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Nevus sebaceus is a hamartomatous lesion characterized by epidermal, follicular, sebaceus, and apocrine gland abnormalities. Approximately 25% of affected individuals may develop benign or malignant secondary neoplasms within the preceding nevus sebaceus. Primary cutaneous apocrine carcinoma (PCAC) is a rare malignant skin tumor affecting elderly adults in their sixth decade of life. Histologically, PCAC appears as a dermal tumor displaying apocrine differentiation with decapitation secretion and malignant features. Secondary malignancy arising from nevus sebaceus is a rare complication, especially for apocrine carcinoma. To date, approximately 200 cases of PCAC have been reported in the literature, and only a few cases have developed PCAC on the scalp. Very few cases (approximately only 12) of PCACs developing in nevus sebaceus have been reported. Here, we report an extremely rare case of the coexistence of PCAC and syringocystadenoma papilliferum arising within nevus sebaceus of the scalp.
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Pilar leiomyoma or piloleiomyoma is a benign neoplasm of the smooth muscle arising from the arrector pili muscle. It manifests as brown to red firm papulonodules with sites of predilection being the face, trunk, and extensor surfaces of the extremities. Histologically, the lesions exhibit ill-defined dermal tumors with interlacing fascicles of spindle cells. Some genodermatoses are characterized by the development of visceral tumors and cutaneous leiomyomatosis such as Reed’s syndrome, and hereditary leiomyomatosis and renal cell cancer (HLRCC). A 55-year-old male presented with reddish-brown papules and nodules on the face and upper back, accompanied by sharp episodic pain on the face. He had undergone nephrectomy for renal cancer 9 years ago, and his younger brother had similar cutaneous manifestation. Histopathologic findings were consistent with pilar leiomyoma, showing bundles of smooth muscle tumors in the dermis. Based on the clinical information including clinical features, past medical history, and family history, HLRCC was highly suspected.To confirm the diagnosis, whole exome sequencing was performed using peripheral blood, which revealed a novel point mutation (c.739G>A, p.Glu247Lys) in the fumarate hydratase (FH) gene. We describe a confirmed case of HLRCC, which is a genetic disorder with a potential to cause visceral cancers, which dermatologists might overlook as a benign condition.
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Background@#Eosinophilic cellulitis, also known as Wells’ syndrome, is an uncommon skin disease characterized by recurrent pruritic polymorphous plaques or nodules. There is limited knowledge in the Korean literature regarding the clinical characteristics and course of eosinophilic cellulitis. @*Objective@#To investigate the clinical and histological features of eosinophilic cellulitis in Korean patients. @*Methods@#In this case series study, we retrospectively reviewed the electronic medical records of patients diagnosed with eosinophilic cellulitis at our institutions from 2004 to 2022. We also analyzed the literature published in dermatology and internal medicine journals in Korea. @*Results@#A total of 17 patients were included in this study (age, 39.4±21.8 years; 12 male [70.6%]), with an average disease duration of 4.4 months. We identified six clinical variants, with the typical plaque type being the most common (33.3%), followed by the papulonodular type (22.2%). Eosinophilia was observed in 78.6% of patients, and a flame figure, which is a typical histopathological feature of eosinophilic cellulitis, was observed in 52.9% of patients. Systemic and topical steroids and antihistamines were used as first-line treatment with generally favorable results (82.4%), followed by antibiotics (35.3%), cyclosporine (23.5%), and topical calcineurin inhibitors (23.5%).The recurrence rate during the mean follow-up period of 21.8 months was 29.4%. @*Conclusion@#Eosinophilic cellulitis can present with various clinical manifestations, and flame figures do not appear in all cases; therefore, clinical and histological correlations are critical for accurate diagnosis of patients with eosinophilic cellulitis.
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Background@#Pediatric alopecia areata (AA) can affect the quality of life (QoL) of patients and their family members. Research on the QoL and burden on family members in pediatric AA is limited. @*Objective@#This nationwide multicenter questionnaire study described the QoL and burden of the family members of patients with pediatric AA. @*Methods@#This nationwide multicenter questionnaire study enrolled AA patients between the ages of 5 and 18 years from March 1, 2017 to February 28, 2018. Enrolled patients and their parents completed the modified Children’s Dermatology Life Quality Index (CDLQI) and the modified Dermatitis Family Impact (mDFI). The disease severity was measured using the Severity of Alopecia Tool (SALT) survey scores. @*Results@#A total of 268 patients with AA from 22 hospitals participated in this study. Our study found that the efficacy and satisfaction of previous treatments of AA decreased as the severity of the disease increased. The use of home-based therapies and traditional medicines increased with the increasing severity of the disease, but the efficacy felt by patients was limited. CDLQI and mDFI scores were higher in patients with extensive AA than those with mild to moderate AA. The economic and time burden of the family members also increased as the severity of the disease increased. @*Conclusion@#The severity of the AA is indirectly proportional to the QoL of patients and their family members and directly proportional to the burden. Physicians need to understand these characteristics of pediatric AA and provide appropriate intervention to patients and their family members.
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Background@#Understanding the age-related morphological changes of facial soft tissue is fundamental in achieving improved outcomes of rejuvenating procedures. Three-dimensional (3D) photogrammetry is a reliable and convenient anthropometric tool to assess facial soft tissue. @*Objective@#The aim of this study was to establish age-related facial soft tissue morphology in Korean adult females using non-invasive 3D photogrammetry. @*Methods@#One hundred and ninety-two female participants were divided into three groups based on age: the younger group (aged 20∼39 years), middle group (40∼59 years), and older group (60∼79 years). Thirty-six landmarks were identified via 3D photogrammetric scanning (Morpheus 3D, Morpheus Co., Ltd., Seongnam, Korea). Fortyone facial dimensions were analyzed using the imaging software to find significance between the age groups. @*Results@#Smaller upper-facial volume (p=0.019) and shorter upperfacial height (p=0.034) were observed in the older group than in the younger group. In the mid-face, narrowed palpebral fissure (p＜0.001) with elongated upper eyelid height (p＜0.001) and widened nose (p＜0.001) were observed in the older group compared with the younger group. Longer lower-facial height (p＜0.001) with longer and wider philtrum (p＜0.001, p=0.004, respectively), shorter lower vermilion height (p＜0.001), wider mouth width (p＜0.001), and smaller lower vermilion angle (p＜0.001) were seen in the older group when compared with the younger group. Moreover, greater angles of nasofrontal, nasomental, and labiomental angle (p=0.015, p=0.015, p=0.080, respectively), and smaller nasofacial angle (p=0.034) were observed in the older group than in the younger group. @*Conclusion@#Our results provide clues of aging-related facial morphological characteristics in Korean female population.
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Background@#Melasma shows characteristic histological features of photoaged skin. @*Objective@#We evaluated the effect of dermal rejuvenation using a temperature-controlled continuous non-invasive radiofrequency (RF) device on melasma. @*Methods@#Continuous skin heating at the temperature of 43°C for 20 minutes was performed in ten subjects with melasma who underwent 3 tri-weekly RF sessions. Pigmentation was evaluated with Mexameter® and investigator’s global assessment (IGA). Immunohistochemical staining and image analysis was performed to evaluate biopsies from melasma skin before and after the treatment. @*Results@#The lesional melanin index was decreased by 13.7% at week 9. IGA score was improved from 3.50 at baseline to 2.95 at week 9. No significant adverse event was reported. Histologic analysis revealed reduced melanin and increased collagen density and thickness.The expression of procollagen-1 and type IV collagen was increased after the treatment. The number of p16 INK4A -positive senescent fibroblasts was reduced after the treatment, while the expression of heat shock protein 70 and 90 was increased. Stromal derived factor-1, a senescence-associated anti-melanogenic factor secreted from the fibroblasts, was up-regulated after the treatment, while the level of c-kit was not changed. @*Conclusion@#Thermal skin stimulation by the temperature-controlled continuous RF device improved melasma through dermal rejuvenation.
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BACKGROUND: Kaempferol (3,4′,5,7-tetrahydroxyflavone) is a flavonoid known to have a wide range of pharmacological activities. The 3-OH group in flavonoids has been reported to determine antioxidant activities. OBJECTIVE: We tested whether kaempferol can affect the expression of integrins and the stem cell fate of interfollicular epidermal stem cells. METHODS: Skin equivalent (SE) models were constructed, and the expression levels of stem cell markers and basement membrane-related antigens were tested. The immunohistochemical staining patterns of integrins, p63, and proliferating cell nuclear antigen (PCNA) were compared between kaempferol- and apigenin-treated SE models. Reverse transcription-polymerase chain reaction (RT-PCR) was used to evaluate the mRNA expression of integrins. RESULTS: Kaempferol increased the thickness of the epidermis when added to prepare SEs. In addition, the basal cells of kaempferol- treated SEs appeared more columnar. In the immunohistological study, the expression of integrins α6 and β1 and the numbers of p63- and PCNA-positive cells were markedly higher in the kaempferol-treated model. However, apigenin showed no effects on the formation of three-dimensional skin models. RT-PCR analysis also confirmed that kaempferol increased the expression of integrin α6 and integrin β1. CONCLUSION: Our findings indicated that kaempferol can increase the proliferative potential of basal epidermal cells by modulating the basement membrane. In other words, kaempferol can affect the fate of interfollicular epidermal stem cells by increasing the expression of both integrins α6 and β1. These effects, in particular, might be ascribed to the 3-OH group of kaempferol.
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Apigenina , Membrana Basal , Epiderme , Matriz Extracelular , Flavonoides , Integrinas , Antígeno Nuclear de Célula em Proliferação , RNA Mensageiro , Pele , Células-TroncoRESUMO
Desmoplastic fibroblastoma is a rare fibrous tumor that usually presents as a painless, slow-growing mass in the subcutaneous tissues and skeletal muscles. It has a wide anatomic distribution, with the most common involvement being the arm and shoulder. Here, we report a case of a tiny painful desmoplastic fibroblastoma arising on the scalp. According to a microscopic examination, this tumor was composed of spindle-shaped fibroblasts in the dense collagenous stroma. On immunohistochemical staining, tumor cells were positive for vimentin and negative for smooth muscle actin, CD34, and S100. Our case is unique in that desmoplastic fibroblastoma developed on the scalp and there was presence of pain despite its small size.
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Actinas , Braço , Colágeno , Fibroblastos , Músculo Esquelético , Músculo Liso , Couro Cabeludo , Ombro , Tela Subcutânea , VimentinaRESUMO
BACKGROUND: Skin laser treatment has improved significantly and has become an effective treatment approach for many skin diseases while also having applications for beauty treatments. However, since skin laser transfers energy directly to the skin, the misuse of such treatment may result in permanent damage to skin tissues. OBJECTIVE: This survey of Korean adults, conducted to obtain their perspectives on and their treatment experience with skin laser treatment, will be used to determine the current status of skin laser treatment and to identify necessary changes to ensure proper and safe conduct of skin laser treatment. METHODS: From April 5th to April 12th, 2016, a survey was conducted to obtain information regarding the perspectives and the treatment experience of adults aged 20~59 years. RESULTS: Approximately 50% of the participants had experience with skin laser treatment, and among these, 24.7% had not received treatment at a dermatology clinic. Compared to treatment at a dermatology clinic, the danger of side effects was 1.7 times higher at a non-dermatology clinic, 2 times higher at a skin care shop, and 5.3 times higher at an Oriental medical clinic. Among patients who received skin laser treatment, 16.1% experienced side effects, and among these, 1 out of 4 patients visited a non-dermatologist for treatment of these side effects. CONCLUSION: The results of the survey showed that in order for the public to receive safe and effective skin laser treatment based on professional diagnosis, there is a definitive need to provide correct information to the public and to implement changes to ensure proper understanding of skin laser treatment among this population.
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Adulto , Humanos , Beleza , Dermatologia , Diagnóstico , Higiene da Pele , Dermatopatias , PeleRESUMO
Carbon dioxide (CO2) laser is one of the most widely used lasers in dermatology. CO2 laser can precisely ablate the skin with good hemostasis, which makes it an ideal surgical laser. With the development of pulsed CO2 laser, which enabled cleaner ablation with less residual thermal damage, CO2 laser resurfacing became the gold standard for skin rejuvenation. The rejuvenation effect of full-face CO2 laser resurfacing is unparalleled to other methods; however, it is associated with a relative high incidence of side effects and prolonged downtime. Fractional CO2 laser was developed to overcome this problem. With a new technology of fractionating the laser beam into hundreds of microbeams, fractional CO2 laser resurfacing can improve various skin conditions including skin laxity, photodamage, and acne scars with short downtime and significantly lesser side effects. For optimal treatment results, clinicians have to decide the treatment depth and density based on proper understanding of the laser tissue interaction and underlying skin conditions.
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Acne Vulgar , Dióxido de Carbono , Carbono , Cicatriz , Dermatologia , Hemostasia , Incidência , Lasers de Gás , Rejuvenescimento , PeleRESUMO
BACKGROUND: Formaldehyde (FA) and other volatile organic compounds (VOCs) are considered among the main causes of atopic aggravation. Their main sources include wallpapers, paints, adhesives, and flooring materials. OBJECTIVE: To assess the effects of environmentally friendly wallpaper and flooring material on indoor air quality and atopic dermatitis severity. METHODS: Thirty patients with atopic dermatitis were enrolled in this study. To improve air quality, the wallpaper and flooring in the homes of the subjects were replaced with plant- or silica-based materials. The indoor air concentration of FA and the total VOCs (TVOCs) were measured before remodeling and 2, 6, and 10 weeks thereafter. Pruritus and the severity of atopic eczema were evaluated by using a questionnaire and the eczema area and severity index (EASI) score before and at 4, 8, and 12 weeks after remodeling. The subjects were instructed to continue their therapy for atopic dermatitis. RESULTS: The houses of 24 subjects were remodeled; all subjects completed the study. The concentration of FA in ambient air significantly decreased within 2 weeks after remodeling. The TVOC level showed a decrease at week 2 but increased again at weeks 6 and 10. The reduction of pruritus and EASI score was statistically significant in patients whose baseline EASI score was >3. CONCLUSION: Replacing the wallpaper and flooring of houses with environmentally friendly material reduced FA in ambient air and improved pruritus and the severity of atopic eczema. The improvement of pruritus and eczema was statistically significant in patients whose baseline EASI score was >3.
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Humanos , Adesivos , Poluição do Ar em Ambientes Fechados , Dermatite Atópica , Eczema , Formaldeído , Habitação , Pintura , Projetos Piloto , Prurido , Compostos Orgânicos Voláteis , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Photodynamic therapy (PDT) using topical aminolevulinic acid (ALA) has increasingly been used for the treatment of acne vulgaris and several studies have shown its clinical efficacy. However, ALA-PDT needs a relatively long incubation period and is frequently associated with adverse effects. Indole-3-acetic acid (IAA) has been introduced as a new photosensitizer for the treatment of acne in recent study. IAA-PDT requires only a short incubation period and the procedure is relatively painless in contrast to ALA-PDT. OBJECTIVE: To investigate the efficacy and safety of IAA- PDT in the treatment of acne. METHODS: Twenty-five patients with facial acne lesions were enrolled in this study. IAA-PDT was performed for five sessions at 1-week intervals (week 0~4). IAA was treated with 15 minute occlusion, and green light was given for 15 minutes. Clinical efficacy was determined by evaluating acne lesion counts, severity grading, and the Dermatology Life Quality Index (DLQI) at week 0, 2, 4, and 5. Sebum secretion and erythema index was measured by Sebumeter and Mexameter, respectively, at baseline and one week after each treatment session (week 1~5). Histopathological examination was performed at baseline and week 5. Adverse effects were recorded throughout the study. RESULTS: All the patients completed the study. Numbers of both inflammatory and non-inflammatory acne lesions were significantly decreased. Acne severity grade and the DLQI showed significant reduction. Sebum secretion and erythema were also reduced. Histopathological examination showed a reduction in inflammatory reactions. No adverse effects were observed except for transient pruritus in one patient. CONCLUSION: PDT using IAA and green light was an effective, simple and safe treatment for acne.
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Humanos , Acne Vulgar , Ácido Aminolevulínico , Dermatologia , Eritema , Ácidos Indolacéticos , Luz , Fotoquimioterapia , Prurido , Qualidade de Vida , Sebo , TriazenosRESUMO
Dermal cells from neonatal mice can initiate the formation of hair follicles (HFs) when combined with adult mouse epidermal cells and transplanted subcutaneously into athymic mice. In the present study, the effects of dermal cells on HF formation were tested in terms of total cell number and the time course of cell harvest. Results demonstrated that the number of dermal cells is critical to the formation of HF. Furthermore, hair forming ability is rapidly decreasing as the neonatal mice age. To examine potential differences in gene expression, cDNA array was performed. Results demonstrate that numerous molecules which are directly involved in receptor and signaling correlated with decreased hair inductivity in early time points after delivery. It is reported that bone morphogenic protein (BMP)-6 and Wnt3a treatment increased hair inductivity of dermal papilla cells. But in our study, no changes were observed in the expression levels of BMP-6 and Wnt3a. However, several Wnt related genes demonstrate increased or decreased expression levels. Thus, our results suggest that co-ordinated regulation of these molecules will be important in hair neogenesis within our model system.