A Case of Deep Cutaneous Purpureocillium lilacinum Fungal Infection in an Immunocompetent Patient / 대한의진균학회지

Purpureocillium is a genus of saprophytic fungi that is commonly found in soil or rotting material. Although rarely a pathogen in humans, it can cause serious infections in immunocompromized patients. An 85-year-old woman presented with a 2-week history of pruritic erythematous plaques with yellowish crusts on her right forearm and dorsal hand. Histopathological analysis identified fungal hyphae and spores in the dermis, and Purpureocillium lilacinum was identified through tissue culture, polymerase chain reaction, and DNA sequencing. The skin lesion barely responded to 4 weeks of itraconazole treatment but improved upon the addition of terbinafine. The skin lesion was completely cured after 12 weeks, with no recurrence to date. Here, we report a rare deep cutaneous fungal infection caused by P. lilacinum in an immunocompetent patient and postulate that, in this case, the patient's agricultural lifestyle increased the possibility of P. lilacinum infection.

A Case of Sarcoidosis Manifested as Multiple Subcutaneous Nodules after Acupuncture / 대한피부과학회지

No abstract available.

A Case of Eruptive Syringoma on Forehead in a 9 Year-old Boy / 대한피부과학회지

No abstract available.

Wells' Syndrome Associated with Molluscum Contagiosum in a Child: A Case Report / 대한피부과학회지

Wells' syndrome or eosinophilic cellulitis is usually observed in adults who present with pruritic, erythematous and edematous plaques associated with papules or vesicles. It is a rare inflammatory dermatosis of unknown etiology showing an eosinophil-mediated immune response. Classical histopathological features observed in patients are eosinophil-predominant inflammatory infiltration and marked dermal edema, along with ‘flame figures’. An 11-year-old boy presented with edematous plaques surmounted by vesicles on his abdomen and lower extremities. A month prior to presentation, these skin lesions occurred on other parts of his abdomen; however, they resolved spontaneously within a week. Skin biopsies from the recurrent lesions showed features consistent with Wells' syndrome and a few molluscum bodies in the epidermis. Laboratory tests showed peripheral eosinophilia. We concluded that Wells' syndrome in this young patient was caused by preceding molluscum contagiosum infection.

Circumscribed Palmar Hypokeratosis Showing Bowenoid Change Secondary to Human Papilloma Virus / 대한피부과학회지

Circumscribed palmar or plantar hypokeratosis is a rare condition characterized by the occurrence of an erythematous, well-circumscribed, and depressed macule or patch on the palms or soles. Histopathologically, it is characterized by sharp, stair-like abrupt thinning of the horny layer between the affected and unaffected skin. The pathogenesis of this condition remains unclear. Recently, the human papilloma virus has been implicated as a possible etiological contributor. Circumscribed palmar or plantar hypokeratosis usually shows a benign course. Previous reports have not described malignant changes in these lesions. However, its association with actinic keratosis has been reported in a previous case. We report a case of circumscribed palmar hypokeratosis showing bowenoid epidermal change with expression of the human papilloma virus types 6 and 16 in a patient who was successfully treated with ingenol mebutate gel and cryotherapy.

Palisaded Encapsulated Neuroma Occuring at the Previous Excision Site of Epidermal Cyst on the Scalp / 대한피부과학회지

No abstract available.

A Case of Papular Eruption Associated with Clonorchiasis / 대한피부과학회지

No abstract available.

Use of Complementary and Alternative Medicine for Treatment of Acne in Patients in Busan: Results of a Survey / 대한피부과학회지

BACKGROUND: There is growing interest in the role of complementary and alternative medicine (CAM) in treating patients with acne owing to an inadequate treatment response or adverse effects associated with use of conventional modalities to treat this skin condition. However, there is no literature available or reports of studies performed in Korea describing use of CAM in treatment of acne. OBJECTIVE: To assess the usage and awareness regarding the role of CAM in the treatment of acne, among acne patients. METHODS: A questionnaire was used to interview 159 patients with acne regarding their use of CAM for the treatment of acne. This survey was conducted in 1 tertiary medical center, 1 general hospital, and 2 dermatology clinics. RESULTS: We found that 139 of 159 (87.4%) acne patients reported previous or current use of CAM. Among the 139 CAM users, acne-related cosmetics (71.2%) was the most frequently used category of products, followed by dietary therapy (58.3%), cleansing techniques, and a bath regimen (55.4%). Reportedly, the ‘Internet’ (62.6%) was the most common medium used as a source of information regarding use of CAM. The most common reason for using CAM was reported as the ‘desire to try everything’ (40.3%). Adverse effects related to the use of CAM were reported in 27 (19.4%) patients. The most common type of adverse effect reported was ‘aggravation of acne’. A majority of patients were not favorable for subjective therapeutic effect and satisfaction with CAM (60.0% and 84.2%, respectively). CONCLUSION: Our results indicate that a majority of acne patients use CAM with or without conventional treatment. Nonetheless, there is no study or evidence to prove the effectiveness of CAM in acne patients. Therefore, it is important for dermatologists to be aware of the risks and adverse effects associated with use of CAM for effective management of patients who consult them for treatment of acne.

Primary Cutaneous Nocardiosis Caused by Nocardia takedensis

Nocardia species are aerobic, gram-positive, filamentous, partially acid-fast actinomycetes which are found worldwide in soil and decaying organic plant matter. When they infect human beings, they generally enter through the respiratory tract and then disseminate systemically. Rarely has a primary infection occurred as the result of direct inoculation. Isolation of Nocardia from clinical specimens and identification of species are difficult. But, with the introduction of new genetic technologies, reports of novel species of Nocardia have increased. We describe a case of cutaneous nocardiosis caused by Nocardia takedensis in an 87-year-old woman who was diagnosed by bacterial culture and 16S ribosomal RNA sequencing. N. takedensis has been described as a new species. This report describes the first clinical isolate of N. takedensis from a skin specimen in Korea.

Validation of "quality-of-life questionnaire in Korean children with allergic rhinitis" in middle school students

PURPOSE: The quality of life questionnaire in Korean children with allergic rhinitis (QoL-KCAR) was developed to assess the quality of life in Korean children aged 6–12 years old with allergic rhinitis. The aim of this study was to validate the QoL-KCAR in Korean middle school students with allergic rhinitis. METHODS: A survey with questionnaire and skin prick test was performed on 277 middle school students. The students were classified into 3 groups: allergic-rhinitis (AR), non-allergic rhinitis (non-AR), and controls. AR was defined who had nasal symptoms within 12 months and positive response to skin test. Non-AR group was composed of students with nasal symptoms but had negative response to skin test. The rest who had no symptoms of rhinitis and negative response to skin test were classed as control group. QoL-KCAR has 10 questions with 5-point scales for response options. RESULTS: There were significant differences in the answer scores among the 3 groups (P<0.05). Total answer score is 20.9±10.2, 17.3±8.8, 4.4±5.6 in the AR, non-AR group, and control groups, respectively. It showed significant differences in all items between the AR and control groups, and 4 questions between the AR and non-AR groups. There were significant differences in total score and each score of 8 questions between before and after education in AR group. CONCLUSION: QoL-KCAR questionnaire can be useful for assessing quality-of-life in the Korean students aged 12 to 15 years old with allergic rhinitis as well as children aged 6 to 12 years old.

Erratum: Acknowledgments Addition. Validation of “quality-of-life questionnaire in Korean children with allergic rhinitis” in middle school students

In this paper, acknowledgments section for grant support was omitted unintentionally.

A Case of Self-healing Juvenile Cutaneous Mucinosis / 대한피부과학회지

Self-healing juvenile cutaneous mucinosis (SHJCM) is a rare disorder of unknown origin that affects healthy children. It is characterized by multiplication of transient papules and nodules on the head and periarticular area. Histopathologically, lesions show mucin deposition in the dermis or subcutis. A 9-year-old male patient presented with multiple skin-colored papules and nodules on the face and both hands. These papules and nodules had appeared over the preceding months and had been increasing in number. He was otherwise healthy and had no underlying systemic disorders. Skin biopsy in the right thenar nodule revealed deposition of amorphous material stained positively with Alcian blue (pH 2.5) within the dermis and subcutis. Spontaneous resolution occurred over several months without sequelae.

Mycobacterium abscessus Skin Infection Following the Embedding Therapy in a Oriental Clinic / 대한피부과학회지

No abstract available.

Cutaneous and Systemic Plasmacytosis Associated with Renal Amyloidosis

Cutaneous and systemic plasmacytosis (CSP) is a rare disorder of unknown etiology characterized by cutaneous polyclonal plasma cell infiltrates associated with various extracutaneous involvement and polyclonal hypergammaglobulinemia. Here, we report on a 54-year-old male patient with chronic renal insufficiency who presented with disseminated reddish-brown macules and plaques on the face and trunk. In our evaluation, he was found to have lymphadenopathy, polyclonal hypergammaglobulinemia; benign plasma cell infiltration involving the skin, bone marrow, and retroperitoneal area; and renal amyloidosis. To the best of our knowledge, this is the first reported case of CSP associated with renal amyloidosis.

Atypical Lymphocytic Lobular Panniculitis / 대한피부과학회지

Atypical lymphocytic lobular panniculitis (ALLP) is a recently described entity characterized by self-limiting plaques that manifest a waxing and waning course. Although ALLP is known as a benign condition, it needs adequate follow-up to determine the risk of progression to subcutaneous panniculitis-like T-cell lymphoma (SPTCL) because ALLP has morphologic and biologic similarities with SPTCL. We report a case of ALLP in a 13-year-old girl who presented with an unusual tumor-like erythematous mass on the left thigh but without systemic symptoms or laboratory abnormalities. The histopathologic findings showed a dense and diffuse infiltration of the fat lobules by small-to-medium-sized atypical lymphocytes including focal atypical mitosis. Some cells showed characteristic peripheral rimming of individual adipocytes. However, prominent lymphoid atypia, fat necrosis, vasculitis, vascular thrombosis, erythrophagocytosis, mucin deposition, and the striking dominance of CD8+ lymphocytes seen in SPTCL were not detected. The lesion resolved spontaneously in 6 months and there was no recurrence over a 24-month follow-up period.

Fractional exhaled nitric oxide in Korean children with allergic rhinitis

PURPOSE: Fractional exhaled nitric oxide (FeNO) is useful for the diagnosis of allergic rhinitis (AR) as well as bronchial asthma (BA). However, FeNO may differ according to race, age, and other determinants. There have been few studies about FeNO in Korean children with AR. The aims of this study were to evaluate the value of FeNO in AR and to compare FeNO, and determinants of FeNO levels between AR, BA, and combined AR and BA. METHODS: This study included 647 children aged 5 to 17. The children were classified into 5 groups after performing the skin test, FeNO measurement, the pulmonary function test, and the methacholine challenge test: those with nonallergic rhinitis (NAR), those with AR, those with BA, and those with combined AR and BA, and healthy controls,. RESULTS: The values of FEV1 (forced expiratory volume in one second) %predicted were 94.4%+/-12.6%, 93.8%+/-20.7%, 90.0%+/-17.4% in AR, BA, and combined AR and BA, respectively. The values of FeNO in AR (32.3+/-25.0 ppb), BA (31.1+/-20.5 ppb), and combined AR and BA (34.5+/-30.4 ppb) were significantly higher compared to those of NAR (16.8+/-13.5 ppb) and controls (15.9+/-12.5 ppb). There was no significant difference in FeNO among AR, BA, and combined AR and BA. FeNO was significantly higher in patients with > or =4 positive results (36.6+/-29.2 ppb) than in those with <4 positive skin test results (27.6+/-20.7 ppb). When the receiver operating characteristic curve analysis for prediction of AR showed 0.756 of area under the curve, the cutoff level of FeNO was 16 ppb. CONCLUSION: In this study, children with AR had increased levels of FeNO. It is suggested that AR may have eosinophilic bronchial inflammation without BHR or clinical asthma.

Changes in Cardiovascular Function and Arterial Oxygenation during One Lung Anesthesia for Thoracoscopic Sympathectomy / 대한마취과학회지

BACKGROUND: Essential hyperhidrosis is caused by an unexplained over activity of the high thoracic sympathetic nervous system. Since the development of video endoscopic surgery, the use of thoracoscopic sympathectomy has gradually increased. However, reports on major anesthetic problems related to bilateral thoracic symathectomy and one lung ventilation (reventilation of a collapsed lung), which are commonly used for this operation are few. The aim of this study was to evaluate changes in cardiovascular function and arterial oxygenation during reventilation of the collapsed lung for bilateral thoracoscopic sympathectomy. METHODS: Twenty one patients with essential hyperhidrosis in ASA physical status class 1, undergoing bilateral thoracoscopic T2-3 sympathectomy in the semi-Fowler's position were selected. Mean arterial blood pressure (MBP) of both radial arteries, skin temperature of both palmar area, and heart rate (HR) were recorded just before and after, 5 min and 10 min after sympathectomy. Simultaneously, arterial oxygen tension was obtained 30 min after left lung ventilation (LLV, baseline) and right lung ventilation (RLV, left lung collapse) and 10, 20, 30, 40, 50 and 60 min after LLV (reventilation of the collapsed left lung) under general anesthesia (isoflurane-100% oxygen). RESULTS: MBPs of bilateral radial arteries were significantly reduced after sympathectomy. However, there were no difference in the percent change of the MBP between both sides. HR was reduced only after right sympathectomy. The skin temperature of ipsilateral thenar area was significantly elevated after sympathectomy. Aterial oxygen tension was markedly reduced after 10 min of reventilation of the collapsed left lung (246.9 +/- 11.3 --< 102.3 +/- 5.7 mmHg) and then slowly returned to the baseline value after 50 min of reventilation. CONCLUSIONS: Thoracic sympathectomy in patients with essential hyperhidrosis causes a marked decrease of HR and MBP of the bilateral radial arteries and an increase of skin temperature of the ipsilateral palmar area. Reventilation of the collapsed lung for bilateral thoracoscopic T2-3 sympathectomy, causes a marked reduction in the arterial oxygen tension.

Recovery Profile after Inhalation Anesthesia Using Sevoflurane and Desflurane / 대한마취과학회지

BACKGROUND: Sevoflurane and Desflurane are new inhalation anesthetics with a low blood/gas solubility which should allow a fast induction and emergence from anesthesia. This study was designed to compare the induction and recovery characteristics of gynecologic surgical patients receiving sevoflurane, desflurane or isoflurane with nitrous oxide for the maintenance of general anesthesia. METHODS: After a standardized induction of anesthesia with fentanyl, propofol, succinylcholine and tracheal intubation, patients undergoing an elective gynecologic surgery lasting 1 - 2 hr randomly received sevoflurane (n = 23), desflurane (n = 21) or isoflurane group (n = 20). Induction, recovery time and the incidence of postoperative nausea and vomiting, and recall were compared among groups. The liver (SGOT, SGPT, ALP) and renal (BUN, serum creatinine) function were evaluated before and after the operation. RESULTS: Although anesthetic conditions were similar during the operation in the three groups, significant differences were noted in induction and recovery profiles from anesthesia. Induction time was 201 +/- 67 sec for sevoflurane, 124 +/- 66 sec for desflurane and 422 +/- 257 sec for isoflurane. The time required for the end-tidal concentration of anesthetics to decrease by 50% was 180.9 +/- 34.4 sec for sevoflurane, 168.0 +/- 160.1 sec for desflurane, and 222.9 +/- 127.5 sec for isoflurane. The time to response (eye opening following a simple command), and orientation (recall of name and date of birth), to reach 10 points of the PAR (post anesthesia recovery) score and discharge from recovery room were significantly shorter after sevoflurane and desflurane than after isoflurane. There were no significant differences in liver and kidney functions between the periods before and after the operation among the groups. The frequency of side effects such as nausea, vomiting and recall during the postoperative period was similar among the groups. CONCLUSIONS: It is concluded that a balanced anesthetic technique using sevoflurane and desflurane as the main anesthetics has certain advantages compared with isoflurane in terms of faster emergence.

Kerion Celsi Caused by Trichophyton verrucosum: A Report of Two Cases / 대한의진균학회지

In Korea, kerion celsi caused by Trichophyton(T.) verrucosum was first reported in the Honam area in 1986. Since then, more cases have been reported in the Youngnam and Chungcheong areas but there has been no report in Seoul and Kyonggido until now. Recently, two patients with kerion celsi visited Seoul National University Hospital and T. verrucosum was isolated from the scalp lesions of these patients. Case 1 was 52 year-old female living in Kapyoung, Kyonggido and she showed 10x10 cm and 5x3 cm sized, indurated alopecic masses on the scalp which were developed 2 months ago. Case 2 was a 50 year-old female living in Youngju, Kyongsangbukdo and a 10x7 cm sized, purulent alopecic plaque was developed on the scalp 1 month ago. They were farmers raising cows with gray or whitish plaques on their skins. These patients were successfully treated with terbinafine 250 mg per for 7 weeks and 8 weeds, respectively. We report these cases to call more attention to detect this species even in urban areas such as in Seoul. Therapeutic effect of terbinafine on kerion celsi has not been reported in Korea so far and our cases demonstrated the excellent therapeutic effect of terbinafine on kerion celsi cause by T.verrucosum.

Treatment with Low-Dose Danazol in Livedo Vasculitis / 대한피부과학회지

BACKGROUND: Several modalities have been used for the treatment of livedo vasculitis. However, in some cases conspicious morbidity is caused by recurrent painful ulceration resistant to therapy. OBJECTIVE: This study was conducted to determine the effectiveness and adverse effects of the danazol in treatment of livedo vasculitis. METHODS: Nine patients with ulcerative lesions due to livedo vasculitis were included for danazol therapy. Danazol 200mg was administered daily for 4 to 8 weeks. RESULTS: Eight of the patients showed remarkable improvement and were satisfied with this therapy. Significant adverse effects were not observed. CONCLUSION: We suggest that a low dose of danazol may be considered as the first line of treatment and is worthwhile to try in cases recalcitrant to the other treatment.