Clinical and Epidemiological Study of Ear Keloids: A 10-year Single-Institution Study / 대한피부과학회지

Background@#Keloids are benign dermal fibrous growths associated with excessive collagen deposition that usually occurs after trauma or surgery. To date, the clinical features and epidemiology of ear keloids have not been comprehensively investigated. @*Objective@#We investigated the epidemiology and clinical characteristics of ear keloids in Koreans. @*Methods@#We retrospectively investigated Koreans diagnosed with ear keloids by dermatologists at the Department of Dermatology, Chosun University Hospital, between January 2010 and December 2019. @*Results@#The study included 95 patients with 120 ear keloid lesions (mean size of lesions 1.12×1.45 cm2). Based on the ear anatomy, the keloids were observed at the following sites: the helix in 61 (50.8%) patients, the earlobe in 37 (30.8%) patients, antihelix in 10 (8.3%) patients, scapha in 3 (2.5%) patients, and the postauricular region in 9 (7.5%) patients. Among the keloids evaluated, 67 (55.8%), 36 (30.0%), 9 (7.5%), and 8 (6.7%) were categorized as lobular, dumb-bell, button, and wrap-around types, respectively. Most (75%) keloids were located on the posterior surface of the ears. Notably, 26 patients had a family history of keloids, which was significantly correlated with the development of keloids at other sites (p＜0.001). @*Conclusion@#The helix was the most common site of involvement, and lobular keloids represented the most common variety of keloids observed in this study. Keloids occurred most frequently on the posterior surface of the ears and were bigger at these sites. Patients with a family history of keloids were significantly more likely to develop keloids in areas other than the ears.

The Study of Ear Keloids by Surgical Excision with Fillet Flap in a Single Institution / 대한이비인후과학회지

Background and Objectives@#Keloids are benign dermal fibrous growth and excessive collagen deposition that occur usually after trauma or surgery. In the treatment of keloids, the recurrence rate is relatively high after surgical excision. Fillet flap is known to be a good surgical method for keloid lesions. The purpose of this study is to find out manifestation and compare the results of ear keloids after the surgery by fillet flap.Subjects and Method We retrospectively evaluated 22 patients with ear keloids (n=31) who underwent core excision with fillet flap at the Department of Dermatology, Chosun University Hospital from May 2010 to June 2018. @*Results@#With the 22 of treated patients and 31 ear keloid lesions, the average size of keloid lesions was 0.75×1.05 cm2 . The frequencies of occurrence with respect to the location of keloids according to the anatomical structure of the ear were 12 lobule (38.7%), 17 helix (54.8%), 1 antihelical fold (3.2%), and 1 postauricle (3.2%), respectively. There were 14 lobular types (45.2%), 9 dumbbell types (29.0%), 5 button types (16.1%), and 3 wrap-around type (9.7%). Recurrence was found in 8 keloid lesions (25.8%) and 5 patients (22.7%) after the surgery. Earlobe lesions and dumbbell shaped recurred with the highest recurrence rate. Among the 5 patients who relapsed, 4 had family history of keloids. @*Conclusion@#The earlobe and dumbbell shaped types showed the highest recurrence rate and family history was also an important risk factor for recurrence. Also, surgical excision with fillet flap can be very effective and is a good way to treat ear keloids.

Two Cases of Trichotillomania in Children that Were Successfully Treated with N-acetylcysteine / 대한피부과학회지

Trichotillomania (TTM) is a medical condition characterized by an intense urge to pull out of own hair, resulting in a perceptible hair loss pattern. TTM is associated with other psychiatric processes such as obsessive-compulsive disorder and bipolar disorder. TTM generally has a chronic course in most patients and is difficult to treat and manage. There are a few options for treatment in children, and the clinical response is not satisfactory. Recently, N-acetylcysteine (NAC), a glutamate modulator, has shown efficacy in the treatment of TTM and other compulsive behaviors, and it is considered a new alternative therapy in the management of TTM. Here, we present two cases of TTM in children that were successfully treated with NAC. NAC could be an effective and safe treatment option for TTM.

Two Cases of Vesiculopapular Prurigo Pigmentosa / 대한피부과학회지

Prurigo pigmentosa is a rare inflammatory disease of the skin characterized by the unexpected onset of diffuse erythematous papules and macules on the chest, neck, and back, that usually resolves leaving reticular hyperpigmentation behind. Rarely, vesicular or bullous forms have been reported. We present two cases of vesiculopapular prurigo pigmentosa in two women. Two 20-year-old women presented with multiple, pruritic, erythematous vesicles and papules of various sizes on their backs for 4 months and 3 weeks, respectively. One remembered having a similar vesicular eruption 2 years ago. Histological study and clinical findings showed a vesiculopapular prurigo pigmentosa. Treatment with doxycycline 200 mg/day and topical steroid lotion showed good responses. The lesions resolved after leaving a light brown reticulated hyperpigmentation behind. Herein, we report two cases of vesiculopapular prurigo pigmentosa successfully treated with doxycycline and topical steroid lotion.

Two Cases of a Cutaneous Sinus Tract of Dental Abscess Origin / 대한피부과학회지

A cutaneous sinus tract or cutaneous fistula of dental origin occurs when purulent products of dental pulp necrosis spread along the path of least resistance from the root apex to the skin on the face. As many patients present with only skin problems and without toothache, it is frequently misdiagnosed as a cyst, abscess, pyogenic granuloma, actinomycosis, squamous cell carcinomas, and so on. Incorrect diagnoses lead to invasive procedures and long-term antibiotic therapy. We present 2 cases of recurrent suppurative facial dimpled nodules. Both of the cases were referred to the maxillofacial department, where the non-restorable teeth were extracted, and root canal therapy was performed. Lesions may persist for long periods before the correct diagnosis is made and the odontogenic source is treated appropriately. With early correct diagnosis, patients can be protected from unnecessary and ineffective antibiotic therapy or surgical treatment. Herein, we report 2 cases of a cutaneous sinus tract of dental origin.

Clinical Observation of N-acetylcysteine in the Treatment of Child Trichotillomania / 대한피부과학회지

BACKGROUND@#Trichotillomania (TTM) is a medical condition that involves recurrent and irresistible urges to pull out their own hair. TTM generally follows a chronic course in most patients and is difficult to treat and manage. Recently, N-acetylcysteine (NAC) has shown efficacy in the treatment of TTM.@*OBJECTIVE@#The purpose of this study was to assess the efficacy of treatment with NAC in trichotillomania children younger than 13 years of age.@*METHODS@#The purpose of this study was to assess the efficacy of treatment with NAC in trichotillomania children younger than 13 years of age.@*RESULTS@#The mean age of patients was 10.7 years; 8 were boys and 7 were girls. They presented with several asymptomatic focal patches of hair loss with different hair lengths on scalp. The dermoscopic findings were broken hairs, v-sign hairs, coiled hairs, and focal erythema. 10 out of 15 patients had a good response to NAC, whereas 5 patients did not respond to the treatment. The differences between the 2 groups were the treatment duration and total NAC doses. The effective group had a mean NAC of 973 mg/day for 11.5 weeks, while the non-effective group had a 1060 mg/day dose for 4 weeks.@*CONCLUSION@#NAC could be an effective and safe treatment option for TTM in children.

A Case of Subcutaneous and Intranasal Phaeohyphomycosis Caused by Microsphaeropsis arundinis in an Immunocompromised Patient Misdiagnosed with Mucormycosis

Microsphaeropsis arundinis is a dematiaceous fungus capable of causing soft tissue infections known as phaeohyphomycosis, mostly in immunocompromised individuals. These infections arise from the traumatic inoculation of fungal materials into the subcutis, and can spread to adjacent subcutaneous tissues or via the lymphatics in a sporotrichoid manner. A 76-year-old man presented with diffuse erythematous plaques and swelling on both forearms and dorsal hands, and rhinalgia. He had been undergoing treatment for hypertension, angina pectoris, and diabetes. Histopathologic examinations of the skin, painful nasal septum, and molecular identification using internal transcribed spacer regions confirmed a diagnosis of subcutaneous and intranasal phaeohyphomycosis caused by M. arundinis. The patient was treated with oral itraconazole for over 5 months, and no recurrence was observed until the time of writing this manuscript. We report a rare case of subcutaneous and intranasal phaeohyphomycosis caused by M. arundinis and propose that confirmation of the causative strains is necessary, as it could affect the prognosis and treatment of the disease.

Clinical and Serologic Study of Herpes Zoster in Children and Adolescents in Gwangju-Jeonnam Province / 대한피부과학회지

BACKGROUND: Herpes zoster is a common dermatologic disorder. However, it rarely occurs in children and adolescents in Gwangju-Jeonnam province. OBJECTIVE: This study aimed to analyze the epidemiological features and clinical characteristics of herpes zoster in children and adolescents. METHODS: A retrospective survey was conducted on patients who visited the department of dermatology of Chosun University Hospital in Gwangju-Jeonnam province within the past 8 years. The medical records of 103 patients aged <18 years were reviewed. We analyzed for age, gender, accompanying symptoms, dermatomal distribution, underlying disease, treatment, and complications with serologic test. RESULTS: The male-to-female ratio of the participants was 1.08:1, and their mean age was 13.0 years. Underlying diseases were observed in 3% (3/102) of the patients. The most common dermatomal distribution was thoracic dermatome (34%), followed by trigeminal (26%), cervical (20%), lumbar (15%), and non-skin (6%). The most common accompanying symptoms were headache (10%), fever (3%), and myalgia (3%). No difference was observed between patients who were varicella-zoster virus (VZV) IgM-positive and those who were VZV IgM-negative in terms of dermatome, visual analogue scale (VAS), severity, and body mass index (BMI). CONCLUSION: In children and adolescents with herpes zoster, the gender ratio and dermatomal distribution were similar to those previously reported, except for the low rate of underlying diseases. The incidence of herpes zoster in children was not significantly associated with immunosuppression and underlying diseases. Higher VZV IgM titer was not associated with dermatomal distribution, higher VAS score, or BMI. This study first compared the serological test results of children.