A Case of Impetigo Herpetiformis Treated with Isotretinoin / 대한피부과학회지

Impetigo herpetiformis is a rare and severe pustular disorder which primarily occurs in pregnancy. Etretinate and acitretin are effective in impetigo herpetiformis with systemic steroid. A major concern with the use of systemic retinoids is their high teratogenic potential. Isotretinoin is another retinoid but its teratogenic potential lasts only for two months. Hence, isotretinoin may be used to treat women of childbearing years with impetigo herpetiformis. We report a case of impetigo herpetiformis in a 26-year-old woman whose condition was improved with isotretinoin.

A Case of Kerion Celsi Caused by Trichophyton mentagrophytes / 대한의진균학회지

Kerion celsi is an inflammatory type of tinea capitis. It is a deep, boggy swelling and is painful. Patchy hair loss and broken hairs, inflammation and scaling are characteristic. We report a case of kerion celsi caused by Trichophyton(T.) mentagrophytes in 4 year-old boy. He presented with 6 cm x 7 cm and 2cm x 2cm sized erythematous boggy masses with multiple pustules and crusts on the vertex. Cultures from a scalp lesion of the patient on Sabouraud dextrose agar media showed T. mentagrophytes. Treatment was done systemically with itraconazole and prednisolone for 14 weeks.

A Case of Morphea Occuring in Vitiliginous Lesions / 대한피부과학회지

We report a case of morphea occuring in vitiliginous lesions. About 5 months ago, two lesions of 4X4cm-sized depigmented patches appeared on her left thigh. The depigmented patches had begun to be hardened about 3 months ago. Histopathologic examinations showed that the reticular dermis appeared thickened, closely packed, hypocellular, and stained more deeply eosinophilic than in normal skin. The epidermis had no melanin pigments. Dopa stain was negative in white lesion, whereas Dopa stain was positive in normal lesion.

Latex Allergy in Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Allergy against natural rubber latex is an increasing problem in recent years, especially in health care workers, children with spina bifida. Many studies reported atopic dermatitis could be also one of risk factors of latex allergy. OBJECTIVE: Purposes of this study were not only to access the prevalence of latex sensitization in patients with atopic dermatitis, but to evaluate the relationship between latex sensitization and clinical allergy. METHODS: Of the total of 110 patients, 80 patients were atopic dematitis and 30 patients were controls. A questionaire-based history was taken, skin prick tests (SPTs) with latex glove extract and commercial latex allergen and several commercial fruit extracts were done. If SPT to latex was positive, use test performed. Patch tests for delayed type hypersensitivity were carried out with a small piece of latex glove, commercial latex allergens and rubber additives. RESULTS: Eighteens (22.5%) of 80 atopic dermatitis reported symptoms whenever they used rubber products. In skin prick test, 3 of 80 (3.8%) patients with atopic dermatitis were positive to latex glove extration solutions and also the commercial latex antigens. Reactions to fruit extracts including mixed nuts, potato, tomato, banana were 8.8%, 6.3%, 6.3%, 5.0%, respectively. Use test was done with all of 4 patients positive to SPT, and only one of them showed positive reaction. There is no positive result in latex glove or latex extraction in patch tests. CONCLUSION: There were no differences in latex sensitivities between patients with atopic dermatitis and healthy people. In patch tests, ZnBDC and mercapto mix were the highst rate of reaction addictives of NRLs.

A Case of Verrucous Carcinoma Occurring on the Preauricular Region / 대한피부과학회지

Verrucous carcinoma is a relatively non-aggressive, slowly growing, low grade squamous cell carcinoma with little tendency to metastasize. It typically occurs on the oropharynx, genitalia and palmoplantar areas. Until now, there have been several case reports of this tumor occurring on the oral cavity, penile area, sole and lower leg in Korean literature. However, its occurrence on the preauricular area is extremely rare. Herein we report a case of verrucous carcinoma developed on the right preauricular region in a 67-year-old man.

A Case of Eosinophilic Panniculitis Accompanied with Nodal Diffuse Large B-cell Lymphoma / 대한피부과학회지

Eosinophilic panniculitis(EP) is characterized by a prominent infiltration of subcutaneous fat with eosinophils. However, EP is a histopathologic pattern or reactive process rather than a distinct disease entity. It has been identified in patients who have a variety of associated clinical conditions. We report a case of a 37-year-old woman with EP on her abdominal region. Due to the pertinent clinical and laboratory investigation to rule out an accompanied systemic process, we found nodal diffuse large B-cell lymphoma. Although there have been several reports about the cases of EP in Korea, until now no case of EP accompanied with nodal lymphoma had yet been reported.

A Case of Aggressive T/NK-cell Lymphoma/leukemia with Cutaneous Involvement / 대한피부과학회지

Non-nasal T/NK-cell lymphomas(TNKCL) are further subdivided into primary cutaneous and 4 subtypes of secondary cutaneous lymphomas such as nasal type, aggressive, blastic(blastoid), and other specific NK-like T-cell lymphoma. Aggressive T/NK-cell lymphoma/leukemia(ATNKCL) is a rare leukemic variant of nasal type TNKCL. Although ATNKCL invariably exhibits the identical histomorphological, genotypical and immunophenotypical findings with TNKCL, it is distinguishable from the nasal type of TNKCL in that the former reveals atypical cells having large azurophilic cytoplasmic granules in the peripheral blood and bone marrow. We herein report a rare case of ATNKCL with secondary cutaneous lesions.

A Histopathologic and Immunogenetic Analysis of Primary Cutaneous B-cell Lymphomas in Korea / 대한피부과학회지

BACKGROUND: Despite the advent of molecular biology and immunogenetics, the biologic behaviors and disease entities of primary cutaneous B-cell lymphomas(pCBCL) have been undetermined. Moreover, rarity of pCBCL cases and the conflicting datas of current issues have contributed to the dilemmas in understanding of the biology of pCBCL. Until now, a study of the overall features of pCBCL in Korea has been rarely presented. OBJECTIVE: We performed this study in order to identify the histopathologic and immunogenetic characteristics of pCBCL in Korea. METHODS: The histopathologic, immunophenotypic and molecular analysis of preserved specimens of 15 cases with pCBCL were conducted. RESULTS: 1. Of the 15 patients with pCBCL, most common types are follicle center cell lymphomas(73.3%). In REAL classification, diffuse large B-cell lymphoma is most common(66.6%). 2. In bcl-2 immunohistochemical staining, 3 cases(20%) were positive. 3. Only one of 15 cases of pCBCL denoted bcl-2 gene rearrangement by t(14;18) in minor cluster region. 4. Immunohistochemical staining demonstrated overexpression of p53 protein in 3(20%) of 15 cases. 5. 2 cases(13.3%) with point mutations(one for exon 5; the other for exon 8) in p53 DNA sequencing analysis. CONCLUSION: t(14;18) translocation may be rare in pCBCL in Korea. This finding indicates that bcl-2 expression by tumor cells in pCBCL without t(14;18) may occur by different genetic dysregulation. It seems to be that overexpression of p53 protein might not correspond with p53 mutations in pCBCL.

Treatment of Malignant Melanoma Using Sentinel Lymph Node Dissection / 대한피부과학회지

BACKGROUND: Sentinel lymph node dissection is a new therapeutic strategy of malignant melanoma. There was no clinical study about sentinel lymph node dissection in Korea. OBJECTIVE: Our purpose was to analyze the results of the treatment of malignant melanoma using sentinel lymph node dissection and to compare sentinel lymph node dissection with elective lymph node dissection. METHODS: History of 9 cases with malignant melanoma(1 case treated with elective lymph node dissection and 8 cases treated with sentinel lymph node dissection) at our institution over 2 years were reviewed. We evaluated the clinical & histopathologic data, status of sentinel lymph node and results of treatment. RESULTS: Sentinel lymph nodes were located within the regional lymph node basins in all 8 cases of extremity melanoma, except 1 case(trunk melanoma). Of 8 cases treated with sentinel lymph node dissection, the number of sentinel lymph node was 11, and positive lymph nodes was 3. Patients with positive sentinel lymph node were treated with therapeutic regional lymphadenectomy, chemotherapy and adjuvant therapy. No further treatment or only interferon administration was done in patients with negative sentinel lymph node. CONCLUSION: We confirmed the usefulness of lymphoscintigraphy and sentinel lymph node dissection using vital dye staining in the diagnosis and treatment of lymph node metastasis of melanoma.

A Case of Metastatic Small Cell Neuroendocrine Carcinoma of the Lung Mimicking a Merkel Cell Carcinoma / 대한피부과학회지

Metastatic small cell neuroendocrine carcinomas(MSCNC) from distant sites, such as the lung, are high grade tumors with poor prognosis. Histopathologically, it is difficult to distinguish between MSCNC and Merkel cell carcinoma solely on the basis of histologic morphology, electron microscopy, and immunohistochemistry. In recent years, differential expression of cytokeratin(CK) 20 and thyroid transcription factor(TTF)-1 has been proposed as useful distinguishing features. It must be emphasized that clinical correlation(e.g. symptomatology, chest X-ray) and a combination of CK 20 and TTF-1 markers, are essential to differentiate these two disease entities. We herein present a case of MSCNC of the lung that might be misdiagnosed as Merkel cell carcinoma.

A Case of Angioma Serpiginosum Accompanied with Ipsilateral Nevus Flammeus on the Hand / 대한피부과학회지

Angioma serpiginosum is an acquired benign vascular neoplasm characterized by minute purple-colored, grouped nonpalpable punta on the extremities. However, nevus flammeus is a congenital vascular malformation that shows unilateral red macules. Although the evidence for association between vascular tumor and malformation have been posed, angioma serpiginosum is known to be rarely associated with nevus flammeus. We herein report a rare case of angioma serpiginosum accompanied with nevus flammeus on the ipsilateral hand.

A Retrospective Clinical Epidemiological Study of the Health Care Utilization of the Outpatients in the Dermatologic Field after 1 year's Separation of Dispensary from Medical Practice / 대한피부과학회지

BACKGROUND: Despite 2 years' separation of dispensary from medical practice since year of 2000, many outpatients in Korea have a lack of understanding this separation. In addition, the illegal practices of pharmacists such as medical examination have contributed to the recent problematic situation. OBJECTIVE: We performed this study to evaluate the actual situation of the separation of dispensary from medical practice in the dermatologic field. METHODS: The clinico-epidemiologic analysis of 17 months' data of 18, 230 outpatients was conducted through the available medical records and serial questionnaires. RESULTS: The medical or non-medical institutions that 18, 230 outpatients with skin diseases had chosen at first, were as follows by the order of frequency; pharmacy(78.5%), folk remedies or self-medication(9.8%), dermatologic institutions(5.5%), non-dermatologic medical clinics(3.4%), herb clinics(2.8%). Accordingly, most(94.5%, 17, 223) of the new patients did not select a dermatologic institution for the care of their skin diseases. The patterns of health care utilization of the patients mostly(72.9%) showed a fixed tendency to visit the one particular institution or formula continuously prior to final visit to the research hospitals. Most of the patients(62.8%) firstly visited a pharmacy for their disease care and did not revisit another institution. Since the first visit to a pharmacy, 9.6% of the patients repetitively utilized one or more herb clinic(s) or folk remedies in addition to one or more medical institution(s). The patients utilizing non-dermatologic measures for skin disease care at first, were mostly in their fifties(25.3%). The patients seeking herb medicine or non-dermatologic medical clinics, were in their teens(27.3% and 24.3%, respectively). Of the cases misdiagnosed as another disease or aggravated in the patients choosing non-dermatologic care, fungal infections are most common(24.0%). In front of 97.1% of the patients seeking pharmacy at first, the pharmacists practiced medicine like a physician in a wrong way instead of dispensing a prescription. CONCLUSION: In Korea, the majority of dermatologic clinics has been deprived of a position as an institution for primary care of skin diseases. It is imperative that dermatologists should be granted independent and unconstrained authority in the medical profession for the benefit of their patients.

A Case of Paraneoplastic Acral Vascular Syndrome Accompanied with Metastatic Adenocarcinoma / 대한피부과학회지

Paraneoplastic acral vascular syndrome(PAVS) designates the various acral ischemic changes in the elderly patients with occult cancer in the absence of usual causative conditions such as connective tissue disease, hemostatic abnormalities, cardiovascular disease, metabolic disease, peripheral neuropathy, trauma, emboli, and drugs. The common clinical presentation in PAVS is as follows; Raynaud phenomenon, digital gangrene, pulp ulceration, splinter hemorrhage, and acrosclerosis. Most common neoplastic origin of PAVS has been known to be adenocarcinoma occurring in the lung, ovary or uterus. Until now, PAVS have been rarely reported in the Korean literature. We herein report a rare case of PAVS associated with metastatic adenocarcinoma of unknown primary origin.

A Case of Secondary Syphilis Showing Clinical Features of Annular Pustular Psoriasis Following the Acupuncture and Venous Drainage in a Herb Clinic / 대한피부과학회지

Secondary syphilis has a myriad of clinical presentations as "the great imitator". However, syphilid mimicking annular pustular psoriasis has been rarely reported in the Korean literature. Although the incidence of syphilis has been declining in recent years, serologic testing for syphilis might be mandatory in all types of the unestablished psoriasiform dermatoses, in that failure to diagnose early syphilis correctly can have potentially serious legal ramifications. Though the risk of non-sexual transmission of syphilis has been extremely low, the probability of transmission following needle-stick injury or acupuncture can not be excluded. We herein report a rare case of secondary syphilis with clinical features of annular pustular psoriasis following the repeated acupuncture and venous drainage by a herb doctor.

A Study on the Proliferation and the Collagen Synthesis of the Fibroblasts Cultured from Normal Skin and Hypertrophic Scar / 대한피부과학회지

BACKGROUND: As wound healing proceeds, fibroblasts proliferate by platelet derived growth factor(PDGF) and basic fibroblast growth factor(bFGF), while PDGF and transforming growth factorbeta (TGF-beta) play a major role in controlling the composition and amount of extracellular matrix synthesized by fibroblasts. This indicates that there will be a close relationship between scar formation and growth factors such as PDGF, TGF-beta and bFGF. OBJECTIVE: The aim of this study is to know whether there are any differences between the fibroblasts derived from normal skin and the fibroblasts derived from hypertrophic scar in their responses to growth factors, which seems to be a clue to the cause of differences in scar formation. METHODS: Fibroblasts cultured from normal skin and hypertrophic scar were compared according to different parameters such as rate of cell proliferation, and synthesis of collagen, and effects of PDGF, TGF-beta and bFGF on them. RESULT: The proliferative activity measured by MTT assay showed that the optical density of normal skin fibroblasts and hypertrophic scar fibroblasts were similar. However, the degree of responses to growth factors relative to the control groups was different in each fibroblasts. Normal skin fibroblasts showed more cell proliferation by PDGF and bFGF. In contrast, hypertrophic scar fibroblasts showed more cell proliferation by TGF-beta. But, there were no significant differences. The collagen synthesis by PDGF was lower than those of control in normal skin fibroblasts and hypertrophic scar fibroblasts. The collagen synthesis by bFGF was lower than that of control in hypertrophic scar fibroblasts and the percent collagen synthesis by bFGF were lower than those of control in normal skin fibroblasts and hypertrophic scar fibroblasts. Whereas the collagen synthesis and the percent collagen synthesis by TGF-beta were higher than those of control in normal skin fibroblasts and hypertrophic scar fibroblasts. Especially, in the hypertrophic scar fibroblasts, the collagen synthesis and the percent collagen synthesis by TGF-beta were significantly higher than those by control and other growth factors. CONCLUSION: There were differences in characteristics, growth rates and collagen synthesis by PDGF, bFGF, TGF-beta among cultured fibroblasts from normal skin and hypertrophic scar. Therefore, the response of fibroblasts to TGF-beta may have a significant role in the formation of hypertrophic scar. And there is the difference of responsiveness between fibroblasts. In this viewpoint, the difference of responsiveness of fibroblasts plays an important role the formation of hypertrophic scar.

A Study of Prevalence of Activated Protein C Resistance and Leiden Mutation among Korean Patients with Venous Ulcers / 대한피부과학회지

BACKGROUND: Recently, resistance to activated protein C(APC) is known to be an important risk factor for venous leg ulcers. Leiden mutation in clotting factor V is the most common genetic defect leading to APC resistance in western countries. Until now, the prevalence of APC resistance and Leiden mutation in Korean patients with venous ulcers has been ill defined. OBJECTIVE: We performed this study in order to investigate the prevalence of APC resistance and Leiden mutation in Korean patients with venous ulcers. METHODS: The functional analysis for APC resistance(APC resistance ratio) and genetic study for Leiden mutation were conducted in 40 patients with venous ulcers. RESULTS: 1. Of the 40 patients with venous ulcers, resistance to APC was documented in 11 individuals (27.5%). 2. We could not find factor V Leiden mutation in 40 patients. 3. Patients with APC resistance more frequently represented recurrence of venous ulcers and venous thrombosis than in their non-APC resistant counterparts. CONCLUSION: APC resistance may be one of the thrombophilic defects in relation with venous ulcers in Korea. However, Leiden mutation may be rare in Korean patients with venous ulcers than in Caucasians. These findings suggested that the other genetic or non-genetic factors may be involved in the pathogenesis of APC resistance in Korea.

A Case of Recurrent Pyogenic Granuloma with Multiple Satellites / 대한피부과학회지

Pyogenic granuloma is a common proliferative lesion that often occurs shortly after a minor injury or infection of the skin. Typically the lesion grows rapidly for a few weeks before stabilizing as an elevated, bright red papule, usually not more than 1 to 2 cm in size. Recurrence after surgery or cautery is not rare. The development of multiple satellite angiomatous lesions at and around the site of a previously destroyed pyogenic granuloma is a rare and alarming event. Herein we report a case of recurrent pyogenic granuloma with multiple satellites that developed after excision of a single lesion of pyogenic granuloma in an 8-year-old boy.

Epidemiologic and Clinical Survey of Behcet's Disease in Korea: the First Multicenter Study

The prevalence of Behcet's disease is the highest in the East Asian and the Medi-terranean countries. Behcet's disease is also distributed in the Asian countries, but the nationwide survey has not been performed in Korea yet. The Korean Study Group for Behcet's Disease, founded in 1999, conducted a multicenter, retrospective survey on epidemiologic and clinical features of the patients with Behcet's disease from 20 hospitals around the nation from 1997 to 1999. Of 3,497 patients, 1,527 were classified into complete or incomplete type of Behcet's disease according to the revised Shimizu's classification. The sex ratio was 1:1.75 with the female predominance. Geographical distribution showed the highest frequency in Seoul (38.5%). Clinically, 98.8% had oral ulcers, 83.2% had genital ulcers, 84.3% had skin lesions and 50.9% had ocular lesions. As for the minor clinical manifestations, articular symptoms were the most frequent. The pathergy test showed positive in 15.4% of patients and revealed a higher positive rate in males (20.2%) than in females (12.7%). In conclusion, we performed the first multicenter study on Behcet's disease in Korea and revealed the female predominance, higher frequency of ocular lesions, and lower positivity of pathergy test in the patients.

Use of Alternative Medicine by Patients with Psoriasis

BACKGROUND: Psoriasis is a disabling and intractable disease influencing the psychosocial life of the patients. Patients who are frustrated with orthodox medicine may explore alternative therapies. OBJECTIVE: This study was done to research on the actual condition of the use of alternative medicine in the patients with psoriasis. METHODS: A self-administered questionnaire was constructed, and was given to the patients to answer our questions. RESULTS: Among 128 patients with psoriasis, 61 (47.7%) reported previous use of one or more forms of alternative medicine. The absence of satisfactory long-term effects of physician-provided therapy was the main reason for patients trying alternative medicine. Persons without skin s disease and the mass media were the main sources of information on alternative medicine. CONCLUSION: Alternative therapies were widely utilized by subjects participating in this study, and dermatologists need to be aware of alternative treatments employed by their patients.

Cutaneous Immune Reactions to Trichophytin in Dermatophytosis / 대한의진균학회지

BACKGROUND: The cell mediate immunity is of importance for the development of host resistance to dermatophytic infection. OBJECTIVE: The aim of this study was to estimate the clinical usefulness of purified trichophytin and to correlate cell mediate immunity to the clinical parameters of dermatophytosis, i. e. duration of infection, localization of infection and the type of dermatophyte involved. METHODS: For evaluation of cell mediate immunity in dermatophytosis, cutaneous immune reaction was measured in 102 patients with dermatophytosis (75 patients with chronic dermatophytosis and 27 patients with non-chronic dermatophytosis) by means of intradermal injection of purified trichophytin extracted from Trichophyton(T.) mentagrophytes. RESULTS: The results are summarized as follows: Patients with chronic dermatophytosis were positive in 10.7% of cases, while 51.9% of the patients with non-chronic dermatophytosis showed positive delayed cutaneous reactions (p<0.05). Of the dermatophytes isolated, 81.4% of the patients were chronically infected by T. rubrum. Delayed cutaneous reactions occured in infections with T. rubrum in only 17.1% of cases, but this difference was not statistically significant (p=0.06). Of the patients with tinea cruris, delayed cutaneous reactions were registered in 50%, but only in 15.1% those with tinea unguium (p<0.05). The significant difference in the rate of positivity in delayed reactions was not shown between the patients group with nail infection (15.1%) and the patients group without nail infection (28.6%). The rate of positivity in immediate and delayed reactions of the patients group in the multiple lesions (50%, 13.2%, respectively) was higher than that of the patients group in the single lesion (46.9%, 26.6%, respectively). CONCLUSION: The present study reinforced the hypothesis that susceptibility to chronic dermatophytosis is related to a lack of cell mediate immunity to the infectious agents and clinically, purified trichophytin is good for the evaluation of host sensitization to dermatophyte antigens as well as cell mediate immunity in dermatophytosis.