Refractory Livedoid Vasculopathy Treated by Low-Molecular-Weight-Heparin / 대한피부과학회지

No abstract available.

A Case of Isolated Plantar Collagenoma Presenting as Cerebriform Hyperplasia / 대한피부과학회지

Collagenomas, or connective tissue nevi of the collagen type, are hamartomatous growths of otherwise normal collagen. They are divided into two groups: the inherited form that contains familial cutaneous collagenoma and shagreen patches in tuberous sclerosis, and the acquired form that contains eruptive collagenoma and isolated collagenoma. Among them, isolated plantar collagenoma with a cerebriform appearance is a relatively rare type of connective tissue nevus. It has been described as one of the major skin findings in Proteus syndrome. We present an unusual case of acquired isolated plantar collagenoma presenting as cerebriform hyperplasia, which was not associated with Proteus syndrome.

Protruding Type of Fibrous Hamartoma of Infancy / 대한피부과학회지

Fibrous hamartoma of infancy (FHI) is a rare benign soft tissue tumor that is composed of an organoid pattern of fibrous tissue and primitive mesenchyme and adipose tissue. The majority of cases of fibrous hamartoma of infancy occur within the first year of life as a single painless subcutaneous nodule. We experienced and report on an uncommon case of protruding fibrous hamartoma of infancy in an 1-year-old girl.

Protruding Type of Fibrous Hamartoma of Infancy / 대한피부과학회지

Fibrous hamartoma of infancy (FHI) is a rare benign soft tissue tumor that is composed of an organoid pattern of fibrous tissue and primitive mesenchyme and adipose tissue. The majority of cases of fibrous hamartoma of infancy occur within the first year of life as a single painless subcutaneous nodule. We experienced and report on an uncommon case of protruding fibrous hamartoma of infancy in an 1-year-old girl.

The Efficacy of Oral Isotretinoin (Roaccutane(R)) in the Treatment of Acne by Using the Korean Acne Grading System / 대한피부과학회지

BACKGROUND: Although oral isotretinoin is an effective established therapy for acne, Korean data related with this therapy is very limited. Moreover, there is no published data available on the efficacy of this drug that uses a grading system suitable for Korean acne patients. OBJECTIVE: The purpose of this study is to evaluate the efficacy of oral isotretinoin (Roaccutane?) by using the Korean Acne Grading System (KAGS) and the general satisfaction of patients in treating acne. METHODS: In this multicenter and prospective clinical study, 499 patients with acne, who visited at 5 dermatologic clinics during 11 months, were enrolled. The drug dosage was 0.2~1.0 mg/kg/day over 4 months. The efficacy assessment was performed at baseline and monthly after, with an acne grading based on the KAGS and the patient satisfaction questionnaire. RESULTS: Out of the 499 patients, 435 and 371 have completed the 3-month and 4-month treatments, respectively. After the 4-month treatment, the mean acne grades significantly decreased from 2.71 to 0.68, thus showing a 75.9% reduction in pretreatment scores. The mean patient satisfaction scores improved at the end of 4-month treatment, showing a 4.42 out of 5. CONCLUSION: In this paper, we describe the efficacy of oral isotretinoin by using the KAGS, which has not been previously reported in the Korean literature. Our results show that oral isotretinoin is an effective and satisfactory treatment modality for acnes of all grades in Korean patients, regardless of the dosage.

Korean Acne Grading System / 대한피부과학회지

BACKGROUND: A good acne grading system should reflect epidemiological and clinical features of a particular patient group. Current Korean acne grading systems are mostly based on the skin colors, epidemiology, and clinical features of Western countries, which make them less than being ideal for Korean acne patients. OBJECTIVE: We tried to devise an acne grading system based on clinical and epidemiological characteristics of Korean acne patients. This system is intended for use in primary care setting as well as in research purposes. METHODS: In the formulation of a new acne grading system, a panel of 5 dermatologists from 5 referral centers took into account the degree of complexity of the system, criteria for severity as well as skin colors through the review of clinical photographs of 250 acne patients. The new grading system then underwent inter-rater and intra-rater discrepancy assessment and simulation with 149 patient photos to find out an optimal epidemiological representation. RESULTS: We developed 6-scale grading system with both standard pictures and ranges of number of lesions as criteria. Intra-rater and inter-rater reproducibility turned out to be moderate to strong, suggesting clear instruction and easy performance. Simulation with 4 different models yielded best parameter ranges for the optimal criteria. CONCLUSIONS: With the feedback from the large-scale field applications, this new acne grading system will serve as a multipurpose acne grading system for Korean patients.

The Relapse Rate after 1 Year Treatment with Oral Isotretinoin in Korean Patients with Mild to Moderate Acne / 대한피부과학회지

BACKGROUND: The efficacy of isotretinoin in the treatment of acne has been widely established. Recently oral isotretinoin has been used for any grades and any types of acne. There have been many articles on long-term follow up data with oral isotretinoin therapy. OBJECTIVE: To assess, after 1 year post-treatment with oral isotretinoin, the relapse rate, risk factor which influence the outcome, and the total cumulative dose of oral isotretinoin in mild to moderate acne patients in Korea, prospectively. MATERIAL AND METHODS: Patients with mild to moderate acne, visiting out-patient dermatology clinics of four university hospitals have taken oral isotretinoin 0.3-1.0mg/kg/day over 16 weeks. The outcomes were evaluated by telephone contact, with regard to relapse, further treatment in cases of relapse; subjective assessment of sebum secretion and patient satisfaction. A total of 230 patients were evaluated at the end of the preliminary report, and 124 out of the 230 were contacted in this 1 year follow up. RESULT: A relapse rate of 25% was obtained on our study. The patient's sex, seborrhea, acne grade prior to treatment, previous severest acne grade did not influence the relapse rate. It appeared that young age and the total cumulative dose (TCD) influenced the percentage of relapse. About 71.3% of patients were satisfied with the result after 1 year post-treatment with oral isotretinoin. CONCLUSION: The dose schedule, in particular the cumulative dose, was an important factor in determining the relapse rate. It is capable of producing a low relapse rate and long-term remission in mild to moderate acne patients in Korea, if given in a dose regimen of a cumulative dose of 80 mg/kg.

Awareness of Harmful Effects of Sun Exposure and Sunscreen Use in Korean / 대한피부과학회지

BACKGROUND: Skin cancer is one of the most preventable cancers by sun-protection and sunscreen is the most commonly used method of sun protection. OBJECTIVES: The aim of this study is to evaluate the awareness of harmful effects of sun exposure and behavior of sunscreen use in Korean. METHODS: One thousand, two hundred and seventy-four subjects who visited Dermatology Department at Asan Medical Center between April and July 2000 were interviewed. The questionnaire provided information about demographic characteristics, daily sun-exposure time, and sunburn history in the year before. It also included the questions about the causes of wrinkle, sunspot, chloasma, and skin cancer, as the awareness of the harmful effects of sun exposure. The use of sunscreen or other sun-protective methods, and the knowledge about sun protection factor (SPF) were also reported. RESULTS: The harmful effects of the sun in causing wrinkle, sunspot, chloasma, and skin cancer were conceived by 11.1%, 24.4%, 41.4%, and 44.3% of the respondents respectively. Thirty nine percent of the respondents used sunscreens, and the other 61% hardly knew necessity of sunscreens. Those who understood the meaning of sun protection factor(SPF) were 23.7%. Sun-protective methods except using sunscreens were use of a hat or a cap(53.2%), long-sleeved clothing(27.2%), a parasol(27.0%), heavy make-up(11.2%), and a towel(3.8%). Male respondents, people who were younger than 20 or older than 70, and those who had not sunburned the year before were less likely to use sunscreens. CONCLUSION: The results indicate an urgent need for education about the harmfulness of sun exposure as well as benefits of sunscreens.

Two cases of Cutaneous Larva Migrans / 대한피부과학회지

Cutaneous larva migrans(CLM) is a creeping cutaneous eruption that results from skin invasion by the larval form of nematodes. We experienced two patients who had typical clinical findings of CLM. One patient had a history of contact with possibly contaminated fertilizer by the larva of nematotes. The other had a history of travelling to the endemic tropical areas. We report herein two cases of CLM with the literature review of the previous CLM cases in Korea.

Clinicopathologic Study of 37 Cases of Xanthelasma Palpebrarum; Clinical Significance of Xanthelasma Palpebrarum in Hyperlipidemiae and Cardiovascular Diseases / 대한피부과학회지

BACKGROUND: Xanthelasma palpebrarum is the most common cutaneous xanthoma. Although xanthelasma is a type of xanthoma, a half of patients in most series are known to be normolipemic. OBJECTIVE: This study is an attempt to elucidate the clinical and pathologic features of xanthelasma in Korea and to know the clinical significance of xanthelasma, especially suggested role as a marker for hyperlipidemiae and increased risk for cardiovascular diseases. METHOD: Thirty seven cases of xanthelasma were clinially and pathologically analyzed. Incidence of abnomal lipid profiles and cardivascular diseases were compared with those of control group using logistic regression statistics. RESULTS: 1. The incidence of xanthelasma was 0.09% of the total number of dermatologic patients. 2. The ratio between male and female was 1: 1.8 and the mean age was 52.4 years (range;17-71 years). 3. Clinically, it typically presented as yellow or orange papules on the inner canthus of both upper eyelids. 4. The incidences of abnormal lipid profiles(hyperlipidemia and dyslipoproteinemia) are 42.4-44.0%. The levels of total cholesterol and low density lipoprotein-cholesterol were increased significantly. The incidence of the cardiovascular diseases was 16.2%, which was not statistically different from that of control group. 5. Histopathologic findings of 23 cases showed masses of foam cells in the upper dermis accompanied with sparse inflammatory cells and few giant cells. CONCLUSION: Xanthelasma seems to help to identify persons with abnormal lipid profiles which are risk factors of cardiovascular diseases and we recommand examination of lipid profiles in patients with xanthelasma.

Trichosporon Species in Onychomycosis and Tinea Pedis / 대한피부과학회지

BACKGROUND: Onychomycosis and tinea pedis are common superficial fungal infections. Causative organism in onychomycosis and tinea pedis have been extensively studied, but the pathogenic role of non-dermatophyte is still controversial. Trichosporon species are soil and water-inhabiting yeasts, and occasionally found in the normal flora of human skin, mouth, and nails. Trichosporon spp. have been reported to be one of the pathogens in onychomycosis and tinea pedis. OBJECTIVE: We performed mycologic studies to investigate the prevalence and significance of trichosporon spp. in skin and nail lesions, which were clinically suspected of onychomycosis and tinea pedis. METHOD: We performed a survey of the mycologic laboratory records of patients clinically suspected of onychomycosis and tinea pedis from August 2001 to July 2002, and tried to identify trichosporon to species level by using API 20C kit systems. RESULTS: Out of total 1509 nail and skin samples examined, 663(43.9%) were culture positive. Trichosporon spp. were recovered from 11.2%(74/663) of the samples. In onychomycosis considered alone, the prevalence of solitary isolated Trichosporon spp. was 7.7%. In species level, T. asahii(62.1%), T. mucoides(20.3%), and T. inkin(14.9%) were isolated in decreasing frequency. The positive rate for KOH examination in trichosporon spp. was 52.9%. Among the isolated trichosporon spp., mixed cultures with other organisms were 13(17.6%) and solitary isolates were 61(82.4%). 31(41.9%) were not only positive for KOH examination but also founded in pure culture in relatively large colony counts. In pure culture isolations, high colony counts predominated over mixed cultures. CONCLUSION: Trichosporon spp. is a relatively common isolates from fungal cultures of skin and nail, and it may be pathogenic in some cases of skin or nail infection.

Two Cases of Acquired Fibrokeratoma Occuring on the Prepatellar Area and the Nail Bed / 대한피부과학회지

Aquired fibrokeratoma is a rare, benign tumor which occurs most frequently on the fingers. Because of the digital predilection, a term of digital fibrokeratoma has been frequently used. We present here two cases of acquired fibrokeratoma occurring on the prepatellar area and the proximal nail bed which are unusual sites of this lesion. A skin-colored, hyperkeratotic tumor with finger-like projection was found on the prepatellar area of a 29-year-old man and a round pedunculated nodule was found on the proximal nail bed of second finger of a 74-year-old woman. Histopathologic examination revealed typical features of acquired fibrokeratoma.

A Case of Mucormycosis Involving the Skin in Renal Transplant Recipient / 대한피부과학회지

Mucormycosis is a rare and opportunistic infection usually associated with hematologic diseases, diabetes mellitus, renal failure, solid tumors, and organ transplantations. We present here a considered case of disseminated mucormycosis in renal transplant recipient. A 60-year-old man who had undergone second kidney transplantation for a month visited emergency room due to 5 day history of cough with spiking fever and abnormal mental status and vital signs were rapidly deteriorated. Septic shock was suspicious. He was admitted to ICU and treated with broad spectrum antibiotics and antiviral agents, but there was no improvement. A few days later, several large hemorrhagic blisters and purpura occurred on the face, trunk, and both lower extremities. The histopathologic examination from skin specimen revealed large, broad, nonseptate hyphae branched at right angles in the dermis and blood vessels, which was consistent with mucormycosis. But the skin culture for fungus was negative. He had had no skin trauma history and evidence. So we considered the disseminated mucormycosis from unknown primary origin. He died of progressive respiratory failure before antifungal treatment.

Clinico-Epidemiologic study on the Abuse, Misuse, and Adverse Effects of Topical Dermatologic Drugs / 대한피부과학회지

BACKGROUND: The abuse, misuse, and adverse effects to topical drugs have been widespread in Korea due to lack of awareness of seriousness of drug abuse and misuse, and improper designation of prescription and non-prescription drugs. OBJECTIVE: This study was conducted to bring Korean people to an awareness of the abuse, misuse, and adverse effects of topical drugs, and to stress the importance of proper designation of non-prescription drugs. METHODS: A multicenter, prospective, clinico-epidemiologic evaluation was made from patients with adverse effects to topical drugs who visited 31 dermatologic departments in university hospitals or private clinics nationwide from march, 2002 to December, 2002. RESULTS: The diagnostic incidence of adverse effects from topical drugs are abuse and misuse (40%), dermatophytosis incognito (29%), bacterial infection (14%), contact dermatitis (9%), acne (2.5%), skin atrophy (1.4%), telangiectasia (1%). Erghty three percent of adverse effects are caused by topical corticosteroids, and betamethasone valerate, prednicarbate and triamcinolone acetonide are commonly used topical corticosteroids that induce adverse effects frequently. The most common way to obtain topical drugs is purchase directly from pharmacist without prescriptions. CONCLUSION: From this study, we confirmed that adverse effects to topical corticosteroids are very common even after the enforcement of designation of prescription drugs and non-prescription drugs. The proper designation of prescripton drugs should be reevaluated and based on the safety of patients to protect people from adverse effects of topical drugs.

A Case of Hair Follicle Nevus / 대한피부과학회지

Hair follicle nevus is a very rare hair follicle tumor and should be differentiated from other hair follicle hamartomas, such as trichofolliculoma, dilated pore of Winer, pilar sheath acanthoma, and trichodiscoma. We describe a 4-year-old female patient who presented erythematous papule on the face that was histopathologically diagnosed as hair follicle nevus.

A Case of Toenail Onychomycosis Caused by Trichosporon asahii / 대한피부과학회지

We report the first case of toenail onychomycosis caused by Trichosporon asahii in a 60-year old Korean man. The patient presented with a typical distal subungual onychomycosis. Direct microscopic examination of scrapings on the potassium hydroxide(KOH) preparation revealed fungal elements. On modified dermatophyte agar, the colony was white color and wrinkled, folded with furrows and convolutions and microscopic morphology showed long rectangular arthroconidia and lateral blastoconidia of trichosporon species. The fungus was identified as T. asahii using API 20C AUX (bioMerieux S.A., l'Etolile, France) kit.

Prevalence and Risk Factors of Tinea Pedis in Workers of Shipbuilding Industry / 대한산업의학회지

OBJECTIVES: Recently,tinea pedis has been reported to be a type of occupational dermatoses because of its high prevalence in specific working conditions.Although there is no doubt that the environment surrounding work places, the usual habits of workers etc are intimately related to this skin conditions, there is some controversy as to whether or not this condition is a real occupational illness and what is the exact cause of the high prevalence of this illness is. In this study, the prevalence of tinea pedis in workers from the shipbuilding industry was investigated andthe risk factors of this disease were evaluated. This study also aimed to verify whether or not tinea pedis is one of the occupational diseases. METHODS: The results of interviews, questionnaires and clinical findings from 1,419 workers who visited the occupational health center for an annual routine check for their health state were analyzed. RESULTS: Among the 1,419 workers, 778 workers (54.8%)had tinea pedis. By simple logistic regression analysis,the prevalence of tinea pedis was found to be affected by some variables, including the job category, the types of work,the kinds of footwear, whether or not they were using communal baths in the work places, and a family history of tinea pedis.In contrast, by multiple logistic regression analysis,only utilization of the communal baths in the work places and a family history of tinea pedis turned out to be statistically significant risk factors. CONCLUSIONS: In this study, the major factors contributing to the high prevalence of tinea pedis are the use of communal baths in the workplace and a positive family history. However, the wearing of safety shoes was not statistically significant. Therefore, tinea pedis could not be confirmed to be an occupational disease. On the basis of these results, a solution to the environmental hygiene of communal baths and the personal hygiene of individuals needs to be improved in order to prevent tinea pedis.

Clinicopathological study of 30 Cases of Cutaneous Mastocytosis / 대한피부과학회지

BACKGROUND: Mastocytosis is characterized by accumulation of mast cells in various organs, most frequently, in skin. Cutaneous mastocytosis is a relatively rare disease in outpatient clinics and the clinicopathological study has not been done yet in Korea. OBJECTIVE: The aim of this study is to analyze the clinicopathological features of cutaneous mastocytosis. In addition, we examined CD117 expression in the skin biopsy specimens immuno histochemically. METHODS: Thirty cases of cutaneous mastocytosis were collected from 1990 to 1999 in Asan Medical Center. Clinical records, photographs, and biopsy slides were reviewed. In each biopsy specimen, CD117 was stained by immunoperoxidase method. RESULTS: Among 30 cases, 29 cases were childhood type urticaria pigmentosa(76.7%) or masto cytoma(20.0%) and only 1 case occurred after 16 years of age. The incidence showed a peak under 1 year old (70.0%) and males affected 2.3 times as much as females. The trunk and distal extremities are the most common site of urticaria pigmentosa and mastocytoma, respectively. CD117 was strongly positive in all cases of urticaria pigmentosa (both child and adult type) and mastocytoma. CONCLUSION: Urticaria pigmentosa of infantile onset was the most common, followed by infantile mastocytoma. Systemic reactive manifestations are rare in cutaneous mastocytosis. The strong expression of CD117 was seen regardless of the type of cutaneous mastocytosis.

A Case of Guttate Psoriasis in the Recipients of Allogeneic Bone Marrow Transplantation / 대한피부과학회지

In many studies, it has been demonstrated that donor-derived cells would eventually replace the hematopoietic and immune system of the recipient after allogeneic bone marrow transplantation (BMT). And there are several case reports describing resolution or development of autoimmune diseases after BMT. Psoriasis is considered to be an autoimmune disease of abnormal keratinocyte proliferation induced by T lymphocytes. Herein we describe a 17-year-old woman presenting with guttate psoriasis, who suffered from acute lymphocytic leukemia and underwent allogeneic BMT 6 months ago. This is the first case of guttate psoriasis possibly associated with BMT in the Korean literature.

Scleredema: Clinicopathological Study / 대한피부과학회지

BACKGROUND: Scleredema is a rare connective disorder with unknown etiology. There were no comprehensive studies about the clinical and histopathological features of scleredema in Korea. OBJECTIVE: Our purpose was to find the clinical and pathological features of scleredema. METHODS: The 31 patients with scleredema at our institution over ten years were retrieved. We reviewed medical records, clinical photographs, and histopathology slides of these patients, retrospectively. RESULTS: 1. The male to female ratio was 23:8 (2.9:1). 2. Most of the patients had the insidious onset and chronic localized lesion on the nape and upper back. 3. In sixteen patients (16/31, 51.6%), the diabetes mellitus was accompanied. In these patients, the male predominance (14/16, 87.5%) was significant. 4. The positive staining was in 75%(15/20) of the tissues with alcian blue or mucicarmine staining. 5. In four patients, localized electron beam therapy markedly improved the skin lesion without serious adverse effects. CONCLUSION: A preceding respiratory infection was uncommon. Almost all patients had insidious onset and chronic course. Diabetes mellitus was commonly accompanied, especially in male patients. Electron beam therapy appears to be effective in the treatment of scleredema.