A Case of Deep Aneurysmal Benign Fibrous Histiocytoma with Atypical Clinical Features / 대한피부과학회지

No abstract available.

The Effects of Peroxisome Proliferator Activated Receptor alpha (PPARalpha) Activator on Patients with Facial Erythema / 대한피부과학회지

BACKGROUND: Long-term use of topical steroids for inflammatory skin diseases can induce complications, and efforts to find a better treatment are being continued. Peroxisome proliferator activated receptor alpha (PPARalpha) suppresses the skin's inflammatory reaction, maintains the homeostasis of the skin, and plays an important role in skin barrier function. OBJECTIVE: This study analyzed the effects of a skin moisturizer containing PPARalpha activator on various inflammatory skin diseases causing facial erythema and evaluated the observed improvements. METHODS: The PPARa activator used for this study is composed of supercritical extracts from Euryale ferox, Euphorbia lathyris, and Rosa multiflora, which showed significant effects in the transactivation assay compared to Wy14643. Moisturizer containing PPARalpha was applied to the faces of 31 patients with symmetric facial erythema, with PPARalpha applied on one-half of the face and a control moisturizer on the other half of the face twice a day for 2 weeks. The percentage of erythema index, erythema index, skin hydration, and transepidermal water loss was checked to evaluate treatment effect. Both patients and clinicians each assessed the improvement of erythema on both sides of a patient's face. RESULTS: Moisturizer containing PPARalpha agonist significantly improved erythema index measured with Mexameter MX18(R) and percentage of erythema index by polarization color imaging system (DermaVision-PRO(R)) (p<0.05). However, there was no significant improvement in skin hydration and transepidermal water loss. Improvement of erythema was also shown on both the patient and clinician graded assessments. CONCLUSION: Topical PPARalpha agonist applied during clinical practice was relatively safe and effective. This can be applied clinically to various inflammatory skin diseases causing erythema.

Lymphomatoid Papulosis Associated with Pregnancy / 대한피부과학회지

No abstract available.

A Case of Rapidly Spread Generalized Darier's Disease / 대한피부과학회지

No abstract available.

Alopecia Areata in a Patient Treated with Interferon Alpha-2a for Chronic Hepatitis B / 대한피부과학회지

Recent studies recommend pegylated interferon alpha2a as the first choice treatment for chronic hepatitis B, especially when the patient is negative for HBeAg. Pegylated interferon alpha is known to show variable side effects including skin symptoms, with alopecia as the most common dermatologic side effect experienced for 10% up to 36%. pcc) Most alopecia cases related to pegylated interferon alpha were presented with telogen effluvium pattern, but alopecia areata cases are reported rarely. In this case, typically localized alopecia areata was presented with pegylated interferon alpha2a treatment in hepatitis B patient, and the course of alopecia areata seemed to be related with administration and discontinuation of pegylated interferon alpha2a.

A Case of Keratosis Follicularis Squamosa (Dohi) Treated with Topical 1% Pimecrolimus / 대한피부과학회지

Keratosis follicularis squamosa (Dohi) is a keratinizing disorder which is a separate clinical entity from keratosis follicularis (Darier's disease). It occurs predominantly in Japanese and appears clinically as scaly patches of 3~10 mm in diameter with brownish follicular plugs in the center, which are symmetrically scattered on the trunks and thighs. Scales on the margin, slightly detached from the underlying epidermis, look like 'lotus leaves on the water'. The efficacy of minocycline has already been confirmed in many cases. In this report, we describe a case of using 1% of pimecrolimus cream for keratosis follicularis squamosa (Dohi) instead of minocycline.

A Nevus Comedonicus Symmetrically Developed on Both Eyelids in Middle Aged Man / 대한피부과학회지

Nevus comedonicus is a relatively rare hamartoma, which originates from pilosebaceous unit. The disease usually occurs at birth or during childhood and most commonly unilateral or along with Blascko line. A 59-year-old man presented with black grouped dilated pores, with keratin plug on both eyelids. A histopathologic finding showed multiple keratin filled epidermal invaginations. We herein report an unusual case of bilateral nevus comedonicus developed in middle aged persons.

Neonatal Lupus Erythematosus Presenting with "Eye Mask" Facial Rash and Telangiectasia / 대한피부과학회지

Neonatal lupus erythematosus (NLE) is an autoimmune disease associated with the maternal anti-SSA/Ro and anti-SSB/La antibodies. NLE is characterized by cutaneous erythema, congenital heart block (CHB), hepatic dysfunction and hematological abnormalities. The characteristic cutaneous lesion is an annular or polycyclic erythematous patch or plaque. Individual annular lesions are often about 1 cm in diameter. We report a case of NLE in a 7-day-old female infant, born of a clinically asymptomatic mother, presenting "eye mask" shape rash and telangiectasia on her face. Periorbital rash with "eye mask" appearance presents in a few of NLE cases, and this cutaneous sign has been emphasized as a diagnostic clue to NLE. Her serological tests revealed high titers of anti-SSA/Ro, anti-SSB/La and antinuclear antibody. Based on these clinical and serological findings, the patient was diagnosed as NLE with characteristic periorbital skin findings.

The Study of the Clinical, Histopathological Features of Pilomatricoma and the Differentiation to Normal Hair Follicles / 대한피부과학회지

BACKGROUND: Pilomatricoma is a benign appendageal tumor characterized by basaloid and shadow cells. Differentiation towards normal hair follicles is often observed in this condition. OBJECTIVE: The purpose of this study was to analyze the clinical and histopathological features of pilomatricoma and to confirm diverse types of differentiation towards normal hair follicles, and its origin. METHODS: We retrospectively reviewed medical records and histopathological findings of 64 patients who had visited our hospital in the last 7 years. The evolutional stages of tumor and differentiation were analyzed through histopathological findings. RESULTS: The majority of the tumors occurred in the first two decades (69.8%). Unlike previous reports, the male to female ratio was 1.1:1. The mean duration was 11.8 months. The predilection sites were the upper extremities (40.8%), face (33.8%), neck (15.5%), back (2.8%), scalp (2.8%), and thigh (2.8%) in that order. Histopathologically, most of the tumors were located in the lower dermis (76%) and enclosed by pseudocapsules. The evolution of tumor was divided into four groups- early, fully developed, early regressive, and late regressive stage, as previously reported. Our 71 cases were classified as: 2 early, 16 fully developed, 34 early regressive, and 19 late regressive stage. Calcification (60.5%) and ossification (8.4%) were observed, and the ratio increased as the tumor aged. Inflammatory cell infiltration and multinucleated giant cells were observed disorderly. Differentiation to normal hair follicles was observed: 14 cases to infundibulum, 10 isthmus, 17 outer root sheath, and 11 inner root sheath. CONCLUSION: Pilomatricoma is a benign tumor that differentiates toward the hair cortex. Basaloid and shadow cells correspond to hair matrix cells and immature hair cortex cells, respectively. Basaloid cell can also differentiate to normal hair follicles.

Pachyonychia Congenita Affecting the Nails Only in the Mother and Son / 대한피부과학회지

Pachyonychia congenita (PC) is a rare autosomal-dominant ectodermal dysplasia, which is characterized by hypertrophic nail dystrophy, diffuse or focal symmetrical hyperkeratosis of the palms and soles, oral leukokeratosis, follicular keratosis on the extensor surfaces of the extremities, and other ectodermal defects. However, the variable degree of gene mutation may result in nail abnormalities alone. The nail changes presented in our patient are the only clinical manifestation. Hypertrophic nail dystrophy and yellowish discoloration, without involving any other organs, were shown in both mother and baby since birth. To the best of our knowledge, the case of PC affecting only the nails has never been reported in Korea before. Herein, we report monosymptomatic form of PC, which is notable for its rareness and unique pattern, distinct from previously reported cases.

A Case of Type 1 Pachyonychia Congenita (Jadassohn-Lewandowsky Syndrome) / 대한피부과학회지

Pachyonychia congenita (PC) is characterized by hypertrophic nail dystrophy, focal palmoplantar keratoderma and blistering, oral leukokeratosis, cyst formation, palmoplantar hyperhydrosis, and follicular keratoses on the trunk and extremities. PC is diagnosed by clinical findings and molecular genetic studies. A 26-year-old man presented with hypertrophic nail dystrophy and subungual debris of all 20 nails, hyperkeratotic plaques on the heels of both soles, and oral leukokeratosis. He had no family history of similar clinical findings. The patient's clinical presentation and history were consistent with PC. Herein we report on a rare case of pachyonychia congenita with a review of literature.

Vitiligo Universalis Associated with Chronic Hepatitis B / 대한피부과학회지

Vitiligo universalis is an uncommon variant that is rarely seen. Interestingly, vitiligo universalis often accompanies systemic diseases such as endocrinopathies. A 43-year-old man presented with whole body depigmentation and poliosis affecting most of his scalp and body hair. He had undergone a liver transplant 2 years ago due to liver cirrhosis from a chronic hepatitis B infection and has been treated for diabetes mellitus for several years. Histopathology showed no melanocytes and an absence of epidermal pigmentation on the skin. We herein report a rare case of vitiligo universalis associated with chronic viral hepatitis B.

A Case of Trauma-Induced Single Xanthelasma Palpebrarum

A 33-year old Korean man visited our department complaining of single mildly pruritic yellowish flat-topped papule on left upper eyelid. Lipid profile including low density lipoprotein-cholesterol and triglyceride level was above normal range. He remembered that the site was scalded by boiling oil about eight months ago. The patient was diagnosed with xanthelasma palpebrarum (XP) based on the clinical and histopathological findings, including diffuse infiltrate of large, pale-staining cells which have abundant foamy cytoplasm in the dermis. He was treated with CO2 laser ablation followed by application of 70% trichloroacetic acid with wooden stick. After a month, the skin lesion showed moderate improvement with disappearance of yellowish color and flat-topped elevation. So far, case of XP developed after minor trauma has not been reported. This case illustrates that minor trauma could be a trigger factor in the development of the disorder.

A Case of White Fibrous Papulosis of the Neck / 대한피부과학회지

White fibrous papulosis of the neck is a rare skin disease that manifests with tiny papules that are distributed on the neck. Thick collagen bundles in the papillary dermis and diminution of the elastic fiber are characteristic on histologic examination. It is thought to be a normal aging process of the skin or an associated disorder. We report here on a case of white fibrous papulosis of the neck of a 49-year-old Korean woman.

Beta-Lactam Antibiotic Sensitization and Its Relationship to Allergic Diseases in Tertiary Hospital Nurses

PURPOSE: Skin allergies through type 1 and 4 hypersensitivity reactions are the most frequent manifestations of drug allergies. We had previously experienced a case of a nurse with cefotiam-induced contact urticaria syndrome. To aid in preventing the progression of drug-induced allergic disease in nurses, we conducted a survey of tertiary hospital nurses who were likely to have been exposed professionally to antibiotics. METHODS: All 539 staff nurses at a tertiary hospital were asked to respond to a questionnaire regarding antibiotic exposure. Of the 457 nurses (84.8%) who responded, 427 (79.2%) received a physical examination of the hands and 318 (59.0%) received skin prick tests with the beta-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G. RESULTS: A positive response to at least one of the antibiotics occurred in 8 (2.6%) of the 311 subjects included in the analysis and stages 1 and 2 contact urticaria syndrome were observed in 38 (8.9%) and 3 (0.7%) of 427 nurses, respectively. The frequencies of a positive antibiotic skin test (6.9 versus 1.3%, chi-square=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, chi-square=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, chi-square=18.28, P=0.000) were higher in subjects with a positive skin allergy history than in those without. Allergic rhinitis (P=0.02, OR=3.86, CI=1.23-12.06), night cough (P=0.04, OR=3.12, CI=1.03-9.41) and food allergy (P=0.00, OR=9.90, CI=3.38-29.98) were significant risk factors for drug allergy. CONCLUSIONS: Antibiotic sensitization and drug allergy occurred more frequently in nurses with a positive skin allergy history. Atopy may be an important risk factor for drug allergy.

Beta-Lactam Antibiotic Sensitization and Its Relationship to Allergic Diseases in Tertiary Hospital Nurses

PURPOSE: Skin allergies through type 1 and 4 hypersensitivity reactions are the most frequent manifestations of drug allergies. We had previously experienced a case of a nurse with cefotiam-induced contact urticaria syndrome. To aid in preventing the progression of drug-induced allergic disease in nurses, we conducted a survey of tertiary hospital nurses who were likely to have been exposed professionally to antibiotics. METHODS: All 539 staff nurses at a tertiary hospital were asked to respond to a questionnaire regarding antibiotic exposure. Of the 457 nurses (84.8%) who responded, 427 (79.2%) received a physical examination of the hands and 318 (59.0%) received skin prick tests with the beta-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G. RESULTS: A positive response to at least one of the antibiotics occurred in 8 (2.6%) of the 311 subjects included in the analysis and stages 1 and 2 contact urticaria syndrome were observed in 38 (8.9%) and 3 (0.7%) of 427 nurses, respectively. The frequencies of a positive antibiotic skin test (6.9 versus 1.3%, chi-square=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, chi-square=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, chi-square=18.28, P=0.000) were higher in subjects with a positive skin allergy history than in those without. Allergic rhinitis (P=0.02, OR=3.86, CI=1.23-12.06), night cough (P=0.04, OR=3.12, CI=1.03-9.41) and food allergy (P=0.00, OR=9.90, CI=3.38-29.98) were significant risk factors for drug allergy. CONCLUSIONS: Antibiotic sensitization and drug allergy occurred more frequently in nurses with a positive skin allergy history. Atopy may be an important risk factor for drug allergy.

A Case of Cutaneous Rosai-Dorfman Disease Manifesting as Multiple Tumors / 대한피부과학회지

Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML) is an idiopathic, benign, self-limited, histiocytic proliferative disease confined mainly to cervical lymph nodes. The disease is usually accompanied by massive bilateral lymphadenopathy, fever, elevated erythrocyte sedimentation rate, leukocytosis with neutrophilia, and polyclonal hypergammaglobulinemia. Although cutaneous manifestations are observed in 10% of patients, pure cutaneous RDD without any nodal or systemic involvement is very rare. We report a case of pure cutaneous RDD occurring in a 37-year-old man with asymptomatic erythemaotus to yellowish multiple widespread nodules and tumors on the face and trunk. Histopathologic examination characteristically showed a diffuse infiltrate composed of large histiocytes exhibiting emperiopolesis and mixed inflammatory cells including many plasma cells. Immunohistochemically, these histiocytes were positive for S-100 protein and CD68, but negative for CD1a. During 2 years of follow-up, the patient showed neither nodal nor systemic involvement of the disease and the skin lesions gradually disappeared. The final diagnosis was made by typical cutaneous manifestations without nodal or extranodal involvement and histopathological findings compatible with RDD.

A Case of Psoriasiform Drug Eruption Induced by Imatinib Mesylate (GleevecTM) / 대한피부과학회지

Imatinib mesylate (GleevecTM, formerly known as STI571) is an oral drug that selectively inhibits bcr-abl, c-kit and platelet-derived factor receptor (PDGFR) tyrosine kinase. It has been used for treating chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors. Various adverse cutaneous reactions have been reported, yet the development of psoriasis or a psoriasiform drug eruption by the drug has rarely been reported. We herein report on a case of psoriasiform drug eruption that developed after administering imatinib mesylate to treat CML.

Clinical Evaluation of 168 Korean Patients with Rosacea: The Sun Exposure Correlates with the Erythematotelangiectatic Subtype

BACKGROUND: Although rosacea is a chronic cutaneous inflammatory disorder that's commonly seen in adults, the etiology and pathogenesis of the illness remain unclear. A well established diagnostic classification and grading system may play a critical role in performing research and it would serve as a diagnostic reference in the clinical field. OBJECTIVE: We sought to classify the patients with the new standard classification and grading system and we wanted determine the peculiar features and relationships of each subtype. We also analyzed the relationships between the degree of sun exposure and each subtype. METHODS: We reviewed the medical records and clinical photos of 168 patients who were diagnosed with rosacea from 2002 to 2007 at our hospital. The standard classification and grading system suggested by the National Rosacea Society (NRS) Expert Committee was adopted to evaluate each patient's subtype and the severity. RESULTS: The male:female ratio was 1:2.29. The mean age at the time of diagnosis was 47.8 years. The mean duration of disease was 3.5 years. Sun exposure and hot baths/exercise were the two most common precipitating factors, while the majority of patients did not have any specific factor that relieved their symptoms. According to the NRS classification and grading system, the patients were classified into four subtypes. One hundred sixty two (96.4%) patients were diagnosed with the erythematotelangiectatic subtype irrespective of severity. Eighty five (50.6%) patients had the papulopustular subtype and 24 (14.3%) patients had ocular rosacea. Eight (4.8%) patients displayed mild phymatous change. The degree of sun exposure had significant correlation with the development and severity of the erythematotelangiectatic subtype (p<005), while it had no correlation with the papulopustular, ocular and phymatous subtypes. CONCLUSION: Although the erythematotelangiectatic subtype was the most common subtype of rosacea, many patients also had other subtypes of rosacea simultaneously. Based on our results, we proved that ocular rosacea is an extension of the clinical spectrum of erythematotelangiectatic rosacea. In addition, the results of our study particularly suggest that sun exposure has a different influence on each subtype of rosacea.

Standard Patch Test Results in Patients with Contact Dermatitis / 대한피부과학회지

BACKGROUND: A number of skin manifestations in patients with allergic contact dermatitis result from sensitization with specific allergens. The patch test is a primary diagnostic tool for identifying allergens causing allergic contact dermatitis. OBJECTIVE: We identified the results of patch test with Korean standard series in patients with clinically diagnosed with contact dermatitis, and evaluated the specific relationship with each allergen. METHODS: During a 5-year period, 743 patients were examined with patch test of standard Korean series. The results of patch test were then evaluated. Location of the skin lesion, age, sex, and occupation of the patients were completely reviewed. RESULTS: Overall, 68.5% of patients had at least one positive reaction and 43.6% of patients had two or more positive reactions. Allergens most frequently causing positive reactions were nickel sulfate (27.1%), cobalt chloride (22.1%), potassium dichromate (17.9%), mercuric ammonium chloride (13.8%), and 4-phenyledediamine base (10.2%). Those patients in their 10s and 40s showed the highest rate of positive reaction. Metal allergens displayed higher positive rates than any other standard allergens. Of 201 patients who showed positive reaction to nickel, 37.8% and 27.3% of them also showed positive reaction to cobalt and chromium, respectively, representing concomitant reactions between metal-related antigens. In addition, polysensitization to cosmetics-related antigens including balsam peru and fragnance mix was evident. CONCLUSION: There was no significant difference in overall positive rate in patch test results compared with recent studies. However, we confirmed that metal-related allergens remain most common, and that multiple contact allergy were relatively common.