A Study of Food Allergy in Atopic Dermatitis Using CAP-RAST FEIA and Open Food Challenge Test / 대한피부과학회지

BACKGROUND: The role of dietary factors in atopic dermatitis has been the subject of debate for several decades. Recently it has received convincing support from a double-blind controlled trial of an exclusion diet, showing benefit from careful avoidance of egg and milk in a group of atopic children. OBJECT: The purpose of this study was to determine the prevalence of specific food allergies in Korean atopic dermatitis and the potential utility of the Pharmacia CAP-RAST FEIA in the diagnosis of food allergy. METHODS: One hundred ten patients with atopic dermatitis were evaluated for food hypersensitivity by history, skin prick test, CAP-RAST FEIA, and open food challenge test(OFCT). RESULTS: The prevalence of specific food allergies in the study population was 28.2% in history and 18.2% in CAP-RAST FEIA and OFCT. The frequent food allergens were milk, egg, peanut, and wheat. There was no correlation between the clinical severity of atopic dermatitis and CAP-RAST FEIA and OFCT results. Plasma eosinophil and IgE levels were correlated with CAP-RAST FEIA results, but not OFCT results. According to the history, 31 atopic dermatitis patients answered that their dermatitis was related to food, and of the 31 patients, positive reactions to prick test and CAP-RAST FEIA were observed in 8 and 22 patients, respectively. Among the other 79 patients who answered that there was no relation between atopic dermatitis and food, 14 patients reacted positively to prick test and 47 patients showed positive result to CAP-RAST FEIA. CONCLUSION: The CAP-RAST FEIA provides standardized measurement of food specific IgE antibodies which may be useful to diagnose food allergy in atopic dermatitis.

A Case of Generalized Pustular Psoriasis Associated with Myasthenia Gravis / 대한피부과학회지

Generalized pustular psoriasis(GPP) is an uncommon and severe form of psoriasis. The possible provocative factors such as steroid therapy, infection, stress, drugs, pregnancy, sun exposure, and metabolic disorders were reported. Among them, corticosteroid therapy is thought to be the most common factor. Although the cause of psoriasis remain obscure, the coexistence of psoriasis and autoimmune disease and cyclosporin accepted for the treament of psoriasis emphasize the importance of immunologic mechanism in the pathogenesis of psoriasis. We present a case of GPP in a 48-year-old male, who has had a history of myasthenia gravis since the age of 34 years and managed with long-term corticosteroid therapy. With the administration of acitretin and cyclosporin, generalized pustular eruptions nearly cleared and clinical improvement was achieved.

Evaluation of Pharmacia CAP System FEIA for House Dust Mites in Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Specific serum IgE determination is widely used in the diagnosis of IgE-mediated allergic diseases. House dust mite allergens are known to show good sensitivity on in vitro tests. We report the results of specific IgE against house dust allergen by Pharmacia CAP system FEIA and compared them with those of in vivo test. OBJECTIVE: The aim of this study is to find out the clinical application of Pharmacia CAP system FEIA in atopic dermatitis. METHODS: In 46 atopic dermatitis patients, skin prick test and Pharmacia CAP system FEIA were performed for Dermatophagoides pteronyssinus and Dermatophagoides farinae allergens. For all patients, atopy and family histories were taken. RESULTS: The positive results were more frequent in adult patients(over 16 years old, 73.3%) than in child patients(below 15 years old, 38.7%) in skin prick test for both Dermatophagoides pteronyssinus and Dermatophagoides farinae allergens. When skin prick tests were used as a reference standard, the sensitivity of Pharmacia CAP system FEIA was 89.5% for Dermatophagoides pteronyssinus and 90.0% for Dermatophagoides farinae, and the specificity of Pharmacia CAP system FEIA was 77.8% for Dermatophagoides pteronyssinus and 80.8% for Dermatophagoides farinae. Correlations were found between Pharmacia CAP system FEIA results and serum total IgE (r=0.574 for Dermatophagoides pteronyssinus and r=0.534 for Dermatophagoides farinae). CONCLUSION: Our results suggest that Pharmacia CAP system FEIA offers high sensitivity and can be an effective method of screening for allergies to Dermatophagoides pteronyssinus and Dermatophagoides farinae in atopic dermatitis.

A Case of Intradermal Nevus with Seborrheic Keratosis / 대한피부과학회지

A review of the literature indicates that the simultaneous occurrence of two or more neoplasms in one specimen is a relatively infrequent finding. The finding of nevocellular nevi in close association with seborrheic keratosis, desmoplastic trichoepithelioma, syringoma, basal cell carcinoma, trichilemmal cyst, and epidermoid cyst raises interesting points about the histogenesis of these lesions. The combined occurrence of nevus with other epithelial neoplasms may indicate that changes in the microenvironment produced by nevus result in the induction of growth of the ectodermal origin neoplasms. We report a case of simultaneous occurrence of intradermal nevus and seborrheic keratosis.

A Case of Cutaneous Metastasis of Male Breast Cancer / 대한피부과학회지

Male breast cancer is a rare disease, accounting for approximately 1% of all breast cancer. We report a case of cutaneous, osteolytic, pulmonary, and hepatic metastases of male breast cancer in a 40-year-old male who presented 4x2.5 cm erythematous plaque with ulceration and bloody discharge on the areolar area of the left anterior chest. The histopathologic findings of the lesion showed nests and strands of invasive carcinoma forming ductlike structures and cellular arrangement in single-row line, referred to as Indian filing, between collagen bundles. The tumor cell showed positive reaction for estrogen receptor, but negative reaction for progesterone receptor. He was treated with tamoxifen, 5-fluouracil, adriamycin, and cyclophosphamide. Six months after initiation of the treatment, skin lesion was improved. Also, number and size of the metastatic cancer nodules decreased in the computer tomographic imaging.

A Case of Allopurinol Hypersensitivity Syndrome

Allopurinol is a xanthine oxidase inhibitor widely used to control plasma uric acid levels. Serious and life threatening adverse effects such as the allopurinol hypersensitivity syndrome(AHS) are rare. We describe a 32-year-old female patient who was treated with allopurinol and developed fever, rash, and renal and liver dysfunction.

A Case of Deep Juvenile Xanthogranuloma / 대한피부과학회지

Juvenile xanthogranuloma(JXG) is a disorder of histiocytes usually associated with cutaneous lesions. JXG developing in soft tissue is rare and receives little attention. Therefore deeply located JXG may present a diagnostic difficulty in the absence of cutaneous lesions. Clinically, deep JXG seems to occur as solitary lesions on the trunk rather than on the head and neck region and tends to be composed of a monotonous population of histiocytic cells, with rare, if any, foamy macrophages or Touton-type multinucleated giant cells. We report an unusual case of JXG in a 4-month-old male infant who had a deep-seated mass located on the subcutaneous and muscle layer of the left forearm.

A Case of Ramsay Hunt Syndrome with Vocal Cord Paralysis / 대한피부과학회지

Ramsay Hunt syndrome or herpes zoster oticus is a viral disease associated with otalgia, vesicular eruption, facial paralysis, hearing disturbance, tinnitus, vertigo and other symptoms. Rarely it can be associated with involvement of IV, V, IX, X, XI, XII cranial nerves, cervical plexus, and diffuse encephalitis. We report a case of Ramsay Hunt syndrome with vocal cord paralysis which developed prior to facial nerve paralysis.

A Case of Metastatic Cancer of the Penis from Urinary Bladder Carcinoma / 대한피부과학회지

Despite abundant blood supply, metastatic tumors of the penis are rare. We report herein a case of metastatic cancer of the penis from urinary bladder carcinoma in a 80-year-old man. He presented with 1 month history of erythematous tender mass on the penis which developed 16 months later after the diagnosis of carcinoma of the urinary bladder had been made. Skin biopsy from this lesion revealed variable sized atypical cells with hyperchromatic and pleomorphic nuclei similar to those of the urinary bladder. On immunohistochemical staining, infiltrating cells of both bladder and penis showed positive reaction to thrombomodulin and carcinoembryonic antigen(CEA), but negative reaction to cytokeratin20 and C-erB-2 oncogene.

A Case of Dystrophic Calcinosis Cutis on the skin graft site / 대한피부과학회지

Calcinosis cutis is the deposition of calcium phosphate into the skin. It is classified as dystrophic if the calcium is deposited in previously damaged tissue and serum calcium and phosphorous levels are normal. We report a case of dystrophic calcinosis cutis in a 35-year-old man. About 2 months ago, he developed an ulcer in the left thigh that was treated by grafting. Histopathologically, amorphous basophilic materials that stained with von Kossa were deposited in the dermis.

A Case of Solar Urticaria / 대한피부과학회지

Solar urticaria is an uncommon disorder characterized by pruritus, erythema and whealing occurring minutes after exposure to sunlight or artificial radiation, and generally resolves in a few hours. A 46-year-old woman presented with a 2-year history of pruritus and whealing, which occurred immediately after exposure to sunlight. Phototesting elicited urticarial reactions in the UVA and visible sepectra. The results of passive and reverse passive transfer studies were all negative. The patient was treated with cetirizine, doxepin and prednisolone. After 2 months of the treatment, the symptoms did not appear.

A Case of Epidermal Cyst containing Hair Shafts and Trichilemmal Cyst occurring on the Knees / 대한피부과학회지

We report a case of 4-year-old girl with erythematous papule and nodule on the right knee and left knee, respectively. Histopathologically, the findings of walls of the each cystic lesions were those of the epidermal cyst containing hair shafts of lanugo size on the right knee and the trichilemmal cyst on the left knee. The observation of hair shafts in a cystic cavity represents an important clue for identifying some unusual varieties of cystic lesions. We report a interesting case of epidermal cyst containing hair shafts and trichilemmal cyst simultaneously and independently occurred on the right knee and left knee, respectively.

The efficacy of thymopentin in the treatment of atopic dermatitis / 천식및알레르기

BACKGROUND: Thymopentin(TP-5) is an immunomodulatory agent which may be a promising new drug in the treatment of patients with severe atopic dermatitis. OBJECTIVE: The aim of this study was to evaluate the efficacy of thymopentin for treatment of severe atopic dermatitis. MATERIAL AND METHOD: Fifteen patients with severe atopic dermatitis received subcutaneous injections of 50mg thymopentin three times per week for 6 weeks. Clinical extent and severity parameters were assessed at baseline, at regular intervals during therapy and 4 weeks posttherapy. Use of antihistamine and topical steroid were permitted. RESULT: Significant reduction in severity scores and body surface area involvement was observed and no significant side effects were noted(p<0.05). CONCLUSION: Thymopentin may be considered to be an effective adjunctive therapeutic agent in the treatment of severe atopic dermatitis. Further studies will be needed to determine the action mechanism of thymopentin.

A Case of Malignant Histiocytosis Showing Papulosquamous Skin Lesions and Fever as Initial Manifestations

We report a case of malignant histiocytosis which began with intermittent fever and scaly skin lesions. A 3-year-old girl presented with erythematous scaly papules on the face and the trunk, and high fever for 3 months. The cutaneous lesions consisted of widespread coin-sized erythematous scaly papules with marginal brownish pigmentation. She was anemic and thrombocytopenic and had impairment of the liver function. Histopathologic study of the skin lesions showed non-specfic findings except for hyperkeratosis. However, bone marrow examination revealed an increased number of histiocytes, mostly immature with active phagocytosis of erythroid cells, myeloid cells, and platelets. She was diagnosed as having malignant histiocytosis and treated with cyclophosphamide and vincristine. She died the next day after the treatment had begun.

A Study of the Personality of Adult Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Atopic dermatitis will persist into adult life and chronic severe atopic dermatitis may cause significant interference in social interaction. Despite the controversy concerning the existence of specific personality exhibited by patients with atopic dermatitis, psychological and social factors have long been considered important factors that have influence on the course of the disease. OBJECTIVE: The purpose of this study was to investigate the charateristics of the personalities of adult patients with atopic dermatitis and their relationship to psychological factors and clinical characteristics. METHODS: Eysenck Personahty Questionnaire(EPQ) was carried out on 54 adult patients with atopic dermatitis. Using the EPQ scores, a cluster analysis was done to identify the subgroup of psychologically disabled patients. The psychological and social aspects of the identified patients were then investigated using a designed questionnaire. RESULTS: 1. A cluster analysis identified two patient subgroups. Psychoticism(P), extroversion-introversion(E), and neuroticism(N) scores were significantly different between the subgroups. The neuroticism scores were above the upper limit of the normal range in the higher EPQ scored subgroups. However, the total clinical severity score which was evaluated in 25 patients showed no significant difference between these subgroups. 2. The higher psychoticism, extroversion-introversion, and neuroticism scored patients tended to express severe disability due to atopic dermatitis and a high level of stress which was evaluated by the designed questionnaire. CONCLUSION: Eysenck personality questionnaire can be helpful in identifying a subgroup of patients who may need psychiatric intervention.

A Case of Primary Osteoma Cutis

No abstract available.

A Case of Juvenile Chronic Myelogenous Leukemia Presented as Recurrent Erythema Nodosum-Like Lesions

No abstract available.

The Correlation between Responses of Peripheral Blood Mononuclear Cells and Immediate Hypersensitivity of Skin to Mite Antigen in Atopic Dermatitis / 대한피부과학회지

BACKGROUND: House dust mites have been reported to play an aportant role in the pathogenesis of atopic dermatitis(AD). In fact a high positive rate for house dust mites in the skin prick test was observed in patients of AD. However, it is quite difficult to determine the clinical relevance of positive immediate hypersensitivity to mite antigen by clarical history alone because AD patients are nearly always exposed to these antigens in their daily lives. OBJECTIVE: The aim of this study was to elucidate the clinical. singficance of a positive immediate hypersensitivity reaction by observing the proliferative respons of peripheral blood mononuclear cells(PBMC) to mite antigen in the AD. METHODS: The proliferative response of PBMC separated from Dermatopkagoides farinae(Df) positive AD patients to Df antigen was compared with that from Df negative normal controls, Df positive normal controls and Df negative AD patients. RESULTS: PBMC from Df positive AD patients showed signinc not proliferation in response to Df antigen evaluated by comparing stimulation indices(SI) among different experiment groups. CONCLUSION: Significant correlation between responses of PBMC and immediate hypersensitivity of skin to Df antigen in AD was found, and it was suggested the Df may be a real aggravating factor in the Df positiv AD patients. SI may be used as ar objective criteria to select patients for hyposensitization therapy after doing a skin test.

Polymorphism in the IL-1 Receptor Antagonist Gene in Vitiligo

BACKGROUND: The severity of several chronic inflammatory diseases was reported to be associated with polymorphism of the IL-1 receptor antagonist gene(IL-lrn). OBJECTIVE: This study was performed to study the polymorphism of the IL-1rn in vitiligo and in the normal Korean population. METHODS: Thirty one cases of vitiligo and seventy nine normal Koreans as control were studied for the polymorphism of IL-1 rn. RESULTS: The frequency of allele 2 of the IL- I rn in 31 patients with vitiligo was compared with that of the 79 healthy controls. The frequency of allele 2 was 1.6% in vitiligo patients and 3.8% in the normal controls. CONCLUSION: There was no significant difference in the frequency of allele 2 between the vitiligo patients and normal controls.

Three Cases of Allopurinol Hypersensitivity Syndrome / 대한피부과학회지

The allopurinol hypersensicivity syndrome is a rare, but life thereaning immunologic reaction of allopurinol therapy, characterized by multiple abnormalities such as fever, rash, decreased renal function, hepatocellular injury, leukocytosis, and eosinophila. It may require prolonged hospitalization and occasionally involves residual morbidity. Three patients developed erythematous skin eruption three to five weeks after beginning therapy with allopurinol. The clinical, laboratory, and histologic findings of these patients were compatible with a allopurinol hyperensitivity syndrome.