Treatments of Infra-Orbital Dark Circles by Various Etiologies

Dark circles refer to visible darkness of the infra-orbital areas. Dark circles are a cosmetic concern for many individuals, although not a medical concern. Moreover, clear definitions and possible causes of dark circles have not been elucidated. This study reviews the possible causes and treatment options for dark circles based on a review of the medical literature and the authors' clinical experience. Potential factors that contribute to dark circles include excessive pigmentation, shadowing due to tear troughs and infra-orbital fat herniation, shadowing due to infraorbital laxity and wrinkles, and thin, translucent skin overlying the orbicularis oculi muscle. Given the different possible causes for dark circles, therapeutic modalities must be individualized for each patient. Because various factors cause dark circles, it is useful to identify the underlying causes in order to select the appropriate treatment.

Intradermal Injection of Botulinum Toxin: A Safer Treatment Modality for Forehead Wrinkles

Intramuscular injection of botulinum toxin A (BTXA) is commonly used for the treatment of forehead wrinkles. In practice, physicians often use an intradermal injection for this purpose, as they feel that there is a lower risk of adverse effects compared with intramuscular injection. However, there are no direct comparative studies between those two injection modalities. We conducted a 24-week long, double-blinded, split-face, pilot study of three participants to compare the efficacy and safety of intradermal or intramuscular injection of BTXA for the treatment of forehead wrinkles. Maximum improvement of wrinkles and the time to achieve maximum effect were similar for both methods. The brow level was lower on the intramuscular injection side throughout the follow-up period for all participants. Subjective satisfaction with wrinkles was similar on both sides, but patients felt more heaviness of the eyebrow on the intramuscular side. No serious side effects were noted. In conclusion, the anti-wrinkle effect of BTXA was not significantly different between intramuscular and intradermal injections. However, side effects such as eyebrow ptosis, and heaviness were more prominent after intramuscular injection.

Exaggeration of Wrinkles after Botulinum Toxin Injection for Forehead Horizontal Lines

There have been no long-term complications or life-threatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications.

Kerion Celsi Caused by Trichophyton verrucosum: A Report of Two Cases / 대한의진균학회지

In Korea, kerion celsi caused by Trichophyton(T.) verrucosum was first reported in the Honam area in 1986. Since then, more cases have been reported in the Youngnam and Chungcheong areas but there has been no report in Seoul and Kyonggido until now. Recently, two patients with kerion celsi visited Seoul National University Hospital and T. verrucosum was isolated from the scalp lesions of these patients. Case 1 was 52 year-old female living in Kapyoung, Kyonggido and she showed 10x10 cm and 5x3 cm sized, indurated alopecic masses on the scalp which were developed 2 months ago. Case 2 was a 50 year-old female living in Youngju, Kyongsangbukdo and a 10x7 cm sized, purulent alopecic plaque was developed on the scalp 1 month ago. They were farmers raising cows with gray or whitish plaques on their skins. These patients were successfully treated with terbinafine 250 mg per for 7 weeks and 8 weeds, respectively. We report these cases to call more attention to detect this species even in urban areas such as in Seoul. Therapeutic effect of terbinafine on kerion celsi has not been reported in Korea so far and our cases demonstrated the excellent therapeutic effect of terbinafine on kerion celsi cause by T.verrucosum.

Two Cases of Acral Lentiginous Melanoma in situ Presenting a Melanonychia / 대한피부과학회지

Black or brown pigmentation of the nail plate commonly results from melanin produced by melanocytes in the matrix secondary to inflammatory dermatoses or systemic medications. It can also be caused by a benign pigmented nevus in the matrix or malignant melanoma. We report two cases showing black discoloration of the finger nail which were histologically found to be acral lentiginous melanoma in situ. It follows that melanoma, when the cells are separated from the dermis by a basement membrane zone, will have a good prognosis. Total resection for the lesion, including the nail matrix and nail bed with a free margin of 0.5 to 1.0cm, may be adequate.

A Case of SVC Obstruction in Behcet's Syndrome

The clinical triad of relapsing iritis, ulcers of the mouth and genitalia was first described in 1939 by Hulusi Behcet. This entity, originally confined to the above triad of symptoms appears to be systemic disease manifested by skin lesion, thrombophlebitis, neurologic, cardiovascular or visceral symptoms. The vascular involvement in Behcet's syndrome has been reported since Mischima first described a case in 1961, four types of vascular lesion are freuqnetly observed most commonly on the inferior or superior vena cava. Treatments consist of anticoagulation and administering oral steroids. We report a case of SVC obstruction in 36 years old female patient with Behcet's syndrome.