A Case of Cold Urticaria and Cholinergic Urticaria in the Same Patient / 대한피부과학회지

Cold urticaria and cholinergic urticaria are considered to be distinct disorders in which mediator release and hives can be induced by different stimuli. Cold urticaria can be induced by cold stimuli, and cholinergic urticaria, characterized by micropapular wheals, by exercise, emotional stimuli, or other stresses that increase the body temperature. While neither cold urticaria nor cholinergic urticaira is rare, it is unusual to see both disorders occurring in the same patient. Also, our case presents atypical urtication to cold exposure, similar to classic cholinergic urticarial lesions, called "cold-induced cholinergic urticaria". We present a 20-year-old man with 4-year history who experienced generalized micropapular wheals induced by cold exposure as well as exercise and hot environment.

Shiitake Dermatitis in Korea ; Clinical and Histopathologic Study / 대한피부과학회지

BACKGROUND: Shiitake dermatitis has been reported mostly from Japan and characterized by distinctive pattern of itchy skin eruption after the ingestion of raw shiitake mushrooms. OBJECTIVE: The purpose of this study is to investigate clinical, laboratory and histopathologic profiles about shiitake dermatitis occurring in Korea. METHODS: From 1997 to 2001, we had observed 58 patients with shiitake dermatitis and investigated clinical, laboratory and histopathologic aspects. RESULT: Most patients with shiitake dermatitis presented with a very strong itching sensation, which was accompanied with linearly grouped or disseminated small erythematous papules. 53 patients(91%) had noticed their skin eruption within 3 days after eating shiitake mushrooms. The involved sites were trunk, extremities, neck and face in decreasing order of frequency. Laboratory and histopathologic findings were nonspecific. In 33 patients(57%), the eruption occurred after eating boiled or panbroiled shiitake mushrooms. CONCLUSION: In this study, clinical, laboratory and histopathologic findings of shiitake dermatitis were almost consistent with the previous reports. But, contrary to the previous reports in Japan, many cases with shiitake dermatitis occurred on eating sufficiently boiled or cooked shiitake mushrooms. This may imply another eiologic factor different from thermolabile toxin.

Prevalence of Fungal Infection on Foot in Diabetic Patients and Correlation between Diabetic Ulcer and Fungal Infection on Foot / 대한피부과학회지

OBJECT: The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. METHODS: A total of 21, 693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. RESULTS: 13, 271 patients had certain kinds of foot problem, accounting for 61.2% of 21, 693 diabetics examined. Of these, fungal foot disease were found in 10, 403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6, 496 (29.9%), onychomycosis in 7, 783 (35.9%), and coexistence was in 3, 883 (17.9%). Foot deformity was in 1, 346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1, 051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5, 486 patients paid a visit to the department of dermatology. Of these, 4, 519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2, 272 males and 2, 247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3, 847 patients (70%) and onychomycosis was proven mycologically in 3, 276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3, 885(70.8%) and tinea pedis was found in 3, 209 (58.5%), most commonly involving the soles. CONCLUSION: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.

Clinicopathologic Study of 8 Patients with Plasma Cell Cheilitis / 대한피부과학회지

BACKGROUND: Plasma cell cheilitis is an idiopathic, benign, inflammatory mucosal condition characterized by a dense plasma cell infiltrate in the mucosa. OBJECTIVE: The aim of this study was to examine the clinical & histopathologic findings of plasma cell cheilitis and review the literatures. METHODS: A total of 8 patients confirmed as plasma cell cheilitis at the Catholic University Hospital from 1999 to 2001 were retrospectively analyzed with hospital charts and histopathologic slides to determine the clinical manifestations, associated diseases, etiology, course, and prognosis and histopathologic findings. RESULTS: The results are summarized as follows; 1. The male and female ratio was 3: 1. 2. The mean age of patients was 68.5 years. 3. The site of plasma cell cheilitis was the lower lip on all patients. 4. The lesion accompanied erosion or ulcer in 75% of patients and easily bleeding in 50% of patients. 5. There was no specific symptom in 50% of patients and pain accompanied in 37.5% of patients. 6. There were good responses on topically applicated clobetasone propionate. 7. Histopathologic features revealed band-like dense infiltration of plasma cells in the upper dermis and there are no atypical nucleus and mitosis. CONCLUSION: Characteristically, plasma cell cheilitis affects the low lip of an elderly person. The histological features are diagnostic. We suggest that plasma cell cheilitis exists much more than diagnosed and that physicians must pay attention to it.

A Case of Piebaldism Treated by Combination Therapy with Suction Blister Epidermal Graft and the Alexandrite Laser / 대한피부과학회지

Piebaldism is a rare, autosomal dominant inherited disorder, characterized by inborn hypopigmented skin and hair. It is characterized by stable leukoderma with white forelock and vitiligo like amelanotic macules usually containing hyperpigmented macules at the periphery. As the leukodermic lesions in piebaldism are unresponsive to any form of topical or systemic medical treatment, several methods for autologous transplantation of melanocytes and epidermal transplantation methods have been developed and there are no specific treatment methods for hyperpigmented patch in piebaldism. A 12-year-old female had piebaldism from birth. Suction blister epidermal graft was tried at hypopigmented patches on the posterior aspects of both lower legs and the Q-switched Alexandrite laser was used at the site of the hyperpigmented patches. Combination therapy with suction blister epidermal graft and a Q-switched Alexandrite laser on piebaldism may be effective method.

Metastatic Cancer of the Skin: Clinical and histopathologic study / 대한피부과학회지

BACKGROUND: Metastatic skin cancer may have profound diagnostic, therapeutic, and prognostic significance. OBJECTIVE: We studied patients with metastatic skin cancer to determine the relative frequencies of metastatic skin cancer according to the type and location of the primary tumor and the site of the cutaneous metastasis. METHODS: We reviewed medical records and histologic materials of 68 patients with metastatic skin cancer in Catholic University Hospital from January 1991 to March 2001. RESULTS AND CONCLUSIONS:Of 61,218 patients with internal malignancy, 68(0.11%) had metastatic skin cancer. The mean age at diagnosis was 64.7 in male and 58.2 in female. Male to female ratio was 1:2.2. Breast carcinoma was by far the most common primary neoplasm resulting in skin involvement and accounted for 31(45.6%) of total cases and 63.8% of the cases in women. The most common clinical presentation is a nodule(26.5%) or multiple nodules(64.7%) although carcinoma erysipelatoides(4.4%) and carcinoma en cuirasse(4.4%) were also seen. Histopathologic examination most frequently revealed adenocarcinoma(70.6%) that was sometimes suggestive of the site of origin.

Disappearing Atypical Lentiginous Pigmentation of the Desmoplastic Malignant Melanoma

A 38-year-old man presented with a black pigmented patch overlying his upper lip, a part of the gingiva and the hard palate. An intradermal tumor mass was palpated at the central portion of the pigmented patch of the upper lip. Diphenylcyclopropenone (DPCP) is a potent contact sensitizer that could stimulate non-specific immunity. We report a case of desmoplastic malignant melanoma (DMM) in which an atypical lentiginous pigmentation disappeared with topical DPCP immunotherapy and the dermal tumor mass was removed by a surgical wedge-shaped excision. Though an atypical lentiginous pigmentation of DMM sometimes undergoes extensive spontaneous regression, in our case it could be attributed to the therapeutic effect of topical DPCP immunotherapy rather than a spontaneous regression.

A Case of Kikuchi's disease associated with Systemic Lupus Erythematosus / 대한피부과학회지

Described originally in young Japanese women, Kikuchi's disease produces a histiocytic necrotizing lymphadenitis of predominant cervical lymph nodes. Histiocytic necrotizing lymphadenitis, Kikuchi's disease, is a condition rarely associated with systemic lupus erythematosus(SLE). We present a 34-year-old woman with tender multiple cervical lymphadenopathy of 1-year duration and SLE symptoms. Histologic examination of lymph node shows histiocytic necrotizing lymphadenitis. She showed high titer of antinuclear antibody, skin lesion with photosensitivity, thrombocytopenia and arthritis. We describe a case of Kikuchi's disease associated with SLE.

Linear Focal Elastosis Associated with Striae Distensae in an Atopic Patient / 대한피부과학회지

We report a case of linear focal elastosis associated with striae distensae. A 20-year-old man presented with asymptomatic, several, striae-like yellow palpable bands extending horizontally in the lumbar region. Histologic examination revealed many fine wavy and fragmented bundles of elastic fibers in the dermis. Striae distensae were also presented in the buttock, axilla. He had been treated with topical steroids for atopic dermatitis since childhood. This patient can be one more case to support the association between linear focal elastosis and striae distensae.

Giant cell tumor of tendon sheath on the fingertip / 대한피부과학회지

Giant cell tumor of tendon sheath is a benign histiocytic proliferation of the articular and peritendinous synovial tissue and manifests as a painless, firm, smooth, subcutaneous mass which occurs predominantly on the hand where it is typically located adjacent to the interphalangeal joints of the hands, especially the terminal interphalangeal joints. Histologically, it is characterized by the presence of multinucleated giant cells. We herein report a case of giant cell tumor of tendon sheath located on the fingertip with the involvement of overlying skin, which shows rare location and unusual clinical manifestation.

Two cases of surgically treated extramammary Paget's disease guided by photodynamic diagnosis / 대한피부과학회지

Extramammary Paget's disease is a rare malignancy occuring mainly in apocrine gland- bearing areas such as vulva, scrotum, perianal area, and axilla. Histopathologically, the Paget's cells are usually confined within the epidermis and may be associated with underlying adenocarcinoma. Although surgical excision is the treatment of choice, the clinical demarcation of the lesion is still a frequent problem in the treatment of extramammary Paget's disease. We tried photodynamic diagnosis to determine the surgical margin of extramammary Paget's disease and with surgical excision guided by photodynamic diagnosis successfully treated two cases.

A Case of Trichilemmal Horn

Trichilemmal horn(trichilemmal keratosis) is a rare keratinizing tumor that resembles a cutaneous horn. Histologically, it is characterized by an abrupt maturation of keratinocytes into lamellar keratin without the formation of a granular layer. We describe a case of a trichilemmal horn on the right cheek of a 78-year-old woman.

A Case of Fordyce's Disease with Wide Distribution

Fordyce's disease is a condition known as ectopically located sebaceous glands on the vermilion borders of the lips and oral mucosa. Clinically, it is groups of minute, yellowish, globoid macules and papules. Histologically, it is characterized by sebaceous glands not associated with hair follicles. We report on a 40-year-old man with Fordyce's disease showing particularly wide distribution on the buccal mucosa and upper lip.

A Case of Steatocystoma Multiplex on the Face in a Family / 대한피부과학회지

We describe a family with a two-generation history of steatocystoma multiplex with an unusual clinical manifestation. A 7-year-old boy had multiple asymptomatic, small, yellowish cysts on the face since birth. His father and 4-year-old brother also presented several similar persistent cysts localized to the face. This family had no other abnormality on physical examination. The cysts discharged oily yellow material when incised. Biopsy of several lesions disclosed that the cysts had typical features of steatocystoma multiplex histologically.

A Case of Trichotillomania Associated with Diffuse Neurofibroma / 대한피부과학회지

A 13-year-old girl presented in our unit with progressive alopecia and a long history of edematous scalp in the occiput. Biopsy specimen of a lesion showed two-type pathologic abnormality consisting of diffuse neurofibroma in the lower portion and trichotillomania in the upper portion. Since the tumor spread diffusely through the lower dermis and subcutaneous fat tissue without destroying surrounding structures, we concluded that the trichotillomania might result from repetitive scratching or other traumatic behavior at the same site of underlying diffuse nerurofibroma. We reported a case of the concomitant occurrence of trichotillomania associated with diffuse neurofibroma.

Two Cases of Lichen Nitidus Treated with Diphenylcyclopropenone Immunotherapy / 대한피부과학회지

Lichen nitidus is a rare, usually asymptomatic chronic inflammatory dermatosis composed of numerous, tiny, discrete, flesh colored, shiny papules. Since the disease is asymptomatic and self-limiting, the specific treatment is not required in most cases. But when the lesion is generalized, symptomatic, persistent, interfering with outlook, the treatment is required. Diphenylcyclopropene (DPCP), a potent contact sensitizing agent has been used for refractory wart and alopecia areata based on its ability to induce delayed hypersensitivity reaction or nonspecific cell-mediated immunity. We report two cases of lichen nitidus improved after topical DPCP application.

Clinical Experiences of Photodynamic Therapy in the Extramammary Paget's Disease / 대한피부과학회지

BACKGROUND: Photodynamic therapy(PDT) is a kind of non-invasive photochemotherapy, which is designed to kill the target cells through photodynamic reaction. It has been reported that PDT is very effective in superficial lesions, including extramammary Paget's disease. Yet, there has been no clinical trial for the treatment of extramammary Paget's disease using PDT in Korea. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of PDT in treating extramammary Paget's disease METHOD: Seven patients with anogenital extramammary Paget's disease were treated repeatedly with local PDT using topical ALA 20% and intralesional injection of hematoporphyrin derivative (HpD), and systemic PDT using HpD. Fluences of 125-200J/cm2 and intensities of 50-100mW/cm2 were used. RESULT: The clinical outcomes were disappointing. All the patients experienced only partial responses despite repeated treatments. But side effects were minimal. CONCLUSION: PDT is not effective enough for the treatment of extramammary Paget's disease to be used as a primary therapy. It would be better to use as an adjuvant to other treatment methods. Photodynamic sensitization, also known as photodynamic diagnosis, might help us define a more reliable border of the extent involved and the surgical margin to be excised.

Clinical Experiences of Photodynamic Therapy in the Extramammary Paget's Disease / 대한피부과학회지

BACKGROUND: Photodynamic therapy(PDT) is a kind of non-invasive photochemotherapy, which is designed to kill the target cells through photodynamic reaction. It has been reported that PDT is very effective in superficial lesions, including extramammary Paget's disease. Yet, there has been no clinical trial for the treatment of extramammary Paget's disease using PDT in Korea. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of PDT in treating extramammary Paget's disease METHOD: Seven patients with anogenital extramammary Paget's disease were treated repeatedly with local PDT using topical ALA 20% and intralesional injection of hematoporphyrin derivative (HpD), and systemic PDT using HpD. Fluences of 125-200J/cm2 and intensities of 50-100mW/cm2 were used. RESULT: The clinical outcomes were disappointing. All the patients experienced only partial responses despite repeated treatments. But side effects were minimal. CONCLUSION: PDT is not effective enough for the treatment of extramammary Paget's disease to be used as a primary therapy. It would be better to use as an adjuvant to other treatment methods. Photodynamic sensitization, also known as photodynamic diagnosis, might help us define a more reliable border of the extent involved and the surgical margin to be excised.

Lipoid Proteinosis / 대한피부과학회지

Lipoid proteinosis is a rare autosomal recessively inherited disorder that is characterized by the deposition of hyaline-like material in the skin, oral cavity, and other organs. Microscopically, there is extensive deposition of amorphous eosinophilic material surrounding capillaries, sweat glands and in papillary dermis. Although the pathogenesis of this disease is not well understood, it is believed that it may result from the defect of collagen metabolism leading to abnormal accumulation of noncollagenous glycoprotein. We report a case of lipoid proteinosis in a 20-year-old female that demonstrates the characteristic clinical, histopathological, and ultramicroscopic features of this disease.

Clinical Characteristics of Hand-foot Dermatitis in Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Hand-foot (H-F) dermatitis is common in atopic dermatitis patients, but its clinical characteristics have not been studied well. OBJECTIVE: We performed this study to examine the clinical characteristics of H-F dermatitis of AD and to assess its etiologic associations. METHODS: Clinical manifestations of H-F dermatitis were examined in 134 patients with H-F dermatitis of AD between May 1997 and July 1998 at our AD clinic. RESULTS: Both hand and foot were involved in 63(47.0%) patients, and either hand or foot involvement was observed in 20(14.9%) and 51(38.1%) patients, respectively. It usually began in childhood with an early onset of AD. Pruritus was the most frequent symptom, and erythema, scales, lichenification, hyperkeratosis, fissures, and keratolysis exfoliativa were also common. Palmar or plantar involvement showed an equal frequency with the dorsal lesions. The great toe was affected more often than the other toes. Two thirds presented with manifestations of ichthyosis triad (ichthyosis vulgaris, hyperlinear palm and keratosis pilaris) and sandpaper-like skin lesions on the elbow, knee, and lateral malleolus. Palmar or plantar hyperhidrosis was reported in 21% and 27% respectively. The ichthyosis-associated group showed a significantly higher incidence of sandpaper-like skin lesions, fissures, and scales, mainly involving the dorsa of hands and feet. The hyperhidrosis- associated group showed an association with glassy lesions, localized to palmar or plantar areas. CONCLUSION: Clinical characteristics of AD-associated H-F dermatitis were demonstrated. The disease was suggested to be associated with the nonimmunologic etiologies of AD and clinical subgroups could be identified on the basis of nonimmunologic backgrounds.