Primary Cutaneous Nocardiosis Caused by Nocardia brasiliensis / 대한피부과학회지

Nocardiosis is an uncommon, potentially life-threatening infectious disease caused by several species of the genus Nocardia, which are Gram-positive branched bacilli. Most infections enter through the respiratory tract and then disseminate systemically but rarely has a primary infection occurred resulting from direct inoculation. Isolation of Nocardia from clinical specimens and identification of species is difficult and require a specialized microbiologist. We report a case of primary cutaneous nocardiosis caused by N. brasiliensis in a 68-year-old man who was diagnosed by bacterial culture and 16S ribosomal RNA sequencing. The skin lesions improved with trimethoprim- sulfamethoxazole antibiotic therapy for 6 months.

Multiple Merkel Cell Carcinoma in a Vietnam Veteran Exposed to Agent Orange / 대한피부과학회지

Merkel cell carcinoma is a rare aggressive primary skin cancer which mostly occurs in the elderly on sun-exposed skin. It usually presents as a solitary dome-shaped red or purple nodule on the head, neck and extremities. The mortality rate is higher than the rate for malignant melanoma because its local recurrence is common. Agent Orange, an herbicide widely used as a defoliant in the Vietnam War, contains dioxin contaminants and can cause several dermatoses and skin cancers. We report a case of multiple Merkel cell carcinoma in a 65-year-old male with lesions on the head and neck, who had been exposed to Agent Orange during Vietnam War.

Annular Syphilid Mimicking Tinea Corporis / 대한피부과학회지

Syphilid has been called the "great imitator" of skin disease, and it can have protean clinical manifestations and it may present with unusual lesions. Annular syphilid, which can mimic sarcoid, granuloma annulare, Sweet syndrome or tinea corporis, is a rare variant of syphilid. We report here on a case of annular syphilid that mimicked tinea corporis in a 29-year-old female who showed a three month history of multiple, pruritic, well-demarcated annular scaly erythematous patches with central clearing and an elevated border on the trunk and both upper extremities. Direct mycological examination and culture did not result in finding any fungal elements, and annular syphilid was confirmed according to the histopathologic and serologic findings. She and her boyfriend were treated with benzathine penicillin G, and the skin lesions disappeared completely.

A Case of Linear Porokeratosis on the Trunk / 대한피부과학회지

Porokeratosis is a genodermatosis that is characterized by abnormal epidermal keratinization with the histologic finding of a cornoid lamella. Linear porokeratosis is an uncommon variant that presents a characteristic linear nevoid distribution along the Blaschko's lines and linear porokeratosis has the highest potential for malignant degeneration of all the porokeratoses. Many treatment modalities have been used, but the treatment outcomes are variable and the treatments are poorly standardized. We report here on a case of linear porokeratosis in a 48-year-old female who showed localized, linear, brownish macules with a well-demarcated hyperkeratotic border on the left lower abdomen and back.

A Case of Rosacea-like Tinea Faciei Caused by Trichophyton rubrum / 대한의진균학회지

We report a case of rosacea-like tinea faciei in a 62-year-old female. The lesions were manifested by 2.0x2.0 cm and 2.0x2.0 cm-sized, two, pruritic, well-demarcated, erythematous macules on the nose and left ala nasi. Histopathologic examination of the skin lesion showed chronic dermal inflammation with presence of fungal hyphae in the honey layer of the epidermis. Fungal culture of the biopsy specimen grew out typical white cottony colonies of Trichophyton rubrum. The patient was treated with 250 mg of terbinafine daily for 1 month and topical lanoconazole application. Skin lesions improved one month after the treatment, and recurrence has not been observed.

Cutaneous Infection due to Mycobacterium fortuitum Originated from Soil / 대한피부과학회지

Mycobacterium (M.) fortuitum is a rapidly growing mycobacterium. It is classified as Runyon's group IV with M. abcessus and M. chelonae that are mostly found in water and soil. M. fortuitum infection usually occurs after trauma, surgery or procedures such as acupuncture that cause cutaneous or soft tissue manifestations. We report a case of cutaneous infection due to M. fortuitum in a 72-year-old woman with erythematous deep-seated nodules on her left hand. She inflicted a minor injury to her left hand in a farm. Culture from skin biopsy specimens on 3% Ogawa medium yielded bacterial colonies after 5 days. The microorganism was subsequently identified as M. fortuitum by PCR-restriction fragment length polymorphism analysis. The skin lesions were improved by antibiotic therapy with clarithromycin for 6 months.

Antifungal Susceptibility Testing of Dermatophytes Using Etest / 대한의진균학회지

Background: It is necessary to perform antifungal susceptibility testing of dermatophytes. Etest (AB Biodisk, Sweden) is a rapid, easy-to-perform in-vitro antifungal susceptibility test. Objective: The purpose of this study was to investigate the minimal inhibitory concentration (MICs) of dermatophytes isolated from skin using Etest. Methods: 21 species of dermatophytes (12 strains of T. rubrum, 7 strains of T. mentagrophytes, M. canis and M. gypseum) and two standard strains (Aspergillus flavus KCTC 6905, Aspergillus fumigatus KCTC 6145) were tested MIC endpoints of Etest for itraconazole (ITZ) and amphotericin B (AMB) were read after 72, 96, and 120 hours incubation for each strains on RPMI 1640 agar. Results: MIC of ITZ was 0.12~0.47 microg/mL on T. rubrum, 0.012~1.0 microg/mL on T. mentagrophytes, 0.012 microg/mL on M. canis, and 0.023 microg/mL on M. gypseum. MIC of AMB was 0.094~0.5 microg/mL on T. rubrum, 0.032~1.0 microg/mL on T. mentagrophytes, 0.19 microg/mL on M. canis, and 0.032 microg/mL on M. gypseum. One strain of T. mentagrophytes isolated from patient with tinea pedis showed ITZ-resistant. Conclusion: This study showed that Etest represented a simple and efficacious method for antifungal susceptibility testing of dermatophytes.

A Case of Non-Hallopeau-Siemens Recessive Dystrophic Epidermolysis Bullosa

Dystrophic epidermolysis bullosa (DEB) is a rare group of heritable mechanobullous disorders that are characterized by blistering and scarring of the skin and mucosae and these lesions are induced by minor trauma, DEB is also associated with nail dystrophy. DEB can be inherited either in an autosomal recessive or dominant fashion. Regardless of the mode of inheritance, DEB is caused by defects of the ultrastructural entity known as the anchoring fibril, which results in separation of the sublamina densa. Recessive DEB (RDEB) is classified into Hallopeau-Siemens and non- Hallopeau-Siemens. We herein report on a case of non- Hallopeau-Siemens RDEB and there was no family history of this malady, and we present the clinical, histological and electron microscopy findings.

Seborrheic Dermatitis-like Norwegian Scabies on a Patient Living in an Eldercare Hospital / 대한피부과학회지

Norwegian scabies is a crusted rash that's caused by a massive infestation with the mite Sarcoptes scabiei. The characteristic skin lesions of this form are gross scaling and hyperkeratotic plaques, and especially on the hands, feet, face, nails and scalp with varying degrees of pruritus. It is often seen in the individuals with human immunodeficiency virus infection, the elderly, immunocompromised patients and institutionalized persons. We report here on a case of Norwegian scabies on an 86-year-old patient who was living in an eldercare hospital, and the patient presented with localized, pruritic, erythematous patches with thick yelolwish crusts on the scalp.

A Case of Reticulate Pigmented Anomaly of the Flexures (Dowling-Degos Disease) / 대한피부과학회지

Reticulate pigmented anomaly of the flexures is a rare autosomal dominant genodermatosis, and this is also known as Dowling-Degos disease. The clinical symptoms are characterized by the progressive evolution of small hyperpigmented macules in a reticulate distribution, and this shows a predilection for the flexural regions, including the axillae, antecubital fossae, inframammary regions, neck and groin. The histopathology of reticulate pigmented anomaly of the flexures typically shows filiform epithelial down-growth of the epidermal rete ridges along with basal hyperpigmentation. We report here on a case of reticulate pigmented anomaly of the flexures in a 45-year-old male who showed multiple, asymptomatic, scaly brownish reticulated macules on the flexural areas.

A Case of Tinea Corporis Caused by Microsporum gypseum and Keloid While Applying Tinea Corporis with Glacial Acetic Acid Improperl / 대한의진균학회지

We report a case of tinea corporis caused by Microsporum(M.) gypseum and keloid while applying tinea corporis with glacial acetic acid improperly in a 59 year-old female. The lesions were manifested by 7.0x4.5 cm-sized, localized pruritic fine scaly erythematous annular patch and keloid on left antecubital fossa. Culture from the annular skin lesion of patient on Sabouraud's dextrose agar showed typical colony of M. gypseum. The patient was treated with 250 mg of terbinafine daily for 1 month and topical lanoconazole application. Keloid was improved by intralesional steroid injection.

A Case of Tinea Corporis Caused by Microsporum gypseum and Keloid While Applying Tinea Corporis with Glacial Acetic Acid Improperl / 대한의진균학회지

We report a case of tinea corporis caused by Microsporum(M.) gypseum and keloid while applying tinea corporis with glacial acetic acid improperly in a 59 year-old female. The lesions were manifested by 7.0x4.5 cm-sized, localized pruritic fine scaly erythematous annular patch and keloid on left antecubital fossa. Culture from the annular skin lesion of patient on Sabouraud's dextrose agar showed typical colony of M. gypseum. The patient was treated with 250 mg of terbinafine daily for 1 month and topical lanoconazole application. Keloid was improved by intralesional steroid injection.

A Case of Trichophytic Granuloma of the Leg Caused by Trichophyton rubrum / 대한의진균학회지

Dermatophytes usually do not invade beyond the epidermis. However, mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state, such as diabetes mellitus, lymphoma, and long term steroid use may allow penetration of the fungi into dermis. We report a case of trichophytic granuloma of the thigh caused by Trichophyton(T.) rubrum in a 21-year-old chinese male, who showed a pruritic, 17x10 cm sized, erythematous to brownish patch with multiple papules on the left thigh for 3 months. Fungal culture of the biopsy specimen grew out typical white cottony colonies of T. rubrum. Histopathologic examination of the skin lesions showed chronic granulomatous inflammation and fungal elements in the dermis. After one month of itraconazole therapy (200 mg/day), lesions were completely cleared.

A Case of Tinea Corporis Caused by Trichophyton verrucosum Showing Tinea Imbricata-like Clinical Appearance / 대한의진균학회지

We report a case of tinea corporis arising in previous burn area which shows tinea imbricata-like clinical appearance in a 69-year-old male. He showed round, 5.0x5.0 cm sized, fine scaly, well-defined erythematous patch with concentrically arranged rings of scales on the right forearm. Histopathologically, PAS staining revealed fungal hyphae in the horney layer of the epidermis. Fungal culture of scales of the lesions on Sabouraud's dextrose agar showed typical Trichophyton verrucosum. He was treated with oral terbinafine (250 mg/day) and topical lanoconazole for 1 month. Skin lesions improved one month after the treatment, and recurrence has not been observed

A Case of Acquired Distal Trichorrhexis Nodosa / 대한피부과학회지

Trichorrhexis nodosa (TN) is the most common hair shaft anomaly and is caused by physical or chemical trauma. It is characterized by nodular swellings of the hair shaft accompanied by frayed fibers and loss of cuticle. The fibers then fracture and the shaft breaks with the resultant appearance of a splayed paintbrush or fan-like array. Trichorrhexis nodosa is classified into congenital TN and acquired TN. Acquired TN is further classified into three groups, acquired localized TN, acquired proximal TN, and acquired distal TN. To date, no case of distal trichorrhexis nodosa has been reported in Korean dermatologic literature. We herein report a case of acquired distal trichorrhexis nodosa in a 12-year-old boy.