Periadnexal Mucin as an Additional Histopathologic Feature of Chronic Eczematous Dermatitis

BACKGROUND: Cutaneous mucinoses are a heterogeneous group of disorders characterized by an abnormal amount of mucin in the skin. However, the pathomechanism of an excessive mucin deposition in the skin is still unknown. Eczematous dermatitis is sub-classified histologically into acute, subacute, and chronic variants. The characteristic histopathologic findings for chronic eczema are variable. However, periadnexal mucin deposition is not known as a feature of chronic eczema. OBJECTIVE: To evaluate the presence of periadnexal mucin deposition in chronic eczematous dermatitis. METHODS: We analyzed the skin biopsy specimens from 36 patients who were pathologically diagnosed with chronic eczematous dermatitis. Alcian blue, colloidal iron, and periodic acid-Schiff stains were used to evaluate the mucin deposition in histologic sections. Two dermatologists and two dermatopathologists evaluated the degree of mucin deposition using a 4-point scale. RESULTS: Various amounts of mucin deposition were observed in the periadnexal area of patients who were diagnosed with chronic eczema. Mucin deposition was more visible after staining with mucin-specific stains. Evaluation of the staining analysis scores revealed that the staining intensities were significantly higher in patients with chronic eczema than age- and site-matched controls (normal, acute to subacute eczema, and psoriasis vulgaris). CONCLUSION: Periadnexal mucin (secondary mucinoses) may be an additional finding of chronic eczematous dermatitis.

Sebaceous Hyperplasia Effectively Improved by the Pin-Hole Technique with Squeezing

No abstract available.

A Case of Zinc Deficiency Dermatitis in Breast Milk Fed Infant Mimicking Atopic Dermatitis / 소아알레르기및호흡기학회지

Zinc deficiency can result from acrodermatitis enteropathica, an inadequate dietary intake, malabsorption, increased body loss, or intravenous feeding. Unlike acrodermatitis enteropathica, breast feeding-induced acrodermatitis is transient and improves when nursing ends. Breast feeding-induced acrodermatitis is caused by a ZnT-2 transporter dysfunction in the mother's mammary glands. We report a case of a 6-month-old male infant who presented with erythematous patches and plaques involving the perioral, perineal, and acral areas and loose stools since 2 weeks after birth. Atopic dermatitis was considered initially, but the lesions did not respond to topical antibiotics, corticosteroids, or maternal dietary restriction from allergenic food. The patient's serum zinc concentration was low, and the mother's serum and milk had low zinc levels. The differential diagnosis for atopic dermatitis is extensive. Physicians should be alert for the possibility of zinc deficiency dermatitis in breast milk fed infants that mimics atopic dermatitis.

Surveillance of home environment in children with atopic dermatitis: a questionnaire survey

BACKGROUND: The increasing prevalence of atopic dermatitis (AD) suggests a role for environmental factors in triggering a genetic predisposition in sufferers. OBJECTIVE: The purpose of this study was to investigate home environmental factors related to AD severity. METHODS: We conducted a questionnaire survey about the home environmental factors in 380 children from two daycare centers and the Samsung Medical Center outpatient clinic. AD was diagnosed by Hanifin and Rajka's criteria and its severity was assessed by the Severity Scoring of Atopic Dermatitis index. Children were divided into normal control group, mild AD group and severe AD group. Home environmental factors were compared among the three groups and were statistically analyzed using analysis of variance, Chi-square test, Fisher's exact test, and multiple logistic analysis. RESULTS: Indoor remodeling activities, such as painting (p = 0.004), floor covering (p = 0.001) and wallpaper changing (p = 0.002) were associated with severity of AD. Those in the severe AD group were more likely to live in an apartment (p < 0.001). Severe AD was observed more frequently when the monthly income of household (p = 0.027) and final educational status of mother (p = 0.001) were higher. CONCLUSION: Some home environmental factors were associated with AD severity, but its causal relationship is not clear. Further research is needed to confirm these associations and to clarify whether they are causative.

Concurrent Occurrence of Mucocele and Pyogenic Granuloma

A mucocele is a common, benign lesion of the oral cavity that develops following the extravasation or retention of mucous from a major or minor salivary gland. A pyogenic granuloma (PG) is also a common, benign condition characterized by proliferating capillaries that affect the skin and mucous membranes. The concurrent occurrence of a mucocele and a PG lesion has rarely been reported in the medical literature. This case study reports such a finding in a 16-year-old patient who presented to our department.

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.

Nevus Sebaceous Accompanying Secondary Neoplasms and Unique Histopathologic Findings

Nevus sebaceous (NS) is a type of classical nevus or congenital malformation that is often present at birth and commonly involves the scalp or face. The lesion usually presents as a linear, yellow, hairless, and verrucous plaque. It has been well-established that several benign and malignant tumors can develop from the NS; however, there have been no reports about ectopic fat cells in the dermis, and cornoid lamella arising from the NS. We report a case of NS on the scalp with accompanying unusual histopathologic findings.

Case of Epidermolysis Bullosa with Pyloric Atresia

Epidermolysis bullosa (EB) is a rare hereditary disorder characterized by formation of blisters following minor trauma. It has been traditionally categorized by the level of basement membrane zone separation into EB simplex (EBS), junctional EB (JEB), and dystrophic EB (DEB). Recently, hemidesmosomal EB has been proposed as a fourth category, which includes EB with muscular dystrophy and EB with pyloric atresia. We report here on a case of concomitant occurrence of EB and pyloric atresia, a rare form of EB.

A Case of Anaphylaxis after the First Dose of Sublingual Immunotherapy with House Dust Mite / 소아알레르기및호흡기학회지

The advantages of sublingual immunotherapy (SLIT) are its friendly route of administration and less frequent occurrence of severe side-effects. The most frequently reported events were irritation of the throat and oral itching. According to the recent data, the number of side effects seems to be dose-dependent. We report on one case of anaphylaxis after the first dose of SLIT with house dust mite drop. A 10-year-old girl suffered from severe allergic rhinitis with perennial symptoms and asthma for which a low dose inhaled corticosteroid was used. Her allergy workup disclosed a positive skin prick test to Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, hazel tree, alder, dog, cat, platane, and acacia pollens. We started SLIT (Pangramin SLIT, ALKAbello, Madrid, Spain) with D. pteronyssinus and D. farinae. Fifteen minutes after the first dose taken at home, she experienced local irritation, lip swelling, facial rash, rhinorrhea and cough. Provocation test was performed in the clinic with the same drug (0.00015 microg/drop, 1.6 STU/mL of D. pteronyssinus and D. farinae, respectively). After twenty minutes, she reported lip swelling, perioral wheals, rash and cough. Wheezing was aggravated, and peak expiratory flow rate (PEFR) dropped by 13% compared to prechallenge PEFR. We stress to have the first dose of SLIT taken in the clinic with an observation period.

Clinical Significance of Interferon gamma Release Assay for Diagnosis of Tuberculosis in Children / 소아감염

PURPOSE: The purpose of this study is to evaluate the usefulness and limitation of QuantiFERON-TB Gold (QTB) for diagnosis of latent tuberculosis in children. METHODS: The medical records of 112 children who were tested by tuberculin skin test (TST) and QTB for detection of latent tuberculosis (TB) in Eulji General Hospital during the period from January 2007 to June 2009 were retrospectively reviewed. RESULTS: Of the 112 participants, the clinical TB group included 15 (13.4%), the contact group included 43 (38.4%), and the non-contact group included 54 (48.2%). Positive rates of TST and QTB were 100% and 80% in the clinical TB group, 64% and 14% in the close contact group, 27% and 0% in the casual contact group, and 52% and 2% in the non-contact group, respectively. Sensitivity of QTB was 80.0% and specificity was 92.6%. Agreement between QTB and TST was poor (kappa=0.209). We also confirmed that the positive rate of QTB increased as the age of the patient increased (P=0.011). A QTB indeterminate result was observed in 11 (9.8%) subjects. QTB was retested in 15 subjects. In 5 of the 6 subjects who had positive results initially, positive results persisted for a median 2.2 months after termination of treatment. CONCLUSION: Although QTB was associated with several problems, including low sensitivity and a high rate of indeterminate results, it had clinical importance due to its high specificity. We found good correlation with regard to exposure and QTB positivity, including that of young children under 5 years of age. However, clinical application of interferon-gamma releasing assay for young children for diagnosis of active and latent tuberculosis will require additional prospective studies.

Dermal Proliferative Effect and Safety of Automicroneedle Therapy System (AMTS) / 대한피부과학회지

BACKGROUND: Various topical cosmeceuticals and lasers have been used to treat photo-aged skin that has wrinkles, acne scars and dilated pores. The microneedle therapy system (MTS) that mechanically makes multiple holes on the skin has come into the limelight to treat these skin problems via stimulating collagen remodeling. The automicroneedle therapy system (AMTS) is a developed version of MTS and it has several advantages compared with conventional MTS. AMTS can achieve regular treatment results because of its automatically punching method. In addition, AMTS can treat smaller area and it has cost advantages due to the inexpensive disposable needle head. OBJECTIVE: This study was designed to determine the dermal proliferative effects and safety of AMTS on the skin compared with that of the conventional MTS roller. METHODS: Twelve hairless mice were divided into two groups; one group was treated with a 0.25 mm needle and the other group was treated with a 2 mm needle. The first group was subdivided into the AMTS-H and the MTS groups and the no treatment group as a control, while the second group was subdivided into the AMTS-H, AMTS, MTS and control groups. Each treated group underwent four procedures every other day. The dermal proliferative efficacies of the treatment were evaluated by the histology, including the dermal thickness and the densities of the collagen fibers. Western blot was also performed for the evaluation of the protein expression of procollagen type I and matrix metalloproteinase-13. For safety profiles, we performed gross observation, basal skin barrier function testing and histologic examination. RESULTS: Treatment by AMTS significantly increased dermal collagen synthesis and the dermal thickness in the hairless mice. In addition, the expression of procollagen type I protein was increased, which accounted for the increased dermal collagen density. There was no specific safety problem related to the treatment. CONCLUSION: These results indicated that AMTS is an effective, safe modality for treating skin problems that require dermal proliferation. We anticipate that AMTS could be a new therapeutic option for inducing dermal proliferation or regeneration.

Hypertrophic Lupus Erythematosus Successfully Treated with Triamcinolone Intralesional Injection / 대한피부과학회지

Hypertrophic lupus erythematosus (HLE) is a distinct and rare clinical variant of chronic cutaneous lupus erythematosus (CCLE). It is characterized by verrucous lesions and a chronic course of disease. HLE tends to be much more refractory to treatment than classical CCLE. Therefore, the traditionally available therapeutic options including sun protection, topical and oral corticosteroids, hydroxychloroquine, retinoid and thalidomide are often unable to control the disease. We report here on the successful use of triamcinolone intralesional injection in a patient with HLE and who failed to respond to conventional treatment such as acitretin and hydroxychloroquine.

Rippled-pattern Sebaceoma / 대한피부과학회지

Sebaceoma is a benign neoplasm with sebaceous differentiation, and this is characterized by dermal aggregations of basaloid, immature sebaceous cells and sebaceous duct-like structures. Recently, some cases of sebaceoma that presented as a rippled-pattern resembling the palisading of nuclei of verocay bodies have been reported in the English literature. However, there has been no such report in the Korean dermatologic literature. We report here on a case of rippled-pattern sebaceoma that developed in a 78-year-old Korean man.

A Congenital Solitary Glomus Tumor / 대한피부과학회지

A glomus tumor is a kind of hamartoma that was first described by Masson in 1924. There are two major clinical forms of glomus tumor: solitary and multiple. Solitary glomus tumor which usually occurs in older age is characterized by a painful pink to red colored papule. A 2-week-old female infant presented to our department with a 1.3x0.4 cm sized tumor on her right foot, which had been present since birth. Histopathologic examination showed many vessels lined by thin endothelial cells and multiple rows of glomus cells. Ultrasonography of the foot revealed intense blood supply in the tumor bed. We diagnosed the patient with a congenital solitary glomus tumor, based on history, skin lesion, ultrasonography, and histopathologic findings. We report a case of a congenital, solitary glomus tumor in a 2-week-old female infant.

The Prevalence of Obesity and Metabolic Abnormalities in Korean Pediatric Population / 대한소아소화기영양학회지

PURPOSE: Childhood obesity can be complicated by hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and diabetes mellitus. The aim of this study was to evaluate the prevalence of obesity and metabolic complications of children and adolescents based on the degree of obesity. METHODS: We analyzed the records of 8,880 students who received student health examinations between May 2006 and October 2008 at the Eulji General Hospital. The prevalence of obesity was evaluated by the body mass index and obesity index. A total of 1,076 obese students had blood tests. We analyzed aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, total cholesterol, and blood pressure according to the degree of obesity. RESULTS: According to the body mass index, the overall prevalence of obesity was 7.2% (7.8% of male and 6.5% of female students). Based on the obesity index, 12.3% of students (mild: 6.3%, moderate: 5.0%, and severe: 1.0%) were obese. The prevalence of hypercholesterolemia, ALT elevation, and hypertension were increased as a function of the degree of obesity (p<0.05), but hyperglycemia showed no significant differences (p=0.298). The overall prevalence of ALT elevation was 17.7% (mild obese group, 10.4%; moderate obese group, 20.5%; and severe obese group, 46.8%). The prevalence of hypercholesterolemia, hypertension, and hyperglycemia were significantly higher in the elevated ALT group (24.7%, 42.6%, and 5.2%, respectively) compared to the normal ALT group (11.1%, 29.8%, and 2.0%, respectively; p<0.05). CONCLUSION: Hypercholesterolemia, liver function test abnormalities, and hypertension were associated with the degree of obesity. We should focus our attention on managing obese children and adolescents to prevent metabolic complications.

A Case of Trichilemmal Cyst on the Abdomen / 대한피부과학회지

Trichilemmal cyst is a benign tumor that originates from the external root sheath. It usually occurs on the scalp, but rarely on the face, neck and trunk. A 41-year-old man presented with a skin-colored non-tender subcutaneous nodule on his abdomen. The histopathologic findings of the lesion showed a well demarcated cystic mass with trichilemmal keratinization in the dermis. It was diagnosed as a trichilemmal cyst and then it was totally excised. We report here on a case of trichilemmal cyst on the abdomen, which is known to be an unusual site for this type of lesion.

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.

A Case of Lichen Planus Pigmentosus Along the Lines of Blaschko / 대한피부과학회지

Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus that presents clinically as hyperpigmented, dark brown macules or patches in sun-exposed areas and flexural folds. LPP has been described previously as a pigmented form of actinic lichen planus or as erythema dyschromicum perstans. Recently, however, these diseases have been recognized as different clinical entities. Histopathologically, in atrophic epidermis, vacuolar alteration of the basal cell layer and scarce lymphohistiocytic lichenoid infiltration and pigment incontinence are seen. Herein, we report a case of LPP that developed in a unilateral linear pattern, probably in relation to Blaschko's lines.

A Cutaneous Odontogenic Sinus / 대한피부과학회지

Cutaneous odontogenic sinuses are the most common cause of chronic draining sinus tracts on the face and neck. These lesions present as erythematous nodules with surrounding dimples, which intermittently drain purulent fluid. Although most patients do not have dental symptoms, careful questioning of a patient's past symptoms may help the clinician identify a dental etiology. A history of toothache in the affected area that resolves without dental intervention is useful information. Clinical and radiographic examination may reveal carious teeth with radiolucent areas. Elimination of the source of infection by endodontic treatment or tooth removal results in resolution of the sinus tract, typically within 2 weeks. Early precise diagnosis and appropriate dental treatment can circumvent unnecessary and ineffective antibiotic therapy or surgical treatment. We report a case of a cutaneous odontogenic sinus in the right cheek area.