Baumann Skin Type in the Korean Female Population

BACKGROUND: To meet the need for a subspecialized skin type system, the Baumann skin type (BST) system was proposed. OBJECTIVE: To evaluate the distribution of BST types and influencing factors among Korean women. METHODS: BST questionnaires were administered to 1,000 Korean women. The possible responses were as follows: oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). The correlations of the BST with the subjects' age, location, ultraviolet (UV) ray exposure, drinking and smoking habits, and blood type were assessed. RESULTS: The OSNT, DSNT, DRNT, and OSNW skin types were the most common skin types (55.3%). The O, S, P, and W types accounted for 46.6%, 68.8%, 23.2%, and 31.9%, respectively. The proportion of the O and S type was the highest in Gyeongsangbuk-do (55.0%) and Seoul (77.2%). The proportion of the P and W type was the highest in Gyeongsangbuk-do (33.0%) and Chungcheong-do (39.0%). The O type decreased in the higher age group, whereas the P and W type showed a reversed tendency. In smokers, the proportion of W type was significantly higher than in the non-smokers (66.3% vs. 24.1%, p<0.05). CONCLUSION: The 4 most common BST types were OSNT, DSNT, DRNT, and OSNW. In the comparison across the 4 BST parameters according to the age, region, smoking and drinking habits, occupation, blood type, and UV exposure, significant differences were observed. Individualized and customized skin care is required according to the personal skin type.

Smart-Phone Addiction, Depression/Anxiety, and Self-Esteem with Attention-Deficit Hyperactivity Disorder in Korean Children

OBJECTIVES: The current study investigated the risk of smartphone addiction among children and adolescents with or without attention-deficit hyperactivity disorder (ADHD), risk of depression, anxiety, and self-esteem using the Smartphone Addiction Scale Proneness, Kovac's Children's Depression Inventory, State-Trait Anxiety Inventory, and Rosenberg Self-Esteem Scale, commonly used in clinical medicine. METHODS: Ninety five students with ADHD who visited psychiatry outpatient clinics completed the questionnaire. At the same time, 592 middle and high school students living in a similar area regardless of ADHD diagnosis, completed the questionnaire as control subjects. RESULTS: Overall, 40.0% of 95 ADHD and 12.8% of 592 control subjects were classified as the smartphone addiction proneness group, 26.3% of the ADHD subjects and 8.3% of the control group were classified as the depression group, and 32.6% of the ADHD subjects and 16.2% of the control group were classified as the anxiety group. Significant differences were observed between the two groups. CONCLUSION: The results of this study suggest that ADHD subjects are more prone to smartphone addiction, becoming depressed or anxious than those in the control group. From this study, we could suggest that students with ADHD are more easily affected by smartphone addiction than normal control subjects. In addition, we might understand how some psychiatric problems like depression, anxiety, and low self-esteem are related to ADHD and smartphone addiction.

Effect of tracheal lidocaine on intubating conditions during propofol-remifentanil target-controlled infusion without neuromuscular blockade in day-case anesthesia / 대한마취과학회지

BACKGROUND: Lidocaine is a useful intravenous and topical adjunct to facilitate tracheal intubation. We evaluated the effect of tracheal lidocaine on tracheal intubating conditions without neuromuscular blocking agent and hemodynamics during anesthesia induction with propofol and remifentanil target-controlled infusion (TCI). METHODS: Fifty patients, aged 18-60 years, scheduled for closed reduction of fractured nasal bone were randomly assigned to the control group (n = 25) or lidocaine group (n = 25). Anesthesia was induced with propofol-remifentanil TCI with the effect-site concentration of 5 microg/ml and 5 ng/ml. Four minutes after the start of propofol-remifentanil TCI, 4% lidocaine or saline 3 ml was instilled to larynx and trachea, and intubation was performed 1 min later. Acceptable intubation was defined as excellent or good intubating conditions. Hemodynamic data, induction and recovery profiles were recorded. RESULTS: Intubating condition was clinically acceptable in 13 out of 25 (52%) patients in the control group and in 22 out of 25 (88%) in the lidocaine group, and there was a significant difference between the two groups in regard to acceptable intubating conditions (P = 0.005). Mean arterial pressure change over time was significantly different between the two groups. There were no significant differences in the heart rate between the two groups. CONCLUSIONS: This study demonstrated that laryngotracheal administration of 4% lidocaine could increase the percentage of acceptable conditions for tracheal intubation during propofol and remifentanil anesthesia without neuromuscular blockade.

Spinal Arteriovenous Malformation Masquerating Zoster Sine Herpete

Zoster sine herpete (ZSH) is difficult to diagnosis during an acute period due to the absence of the characteristic zosteriform dermatomal rash; therefore, progression to postherpetic neuralgia is more common than typical zoster. In addition, misdiagnosis of other neuropathic pain as ZSH is common in clinical situations. Here, we report a case of spinal arteriovenous malformation that mimics ZSH. This is a rare condition; therefore, high clinical suspicion for a correct diagnosis and proper examination are not easy. However, early diagnosis and definitive treatment are essential to prevent neurologic deficit and mortality.

Reconstruction with Burow's Graft After Mohs' Micrographic Surgery of Facial Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: In reconstruction of facial defects, large defects or defects with insufficient skin laxity could pose a challenge. Burow's graft is a modified full-thickness skin graft which utilizes adjacent skin as the donor site. OBJECTIVE: To describe the surgical technique of Burow's grafts and to report our experience with the postoperative cosmetic outcome. METHODS: This is a retrospective review of 16 cases of basal cell carcinoma, reconstructed with Burow's grafts after Mohs' micrographic surgery. Burow's graft was performed in surgical defects which were too large for primary closure. Burow's grafts were then placed on the remaining primary defects and sutured. The size of the tumor and postoperative surgical defects, local complications, and cosmetic outcomes were assessed. RESULTS: The size of primary defects ranged from 0.9 to 3.5 cm (with a mean of 1.98 cm) in greatest diameter. Seven cases were located on the nose, 3 on the cheek, 2 on the ear, 2 on the temple, and one on the eyebrow and lower eyelid. During the follow-up period, partial graft necrosis occurred in 2 patients but there was no evidence of acute bleeding, hematoma, or infection. There was no tumor recurrence and most of the patients showed minimally discernable scarring with satisfactory aesthetic outcomes. CONCLUSION: Burow's graft could be recognized as a useful reconstructive method in large skin defects and in areas with limited skin laxity. It provides an aesthetically pleasing result, and it is also simple and easy to perform.

Reconstruction with O-Z Flap and Double O-Z Flap after Mohs' Micrographic Surgery for Skin Cancer of the Face / 대한피부과학회지

BACKGROUND: The O-Z flap is a kind of rotational flap that consists of a combination of two opposing rotation flaps. The double O-Z flap is a variant of the O-Z flap applied in multiple adjacent surgical defects that can simplify closure by combining closure into one technique. OBJECTIVE: To report our experience with the O-Z flap and double O-Z flap in the reconstruction of surgical defects of the face after Mohs' micrographic surgery (MMS), using postoperative clinical and cosmetic results. METHODS: Sixteen patients diagnosed with non-malignant melanoma skin cancer on the face were treated with MMS. The resultant surgical defects were reconstructed with an O-Z flap in 14 patients and with a double O-Z flap in 2 patients. Clinical outcomes were reviewed, and cosmetic results were scored as excellent, good, fair, poor, or very poor. RESULTS: In the 14 patients using O-Z flap, 6 cases were located on the temple, 4 on the forehead, 2 on the cheek, and 1 of each on the nose and philtrum. Of the two patients using double O-Z flap, one had two adjacent basal cell carcinomas on the cheek, and the other had two adjacent squamous cell carcinomas on the forehead. The size of the primary defects ranged from 1.1 to 2.5 cm in greatest diameter (mean, 1.93 cm). There were no significant local complications. There was no tumor recurrence, and 14 of 16 patients showed satisfactory aesthetic outcomes scored as excellent or good. CONCLUSION: O-Z flap reconstruction was effective for the closure of surgical defects with limited skin laxity in the face. The double O-Z flap is ideally suited to combine closure of adjacent surgical defects into one technique without exerting undue tension or distorting the surrounding structures. We found these flaps were simple to construct and provided aesthetically pleasing results. Therefore, they could be useful reconstructive options in facial skin defects after MMS.

The Effect of Detergents on the Morphology and Immunomodulatory Activity of Malassezia furfur

BACKGROUND: Several workers have found that Malassezia are capable of suppressing cytokine release and downregulating the phagocytic function of monocytes. But lipid-depleted Malassezia furfur (M. furfur) extracts have also been shown to induce increased production of TNF-alpha, IL-6 and IL-1beta in monocytes. We thought that the detergents in shampoos or soaps could change the composition of the lipid in the M. furfur cell wall. OBJECTIVE: We studied whether detergents affect the morphology of M. furfur and if the inflammatory cytokine profiles change in the monocytes treated with detergent-treated M. furfur. METHODS: Commonly used detergents such as sodium lauryl sulfate, ammonium lauryl sulfate and tween-80 were respectively added to the modified Leeming-Notman's media. M. furfur was cultivated in each media (detergent-added or untreated). Thereafter, the surface morphology of the yeast was evaluated by scanning and transmission electron microscopy. The cytokine profiles of monocytes, which were treated by M. furfur with or without detergents, were also evaluated. RESULTS: The detergent- treated M. furfur were similar to the lipid-extracted form of M. furfur on the electron microscopic study, with a recessed, withered surface and with thinner and rather electron transparent cell walls than the detergent-untreated M. furfur. The levels of TNF-alpha were higher in monocytes treated with detergent-treated Malassezia than that in the monocytes treated with the detergent-untreated Malassezia (p <0.05). CONCLUSION: According to the findings in this study, it could be inferred that the detergents in shampoos or soaps affect the lipid layers of the Malassezia cell wall and these lipid-extracted Malassezia induce or aggravate some inflammatory conditions. But to correlate the relationship between detergents and Malassezia-associated diseases, in vivo experiments that will focus on short-term contact with detergents in real life conditions should be done.

The Effect of Detergents on the Morphology and Immunomodulatory Activity of Malassezia furfur

BACKGROUND: Several workers have found that Malassezia are capable of suppressing cytokine release and downregulating the phagocytic function of monocytes. But lipid-depleted Malassezia furfur (M. furfur) extracts have also been shown to induce increased production of TNF-alpha, IL-6 and IL-1beta in monocytes. We thought that the detergents in shampoos or soaps could change the composition of the lipid in the M. furfur cell wall. OBJECTIVE: We studied whether detergents affect the morphology of M. furfur and if the inflammatory cytokine profiles change in the monocytes treated with detergent-treated M. furfur. METHODS: Commonly used detergents such as sodium lauryl sulfate, ammonium lauryl sulfate and tween-80 were respectively added to the modified Leeming-Notman's media. M. furfur was cultivated in each media (detergent-added or untreated). Thereafter, the surface morphology of the yeast was evaluated by scanning and transmission electron microscopy. The cytokine profiles of monocytes, which were treated by M. furfur with or without detergents, were also evaluated. RESULTS: The detergent- treated M. furfur were similar to the lipid-extracted form of M. furfur on the electron microscopic study, with a recessed, withered surface and with thinner and rather electron transparent cell walls than the detergent-untreated M. furfur. The levels of TNF-alpha were higher in monocytes treated with detergent-treated Malassezia than that in the monocytes treated with the detergent-untreated Malassezia (p <0.05). CONCLUSION: According to the findings in this study, it could be inferred that the detergents in shampoos or soaps affect the lipid layers of the Malassezia cell wall and these lipid-extracted Malassezia induce or aggravate some inflammatory conditions. But to correlate the relationship between detergents and Malassezia-associated diseases, in vivo experiments that will focus on short-term contact with detergents in real life conditions should be done.

Postauricular Island Pedicle Flap ("Flip-Flop" Flap) for Reconstruction of the External Ear Defect / 대한피부과학회지

About six percent of head and neck cancers occur on the external ears. Excision of the cancer can cause changes of morphology and poor cosmesis. Reconstruction of ear defects presents a unique and notable challenge to the dermatologic surgeons. This is due to the complex architecture of the external ear which is difficult to duplicate surgically. Several methods are available for reconstruction of defects to the external ear. However, the diversity of external ear shapes shows how difficult it is to achieve a certain solution to this problem. Postauricular island pedicle flap was initially reported as a technique for reconstruction of small defects of the concha after excision, and has since been used successfully in the repair of more extensive defects involving not only the concha, but also the antihelix and external auditory meatus. We report two cases of auricular squamous cell carcinoma in which the skin defect is reconstructed by a postauricular island pedicle flap ("flip-flop" flap).

A Case of Widespread Follicular Mucinosis in a 5-year-old Girl / 대한피부과학회지

Follicular mucinosis, also known as alopecia mucinosa, is a rare disease characterized by mucinous follicular degeneration and may be accompanied by cutaneous lymphoma, particularly mycosis fungoides. Two categories of disease have been identified in patients with the benign primary form. The first occurs in younger patients with localized lesions and spontaneous regression within 2 years of the onset. The second occurs in elderly patients and shows a chronic relapsing, but benign course. In the second type, the patients are older and have widespread and infiltrated lesions that can progress to mycosis fungoides. We report a case of follicular mucinosis in a 5-year-old girl who had widely distributed lesions. We think that long-term follow-up is mandatory for the occurrence of lymphoma-associated disease.

A Case of Giant Apocrine Hidradenoma / 대한피부과학회지

Hidradenoma is a relatively rare benign cutaneous tumor of sweat gland origin showing eccrine (eccrine or poroid hidradenoma) or apocrine (apocrine hidradenoma) differentiation. It usually presents as a slowly growing solitary nodule measuring between 0.5 and 2 cm in diameter. The large variant is rare, but may occur when they grow without appropriate treatment for several years. We report a case of apocrine hidradenoma in a 67-year old woman who presented with a solitary, erythematous, pedunculated, giant mass measuring 10.5x6.7x4.0 cm in size on the left lateral aspect of frontal scalp for 10 years. This is the largest among reported cases in the Korean literature.

Two Cases of Vulvar Melanoma / 대한피부과학회지

Vulvar melanoma is the second most common vulvar malignancy but occupies less than 1% of all melanomas. It occurs predominantly in the fifth to eighth decades of life and the most common presentation is a vulvar mass or lump, although pruritus and bleeding are also frequent. Vulvar melanoma usually shows deep infiltratition earlier than cutaneous melanoma due to abundant lymphatic channels and blood vascularization, and so its prognosis is mostly poor. Depth of invasion has been reported as the single most important indicator of prognosis. Previously the treatment of choice for vulvar melanoma has been radical vulvectomy with bilateral inguinofemoral lymphadenectomy but recently there have been reports suggesting that a comparable survival rate may be achieved by local wide excision. We herein report two cases of vulvar melanoma presented in labia minora with a brief review of the literature.

Four Cases of Infantile Nodular Scabies: The Usefulness of Dermoscopy for in Vivo Detection of Scabies / 대한피부과학회지

The typical history of pruritus with nocturnal exacerbation and distribution of the eruption of inflammatory papules is suggestive of a scabies infestation. However, atypical cases of scabies, such as nodular scabies, frequently lack classical symptoms, leading to misdiagnosis. Dermoscopy is a very helpful tool for differential diagnosis of pigmented skin lesions. Moreover, unique dermoscopic findings such as 'jet with condensation trails' are considered as specific features in scabies. Dermoscopy is especially suitable for the detection of mites in cases of atypical scabies where no typical burrows or papules could be found. Also, it can be useful for infantile scabies because it permits rapid, non-invasive examination without causing pain or discomfort to the patient. We herein report 4 cases of infantile nodular scabies diagnosed by dermoscopy. We suggest that it is an effective diagnostic method for scabies.

A Case of Perforating Osteoma Cutis / 대한피부과학회지

Among skin disorders associated with changes to the bony tissue or abnormalities of calcification, osteoma cutis is a rare, benign tumor of the skin composed of compact bone. Osteoma cutis is primary ossification without preceding skin disease, trauma or evidence of Albright's hereditary osteodystrophy. A 59-year-old man presented with a firm erythematous nodule containing centrally punctuated ulcer on the right mandibular angle. A biopsy specimen showed calcification and ossification with many osteocytes, which had extruded through the perforating epidermal channel. We herein report a rare case of perforating osteoma cutis.

A Case of Digital Myxoid Cyst Coexisting with Epidermal Inclusion Cyst

A 62-year-old male developed a solitary asymptomatic nodule on the lateral aspect of the distal interphalangeal joint of the right great toe. Histopathologic findings demonstrated a myxoid cyst with a concomitant epidermal inclusion cyst. To the best of our knowledge, this is the first case of concurrent occurrence of digital myxoid cyst and epidermal inclusion cyst. Although the exact mechanism for developing a digital myxoid cyst and an epidermal inclusion cyst simultaneously at the same site is not explained, trauma might be a possible cause.

A Case of Unilateral Darier's Disease; Acantholytic Dyskeratotic Epidermal Nevus? / 대한피부과학회지

Darier's disease is an uncommon genodermatosis, characterized by the symmetric eruption of keratotic papules, focal loss of epithelial adhesion and abnormal keratinization. A unilateral, or localized variant has been identified as a mosaic form, involving linear or 'zosteriform' epidermal lesions with clinical and histological features of Darier's disease. Some suggest that unilateral lesions should be classified as acantholytic dyskeratotic epidermal nevi, rather than localized Darier disease. A 17-year-old male presented with unilateral zosteriform distribution of brownish hyperkeratotic papules with ipsilateral v-notching of the thumb nail. A biopsy specimen revealed acantholysis, suprabasal cleft and multiple dyskeratotic cells. We report a case of unilateral Darier's disease which further supports unilateral dermatologic manifestation as a variant of Darier's disease.

Generalized Pustular Psoriasis and Hepatic Dysfunction Associated with Oral Terbinafine Therapy

We report a case of 61-yr-old man with stable psoriasis who progressively developed generalized pustular eruption, erythroderma, fever, and hepatic dysfunction following oral terbinafine. Skin biopsy was compatible with pustular psoriasis. After discontinuation of terbinafine and initiating topical corticosteroid and calcipotriol combination with narrow band ultraviolet B therapy, patient's condition slowly improved until complete remission was reached 2 weeks later. The diagnosis of generalized pustular psoriasis (GPP) induced by oral terbinafine was made. To our knowledge, this is the first report of GPP accompanied by hepatic dysfunction associated with oral terbinafine therapy.

A Case of Vegetative Pyoderma Gangrenosum / 대한피부과학회지

Pyoderma gangrenosum is a rare cutaneous disorder composed of chronic recurrent painful ulcers. The variants of pyoderma gangrenosum are classified as ulcerative, pustular, bullous, and vegetative types. Vegetative pyoderma gangrenosum is a very rare variant of pyoderma gangrenosum characterized by a non-painful and not undermined superficial ulcer that has an exophytic and vegetative border. Systemic disease is rarely associated with this variant and the course is usually benign. Furthermore the response of therapy is so good that nonaggressive treatment such as antibiotics or topical steroids are sufficient for complete healing of the lesion. Recently, we were presented with a case of a 71 year old man who had had chronic recurrent cutaneous lesions composed of erythematous vegetative plaques, and superficial ulcers with serous discharge on the suprapubic region, both forearms and thighs. After skin biopsy, a diagnosis of 'vegetative pyoderma gangrenosum' was made. We report this case along with a review of the literature.

The Effect of Topical Tacrolimus in the Murine Contact Hypersensitivity and Dermatitis of Repeated Applications Induced by Diphenylcyclopropenone / 대한피부과학회지

BACKGROUND: Topical tacrolimus is widely used for the treatment of inflammatory skin diseases like atopic dermatitis, but there are few studies about the effect of topical tacrolimus for allergic contact dermatitis. Allergic contact dermatitis develops in two phases, the clinically silent sensitization phase, and the clinically apparent elicitation phase. OBJECTIVE: The purpose of this study is to investigate whether topical tacrolimus has an effect on both phases of murine contact hypersensitivity and dermatitis of repeated applications induced by diphenylcyclopropenone (DPCP). METHODS: Hairless mice were treated with topical tacrolimus before and after DPCP challenging. The suppressive effect of topical tacrolimus was measured by skin erythema, ear swelling, weight change and cell numbers of local lymph nodes. In addition, a biopsy was carried out and epidermal hyperplasia was investigated microscopically. TNF-alpha mRNA on the mice which were treated with topical tacrolimus to one side of the ears was measured before and after being chronically challenged with DPCP on both ears. RESULTS: Topical tacrolimus pretreatment dramatically supressed inflammatory reactions in the sensitization phase, and treatment of topical tacrolimus after sensitization dramatically supressed inflammatory reactions in the elicitation phase. Topical tacrolimus also dramatically supressed inflammatory reactions in the repeated DPCP-induced dermatitis. CONCLUSION: The data revealed topical tacrolimus could effectively suppress murine contact hypersensitivity and dermatitis of repeated applications induced by DPCP. Putting these results together, topical tacrolimus can be very effective in not only the treatment but also the prevention of allergic contact dermatitis. Larger studies are needed to determine the clinical relevance.

Adult-onset Eruptive Pseudoangiomatosis / 대한피부과학회지

BACKGROUND: Eruptive pseudoangiomatosis (EPA) is a rare, benign, spontaneously regressing childhood exanthem. It is characterized by the sudden onset of several bright red angioma-like papules surrounded by pale halos with a distinct histopathology from true angiomas. OBJECTIVE: This study was performed to evaluate the clinical and histopathologic characteristics of EPA occuring in adults. METHODS: Ten adult patients who visited Pusan National University Hospital and Mok Hye-Soo . Jang Ho-Sun Dermatology Clinic from March 2005 to September 2006 were evaluated. We prospectively evaluated the sex, age, onset season, past medical history including immunosuppressive abnormalities, systemic disorders and other diseases including allergies. We also investigated the relations of mosquito biting, patients' occupations and outdoor activities to occurrence of EPA. In addition, simultaneous occurrence in family members, the clinical, histopathologic, laboratory findings, disease courses and responses to treatment were evaluated. Based on medical records, photographs and pathologic slides, we retrospectively diagnosed another 20 EPA patients suspected as insect bite from October 2003 to March 2005. The same questions were inquired as for the 10 patients who prospectively underwent evaluation. RESULTS: In the study, female predominance (76.7%) was observed and the average age of onset was 54.2 years. Interestingly, there was no child patient during the period of study. Multiple, 2~5 mm sized, red angiomatous papules surrounded by pale halos occurred on exposed areas such as the arms (86.7%), legs (50%), and face (46.7%), although it could also occur to a non-exposed area. EPA occuring in adults usually appeared in summer (80%). The mean disease duration was 3.4 weeks. Although EPA spontaneously regressed, it had the potential of recurrence (46.7%). Histopathologic findings showed dilated dermal blood vessels without the evidence of increase in numbers, and perivascular lymphocytes infiltration. Inside the lumen of dermal blood vessels, plump endothelial cells were found. CONCLUSION: EPA occuring in adults usually happened to exposed sites in summer, so it can be misdiagnosed as insect bite. We suggest that dermatologists should be concerned about EPA in adults and conduct further investigation to have a better understanding of the disease.