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Background@#The forehead is a region connected to the scalp and is accompanied by various structures. In some tumors, the pattern of development may differ from that of other anatomical sites. When a noninflammatory skin-colored tumor develops on the forehead, it is difficult to diagnose accurately. @*Objective@#This study aimed to identify the epidemiologic data and clinical features of noninflammatory skin-colored tumors of the forehead. @*Methods@#We retrospectively reviewed the medical records of 200 patients with noninflammatory, skin-colored tumors diagnosed after skin biopsy over a period of 11 years. We evaluated tumor prevalence, clinical features, and differences according to sex and age. If the tumor was large and deeply located, a radiologic study was performed. @*Results@#Of the 12 different histopathologic results, lipoma (52.0%) was the most frequent, followed by epidermal cyst (17.0%), osteoma (13.5%), steatocystoma (6.0%), and pilomatricoma (3.5%). Statistical analysis showed that females were dominant in the osteoma group. For an accurate diagnosis, 25 of the 52 patients who underwent computed tomography were diagnosed with lipoma, and 19 (76.0%) of them were identified as deep-seated lipoma. @*Conclusion@#The most common tumor among noninflammatory, skin-colored tumors of the forehead was lipoma.When they occur on the forehead, the proportion of deep-seated lipomas is higher than that at other sites. In the case of a solid and fixed tumor, a deep-seated lipoma should be considered. Computed tomography should be performed in addition to ultrasonography because the sensitivity of ultrasonography for the diagnosis of deep-seated lipoma is unsatisfactory.
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Juvenile temporal arteritis (JTA) is a non-giant cell inflammation of the temporal artery, characterized by eosinophilic infiltration. It generally affects both adolescents and young adults. JTA is clinically represented by an asymptomatic, palpable lump in the temporal area, with no associated signs, such as fever, myalgia, or visual symptoms. A 38-year-old female presented to our hospital with a history of bilateral linear plaques in both temporal areas for 3 months. Histopathological findings of the right temporal lesion showed infiltration of eosinophils and lymphocytes in the arterial wall and intimal hyperplasia but no giant cell or granulomatous lesions. Doppler ultrasonography revealed a tortuous tubular anechoic lesion, with non-visualization of internal vascular flow. Laboratory findings highlighted eosinophilia of up to 13.8% and a total immunoglobulin E level of 1,182 IU/mL. Here, we report a rare case of bilateral JTA with eosinophilia.
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Background@#Cellulitis is one of the most common infectious skin diseases treated by hospitalization, and presents with various clinical features and treatment responses. Therefore, more detailed analysis on this condition is required. @*Objective@#To investigate the clinical characteristics of cellulitis among dermatology inpatients in a single center. @*Methods@#We retrospectively reviewed the medical records of 84 patients hospitalized with cellulitis between January 2012 and August 2020. We analyzed the differences by dividing them into ＜60-year-old and ＞60-year-old age groups. @*Results@#The average age of the 84 inpatients in this study was 48.8 years with the peak incidence in fifties.Cellulitis was most prevalent in the calf (39.8%). Erythrocyte sedimentation rate (ESR) and risk factors such as obesity and smoking had positive correlations with duration of hospital stay (p＜0.05). There was no significant difference in duration of hospital stay between those administered first-generation cephalosporin and other antibiotics. @*Conclusion@#Our data showed that ESR, obesity, and smoking were correlated to the hospitalization periods. In particular, it showed positive correlation of C-reactive protein and ESR with duration of hospital stay in those below the age of 60 years.
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Background@#Cellulitis is one of the most common infectious skin diseases treated by hospitalization, and presents with various clinical features and treatment responses. Therefore, more detailed analysis on this condition is required. @*Objective@#To investigate the clinical characteristics of cellulitis among dermatology inpatients in a single center. @*Methods@#We retrospectively reviewed the medical records of 84 patients hospitalized with cellulitis between January 2012 and August 2020. We analyzed the differences by dividing them into ＜60-year-old and ＞60-year-old age groups. @*Results@#The average age of the 84 inpatients in this study was 48.8 years with the peak incidence in fifties.Cellulitis was most prevalent in the calf (39.8%). Erythrocyte sedimentation rate (ESR) and risk factors such as obesity and smoking had positive correlations with duration of hospital stay (p＜0.05). There was no significant difference in duration of hospital stay between those administered first-generation cephalosporin and other antibiotics. @*Conclusion@#Our data showed that ESR, obesity, and smoking were correlated to the hospitalization periods. In particular, it showed positive correlation of C-reactive protein and ESR with duration of hospital stay in those below the age of 60 years.
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Diabetic radiculoneuropathy is an uncommon complication of diabetes mellitus that can affect the cervical, thoracic, or lumbosacral nerve roots. When the thoracic nerve roots are affected, it can cause truncal pain and, more rarely, abdominal bulging. A 62-year-old man with diabetes developed sudden pain in his right abdomen with subsequent distention overlying the area for 10 days. Neither vesicular eruptions nor cutaneous scarring was noted. Imaging scans of the abdomen and spinal cord did not reveal any other causes of abdominal distention. Needle electromyography showed evidence of radiculoneuropathy in the right thoracic regions (T6 through T9), and nerve conduction study of the upper and lower extremities also showed evidence suggestive of severe distal symmetric polyneuropathy. With the exclusion of any apparent causes of abdominal distention, a diagnosis of diabetic radiculoneuropathy was made.
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Background@#Facial herpes zoster can be accompanied by several complications. In particular, postherpetic neuralgia (PHN) and ocular complications (OCs) are relatively common. Both PHN and OC are of interest because they can lower the quality of life. @*Objective@#This study aimed to evaluate the clinical features of facial herpes zoster and to assess the risk factors of OCs and PHN. @*Methods@#We analyzed the medical records of 146 patients with facial herpes zoster from January 2014 to May 2019. We assessed the proportion of OCs and PHN in patients with facial herpes zoster according to several clinical factors, including age, sex, dermatomal distribution, delayed time to treatment, and associated systemic conditions. OCs were divided into mild and severe ocular complications (SOC) by ophthalmologic diagnosis. @*Results@#The incidence rate of OCs (83.8%) and SOC (37.8%) were highest in patients in their 70s. Herpes zoster involving the ophthalmic and maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of OCs and SOC than those involving only the ophthalmic branch (p=0.031, p=0.025). Patients who received antiviral treatment within 4 days showed lower rates of OCs and SOC than patients who received treatment after 5 days (p＜0.001, p=0.003). The incidence of PHN was significantly higher in those over 60 years old, when both the ophthalmic and maxillary branches were involved, and for those treated more than 4 days after the onset. @*Conclusion@#To decrease the risk of OCs and PHN in facial herpes zoster, it is important to provide early antiviral treatment and appropriate ophthalmologic consultation.
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Metastatic skin cancers are a relatively uncommon malignant tumor. Visceral tumors such as breast, lung, and colon cancers are commonly found to be the primary origin. Cutaneous metastasis with esophageal cancer is exceedingly rare, accounting for less than one percent of all skin metastasis. Here, we report a case of cutaneous metastatic squamous cell carcinoma that originated from esophageal carcinoma. The patient was a 48-year-old male who complained of a 2-cm-sized non-tender, skin-colored nodule on his left lower back. Positron emission tomography-computed tomography (PET-CT) showed focal fluorodeoxyglucose (FDG) uptake in the lesion. In the histopathological examination, the tumor cells stained positive for epithelial membrane antigen (EMA) and cytokeratin 5/6 (CK5/6), which was consistent with squamous cell carcinoma. This case suggests that patients who have been treated for primary esophageal carcinoma should undergo a skin biopsy to rule out metastatic skin cancer if the tumor appears to be suspicious.
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Background@#Alopecia areata is an autoimmune disease that presents as non-scarring hair loss and can affect all age groups. The clinical course of alopecia areata is unpredictable. @*Objective@#This study aimed to analyze the characteristics, treatment response, and relapse rate of alopecia areata in patients of different ages with long-term follow-up. @*Methods@#The medical records of 121 patients diagnosed with alopecia areata were retrospectively reviewed, and their prognosis was assessed on the basis of various indices. @*Results@#A total of 121 patients, including 24 cases of childhood-onset, 83 adult-onset, and 14 late-onset alopecia areata, were analyzed. In the first episode, 72.7%, 14.7%, and 9.9% of patients had mild, moderate, and severe alopecia areata, respectively. A significant and complete response was observed in 66.7%, 89.2%, and 100% of childhood-onset, adult-onset, and late-onset patients, respectively. The duration of the initial episode showed a negative correlation with age. The overall frequency of relapse was 47.1%, whichc significantly declined with time, with a majority (63.3%) of relapses occurring in the first year. Younger age at initial presentation and thyroid diseases were strongly associated with poor prognosis. @*Conclusion@#Younger patients showed a tendency of poor prognosis regardless of the prognostic factors. A longer follow-up period might be required for the younger onset patients.
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Diabetic radiculoneuropathy is an uncommon complication of diabetes mellitus that can affect the cervical, thoracic, or lumbosacral nerve roots. When the thoracic nerve roots are affected, it can cause truncal pain and, more rarely, abdominal bulging. A 62-year-old man with diabetes developed sudden pain in his right abdomen with subsequent distention overlying the area for 10 days. Neither vesicular eruptions nor cutaneous scarring was noted. Imaging scans of the abdomen and spinal cord did not reveal any other causes of abdominal distention. Needle electromyography showed evidence of radiculoneuropathy in the right thoracic regions (T6 through T9), and nerve conduction study of the upper and lower extremities also showed evidence suggestive of severe distal symmetric polyneuropathy. With the exclusion of any apparent causes of abdominal distention, a diagnosis of diabetic radiculoneuropathy was made.
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Localized cutaneous argyria is a rare condition in which the skin changes into blue-grey spots due to the absorption of silver. The lesions need to be differentiated from other pigmentary disorders and require radiographic and histological examination for more accurate diagnosis. Scanning electron microscopy and energy dispersive x-ray spectroscopy can be a confirmatory tool in the evaluation of silver elements in biopsy tissue. This report shows the localized cutaneous argyria in earlobe of a 21-year-old woman who wears silver earrings for 10 years.
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Feminino , Humanos , Adulto Jovem , Absorção , Argiria , Biópsia , Diagnóstico , Orelha , Microscopia Eletrônica de Varredura , Nevo Azul , Prata , Pele , Espectrometria por Raios XRESUMO
An atypical teratoid/rhabdoid tumor (AT/RT) is a rare malignancy occurring in the first few years of life. This tumor shows rapid growth, a poor response to treatment, and poor prognosis. Cutaneous metastases presents as hamartomatous lesions mimicking skin tags. Immunohistochemical examination shows varied patterns of expression based on the sites of the body affected. Integrase interactor-1 (INI-1) gene sequencing and loss of expression of INI-1 observed with immunostaining can confirm AT/RT. In our patient, the skin lesion was identified at birth. Histopathological examination of the skin lesion could not establish an accurate diagnosis. Two months later, the patient presented with a brain tumor. Immunohistochemical examination of the brain lesion revealed complete loss of INI-1 expression in tumor cells, and the lesion was diagnosed as AT/RT. After that, we can detect the loss of INI-1 expression in the skin on the back. We report a rare case of AT/RT affecting the brain with cutaneous metastasis diagnosed with immunohistochemical staining.
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Humanos , Encéfalo , Neoplasias Encefálicas , Diagnóstico , Integrases , Metástase Neoplásica , Parto , Prognóstico , PeleRESUMO
Leprosy is a chronic infectious and granulomatous disease caused by Mycobacterium leprae. It is treated with a multidrug therapy (MDT), which is consisted of dapsone, rifampicin, and clofazimine. However, there were relapsed leprosy associated with various predisposing factors; persisting organism, multiple involved skin lesions and nerves, HIV infection, monotherapy, inadequate and irregular therapy. Early or late relapses were observed in leprosy. Early onset relapses may occur due to insufficient treatment, and late relapses are probably with persistent bacilli and drug resistant organisms. Herein, we report on an interesting case of a 78-year-old man presented with relapsed leprosy associated with ulcerative skin lesions. The patient was diagnosed with lepromatous leprosy about 40 years ago, and he was treated with dapsone monotherapy and MDT. Our case is thought to have occurred due to persistent bacilli related to irregular therapy.
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BACKGROUND@#Inpatient dermatological consultations are getting more important and, therefore, several studies ofdermatologic consultation from various inpatient departments have recently been reported. However, data regardingthe analyses of these consultations for infectious diseases inpatients are limited.@*OBJECTIVE@#The purpose of this study was to analyze and quantify the patterns of dermatologic consultations referred by the Division of Infectious Diseases.@*METHODS@#We retrospectively reviewed 149 consultation reports for inpatients referred by the Division of Infectious Diseases from January 2014 to May 2019. We analyzed the medical records and noted age, sex, reasons for dermatologic consultation, diagnosis of the dermatoses, and change in diagnosis after the consultation in a single secondary referral center.@*RESULTS@#The percentage of patients who were referred by the Division of Infectious Diseases and consulted by the Department of Dermatology was 13.2%. The most frequent age group was the 7th decade of life (24.8%) and the male to female ratio was 1:1.04. The main reasons for dermatologic consultations were dermatologic disease not related to underlying infectious disease (43.0%), dermatologic disease related to underlying infectious disease (24.2%), and skin lesions related to the treatment (18.1%). The most common dermatoses were infectious disease (40.3%), followed by eczema (22.1%), and drug eruption, erythema and urticaria (19.5%). There were 10 cases in which the diagnosis of undetermined dermatoses was changed after dermatologic consultation.@*CONCLUSION@#This study revealed the distribution of skin disorders inpatients referred by the Division of Infectious Diseases for dermatologic consultation. In conclusion, dermatologists should take an active role in dermatologic consultations for more accurate examinations and treatment of infectious diseases patients.
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Stewart-Treves syndrome (STS) is a rare cutaneous angiosarcoma that develops in chronic lymphedema. The majority of STS is described in the upper extremity after aggressive locoregional therapy for breast cancer and is rarely reported in lower extremities. A 68-year-old woman presented with a 3-month history of multiple purpuric tumorous plaques and nodules on the right posterior thigh. She had a history of radical hysterectomy with lymph node dissection and postoperative radiotherapy due to uterine cervical cancer 16 years ago. She received right total hip replacement surgery due to hip joint avascular necrosis 14 years ago. She had suffered from chronic leg edema, especially on the right side. Skin biopsy on the right posterior thigh showed irregular vascular channels lined by atypical endothelial cells. Special stains showed positivity for CD31, CD34, factor VIII, and D2~40, which are pan-vascular or lymphatic markers. She showed a pelvic mass and pelvic bone metastasis on radiologic staging work-up. She refused all treatment, including surgery, radiotherapy, and chemotherapy, except for pain control. She died 2 months after diagnosis of this highly malignant tumor. The lymphedema on both lower extremities after uterine cervical cancer treatment was aggravated especially on the right lower extremity after right total hip replacement surgery. Increased weight of the right lower extremity resulted in 4 episodes of recurrent hip dislocation. We contend that these multiple factors (uterine cervical cancer treatment, total hip replacement surgery on the right side, and recurrent hip dislocations) attributed to development of Stewart-Treves syndrome. We herein report a case of Stewart-Treves syndrome of the lower extremity following chronic leg lymphedema after uterine cervical cancer treatment and hip surgery.
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Idoso , Feminino , Humanos , Artroplastia de Quadril , Biópsia , Neoplasias da Mama , Corantes , Diagnóstico , Tratamento Farmacológico , Edema , Células Endoteliais , Fator VIII , Hemangiossarcoma , Quadril , Luxação do Quadril , Articulação do Quadril , Histerectomia , Perna (Membro) , Extremidade Inferior , Excisão de Linfonodo , Linfedema , Necrose , Metástase Neoplásica , Ossos Pélvicos , Radioterapia , Pele , Coxa da Perna , Extremidade Superior , Neoplasias do Colo do ÚteroRESUMO
No abstract available.
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Canal Anal , Doença de Paget Extramamária , Radioterapia , VulvaRESUMO
BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is a malignant proliferation of keratinocytes of the epidermis. It may have the potential to metastasize distally in contrast to the cutaneous basal cell carcinoma. OBJECTIVE: We investigated the recent trend of cSCC development from a clinical, histopathological, and prognostic perspective. METHODS: One hundred and sixty cases of cSCC in patients who had visited the Samsung Changwon Hospital over the past 10 years (between 2006 and 2016) were retrospectively studied. We analyzed their age, sex, location, etiologic factor, histopathologic finding, and treatment. RESULTS: The average age of cSCC was 77 years old and the sex ratio was 1:2.27. The most commonly involved location was the head and neck (73.13%). The etiologic factors were unknown (61.88%), actinic keratosis (23.13%), Bowen's disease (10.63%), burn scar (2.5%), chronic eczema (0.63%) and chronic inflammatory disease (0.63%). The average tumor diameter and thickness were 18.1 mm and 3.58 mm, respectively. The degrees of differentiation were well-differentiated (68.75%), moderately differentiated (28.75%) and poorly differentiated (2.5%). The occurrence rate of cSCC metastasis was 6.25% (10 cases/160 cases). The most common primary locations of cSCC metastasis were the lower extremities (5 cases/10 cases) and head and neck (2 cases/10 cases). All 10 cases were metastasis to adjacent lymph nodes. Five cases showed metastasis to distant lymph nodes, the lungs, liver or bone. The average tumor diameter and thickness of cSCC metastasis were 45.3 mm and 9.46 mm, respectively. Histopathologically, the degrees of differentiation were well-differentiated, moderately differentiated and poorly differentiated type (4 cases, 5 cases, and 1 case, respectively). CONCLUSION: The location of the lower extremities (p=0.000) and a size larger than 20 mm (p=0.000) were related to cSCC metastasis. cSCC metastasis was found at an average of 7.5 months after diagnosis. High-risk cSCC patients should be followed closely, particularly during the first 2 years after diagnosis.