was also higher by 36.7-40.2%, Korean soldiers seem to possess higher risk of tinea pedis due to their tight-fitting army boots. The spread of infection among non-infected soldiers might have resulted from the communal bath and Korean traditional habit of taking-off their shoes in a large dormitory where they sleep together. Moreover, the fact that the prevalence of tinea pedis increases markedly with their ranks suggests that tinea pedis should be considered as an occupational disease among Korean soldiers.

Kerion Celsi Caused by Trichophyton verrucosum: A Report of Two Cases / 대한의진균학회지

In Korea, kerion celsi caused by Trichophyton(T.) verrucosum was first reported in the Honam area in 1986. Since then, more cases have been reported in the Youngnam and Chungcheong areas but there has been no report in Seoul and Kyonggido until now. Recently, two patients with kerion celsi visited Seoul National University Hospital and T. verrucosum was isolated from the scalp lesions of these patients. Case 1 was 52 year-old female living in Kapyoung, Kyonggido and she showed 10x10 cm and 5x3 cm sized, indurated alopecic masses on the scalp which were developed 2 months ago. Case 2 was a 50 year-old female living in Youngju, Kyongsangbukdo and a 10x7 cm sized, purulent alopecic plaque was developed on the scalp 1 month ago. They were farmers raising cows with gray or whitish plaques on their skins. These patients were successfully treated with terbinafine 250 mg per for 7 weeks and 8 weeds, respectively. We report these cases to call more attention to detect this species even in urban areas such as in Seoul. Therapeutic effect of terbinafine on kerion celsi has not been reported in Korea so far and our cases demonstrated the excellent therapeutic effect of terbinafine on kerion celsi cause by T.verrucosum.

Reconstruction of the Defect with Dermal Graft After the Removal of Subungual Squamous Cell Carcinoma / 대한피부과학회지

Squamous cell carcinoma of the nail bed is a low grade, slowly progressive, malignant neoplasm. A 66-year-old man had nail lesion on his right thumbnail for two years. After partial nail avulsion, an incisional biopsy was done. The histologic diagnosis was a squamous cell carcinoma. A radiological examination of digit was normal and no lymphadenopathy was palpable. The lesion was totally excised and surgical defect of nail bed was reconstructed by dermal graft. There was no recurrence of tumor till one year after surgery and out-look of nail recovered almost normal. When the underlying malignancy is suspected, it is necessary to examine the nail bed after partial nail avulsion. And application of dermal graft may be useful procedure for regeneration of nail plate when there is a large nail bed defect after excision.

Reconstruction of the Defect with Dermal Graft After the Removal of Subungual Squamous Cell Carcinoma / 대한피부과학회지

Squamous cell carcinoma of the nail bed is a low grade, slowly progressive, malignant neoplasm. A 66-year-old man had nail lesion on his right thumbnail for two years. After partial nail avulsion, an incisional biopsy was done. The histologic diagnosis was a squamous cell carcinoma. A radiological examination of digit was normal and no lymphadenopathy was palpable. The lesion was totally excised and surgical defect of nail bed was reconstructed by dermal graft. There was no recurrence of tumor till one year after surgery and out-look of nail recovered almost normal. When the underlying malignancy is suspected, it is necessary to examine the nail bed after partial nail avulsion. And application of dermal graft may be useful procedure for regeneration of nail plate when there is a large nail bed defect after excision.

Three Cases of Nail Matrix Nevus in Children / 대한피부과학회지

Melanonychia is a pigmented nail plate. It can be produced by so many agents and diseases that it is often impossible to differentiate from one another by history and clinical examination alone. So, a nail biopsy is often required especially to exclude subungual melanoma. Herein, we reported 3 children with melanonychia. Junctional nevus in nail matrix was the cause of their melanonychia, although their lesions were suggestive of subungual melanoma by showing Hutchinson's sign, discoloration of total nail plate and destruction of nail plate, respectively. Considering the rarity of subungual melanoma in childhood and the higher risk of permanent nail deformity after nail matrix biopsy in young children, regular observation is recommended even if the melanonychia mimic subungual melanoma clinically.

Clinical Features and Classification of Nail Diseases / 대한피부과학회지

BACKGROUND: Nail diseases are frequently encountered disorders to dermatologists comprising approximately 10% of entire dermatologic conditions. Despite tremendous development in dermatology, there are still difficulties in making a proper diagnosis of nail diseases. Furthermore, no methods have proven to be satisfactory in classifying nail diseases up to now. OBJECTIVE: The aim of this study was to clarify and classify the clinical characteristics of patients with nail diseases who visited 'Nail disease clinic' in Seoul National University Hospital, and in Seoul City Boramae Hospital from July, 1996 to December, 1998. MATERIALS AND METHODS: Retrospective analysis was undertaken by reviewing the clinical records, photographs and results of mycological and histopathological studies. Patients were classified according to the cause of their nail diseases or to the main physical signs of nail apparatus. RESULTS: The total number of patients was 255(male 95, female 160). Specific cause of nail diseases was found in 135 patients(52.9%). The remaining 120 patients were classified according to the main physical signs such as trachyonychia, onycholysis, chronic paronychia and so on. CONCLUSION: Major disease groups classified according to their physical signs had its own characteristics besides age and sex distribution. So when the cause of nail disease can not be determined, classifying these nail diseases by physical signs could be useful in treating and managing these patients appropriately.

A Case of Plexiform Schwannoma / 대한피부과학회지

Plexiform schwannoma is a rare variant of shwannoma, originating from the nerve sheath. It is very impoirtant to differentiate plexiform schwannoma from plexiform neurofibroma, which is pathognomonic of von Reckilnghausen's disease and carries a significant risk of malignant transformation. Plexiform schwannoma is not necessarily associated with von Reckilnghausen's disease and malignant transformation has never been observed. We present a 11-year-old boy who had a nodole on right forearm with tenderness and a tingling sensation. On the histopathological and immunohistochemical examinations, the lesion showed typical features of plexiform schwannoma, The nodule was totally excised under local anesthcsia. Recurrence has not been observed in the six months follow-up period.