A Case of Fungal Folliculitis Clinically Mimicking Lupus Miliaris Disseminatus Faciei / 대한피부과학회지

Dermatophytes generally cause infection of the stratum corneum and superficial layers of skin. They are, therefore, found less frequently in the rete layer and do not ordinarily penetrate deeper than the basal cell layer. Nevertheless, under special circumstances such as the pressure generated during trauma or long term topical steroid application, the fungus elements of some dermatophytes will be forced into the dermis where they instigate a chronic granulomatous reaction. We report a 43-year-old male who presented with multiple erythematous brown colored dome-shaped papules on both periorbital areas, which were clinically similar to lupus miliaris disseminatus faciei (LMDF). Histologic examination revealed follicular and perifollicular infiltration by inflammatory cells, and perifollicular granuloma. Trichophyton species were isolated from the fungus culture of the lesional tissue. The patient was treated with an antifungal agent, resulting in clearance of the skin lesions, and there was no recurrence of skin lesions during a 13-month follow-up period. We suggest that it is important to perform biopsies and cultures on periorbital papules which mimick LMDF, refractory to conventional therapy.

A Case of Pseudoporphyria / 대한피부과학회지

Pseudoporphyria is a generic term that is used to describe photoaggravated bullous dermatoses associated with multiple iatrogenic causes, including medications and dialysis. The bullous lesions of pseudoporphyria are similar to those of porphyria cutanea tarda, both clinically and histologically, but they occur in the absence of the abnormally high levels of porphyrins which are found in true porphyrias. Treatment entails discontinuation of suspected agents and sun protection, especially against UVA wavelengths. We report a case of pseudoporphyria in a 28-year-old male who had erythematous crusted erosions, vesicles and hyperpigmented macules on his face and both forearms. A biopsy from his Lt. forearm revealed subepidermal bullaes with festooning of dermal papillae, and mild lymphocytic perivascular infiltrations. However laboratory tests for porphyrin were negative in his urine, blood and stool.

Neutrophilic Dermatoses Associated with Myelodysplastic Syndrome / 대한피부과학회지

Cutaneous involvement in myelodysplastic syndrome (MDS) is the form of either a neoplastic infiltration or various nonspecific lesions. The nonspecific lesions are more common and include cutaneous infection, vasculitis and neutrophilic dermatoses. The occurrence of these lesions may be the presenting feature of the disease (MDS) or may herald its progression to acute leukemia. Recognition and early diagnosis of any skin lesion in MDS patients have therapeutic and prognostic significance. We report a case of neutrophilic dermatoses associated with MDS in a 26-year-old man who presented with high fever, tender annular erythematous plaques with crust on the face and upper extremities. He was diagnosed as anemia and thrombocytopenia 3 months ago. Skin biopsy showed dense infiltration of neutrophils in the dermis. Bone marrow biopsy revealed dyspoiesis of marrow cells, consistent with MDS. It is important to investigate any skin involvement in MDS patients.

CD8 Expression in Mycosis Fungoides / 대한피부과학회지

BACKGROUND: Mycosis fungoides (MF) is malignant proliferation of T-helper memory lymphocyte, and only a minority of cases present with other phenotypes such as CD3+, CD4-, CD8+ or CD3+, CD8+. Primary cutaneous CD8+ epidermotropic cytotoxic T-cell lymphoma is known to represent aggressive course. OBJECTIVES: The purpose of this study was to define the CD8 expression in mycosis fungoides and clinical characteristics of CD8+ MFs. In addition, we also studied whether the presence of CD8+ tumor-infiltrating lymphocytes (TIL) had any impact on prognosis of the disease. Patients & METHODS: We retrospectively analyzed 9 patients with MFs by chart review and medical records including age, location, disease duration and patients prognostic features. We also observed CD4 and CD8 expression through the immunohistochemical staining on paraffin-embedded tissue. RESULTS: All the patients, including the present study, showed positive response to CD8 immunohistochemical staining. CD8+ TIL was found in upper dermis (100.0%) of all patients. Two patients had lesion with CD4 TIL more strongly stained than with CD8 TIL, 2 patients with CD8 more than CD4, and the rest showed equally stained lesion. There were no significant differences among the location of CD8 TIL, the density of staining, CD4 TIL/ CD8 TIL and disease prognosis. On long-term follow-up, these results described herein showed that patients with CD8+ cutaneous T-cell lymphomas enjoyed good prognosis. CONCLUSIONS: Our results revealed that all MFs showed positive response to CD8 immunohistochemical staining. Our CD4+ and CD8+ MFs showed clinical features similar to those reported CD4+ and CD8- MFs and enjoyed good prognosis rather than aggressive clinical behavior on long-term clinical follw-up.

Three Cases of Clear Cell Acanthoma on Nipple and Areola / 대한피부과학회지

Clear cell acanthoma is a relatively uncommon benign disease, which usually presents as solitary lesions, often localized on the lower legs of middle aged or elderly individuals1. Clinically it presents as a flat or dome-shaped, sharply demarcated papule or nodule. Histopathologic findings are composed of clear cells within sharply demarcated area of the epidermis. We report three cases of clear cell acanthoma developed on the nipples and areolar areas of the young women. These cases should be differentiated from various diseases showing clinically benign eczematous feature. In conclusion, clear cell acanthoma could be included in the differential diagnosis of eczema, and it is suggested that biopsies specimen should include the lesion as well as the normal tissue.

A Case of Adult Onset Verrucous Hemangioma / 대한피부과학회지

Verrucous hemangiomas are usually congenital lesions which typically present as warty, bluish, vascular papules, plaques, or nodules mainly on the lower limbs of children. It is a structural variant of capillary or cavernous hemangioma, in which reactive epidermal changes develop secondarily. They show no tendency to spontaneous resolution, and tend to spread and recur after inadequate treatments. It is important, from a prognostic and therapeutic point of view, to make a correct diagnosis between verrucous hemangioma and angiokeratoma circumscriptum, because the former needs a large and deep excision and the latter responds to the common means of physical therapy. We report a case of 37-year-old man with verrucous hemangioma which was developed at his third decade.

A Case of Epidermodysplasia Verruciformis Associated with non-Hodgkin's Lymphoma Improved with Acitretin Treatment / 대한피부과학회지

Epidermodysplasia verruciformis(EV) is a rare disease characterized by a unique susceptibility to widespread infection with human papilloma virus. It induces flat papular skin lesions, characterized by large vacuolated cells in the upper epithelial layers. We report a patient of EV in association with non-Hodgkin"s lymphoma(NHL) improved with systemic acitretin treatment. A 69-year-old man presented multiple red flat-topped papules and plaques on his face and upper extremities for 12 years. Past various therapeutic modalities including DPCP sensitization were entirely ineffective. Several years ago, NHL of cervical lymph node was diagnosed. With the treatments with chemotherapy and radiotherapy, he is now in remission state. His skin biopsy specimen showed extensive vacuolation of upper malpighian layer. Bleomycin IL trial showed no response. Only 1 week after oral acitretin administration, his lesions began to exfoliate and became much flatter. Acitretin was effective but not suitable for maintenance therapy.