Intranasal Vaccination with OuterMembrane Protein of Orientia tsutsugamushi induces Protective Immunity Against Scrub Typhus

Scrub typhus develops after the individual is bitten by a trombiculid mite infected with Orientia tsutsugamushi. Since it has been reported that pneumonia is frequently observed in patients with scrub typhus, we investigated whether intranasal (i.n.) vaccination with the outer membrane protein of O. tsutsugamushi (OMPOT) would induce a protective immunity against O. tsutsugamushi infection. It was particular interest that when mice were infected with O. tsutsugamushi, the bacteria disseminated into the lungs, causing pneumonia. The i.n. vaccination with OMPOT induced IgG responses in serum and bronchoalveolar lavage (BAL) fluid. The anti-O. tsutsugamushi IgA Abs in BAL fluid after the vaccination showed a high correlation of the protection against O. tsutsugamushi. The vaccination induced strong Ag-specific Th1 and Th17 responses in the both spleen and lungs. In conclusion, the current study demonstrated that i.n. vaccination with OMPOT elicited protective immunity against scrub typhus in mouse with O. tsutsugamushi infection causing subsequent pneumonia.

Photodynamic Therapy for Bowen's Disease of the Vulva Area

Bowen's disease is a squamous cell carcinoma in situ and has the potential to progress to a squamous cell carcinoma. The authors treated two female patients (a 39-year-old and a 41-year-old) with Bowen's disease in the vulva area using topical photodynamic therapy (PDT), involving the use of 5-aminolaevulinic acid and a light-emitting diode device. The light was administered at an intensity of 80 mW/cm2 for a dose of 120 J/cm2 biweekly for 6 cycles. The 39-year-old patient showed excellent clinical improvement, but the other patient achieved only a partial response. Even though one patient underwent a total excision 1 year later due to recurrence, both patients were satisfied with the cosmetic outcomes of this therapy and the partial improvement over time. The common side effect of PDT was a stinging sensation. PDT provides a relatively effective and useful alternative treatment for Bowen's disease in the vulva area.

Reed Syndrome / 대한피부과학회지

Reed syndrome is an autosomal dominantly inherited disease with incomplete penetrance that is characterized by uterine and cutaneous leiomyoma. While the skin tumors are relatively uncommon and benign, women of affected families often develop uterine leiomyoma with associated infertility, pain and bleeding. Here, we report a case of Reed syndrome in a family with multiple cutaneous and uterine leiomyomas. A 30-year-old woman had not only multiple cutaneous leiomyomatosis on cheek and neck, but also uterine multiple leiomyoma. Her mother had lesions that the multiple cutaneous leiomyomatosis on both shoulders and underwent myomectomy for a huge uterine leiomyoma at the age of 45. Her older sister also underwent myomectomy for uterine leiomyoma.

Pediatric Sweet Syndrome / 대한피부과학회지

Sweet syndrome or acute febrile neutrophilic dermatosis is characterized by abrupt onset of fever, leucocytosis, and tender erythematous nodules or plaques that respond to systemic corticosteroids. It occurs most commonly in middle aged women and is rare in children. We report a 2-year-old boy with Sweet syndrome who had fever, leukocytosis, neutrophilia and presented with erythematous maculopapules with tiny pustules over the whole body. Additionally he had an antecedent infection. Our evaluation and long term follow-up of this child failed to reveal evidence of an underlying malignancy or a chronic systemic illness.

The Neumann Type of Pemphigus Vegetans Treated with Combination of Dapsone and Steroid

Pemphigus vegetans is a rare variant of pemphigus vulgaris and is characterized by vegetating lesions in the inguinal folds and mouth and by the presence of autoantibodies against desmoglein 3. Two clinical subtypes of pemphigus vegetans exist, which are initially characterized by flaccid bullae and erosions (the Neumann subtype) or pustules (the Hallopeau subtype). Both subtypes subsequently develop into hyperpigmented vegetative plaques with pustules and hypertrophic granulation tissue at the periphery of the lesions. Oral administration of corticosteroids alone does not always induce disease remission in patients with pemphigus vegetans. We report here on a 63-year-old woman with pemphigs vegetans. She had a 2-year history of vegetating, papillomatous plaques on the inguinal folds and erosions of the oral mucosa. The enzyme-linked immunosorbent assay was positive for anti-desmoglein 3, but it was negative for anti-desmoglein 1. She was initially treated with systemic steroid, but no improvement was observed. The patient was then successfully treated with a combination of systemic steroid and dapsone with a good clinical response.

Photosensitivity Reactions to Vandetanib: Redevelopment after Sequential Treatment with Docetaxel

Vandetanib (ZD6474, Zactima(TM)) is a novel, orally available inhibitor of different intracellular signaling pathways involved in tumor growth, progression, and angiogenesis, including vascular endothelial growth factor receptor-2, epidermal growth factor receptor, and rearranged during transfection tyrosine kinase activity. The most frequently reported adverse events attributed to vandetanib include diarrhea, elevated aminotransferase, asymptomatic corrected QC interval prolongation, and hypertension. In a few randomized, double-blinded studies, cutaneous adverse events including these general symptoms have been reported, but there are only a few reports on the photosensitivity reaction to vandetanib domestically as conducted by dermatologists. In this report, we describe two cases of photosensitivity reactions induced by vandetanib. After improvement with steroid and antihistamine, the photosensitivity reaction was redeveloped by sequential treatment with docetaxel.

Causality Assessment of Cutaneous Adverse Drug Reactions

BACKGROUND: Cutaneous adverse drug reactions (ADRs) are the most common adverse reactions attributed to drugs. A systematic and effective approach to a patient with suspected drug eruption allows for prompt recognition, classification and treatment of cutaneous ADRs. A standardized and effective approach for objective causality assessment is necessary to make consistent and accurate identification of ADRs. OBJECTIVE: Although the Naranjo algorithm is the most widely used assessment tool, it contains many components which are not suitable for clinical assessment of ADRs in Korea. The purpose of this study is to compare correlations of the Naranjo algorithm and the Korean algorithm to evaluate usefulness of both algorithms in order to make a causal link between drugs and cutaneous ADRs. In addition, this study classifies the clinical types and causative agents of cutaneous ADRs. METHODS: The authors retrospectively reviewed the clinical types and laboratory findings of patients who were diagnosed with cutaneous ADRs in the dermatology clinic at Gil hospital. One hundred forty-one patients were enrolled in this evaluation. The causal relationship of ADRs was assessed by using the Naranjo algorithm and Korean algorithm (version 2.0). RESULTS: A cross-tabulation analysis was applied to the Naranjo algorithm and Korean algorithm (version 2.0). Simple correlation analysis and a Bland-Altman plot were used for statistical analysis. Correlation analysis confirmed that the two assessment algorithms were significantly correlated. Exanthematous eruptions (68.8%), Stevens- Johnson syndrome (10.6%), and urticaria (8.5%) were the most common types of cutaneoues ADRs. The most common causative agents were antibiotics/antimicrobials, antipyretics/non-steroidal anti-inflammatory drugs, and central nervous system depressants. CONCLUSION: The Naranjo algorithm and Korean algorithm (version 2.0) were significantly correlated with each other, and thus reliable assessment methods to determine cutaneous ADRs.

A Malignant Melanoma Associated with a Blue Nevus of the Lip

Blue nevi are characterized by a collection of pigment-producing melanocytes in the dermis. These lesions clinically present as well demarcated cerulean-blue or bluish black colored papules or plaques that usually measure less than 1 cm in diameter. They are typically found on the dorsal surface of the hands and feet or in the head and neck region; however, they are rarely found in the oral cavity. These lesions are usually benign and stable over time. However, malignant melanomas developing in or associated with a blue nevus (which is also called malignant blue nevus) have been only rarely reported. A malignant blue nevus might develop in a common blue or cellular blue nevus, a giant congenital nevus or in a nevus of Ota, or it may be malignant from the start. Malignant blue nevi most commonly are found on the scalp. A malignant blue nevus of the lip has not been previously reported in the medical literature. We report here on a patient with a malignant melanoma associated with a blue nevus of the lip. The malignant melanoma was presumed to have developed from a blue nevus that was present on the upper lip of a 50-year-old male.

Sweet Syndrome as an Initial Presentation in a Patient with Systemic Lupus Erythematosus / 대한피부과학회지

Sweet syndrome is also called acute febrile neutrophilic dermatosis and this malady is characterized by an abrupt onset of fever, leukocytosis and tender erythematous plaques that are infiltrated by neutrophils. It most commonly occurs in women who are between 30 to 50 years of age. About 50% of the cases are associated with autoimmune disease, sarcoidosis, Behcet's disease and pregnancy. We present here a 48-year-old woman who had tender erythematous tender plaque and nodules with vesicles and pustules over both extremities. She complained of general weakness, chills and arthralgia. We biopsied the nodule and performed laboratory tests. The results of the biopsy were compatible with Sweet syndrome and the laboratory test showed systemic lupus erythematosus. We report here on a case of Sweet syndrome as an initial presentation of systemic lupus erythematosus.

Chromoblastomycosis Caused by Phialophora richardsiae

Chromoblastomycosis is a chronic fungal disease of the skin and subcutaneous tissues caused by a group of dematiaceous (black) fungi. The most common etiologic agents are Fonsecaea pedrosoi and Cladophialophora carrionii, both of which can be isolated from plant debris. The infection usually follows traumatic inoculation by a penetrating thorn or splinter wound. Several months after the injury, painless papules or nodules appear on the affected area; these papules then progress to scaly and verrucose plaques. We report a case of chromoblastomycosis caused by Phialophora richardsiae, which has been rarely associated with chromoblastomycosis. The case involved a 43-year-old male, who for the past 2 months had noted an erythematous, pustulous plaque that was somewhat dark brown in color on his right shin; the plaque also had intermittent purulent discharge and crust formation. On histopathological examination, chronic granulomatous inflammation and sclerotic cells were seen. The tissue fungus culture grew out the typical black fungi of P. richardsiae, which was confirmed by polymerase chain reaction. The patient has been treated with a combination of terbinafine and itraconazole for 3 months with a good clinical response.

Three Cases of Pilomatricoma That Clinically Presented as Hemangioma on the Eyelid / 대한피부과학회지

Pilomatricoma is a common benign neoplasm that originates from the matrix of the hair root. The tumor usually presents as a deep-seated, solitary, firm nodule with overlying epidermis. It occurs more frequently in the head and neck region of children and adolescents, and it often involves the eyelid or eyebrow. Pilomatricoma is often misdiagnosed clinically and the correct diagnosis can be established only after excision and histological examination. The pathologic diagnosis of pilomatricoma is based on finding large masses of shadow cells, combined with basophilic cells, inflammation, foreign body giant cells, calcification and ossification. We report here on 3 cases of pilomatricoma that clinically presented as hemangioma on the eyelid. Punch and excisional biopsy were done after ultrasonography, and we diagnosed the lesions as eyelid pilomatricoma.

Ecthyma Gangrenosum: A Rare Cutaneous Manifestation Caused by Stenotrophomonas maltophilia in a Leukemic Patient

Ecthyma gangrenosum (EG) is a well-recognized cutaneous infection that most commonly affects immunocompromised patients. It typically occurs on the extremities, or in gluteal and perineal regions. Although Pseudomonas aeruginosa is the most well-known pathogen causing EG, other organisms have been reported to cause EG. Herein we report a rare case of ecthyma gangrenosum presenting as aggressive necrotic skin lesions in perioral and infraorbital areas in a 47-year-old patient with acute myelocytic leukemia after allogeneic bone marrow transplantation. It was caused by Stenotrophomonas maltophilia, which is an aerobic, gram-negative pathogen that has been associated only rarely with cutaneous disease. Blood culture and tissue culture were positive for S. maltophilia. Histological examination revealed numerous tiny bacilli in the dermis and perivascular area. Early recognition of skin lesions caused by S. maltophilia is important to decrease associated mortality in immunosuppressed patients.

Metastatic Malignant Fibrous Histiocytoma Mimicking Keratoacanthoma / 대한피부과학회지

Malignant fibrous histiocytoma (MFH) has been considered to be the most common malignant soft tissue tumor of middle and late adulthood. This tumor is usually a skin-colored subcutaneous nodule. It metastasizes to the lung, lymph node, bone and liver. Metastasis to the skin is very rare. We present a case of a 69-year-old man who presented with an asymptomatic dome-shaped large nodule with central umbilical ulceration on his scalp that had grown abruptly over 3 months. The lesion clinically mimicked keratoacanthoma. Biopsy of the nodule was done to differentiate keratoacanthoma from MFH confirmed the latter. The result of biopsy was MFH. Diagnosis was MFH of unknown primary tumor origin. We report a case of metastatic MFH mimicking keratoacanthoma.

A Case of Lichen Nitidus That Was Improved with Topical Tacrolimus / 대한피부과학회지

Lichen nitidus is a rare chronic inflammatory disease that was first described by Pinkus in 1907. It is characterized by asymptomatic multiple minute, flesh-colored, shiny dome shaped papules that occur on the abdomen, chest, extremities and genitalia of children or young adults. This disorder is most often localized and only a few cases of generalized lichen nitidus have been reported. Because lichen nitidus tends to be asymptomatic and it spontaneously resolves within several years, it usually does not require treatment except in the symptomatic, persistent and generalized cases. We report here on a case of a 27-year-old woman who was diagnosed with lichen nitidus, and her condition was refractory to general treatment. She was successfully treated with the application of 0.03% tacrolimus ointment.

A Case of Varicella Combined with Hand-foot-mouth Disease in a Healthy Child

We report here on an 11-year-old child with a pustulovesicular eruption on her whole body, including her palms, soles and oral mucosa, and this was accompanied with fever. A serologic test was positive for IgM varicella zoster antibody and coxsackievirus A16 antibody. The histopathologic examination from the palm revealed intraepidermal pustules that showed neither inclusion bodies nor multinucleated giant cells. We made the final diagnosis, according to the serologic tests and histopathologic findings, as varicella combined with hand-foot-mouth disease caused by coxsackievirus A16 in a previously healthy child