Evaluation of the Efficacy, Safety, and Treatment-Related Skin Irritation of Adapalene-Benzoyl Peroxide Combination Gel and Adapalene Gel in Acne Patients: A Randomized Comparative Study / 대한피부과학회지

BACKGROUND: While adapalene and benzoyl peroxide have both been demonstrated to be effective for the treatment of acne vulgaris, they can also cause skin irritation, resulting in patient incompliance. In addition, the irritation may be severe when adapalene is co-administered with benzoyl peroxide. OBJECTIVE: The intention of this study was to evaluate the efficacy and safety of adapalene 0.1%-benzoyl peroxide 2.5% fixed-dose combination gel, and adapalene 0.1% gel monotherapy, for the treatment of mild to moderate acne. Any changes in the skin barrier function were also measured. METHODS: A total of 52 patients applied adapalene-benzoyl peroxide gel or adapalene gel once daily. The changes in lesion counts, investigator's global assessment, patient satisfaction, and adverse events were recorded for 6 weeks. The biophysical profiles of the skin, including transepidermal water loss and redness, were measured for 3 weeks. RESULTS: Both agents were effective for the treatment of acne lesions. Adapalene-benzoyl peroxide showed a faster onset of action than adapalene, especially on inflammatory lesions. However, at week 6, both agents showed a similar effect in reducing lesion counts. While most patients in both groups experienced skin irritation from week 1, this gradually reduced. Likewise, the changes in transepidermal water loss and redness showed peak rates at week 1 and 2, but decreased over time. CONCLUSION: Adapalene-benzoyl peroxide gel is effective for the treatment of acne with a safety profile comparable to adapalene gel. The skin irritation experienced may be associated with the changes in skin barrier disruption, which lasts for 1~2 weeks.

Kaposi Sarcoma in a Patient with Chronic Renal Failure Undergoing Dialysis

Kaposi sarcoma (KS) is a multicentric proliferative vascular tumor involving the skin and other organs. Human herpesvirus 8 (HHV-8) has been detected in KS lesions and is considered the putative causative agent of KS. The relationship between chronic renal failure, HHV-8, and KS is not clear. KS appears to develop in association with renal transplantation, but is unlikely with dialysis, and there have been few reports on this. Here, we report the case of a 51-year-old man, who underwent peritoneal dialysis to treat chronic renal failure, and presented with multiple brownish plaques on his soles. On histopathological examination, abnormally proliferated vessels, vascular slits, and spindle-shaped cells were seen in the dermis. Immunohistochemical staining for HHV-8 was positive. This case is another example in which factors other than immunosuppression contributed to the development of KS, due to activation of HHV-8.

Detection of a Novel Missense Mutations in Atrichia with Papular Lesions

BACKGROUND: Atrichia with papular lesions (APL) is a rare inherited disease characterized by early onset of total hair loss, followed by papular lesions over the extensor areas of the body. Recently, mutations in the human hairless (HR) gene have been implicated in its pathogenesis. The identification of mutations in the HR gene is important for differentiating between APL and alopecia universalis (AU). OBJECTIVE: We compared the HR genes of patients with presumed AU who showed minimal or no response to treatment with the HR genes of healthy controls. METHODS: The subjects were 11 patients with presumed AU who had not responded to treatments. Fifty healthy people were included as controls for molecular analysis. To screen for mutations, polymerase chain reaction was performed. RESULTS: DNA analysis identified a novel heterozygous G-to-A transition at nucleotide position 191 in exon 5. The mutation was not found in the controls, other AU patients, or any unaffected family members except for the patients' mother and maternal grandfather, who were heterozygous HR gene carriers. CONCLUSION: Our study identifies a novel missense mutation in exon 5 of the HR gene in a Korean APL patient previously diagnosed as AU.

Acute Localized Exanthematous Pustulosis on the Face

Acute localized exanthematous pustulosis (ALEP) is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 26-year-old woman presented with multiple erythematous pustules on her face, which had appeared three days after taking antibiotics. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules were resolved within 2 weeks after the patient discontinued the antibiotics. Herein, we present a case of a woman with a cutaneous drug reaction consistent with ALEP that occurred subsequent to administration of antibiotics.

Steatocystoma Multiplex Confined to the Scalp with Concurrent Alopecia

Steatocystoma multiplex (SM) is an uncommon disorder of the pilosebaceous unit characterized by the development of numerous sebum-containing dermal cysts which rarely involves the scalp. Here, we report a case of a 50-year-old man with multiple cystic nodules and alopecic patches on his scalp. On histopathological examination, the folded cyst was found to be lined by stratified squamous epithelium, while flattened sebaceous gland cells were identified in the cystic wall. Pigment casts were present in the hair papillae and perifollicular regions, suggesting trichotillomania as a possible cause of the observed alopecia. This case appears to represent an unusual clinical manifestation of SM.

Giant Acquired Digital Fibrokeratoma Occurring on the Left Great Toe

Acquired digital fibrokeratoma is an uncommon, benign fibrous tumor which usually occurs in adults as a solitary lesion. The most frequent locations are fingers and toes and the size of the tumor is generally small, around 3~5 mm. An 18-year-old female presented with a solitary, skin-colored, round and protruded nodule of the left great toe. The size of nodule was 2.5x1.6x1.4 cm. Histopathologic examination revealed typical findings of acquired digital fibrokeratoma. Herein, we report a giant acquired digital fibrokeratoma.

Retronychia, a Proximal In-growth of the Nail Plate / 대한피부과학회지

Retronychia is a process of a nail embedding itself into the proximal nail fold due to an incomplete shedding of the nail, and this usually occurs after physical trauma. Retronychia causes persistent paronychia and defective nail growth on the patients. Simple avulsion of the superimposed nail is curative. A 17-year-old man presented with tender erythema and swelling on the proximal nail fold of the right 3rd and 4th fingers for 2 months after an operation that was performed due to metacarpal bone fracture. The second patient was a 25-year-old male who presented with a 1-month history of persistent paronychia on his right great toe after blunt trauma. For both patients, simple avulsion of the damaged nail was curative and underlying new nails were revealed. We report here on two cases of retronychia that could be easily overlooked and such cases have not been previously reported in the Korean dermatologic literature.

Fibroepithelioma of Pinkus Resembling Seborrheic Keratosis on the Thigh / 대한피부과학회지

Fibroepithelioma of Pinkus (FEP) is an uncommon variant of basal cell carcinoma and this typically appears as single or multiple nodular lesions on the lower back of the elderly. We report here on a case of a 59-year-old woman who presented with an asymptomatic erythematous sessile plaque on the lateral side of her right thigh, and she'd had this lesion for 8 years. Histologic examination showed anastomosing strands of basaloid cells extending from the overlying epidermis into the dermis. The tumor cells with large, oval nuclei and relatively little cytoplasms were grouped in a palisade pattern at the periphery of the tumor mass. The tumor was completely excised with a clear resection margin. The patient showed no recurrence for 10 months. For an elderly patient with a long-standing nodule found anywhere on the body, performing a skin biopsy should be considered to exclude malignancy, including FEP.

A Case of Linear Focal Elastosis with a Family History

Linear focal elastosis is an uncommon disorder typically occurring in the back region, which clinically presents as band-like striae, having a histological focal increase in abnormal elastic fibers. Until now, linear focal elastosis occurring in patients with a family history have been rarely reported. Here, we present one such case, of linear focal elastosis which occurred in a brother and sister.

Effect of Allopurinol on Foreign Body Granuloma / 대한피부과학회지

A 68-year-old woman presented with erythematous indurated plaques on both her eyebrows. The skin lesions appeared 3 months after she was tattooed on both eyebrows. On histopathologic examination, a granulomatous infiltration was observed in the dermis with no evidence of any fungal, mycobacterial organisms. She was treated with intralesional injection of triamcinolon acetonide, but there was no improvement. After she started to take allopurinol for 5 months, the skin lesion improved without side effects. To the best of our knowledge, this is the first case of foreign body granuloma that was successfully treated with allopurinol in the Korean dermatologic literature.

Multiple Annular Tufted Angioma / 대한피부과학회지

Tufted angioma is a rare, slow-growing, benign, vascular tumor that usually occurs in children. It appeared as an erythematous to red-brown, indurated papule on the trunk or neck. Histopathologic examination shows multiple capillary lobules in a cannon ball appearance scattered throughout the dermis. We present here a 32-year-old woman with multiple annular lesions on her right thigh, which started as red papules and they progressed with annular extension and central regression for 3 years. The histopathologic findings were compatible with tufted angioma. The lesions were treated with 3 sessions of sclerotherapy. We report here on an unusual tufted angioma that occurred as multiple lesions which showed annular extension with central regression.

A Case of Eruptive Vellus Hair Cyst Involving the Face, Trunk, and Extremities / 대한피부과학회지

Eruptive vellus hair cyst (EVHC) is a benign epithelial tumor. Clinically, it usually presents as grouped or scattered yellowish to reddish-brown papules. It predominantly appears on the anterior part of the chest and extremities. Facial involvement is uncommon and 4 cases with facial involvement have been reported in the Korean dermatologic literature. However, involvement of the face coexistent with involvement of the trunk and extremities has never been reported in the Korean dermatologic literature. Herein, we report on a 10-year-old girl with multiple asymptomatic papules on her face, back and upper arms. To the best of our knowledge, this is the first report of EVHC that involves not only the face, but also the trunk and extremities in the Korean dermatologic literature.

A Case of Invasive Aspergillosis with Skin Involvement in a Renal Transplant Recipient / 대한피부과학회지

Aspergillosis is the second most common opportunistic fungal infection in immunocompromised patients yet skin involvement very rarely occurs. Herein, we report on a 22-year-old female renal transplant recipient who presented with multiple subcutaneous nodules. The biopsy and the culture of her cutaneous lesions confirm the diagnosis of invasive aspergillosis with skin involvement. Invasive aspergillosis should be included in differential diagnosis of immunocompromised patient with multiple subcutaneous nodules.

A Case of Syphilitic Keratoderma Concurrent with Syphilitic Uveitis

Syphilitic keratoderma is a rare cutaneous manifestation of secondary syphilis, characterized by symmetrical and diffuse hyperkeratosis of the palms and soles. In addition, no cases of syphilitic keratoderma and uveitis have been reported in the dermatologic literature. A 69-year-old woman presented with steroid-resistant hyperkeratotic patches on the palms and soles and uveitis for 4 months. As steroid-resistant uveitis must be evaluated for syphilis, viral infections, and autoimmune diseases, we ran several laboratory tests and the serologic test for VDRL was reactive (titer; 1:128). After treatment with penicillin G (4 MU, IV every 4 hours for 2 weeks), her skin lesions and visual disturbance were completely resolved. Therefore she was diagnosed as having syphilitic keratoderma and uveitis. Here, we report a rare case of syphilitic keratoderma concurrent with syphilitic uveitis and suggest that evaluation for syphilis may be required when skin lesions and ocular disturbance are resistant to long-term steroid therapy.

Pruritic Urticarial Papules and Plaques of Pregnancy: Clinical Experience with 22 Patients / 대한피부과학회지

BACKGROUND: Pruritic urticarial papules and plaques of pregnancy is a common benign dermatosis of pregnancy. It occurs mainly in primigravidas in the third trimester, it resolves spontaneously or with delivery, and it is usually responsive to topical treatment. The morphological spectrum of pruritic urticarial papules and plaques of pregnancy includes (1) urticarial papules and plaque (type I), (2) non-urticarial erythematous patches that are discrete or confluent and they are surrounded by tiny papules or vesicles, or clusters or sheets of 1-mm to 2-mm erythematous papules (type II) and (3) a combination of these features (type III). OBJECTIVE: This study evaluated our clinical experience with 22 Korean patients with pruritic urticarial papules and plaques of pregnancy. METHODS: From June 1997 to August 2008, 22 patients with pruritic urticarial papules and plaques of pregnancy were evaluated. The clinical manifestations, the lesion distribution and the obstetric and pediatric findings were retrospectively investigated with using the patients' medical records and clinical photographs. RESULTS: There were 9, 11 and 2 patients with types I to III, respectively. Many patients (n=14) were primigravida and the mean time of onset was a gestational age of 29.8 weeks. There were no pediatric problems such as intra-uterine growth retardation, or a small or large size for the gestational age.Most of the patients (n=20) were treated with topical corticosteroid or antihistamine; there was one case of recurrent pruritic urticarial papules and plaques of pregnancy. CONCLUSION: Pruritic urticarial papules and plaques of pregnancy usually occur in primigravidas, but this can also occur in multigravida patients. The number of patients with pruritic urticarial papules and plaques of pregnancy and who had obstetric obesity, a multiple pregnancy or pregnancy-induced hypertension was fewer than we expected. Pruritic urticarial papules and plaques of pregnancy can be divided into three categories, although this is rather redundant because the disease prognosis and treatments are not different according to the type.

A Case of Unilateral Ashy Dermatosis

Ashy dermatosis, also known as erythema dyschromicum perstans, is a peculiar, slowly progressive, idiopathic dermal melanosis. In most cases, slate gray- to lead-colored patches are symmetrically distributed over the body. Ashy dermatosis with a unilateral distribution is rare. We report a case of unilateral ashy dermatosis in a 27-year-old Korean man.

A Case of Benign Symmetric Lipomatosis Limited to the Face / 대한피부과학회지

Benign symmetric lipomatosis is a very rare disease that's characterized by a symmetric accumulation of excessive amounts of adipocytes. The lesions are located mainly on the neck, trunk and proximal extremities. Although its etiology is unknown, it has been described to be associated with a heavy alcohol intake. A 51-year-old woman presented with a two year history of ill-defined soft masses on both mandibular areas. We made the diagnosis of benign symmetric lipomatosis according to the histopathologic examination. As a difference from other reports of benign symmetric lipomatosis, our patient was non-drinker for her past history. We present here a case of benign symmetric lipomatosis at an unusual predilection site and this developed in a non-drinker.

A Case of Solitary Neurofibroma Resembling a Hemangioma / 대한피부과학회지

Solitary neurofibroma is a benign soft tissue tumor. Clinically, it appeared protuberant to pedunculated, flesh-colored, soft papules or nodules. Although it can appear on any site of the body, finger involvement is rare. Herein, we report the case of a 57-year-old woman with a solitary neurofibroma of the right 4th finger which looked like hemangioma.

A Case of Solitary Neurofibroma Resembling a Hemangioma / 대한피부과학회지

Solitary neurofibroma is a benign soft tissue tumor. Clinically, it appeared protuberant to pedunculated, flesh-colored, soft papules or nodules. Although it can appear on any site of the body, finger involvement is rare. Herein, we report the case of a 57-year-old woman with a solitary neurofibroma of the right 4th finger which looked like hemangioma.

A Case of Superior Mesenteric Artery Syndrome Treated by Laparoscopic Surgery / 대한소화기내시경학회지

Superior mesenteric artery (SMA) syndrome is a symptom complex resulting from compression of third portion of duodenum by the root of the small bowel mesentery at the level of the SMA. This syndrome can occur as an acute illness but more commonly it appears as chronic condition. Identification of this syndrome can be a diagnostic dilemma and it is frequently made by exclusion. In our patient, rapid weight loss, nausea and bile stained vomiting were present. Ultrasound and MR-angiography were performed for measuring the angle and the distance between the SMA and the aorta. We confirmed the diagnosis via the reduced aorto-mesenteric angle and distance and the patient was then treated by laparoscopic surgery. After lysis of the ligament of Treitz, the patient's symptom were improved. This syndrome must be considered as one of the causes of upper gastrointestinal obstruction.