A Descriptive Review of Herpes Zoster-Associated Voiding Dysfunction / 대한피부과학회지

Background@#Voiding dysfunction is a rare complication of herpes zoster but impairs patients’ quality of life. @*Objective@#We investigated the clinical features and progression of zoster-associated voiding dysfunction based on the clinical presentation of urological symptoms and sites of zoster. We also investigated factors associated with delayed improvement in urological symptoms. @*Methods@#This retrospective study included 54 patients diagnosed with both herpes zoster and voiding dysfunction within a 15-day period at the National Health Insurance Service Ilsan Hospital between March 2000 and April 2019. Urological symptoms included voiding (urinary retention) and storage (cystitis and overactive bladder) symptoms. @*Results@#Patients were aged 22∼92 years (median 68.5 years), including 19 males (35.2%). We observed sacral, thoracic, lumbar, trigeminal, and disseminated zoster (44.4%, 31.5%, 18.5%, 1.9%, and 3.7%, respectively). Thirty-one patients (57.4%) showed voiding symptoms (61.3% with sacral zoster), 18 (33.3%) showed storage symptoms (83.3% with thoracolumbar zoster), and 5 (9.3%) had both symptoms. The median recovery time from urological symptoms was 14.5 days (3∼150 days), significantly longer in patients with voiding symptoms (22 days [5∼150 days]) than with storage symptoms (10 days [3∼35 days]) (p=0.001). Patients with prolonged urological symptoms (＞4 weeks vs. ≤4 weeks) were older (73 years [57∼92 years] vs. 68 years [22∼88 years]), more likely to be male (57.1% vs. 23.7%), and showed persistent pain (35 days [7∼700 days] vs. 23 days [9∼180 days]) (p＜0.05). @*Conclusion@#Voiding dysfunction in patients with zoster warrants attention. Delayed recovery of voiding function is associated with old age, male sex, and persistent pain.

A Descriptive Review of Herpes Zoster-Associated Voiding Dysfunction / 대한피부과학회지

Background@#Voiding dysfunction is a rare complication of herpes zoster but impairs patients’ quality of life. @*Objective@#We investigated the clinical features and progression of zoster-associated voiding dysfunction based on the clinical presentation of urological symptoms and sites of zoster. We also investigated factors associated with delayed improvement in urological symptoms. @*Methods@#This retrospective study included 54 patients diagnosed with both herpes zoster and voiding dysfunction within a 15-day period at the National Health Insurance Service Ilsan Hospital between March 2000 and April 2019. Urological symptoms included voiding (urinary retention) and storage (cystitis and overactive bladder) symptoms. @*Results@#Patients were aged 22∼92 years (median 68.5 years), including 19 males (35.2%). We observed sacral, thoracic, lumbar, trigeminal, and disseminated zoster (44.4%, 31.5%, 18.5%, 1.9%, and 3.7%, respectively). Thirty-one patients (57.4%) showed voiding symptoms (61.3% with sacral zoster), 18 (33.3%) showed storage symptoms (83.3% with thoracolumbar zoster), and 5 (9.3%) had both symptoms. The median recovery time from urological symptoms was 14.5 days (3∼150 days), significantly longer in patients with voiding symptoms (22 days [5∼150 days]) than with storage symptoms (10 days [3∼35 days]) (p=0.001). Patients with prolonged urological symptoms (＞4 weeks vs. ≤4 weeks) were older (73 years [57∼92 years] vs. 68 years [22∼88 years]), more likely to be male (57.1% vs. 23.7%), and showed persistent pain (35 days [7∼700 days] vs. 23 days [9∼180 days]) (p＜0.05). @*Conclusion@#Voiding dysfunction in patients with zoster warrants attention. Delayed recovery of voiding function is associated with old age, male sex, and persistent pain.

A Descriptive Review of Kerion and Non-inflammatory Tinea Capitis / 대한피부과학회지

BACKGROUND: Tinea capitis manifests either as a non-inflammatory or inflammatory type including kerion, which may cause permanent alopecia. In addition to antifungals, systemic corticosteroids (prednisolone at 1~2 mg/kg/day) have been used to reduce inflammation in patients with kerion. OBJECTIVE: We studied the clinical and laboratory features, treatments, and prognosis of tinea capitis. METHODS: We performed a retrospective review of 12 cases of kerion and 12 cases of non-inflammatory tinea capitis (median age, 8 years; range, 3 months~80 years) diagnosed using a potassium hydroxide mount at the National Health Insurance Service Ilsan Hospital between November 2011 and April 2018. RESULTS: Fungal cultures showed Microsporum species in 6 cases and Trichophyton species in 1 case. The duration of diseases and extent of lesions were greater in the kerion group than in the non-inflammatory tinea capitis group (p<0.05). Sixteen patients were treated with systemic antifungals. In the kerion group, 10 patients were treated with systemic antifungals (6 with itraconazole [median, 26 days; range, 21~58 days] and 4 with terbinafine [median, 24.5 days; range, 13~31 days]). The median intervals between the onset of treatment and scalp clearing (in 10 cases), the onset of new hair growth (in 9 cases), and complete regrowth of hair (in 7 cases) were 27 (range, 13~77), 33 (range, 19~63), and 89 (range, 42~180) days, respectively, in the kerion group. The median dosage of prednisolone used in patients with kerion was 0.26 mg/kg/day (range, 0.15~0.42) with good clinical response. CONCLUSION: The patients with kerion responded well to antifungal treatments. A lower dose of prednisolone was adequate when systemic corticosteroids were required for the treatment of kerion.

Four Cases of Perianal Streptococcal Dermatitis / 대한피부과학회지

No abstract available.

Ecthyma Gangrenosum in a Previously Healthy Adolescent / 대한피부과학회지

No abstract available.

A Descriptive Study on Meningitis and Meningoencephalitis Caused by Varicella Zoster Virus / 대한피부과학회지

BACKGROUND: Herpes zoster meningitis and meningoencephalitis, rare complications of herpes zoster, may follow the onset of rash, precede it, or even occur without rash. There have been few studies describing the order of occurrence of neurological symptoms and zoster. OBJECTIVE: We compared the clinical and laboratory features, treatments, and progress of the conditions among patients with herpes zoster meningitis and meningoencephalitis according to the timing of zoster onset in relation to neurological symptoms and also according to the immune status. METHODS: We performed a retrospective review of 21 patients with meningitis and 3 patients with meningoencephalitis who showed the characteristic rash of herpes zoster at National Health Insurance Service Ilsan Hospital between March 2000 and June 2015. RESULTS: The 11 patients in whom zoster preceded neurological symptoms had a shorter duration of neurological symptoms (median 3 days; range 1~10) than did the 13 patients who experienced neurological symptoms first (median 10 days; range 4~27) (p<0.05). The intervals between the onset of neurological symptoms and a) presentation to the hospital, b) cerebrospinal fluid tests, and c) intravenous acyclovir treatment were all shorter in the patients with zoster preceding neurological symptoms (p<0.05). No significant differences in age or immune status were observed between the two groups. In the 9 immunocompromised patients, higher incidence of meningoencephalitis and neurologic complications was noted in comparison to the 15 immunocompetent patients (p<0.05). CONCLUSION: Antecedent zoster rash in varicella zoster virus-induced meningitis and meningoencephalitis appears to lead to more rapid initiation of diagnostic tests and antiviral treatment. The possibility of central nervous system complications should not be overlooked even in patients with herpes zoster.

Generalized Pustulosis Diagnosed as Acute Generalized Exanthematous Pustulosis: Tzanck Smear and Pathological Evaluation of the Pustule Roof Can Provide Evidence for Early Diagnosis

No abstract available.

Generalized Pustulosis Diagnosed as Acute Generalized Exanthematous Pustulosis: Tzanck Smear and Pathological Evaluation of the Pustule Roof Can Provide Evidence for Early Diagnosis

No abstract available.

Acute Generalized Exanthematous Pustulosis with Hemodynamic Instability Induced by Ingestion of Lacquer Chicken / 대한피부과학회지

No abstract available.

Staphylococcal Scalded Skin Syndrome, A Descriptive Review of 17 Korean Patients / 대한피부과학회지

BACKGROUND: Staphylococcal scalded skin syndrome is a superficial blistering skin disease caused by exfoliative toxins of Staphylococcus aureus. Adult cases are rare but accompanied by high mortality rates and poor prognoses. A rapid diagnosis, including distinguishing this disease from toxic epidermal necrolysis, and immediate treatment are essential. An increasing number of methicillin-resistant Staphylococcus aureus cases has been reported recently, which further complicates the treatment options. OBJECTIVE: We performed this study to evaluate clinical features and courses, and to investigate microbiological and histological manifestations of staphylococcal scalded skin syndrome in Korean children and adults. METHODS: We retrospectively reviewed, among 14 children (including 2 neonates) and 3 adults, medical records, clinical photographs, microbiological results and histological findings, including frozen section on the blister roof and Tzanck smear in some patients. RESULTS: The adult patients had longer disease durations than children (mean 24.7 versus 9.9 days). One adult patient died of pneumonia and sepsis. The children recovered without complications. All of cultured Staphylococcus aureus in 11 of the 17 patients were methicillin-resistant. On the frozen sections, the roof of the blister consisted of the uppermost epidermis. Taking specimens from fresh blisters was important for clear diagnosis. CONCLUSION: Adult patients had longer disease durations and poorer prognoses than children. The frozen section on the roof of fresh blister and the Tzanck smear were convenient methods for early and dependable diagnosis. Given the prevalence of methicillin-resistant strains of Staphylococcus aureus, treating the condition with antibiotics covering this strain should be considered.

Two Cases of Widespread Eczema Herpeticum with Low Serum Vitamin D Levels / 대한피부과학회지

Eczema herpeticum is a disseminated herpes simplex virus infection mainly in atopic individuals. Low expression of cathelicidin in atopic dermatitis contributes to the lack of defense capability against viral infection. Serum vitamin D level, which is essential for cathelicidin induction, is reported to be low in patients with severe atopic dermatitis. However, serum vitamin D level has not been studied in patients with eczema herpeticum. The mainstay of treatment of eczema herpeticum is systemic antiviral therapy. In atopic individuals with eczema herpeticum, intravenous immunoglobulin is less likely to enhance cutaneous viral susceptibility than other immunomodulators. Herein, we report two pediatric cases of widespread eczema herpeticum, both accompanied by high fever and low serum vitamin D levels. The patients were successfully treated with intravenous acyclovir and intravenous immunoglobulin. Serum 25-hydroxyvitamin D3 level was even less than 4.0 ng/ml in one patient, and no more repeated episodes of eczema herpeticum occurred, after supplementation of vitamin D.

Analysis of Polycheck Allergy Results of the Recent Two Years: Comparison with Skin Prick Test and ImmunoCAP

BACKGROUND: Multiple Antigen Simultaneous Test (MAST)-immunoblot assay is a practical and economical test, which has been recently introduced nationwide. Authors investigated test efficiency of a MAST-immunoblot assay, Polycheck Allergy (PA). METHODS: A total of 3,153 patients were tested by PA and the results were compared with the results of ImmunoCAP and skin prick test (SPT) in 532 and 75 patients, respectively. The correlation with the lgE results measured by VIDAS was also analyzed. RESULTS: The agreements of PA with SPT were 87.8% in the Inhalant Panel and 89.3% in the Food Panel and the agreement of ImmunoCAP with SPT was 95.2%. The most common allergens giving positive reactions were Dermatophagoides farinae (46.2%) and Dermatophagoides pteronyssinus (40.0%). SPT taken as a reference, PA compared with ImmunoCAP showed higher agreement (D. farinae, 76.0 vs. 70.7%; D. pteronyssinus, 76.0 vs. 74.4%), sensitivity (D. farinae, 72.7 vs. 68.2%; D. pteronyssinus, 75.0 vs. 71.2%) and specificity (D. farinae, 85.0 vs. 81.3%) except for the specificity for D. pteronyssinus (78.3 vs. 87.5%). The rate of allergen specific IgE positive patients was higher than that of negative patients when total IgE was over 100 kU/L. CONCLUSIONS: Our results showed that the agreement, sensitivity and specificity of PA were similar to or better than those of the previously established test, ImmunoCAP. The allergen specific IgE results of PA were in correlation with total IgE. PA may be used for testing allergen specific IgE to diagnose and treat allergic diseases.

Analysis of Polycheck Allergy Results of the Recent Two Years: Comparison with Skin Prick Test and ImmunoCAP

BACKGROUND: Multiple Antigen Simultaneous Test (MAST)-immunoblot assay is a practical and economical test, which has been recently introduced nationwide. Authors investigated test efficiency of a MAST-immunoblot assay, Polycheck Allergy (PA). METHODS: A total of 3,153 patients were tested by PA and the results were compared with the results of ImmunoCAP and skin prick test (SPT) in 532 and 75 patients, respectively. The correlation with the lgE results measured by VIDAS was also analyzed. RESULTS: The agreements of PA with SPT were 87.8% in the Inhalant Panel and 89.3% in the Food Panel and the agreement of ImmunoCAP with SPT was 95.2%. The most common allergens giving positive reactions were Dermatophagoides farinae (46.2%) and Dermatophagoides pteronyssinus (40.0%). SPT taken as a reference, PA compared with ImmunoCAP showed higher agreement (D. farinae, 76.0 vs. 70.7%; D. pteronyssinus, 76.0 vs. 74.4%), sensitivity (D. farinae, 72.7 vs. 68.2%; D. pteronyssinus, 75.0 vs. 71.2%) and specificity (D. farinae, 85.0 vs. 81.3%) except for the specificity for D. pteronyssinus (78.3 vs. 87.5%). The rate of allergen specific IgE positive patients was higher than that of negative patients when total IgE was over 100 kU/L. CONCLUSIONS: Our results showed that the agreement, sensitivity and specificity of PA were similar to or better than those of the previously established test, ImmunoCAP. The allergen specific IgE results of PA were in correlation with total IgE. PA may be used for testing allergen specific IgE to diagnose and treat allergic diseases.

Two Cases of Eccrine Poroma on the Abdomen / 대한피부과학회지

No abstract available.

The Effect of Ultrasound on Epidermal Permeability Barrier and Lipid Synthesis / 대한피부과학회지

BACKGROUND: Abrogation of the epidermal permeability barrier results in an increased lipid synthesis and lipid synthetic enzymes. Recent studies have shown that ultrasound can induce changes in the epidermal calcium gradient that increase lamellar body secretion without increasing transepidermal water loss (TEWL). OBJECTIVE: We undertook this study to identify whether ultrasound can stimulate lipids synthetic enzymes and lipids synthesis. METHODS: Ultrasounds were applied to the skin of hairless mice, and we then quantified lipid synthesis, real time RT-PCR to measure mRNA activities of lipid synthetic enzymes and TEWL. We also performed RuO4 post fixation and calcium ion capture cytochemistry. RESULTS: There were no significant changes of TEWL before and after ultrasound treatment. Calcium in upper epidermis decreased and that in lower epidermis increased after treatment of ultrasound and some recovery of epidermal calcium gradient after 6 hours. In RuO4 post fixation, lacuna dilatation, partial distension of intercorneocyte space, loss of multilamellar structures and increased lamellar body secretion were observed in the epidermis of the ultrasound treated hairless mice. The mRNA levels of 3-hydroxy 3-methylglutaryl coenzyme A (HMG CoA) reductase, serine palmitoyl transferase (SPT), fatty acid synthase (FAS) and lipid synthesis were increased in the epidermis of the ultrasound treated hairless mice. CONCLUSION: Ultrasound can increase mRNA of lipids synthetic enzymes and lipids synthesis without increasing TEWL by changing calcium ion gradients.

Epithelioid Hemangioma Associated with Nevus Flammeus / 대한피부과학회지

Epithelioid hemangioma, the term which was first used by Enzinger and Weiss, is synonymous with angiolymphoid hyperplasia with eosinophilia. It defines a lesion occurring usually in the dermal and subcutaneous tissue of the head and neck, characterized by localized, marginated and relatively symmetrical proliferation of the capillaries around a medium-sized vessel with an epithelioid hyperplasia of endothelial cell. There is a marked inflammatory reaction composed of lymphocytes and eosinophils. We report a case of epithelioid hemangioma associated with nevus flammeus in a 53-year-old male. Histology revealed typical feature of epithelioid hemangioma that proliferation of dilated vessels with prominent endothelial cells surrounded by dense lymphoid cell infiltrates but no eosinophils were identified.

Atopic Dermatitis and Skin Barrier

Atopic dermatitis (AD) is an inflammatory skin disorder characterized by itching, chronically relapsing course, typical stribution, and family history of allergies. The pathogenesis of AD is unknown but the development of AD is undoubtedly influenced by immunologic abnormality. But the broad clinical spectrum of this disease cannot be explained simply by allergy or immunological abnormalities. In recent studios revealed skin barrier dysfunctions in AD. We consider immunological abnormality and skin harrier dysfunction as two core defects of AD. The wide range of clinical manifestation of AD can be more easily comprehended by partial overlapping of these two core abnormalities. These two core abnormalities influences each other. This sequence results in a 'vicious cycle', which plays the most important role in pathogenesis of AD.

Efficacy of a 20% Aluminum Chloride in Alcohol Solution in the Treatment of Hyperhidrosis: A Study Using a Hydrometer

BACKGROUND: Excessive sweating, especially of the palms, soles and axillae, is a socially and an occupationally distressing, and sometimes disabling condition. A variety of treatment methods are used to reduce profuse sweating including topical agents, iontophoresis and symphatectomy. OBJECTIVE: We investigated whether a 20% aluminum chloride solution is efficient in the treatment of axillary and palmoplantar hyperhidrosis using a skin surface hydrometer. METHODS: We treated 31 patients (7; male, 24; female) by Drysol once a day at bedtime for four weeks. We had measured the conductances on the stratum corneum of the palms, soles and axillae using a skin surface hydrometer before and after treatment every week for four week RESULTS: There was a reduction of conductances after the treatment by Drysol (p<0.05). The reduction of conductances was continued for four weeks (p<0.05). CONCLUSION: Drysol is an efficient, safe, and simple method for initial treatment of the primary hyperhidrosis.

Hypomelia-Hypotrichosis-Facial Hemangioma Syndrome

We report a mild variant of hypomelia-hypotrichosis-facial hemangioma syndrome in a 3 month-old female. The patient showed major features of the previously reported cases including flexion deformities of both upper extremities, sparse light colored hair, mid-facial hemangioma and a characteristic facial appearance. Roentgenogram showed radio-humeral synostosis at both elbow joints by which shortening of upper limbs could be anticipated. However, intra- and extrauterine growth retardation were not remarkable and the lower limbs were not affected.

A Case of Type III Hyperlipoproteinemia Associate with Xanthoma Tuberosum and Xanthoma Striatum Palmare / 대한피부과학회지

We report a case of type III hyperlipoproteinemia associated with xanthoma eruptivum. Xanthoma tuberosum, and xanthoma striatum palmare whose clinical symptoms have been improved by the treatment of gemfibrozil. A 31-year-old male patient visited our clinic for evaluation of multiple yellowish nodules on the elbows, multiple yellowish plaques on the buttocks and linear yellowish plaques along with the palmar creases on both palms. The blood chemistry showed an elevation of cholesterol and triglyceride. Lipoprotein electrophoresis showed broad betazone and plasma standing test showed turbid plasma. Lipoprotein ultracentrifugation showed that the ratio of VLDL cholesterol and plasma triglyceride was 0.38. According to the above findings, we diagnosed this patient as type III hyperlipoproteinemia. After 4 months of treatment with diet and gemfibrozil, the serum level of cholesterol and triglyceride were reduced to normal range. The skin lesions of both palms showed marked improvement but the skin lesions on elbows and buttocks were not much improved.