Multiple Spider Angiomas as a Predictive Diagnostic Marker of Alcoholic Liver Cirrhosis / 대한피부과학회지

Spider angioma (SA) may present as solitary or multiple lesions. Studies have shown that approximately 60% of pregnant women and 38% of healthy children have at least one spider telangiectasia. Hence, solitary SA in an otherwise healthy individual does not warrant further workup. However, multiple spider angiomas (MSAs) are usually suggestive of an underlying systemic disease. Physical examination for MSAs has been reported as the most reliable method to diagnose alcoholic liver cirrhosis; the presence of MSAs is more indicative of liver cirrhosis than just the history of alcohol use because a very low proportion of alcohol drinkers among the general population develop liver cirrhosis. We report a case of MSAs in a 42-year-old alcoholic woman suggesting that MSA is reliable indicator and a warning sign of liver cirrhosis, suggesting that further evaluation and management with the department of hepatology is necessary.

Diffuse Systemic Sclerosis in a Patient with Primary Biliary Cirrhosis and Autoimmune Hepatitis Overlap Syndrome: A Case Report

Chondroid Syringoma of the Leg with Unusual Presentations

No abstract available.

Annular Elastolytic Giant Cell Granuloma: Chronic Heat Exposure, an Underestimated Factor

No abstract available.

A Case of Graphite Granuloma Mimicking Melanoma / 대한피부과학회지

No abstract available.

Role of dermoscopy and biopsy in the diagnosis of skin cancer: it takes two to tango

Although the dermoscopy had very long history since its introduction in 17th century, only recently it has been possible to see the widespread application of dermoscopy in the dermatology clinic. One of the most promising areas where the dermoscopy can be applied is the diagnosis of skin cancer, especially malignant melanoma. Due to its inherent limitation to obtain in-depth information—literally, from more than skin-deep and more importantly, from microscopic structures—of skin cancers, dermoscopy cannot replace the present gold-standard ‘biopsy’ in the diagnosis of skin cancer. However, several advantages of dermoscopy over biopsy merit further considerations. For example, as a non-invasive tool, dermoscopy is best suited for the follow-up of suspicious skin lesions, and as an all-at-a-glance tool, dermoscopy can aid the selection of the best biopsy-site to obtain the most meaningful pathological information from the minimal tissue specimen. There goes a saying that ‘it takes two to tango,’ similarly, we might need the two (biopsy and dermoscopy) to cope rhythmically with the varying tempos of ever-progressing skin tumorigenesis and to reveal the true face of skin cancers usually hidden in various disguises.

Lipedematous Alopecia in an Asian Woman: Is It an Advanced Stage of Lipedematous Scalp?

Lipedematous alopecia (LA) is a rare disease entity that manifests as increased thickness of subcutaneous fatty tissue in the scalp with a variable degree of acquired, non-scarring alopecia. Although the pathogenesis of alopecia in LA is not clear, it is assumed that the increased thickness of subcutaneous fat retards hair growth by disturbing the peripheral microenvironment of the hair bulb. LA is clinically distinguishable from lipedematous scalp (LS) in that LS is not associated with any hair abnormalities, while LA is characterized by variable degree of hair loss. However, both LA and LS share increased scalp thickness. Here, we describe a rare case of LA on the frontal scalp of an Asian woman, further characterize the clinical and histologic features, and suggest applying an integrated diagnosis as lipedematous diseases of the scalp.

A Case of Focal Acral Hyperkeratosis with Autosomal Dominant Inheritance / 대한피부과학회지

Focal acral hyperkeratosis (FAH) is a rare genodermatosis inherited by autosomal dominant transmission; however, some sporadic cases have also been reported. FAH is characterized by multiple late-onset crateriform hyperkeratotic papules with a yellow color on the border of the hands and feet. A 31-year-old man presented with yellowish discrete flat-topped papules on the lateral side of his palms and fingers. The patient had a family history of similar lesions throughout three generations. The histological findings revealed hyperkeratosis with mild hypergranulosis in the epidermis, and the dermis showed no specific changes including elastorrhexis. These clinicopathologic findings were consistent with the diagnosis of FAH. Herein, we report a rare case of FAH with autosomal dominant inheritance.

A Protruding Nodule after Filler Injection / 대한피부과학회지

No abstract available.

Role of dermoscopy and biopsy in the diagnosis of skin cancer: it takes two to tango

Although the dermoscopy had very long history since its introduction in 17th century, only recently it has been possible to see the widespread application of dermoscopy in the dermatology clinic. One of the most promising areas where the dermoscopy can be applied is the diagnosis of skin cancer, especially malignant melanoma. Due to its inherent limitation to obtain in-depth information—literally, from more than skin-deep and more importantly, from microscopic structures—of skin cancers, dermoscopy cannot replace the present gold-standard ‘biopsy’ in the diagnosis of skin cancer. However, several advantages of dermoscopy over biopsy merit further considerations. For example, as a non-invasive tool, dermoscopy is best suited for the follow-up of suspicious skin lesions, and as an all-at-a-glance tool, dermoscopy can aid the selection of the best biopsy-site to obtain the most meaningful pathological information from the minimal tissue specimen. There goes a saying that ‘it takes two to tango,’ similarly, we might need the two (biopsy and dermoscopy) to cope rhythmically with the varying tempos of ever-progressing skin tumorigenesis and to reveal the true face of skin cancers usually hidden in various disguises.

Current Management of Moderate-to-Severe Atopic Dermatitis: A Survey of Allergists, Pediatric Allergists and Dermatologists in Korea

PURPOSE: There is an unmet need for the treatment of moderate-to-severe atopic dermatitis (AD), leading to variation in management strategies. To investigate distinct features and treatment modalities according to physicians' specialties, we collected data on the current treatment approach to moderate-to-severe AD among allergists, pediatric allergists and dermatologists in Korea. METHODS: This questionnaire-based study was administered to physicians from the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI), Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD), and Korean Atopic Dermatitis Association (KADA). RESULTS: A total of 93 physicians participated in the study; 64.5% were pediatric allergists and 31.2% were dermatologists. The major patient age groups were “less than 5 years” for 100% of pediatric allergists and “6–12 years old” for 38% of dermatologists. The proportion of patients with moderate-to-severe AD was higher for dermatologists and allergists compared to pediatric allergists. Physicians agreed on the necessity of education including demonstration of basic skin care and application of topical therapies (88.2%), nutritional consultation (83.9%) and psychological counseling (75.3%). However, less than half were able to educate and counsel their patients in real practice. There were noticeable differences in first-line treatment among physician groups. For pediatric allergists, the order of preferred systemic treatment was wet wrap therapy, systemic corticosteroids and oral cyclosporin. Dermatologists ranked cyclosporin, phototherapy, and systemic corticosteroids as first-line treatment regimens. Major reported barriers to proper management were steroid phobia, unproven complementary and alternative medicine, lack of education, and the unreasonable insurance system. CONCLUSIONS: Our findings suggest there are distinct differences in moderate-to-severe AD treatment according to physicians' specialties. Medical policy changes along with governmental supports are required in order to implement the ideal approach in real practice. For moderate-to-severe AD, a consensus on the approach to optimal management should be reached for the best outcomes, based on further randomized controlled trials.

A Tender Fingertip Papule in an Elderly Woman / 대한피부과학회지

No abstract available.

Tattoo Granuloma Restricted to Red Dyes

No abstract available.

Fixed Drug Eruption Caused by Sildenafil Citrate

No abstract available.

A Case of Facial Sarcoptes scabiei in a Female Child

No abstract available.

Introduction of the Reliable Estimation of Atopic Dermatitis in ChildHood: Novel, Diagnostic Criteria for Childhood Atopic Dermatitis

PURPOSE: Questionnaire-based diagnostic criteria for atopic dermatitis (AD) have been proposed to detect the major group of AD with flexural dermatitis. We aimed to develop novel, questionnaire-based diagnostic criteria for childhood AD, which can detect more comprehensive AD including non-flexural type. METHODS: The draft version of questionnaire to detect childhood AD was prepared to be used for preliminary hospital- (n=1,756) and community-based (n=1,320) surveys. From analysis, the Reliable Estimation of Atopic dermatitis of ChildHood (REACH) was derived and verified in derivation (n=1,129) and validation (n=1,191) sets by community-based surveys. RESULTS: The REACH consists of 11 questions including 2 major and 9 minor criteria. AD is diagnosed as the major group of 'eczema on the antecubital or popliteal fossa' to fulfill the 2 major criteria (2M), and the minor group of 'eczema on the non-antecubital or popliteal fossa' to fulfill the 1 major plus 4 or more minor criteria (1M+4m). In the validation set, the overall 1-year AD prevalence by the REACH was estimated as 12.3% (95% CI, 10.5%-14.2%), and the REACH showed a sensitivity of 75.2%, a specificity of 96.1%, and an error rate of 6.4%. The REACH demonstrated better diagnostic performance than the ISAAC in terms of the number of misclassification (10.0%). CONCLUSIONS: We propose the REACH as new full, questionnaire-based diagnostic criteria for childhood AD in epidemiological surveys. Further studies are warranted to validate the REACH in different populations or countries in the context of large-scale, epidemiological surveys.

An Analysis of the Filaggrin Gene Polymorphism in Korean Atopic Dermatitis Patients

Research of the FLG mutation in various ethnic groups revealed non-overlapping mutation patterns. In addition, Japanese and Chinese atopic patients showed somewhat different mutations. These ethnic differences make the research on Korean patients mandatory; however, no systematic research on Korean atopic dermatitis (AD) patients has been performed. This study aims to investigate the genetic polymorphism of FLG in Korean atopic dermatitis patients. The study was made up of three groups including 9 Ichthyosis vulgaris (IV) patients, 50 AD patients and 55 normal controls: the ichthyosis group was incorporated due to the reported association between the FLG mutation and IV. In comparison to other sequencing methods, the overlapping long-range PCR was used. We revealed the genetic polymorphism of filaggrin in Koreans, and at the same time, we discovered nonsense mutations in p.Y1767X and p.K4022X in Korean AD patients. By using FLG sequencing techniques confirmed in this study, new mutations or genetic polymorphisms with ethnic characteristics would be detected and further larger studies of repeat number polymorphisms could be performed.

A Case of Protothecosis on Scalp and Face in the Immunocompetent Patient / 대한의진균학회지

Protothecosis is an unusual human infection, caused by the genus prototheca, especially Prototheca wickerhamii. A 80-year-old immunocompetent man presented with a 1-month history of multiple reddish brown lobulated plaques on the scalp and face. He denied any history of trauma and had no evidence of underlying diseases such as diabetes mellitus or malignancy. On histopathological examination, characteristic morula-like sporangia in the dermis was revealed. After treatment with oral itraconazole for 8 weeks, the patient's skin lesions are almost healed.

Economic Impact of Atopic Dermatitis in Korean Patients

BACKGROUND: Atopic dermatitis is a global public health concern owing to its increasing prevalence and socioeconomic burden. However, few studies have assessed the economic impact of atopic dermatitis in Korea. OBJECTIVE: We conducted a cost analysis of atopic dermatitis and evaluated its economic impacts on individual annual disease burden, quality of life, and changes in medical expenses with respect to changes in health related-quality of life. METHODS: The cost analysis of atopic dermatitis was performed by reviewing the home accounting records of 32 patients. The economic impact of the disease was evaluated by analyzing questionnaires. To handle uncertainties, we compared the results with the data released by the Health Insurance Review & Assessment Board on medical costs claimed by healthcare facilities. RESULTS: The direct cost of atopic dermatitis per patient during the 3-month study period was 541,280 Korean won (KRW), and expenditures on other atopic dermatitis-related products were 120,313 KRW. The extrapolated annual direct cost (including expenditures on other atopic dermatitis-related products) per patient was 2,646,372 KRW. The estimated annual indirect cost was 1,507,068 KRW. Thus, the annual cost of illness of atopic dermatitis (i.e., direct+indirect costs) was estimated to be 4,153,440 KRW. CONCLUSION: The annual total social cost of atopic dermatitis on a national level is estimated to be 5.8 trillion KRW.

A Case of Drug Eruption Similar to Erythema Multiforme Induced by Sorafenib / 대한피부과학회지

Sorafenib is an oral multi-kinase inhibitor with effects on tumor cell proliferation and tumor angiogenesis. The drug is associated with a relatively high incidence of dermatologic adverse events. Frequently observed clinical presentations include skin rash, a hand-foot skin reaction, alopecia, splinter subungual hemorrhages, and xerosis. There have been few reports of erythema multiforme or leukocytoclastic vasculitis related to sorafenib use. We report a case of a 72 year-old male diagnosed with renal cell carcinoma with distant metastasis, who developed an erythema multiforme-like drug eruption on his trunk and extremities after use of sorafenib.