A Rare Case of Juvenile Gangrenous Vasculitis of the Scrotum in Korea

Juvenile gangrenous vasculitis is characterized by the abrupt onset of scrotal ulcerations in young males, preceded by fever and pharyngeal symptoms. The etiology of this disease is poorly understood. The course is benign and self-limiting within a few weeks with no relapse. Because of its rare incidence, physicians often confuse it with Fournier’s gangrene, which progresses rapidly to severe systemic symptoms requiring urgent surgical intervention. Herein, we report a rare case of juvenile gangrenous vasculitis of the scrotum and emphasize the importance of awareness of this diagnosis to avoid unnecessary invasive surgical intervention. A 17-year-old boy presented with painful and tender, diffuse erythema and swelling with a necrotic lesion on the scrotum for three days. Preceding the cutaneous manifestations, he had a fever and sore throat. Physical examination showed an about 2 cmsized well-demarcated necrotic lesion on the anterior scrotum. Laboratory findings revealed neutrophilic leukocytosis with an elevated C-reactive protein and erythrocyte sedimentation rate. On scrotal ultrasonography, only edematous skin thickening and an increase in vascularity were observed. Histopathological examination showed epidermal necrosis and dermal neutrophilic infiltration. Empirical antibiotic treatment with ampicillin/sulbactam and clindamycin was administered and a prompt clinical resolution was observed.

A Case of Collision Tumor Composed of Dermatofibroma and Ito Nevus / 대한피부과학회지

Collision tumors in which two different skin tumors appear in one lesion have often been reported. The cause of the collision tumor is not clearly known, but there is an opinion that it is a simple coincidence, and other authors assumed that one tumor will cause another. This rare but well-documented phenomenon often presents a diagnostic challenge to dermatologists due to its unusual and nonspecific presentation. We experienced a case of a 32-year-old woman who came to our hospital with a 1.5×1.5-cm-sized red-brown nodule with a surrounding brown patch on her right posterior shoulder that had been present since her childhood. Histologically, this lesion was thought to be a collision tumor with dermatofibroma and Ito nevus in the same lesion. No further treatment was done for this patient and a close follow-up is ongoing. Herein, we reported a first case of collision tumor with dermatofibroma and Ito nevus.

Comparison of Th1 and Th17 Inflammatory Cytokine Profiles Between Chronic Plaque and Acute Guttate Psoriasis

Background@#The phenotypic heterogeneity of psoriasis is suspected to reflect differences in its pathogenesis, but not yet completely elucidated. Studies of the Th1 and Th17 cytokines associated with different phenotypes of psoriasis have yielded inconsistent results. @*Objective@#To investigate the tissue expression levels of Th1 and Th17 cytokines among patients with chronic plaque psoriasis, acute guttate psoriasis, and healthy control. @*Methods@#A total of 20 patients with psoriasis (10 with chronic plaque type and 10 with acute guttate type) and 5 healthy controls were enrolled. The tissue mRNA and protein levels of following cytokines were measured: interleukin (IL)-12, IL-2, interferon (IFN)-γ, IL-23, IL-17A, and IL-22. @*Results@#The tissue mRNA levels of IL-12, IFN-γ, IL-23, IL-17A, IL-22 and the protein levels of IL-12, IL-2, IFN-γ, IL-17A, IL-22 were significantly increased in the psoriasis patients compared with the healthy controls. In comparisons of the subtypes, the tissue mRNA level of IFN-γ was increased in acute guttate psoriasis, whereas the protein levels of IL-12 and IL-17A were significantly increased in chronic plaque psoriasis. The cytokine ratios of IL-17A/IL-2 and IL-22/IL-2 were significantly higher in chronic plaque psoriasis than in acute guttate psoriasis. @*Conclusion@#We confirmed that the tissue levels of Th1 and Th17 cytokines were increased in psoriasis patients compared with healthy controls. The increased IFN-γ mRNA level in acute guttate psoriasis and increased IL-12 and IL-17A protein levels in chronic plaque psoriasis suggest that an imbalance between Th1 and Th17 cytokines may play a role in the phenotypic transition of psoriasis.

Recurrent Cellulitis Associated with Acupuncture with Migratory Gold Threads

In Asian countries, acupuncture with gold threads has been widely used in the treatment of pain. However, several reports have suggested that the implanted gold threads can become fragmented and migrate to other parts of the body, damaging surrounding tissues. A 75-year-old female presented with diffuse erythematous edema with multiple vesicles on the right lower leg for 3 days. She had previously suffered from cellulitis on the same region twice for the last 1year. Her past medical history included acupuncture with gold threads on the back due to lumbar herniated nucleus pulposus (HNP) about 10 years ago. Histopathological examination demonstrated marked subepithelial edema and diffuse perivascular infiltrate of inflammatory cells in the dermis. Simple radiography of the leg revealed numerous radiodense threads in the soft tissue. Since the patient did not receive acupuncture on any other sites except on the back, we hypothesized that the gold threads injected on the back may have migrated through the vessels to the leg. These metal fragments can cause inflammatory reaction and make the tissues more susceptible to secondary infections. The lesion gradually improved after treatment with systemic steroid and antibiotics for 1 week.

To What Depth Is a Congenital Melanocytic Nevus Affected by 84 Pigment Laser Treatments? / 대한피부과학회지

Total excision is the treatment of choice of congenital melanocytic nevus. However, it is often infeasible, laser therapy is being explored as a useful therapeutic approach. A 26-year-old woman presented with a solitary, skin-colored plaque surrounded by whitish patches on her right calf. She was diagnosed with a congenital melanocytic nevus and underwent 84 laser treatment sessions using a 1,064 nm Nd:YAG laser over 7 years. Histopathological examination of the whitish plaque revealed small foci of nevus cells that penetrated the tissue to a depth that was 12-fold higher than the epidermal depth (1,260 μm). No report in the literature describes histopathological findings of a congenital melanocytic nevus treated with 84 sessions of laser therapy. This case report highlights the depth of penetration of pigment laser to treat a congenital melanocytic nevus. Our findings will serve as useful clinical guidelines to perform laser treatment for congenital melanocytic nevi.

The Economic Burden of Psoriasis in Korea / 대한피부과학회지

Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.

Hypersensitivity Reactions to Contrast Media Used in Computed Tomography in Korea / 대한피부과학회지

Background@#Contrast media have been widely used for the diagnosis of numerous diseases. Although they are generally safe, the reported number of hypersensitivity reactions to contrast media has increased annually. @*Objective@#We aimed to investigate the incidence of hypersensitivity reactions due to intravenous nonionic contrast media. Also, we investigated whether the risk of contrast media-associated hypersensitivity was increased by specific types of contrast agents. @*Methods@#We performed a retrospective review of patients who had hypersensitivity reactions after enhanced computed tomography scans at Bucheon St. Mary’s Hospital, Bucheon, Korea from January 2016 to December 2019.We classified the hypersensitivity reactions into immediate (＜1 hour) or delayed (≥1 hour) reactions. All demographic data and information regarding the hypersensitivity reactions were obtained from the electronic medical records. @*Results@#The overall incidence of hypersensitivity reactions to contrast media was 0.49% (262 cases resulting from 53,733 exposures). The incidence increased annually from 0.19% in 2016 to 0.86% in 2019. Among the 262 cases, 199 cases (76.0%) were immediate-type while the delayed-type accounted for 63 cases (24.0%). The immediate hypersensitivity reaction incidence was not significantly different among contrast agents. However, the incidence of the delayed-type was significantly different (ranging from 0.02% for iomeprol to 0.25% for iodixanol, p＜0.05). @*Conclusion@#This study found that the hypersensitivity reaction incidence has increased annually. Immediate hypersensitivity reactions occurred at a higher rate than delayed hypersensitivity reactions. The incidence of delayed hypersensitivity reactions was significantly greater in patients who received iodixanol than in those who received the other types.

Recurrent Cellulitis Associated with Acupuncture with Migratory Gold Threads

In Asian countries, acupuncture with gold threads has been widely used in the treatment of pain. However, several reports have suggested that the implanted gold threads can become fragmented and migrate to other parts of the body, damaging surrounding tissues. A 75-year-old female presented with diffuse erythematous edema with multiple vesicles on the right lower leg for 3 days. She had previously suffered from cellulitis on the same region twice for the last 1year. Her past medical history included acupuncture with gold threads on the back due to lumbar herniated nucleus pulposus (HNP) about 10 years ago. Histopathological examination demonstrated marked subepithelial edema and diffuse perivascular infiltrate of inflammatory cells in the dermis. Simple radiography of the leg revealed numerous radiodense threads in the soft tissue. Since the patient did not receive acupuncture on any other sites except on the back, we hypothesized that the gold threads injected on the back may have migrated through the vessels to the leg. These metal fragments can cause inflammatory reaction and make the tissues more susceptible to secondary infections. The lesion gradually improved after treatment with systemic steroid and antibiotics for 1 week.

To What Depth Is a Congenital Melanocytic Nevus Affected by 84 Pigment Laser Treatments? / 대한피부과학회지

Total excision is the treatment of choice of congenital melanocytic nevus. However, it is often infeasible, laser therapy is being explored as a useful therapeutic approach. A 26-year-old woman presented with a solitary, skin-colored plaque surrounded by whitish patches on her right calf. She was diagnosed with a congenital melanocytic nevus and underwent 84 laser treatment sessions using a 1,064 nm Nd:YAG laser over 7 years. Histopathological examination of the whitish plaque revealed small foci of nevus cells that penetrated the tissue to a depth that was 12-fold higher than the epidermal depth (1,260 μm). No report in the literature describes histopathological findings of a congenital melanocytic nevus treated with 84 sessions of laser therapy. This case report highlights the depth of penetration of pigment laser to treat a congenital melanocytic nevus. Our findings will serve as useful clinical guidelines to perform laser treatment for congenital melanocytic nevi.

The Economic Burden of Psoriasis in Korea / 대한피부과학회지

Background@#Psoriasis is a chronic disease that can have accompanying comorbidities including arthritis, metabolic syndrome, and cardiovascular diseases. Patients with psoriasis tend to frequently visit medical institutions, and their economic burden for medical services is high. @*Objective@#To investigate the economic burden of psoriasis in Korea. @*Methods@#The Korean Society for Psoriasis conducted a multi-center field survey of the patients and analyzed the national insurance claim data. Also, we discussed the medical environment of psoriasis in Korea based on the results. @*Results@#The economic burden of psoriasis patients is substantial and varied by the type of medical institute. Patients also paid the indirect and intangible medical costs. Biological agents, which is used in patients with severe psoriasis, led to an increase in the cost. @*Conclusion@#This is the first study to estimate the economic burden of psoriasis in Korea comprehensively. To improve the medical environment of psoriasis and alleviate the burden of patients, discussion on the more efficient health policy and medical insurance criteria for psoriasis would be needed.

Hypersensitivity Reactions to Contrast Media Used in Computed Tomography in Korea / 대한피부과학회지

Background@#Contrast media have been widely used for the diagnosis of numerous diseases. Although they are generally safe, the reported number of hypersensitivity reactions to contrast media has increased annually. @*Objective@#We aimed to investigate the incidence of hypersensitivity reactions due to intravenous nonionic contrast media. Also, we investigated whether the risk of contrast media-associated hypersensitivity was increased by specific types of contrast agents. @*Methods@#We performed a retrospective review of patients who had hypersensitivity reactions after enhanced computed tomography scans at Bucheon St. Mary’s Hospital, Bucheon, Korea from January 2016 to December 2019.We classified the hypersensitivity reactions into immediate (＜1 hour) or delayed (≥1 hour) reactions. All demographic data and information regarding the hypersensitivity reactions were obtained from the electronic medical records. @*Results@#The overall incidence of hypersensitivity reactions to contrast media was 0.49% (262 cases resulting from 53,733 exposures). The incidence increased annually from 0.19% in 2016 to 0.86% in 2019. Among the 262 cases, 199 cases (76.0%) were immediate-type while the delayed-type accounted for 63 cases (24.0%). The immediate hypersensitivity reaction incidence was not significantly different among contrast agents. However, the incidence of the delayed-type was significantly different (ranging from 0.02% for iomeprol to 0.25% for iodixanol, p＜0.05). @*Conclusion@#This study found that the hypersensitivity reaction incidence has increased annually. Immediate hypersensitivity reactions occurred at a higher rate than delayed hypersensitivity reactions. The incidence of delayed hypersensitivity reactions was significantly greater in patients who received iodixanol than in those who received the other types.

Lipoma on the Lower Lip / 대한피부과학회지

Lipoma is a very common benign tumor of the adipose tissue, but it occurs infrequently in the oral cavity. A 66-year-old man presented with an asymptomatic, solitary, 1×1-cm-sized yellowish mass on the lower lip, since 2 years. For differential diagnosis, skin biopsy was performed, and histopathologic examination showed features indicative of lipoma. We herein report a rare case of oral lipoma occurring on the lower lip.

Multiorgan Serum IgG4-related Disease Diagnosed with Dermatopathology: A Case Report / 대한피부과학회지

Immunoglobulin G4-related disease (IgG4-RD) is a recently discovered condition that was first reported in 2001. It is characterized by IgG4-positive plasma cell infiltration. Cutaneous involvement is rare but increasingly reported. A 48-year-old male presented with multiple, black-brown, indurated plaques on his trunk and axillae. Laboratory examination revealed anemia of unknown etiology and hyperglobulinemia with markedly elevated serum IgG and IgG4 levels. Histopathologic examination showed lymphoplasmacytic infiltration with abundant IgG4-positive plasma cells. The bone marrow biopsy results were consistent with the skin biopsy. Computed tomography demonstrated multiple lymph node involvement. Under the care of the rheumatology department, the patient has been treated with a systemic steroid and immunosuppressive agents, and he has shown gradual improvement in the laboratory findings.

Acquired Periungual Fibrokeratoma: An Atypical Case Covering the Entire Thumb Nail / 대한피부과학회지

Acquired periungual fibrokeratoma, first reported by Cahn in 1977, is a rare, benign fibrous tissue tumor located in the periungual area. The pathophysiology of acquired periungual fibrokeratoma is unknown. In general, trauma is often thought to be a predisposing factor. A 57-year-old woman presented with a 15-year-old asymptomatic, solitary, 1.8×1.5-cm, skin-colored mass on the Lt. thumb nail. The patient reported that they had been wounded on the nail root and the mass had since grown. For differential diagnosis and to determine the extent of the tumor, MRI of the finger was performed. Radiologic presentation showed a non-enhancing T2 low, T1 low signal mass above the nail plate. Histopathologic examination demonstrated a dome-shaped tumor consisting of thick dermal collagen bundles with increased capillaries. Through clinical, radiological, and histopathologic findings, we diagnosed the tumor as acquired periungual fibrokeratoma, and the lesion was removed through complete excision. Herein, we present a rare case of acquired fibrokeratoma covering whole thumb. The specific diagnosis was aided by MRI more through the acquisition of more accurate information about the location and signal characteristics that reflect underlying pathological features.

Improvement in Multiple Metastatic Calcinosis Cutis Lesions after Hemodialysis in a Patient with Chronic Renal Failure: A Case Report / 대한피부과학회지

Metastatic calcinosis cutis refers to the deposition of calcium salts in normal tissue secondary to an underlying defect in calcium and/or phosphate metabolism. It commonly affects periarticular areas in patients with chronic renal failure. We report a case of a 51-year-old man with a past medical history of peritoneal dialysis for chronic renal failure, who presented with multiple yellowish nodules on his right thumb. In view of the asymptomatic non-inflamed fluctuating nodules, the differential diagnoses included bacterial, tuberculous, atypical mycobacterial, or fungal infections. Histopathological and radiological examinations revealed calcifications in the right thumb and shoulder with elevated serum phosphorus and parathyroid hormone levels. The lesions improved after the patient was switched from peritoneal dialysis to hemodialysis. We report a case of metastatic calcinosis cutis in a patient with chronic renal failure. We emphasize the importance of imaging for accurate diagnosis and follow-up of calcinosis cutis and that hemodialysis scores over peritoneal dialysis in the treatment of this condition.

Validation of Herpes Zoster Diagnosis Code in the Electronic Medical Record: A Retrospective, Multicenter Study

No abstract available.

A Case of Cholesterol Granuloma Presenting as a Cutaneous Nodule

No abstract available.

The Clinical Profile of Patients with Psoriasis in Korea: A Nationwide Cross-Sectional Study (EPI-PSODE)

BACKGROUND: Psoriasis is an immune-mediated, chronic inflammatory disease affecting multiple aspects of patients' lives. Its epidemiology varies regionally; however, nationwide epidemiologic data on psoriasis depicting profile of Korean patients has not been available to date. OBJECTIVE: To understand nationwide epidemiologic characteristics and clinical features of adult patients with psoriasis visited university hospitals in Korea. METHODS: This multicenter, non-interventional, cross-sectional study recruited 1,278 adult patients with psoriasis across 25 centers in Korea in 2013. Various clinical data including PASI, BSA, DLQI, SF-36 and PASE were collected. RESULTS: A total of 1,260 patients completed the study (male:female=1.47:1). The mean age was 47.0 years with a distribution mostly in the 50s (24.9%). Early onset (<40 years) of psoriasis accounted for 53.9% of patients. The mean disease duration was 109.2 months; mean body mass index was 23.9 kg/m²; and 12.7% of patients had a family history of psoriasis. Plaque and guttate types of psoriasis accounted for 85.8% and 8.4%, respectively. Patients with PASI ≥10 accounted for 24.9%; patients with body surface area ≥10 were 45.9%. Patients with DLQI ≥6 accounted for 78.8%. Between PASI <10 and PASI ≥10 groups, significant difference was noted in age at diagnosis, disease duration, blood pressure, waist circumference of female, and treatment experiences with phototherapy, systemic agents, and biologics. CONCLUSION: This was the first nationwide epidemiologic study of patients with psoriasis in Korea and provides an overview of the epidemiologic characteristics and clinical profiles of this patient population.

Gene Expression Analysis of Inflammatory Cytokines in Korean Psoriatic Patients

BACKGROUND: Although phenotypic heterogeneity of psoriasis is suggested by the alternate activation of either T-helper (Th)1-related or Th17-related cytokines, little is known about the mRNA levels of inflammatory cytokines. OBJECTIVE: To investigate whether there is differential expression of Th1-related and Th17-related inflammatory cytokine genes 1) between psoriatic patients and healthy controls, and 2) between patients with different psoriasis phenotypes. METHODS: Twenty-five patients with psoriasis (10 with guttate psoriasis and 15 with plaque psoriasis) and 5 healthy volunteers were enrolled in this study. The mRNA levels of circulating cytokines (interleukin [IL]-2, IL-12p40, interferon-γ, IL-17A, IL-22, and IL-23R) were measured by real-time reverse transcription polymerase chain reaction. RESULTS: The comparison between psoriatic and healthy control samples revealed that IL-12p40, IL-17A, and IL-22 mRNA levels were significantly higher (approximately 4∼6 folds) in the patients with psoriasis. The mRNA levels of these six cytokines in the blood did not differ between the guttate and plaque psoriasis groups. CONCLUSION: We found that the mRNA levels of blood inflammatory cytokines (IL-12p40, IL-17A, and IL-22) were significantly elevated in patients with psoriasis compared to the levels in healthy controls, but they did not significantly differ between patients with guttate and plaque type psoriasis.

A Case of Terra Firma-forme Dermatosis Treated with CO₂ Laser / 대한피부과학회지

No abstract available.