Differences in Comorbidity Profiles between Early-Onset and Late-Onset Alopecia Areata Patients: A Retrospective Study of 871 Korean Patients

BACKGROUND: Alopecia areata (AA) is a common dermatologic condition with a broad spectrum of clinical features and age of onset, classically characterized by nonscarring patches of hair loss. In the past, early-onset (before adolescence) AA has been associated with various autoimmune diseases, especially atopic diseases and lupus erythematosus and demonstrates a worse prognosis compared with late onset AA. OBJECTIVE: To evaluate the differences in the comorbidity profile of AA with regard to age at onset. METHODS: We completed a retrospective study of 871 Korean AA patients seen at our department within the last 10 years. After these patients were subdivided according to onset before or after age 13 years, the two groups were compared on the basis of their comorbid disorders, family history of AA, and hematologic test results. RESULTS: Our results demonstrate that significantly more patients in the early-onset group had a personal history of atopic dermatitis or family history of AA. These findings are consistent with previous reports associating early-onset AA with autoimmune diseases and a family history of AA in different ethnic populations. Most of the serologic test values showed no significant differences between the groups and the results were considerably affected by age. CONCLUSION: This study is significant because it is a large group study in Korean AA patients, and Korean AA patients with an onset age before adolescence show similar clinical manifestations to other ethnic populations.

Hidroacanthoma Simplex Clinically Mimicking Squamous Cell Carcinoma / 대한피부과학회지

No abstract available.

Effect of IGF-I on Hair Growth Is Related to the Anti-Apoptotic Effect of IGF-I and Up-Regulation of PDGF-A and PDGF-B

BACKGROUND: Insulin-like growth factor-I (IGF-I) shares a high degree of structural and functional homology with insulin and is a potent mitogen supporting cell growth and survival in many kinds of the tissues and cells. It also plays a role in some differentiation and anti-apoptotic functions. In previous reports, it has been shown that IGF-I stimulates hair follicle (HF) growth, maintains the anagen stage, and postpones the catagen stage. OBJECTIVE: The exact mechanism of the effect of IGF-I on HF growth is not yet established. Therefore, we investigated the relationships between IGF-I and various other factors (i.e. apoptosis related molecules, pro-inflammatory cytokines, other growth factors, etc.) in the control of HF growth. METHODS: The effect of IGF-I on human hair growth was measured using an organ culture model of human HFs and compared with a control group that did not receive IGF-I. We also measured mRNA expression of factors related to hair growth and apoptosis (which was determined by reverse transcription polymerase chain reaction (RT-PCR). RT-PCR was done on days 2, 4, 6, and 8 of organ culture. RESULTS: In organ cultured human hair follicles, IGF-I had a positive effect on the rate of linear hair growth. IGF-I maintained the anagen phase. IGF-I increased the expression of platelet-derived growth factor (PDGF)-A, PDGF-B and the expression ratio of Bcl-2/Bax. CONCLUSION: The effect of IGF-I on hair growth appears to be related to the upregulation of PDGF-A and PDGF-B and to the anti-apoptotic effect of IGF-I.

A Case of Atrophoderma of Pasini and Pierini Associated with Borrelia burgdorferi Infection Successfully Treated with Oral Doxycycline

Atrophoderma of Pasini and Pierini is a form of dermal atrophy that manifests as either single or multiple, sharply demarcated, hyperpigmented, non-indurated patches. These patches are marked by a slight depression of the skin, with an abrupt edge (i.e., the "cliff-drop" borders), usually located on the backs of adolescents or young adults. The pathophysiology of the disease is unknown, but some authors have suggested a role of Borrelia burgdorferi infection. A 35-year-old woman visited our department because of asymptomatic, hypopigmented, depressed patches on her chest and back lasting for three months. Laboratory evaluations were normal, except for positive serum antibodies to Borrelia burgdorferi. Histologic examination revealed a significantly decreased thickness of the dermis. The patient underwent treatment with oral doxycycline 200 mg/day for six weeks, after which the depth of depression was improved. Herein, we report a case of atrophoderma of Pasini and Pierini, associated with Borrelia burgdorferi infection, successfully treated with oral doxycycline.

A Case of Membranous Lipodystrophy Observed in Lichen Amyloidosis

Membranous lipodystrophy is characterized by the presence of microcysts lined by amorphous, eosinophilic material with an arabesque appearance. We experienced a case of a 72-year-old man who had dark brownish, pruritic papules on the arms, legs, and back. Histopathologic examination of a biopsied lesion showed homogeneous, eosinophilic material in the papillary dermis, as well as membranous lipodystrophy. We report a case of membranous lipodystrophy observed in lichen amyloidosis.

An Open Label, Multi-center Clinical Trial of Topical 5% Minoxidil Solution for the Treatment of Male Androgenetic Alopecia (A Phase IV Study) / 대한피부과학회지

BACKGROUND: Topical 5% minoxidil solution stimulates new hair growth and it helps stop the loss of hair on individuals with androgenetic alopecia (AGA). OBJECTIVE: We wanted to assess the efficacy and safety of topical 5% minoxidil solution for treating Korean men with AGA. METHODS: This was a 24-week, open label, clinical trial that was conducted at 14 university dermatologic centers nationwide throughout South Korea as a multicenter study of the Korean Hair Research Society. The eligible subjects for this study were 18- to 65 year-old men with androgenetic alopecia, as defined by the Norwood scale as type III vertex, IV and IVA. A total of 175 men (20~62 years old) with AGA applied topical 5% minoxidil solution twice daily. Efficacy was evaluated by 1) the total hair count per 1 cm2 and 2) the mean hair diameter and 3) the patient assessment and 4) the investigator assessment of the change in scalp coverage and the benefit of treatment. RESULTS: At week 24 as compared with baseline, there was a statistically significant increase in the total hair counts and the mean hair diameter (p<.0001). Topical 5% minoxidil solution helped improve the investigator and patient assessments. The topical 5% minoxidil solution was well tolerated over a 24-week period. CONCLUSION: We believe that topical 5% minoxidil solution is a safe and effective drug for Korean men with AGA.

Linear Scleroderma Improved by Narrow Band UVB Phototherapy / 대한피부과학회지

Morphea is a sclerotic connective tissue disorder and it is thought to be caused by the decreased activity of collagenase. Various therapeutic modalitiessuch as topical steroid and systemic steroid, antimalarial agents, cyclosporine and phototherapy have been shown to be effective to treat this illness. Recently, PUVA and UVA1 phototherapy for localized scleroderma have been shown to have excellent efficacy. But PUVA and UVA1 phototherapy also have some disadvantages. So another phototherapy modality is warranted. Herein we report on a case of a 7 year female patient with linear scleroderma and she obtained a successful result with NBUVB phototherapy.

A Case of Hunter Syndrome / 대한피부과학회지

We report a case of Hunter syndrome in a 4 year old boy, who presented with firm skin colored papules and nodules that coalesce to form a reticular pattern (pebbling of the skin) with extensive Mongolian spots. The lesions are arranged bilaterally and symmetrically over the scapulae, upper arm and lateral aspects of the thighs. He also has low intelligence, coarse face, saddle nose and claw hand contracture of both hands. The result of qualitative analysis of urine was positive for dermatan sulfate and heparan sulfate. And enzyme activity of iduronate-2-sulfatase is decreased in plasma and leukocyte. A skin biopsy specimen section stained with hematoxylin-eosin showed widely separated collagen bundles in the dermis associated with mucin deposition.

A Case of Pigmented Fungiform Papillae of the Tongue / 대한피부과학회지

Pigmented fungiform papillae of the tongue are characterized clinically by pigmentation confined to these papillae and histopathologically by melanophages in the lamina propriae. We report a case of pigmented fungiform papillae of the tongue in a 24-year-old Korean woman who has a dark brown-colored pigmented lesion on the anterolateral fungiform papillae.

A Case of Secondary Cutaneous Plasmacytoma, IgDlambda Type on Scalp / 대한피부과학회지

Cutaneous plasmacytoma (CP) is a localized collection of monoclonal plasma cells in the skin. The disease is divided into primary cutaneous plasmacytoma and secondary cutaneous plasmacytoma groups. Secondary cutaneous plasmacytoma, which is so rare as to occur in only 2% of myeloma cases, usually represents terminal expression of the primary diseases and is associated with increased tumor burden. CP can occur at any site of the skin, but we could find only 1 case in English literature related to scalp metastasis alone. Also serum and urine electrophoresis, tissue immunohistochemistry for IgD are not usually conducted in the laboratory. IgDlambda subtype seems to be another value to report. We report a case of secondary cutaneous plasmacytoma, IgDlambda type which developed on the scalp alone of a 41-year-old woman, with a review of related literatures.

A Case of Angiolymphoid Hyperplasia with Eosinophilia / 대한피부과학회지

Angiolymphoid hyperplasia with eosinophilia (ALHE) usually presents as pink to red-brown, dermal papules or nodules on the head and neck, especially around the ears and on the scalp. ALHE also occurs in the mouth, trunk, and extremities, penis and vulva. It can be painful or itchy and is known to be partly (20%) associated with peripheral blood eosinophilia. Histopathological findings show proliferation of blood vessels with plump endothelial cells and perivascular infiltration of numerous lymphocytes and eosinophils. We reported a 30-year-old female patient who had mild pruritic erythematous papules on the scalp that histopathologically showed features of ALHE. She was successfully treated with an intralesional injection of triamcinolone acetonide.

Pyogenic Granuloma Showing Incidental Focal Acantholytic Dyskeratosis / 대한피부과학회지

Incidental focal acantholytic dyskeratosis (IFAD) has been described for various cutaneous lesions. A 58-year-old man presented with a purple colored, 5 mm crusted papule on the back. An excisional biopsy was performed and histopathological examination showed angiomatous tissue occurring in a discrete mass. It was enclosed by a collarette of acanthotic epidermis. The angiomatous tissue comprised a variably dilated network of blood-filled capillaries, which was surrounded by myxoid stroma. Hyperkeratosis, acantholysis, dyskeratosis and intraepidermal clefts were also focally present. Correlation of the clinical features and the histopathology results established a diagnosis of pyogenic granuloma showing IFAD.

Two Cases of Pancreatic Panniculitis / 대한피부과학회지

Several pancreatic diseases have been associated with a characteristic variant of panniculitis, named pancreatic panniculitis. This variant appears in approximately 2~3% of all patients with pancreatic diseases. We experienced two cases of panniculitis associated with pancreatic diseases. Two patients presented with erythematous tender subcutaneous nodules on the lower extremities. The serum amylase and lipase levels were significantly elevated. Histopathologic findings showed subcutaneous fat necrosis, ghost cell formation and mixed infiltration of neutrophils at the periphery. The lesions subsided gradually with the correction of the underlying pancreatic diseases.

A Case of Nasal CD56+ NK/T Cell Lymphoma Mimicking Cellulitis which Developed after Persistent Orbital Swelling / 대한피부과학회지

Recently another distinct subtype of lymphoma has been discovered, the natural killer (NK)T cell lymphoma, which can involve the skin in a primary or secondary fashion. NK/T cell lymphoma is characterized by the biphenotype expression of the T-cell marker and NK cell marker, especially CD56. These CD56+ lymphomas are further subdivided into nasal NK/T-cell lymphomas and non-nasal NK/T-cell lymphomas. We report a case of primary nasal NK/T cell lymphoma, which showed as an atypical cellulites-like lesion on the face. The patient had suffered with recurrent orbital swelling for several years before diagnosis.

Erythema Nodosum Developed in a Child with Kerion Celsi / 대한피부과학회지

A 7 year-old boy visited our hospital with a 2 week history of inflammatory, pustular, tender patches and plaques on the right scalp and face area. He had been treated with topical steroid and antibiotics in a private clinic. In a KOH smear mount, multiple hyphaes and spores appeared on stratum corneum of the outer root sheath layer of his hair. The diagnosis of kerion celsi induced by dermatophytes was made. The patient was treated with oral griseofulvin, and on the 2nd day after starting treatment, multiple erythematous and tendered subcutaneous nodules occurred on his shin. A photosensitive dermatitis like lesion also occurred on his periorbital area. Griseofulvin changed to terbinafine. On the 6th day after treatment, the skin lesions on his face and scalp had improved, as had his shin lesions. The interest of this case lies in the unusual association of kerion and erythema nodosum, of which only eleven cases have been reported in dermatologic literature, and all cases were kerion induced Trichophyton species.

Intratumoral Fat in Neurofibroma and Coexistence of Eccrine Hidrocystoma

We report a case of intratumoral fat in neurofibroma and coexistance of eccrine hidrocystoma on the occipital area of the scalp for one year duration. There are several diseases showing fatty change histopathologically. Among them, few cases of neurofibroma showing fatty change had been reported. The mechanism of fatty change is unclear, but several hypotheses are proposed. Here we report a case of neurofibroma showing fatty change and coexistence of eccrine hidrocystoma, and discuss the pathomechanism of fatty change and its relationship with disease.

The Effect of Stellate Ganglion Block on Herpes Zoster / 대한피부과학회지

BACKGROUND: Stellate ganglion block has been proposed as one of the effective therapetic modalities for herpes zoster. However, the effect on the reduction of acute herpes zoster pain and postherpetic neuralgia is not well known. OBJECTIVE: To evaluate the reduction of acute herpes zoster pain and the prevention of postherpetic neuralgia by stellate ganglion block. METHODS: Twenty one patients with herpes zoster were included in this study, and were divided into two groups: the group treated with I.V acyclovir, analgesics and stellate ganglion block during 7-days of a hospitalization period, and a control group which were treated with I.V acyclovir and analgesics alone. To evaluate it's effect on pain, the score of pain presented by patients, where initial pain was defined as 100 and no pain defined as 0, was recorded and compared between the groups. RESULTS: An average day required for the relief of pain was significantly shorter in the treated group than the control group: the average number of days needed to reduce the pain score from 100 to 50, implicating relief of acute pain, was 2.3 days, compared to 3.7 days in the control group (p=0.036). The total duration of pain, implicating postherpetic neuralgia, was also significantly shorter in the treated group (17.4 days) than the control group (42.3 days) (p=0.035). CONCLUSION: Stellate ganglion block is an effective method which can be used to relieve acute herpes zoster pain involving the trigerminal and cervical nerves, and can prevent postherpetic neuralgia.