A Survey on the Perception and Behavior Regarding Tinea Pedis among Korean Adults / 대한피부과학회지

Background@#Dermatophyte infection is one of the most common skin diseases affecting the skin, hair, and nails. Despite widespread recognition of the disease, missing details and misperceptions are commonplace in the general population. @*Objective@#This study aimed to investigate the public perception and behavior regarding dermatophytosis of the hands and feet. @*Methods@#This results from an online survey conducted between July 2022 and August 2022. The survey included 1,000 Korean participants aged 20 to 69 years, of whom 60% experienced symptoms of tinea pedis or onychomycosis. The questionnaire focused on the awareness and personal experience of tinea pedis and perception of the treatment of dermatophytosis. @*Results@#Of the 1,000 participants, nearly 80% regarded tinea pedis as a common skin condition by which anyone can be affected. Furthermore, 88.4% had heard that the treatment of tinea pedis could be harmful, causing skin rash (60.4%) and worsening liver function (48.5%). Among 896 participants who noticed suspicious symptoms, 81.2% did not visit the clinic because it was not severe (50.1%) and seemed easily manageable (25.7%). Of the respondents, 84.4% preferred to meet dermatologists rather than non-dermatologist doctors regarding skin diseases, mainly because of trust in experts and belief in a faster cure. @*Conclusion@#Providing accurate and detailed information via online media, educational campaigns, and medical papers can rectify misconceptions and improve patient appliance, contributing to public skin health.

Identification of P-Glycoprotein and Transport Mechanism of Paclitaxel in Syncytiotrophoblast Cells

When chemotherapy is administered during pregnancy, it is important to consider the fetus chemotherapy exposure, because it may lead to fetal consequences. Paclitaxel has become widely used in the metastatic and adjuvant settings for woman with cancer including breast and ovarian cancer. Therefore, we attempted to clarify the transport mechanisms of paclitaxel through blood-placenta barrier using rat conditionally immortalized syncytiotrophoblast cell lines (TR-TBTs). The uptake of paclitaxel was time- and temperature-dependent. Paclitaxel was eliminated about 50% from the cells within 30 min. The uptake of paclitaxel was saturable with Km of 168 microM and 371 microM in TR-TBT 18d-1 and TR-TBT 18d-2, respectively. [3H]Paclitaxel uptake was markedly inhibited by cyclosporine and verapamil, well-known substrates of P-glycoprotein (P-gp) transporter. However, several MRP substrates and organic anions had no effect on [3H]paclitaxel uptake in TR-TBT cells. These results suggest that P-gp may be involved in paclitaxel transport at the placenta. TR-TBT cells expressed mRNA of P-gp. These findings are important for therapy of breast and ovarian cancer of pregnant women, and should be useful data in elucidating teratogenicity of paclitaxel during pregnancy.

Identification of P-Glycoprotein and Transport Mechanism of Paclitaxel in Syncytiotrophoblast Cells

When chemotherapy is administered during pregnancy, it is important to consider the fetus chemotherapy exposure, because it may lead to fetal consequences. Paclitaxel has become widely used in the metastatic and adjuvant settings for woman with cancer including breast and ovarian cancer. Therefore, we attempted to clarify the transport mechanisms of paclitaxel through blood-placenta barrier using rat conditionally immortalized syncytiotrophoblast cell lines (TR-TBTs). The uptake of paclitaxel was time- and temperature-dependent. Paclitaxel was eliminated about 50% from the cells within 30 min. The uptake of paclitaxel was saturable with Km of 168 microM and 371 microM in TR-TBT 18d-1 and TR-TBT 18d-2, respectively. [3H]Paclitaxel uptake was markedly inhibited by cyclosporine and verapamil, well-known substrates of P-glycoprotein (P-gp) transporter. However, several MRP substrates and organic anions had no effect on [3H]paclitaxel uptake in TR-TBT cells. These results suggest that P-gp may be involved in paclitaxel transport at the placenta. TR-TBT cells expressed mRNA of P-gp. These findings are important for therapy of breast and ovarian cancer of pregnant women, and should be useful data in elucidating teratogenicity of paclitaxel during pregnancy.

Three Cases of 'Morsicatio Labiorum'

Morsicatio labiorum is a form of tissue alteration caused by self-induced injury, mostly occurring on the lips, and is considered to be a rarely encountered mucocutaneous disorder. Clinically, it is a macerated grey-white patch and plaque of the mucosa caused by external stimuli (self-induced injury) such as habitual biting, chewing, or sucking of the lip. It is often confused with other dermatological disorders involving the oral mucosa, which can lead to a misdiagnosis. We herein report three cases of morsicatio labiorum; two cases were misdiagnosed as exfoliative cheilitis at the time of the first visit.

Metastatic Cutaneous Adenosquamous Carcinoma in a Patient Undergoing Chemotherapy for Lung Adenocarcinoma / 대한피부과학회지

Cutaneous metastasis originating from lung cancer is relatively rare and accounts for only 0.5~6.7% of of lung cancer metastases. In general, there is a histomorphologic resemblance between primary carcinoma and cutaneous metastatic carcinoma. A 45-year-old woman presented with a painless 0.8 cm erythematous nodule on her left shoulder. During the past 3 years, she had been receiving chemotherapy for the treatment of lung adenocarcinoma with bone metastases. A histopathological examination of the skin lesion showed adenocarcinoma and squamous cell carcinoma components, which were compatible with adenosquamous carcinoma. Herein, we report an interesting case of adenosquamous carcinoma showing cutaneous metastasis, which is a different pathologic subtype from primary lung adenocarcinoma.

Dermoscopic Features of Seborrheic Keratoses: Observations in 25 Korean Cases / 대한피부과학회지

BACKGROUND: Dermoscopy is in vivo cutaneous surface microscopy at 10~20 X magnification. It has been gaining in popularity in clinical dermatology. The recognition of dermoscopic features of melanoma and other skin lesions including seborrheic keratosis (SK) is valuable for improving clinical diagnostic accuracy and for reducing unnecessary excisions. OBJECTIVE: The aim of this study was to clarify the dermoscopic features observed in SK, estimate the prevalence of the findings among Korean patients, and compare findings between Koreans and Caucasian peoples. METHODS: A total of twenty five patients with biopsy-proven SK were selected. The dermoscopic features of SK that we investigated have been well described by Braun et al. including 'milia-like cyst' and 'comedo-like opening'. We determined the frequency of each feature. RESULTS: Among the twenty five SK cases, the main dermoscopic features of SK such as 'milia-like cyst' and 'comedo-like opening' were found in about half of cases (52% and 52%, respectively). Additional dermoscopic features and frequencies (in parenthesis) were: 'sharp demarcation' (92%), 'fissure' (72%), 'moth-eaten border' (56%), 'hairpin blood vessel' (20%), 'network-like structure' (20%), 'exophytic papillary pattern' (20%), and 'globular pattern' (4%). The frequency of 'hairpin blood vessel' and 'network-like structure' was significantly lower in Koreans than in Caucasians (p<0.05). The small size is a limitation of the study. CONCLUSION: Most dermoscopic features (morphology and frequency) of SK observed in Korean patients (with the relatively rare exception of additional features) are similar to the features reported for Caucasians.

Subcutaneous Myxoid and Round Cell Liposarcoma

Myxoid and round cell liposarcoma is a variant of liposarcoma characterized by a morphologic continuum in which tumor progression from low-grade myxoid to high-grade hypercellular or round cell areas may be observed. A 28-year old man presented with a painful skin colored subcutaneous mass on his left flank. The skin lesion was discovered about two months ago. Computed tomography revealed a well-defined tumor in the subcutaneous area without significant lymphadenopathy. A histopathologic study showed a nonencapsulated nodular growing tumor mass under the deep dermis composed of a mixture of atypical proliferating lipoblasts in a prominent myxoid stroma, occasional uniform round to oval shaped primitive nonlipogenic mesenchymal cells and plexiform, chicken wire shaped capillaries. Based on these findings, we diagnosed this case as myxoid and round cell liposarcoma. Because liposarcomas are large tumors of the deep subcutis or deeper soft tissue, they rarely come to the attention of the dermatologist. However, liposarcoma should be of concern, especially when rapid growing subcutaneous tumors are shown.

Successful Treatment of Cutaneous Lesions of Dermatomyositis with Topical Pimecrolimus

Dermatomyositis (DM) is an idiopathic inflammatory process characterized by proximal muscle weakness and cutaneous lesions, such as the Gottron's sign, heliotrope rash, and erythematous photosensitive rash. Administration of systemic agents for the treatment of underlying systemic diseases leads to remission of the cutaneous lesions in many cases. However, cutaneous lesions may remain refractory to treatment. Pimecrolimus is a calcineurin inhibitor with combined anti-inflammatory and immunomodulatory activity. It has high affinity to the skin and low permeation potential, even in patients with acute skin inflammation and in those undergoing post-topical corticosteroid therapy. We herein report two DM patients whose cutaneous lesions were refractory to conventional treatment but showed dramatic response to topical pimecrolimus. The clinical outcomes suggest that topical pimecrolimus may be a good therapeutic alternative for the management of the cutaneous lesions of DM.

A Sporadic Case of Mal de Meleda Caused by Gene Mutation in SLURP-1 in Korea

Mal de Meleda (MDM), also known as keratoderma palmoplantaris transgrediens, is a rare inherited form of palmoplantar keratoderma. It is characterized by erythema and hyperkeratosis of the palms and soles, extending to the dorsal aspects of the hands and feet. A 15-year-old Korean female presented with sharply demarcated hyperkeratotic plaques on the palms and soles, which extended to the dorsal surfaces of the hands and feet, in a "glove-and-socks" distribution. The histopathologic study showed marked hyperkeratosis, acanthosis, and normogranulosis, without epidermolysis. Her genetic study detected compound heterozygous mutation in exon 3 of the ARS gene encoding SLURP-1. Family history did not reveal any other affected members and no consanguineous relationship was found. In view of these findings, we diagnosed this case as the first reported sporadic case of MDM in Korea, the farthest location from the endemic island of Meleda.

A Case of Uterine Leiomyosarcoma Metastasized to the Skin: Local Recurrence and Rapid Growth after Excision / 대한피부과학회지

Leiomyosarcoma is a rare malignant neoplasm of smooth muscle cells usually found in the uterus, retroperitoneum, gastrointestinal tract, or deep soft tissue. Metastasis of leiomyosarcoma tends to occur through hematogenous routes. Cutaneous metastasis is therefore a rare occurrence. A 57-year-old female presented with several weeks history of a solitary erythematous 0.8x0.8 cm sized firm nodule on the scalp. She had a past history of transabdominal hysterectomy due to primary uterine leiomyosarcoma and pulmonary lobectomy due to metastatic lung nodules. Histopathologic examination of her scalp nodule revealed a poorly circumscribed tumor mass composed of malignant spindle cells with abundant eosinophilic cytoplasm, elongated and blunt ended nuclei, and frequent mitotic activity. Immunohistochemical staining with caldesmon was positive. After 3 weeks, a 1.5x3.5 cm sized tumor had developed at the previous excision site. From these findings, we diagnosed this case of uterine leiomyosarcoma metastasized to the skin as a local recurrence with rapid growth after excision.

Two Cases of Dermatofibroma with Atypical Clinical Features / 대한피부과학회지

Dermatofibroma is a common benign fibrohistiocytic tumor with a propensity for the lower extremities and this manifests with firm, indolent nodules. However, dermatofibroma may show a wide variety of clinicopathologic variants and so it is often misdiagnosed. We experienced two patients who showed atypical clinical features of dermatofibroma. The first case was a 35-year-old female who presented with a 3-month history of a solitary skin-colored hyperkeratotic nodule on the right palm. She had past history of recurrence after laser ablation at a private hospital. The second case was a 66-year-old female who presented with a 3-year history of a solitary brownish irregular shaped atrophic plaque on the right thigh. Histopathologic examination of both patients' lesions revealed poorly circumscribed nodular tumor composed of collagen bundles, fibroblasts and histocytes, and this was all consistent with dermatofibroma. From these finding, we diagnosed these cases as dermatofibroma. Clinical awareness may be the first step to identify the patients with the various features of dermatofibroma.

A Case of Hereditary Hemorrhagic Telangiectasia

Hereditary hemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is an autosomal dominant disorder of the fibrovascular tissue. It is characterized by the classic triad of mucocutaneous telangiectasias, recurrent hemorrhages, and familial occurrence. The cutaneous manifestation appear clinically as punctuate, linear, or splinter-like telangiectasias of the upper body, oral, and nasal mucous membranes, and nail beds. A 73-year-old woman presented with purpuric, punctuate, and tiny macules on the finger tips of both hands and the tongue. The skin lesions were discovered about 50 years previously. She had a family history of cutaneous telangiectasia. Also, she had episodes of recurrent epistaxis, gastrointestinal bleeding, and anemia. The gastroendoscopy revealed gastric angiodysplasia of the fundus and body of the stomach. The histopathologic study showed dilated capillaries lined by flat endothelial cells in the papillary dermis. From these findings, we diagnosed this case as hereditary hemorrhagic telangiectasia, which has rarely been reported in the dermatologic literature.