A Case of Pemphigus Foliaceus Presenting as Verrucous Plaque / 대한피부과학회지

Pemphigus foliaceus is a rare, relatively mild and chronic variety of pemphigus which is characterized by superficial flaccid bullae which show acantholytic changes in the upper part of the epidermis histopathologically. Present case is a 40-year-old female with a 2 month history of yellowish colored verrucous plaques on the whole scalp. 6 years ago, she had been admitted to our hospital because of nearly generalized erythematous eroded patches, crusted plaques and bullae and diagnosed as pemphigus foliaceus and treated with corticosteroid and methotrexate. 2 months ago, an additional lesion was found on the scalp, where yellowish colored, verrucous surfaced plaques were observed. Histologic examination on the verrucous plaque showed hyperkeratosis, acanthosis and papillomatosis with acantholysis in the granular layer, leading to a subcorneal blister and dyskeratotic granular keratinocytes were seen within the blister. On the basis of clinicopathologic examination we diagnosed as pemphigus foliaceus and then we treated her with prednisolone and the skin lesion had subsided 7 months later. We report a patient of pemphigus foliaceus who was presented with verrucous surfaced plaque, which clinically mimicked pemphigus vegetans.

Ethylene Oxide(EO) Induced Cutaneous Hypersensitivity in a Patient on Hemodialysis

A 46-year-old male patient had recurrent episodes of generalized pruritic wheals during hemodialysis. He has experienced urticaria during hemodialysis whenever he used a capillary dialyser sterilized by ethylene oxide(EO, Polysulfone-) gas which is used to sterilize hemodialysers and other medical equipment. On the other hand, capillary dialyser sterilized by Gamma ray (Hemophad) has not evoked urticaria. Although the presence of EO-specific antibodies was not detected, urticarial rash never developed when the equipment was switched to a gamma-sterilized one. We herein report a case referred to ethylene oxide induced cutaneous hypersensitivity during hemodialysis.

A Case of Drug Eruption Caused by Rifampin and Isoniazid / 대한피부과학회지

Drug eruption is a cutaneous reaction caused by various drugs, which include antibiotics, antipyretics, anti-inflammatory analgesics, antidepressants, antituberculosis drugs, etc. Drug eruptions caused by antituberculosis drugs are relatively uncommon and there have been no previous reports in Korea which caused simultaneously by isoniazid and rifampin. A 57-year-old female patient, who was treated with antituberculosis drugs, was seen with generalized erythematous maculopapular eruption. We performed patch test and prick test with the antituberculosis drugs and could confirm a drug eruption caused by isoniazid and rifampin. And we performed desensitization to isoniazid for an optimal antituberculosis regimen and completed the treatment with isoniazid, successfully.

A Case of Segmental Neurofibromatosis / 대한피부과학회지

Neurofibromatosis(NF) is a heterogeneous disorder clinically characterized by the presence of neurofibromas, multiple caf au lait spots, intertriginous freckles and Lisch nodules. It is usually expressed as a generalized form, but is rarely localized in a limited part of the body as a segmental form. In 1982, Riccardi classified NF into 8 types and in a segmental NF(type V) the cutaneous lesions are limited to a single body segment, often in a unilateral, dermatomal disposition. We report a 45-year-old Korean woman who presented with several grouped soft, fresh red colored papules and nodules on the left side of the neck(left C2, C3 dermatomes). There were no caf -au-lait spots, axillary freckles, Lisch nodules or family history. A biopsy specimen of cutaneou nodules showed circumscribed non-encapsulated tumor of the dermis was composed of loosely spaced spindle cells with elongated, wavy nuclei and thin, wavy collagenous strands. On the basis of clinicopathologic examination we diagnosed as segmental NF.

Patch Test and Specific IgE Level with Food Antigens in Atopic Dermatitis Patients / 대한피부과학회지

BACKGROUND: Food allergies have been demonstrated to play an important role in the pathogenesis of atopic dermatitis(AD), affecting around 10 to 40% of patients with AD. While immediate-type clinical reactions to food can easily be identified, the evaluation of a food allergy in the absence of immediate clinical reactions still presents diagnostic difficulties. OBJECTIVE: The purpose of this study was to evaluate the diagnostic value of the atopy patch test with regard to late-phase reactions and to evaluate the relationship between patch test and specific serum IgE level. METHODS: We performed the patch test and chemiluminescent assay(CLA) for food antigens(cow's milk, soybean milk and hen's egg) in 45 patients with AD who were suspicious of food-related symptoms and 15 normal controls. RESULTS: 1. Positive reaction of CLA in 45 patients with AD were 7/18(38.9%) for the cow's milk, 5/14(35.7%) for the soybean milk and 4/13(30.7%) for the hen's egg. 2. Positive reaction of the patch test in patients with AD were 5/18(27.8%) for the cow's milk, 6/14(42.9%) for soybean milk and 4/13(30.7%) for hen's egg, but only one(6.7%) for cow's milk in 15 normal controls. 3. A highly significant correlation to food antigens existed between patch test and CLA, but one patient showed a positive reaction in the patch test for soybean milk despite the negative reaction in CLA. 4. There was no significant statistical correlation between the severity of AD and the positive reaction rate of the patch test. 5. There were no significant statistical differences between the age of AD patients and the positive reaction rate of the patch test. CONCLUSION: The atopy patch test seems to be a valuable tool in the diagnostic work-up of food allergies in patients with AD-especially with regard to late-phase clinical reactions.

A Case of Hereditary Hemorrhagic Telangiectasia / 대한피부과학회지

Hereditary hemorrhagic telangiectasia, also known as Osler-Rendu-Weber disease, is an autosomal dominant hereditary disorder leading to easily bleeding telangiectases on skin and mucosal surfaces, and it is associated with the presence of arteriovenous malformations in multiple organ systems. It is usually recognized as classic triad of telangiectasia, recurrent epistaxis and a family history of the disorder. We report herein a case of hereditary hemorrhagic telangiectasia in a 12-year-old male who had episodes of recurrent epistaxis and compatible telangiectatic skin lesion. And his grandfather, father, uncle and cousin also had similar punctiform, linear and spider-like telangiectatic lesions.

A Case of Pigmented Apocrine Hidrocystoma Occuring on the Vulva

A 7-year-old female was presentd with two black papules and linear pigmentation between papules on the vulva. No other abnormalities were found in her personal and family history. Histopathological examination was consistent with the apocrine hidrocystoma and the pigment in the luminal cells was iron negative and Fontana Masson positive, confirming its melanin nature. We herein report a 7-year-old female patient with pigmented apocrine hidrocystoma occuring on the vulva with the evidence of melanin as the underlying mechanism of the pigmentation.

Two Cases of Sebaceous Carcinoma Developed on the Unusual Site: A Case of Muir-Torre Syndrome / 대한피부과학회지

Sebaceous carcinoma is a malignant tumor derived from the adnexal epithelium of sebaceous glands and is usually located on the meibomian glands of the eyelid, but may occur on the extraocular sites. We present two cases of sebaceous carcinoma developed on the unusual site. The first case was 66-year old woman, who had 2.2X3.0cm sized, yellowish, verrucous surfaced plaque on the abdomen for 20 years. The second case of 79-year old man had annular shaped erythematous greasy patch with peripherally located flat plaque on the left scapular area for 1 month. His past medical history included subtotal gastrectomy for early gastric cancer(type IIa) and could not find any recurrence or metastasis for 4 years duration. The histopathologic examination revealed irregular, variable sized tumor lobules. Each lobule was composed of sebaceous and undifferentiated cells showing considerable variation in the shape and size of their nuclei and prominent nucleoli. On the basis of clinicopathologic examination we diagnosed first case as sebaceous carcinoma and second case as Muir-Torre syndrome.

A Case of Lentigo Maligna Arising from Nevocytic Nevus / 대한피부과학회지

Lentigo maligna(LM) is a pigmented lesion that occurs on the sun-exposed skin of an older patients and may become lentigo maligna melanoma(LMM). Currently the percentage of LM type melanoma appears to be increasing, and this rise has been attributed to increasing UV radiation exposure. In addition to UV radiation, estrogen and progesterone, and nonpermanent hair dyes have been proposed as risk factors. A case is a 66-year-old female with a 3 years history of pigmented patch. She had a gradually enlarging irregular bordered brown to black mottled patch on the right temple area. Histologic examination revealed atypical melanocytes along the basal layer of atrophic epidermis, arranged in solitary units and small nests. Perilesional skin showed many scattered melanophages and regressing nevus cell nests which suggested preexisting nevus underwent regressive change. On the basis of clinicopathologic examination we diagnosed this case as lenigo maligna arising from nevocytic nevus and then we removed the lesion by wide surgical excision and could not find any recurrence until now.

A Case of Cutaneous Metastasis from Carcinoma of the Urinary Bladder / 대한피부과학회지

Metastases to the skin from bladder carcinoma are very the rare and rate is 1 to 2% of the cutaneous metastases. A 61-year-old man presented with 4 months history of well demarcated erythematous eroded nodules on the both inguinal areas which developed 3 years later after the diagnosis of carcinoma of the urinary bladder had been made. Histological examination of the skin lesion revealed atypical cells having hyperchromatic and pleomorphic nuclei which were similar to those of the urinary bladder. We report herein a case of cutaneous metastasis from carcinoma of the urinary bladder in a 61-year-old man.