Clinical Characteristics of Adolescence and Adult Atopic Dermatitis in Korea / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a very common disease with peak prevalence among infants and children. Until now, adolescence and adult AD (AAD) patients have been overlooked because they were relatively small population and AAD were considered merely consecutive of infant and childhood AD. OBJECTIVE: The aim of this study is to investigate clinical characteristics of AAD in Korea and different characteristics of childhood AD. METHODS: We evaluated the clinical features of AD in 48 patients. We obtained informations about the age of onset, associated allergic diseases, aggravating factors and seasonal aggravation from the history using a standardized questionnaire. And clinical features of all subjects were evaluated by one investigator and recorded according to anatomical region. RESULTS: 23 patients (48%) reported onset of AD was after 12 years old and 25 patients (52%) reported onset before 12 years old. Only nine patients have suffered AD from infancy. 25 patients (52%) were associated with allergic asthma and/or rhinitis. Most important aggravating factor was climate with seasonal variation. Other common aggravating factors were stress, sweating, dryness and house dust. And numerous patients who experienced seasonal aggravation replied that symptoms had flared from July to August and December. The face, trunk, extremities, scalp and neck were common sites of dermatitis and most of the patients (93%) showed the facial involvement. Red face (68%) and dandruff (45%) were the most common features of the face and the scalp, respectively. About one third of the patients showed the involvement of the neck, presenting as dirty neck or dermatitis. Dryness of the trunk and eczema of flexural areas of the extremities were also common. And 13 patients had hand-foot dermatitis. Keratosis pilaris, hyperlinear palm and ichthyosis vulgaris were detected in 21 (43%), 14 (29%) and 9 patients (18%). CONCLUSION: This study shows AAD is so different from childhood AD, suggesting that AAD may not be merely consecutive of infant and childhood AD.

A Case of Subungual Keratoacanthoma / 대한피부과학회지

Subungual keratoacanthoma is a rare, benign tumor occurring mainly on the thumb of middle-aged Caucasians. It presents as a painful keratotic papule or nodule accompanied by consequential partial onycholysis and bacterial infections. Unlike keratoacanthoma of other sites, subungual keratoacanthoma is not spontaneously resolved and surgical interventions have been recommended for treatment. It also needs to be differentiated from other subungual lesions, especially squamous cell carcinoma. We describe a case of subungual keratoacanthoma, which was completely resolved with extraction of the nail followed by oral methotrexate(MTX) medication.

A Case of Trichoblastoma with Trichoepithelioma-like and Sebaceous Differentiation / 대한피부과학회지

We report a 40-year-old woman with trichoblastoma on vertex scalp showing trichoepithelioma-like feature in upper part and focal sebaceous differentiation. The co-presence of trichoblastoma and trichoepithelioma-like feature in a same tumor represented that the inclusive term trichoblastoma is better for trichogenic tumors composed of follicular germinative cells, and sebaceous differentiation meant the common embryonic origin of folliculo-sebaceous-apocrine unit.

A Case of Rudimentary Meningocele / 대한피부과학회지

Rudimentary meningocele, also known as a 'variant of primary cutaneous meningioma' or 'acoelic meningeal hamartoma', is an unusual developmental anomaly in which meningothelial elements are found in the skin. A 8-month-old girl has a well-circumscribed, alopecic, atrophic patch on the midline of the occipital area since birth. Histologically, pseudovascular spaces lined with flattened or cuboidal cells were seen in the papillary and upper reticular dermis without collagen bodies. These flattened or cuboidal cells were positive for vimentin, but negative for EMA, immunohistochemically. Radiographic finding of the scalp revealed no underlying bony defect.

Giant Becker's Nevus with Agminated Lentigine / 대한피부과학회지

We report a case of a 27-year-old male showing Becker's nevus on his trunk and lower extremities. It represented symmetrically bilateral and extensive(about 50% of body surface) involvement. In addition to the usual clinical findings of Becker's nevus, grouped small darker spots were noted on the lesion of the buttock featuring agminated lentigine. Histologic findings of the brownish pigmented lesion consisted of mild acanthosis, hyperkeratosis, elongation of rete ridges, increase of basal layer pigmentation, and numerous terminal hair follicles. A dark macule in agminated lesions on the buttock showed more dense basal layer pigmentation and more regular elongation and fusion of rete ridges consistent with the histologic findings of lentigo simplex. This report describes a rare case of a giant Becker's nevus involving 50% of body surface in a bilateral and symmetrical distribution with associated agminated lentigine.

Giant Becker's Nevus with Agminated Lentigine / 대한피부과학회지

We report a case of a 27-year-old male showing Becker's nevus on his trunk and lower extremities. It represented symmetrically bilateral and extensive(about 50% of body surface) involvement. In addition to the usual clinical findings of Becker's nevus, grouped small darker spots were noted on the lesion of the buttock featuring agminated lentigine. Histologic findings of the brownish pigmented lesion consisted of mild acanthosis, hyperkeratosis, elongation of rete ridges, increase of basal layer pigmentation, and numerous terminal hair follicles. A dark macule in agminated lesions on the buttock showed more dense basal layer pigmentation and more regular elongation and fusion of rete ridges consistent with the histologic findings of lentigo simplex. This report describes a rare case of a giant Becker's nevus involving 50% of body surface in a bilateral and symmetrical distribution with associated agminated lentigine.

A case of chondroid syringoma with folliculosebaceous-apocrine differentiation / 대한피부과학회지

Chondroid syringoma is referred as mixed tumor because it has epithelial structure and mesenchymal elements. Mixed tumors could be divided into two distinct types, eccrine and apocrine. Mixed tumor with follicular, sebaceous and apocrine differentiation is considered as an expression of the common embryologic origin of elements of the folliculosebaceous-apocrine unit. A 32-year old manpresented with an asymptomatic firm erythematous nodule on the left cheek. Histologically, it showed typical features of chondroid syringoma with tubules exhibiting branching and cystic dilatation in the myxoid and chondroid stroma. Our case is unique in that the tumor arose from follicular infundibulum with follicular, sebacesous and apocrine differentiation.

Age, Gender and Seasonal Variations of skin Pigmentation Levels in Koreans / 대한피부과학회지

BACKGROUND: Human skin color shows variations throughout life and many extrinsic and intrinsic factors influence melanogenesis. The characteristics of skin pigmentation have been studied largely in white Caucasians. However, pigmentary changes due to various regulatory factors may be different in Orientals. OBJECTIVE: We observed the variations in skin color due to aging, seasonal changes and gender differences in Koreans with skin type IV or V. METHODS: Skin pigmentation was measured at five body sites (buttock, glabella, V-neck area, inner arm, and dorsal forearm) using skin reflectance spectroscope in 109 subjects in winter and summer. RESULTS: Constitutive pigmentation of the buttock was at the highest level in the first decade of life. It then decreased during the next two decades. This decreased level was maintained after the third decade. The pattern of pigmentation changes of other four sites with aging was similar to that of the buttock. Gender differences were significant except in the first decade. Seasonal change of pigmentation level was observed in dorsal forearm. Interestingly, our study did demonstrate some differences from the observations in Caucasians. We found that facultative pigmentation in Koreans was not increased with aging, so the sun exposure index was not reliable as a measure of cumulative lifetime UV exposure. CONCLUSION: These differences between races could imply that genetically determined basal skin color has important effects on characterizing later responsiveness to UV lights and sex hormones. Understanding these differences in skin pigmentation would be helpful in treating pigmentary diseases and skin cancers, and in studying the regulatory mechanisms of melanogenesis.

Clinical Characteristics of Hand-foot Dermatitis in Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Hand-foot (H-F) dermatitis is common in atopic dermatitis patients, but its clinical characteristics have not been studied well. OBJECTIVE: We performed this study to examine the clinical characteristics of H-F dermatitis of AD and to assess its etiologic associations. METHODS: Clinical manifestations of H-F dermatitis were examined in 134 patients with H-F dermatitis of AD between May 1997 and July 1998 at our AD clinic. RESULTS: Both hand and foot were involved in 63(47.0%) patients, and either hand or foot involvement was observed in 20(14.9%) and 51(38.1%) patients, respectively. It usually began in childhood with an early onset of AD. Pruritus was the most frequent symptom, and erythema, scales, lichenification, hyperkeratosis, fissures, and keratolysis exfoliativa were also common. Palmar or plantar involvement showed an equal frequency with the dorsal lesions. The great toe was affected more often than the other toes. Two thirds presented with manifestations of ichthyosis triad (ichthyosis vulgaris, hyperlinear palm and keratosis pilaris) and sandpaper-like skin lesions on the elbow, knee, and lateral malleolus. Palmar or plantar hyperhidrosis was reported in 21% and 27% respectively. The ichthyosis-associated group showed a significantly higher incidence of sandpaper-like skin lesions, fissures, and scales, mainly involving the dorsa of hands and feet. The hyperhidrosis- associated group showed an association with glassy lesions, localized to palmar or plantar areas. CONCLUSION: Clinical characteristics of AD-associated H-F dermatitis were demonstrated. The disease was suggested to be associated with the nonimmunologic etiologies of AD and clinical subgroups could be identified on the basis of nonimmunologic backgrounds.

Apocrine Mixed Tumor with Follicular Differentiation

Mixed tumor of the skin (chondroid syringoma) is a rare benign tumor composed of epithelial elements intermingled with myxoid or cartilagenous stroma which is not separated by basement membrane. It had been believed to originate from the eccrine gland but recently, it was described to be of apocrine gland origin in case of showing apparent apocrine secretion. We report on a 63-year-old man with a tumor on the right upper eyelid showing typical microscopic features of mixed tumor of the skin. Many apocrine decapitation secretions were seen in tubular structures and follicular differentiations were also seen, which represents the common origin of folliculo-sebaceous-apocrine unit.

Late Onset Ota Nevus

Ota nevus is a dermal melanocytic harmatoma derived from neural crest melanoblast and involves skin innervated by the trigeminal nerve. Although most cases are clinically apparent at birth or around puberty, acquired lesions in adults have been rarely reported. We reported a 73 year-old Korean man with Ota nevus of the face and scalp that onset in his eighth decade and accompanied multiple solar comedo of the face.

A Case of Tubular Apocrine Adenoma

Tubular apocrine adenoma is a well-circumscribed intradermal benign tumor with tubular structures showing apocrine differentiation. Most of those cases occur on the scalp in middle aged women. Histologically, tubular structure with apparent apocrine decapitation secretion, cystic dilatation of tubule, and connection with epidermis are the characteristic features of tubular apocrine adenoma. We presented a case of tubular apocrine adenoma that had recurred after incomplete excision. It showed apocrine decapitation secretion histologically and both eccrine and apocrine differentiation on immunohistochemical study.