Effects of Emollient Containing Bee Venom on Atopic Dermatitis: A Double-Blinded, Randomized, Base-Controlled, Multicenter Study of 136 Patients

BACKGROUND: Atopic dermatitis (AD) is a common, complex disease that follows a chronic relapsing course and significantly affects the quality of life of patients. Skin barrier dysfunction and inflammatory processes induce and aggravate this skin condition. Proper use of an emollient for hydration is a keystone of AD treatment. Bee venom is known to have anti-inflammatory effects and has been widely used in traditional medicine to treat various inflammatory disorders. OBJECTIVE: To find out the beneficial effect of an emollient containing bee venom in the treatment of patients with AD. METHODS: This study included 136 patients with AD who were randomized to receive either an emollient containing bee venom and silk-protein or a vehicle that was identical except for the bee venom for 4 weeks. The patients were instructed to apply the emollient twice daily on their entire body and not to use other medications, including topicals, during the course of the study. The eczema area and severity index (EASI) score, transepidermal water loss, and visual analogue scale (VAS) score of itching were evaluated at the first visit and after 2 and 4 weeks. The investigator global assessment was evaluated at 2 and 4 weeks after the application of emollient containing bee venom or vehicle. RESULTS: Patients applying emollient containing bee venom showed significantly lower EASI score and VAS value compared to patients applying emollient without bee venom. CONCLUSION: Emollient containing bee venom is a safe and effective option for patients with AD.

A Case of Folliculosebaceous Cystic Hamartoma

Folliculosebaceous cystic hamartoma (FSCH) is a recently-recognized cutaneous hamar- toma composed of follicular, sebaceous and mesenchymal elements. We describe an unusual case of FSCH in a 61-year-old male, who had a relatively large, 3x2.5cm sized, smooth subcutaneous nodule on the occipital area of the scalp, an uncommon location for FSCH.

Invasive Squamous Cell Carcinoma of the Oral Mucosa Associated with HPV Type 53

A 77-year old man presented with a fungating mass on the oral mucosa and lip, which had an irregular margin. An incisional biopsy of the mass revealed an invasive squamous cell carcinoma. PCR analysis detected HPV DNA in the biopsy specimen. The HPV type was determined as HPV-53 by direct cycle sequencing. This is the first report of HPV-53 in an oral malignant tumor.

A Case of Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin / 대한피부과학회지

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, mucocutaneous drug reaction, which causes extensive epidermal detachment and serious complications involving ocular structures and internal organs. Recently, intravenous immunoglobulin (IVIG) was suggested to be effective in treating TEN through the blockage of Fas receptors which initiate keratinocyte apoptosis. Herein, we tried IVIG teratment (0.6 g/kg/day for 4 consecutive days) for a case of TEN. As a result, the progression of epidermal detachment was interrupted within 2 days and epithelialization was completed in 3 weeks without significant side effects.

A Case of Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin / 대한피부과학회지

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, mucocutaneous drug reaction, which causes extensive epidermal detachment and serious complications involving ocular structures and internal organs. Recently, intravenous immunoglobulin (IVIG) was suggested to be effective in treating TEN through the blockage of Fas receptors which initiate keratinocyte apoptosis. Herein, we tried IVIG teratment (0.6 g/kg/day for 4 consecutive days) for a case of TEN. As a result, the progression of epidermal detachment was interrupted within 2 days and epithelialization was completed in 3 weeks without significant side effects.

A Study on Clinical Features and Laboratory Findings According to the Severity of Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Although atopic dermatitis (AD) is a very common disease, there is no specific diagnostic or prognostic marker for it. Minor clinical features and a few laboratory findings can be used as ancillary diagnostic criteria and reflect the present state of AD, but cannot predict the disease severity. OBJECTIVE: We performed this study to find out if there is any correlation among minor clinical features, laboratory findings such as blood eosinophil count and serum IgE levels, and the severity of AD. METHODS: One hundred patients with AD were involved in the study. They were divided into two groups by the age of 12 years; group 1( or = 12-year-old, n=53) represented adolescence and adult AD. Subsequently, the severity of AD was assessed by the SCORAD index, and then all the patients were classified into 3 subgroups; mild, moderate and severe groups. They were evaluated for 28 minor clinical features of AD. In addition, blood samples were measured for blood eosinophil count and serum IgE levels. RESULTS: The pattern of minor clinical features correlated significantly with the disease severity was quite different between the two groups, except ventral wrist eczema and eyelid eczema. Blood eosinophil count and serum IgE levels increased significantly as the SCORAD index increased. While perifollicular accentuation was a significant minor clinical feature that correlated with blood eosinophil count in the both groups, there were no minor features showing statistically significant correlation with serum IgE levels. In group 1, keratosis pilaris and infragluteal eczema appeared more frequently as all 3 variables such as the SCORAD index, blood eosinophil count and serum IgE levels, increased simultaneously. However, no minor clinical features which correlated significantly with all variables were observed in group 2. CONCLUSION: We concluded that minor clinical features such as keratosis pilaris and infragluteal eczema reflect the disease severity and can be used as an anticipating sign of severe disease, especially in childhood AD.

A Case of Linear Verrucous Epidermal Nevus with Cutaneous Horn

No abstract available.

A Case of Epithelioid Angiosarcoma on the Back / 대한피부과학회지

Epithelioid angiosarcoma has recently been described as a variant of angiosarcoma, based on its pathologic feature which is characterized by epithelioid or histiocytoid morphology of the malignant tumor cells. We report a case of epithelioid angiosarcoma on the lower back of a 65-year-old man. The patient had several, variable-sized, pedunculated, fungating masses. On histopathologic examination, the tumor was chiefly composed of solid sheets of atypical epithelioid cells with prominent eosinophilic cytoplasm, a large vesicular nuclei, and occasional intracytoplasmic vacuoles. Primitive vascular spaces, and a cleft with malignant cells and proliferating vessels were also found in some areas. The reticulum stain and immunohistochemical stain using factor VII-related antigen and CD 31 were focally positive in the tumor. He was treated by wide surgical excision.

A Clinicopathological Study of Kaposi's Varicelliform Eruption / 대한피부과학회지

BACKGROUND: Kaposi's varicelliform eruption (KVE) is a viral infection with disseminated skin involvement, superimposed on a pre-existing dermatosis. A monomorphic eruption of dome-shaped blisters and pustules in the eczematous lesions, along with severe systemic illness, leads to clinical diagnosis. However, there is no data on the clinicopathologic study of KVE in Koreans. OBJECTIVE: The purpose of this study was to identify clinicopathologic features of KVE. METHOD: We reviewed the medical records and biopsy slides of 21 patients who had previously been diagnosed as having KVE at the National Medical Center between 1990 and 2004. RESULTS: The study results are summarized as follows: 1. The most common pre-existing disease was atopic dermatitis, followed by seborrheic dermatitis and Darier's disease. 2.Men were more commonly affected than women, and the mean age at diagnosis of eczema herpeticum was 30.8 years. 3.Face involvement was seen in 4 patients, and systemic involvement in 6 patients. 4. Histopathologically, common findings included ballooning degeneration (76.1%), reticular degeneration (47.6%), multinucleated giant cell (57.1%), and inclusion body (28.6%), and leukocytoclastic vasculitis (47.6%). CONCLUSION: KVE is a secondary viral infection that can affect patients who suffer from a primary dermatologic condition. In many instances, the history and clinical findings may be sufficient for diagnosis of KVE. However, the clinicopathologic features can help also diagnose KVE and pre-existing dermatosis.

A Case of Congenital Trichofolliculoma / 대한피부과학회지

Trichofolliculoma is a benign, highly structured harmartoma of the pilosebaceous unit characterized by one or more large cystic follicles with smaller radiating follicular structures. This benign neoplasm appears in middle age and rarely occurs prior to early adult life. We report a case of congenital trichofolliculoma in a 10-day-old female neonate noted from birth.

A Case of Prurigo Nodularis Treated with Narrow-band UVB and Naltrexone / 대한피부과학회지

Prurigo nodularis is a distressing, chronic disease, which is considered to be very resistant to therapy. Treatment choice is quite limited. Among them, opiate antagonist and phototherapy have been used with satisfactory results. We report a case of treatment-resistant prurigo nodularis. Narrow band-UVB phototherapy was performed twice weekly for 3 months. Naltrexone 50mg was also taken daily before sleep. Pruritus was midly reduced after 1 week, and had almost completely disappeared after 3 months of treatment.

A Case of Subcutaneous Juvenile Xanthogranuloma

Juvenile xanthogranuloma is a congenital or perinatal tumor, 1 to 2 cm in diameter, usually located on the head. The extracutaneous lesions can occur on the eye, the lung, the epicardium, the oral cavity or the testicles. Subcutaneous form of juvenile xanthogranuloma has been reported very rarely in the literature. We report a unique case of a subcutaneous juvenile xanthogranuloma that showed 4 × 4 cm sized plaque and located on the extremity of 9-year-old girl.

A Case of Irritant Contact Dermatitis due to Garlic / 대한피부과학회지

Garlic has been employed for thousands of years in virtually all cultures for the prevention and the treatment of a wide variety of ailments such as parasitic and fungal infections, chest pain and rheumatism. However, garlic may cause the allergic and irritant contact dermatitis. We experienced a case of irritant contact dermatitis on both legs after external application of garlic. The patient was treated successfully with systemic steroid and wet dressing. We insist the practice of direct application of fresh garlic onto the skin for treating infections should be discouraged.

A Case of Xanthoma Disseminatum Treated with CO2 Laser Vaporization and High Dose Steroid

Xanthoma disseminatum (XD) is one of cutaneous nonhistiocytosis X, and characterized by multiple, widely distributed red, brown, yellowish papules and nodules that tend to coalesce. We present a case of XD with characteristic clinical findings and treated with the combination therapy of COz laser vaporization and high dose steroid.

A Case of Stasis Dermatitis with Secondary Lipodermatosclerosis in a Patient with Antithrombin III Deficiency / 대한피부과학회지

Antithrombin is one of the main endogenous anticoagulants. Antithrombin deficiency may result from hereditary or acquired factors. Inherited antithrombin deficiency is an uncommon autosomal disorder associated with a tendency to venous thromboembolism. Stasis dermatitis occurs as a result of venous stasis caused by venous incompetence or deep vein thrombosis. Furthermore, lipodermatosclerosis that refers to the skin induration and hyperpigmentation of the legs, often occurs in patients who have venous insufficiency. We report a case of stasis dermatitis, complicated by lipodermatosclerosis on both legs of a patient with hereditary antithrombin III deficiency.

A Case of Steatocystoma Multiplex on the Face / 대한피부과학회지

Steatocystoma multiplex is a hamartomatous condition of the pilosebaceous junction. It is thought to be hereditary or non-hereditary and occurs on the face rarely. We report a case of steatocystoma multiplex located only on the face in an 82-year-old woman. Histologic findings showed relatively typical findings of steatocystoma multiplex such as a folded cyst consisting of several layers of epithelial cells, palisading basal layer, absence of granular layer and outer hyalin-like cuticle.

A Case of Squamous Cell Carcinoma Arising in Nevus Sebaceus / 대한피부과학회지

In adulthood, nevus sebaceus is frequently associated with the development of a number of benign and malignant neoplasms. Basal cell carcinoma is known to be the most frequent malignant tumor arising in nevus sebaceus, while squamous cell carcinoma is a rare complication of nevus sebaceus. Herein, we report a 42 year-old man who had a slightly tender, 0.6 X 0.6cm sized, erosive papule in a 1.0 X 3.5cm sized, linear nevus sebaceous on the right parietal scalp. The histopathologic examination showed invasion of the dermis by epidermal masses with many horn pearls. The tumor was excised with 1.5cm margins and there has been no recurrence for 5 months.

Disseminated Eczema Herpeticum Transmitted by Self-inoculation / 대한피부과학회지

Eczema herpeticum is a widespread Herpes simplex virus(HSV) infection, which usually develops in patients with atopic dermatitis. Because pruritus in patients with atopic dermatits leads them to scratch their bodies, it causes the dissemination of Herpes simplex virus. A delay in diagnosing this condition may result in intense and rapid spread of the cutaneous lesions. We report a patient who underwent a prolonged friction with a rough nylon towel while bathing and developed eczema herpeticum. We suspect a bath with a rough nylon towel as a possible route of spread.

Metastatic Cancer of the Skin: Clinical and histopathologic study / 대한피부과학회지

BACKGROUND: Metastatic skin cancer may have profound diagnostic, therapeutic, and prognostic significance. OBJECTIVE: We studied patients with metastatic skin cancer to determine the relative frequencies of metastatic skin cancer according to the type and location of the primary tumor and the site of the cutaneous metastasis. METHODS: We reviewed medical records and histologic materials of 68 patients with metastatic skin cancer in Catholic University Hospital from January 1991 to March 2001. RESULTS AND CONCLUSIONS:Of 61,218 patients with internal malignancy, 68(0.11%) had metastatic skin cancer. The mean age at diagnosis was 64.7 in male and 58.2 in female. Male to female ratio was 1:2.2. Breast carcinoma was by far the most common primary neoplasm resulting in skin involvement and accounted for 31(45.6%) of total cases and 63.8% of the cases in women. The most common clinical presentation is a nodule(26.5%) or multiple nodules(64.7%) although carcinoma erysipelatoides(4.4%) and carcinoma en cuirasse(4.4%) were also seen. Histopathologic examination most frequently revealed adenocarcinoma(70.6%) that was sometimes suggestive of the site of origin.

Histopathologic Evaluation of Linear Lichen Planus and Lichen Striatus

BACKGROUND: Linear lichen planus (LLP) and Lichen striatus (LS) are rare disorder that can be confused because they can share similar clinical and histopathologic features. OBJECTIVE: The purpose of this study was to evaluate the characteristic differences and common features between the two disorders histopathologically. METHODS: We reviewed the clinical records of patients who had been diagnosed as LLP or LS in our dermatology clinic during the 15-year period between 1985 and 1999. We classified twenty seven cases, which were differentiated from other possible linear dermatoses, into LLP and LS on the basis of clinical features, and then compared them histopathologically, and appreciated the characteristic differences or common features of the two disorders. RESULTS: In cases diagnosed as LLP clinically, epidermal changes were mainly composed of hyperkeratosis (78%), acanthosis (78%), basal degeneration (78%), granular layer thickening (67%) and saw-toothed appearance of rete ridges (44%). In dermis, colloid bodies (78%), band-like inflammatory cell infiltration with pigmentary incontinence (78%) were strik-,ting findings. In cases with clinical features of LS, parakeratosis (50%), dyskeratotic cells scattered in the epidermis (61%) and intercellular edema (39%) were noted in the epidermis. Dermal cellular deposits were focally band-like infiltration(89%), more frequently perivascular in-filtration (83%) and often involved deep dermis (50%), hair follicles (44%) and eccrine glands (22%) in contrast to LLP. CONCLUSION: This study presents a comparative histopathologic features of LLP and LS. Three cases of LLP with overlapping histopathologic features suggest the possibility that there may be an intermediate form between either end of a spectrum, LLP and LS.