Regression of Congenital Melanocytic Nevus with Halo Phenomenon Induced by Serial Excision / 대한피부과학회지

Congenital melanocytic nevus is a hamartoma derived from the neural crest that is present at birth. Regression following surgical excision with an apparent halo phenomenon through suture lines has never been reported. A nine-year-old boy presented with a solitary symmetric, oval-shaped, blackish pigmented patch on his right forearm.He reported increasing size of the lesion with no other subjective symptoms. Histological examination of the first excisional biopsy revealed congenital melanocytic nevus, and serial excisions were planned. Interestingly, at the second visit at 18 months after the first biopsy, the size of the congenital melanocytic nevus was reduced with a peripheral whitish halo. Linear regression through suture lines and a peripheral halo was observed after the second and third serial excisions. The mechanism of the halo phenomenon remains elusive but is suggested theorized to be caused by destruction of melanocytes by immune responses of autoantibodies or cytotoxic T cells.

The Efficacy of Topical Tacrolimus Ointment on Cheilitis Induced by Isotretinoin Treatment in Acne Vulgaris Patients / 대한피부과학회지

Background@#Isotretinoin is a gold standard treatment for moderate to severe acne vulgaris but is associated with cheilitis. Though moisturizing agents or petrolatum have been suggested, uncomfortable isotretinoin-induced cheilitis can disrupt treatment of acne patients. Topical tacrolimus has been used in atopic dermatitis with good safety and efficacy; however, there is no study of application of topical tacrolimus in cheilitis induced by isotretinoin. @*Objective@#In this study, we aimed to describe the efficacy of topical tacrolimus 0.1% ointment on cheilitis associated with isotretinoin therapy using isotretinoin cheilitis grading scale (ICGS), investigator global assessment (IGA), and patient global assessment (PGA). We also observed the side effects of topical tacrolimus ointment. @*Methods@#Fifty acne vulgaris patients with isotretinoin-induced cheilitis were randomly allocated to either topical tacrolimus or petrolatum treatment using permuted-block randomization. Patients were followed-up at 4 and 8 weeks, at which cheilitis lesions were photographed and evaluated with ICGS, IGA, and PGA. @*Results@#Compared to petrolatum group, tacrolimus group had greater responses to treatment as measured by mean values of ICGS, IGA, PGA at follow-up visits. Also, the ICGS decrease was larger in the tacrolimus group compared with the petrolatum group even according to isotretinoin dose. @*Conclusion@#Topical tacrolimus ointment had superior efficacy in treating cheilitis induced by isotretinoin compared to petrolatum. Erythema, fissures, scales, and commissures all showed better response to tacrolimus ointment. Topical tacrolimus ointment can be administered as an effective strategy in treatment of cheilitis as a complication of isotretinoin therapy and can improve compliance of acne patients.

Regression of Congenital Melanocytic Nevus with Halo Phenomenon Induced by Serial Excision / 대한피부과학회지

Congenital melanocytic nevus is a hamartoma derived from the neural crest that is present at birth. Regression following surgical excision with an apparent halo phenomenon through suture lines has never been reported. A nine-year-old boy presented with a solitary symmetric, oval-shaped, blackish pigmented patch on his right forearm.He reported increasing size of the lesion with no other subjective symptoms. Histological examination of the first excisional biopsy revealed congenital melanocytic nevus, and serial excisions were planned. Interestingly, at the second visit at 18 months after the first biopsy, the size of the congenital melanocytic nevus was reduced with a peripheral whitish halo. Linear regression through suture lines and a peripheral halo was observed after the second and third serial excisions. The mechanism of the halo phenomenon remains elusive but is suggested theorized to be caused by destruction of melanocytes by immune responses of autoantibodies or cytotoxic T cells.

The Efficacy of Topical Tacrolimus Ointment on Cheilitis Induced by Isotretinoin Treatment in Acne Vulgaris Patients / 대한피부과학회지

Background@#Isotretinoin is a gold standard treatment for moderate to severe acne vulgaris but is associated with cheilitis. Though moisturizing agents or petrolatum have been suggested, uncomfortable isotretinoin-induced cheilitis can disrupt treatment of acne patients. Topical tacrolimus has been used in atopic dermatitis with good safety and efficacy; however, there is no study of application of topical tacrolimus in cheilitis induced by isotretinoin. @*Objective@#In this study, we aimed to describe the efficacy of topical tacrolimus 0.1% ointment on cheilitis associated with isotretinoin therapy using isotretinoin cheilitis grading scale (ICGS), investigator global assessment (IGA), and patient global assessment (PGA). We also observed the side effects of topical tacrolimus ointment. @*Methods@#Fifty acne vulgaris patients with isotretinoin-induced cheilitis were randomly allocated to either topical tacrolimus or petrolatum treatment using permuted-block randomization. Patients were followed-up at 4 and 8 weeks, at which cheilitis lesions were photographed and evaluated with ICGS, IGA, and PGA. @*Results@#Compared to petrolatum group, tacrolimus group had greater responses to treatment as measured by mean values of ICGS, IGA, PGA at follow-up visits. Also, the ICGS decrease was larger in the tacrolimus group compared with the petrolatum group even according to isotretinoin dose. @*Conclusion@#Topical tacrolimus ointment had superior efficacy in treating cheilitis induced by isotretinoin compared to petrolatum. Erythema, fissures, scales, and commissures all showed better response to tacrolimus ointment. Topical tacrolimus ointment can be administered as an effective strategy in treatment of cheilitis as a complication of isotretinoin therapy and can improve compliance of acne patients.

Effect of Epidermal Growth Factor-Containing Ointment for the Management of Laser-Induced Postinflammatory Erythema and Hyperpigmentation / 대한피부과학회지

Background@#Epidermal growth factor (EGF) stimulates wound healing in various skin conditions, and EGFcontaining formulations can promote wound regeneration and help reduce complications after laser treatment. @*Objective@#To evaluate the effect of EGF-containing ointment on wound regeneration after ablative laser treatment and laser-induced postinflammatory erythema (PIE) and hyperpigmentation (PIH). @*Methods@#Twenty-five patients who required treatment with ablative laser on both sides of the face were enrolled and underwent one session of laser treatment. Postoperatively, all patients were instructed to apply the EGFcontaining ointment on the randomly assigned-hemifacial side, while gentamicin cream was applied on the opposite side. Investigators’ global assessment (IGA), evaluating general wound condition, erythema, pigmentation, and scab shedding, and patient’s global assessment (PGA), evaluating patient satisfaction with clinical improvement, were both measured at 1 week and 4 weeks after treatment. Objective assessments, including melanin index (MI), erythema index (EI), skin hydration, and transepidermal water loss (TEWL), were measured before treatment and at 1 week and 4 weeks after treatment. @*Results@#The EGF-containing ointment showed better outcomes with IGA (1 week; p=0.02, 4 weeks; p=0.002) and PGA (1 week; p=0.04, 4 weeks; p=0.01) scores compared to gentamicin cream. Compared to gentamicin cream, treatment with EGF-containing ointment resulted in significantly lower EI (p=0.044) and MI (p=0.023), but skin hydration and TEWL between the two groups exhibited nonsignificant differences. @*Conclusion@#EGF-containing ointment could be an effective adjuvant option for wound regeneration after ablative laser treatment and minimizing laser-induced PIE and PIH in Asian patients.

Risk factors for short term thyroid dysfunction after hematopoietic stem cell transplantation in children / 소아과

PURPOSE: The purpose of this study was to evaluate short-term thyroid dysfunction and related risk factors in pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) during childhood. METHODS: We studied 166 patients (100 boys and 66 girls) who underwent HSCT at the Catholic HSCT Center from January 2004 through December 2009. The mean age at HSCT was 10.0+/-4.8 years. Thyroid function of the patients was tested before and during 3 months of HSCT. RESULTS: Out of 166 patients, 165 (99.4%) underwent allotransplantation. Acute graft-versus-host disease (GVHD, grades II to IV) developed in 76 patients. Conditioning regimens before HSCT include total body irradiation (n=57), busulfan (n=80), and reduced intensity (n=29). Forty-five (27.1%) had thyroid dysfunction during 3 months after HSCT (29 euthyroid sick syndrome [ESS], 6 subclinical hyperthyroidism, 4 subclinical hypothyroidism, 3 hypothyroxinemia, 2 overt hyperthyroidism, and 1 high T4 syndrome). In a univariate logistic regression analysis, age at HSCT (P=0.002) and acute GVHD (P=0.009) had statistically significant relationships with thyroid dysfunction during 3 months after HSCT. Also, in a univariate logistic regression analysis, ESS (P=0.014) showed a strong statistically significant association with mortality. CONCLUSION: In our study 27.1% patients experienced thyroid dysfunction during 3 months after HSCT. Increase in age and acute GVHD may be risk factors for thyroid dysfunction during 3 months after HSCT. There was a significant association between ESS and mortality.

A Case of Thyrotoxic Periodic Paralysis in a 16-Year-Old Adolescent

Thyrotoxic periodic paralysis (TPP) is a transient illness characterized by muscle weakness often associated with hypokalemia during thyrotoxic state. Hypokalemia is induced by thyroid hormone excess through stimulation of Na-K ATPase which pumps extracellular potassium ions into the cell. Muscle weakness resolves when serum potassium level is corrected, but the condition may recur when there is thyrotoxicosis. TPP is most commonly reported in Asian males aged between 20 to 40 years and it is rare in children and adolescents. We report a 16-year-old patient previously diagnosed with Graves' disease who showed recurrent episodes of TPP.

A Case of Thyrotoxic Periodic Paralysis in a 16-Year-Old Adolescent

Thyrotoxic periodic paralysis (TPP) is a transient illness characterized by muscle weakness often associated with hypokalemia during thyrotoxic state. Hypokalemia is induced by thyroid hormone excess through stimulation of Na-K ATPase which pumps extracellular potassium ions into the cell. Muscle weakness resolves when serum potassium level is corrected, but the condition may recur when there is thyrotoxicosis. TPP is most commonly reported in Asian males aged between 20 to 40 years and it is rare in children and adolescents. We report a 16-year-old patient previously diagnosed with Graves' disease who showed recurrent episodes of TPP.

A Pediatric Case of Primary Sjogren's Syndrome Associated with Nephrogenic Diabetes Insipidus and Renal Tubular Acidosis

Sjogren's syndrome (SS) is an autoimmune disorder primarily affecting the salivary and lacrimal glands. In addition, extra-glandular manifestations involving the lungs, liver, kidneys, pancreas, skin and central nervous system were reported in patients with SS. These extra-glandular manifestations are not rare in adult patient, but are very rare in pediatric SS. Renal manifestations are relatively common in adult SS, but are rarely reported in childhood SS. We experienced a girl with primary SS manifested with nephrogenic diabetes insipidus and renal tubular acidosis.

A case of Kikuchi-Fujimoto disease with autoimmune thyroiditis / 소아과

Kikuchi-Fujimoto disease (KFD) is a benign self-limiting disease characterized by fever and lymphadenitis. The etiology and pathogenesis of KFD is unclear. However, two hypotheses have been suggested: a viral infection hypothesis and an autoimmune hypothesis. Several KFD patients with various types of autoimmune diseases have been reported, and these reports support the hypothesis for autoimmune pathogenesis of KFD. Here, we report the case of a 17-year-old female patient diagnosed with KFD and autoimmune thyroiditis. This case serves as additional evidence that the etiology of KFD is autoimmune origin.

The Effect of the Maternal Hypertension on the Lipid Peroxidation and Antioxidant Status in the Newborn Rat Lung

PURPOSE: The aim of this study was to investigate the effect of the maternal hypertension on the lipid peroxidation and antioxidant status of the newborn rat lung. METHODS: We used adult female SHR(essential hypertension, 1b, A, 6-8 weeks), Sprague-Dawley white rats as a model of hypertensive dams. Breeding was accomplished by allowing female and male rats to cohabit overnight. The animals were allowed to spontaneously deliver at term(21.5d). The pups delivered from the hypertensive dams grouped into HBP group. Control group consisted of the pups delivered from normal dams. The content of malondialdehyde(MDA) and activity of superoxide dismutase(SOD) and glutathione(GSH) in the lung tissues were analysed at birth and 24 hours later in both groups. RESULTS: The body weight of the HBP group was significantly lower than the control group at birth. At birth and 24 hours after birth, MDA content and SOD activity were significantly increased in the lung tissues of HBP group compared to control group. There were no significant differences in GSH activity between the two groups. After 24 hours, the elevated MDA value was significantly decreased, and SOD activity was significantly elevated in HBP group but there were no significant changes in the MDA value, SOD or GSH activity in the control group. CONCLUSION: These results support the possibility that maternal hypertension during pregnancy is associated with an increased lipid peroxidation and that compensatory activation of antioxidant system works in the fetal rat lung.