Acquired Partial Lipodystrophy (Barraquer-Simons Syndrome): Early Cosmetic Intervention with Autologous Fat

Barraquer-Simons syndrome is a rare acquired lipodystrophy characterized by gradually symmetric subcutaneous fat loss in a craniocaudal distribution, often associated with hypocomplementemia and nephropathies. Facial cosmetic treatment in this disorder has not been fully described in the literature. We present a patient with Barraquer-Simons syndrome with emphasis on early cosmetic intervention with autologous fat grafting and its long-term efficacy. At the follow-up 37 months after the last fat grafting, preservation of the grafted fat was noted while lipodystrophy progressed in the trunk regions. Autologous fat grafting is suggested for the correction of facial dysmorphism in this type of lipodystrophy.

Bacteriological Study of Paronychia in Military Personnel / 대한의진균학회지

BACKGROUND: Paronychia is a common infectious disease affecting fingernails and toenails. Although bacterial and fungal infections as well as mechanical trauma may play roles in the pathogenesis of this disease, there are few bacteriological studies about paronychia in military personnel. OBJECTIVE: To identify the causative bacteria of paronychia in military personnel. METHODS: We retrospectively analyzed the microbiological results of 145 patients who visited a tertiary referral hospital for Korean soldiers from August 2004 to October 2006. RESULTS: Twenty-eight different types of aerobic bacteria were identified, with the most common being Staphylococcus aureus (38.0%), Streptococcus pyogenes (7.2%), and Pseudomonas aeruginosa (5.4%). Staphylococcus aureus was identified mostly in finger and toe paronychial lesions and Pseudomonas aeruginosa was recovered commonly from toe paronychial lesions. All cases of paronychia were controlled by the combination of antiseptic dressing, topical antibacterial ointment, oral antibiotics, and antimycotic agents. CONCLUSION: The types of bacteria that most commonly caused paronychia in military personnel were Staphylococcus aureus, Staphylococcus pyogenes, and Pseudomonas aeruginosa. Thus, the commonly used oral antibiotics for paronychia, such as amoxicillin-clavulanate, clindamycin, and trimethoprim-sulfamethoxazole, are good choices in the treatment of paronychia in military personnel.

Botulinum Toxin Type A for Facial Wrinkles and Benign Masseter Hypertrophy in Korean Patients / 대한피부과학회지

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.

The Use of Dynamic Ultrasonography for the Confirmation of Lower Leg Muscle Herniation

The term muscle herniation represents focal muscular protrusions through an acquired or congenital fascial defect. The anterior tibialis muscle is the most common site of herniation. Dynamic ultrasonography has become an important tool in dermatology for diagnosing suspected muscle herniation because it is a non-invasive, highly accurate, readily available and cost-effective imaging technique. We present here the case of a 21-year-old male Korean soldier who underwent dynamic ultrasonography to confirm the diagnosis of anterior tibialis muscle herniation.

Clinical Features of Chilblain in Korean Soldiers / 대한피부과학회지

BACKGROUND: Chilblain or pernio is a cold-induced, inflammatory skin problem which occurs usually on acral areas bilaterally. Because chilblain commonly develops in cold, damp climates, many soldiers may experience occupational chilblain during military service in Korea. OBJECTIVE: The purpose of this study is to analyze the clinical characteristics of chilblain in Korean soldiers. METHODS: We reviewed the clinical findings in 199 patients with chilblain who visited the department of dermatology, Armed Forces Capital Hospital during the 5-year period from 2002 to 2007. We investigated the epidemiology, aggravation factors, duration of the disease, clinical manifestations and treatment. RESULTS: The results were as follows; The average age was 21.51+/-1.86 years old. The chilblain usually developed during winter and the duration of symptoms ranged from 1 day to 4 years. All patients developed skin lesions on acral areas. Erythematous skin lesions were observed in 133 patients and purpuric lesions were seen in 56 patients. The lesions were symmetrical in 171 patients 43 patients had history of recurrence. Treatment includes nifedipine and pentoxyfilline. The supportive treatment includes rest and keeping warm, topical corticosteroids or antibiotics and oral antihistamine, analgesics, or antibiotics. CONCLUSION: This investigation is expected to help understand and obtain more information on chilblain.

A Case of Reactivation of Herpes Simplex Virus in Foot Dorsum Followed by Friction by Sandals' Trap / 대한피부과학회지

Herpes simplex virus (Herpesvirus hominis), a member of the herpeptoviridae family, is among the most common infectious viral pathogens in humans. Types of HSV can be subdivided into HSV-1 and HSV-2 on the basis of physiological, serologic and epidemiologic differences, although both are closely related immunologically and DNA sequence homology. HSV-1 is frequently associated with oropharyngeal, eye and skin infections, while HSV-2 is most commonly associated with genital tract infections. Characteristically after the primary infection, HSV can be linked to latency in neural tissue. Reactivation of HSV can be triggered by sunburn, fever, stress, menstruation and local trauma. Here we report a case of reactivation of herpes simplex virus type 2 in foot dorsum followed by repetitive friction due to Sandals' trap.

Clinical Effects of Shark Cartilage Extracts on Erythematotelangiectatic Rosacea Patients / 대한피부과학회지

BACKGROUND: Persistent facial telangiectasia, erythema and flushing are the major cosmetic problems in patients with rosacea. However various therapeutic treatments for rosacea papules and pustules are not effective in reducing telangiectasia and flushing reactions. Matrix-centered theory that dermal matrix degradation can cause telangiectasis, erythema and flushing, is one of the various theories of rosacea pathogenesis. Shark cartilage extracts are collagenase inhibitors and can inhibit dermal matrix degradation. OBJECTIVE: The purpose of this study was to evaluate the clinical effects of shark catilage extracts (Venatrix(R)) for erythematotelangiectatic rosacea patients. METHODS: Twenty three patients with erythematotelangiectatic rosacea applied shark cartilage extracts twice daily for up to 8 weeks. Efficacy was evaluated by erythema index using mexameter (MPA 5, CK, Germany) and clinical photography. RESULTS: Erythema index decreased from 525.7+/-114 to 413.9+/-101.7 (mean reduction: 21.3%) (p<0.1) after 8 weeks treatment. 16 patients (69%) showed excellent or good results by clinical photography. Transient stinging sensation was the most common adverse effect and these symptoms improved after the first few days. There were no other significant side effects. CONCLUSION: Shark cartilage extracts may be an effective treatment for mild erythematotelangiectatic rosacea.

A Clinical Analysis of 29 Cases of Centipede Bite / 대한피부과학회지

BACKGROUND: The relative lack of knowledge and interest in arthropod bites has made it difficult to investigate centipede envenomation in Korea. OBJECTIVE: To describe the epidemiology and clinical characteristics of centipede bites in Korea. METHODS: A prospective study of clinical manifestations in patients with centipede bites was performed during the period of May 2004 to April 2005. Factors investigated included sex, age, location and time of assaults, affected parts of the body, signs and symptoms, treatment modalities, and complications. All centipedes that were involved were brought to the clinic, examined, and species-identified. RESULTS: A total of 29 cases of centipede bite were identified. Scolopendra subspinipes was the causative centipede in all cases. Centipede bites occurred exclusively in summer (June, July, and August). Most of the bites which occurred during the daytime happened outdoors, whereas most nocturnal assaults happened indoors. All patients were bitten on an exposed area and the fingers (37.9%) were the most frequent sites of involvement. Local reactions developed at the bitten sites and usually remained localized. Erythema (100%) and local swelling (79.3%) were the most prominent features. The majority of patients did not show severe systemic symptoms. Most lesions healed completely within a week, without complications. CONCLUSION: Centipede bites are a common occurrance in rural and island areas during the summer season. Dermatologists need to be aware of the clinical manifestations in order to make an appropriate diagnosis and proper treatment decision.

A Clinical Analysis of 133 Cases of Pitted Keratolysis / 대한피부과학회지

BACKGROUND: Pitted keratolysis (PK) is an acquired, chronic, usually asymptomatic, non-inflammatory, superficial bacterial infection of the stratum corneum of the soles. Corynebacterium species are thought to be the causative organisms of PK. This condition is common in feet of active people wearing sweaty shoes, namely, athletes and soldiers. OBJECTIVE: To analyze the clinical manifestations of pitted keratolysis. METHODS: A total of 133 Korean male soldiers diagnosed with PK (aged between 19 and 33, mean 21.9 years) were included in this study. All patients were investigated between April 2004 and May 2005. Factors investigated included age, location, duration, date of visit, physical examination, subjective symptoms, associated medical conditions, and treatment modalities. All patients were examined carefully to verify accompanying erythrasma or trichomycosis axillaris (TMA). RESULTS: About half of the patients visited our department in spring (March, April, and May). However, PK was found in all the seasons. The ball of the foot was the most frequently involved site (92.5%). The big toe (72.2%) was also a frequent site of involvement. Forty-five patients (41.7%) had coexistent erythrasma, 22 (20.4%) had TMA, and 14 (13.0%) had a simultaneous presence of both erythrasma and TMA. Hyperhidrosis (98.5%) and foul odor (95.5%) were the main complaints in most of the patients. Other symptoms associated with PK were sliminess (38.3%), burning (23.3%), itching (18.8%), and prickling (13.5%) sensations. Various treatment modalities such as topical antibiotics, topical antifungal agents, and oral erythromycin have been used. All lesions subsided within 1 month after treatment. Although recurrence rate was high (64.3%), parameters such as period of prevalence, size and shape of the lesion, and treatment modality were not associated with the recurrence rate. CONCLUSION: The present study provides basic clinical information on PK, which is a common condition of the feet of Korean male soldiers.

Caterpillar Dermatitis Caused by Euproctis similis / 대한피부과학회지

The yellow-tail moth Euproctis similis, belongs to the genus Euproctis (Lymantriidae) and has a wide distribution within Korea, Japan, China and Europe. Contact with the 'urticating hairs' of the Euproctis similis caterpillar induces dermatitis due to the combination of mechanical and chemical mechanisms. Clinically, patients with caterpillar dermatitis show wheals in the early stage and/or erythematous papules in the late stage after contact with the spicules. We report 5 young soldiers who developed pruritic wheals and erythematous papules on their upper back after contact with the hairs of the Euproctis similis caterpillar.

Gram-negative Folliculitis following Prolonged Use of Broad-spectrum Antibiotics / 대한피부과학회지

Gram-negative folliculitis is an infection with Gram-negative bacteria that most often occurs as a complication of prolonged broad-spectrum antibiotic therapy in patients suffering from acne or rosacea. A 21-year-old male soldier with acne vulvaris had been treated with broad-spectrum antibiotics for two months because of severe pyoderma on the soles. While the plantar lesions improved significantly, prolonged use of the systemic antibiotics resulted in widespread follicular pustules on his face, scalp, and back of the neck. A skin biopsy showed features of superficial pustular folliculitis. Klebsiella species were identified from the pus culture. A diagnosis of gram-negative folliculitis was made. The lesions almost disappeared after 4 weeks of treatment with oral isotretinoin (0.5 mg/kg/day).

Gram-negative Folliculitis following Prolonged Use of Broad-spectrum Antibiotics / 대한피부과학회지

Gram-negative folliculitis is an infection with Gram-negative bacteria that most often occurs as a complication of prolonged broad-spectrum antibiotic therapy in patients suffering from acne or rosacea. A 21-year-old male soldier with acne vulvaris had been treated with broad-spectrum antibiotics for two months because of severe pyoderma on the soles. While the plantar lesions improved significantly, prolonged use of the systemic antibiotics resulted in widespread follicular pustules on his face, scalp, and back of the neck. A skin biopsy showed features of superficial pustular folliculitis. Klebsiella species were identified from the pus culture. A diagnosis of gram-negative folliculitis was made. The lesions almost disappeared after 4 weeks of treatment with oral isotretinoin (0.5 mg/kg/day).

A Case of Tinea Incognito Induced by 1% Pimecrolimus (Elidel(R)) Cream / 대한피부과학회지

Tacrolimus and pimecrolimus represent a new class of topical non-steroidal medication currently used in the treatment of a variety of inflammatory skin lesions. We report a case of a patient in whom topical pimecrolimus therapy resulted in tinea incognito. Mycologic examination, including a KOH smear and fungal culture, was positive for hyphae and colonies of trichophyton mentagrophytes. The lesion was treated with oral griseofulvin and topical clotrimazole.

Study of Causative Organisms in Pitted Keratolysis / 대한의진균학회지

BACKGROUND: Pitted keratolysis is a superficial bacterial infection which usually affects the pressure bearing areas of the feet. Some bacterial organisms were identified as etiologic agents, including Corynebacterium species, Micrococcus species and Dermatophilus congolensis. However, in Korea, studies to prove the causative organisms have not been performed. OBJECTIVE: We performed this study to identify causative organisms of pitted keratolysis in Korea. METHOD: Twelve normal healthy men and 27 pitted keratolysis patients were enrolled. We cultured the scraped specimens of the stratum corneum and identified the cultured organisms. We compared the cultured organisms of pitted keratolysis group with those of control group. We also compared the distribution of cultured organisms in pitted keratolysis with and without tinea pedis. RESULT: Micrococcus species and Corynebacterium species were identified in pitted keratolysis group much more frequently than in normal control group. In most cases of pitted keratolysis combined with tinea pedis, the identified organisms were Micrococcus species. CONCLUSION: Micrococcus species and Corynebacterium species are thought to be the major causative organisms of pitted keratolysis in Korea. Micrococcus species might play a certain antagonistic role, especially in patients of pitted keratolysis with tinea pedis.

A Case of Cutaneous Scedosporium apiospermum Infection / 대한피부과학회지

Scedosporium (S.) apiospermum is the asexual stage of Pseudallescheria (P.) boydi. The organism is ubiquitous in nature, and has a world-wide distribution. It has been isolated from soil, plant debris, polluted water and sewage. It is an opportunistic organism with low virulence. Infection may occur via direct inoculation and usually affects the extremities. We report a case of cutaneous S. apiospermum infection which occurred in a 58-year-old male during immunosuppressive therapy, 3 months after a kidney transplantation. He presented with an one-month history of cutaneous nodules on the dorsum of the right foot. Cultural isolation showed S. apiospermum and we treated him daily with itraconazole and drainage.

Comparative Study of Benzoyl Peroxide Versus Clindamycin Phosphate in Treatment of Pitted Keratolysis / 대한의진균학회지

BACKGROUND: Pitted keratolysis (PK) is a bacterial infection of the stratum corneum. The infection is characterized by 1 to 7 mm discrete and coalescing craterlike pits on the plantar surfaces of the feet and toes, especially the weight-bearing areas. Topically applied antibiotics such as clindamycin, benzoyl peroxide erythromycin, and clotrimazole are curative. OBJECTIVE: We performed this study to compare treatment efficacy of benzoyl peroxide (BP) and clindamycin phosphate (CP) in PK. METHOD: The clinical study was made in 44 patients with PK. Among 44 patients, 17 patients were treated by BP topical application alone, 15 patients treated by CP. And the others by combined topical application of BP and CP. RESULT: There were no significant differences in the treatment efficacy between BP and CP, and between monotherapy and combination therapy, neither. 1) Gender ratio showed extreme male predominance (M: F = 43: 1), and the mean age of onset was 22 years old. 2) Mean disease duration was 2.8 months and mean period for complete cure was 2.6 weeks. And there was no significant relation between disease duration and mean period for complete cure. 3) Hyperhidrosis (18.1%) was the most commonly associated condition with PK. The followings were Tinea pedis (13.6%), T. cruris (6.8%), erythrasma (6.8%), cellulitis (6.8%), osmidrosis (6.8%), wart (6.8%), and corn (6.8%) in the order of frequency. 4) There was no statistically significant difference in the treatment efficacy between BP and CP (p> 0.05). 5) Among 44 patients, irritation was observed in 4 cases (9.1%). Two cases were related with BP, and the others with CP. But these adverse effects were trivial and disappeared soon. 6) Four cases (9.1%) showed recurrence within 3 month-follow up. And they were all related with hyperhidrosis. There was no statistically significant difference in the recurrence rate between BP and CP, although patients treated with CP showed slightly higher recurrence rate (p> 0.05). CONCLUSION: Our study shows that no significant difference in the treatment efficacy between benzoyl peroxide and clindamycin phosphate, and between monotherapy and combined therapy, neither. Therefore, combination therapy should be spared for only intractable PK.

Two Cases of Plasma Cell Cheilitis Treated with Intralesional Injection of Corticosteroids

Plasma cell cheilitis is a rare inflammatory disorder which shows a dense, band-like infiltrate of plasma cells in the upper dermis. Although the histological picture is shared with other diseases of the lips, plasma cell cheilitis is not associated with any known dermatoses. Some authors have shown the effectiveness of topical or intralesional corticosteroids; however, there have been many reports describing poor therapeutic response to topical steroids. We de-scribe two patients with plasma cell chielitis whose clinical condition responded rapidly to the intralesional injection of corticosteroids.

A Clinicopathologic Analysis of Eighty Patients with Syringoma / 대한피부과학회지

BACKGROUND: Syringoma is a benign tumor of eccrine origin which occurs predominantly in women after puberty. Although it is found commonly in the dermatological practice, studies relative to large series of patients have rarely been reported in the literature. OBJECTIVE: The purpose of this study is to describe general clinicopathologic features of syringoma and to compare clinical and histopathological features among various subtypes of syringoma. METHODS: A total of 80 patients with biopsy-confirmed syringoma were included. Data reviewed were sex, age, age at onset, subjective symptoms, family history, accompanied diseases, color and size, location and distribution, clinical impressions, treatment and course of the disease. Histopathologic features studied include acanthosis, basal pigmentation, tadpole appearance, vacuolization of tumor cells, keratin-filled cysts, calcification, and proliferation of fibrous stroma. RESULTS: Male: female ratio was 1: 4.7 and the mean age at onset was 29.1 years. The most frequent site of involvement was upper or lower eyelids (68.8%), followed by forehead, temple, cheeks, chin, abdomen, upper extremities, neck, vulva and penis, axillae, lower extremities, and perianal skin. Fifty patients showed localized lesions whereas the other thirty patients were classified as having eruptive, generalized syringoma. Twenty-one patients, most of them with vulvar syringomas, complained of itching. Seven patients had a family history of syringoma. Histopathologically, all the previously described features were found. Vacuolization of cells and keratin-filled cysts were not rarely seen and luminal calcification was found in 3 patients. Epidermal changes were associated with the presence of pruritus and stromal fibrosis was commonly found in patients with early onset or longer duration. Clinical and histological features were similar between localized group and generalized group, except for the common presence of brownish lesions in patients with generalized syringoma. Lesions were not resolved spontaneously and treatments were found to be unsatisfactory. According to the results, we conclude that syringoma manifests a wide variety of clinical and histopathological features and should be included in the differential diagnosis of various papular dermatoses.

A Clinicopathologic Analysis of Eighty Patients with Syringoma / 대한피부과학회지

BACKGROUND: Syringoma is a benign tumor of eccrine origin which occurs predominantly in women after puberty. Although it is found commonly in the dermatological practice, studies relative to large series of patients have rarely been reported in the literature. OBJECTIVE: The purpose of this study is to describe general clinicopathologic features of syringoma and to compare clinical and histopathological features among various subtypes of syringoma. METHODS: A total of 80 patients with biopsy-confirmed syringoma were included. Data reviewed were sex, age, age at onset, subjective symptoms, family history, accompanied diseases, color and size, location and distribution, clinical impressions, treatment and course of the disease. Histopathologic features studied include acanthosis, basal pigmentation, tadpole appearance, vacuolization of tumor cells, keratin-filled cysts, calcification, and proliferation of fibrous stroma. RESULTS: Male: female ratio was 1: 4.7 and the mean age at onset was 29.1 years. The most frequent site of involvement was upper or lower eyelids (68.8%), followed by forehead, temple, cheeks, chin, abdomen, upper extremities, neck, vulva and penis, axillae, lower extremities, and perianal skin. Fifty patients showed localized lesions whereas the other thirty patients were classified as having eruptive, generalized syringoma. Twenty-one patients, most of them with vulvar syringomas, complained of itching. Seven patients had a family history of syringoma. Histopathologically, all the previously described features were found. Vacuolization of cells and keratin-filled cysts were not rarely seen and luminal calcification was found in 3 patients. Epidermal changes were associated with the presence of pruritus and stromal fibrosis was commonly found in patients with early onset or longer duration. Clinical and histological features were similar between localized group and generalized group, except for the common presence of brownish lesions in patients with generalized syringoma. Lesions were not resolved spontaneously and treatments were found to be unsatisfactory. According to the results, we conclude that syringoma manifests a wide variety of clinical and histopathological features and should be included in the differential diagnosis of various papular dermatoses.

Primary Cutaneous CD30 (Ki-1) Positive Lymphoproliferative Disorder: Report of a Borderline Case / 대한피부과학회지

Primary cutaneous CD30 positive large cell lymphoma is a cutaneous T-cell lymphoma with a favorable prognosis, which is characterized by solitary or localized skin lesions with a tendency of spontaneous regression and frequent relapses. On the basis of the morphologic and immunophenotypic similarities between the large atypical cells in lymphomatoid papulosis and the neoplastic cells in primary cutaneous CD30 positive large cell lymphoma as well as their favorable prognosis, these two diseases are now regarded to be in a spectrum of primary cutaneous CD30 positive lymphoproliferative disorder. We present a borderline case of primary cutaneous CD30 positive lymphoproliferative disorder which recurred on the anatomic site different to the primary lesions despite multiple-agent chemotherapy.