A Case of Alopecia Mucinosa Occurring in the Nasal Canal of a Child / 대한피부과학회지

We report a case of alopecia mucinosa in a 9-year-old girl. She presented with several papules on an erythematous patch on the right side of the ala nasi, a hairless nodular lesion on the same side of the nasal canal. Histopathologic findings obtained from the nasal canal revealed typical features of alopecia mucinosa, such as reticular degeneration, cystic space formation and mucin deposition in the pilosebaceous follicle. The case displayed no evidence or clinical features of any malignant changes, and we suspect the case to be an acute form of alopecia mucinosa.

A Case of Eccrine Angiomatous Hamartoma / 대한피부과학회지

Eccrine angiomatous hamartoma is a rare condition characterized histologically by increased numbers of eccrine structures and numerous capillary channels. It may be congenital or appear later in childhood. It rarely arises during puberty or adulthood. We report a case of eccrine angiomatous hamartoma on the left shoulder in a 34-year-old man. The patient presented with asymptomatic, dome-shaped, about 3X2.5 cm, reddish telangiectatic nodule on the left shoulder. Histological examination showed an increased numbers of eccrine sweat glands and vascular structures.

Safety and Efficacy of Itraconazole for the Treatment of Onychomycosis in the Diabetic Population / 대한피부과학회지

INTRODUCTION: As the number of diabetics increase with younger onset and longer duration, patients are confronted with higher incidence of diabetes related complications such as distal extremity vasculopathy, neuropathy and various infectious diseases. Such diabetics are more prone to a much higher rate of onychomycosis compared to normal subjects and because this could trigger irreversible consequences, confirmation of fungal involvement should be promptly taken care of. Itraconazole is a widely used drug nowadays and compared to drugs such as griseofulvin and ketoconazole, has many advantages in efficacy, cost, duration of therapy which eventually results in better patient compliance. OBJECTIVE: Our study was designed to better dictate the usage of itraconazole in diabetics so these patient can receive quality treatment when it is needed. METHOD: The study consisted of 101 patients with both onychomycosis and diabetes who were receiving treatment in Eulji hospital. They all received 3 pulses of itraconazole and were evaluated for efficacy and safety of their treatment. The patients were observed on routine examinations for 36 weeks and at their visits they were interviewed and received microscopic examinations. RESULT: Eighty four percent of the patients showed clinical and mycological improvement with 33% of them showing total clearance. There were no hypo- or hyperglycemic events and 17 patients complained of mostly mild side effects such as indigestion. Two patients dropped out of the study due to epigastric pain and peripheral extremity swelling. CONCLUSION: The use of itraconazole in the treatment of onychomycosis seemed to be effective and relatively safe for diabetics.

A Case of Acantholytic Dyskeratotic Epidermal Nevus / 대한피부과학회지

Acantholytic dyskeratosis is seen in Darier's disease, transient acantholytic dermatosis and warty dyskeratoma. It is also occasionally observed incidental histological finding in pityriasis rosea, pityriasis rubra pilaris and is occasionally found in linear epidermal nevus. A 10-month-old boy presented linear hyperkeratotic plaques on the right sole and the left hand along with erythematous scaly papules on the posterior neck, the left axilla and the face. Histological findings showed acantholytic dyskeratosis with common histopathological findings of epidermal nevus. Acantholytic dyskeratosis is an occasional finding in linear epidermal nevus, but has been rarely reported in an infant(5 cases reported in 20 years). We report a case of linear epidermal nevus with acantholytic dyskeratosis in an infant.

A Case of Ulcerative Trichilemmal Carcinoma / 대한피부과학회지

We report a case of trichilemmal carcinoma in a 82-year-old man who presented an ulcerative tumor. Initially, a crusted mass was observed on the scalp and with subsequent removal of the crust, purulent and ulcerative lesion was seen. After treatment with sensitive antibiotics for 8 days, purulent discharge was markedly decreased in the lesion. Histopathologic findings showed clear cells tumor with trichilemmal keratinization. The tumor cells stained positive to PAS, sensitive to diastase and showed negative findings to CEA, EMA and S-100.

A Case of Hyperkeratotic Vascular Stains / 대한피부과학회지

The term, hyperkeratotic vascular stains is a peculiar form of capillary malformations commonly called as angiokeratoma or verrucous hemangioma. Hyperkeratotic vascular stains present at birth and consist of vascular dilatation and epidermal proliferation manifested as hyperkeratosis, acanthosis, and papillomatosis. Some authors insisted that angiokeratoma and verrucous hemangioma are not proper terms because they are not true tumors but malformations due to their lack of endothelial proliferation. Wide and deep excisions have been preferred as a curative therapy. The patient was a 9-year-old girl with multiple, linear, bluish black colored, hyperkeratotic plaques on her left lower leg. The red patches at birth had slowly enlarged and had become verrucous. Some satellite lesions had also developed. Histopathologic examination showed dilated capillaries filled with red blood cells in the papillary dermis and subcutaneous fat layer. The carbon dioxide laser was used to remove hyperkeratotic plaques. The flash-lamp pumped-pulsed dye laser and intense noncoherent pulsed light were used to remove satellite lesions and vascular lesions for a year. One of the lesions resistant to laser therapy was completely excised. Because multiple hyperkeratotic vascular stains are often impossible to be excised completely, laser therapy may be tried as the first choice.

A Case of Relapsing Polychondritis Associated with Thrombophlebitis / 대한피부과학회지

Relapsing polychondritis is a rare systemic disorder characterized by recurrent inflammation of cartilaginous structures, the eye, the audiovestibular and cardiovascular systems. Skin lesions, found in 17% to 38% of cases, include leukocytoclastic vasculitis, livedo reticularis, erythema nodosum, erythema multiforme, keratoderma blenorrhagicum, psoriasis, polyarteritis nodosa, thrombophlebitis and other various conditions. We report a 65-year old man with relapsing polychondritis and associated thrombophlebitis. The patient was treated with oral dapsone and systemic steroid with complete resolution of symptoms. However, the patient died of severe intractable pneumonia.

A Case of Winkelmann Granuloma Associated with Hypothyroidism and Rheumatoid Arthritis / 대한피부과학회지

Winkelmann granuloma is a very rare disorder characterized by histologic findings of perhaps[ic] infiltration, collagen degeneration, and granulomatous inflammation, which usually show palisading features. A number of diseases, especially systemic immunoreactive diseases, are associated with this disorder. We describe a focal neutrophilic necrosis : type of Winkelmann granuloma associated with hypothy- roidism and rheumatoid arthritis.

The Effects of Sorbic Acid, All-trans-retinoic Acid StructuralAnalog, on Retinoids Metabolism in Squamous Cell CarcinomaAMC-HN-6 Cell Line / 대한피부과학회지

BACKGROUND: All-trans-retinoic acid metabolism by cytochrome P450 is one of the major mechanisms that can regulate the level of retinoids in cells. Therefore, enhanced metabolism of all-trans retinoic acid by all-trans retinoic acid induced cytochrome P450 would probably decrease the therapeutic effects of active retinoids. We previously reported that the tail of all-trans retinoic acid (the carboxyl-terminus) may bind to a binding site of cytochrome P450 in part by electrostatic forces, and the head of RA (the beta-cyclogeranylidene ring) may bind to an active site of cytochrome P450 in part by hydrophobic forces. It is very interesting to study the interactions between the RA binding site of cytochrome P450 induced by all-trans retinoic acid and the structural analogs of all-trans retinoic acid and its effects of RA metabolism. OBJECTIVE: The purpose of this study is to examine the effects of sorbic acid, that has a similar structure with the tail of all-trans retinoic acid, on RA metabolism in head-neck squamous cell carcinoma cell line AMC-HN-6 which showed a much increased induction of cytochrome P450 by all-trans retinoic acid. METHODS: We examined the effects of sorbic acid on RA metabolism in all-trans retinoic acid specific cytochrome P450-inducible AMC-HN-6 cell line using cytochrome P450 enzyme assay with total cell lysates and microsomal proteins. Radioisotope-labeled polar metabolites of all-trans retinoic acid were separated by thin layer chromatography and the radioactivity was measured by beta-counter. Metabolic activity was expressed as the percentage of total radioactivity of polar metabolites. RESULTS: The results are summurized as follows: 1. RA metabolism of AMC-HN-6 cell line was inhibited by actinomycin D and cyclohexamide and was also inhibited by ketoconazole, the cytochrome P450 inhibitor, in a concentration-dependent manner. 2. Cytochrome P450-mediated oxidation was induced by all-trans retinoic acid, 13-cis-RA, 9-cis-RA, and retinal, but not by retinol in AMC-HN-6 cell line.3. Sorbic acid inhibited RA metabolism of AMC-HN-6 cell line in a concentration-dependent manner when the enzyme assay was performed on microsomal protein but could not inhibit RA metabolism in total cell lysate enzyme assay. CONCLUSION: The conversion of all-trans retinoic acid to polar metabolites is inhibited by sorbic acid in microsomal enzyme assay of AMC-HN-6 cell line, but not in total cell assay. These results suggest that sorbic acid can bind to the active binding site of cytochrome P450 but binding affinity of sorbic acid to RA binding molecules such as CRABP-I,-II, RARs, RXRs may be stronger than that of sorbic acid to cytochrome P450.

Actinic Keratosis-like and Seborrheic Keratosis-like Lichenoid Keratosis / 대한피부과학회지

Lichenoid keratosis (LK), a lichen planus-like keratosis, is a rather frequent skin disorder that has some histological features similar to lichen planus. However, the classification system for LK has not been settled. We report two cases of LK and propose a new classification for LK correlating with clinicohistopathological findings.

Solitary Congenital Indeterminate Cell Histiocytoma / 대한피부과학회지

Indeterminate cell proliferations are rarely described in dermatology literature. Indeterminate cells are characterized by positivity for S-100 protein and CD-la, but are distinguished from Langerhans cells by the absence of Birbeck granules. We present a case of congenital indeterminate cell histiocytoma in a 6-day-old male infant. A Skin examination revealed a solitary, erythematous, 6*6cm, superficially crusted, dome shaped papule on his forehead. A Histopathologic examination showed a dense cellular infiltrate in the dermis, below the atrophic epidermis. Frequently, the nucleus demonstrated a single cleft or crease like the shape of a kidney. These cells showed positivity for S-100 protein. Birbeck granules were not found on electron microscopic examination.