A Case of Clear Cell Acanthoma / 대한피부과학회지

Clear cell acanthoma has been described clinically as a well circumscribed round 1-2cm sized pink to brown colored solitary nodule or plaque. It develops slowly and affects people aged 40-60 years, and the lower legs are the site of predilection. It is composed of clear cells, and reveals hyperkeratosis, parakeratosis, acanthosis, and no granular layer as well as exocytosis and microabscesses of neutrophils. In the dermis, slight increase of microvasculatures and perivascular inflammatory infiltrations exist. There is just one case reported in Korea about it, and we report another case of clear cell acanthoma developed on the lateral side of the right foot of a 65-year-old woman.

A Case of Acquired Ichthyosis Associated with Diabetes Mellitus, Chronic Renal failure and Hypertension / 대한피부과학회지

Acquired ichthyosis is a rare condition and ususually occurs in adult patients with various systemic diseases and drugs that affect cholesterol metabolism. As a rule when the underlying disease goes into remission, the ichtyosis regress. Clinically and histopathologically it is similar to ichthyosis vulgaris. We report a 43-year-old man with acquired ichthyosis, who associated with diabetes mellitus, chronic renal failure and hypertension.

A Case of Merkel Cell Carcinoma / 대한피부과학회지

Merkel cell carcinoma is an uncommon malignancy originally called "trabecular carcinoma" by Toker in 1972. Although the exact origin of the Merkel cell is unknown, it probably arises from neuroendocrine cell of the basal epidermis. It then grows vertically into the dermis and subcutaneous tissue. The tumor usually affects older persons, with a median age at presentation of 66 years. Although its cause is unknown, its propensity to occur on the head, neck, or extremities suggests that sun exposure may play a role. We report a case of a 58-year-old woman who showed a solitary dusky red-colored tumor on the right upper arm. The tumor had rapidly grown since 2 months ago but there was no evidence of regional lymph node and distant metastases. Microscopically, the tumor cells were uniform with round to oval shaped nucleus and scanty cytoplasm, and showed trabecular, anastomosing cord-like arrangement mainly in the dermis and subcutaneous tissue. Ultrastructually, membrane-bound neurosecretory granules were found in the cytoplasm and characteristic perinuclear filaments were retained in each tumor cell. We performed wide local excision with 3cm margin and prophylactic radiation therapy.

A Case of Mycosis Fungoides following Multiple Open Fractures / 대한피부과학회지

We report a case of mycosis fungoides in a 30 year-old man who had been treated for multiple open fractures after a traffic accident. Histopathologic findings showed epidermotrophism wiih hyperchromatic haloed lymphocytes and atypical lymphocytic infiltration in the upper dermis. The infiltrated cells were positively stained with CD45Ro, but not with CD20. He had no evidence of extracutaneous involvement by laboratory studies, Skin lesions improved markedly after treatment with systemic PUVA therapy combined with topical corticosteroids for 3 months.

A Case of Aneurysmal Benign Fibrous Histiocytoma / 대한피부과학회지

Aneurysmal benign fibrous histiocytoma(ABFH) is a relatively rare variant and has a distinctive histopathological features, that is collections of capillaries, foci of hemorrhage, siderophages, and foamy macrophages surrounding cleft-like and cavernous blood filled spaces in the tumor. But, in spite af the distinctive features, it is not infrequently confused with malignant melanoma, angiomatoid malignant fibrous histiocytoma, and vascular tumors such as spindle cell hemangioendothelioma, nodular Kaposi's sarcoma and angiosarcoma. We report a case of ABFH developed on the left upper extremity of a 41-year-old man.

Localized Trichorrhexis Nodosa Arising From Habitual Rubbing

Trichorrhexis nodosa(TN) denotes small node-like swelling with a loss of cuticle of the hair shaft through which the hair readily fractures. The basic cause of TN is mechanical or chemical trauma, and a contributing factor is an inherent weakness of the hair shaft. We report a case of localized TN in a 37-year-old male. He had an ovoid hair patch with multiple small white-gray dotted and stubby hairs localized to the right occipital scalp. TN is known to be the commonest of all hair shaft anomalies (Price, 1975). However TN is rarely reported, and there have been only four reports in Korean dermatological literature, to our knowledge, which might be due to underdiagnosis of this disorder. We postulated that diagnostic difficulty lies in the discrepancy between terminology and gross morphological findings.

An Immunohistochemical Study of the Expression of Hepatitis B Virus Antigens and p53 in Patients with Cutaneous Vasculitis Accompaied by Hepatitis B Surface Antigen-positive Hepatopathy / 대한피부과학회지

BACKGROUND: Cutaneous vasculitis associated with viral hepatitis seems to occur as a hypersensitivity reaction against the circulating viral antigens. Hepatitis B virus(HBV)-encoded X antigen(HBxAg) is known to participate in the carcinogenesis of hepatocellular carcinoma(HCC) by the inactivation of p53. However, HBxAg has been found in chronic infiammatory lesions without the overexpression of p53. Accordingly, not only EBsAg and HBcAg but also HBxAg may be involved in HCC-associated cutaneous vasculitis, regardless of the alteration of p53. OBJECTIVE: This study was conducted to investigate the expression of HBV-encoded antigens in cutaneous vasculitis accompanied by HBV hepatopathy. Additionally, we have compared the expression of 3 HBV antigens and p53 between vasculitic patients with HCC and in others showing HCC-non-associated vasculitis. METHODS: Immunohistochemically, we examined the expression of HBsAg, HBcAg, and HBxAg in the tissue specimens taken from the vasculitic lesions of the 33 HBsAg-positive enrolled patients with cutaneous vasculitis proven by skin biopsy. RESULTS: 1. The immunohistochemical positivity rate to HBsAg in vasculitic patients with HBV hepatopathy was 66.7% overall. It was 90% in HCC-associated vasculitic subjects and 56.5% in the vasculitic subjects without HCC, respectively. 2. We found the expression of HBxAg in 80% of the vasculitic subjects showing HCC. The vasculitic patients without HCC showed 17,3% of the positivity rate to HBxAg. 3. We could not find the overexpression of p53 in the vasculitic tissue specimens of the HCC patients without the cutaneous metastasis from primary HCC. CONCLUSION: HBsAg, HBcAg and HBxAg may participate in the pathogenesis of cutaneous vasculitis with HBV hepatopathy, regardless of tumorigenesis.

A Clinical Observation of Inflammatory Bowel Disease Occuring in Patients with Psoriasis / 대한피부과학회지

BACKGROUND: Inflammatory bowel disease(IBD) such as ulcerative colitis or Croln's disease is often related with varied diseases including pyoderma gangrenosum, erythema nodosum, ankylosing arthritis and psoriasis. To date, however, a cIinical observation of IBD accompanied by psoriasis has been sparcely accomplished although an immunogenetic mechanism explaining a coexistence of IBD and psoriasis has been proposed. OBJECTIVE: We estimated the prevalence of IBD in patients with psoriasis in Korea and investigated the clinical characteristics of IBD accompanied by psoriasis. METHODS: 92 psoriatic patients and 389 non-psoriatic control subjects were enrolled in this study. Colonoscopic biopsy and barium series were performed in 47 psoriatic patients and 110 control subjects showing irritative intestinal symptoms. RESULTS: 1. The prevalence of IBD in psoriatic patients(14.1%) was significantly greater than in the control group(1.0%). 2. In the temporal relationship, psoriasis developed several years prior to the onset of IBD in 84.6% of psoriatic patients. 3. The frequency of arthropathies in the psoriatic patients possessing IBD(84.6%) was significantly higher than that of non-psariatic counterparts with IBD(25.0%) or that of psoriatics without lBD(2.5%), 4. The psoriatir. patients with IBD demonstrated much more frequently diffuse colonal extension than in non-psoriatic subjects with IBD. CONCLUSION: Our findings of an increased prevalence of IBD in the psoriatic population present further evidence of an association between IBD and psoriasis. In the psoriatic patients showing acute or chronic gastrointestinal symptoms, colonoseopic evaluation might be mandatory for the evaluation of IBD.

Neonatal Lupus Erythematosus / 대한피부과학회지

Neonatal lupus erythematosus (NLE) is a transplacentally acquired autoimmune disorder, which is characterized by cutaneous lesions and/or congenital heart block and less commonly hepatic and hematologic abnormalities. Affected infants acquire anti-SSA/Ro antibody, anti-SSB/La antibody or less commonly anti-U1RNP antibody transplacentally from maternal circulation and it is generally thought that these antibodies are pathogenic. We report a case of NLE in a 40-day-old neonate who had erythematous annular patches on his face and extremities. Serological studies were reactive for antinuclear antibody of the speckled pattern and positive for anti-SSA/Ro antibodies and anti-SSB/La antibodies in both mother and infant. Addition to these findings, his mother had complained photosensitivity and arthralgia and showed hematological abnormalities including anemia and leukopenia, so we diagnosed his mother as systemic lupus erythematosus.

A Prospective Study for the Prevalence of Helicobacter Pylori Infection in Patients with Chronic Urticaria in Korea / 대한피부과학회지

BACKGROUND: Helicobacter pylori(H. pylori) infection is known to be strongly associated with varied dermatoses such as rosacea, vasculitic purpura, and Sweet's syndrome. Also, many antibiotics including amoxicillin, clarithromycin, and tetracycline have been used to ameliorate chronic urticaria. This recent knowledge posed the plausibility that H. pylori infection might be an underlying causative factor of chronic urticaria. OBJECTIVE: This study was conducted to investigate the role of H. pylori infection in patients with chronic urticaria. METHODS: Sixty-five subjects with chronic urticaria were examined for H. pylori infection with enzyme-linked immunosorbent assay for IgG/M against H. pylori and rapid urease test(CLO test) for endoscopically biopsied gastric mucosa. Amoxicillin or clarithromycin combined with omeprazole as a therapy was administrated to the 44 patients with positive test results for 4 weeks. RESULTS: H. pylori infection was more frequently diagnosed in 44 of 65(67.7%) patients with chronic urticaria than in the control subjects(8.8%). After the completion of treatment for 4 weeks, specific IgG antibodies and a CLO test against H. pylori were negative in 28 of 38(73.7%) and 43 of 44(97.7%) patients respectively. At the post-treatment evaluation, 37 of 44(84.1%) patients with H. pylori-positive urticaria showed significant clinical remission of urticaria. CONCLUSION: Eradication of H. pylori in patients with chronic urticaria was accompanied by clinical remission of urtication. There is substantial evidence that unexplained causes of chronic urticaria may be associated with H. pylori infection.

Hair Casts in Sisters / 대한피부과학회지

Hair casts are firm, yellowish white accretions ensheathing but not attached to the scalp and are freely movable up and down the affected shafts. There are two types of hair casts. The common type is found frequently in association with parakeratotic scalp disorders. The uncommon type, peripilar keratin cast is not associated with any cutaneous abnormality either in the scalp or elsewhere and it develops in young girls aged between 2 and 8 years. We report two cases of peripilar keratin casts that had developed in sisters who have had tightly tied-up their hairs for a long time.

Clear Cell Hidradenoma: Report of three cases

Clear cell hidradenoma, generally as an eccrine sweat gland origin, is a fairly uncommon tumor and occurs as a slowly growing, usually solitary nodule. The histological patterns vary from one tumor to another and in different parts of the same tumor. We experienced three cases of clear cell hidradenoma which were diagnosed by the histopathologic examination of the tumor mass removed by surgical excision. Clinical and histopathologic features of each case were reviewed and compared.

A Case of Kaposi's Sarcoma Associated with Kidney Transplantation / 대한피부과학회지

Kaposis sarcoma is well recognized in patient,s with imrnunodef cienicy states such as organ trans plantation, malignancy, and acquired irnmunodeficiency syndrome(tILS). Kaposis sarcorna associated with organ transplantation is, however relatively uncomrnon in Konea. We report a case of Kaposi's sarcorna in a 23 year old male kidney recipient., who was on cyclosporine and prednisolone. The tumor involved the larynx and long as well as the skin. He was treated with radiation therapy and chemotherapy, and the dosage of immunosupressants were reduced.