A Family-Engaged Educational Program for Atopic Dermatitis: A Seven-Year, Multicenter Experience in Daegu-Gyeongbuk, South Korea

BACKGROUND: It is important to educate families of pediatric patients with atopic dermatitis (AD) so that they have a correct understanding of AD. OBJECTIVE: The purpose of this study is to introduce, evaluate, and improve our family-engaged educational program. METHODS: Children suffering from AD and their families have participated in a half-day educational program called "AD school" with catchy slogans such as "Enjoy with AD Families!" every year since 2005. Educational lectures were conducted for parents. For children with AD, various entertaining programs were provided. A feedback survey about AD school was administered for the purpose of evaluation. RESULTS: A total of 827 people (376 patients and 451 family members) participated in this program over 7 years. On-site surveys showed a positive response (i.e., "excellent" or "good") for the prick test (95.1%), emollient education (78.4%), educational lecture (97.0%), drawing contest and games (90.2%), and recreation (magic show; 99.0%) respectively. Telephone surveys one year later also elicited a positive response. CONCLUSION: We herein introduce the experience of a half-day, family-engaged educational program for AD. Family-engaged education programs for AD such as this AD school encourage and validate family participation in the treatment of their children's AD.

A Case of Xanthoma Disseminatum Accentuating over the Eyelids

Xanthoma disseminatum (XD) is a rare, benign non-familial mucocutaneous disorder, which is a subset of non-Langerhans cell histiocytosis. It is characterized by mucocutaneous xanthomas in a disseminated form typically involving the eyelids, trunk, face, and proximal extremities and occurs in flexures and folds such as axillae and the groin. Mucosal involvement of the respiratory or gastrointestinal tracts may lead to hoarseness or intestinal obstruction from a mechanical mass effect. This paper outlines the case of a 47-year-old female with progressive yellow-to-brown confluent nodules and plaques of various sizes on her scalp, face, oral mucosa, neck, shoulder, axillary folds, and perianal area. Xanthomas accentuating over the eyelids and eyelashes led to partial obstruction of her visual field and interfered with blinking. Further, she suffered from xerophthalmia. The presentation of histopathological features including foamy histiocytes, inflammatory cells, and Touton giant cells in conjunction with her clinical findings indicated a diagnosis of XD. Evaluations for extracutaneous involvement including the central nervous system, respiratory tract, gastrointestinal tract, and bone resulted in nonspecific findings. Although she has been treated with surgical excisions, CO2 laser therapy, and oral prednisolone, new lesions are still emerging.

Clinicopathological Observation of Hemangioma of Infancy: The Diagnostic Usefulness of GLUT-1 Immunohistochemical Stain / 대한피부과학회지

BACKGROUND: Hemangioma of infancy (HOI) is one of the most common tumors in childhood. Their clinical features can on occasion look like those of other vascular tumors and malformations, so the correct differentiation of HOI may not always be easy. OBJECTIVE: The purpose of this study was to review the clinicopathological features of HOIs and to particularlyexamine the usefulness of glucose transporter protein isoform-1 (GLUT-1) immunohistochemical stain (IHS) as a specific marker of HOI. METHODS: This study was conducted at the Vascular Anomaly Clinic of Kyungpook National University Hospital during 11 years (1998~2008). Sixty-two cases were selected in addition to selecting other tumors and malformation as a control group. We then reviewed their clinical features and the results of H&E and GLUT-1 IHS for making the differential diagnosis. RESULTS: The male to female ratio was 1 : 2.88. The head and neck were the most commonly involved sites. The complications included ulceration and/or bleeding (12.9%), scarring (9.7%), infection (4.8%), ocular complications (4.8%) like visual axis occlusion, and pain (1.6%). Three phases of proliferating, involuting and involuted of a HOI comprised 11.3%, 37.1% and 51.6% of the lesions, respectively, from the clinical view point and 11.3%, 48.4% and 40.3% of the lesions, respectively, from the pathological point of view. GLUT-1 was positively expressed on almost all of the HOIs (47/57, 82.5%), except for 10 HOIs of the involuted phase and the other controls. CONCLUSION: The clinicopathological findings of this study were similar with those of the previous reports. The expression of GLUT-1 by a HOI can be helpful to make the correct diagnosis from other vascular tumors and malformations.

Verrucous Hemangioma and Angiokeratoma: Their Similarilities and Differences according to the Clinicopathological Features / 대한피부과학회지

BACKGROUND: Verrucous hemangioma (VH) and angiokeratoma (AK) are vascular birthmarks of an unclear nosology and these birthmarks commonly show a superficial hyperkeratotic vascular component. There are both similarilities and differences between VH and AK with some confusion concerning their overlapping features. OBJECTIVE: This study was undertaken to review the clinicopathological features of VHs and AKs and to determine the similarilities and differences between them. METHODS:We retrospectively reviewed 11 VHs and 7 AKs at the Vascular Anomaly Clinic of our hospital over the past 10 years. They were evaluated from the clinicopathologic point of view for factors such as the age of onset, location, size, symptoms, the histopathological epithelial change and involvement of deeper tissue. RESULTS: These birthmarks share common clinical features with the exception of gender and lesion size. Histopathologically, hyperkeratosis, acanthosis and capillary dilatation in the upper dermis were commonly seen. Yet lobular proliferation and dilatation of blood vessels in the deep dermis, or more importantly, the subcutis were detected in VH only. Furthermore there was a case of VH that showed diffusely scattered increased blood vessels in the subcutis, suggesting an evolving stage of VH and there was another case of VH that was erroneously diagnosed as AK via the initial biopsy, and the final diagnosis was changed according to the excised lesion. CONCLUSION:The two diseases share most of their clinicopathological features, but small parts of features like gender, the clinical size and the histological deep dermis/subcutis involvement were differences. Making the correct differential diagnosis between VH and AK through a deep biopsy with appropriate timing and long-term follow-up and/or radiological examination is helpful to avoid erroneous management.

Seven Cases of Acquired Digital Arteriovenous Malformation / 대한피부과학회지

Acquired digital arteriovenous malformation (ADAVM) consists of an abnormal connection between the arteriole and venule in the acral area of extremities, particularly the fingers. Clinically, the lesions appear as small, slightly- elevated, dark brown erythematous macules on the distal part of fingers. The histological specimens shows close approximation between thin-walled venule and thick-walled arteriole and possibly a direct arteriovenous shunt adjacent to each other lying in the dermis. We herein report seven stereotypical cases of ADAVM.

The Significance of Radiologic Examination of the Hip Joint for Patients Who Use Systemic Corticosteroids for a Long Period of Time / 대한피부과학회지

BACKGROUND: Systemic corticosteroid is one of the most common drugs used in dermatology departments. However, physicians are well aware that there are quite a number of side effects from systemic corticosteroid. One of them, avascular necrosis of femoral head, has been frequently documented in association with systemic corticosteroid. OBJECTIVE: The aim of this study was to evaluate the clinical usefulness of hip x-rays to ascertain the presence of avascular necrosis of the femoral head in patients who have used or are using systemic corticosteroid for a long period of time. METHODS: A total of 151 patients who were using systemic corticosteroid and who underwent hip x-ray at our university hospital from December 2004 to July 2007 were enrolled in this study. We reviewed the patients' charts to determine the existence of abnormal results on hip and chest x-rays and also other side effects of corticosteroid, and we wanted to calculate the dosage of corticosteroid that had been used by these patients. RESULTS: Out of the 151 patients who underwent hip x-ray, 5 patients had avascular necrosis of the femoral head, but only 3 patients' cases (2%) were involved with corticosteroid. Three patients showed old tuberculosis findings when they underwent chest x-ray. Among the other side effects of corticosteroid, weight gain side effect was the most common and 14 patients experienced this. CONCLUSION: This study demonstrates that those patients who use systemic corticosteroids for a long period of time for the treatment of chronic dermatologic disease are advised to undergo regular hip x-rays to screen for avascular necrosis of the femoral head.

A Case of Recalcitrant Pyoderma Gangrenosum Treated by Infliximab / 대한피부과학회지

Pyoderma gangrenosum is an uncommon, neutrophilic, ulcerating, chronic dermatosis with obscure etiology. Many therapeutic modalities have been used in the past, but they have not always provided favorable outcomes. Recently, tumor necrosis factor-alpha inhibitors have been gaining attention in the treatment of recalcitrant pyoderma gangrenosum. A 57-year-old woman presented with painful, recurrent erythematous nodules and ulcers on both legs. She had been treated with systemic steroids, immunosuppressants, dapsone, and colchicine, and she experienced improvement with systemic steroids only. After using infliximab (5 mg/kg), she experienced dramatic improvement in her lesions. Thus, we report a recalcitrant case of pyoderma gangrenosum that was successfully treated with infliximab.

Reconstruction of Defects on the Lower Part of the Nose using Nasalis Island Pedicle Flap / 대한피부과학회지

Reconstruction of surgical defects of the nose, particularly the lower one third, is often challenging. The skin of this area is less mobile and fixed on lower structures without a subcutaneous fatty layer. Thus, dissection of tissues is rather difficult and more bleeding can occur during dissection. Furthermore, flap surgery will fail if the flap extends too far. Local flap surgery is one of the more useful techniques that maintains the function and aesthetics of a normal nose. Among these, the nasalis muscle is relatively easy and provides better outcomes. More importantly, vascular supplies from the underlying muscular structure provide greater viability. Additional movement can be achieved by either dissecting under the transverse nasalis or by dividing the transverse nasalis beyond the midline. We report 5 cases of nasalis island pedicle flaps using nasalis muscles. The final results were relatively satisfactory for both functional and cosmetic aspects.

A Clinical Study on the Efficacy of Cosmetics Containing the Ascidian tunic in Reducing Wrinkles / 대한피부과학회지

BACKGROUND: In the last few decades, there has been a substantial increase in the population of aged people. Aging skin is a common concern for many people these days. OBJECTIVE: The purpose of this study was to evaluate the efficacy of cosmetics containing Ascidian tunic in reducing wrinkles. METHODS: Cream containing the Ascidian tunic was applied to right lateral epicanthal areas of 30 subjects for 8 weeks. As control group, a placebo which does not contain the Ascidian tunic was applied to the left lateral epicanthal areas of the subjects. Skin barrier function was evaluated and skin replicas were molded on both epicanthal areas every 4 weeks. The changes of the skin wrinkles were analyzed with skin visiometer. RESULTS: In comparison of the changes between groups treated with placebo and Ascidian tunic, there was statistically significant differences in hydration and sebum secretion. But there were no statistically significant differences in the result of R-value by visiometer. CONCLUSION: The treatment of Ascidian tunic extract seems to be partially effective in improving wrinkles, but further study is required.

A Case of Tinea Corporis Caused by Microsporum ferrugineum / 대한의진균학회지

Microsporum (M.) ferrugineum has almost disappeared in Korea after three cases of tinea capitis that were reported in Jeonbuk province in 1993. It was most common cause of tinea capitis in Korea until 1970s. M. ferrugineum produces abundant chlamydospores. Another characteristic of the species is the production of distorted faviform hyphae and long, straight hyphae with thick septa that resemble segments of bamboo. We report a case of 27-year-old female with tinea corporis caused by M. ferrugineum.

A Quantitative Culture Study of Staphylococcus aureus in Adolescent and Adult Patients with Atopic Dermatitis using the Contact-plate Sampling Technique / 대한피부과학회지

BACKGROUND: The stratum corneum of the skin of patients with atopic dermatitis (AD) is highly susceptible to colonization by various bacteria, including Staphylococcus (S.) aureus. Because the frequency of bacterial colonization is significantly higher, skin barrier function against bacterial invasion appears to be significantly disrupted in AD. S. aureus colonization in AD is thought to be important in the development and aggravation of eczematous skin lesions. Over the past decades, there have been several quantitative methods of cutaneous bacterial culture from the skin; the swab method, scrub method, tape method and contact plate method. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of the contact-plate sampling technique as a quantitative culture method of S. aureus in atopic dermatitis. METHOD: The subjects were 24 patients with AD and 24 age-matched normal controls. S. aureus was sampled at 4 evaluation sites (neck forearm abdomen, popliteal fossa) of AD patients and normal controls using the contact-plate sampling technique. We also checked skin barrier function by measuring the transepidermal water loss (TEWL). RESULTS: Based on the data, we found that the number of S. aureus colonies in the samples from AD patients was significantly higher than from normal controls (p<0.05, 4 sites respectively). Also, TEWL at the 4 evaluation sites of AD patients was significantly higher than in normal controls (p<0.05, 4 sites respectively). However, S. aureus colonization did not usually show significant correlation with TEWL. CONCLUSION: The contact-plate sampling technique provides a reliable qualitative and quantitative culture method of S. aureus, which is inexpensive and convenient so can be used in both children and within a busy clinic.

Feasibility of Clinical and Laboratory Diagnostic Approach to Chronic Female Diffuse Alopecia in Dermatologic Outpatient Clinic / 대한피부과학회지

BACKGROUND: Various kinds of disease can cause chronic diffuse hair loss in females such as female pattern hair loss and chronic telogen effluvium etc, but differential diagnosis between these diseases are so sophisticated that an easy and feasible diagnostic approach to chronic female diffuse alopecia has not yet been established. OBJECTIVE: The purpose of this study is to differentiate chronic female diffuse alopecia through several clinical and laboratory methods, which, can be tried easily in a short time with little doctor and assistants input in the ordinary dermatologic outpatient clinic. METHODS: We examined 187 female patients with a chief complaint of chronic diffuse hair loss and/or decreased hair density for more than 6 months. History taking, detailed patient's questionnaire, physical examination including hair pull test and hormonal test or skin biopsy were performed. RESULTS: Common age of onset was 20~29 years (62 cases, 33.1%) and below 19 years old (41 cases, 21.9%). A family history of similar alopecia including female pattern hair loss was seen in 50% (91 cases) and the father was the most common relative (61 cases). Crash diet restriction for weight reduction was the most common aggravating factor (14 cases, 16.1%) of hair loss and seborrheic dermatitis was the most common associated disease (24 cases, 12.8%). The serum ferritin level was lower than normal in 61 cases (40.7%) and serum copper and zinc were decreased in 22 cases (14.7%) respectively. The result of presumptive diagnosis by our checklists were as follows: female pattern hair loss (149 cases, 83.2%), diffuse alopecia areata (13 cases, 7.3%), chronic telogen effluvium (6 cases, 3.4%), and polycystic ovarian syndrome (3 cases, 1.7%). CONCLUSION: Female pattern hair loss might be the most common disease in chronic diffuse alopecia in females and a decrease of the serum ferritin level was most frequently observed. Further study about diagnostic methods such as transverse section of skin biopsy and phototrichogram will be needed for a more accurate final diagnosis.

Four Cases of Capillary Aneurysm: Clinical Differential Diagnosis with Malignant Melanoma / 대한피부과학회지

Capillary aneurysm is classically described as a suddenly growing dark papule, and is also known as thrombosed capillary or vein. It is clinically significant that the clinical features of capillary aneurysm are closely similar to those of malignant melanoma or dysplastic nevus. The histopathological finding of capillary aneurysm reveals dilated thin-walled venule(s) just beneath the hyperplastic epidermis, lined by a single layer of endothelium and a thrombus in the lumen. This abstract focuses on four patients who presented with a dark black-colored dome-shaped nodule and clinical impression included malignant melanoma, dysplastic nevus, angiokeratoma and lymphangioma circumscriptum. We herein report four cases histologically diagnosed as capillary aneurysm, which should be considered for differential diagnosis.

Seven Cases of Cutaneous Angiosarcoma of the Scalp of the Aged / 대한피부과학회지

Cutaneous angiosarcoma is a rare, aggressive vascular malignancy with a grave prognosis. It usually arises in the scalp or face as a locally-advanced patch, plaque or tumor at presentation and most often affects males and the elderly. Histopathologically, well-differentiated angiosarcomas are composed of well- or ill-formed vascular channels, often lined by flattened atypical endothelial cells and are distinguished from benign counterparts by their so-called "collagen dissection pattern" and anastomosing architecture. Varied differentiation may be observed even in the same tumor. Epithelioid angiosarcoma is a rare variant of poorly-differentiated angiosarcoma. The patients were seven cases of angiosarcomas including an epithelioid variant. They were six males and one female with an age range between 65~84 years (avg. 74 years). Lesions resembled seborrheic dermatitis, erysipelas or "spreading bruise" that varied from blue to red in color and from papule to mass in size. They revealed satellite lesions far from the main lesion in some cases. Skin biopsies were performed for all patients and histopathologic features were compatible with angiosarcoma and epithelioid angiosarcoma. We herein report seven angiosarcomas of diverse clinical features because their early detection and precise differential diagnosis should be mandatory for effective management.

A Case of Norwegian Scabies in a Patient with Pemphigus Foliaceus / 대한피부과학회지

Norwegian scabies can be defined as a generalized, severe scabies infestation which usually affects immunocompromised patients. The diagnosis is commonly missed, and can lead to mismanagement. We describe a patient with Norwegian scabies affecting the whole body. The patient had suffered with pemphigus foliaceus for several years and had an immunosuppressed status due to long-term use of oral corticosteroids. He was admitted to our hospital. At first, we made a diagnosis of exfoliative dermatitis secondary to pemphigus foliaceus. However, no improvement of the condition was seen after an increased dosage of oral corticosteroids, azathioprine, and mycophenolate mofetil. We then identified adult scabietic mites, eggs and scybala upon microscopic examination of skin scales. He was treated with an application of gamma benzene hexachloride cream. We recommend that the diagnosis of scabies be considered in immunocompromised patients with thick skin scales and associated night pruritus.