Two-Week Repeated Dose Toxicity of Atractylodis Rhizoma Alba in F344 Rats

This research is to estimate the toxicity of Atractylodis Rhizoma Alba (ARA) in F344 rats and to find a dose level for the 13 weeks toxicity study. A hot water extract of ARA (ARWE) was administered orally to F344 rats at dose levels of 0 (vehicle control), 500, 1000, 2000, 3500, and 5000 mg/kg/day for 2 weeks. Each group was composed to five male and five female F344 rats. According to the result, there were no ARWE-related adverse changes in mortality, body weights, food consumption, urinalysis, hematology, clinical chemistry, gross finding at necropsy, and organ weight examination. Salivation was observed in 3500 and 5000 mg/kg/day in male and female rats but it could not have found any relationship with ARWE administration. Based on our findings, ARWE may not cause toxicity in rats under the experimental conditions. Therefore, dose level of 5000 mg/kg/day as a highest treatment group in 13-week exposure study is recommended for further toxicity assessment.

A 14-Day Repeated Dose Toxicity of Epimedii Herba Aqueous Extract Administered by Oral Gavage in F344 Rats

The objective of this study is to characterize a toxicity of Epimedii Herba (EH) in F344 rats and to find a dose levels for the 13 weeks toxicity study. EH is well known as medicinal herb in many Asian countries for traditional medicines of antibacterial and antiviral effects, estrogenic and antiestrogenic effects, and for treatment of osteoporosis, hypotensives, fatigue, kidney disorders, and related complications. However, the indispensable and basic information of toxicological evaluation of EH extract is insufficient to support its safe use. Therefore, we conducted toxicological evaluation of this drug in compliance with OECD and MFDS guideline in this study. The extract of EH was administered orally to F344 rats at dose levels of 0, 500, 1000, 2000, 3500, and 5000 mg/kg/day for 2 weeks. Each group was composed of 5 male and female rats. In this study, there were no treatment of EH-related adverse changes in clinical observations, mortality, body weights, food consumption, urinalysis, gross finding at necropsy, and organ weight examination. Total red blood cell count, hematocrit, mean corpuscular hemoglobin concentration, total cholesterol, and phospholipid were decreased in males and females at 5000 mg/kg/day compared to the control animals. Mean corpuscular volume and reticulocyte counts were increased in males and females at 5000 mg/kg/day compared to control animals. Therefore, we recommend that dose level of 5000 mg/kg/day is a highest treatment group in 13-week EH extract exposure study for further toxicity assessment.

Wegener's Granulomatosis Presenting as Pyoderma Gangrenosum / 대한피부과학회지

Wegener's granulomatosis (WG) is a systemic disease of unknown origin characterized by necrotizing granulomatous inflammation and vasculitis. Dermatological symptoms occur in up to 50% of cases, mostly in the form of cutaneous vasculitis or pyoderma gangrenosum. A 51-year-old female presented with multiple ulcerative patches and erythematous nodules on both legs. Histopathological findings showed extensive ill-defined granulomatous lesions and necrotizing vasculitis. Lung biopsy findings were consistent with WG. Nasopharyngeal and gastrointestinal involvement developed later. Skin lesions are improving with systemic corticosteroid and cyclophosphamide. We herein report a case of WG presenting as pyoderma gangrenosum-like cutaneous manifestation with other systemic involvements.

A Case of Verrucous Carcinoma Treated by 5% Imiquimod Cream / 대한피부과학회지

Verrucous carcinoma is a slow-growing, well-differentiated, low grade squamous cell carcinoma with little tendency to metastasize. The best treatment for verrucous carcinoma is excision, and Mohs microsurgery may also be a helpful technique. But some people can not undergo surgical excision because of poor general condition of the site and the size of the tumor. Herein, we report a case of verrucous carcinoma treated by 5% imiquimod cream. A 71-year-old male patient presented with a large hyperkeratotic verrucous plaque on the Rt. buttock. Diagnosis of verrucous carcinoma was based on typical clinical and histologic features. Surgical excision could not be performed due to the size of the tumor. Treatment with 5% imiquimod cream, a topical immune response modifier, applied every other day for 16 weeks, led to tumor regression. Four weeks after the end of treatment, the lesion was evaluated by punch biopsy. The histology just showed scar tissue change. This case demonstrates that the imiquimod cream might be an alternative treatment option for verrucous carcinoma.

A Case of Acral Persistent Papular Mucinosis in Patient with HIV Infection / 대한피부과학회지

Acral persistent papular mucinosis (APPM) is a rare subtype of localized lichen myxedematosus, which involves only the extensor surfaces of the hands, wrists and the distal part of forearms. Some subtypes of lichen myxedematosus including APPM have been reported with increased frequency in a patient with human immunodeficiency virus (HIV) infection. We describe a 31 year-old male patient with an HIV infection who presented with discrete, flesh-colored papules on the extensor surfaces of the wrists and the distal part of the forearms. Histopathologic findings revealed focal deposition of mucin in papillary and mid dermis that spared a small grenz zone. The lesions showed spontaneous regression after starting highly active antiretroviral therapy (HAART). We report a rare case of APPM in a patient with HIV infection which showed spontaneous regression with HAART, suggesting that APPM may represent one of the cutaneous markers of HIV infection.

A Case of Atypical Lipomatous Tumor / 대한피부과학회지

Liposarcoma is the second most common soft tissue sarcoma next to malignant fibrous histiocytoma and occurs almost exclusively in adults. It is thought to originate from primitive mesenchymal cells rather than from mature adipose tissue. Most liposarcomas usually occur in the deep soft tissue of the extremities and the retroperitoneum, and rarely occur in the cutaneous or subcutaneous tissue. We report a case of an atypical lipomatous tumor in a 63-year-old male, who presented with an asymptomatic, subcutaneous mass on his right axilla.

A Clinical and Histopathological Study of 324 Cases of Epidermal Cyst / 대한피부과학회지

BACKGROUND: Epidermal cysts are a common occurrence. But there have been few studies to determine the clinical and histopathological characteristics of epidermal cysts. OBJECTIVE: To evaluate the clinicopathological characteristics of 324 cases of epidermal cyst. METHODS: We evaluated the clinical and histopathologic features of 324 cases of epidermal cyst at the Department of Dermatology at Korea University Anam Hospital over 5 years, from January 2001 to December 2005. RESULTS: The ratio of male to female patients was 1.7 : 1. Age distribution ranged from 7 to 91 years old. The duration of lesions was variable with mean duration of 29.3 months. The most common site of occurrence was the face. Histopathologic changes of cystic walls were atropy, acanthosis, hypergranulosis, vacuolation and parakeratosis. We identified parakeratotic cells, red blood cells, calcifications and bacterial colonies in the cystic contents. We also found verrucous architectures in the cystic walls of 23 cases. Initially, some cases were clinically diagnosed as epidermal cysts, but histopathological findings then discovered only inflammation, granulation, pilomatrichoma or lipoma, rather than an epidermal cyst. We discovered that there was also a close relation between erythema and rupture of the cystic wall. CONCLUSION: Our clinical and histopathologic findings of the epidermal cysts were similar to previous reports. However, we did find verrucous architectures on not only the palmoplantar area, but also many other areas of the body. Quite a few cases which had initially been clinically diagnosed as epidermal cysts, turned out not to be upon histopathologic investigation.

Descriptive Study of Dermatologic Issues Appeared on Television over Seventeen Months (Jan. 2004~May 2005) / 대한피부과학회지

BACKGROUND: Recently, the number of television programs dealing with dermatologic issues has rapidly increased. Since these television programs have great impact on the general public, scientific exactitude of these programs is extremely important. OBJECTIVE: The purpose of this study was to analyze the television programs about dermatologic issues over a 17 months period, form January 2004 to May 2005. METHODS: From all the programs broadcast between January 2004 and May 2005 on the major public and cable television channels such as MBC, KBS, SBS, EBS and MediTV, programs about dermatological issues were selected by internet search and collated. The programs were then categorized and studied by purpose and theme of the programs, running time, and correctness of dermatologic information. RESULTS: The number of programs about dermatologic issues by type were as follows: 80 on news programs (58.0%), 33 on health care programs (23.9%), 19 on daily information programs (13.8%) and 5 on current issues programs (3.6%). Programs dealing with skin cosmetic information were shown most frequently on the television (44 times, 31.9%), followed by those with information about atopic dermatitis (32 times, 28.6%). Of 197 consultants in 138 television programs, dermatologists could account for only 113 (57.4%), and medical specialists of other fields except dermatology as 24 (12.2%). Thirty two percent of dermatology-related television programs were made without the advice of dermatologists. In most cases, information from dermatologists was accurate or reliable (96.5%), however, the information from oriental herbal-medicinal doctors or non-medical specialists was very difficult to check for accuracy. CONCLUSION: Until now, dermatologists have taken the leading role in programs dealing with dermatologic issues. However, the number of unqualified advisors without sufficient dermatologic knowledge in the programs surveyed was found to be surprisingly high. Therefore, we suggest that more dermatologists need to increase their public health role in the mass media.

A Statistical Study on Histopathologic Diagnoses of Skin Diseases / 대한피부과학회지

BACKGROUND: Skin biopsy is an effective diagnostic tool commonly used in dermatology practice. Clinicopathologic correlation is important for diagnostic accuracy. OBJECTIVE: The purpose of this study was to investigate the distribution of skin biopsy specimens, and compare the pathologic diagnosis with the final dermatologic diagnosis. METHODS: This study included 4,018 skin biopsy specimens taken during a period of 10 years from June 1995 to May 2005 at the Department of Dermatology, Korea University Anam Hospital. RESULTS & CONCLUSION: Of all biopsy specimens, 61.49% were diagnosed as tumors, and 38.51% were diagnosed as non-tumors. For the tumors, 87.15% were benign, 4.23% were premalignant and 8.62% were malignant. The rate of concordance between pathologic diagnosis and final dermatologic diagnosis was 76.69%, and the rate of discordance between them was 4.18%. The rate of description without a pathologic diagnosis in pathologic reports was 18.94%. The rate of concordance was higher in tumors (89.65%) than in non-tumors (56.00%), and the rate of description in pathologic reports was higher in non-tumors (39.08%) than in tumors (6.32%). There was no significant difference in the rates of discordance between tumors and non-tumors. The rate of concordance was higher in malignant tumors (95.72%) than in benign tumors (89.77%) or premalignant tumors (74.76%). The rate of description in pathologic reports was higher in premalignant tumors (18.45%) than in benign tumors (6.27%) or malignant tumors (0.95%). There was no significant difference in the rates of discordance between the three groups.

A Case of Eccrine Porocarcinoma on the Scalp / 대한피부과학회지

Eccrine porocarcinoma is a very rare, locally-aggressive, potentially fatal tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. It usually affects older people and is located most commonly on the lower extremities. We report a case of eccrine porocarcinoma which developed on the scalp of an 82-year-old woman. There was no evidence of metastasis, and the tumor was successfully removed by Mohs micrographic surgery.

Three Cases of Basal Cell Carcinoma of the Axilla / 대한피부과학회지

Basal cell carcinoma (BCC) is the most common skin cancer of humans. The incidence of BCC is closely correlated with sun exposure, as well as older age. Because of this, BCCs are frequently found on sun-exposed areas of fair-skinned, older individuals. The axilla is one of the sun-protected sites where BCC rarely develops. We herein report three unusual cases of primary BCC which arose from the axilla.

A Clinicopathologic Study on Eccrine Tumors / 대한피부과학회지

BACKGROUND: Various eccrine tumors are rather common diseases in clinicians. However, data on the clinicopathologic features of eccrine tumors in Korea are limited. OBJECTIVE: The purpose of this study was to investigate the clinicopathologic characteristics of eccrine tumors in Korea. METHODS: Two hundred and sixty five cases of eccrine tumors, seen from 2002 to 2004 in Korea, were retrospectively analyzed clinically and histopathologically. RESULTS: The most common eccrine tumors identified within Koreans were syringoma (61%), followed by eccrine poroma (13%), eccrine hidrocystoma (9%), and nodular hidradenoma (6%). Moreover, eccrine tumors were usually found to occur in middle-aged woman as multiple asymptomatic skin-colored papules. The most common site of occurrence was the face (45%), followed by the neck (9%), scalp (5%), foot (5%), abdomen (4%), and vulvar (3%). CONCLUSION: The results of this study will be useful and fundamental data on eccrine tumors for clinicians and pathologists.

Statistical Methods Used in Articles of the Korean Journal of Dermatology / 대한피부과학회지

BACKGROUND: The Korean Journal of Dermatology, a well-known dermatology journal in Korea, has been an es-sential medium for dermatologists and a symbol of the Korean Dermatological Association. The members of the associa-tion have an obligation to improve the quality of the journal. The statistical analysis is associated directly with the study design and completeness of an article. However, there has been no report on the statistical analyses used in the articles of the Korean Journal of Dermatology. OBJECTIVE: To investigate the usage of statistical methods in the journal and evaluate their accuracy and correctness. METHODS: A total of 264 original articles from 30 recent volumes of the Korean Journal of Dermatology (2003, vol.1 to 2005, vol.6) were collected and analyzed for statistical methods. The descriptive statistics were excluded from the study. The methods were con-sidered as 'correct', 'not-correct', or 'impossible to determine' in order to evaluate the correctness of the analyses. RESULTS: Of the 264 original articles, 126 (47.7%) articles included statistical analysis. The authors most frequently the used t-test and contingency table method. The incorrect analyses appeared in 30 (23.8%) articles, and their most frequently cited reason was their unwillingness to use the nonparametric analysis. CONCLUSION: Recently, the statistical methods in about one fourth of inferentially analyzed original articles of the Korean Journal of Dermatology have been found to be incorrect, and the reasons for the incorrectness appear not to be so difficult for authors to rectify.

Three Cases of Lymphangiectatic Pilomatricoma / 대한피부과학회지

Pilomatricoma is a benign adnexal tumor, differentiating towards elements of the hair matrix and shaft. The tumor typically presents as a solitary, deep-seated, firm nodule with overlying normal epidermis. Herein, we report three cases of pilomatricomas with the dermal bullae overlying tumors. Histopathological examination of the lesions showed marked lymphatic dilatations, edema, and attenuated collagen and elastic fibers above the pilomatricomas in the upper dermis. We diagnosed them as lymphangiectatic pilomatricomas.

Three Cases of Lymphangiectatic Pilomatricoma / 대한피부과학회지

Pilomatricoma is a benign adnexal tumor, differentiating towards elements of the hair matrix and shaft. The tumor typically presents as a solitary, deep-seated, firm nodule with overlying normal epidermis. Herein, we report three cases of pilomatricomas with the dermal bullae overlying tumors. Histopathological examination of the lesions showed marked lymphatic dilatations, edema, and attenuated collagen and elastic fibers above the pilomatricomas in the upper dermis. We diagnosed them as lymphangiectatic pilomatricomas.

A Case of Telangiectasia Macularis Eruptiva Perstans / 대한피부과학회지

Telangiectasia macularis eruptiva pestans is one of the mastocytosis. It appears most frequently in adults and only rarely affects young children or infants, unlike other mastocytosis. The clinical diagnosis of telangiectasia macularis eruptive perstans can be difficult because it does not usually present as a typical childhood mast cell disease. We report a case of telagiectasia macularis eruptiva perstans, a rare form of mastocytosis.

A Case of Spitz Nevus on the Ear Helix / 대한피부과학회지

Spitz nevi, benign melanocytic tumors, have some histologic resemblance to malignant melanoma. They usually appear as asymptomatic, solitary, reddish to pinkish, hairless, dome-shaped, round to oval, smooth-surfaced papules or nodules, measuring less than 1.0 cm in diameter. Histologically, these lesions display striking nests of large spindle cells and epithelioid cells, usually extending from the epidermis to the reticular dermis. Here in, we report a case of Spitz nevus on the helix of the right ear of a 23-year-old man which was treated with Er:YAG laser.

A Case of Large Vascular Plexiform Neurofibroma Associated with Giant Cafe-au-lait Patch and Scoliosis / 대한피부과학회지

Plexiform neurofibromas are benign proliferations arising from the peripheral nerves and represent one of the diagnostic features of neurofibromatosis type 1. We present a case of a 14-year-old boy, who had large vascular neurofibromatous elephantiasis associated with a giant cafe-au-lait patch on his lateral aspect of the left hemithorax. Although he had no perceptible symptoms, radiologic examination revealed mild thoracic scoliosis with left side convexity. Our treatment of the skin lesion was one-stage palliative tumor debulking.

Expression of Ki-67, p27 and Laminin in Actinic Keratosis, Bowen's Disease, and Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: In many cases, the distinction between actinic keratosis (AK), Bowen's disease (BD), and invasive squamous cell carcinoma (SCC) is not histologically clear. Tumor cells crossing the basement membrane was traditionally the boundary between AK and invasive SCC. However, this criteria may not be practical in day-to-day clinical situations. OBJECTIVE: The purpose of this study was to investigate the expression patterns and labeling index of the immunohistochemical staining of Ki-67, p27 and laminin in AK, BD and SCC, to ascertain whether differential expression patterns of Ki-67, p27 and laminin exist. METHOD: Seventeen cases of AK, 19 cases of BD and 16 cases of SCC were investigated. We performed immunohistochemical staining for Ki-67, p27 and laminin. The patterns of positive nuclear staining were noted as either marginal (positive nuclear staining in the basal and parabasal layers but sparing the granular zone) or diffuse (positive nuclear staining in the majority of cells throughout the full thickness of the epithelium or tumor aggregates) and scattered (positive nuclear staining of cells in the focal area of the tumor aggregates). RESULTS: For Ki-67, a marginal pattern of positive nuclear staining was found in the basal/parabasal cell layer of normal epidermis. In AK, Ki-67-stained nuclei were found in the basal/parabasal cell layers (marginal pattern), and the labeling index was 24.5%. In BD, Ki-67-stained nuclei were found throughout the full thickness of the atypical epidermis (diffuse pattern), and the labeling index was 70.5%. The invasive aggregates of SCC had a complex pattern of staining for Ki-67, being diffuse and scattered, and the labeling index was 43.5%. The p27 labeling index in AK, BD and SCC was 86.5%, 91.5% and 67.5%, respectively. The p27 labeling index was significantly decreased in invasive SCC, when compared with those of AK and BD. Laminin was stained strongly and continuously along the basement membrane of the epidermis and vessel walls of normal epidermis, AK and BD. In SCC, laminin was stained along the basement membrane of the tumor nest in well differentiated SCC, and weakly and interrupted in poorly differentiated SCC. CONCLUSION: There results show that the staining pattern of Ki-67 is helpful to differentiate BD (diffuse pattern throught the full thickness of atypical epidermis) from AK (marginal pattern affecting the basal and parabasal layers) and SCC (diffuse and scattered within the atypical aggregate), and increased Ki-67 labeling index is helpful to differentiate BD from AK and SCC. A reduced p27 labeling index is helpful to differentiate SCC from AK and BD. However, the staining pattern of laminin did not seem to be helpful in differentiating these diseases.

A Case of Verrucous Carcinoma Improved by 5% Imiquimod Cream / 대한피부과학회지

Verrucous carcinoma is a low grade, well differentiated, unusual variant of squamous cell carcinoma. It has been described to represent an intermediate lesion between condyloma acuminata and squamous cell carcinoma. Since malignant transformation of verrucous carcinoma has been reported to occur in 30-50% of cases, the first line treatment for verrucous carcinoma is surgery, preferably Mohs surgery. Herein, we describe a case of recurrent verrucous carcinoma on the right buttock of a man with a history of radical excision and radiotherapy of a previous perianal verrucous carcinoma. The patient was successfully treated with 5% imiquimod cream, an immune response modifier with potential antiviral and antitumor effects. Imiquimod may be an effective treatment for verrucous carcinoma and presents an alternative therapy to surgical excision.