Cryotherapy in Dermatology / 대한피부과학회지

Cryotherapy is one of the most widely used procedures in the field of dermatology. Since the development of cryotherapy with the use of liquid nitrogen beginning in the 19(th) century, its use has gradually increased for various dermatologic conditions, including benign conditions, premalignant lesions, and malignancies. Because the therapeutic effects of cryotherapy are diverse, it must be applied specifically for each indication, requiring a thorough understanding of the basic principles and mechanisms of cryotherapy. In addition, both acute and chronic complications can develop, which may possibly leave permanent scars and tissue damage, thus, careful manipulation is required. In conclusion, cryotherapy is a frequently used treatment method but should be performed precisely by well-trained specialists.

Foreign Body Reaction to Injectable Hyaluronic Acid: Late Granuloma Formation

No abstract available.

Photodynamic Therapy for Bowen's Disease of the Vulva Area

Bowen's disease is a squamous cell carcinoma in situ and has the potential to progress to a squamous cell carcinoma. The authors treated two female patients (a 39-year-old and a 41-year-old) with Bowen's disease in the vulva area using topical photodynamic therapy (PDT), involving the use of 5-aminolaevulinic acid and a light-emitting diode device. The light was administered at an intensity of 80 mW/cm2 for a dose of 120 J/cm2 biweekly for 6 cycles. The 39-year-old patient showed excellent clinical improvement, but the other patient achieved only a partial response. Even though one patient underwent a total excision 1 year later due to recurrence, both patients were satisfied with the cosmetic outcomes of this therapy and the partial improvement over time. The common side effect of PDT was a stinging sensation. PDT provides a relatively effective and useful alternative treatment for Bowen's disease in the vulva area.

Multiple Intradermal Soft Tissue Perineuriomas of the Digit / 대한피부과학회지

Perineurioma is a rare benign peripheral nerve sheath tumor, composed uniformly of perineurial cells. Soft tissue perineurioma primarily arises within the subcutaneous tissue of extremities and trunk as a painless solitary nodule, and should be distinguished from dermatofibroma, neurofibroma, dermatofibrosarcoma protuberans, meningioma and so on. A 25 year-old female is presented with three small asymptomatic papules on the third left finger which were found 3 years ago. Punch biopsy was performed on all of the papules. Microscopic examination demonstrated well-demarcated tumor within dermis, and proliferation of spindle cells with wavy nuclei and elongated bipolar cytoplasmic process, arranged in a whorled pattern. According to immunohistochemical analysis, the tumor cell showed positivity for epithelial membrane antigen, but negativity for S-100 protein, factor XIIIa, CD34, and smooth muscle actin. The diagnosis of soft tissue perineurioma was being made. We report this rare case of perineurioma presented as multiple papules localized within dermis of the digit.

Change of Quality of Life after Melasma Treatment / 대한피부과학회지

BACKGROUND: Melasma is an acquired, symmetrical hypermelanosis that occurs on sun-exposed areas of the skin. It has significant emotional and psychological effects on those affected with the condition. Melasma Quality of Life Scale (MELASQOL) is a specific questionnaire to identify the most impaired areas of melasma patient's life. OBJECTIVE: Our purpose of this study is to investigate the changing of MELASQOL after the treatment of melasma. METHODS: A total of 27 volunteers with melasma were enrolled in this 8-week treatment study. The patients were instructed to apply an arbutin-containing cream, once a day for 8 weeks. The assessment of outcomes included the colorimetric value (L*) and MELASQOL score. RESULTS: The arbutin-containing cream group increased more in the colorimetric values (L*) after the 8-week treatment (p<0.01). The MELASQOL score was decreased (p=0.02). No significant adverse reactions were observed. CONCLUSION: The treatment of melasma improves the QOL of melasma patients.

Pityriasis Rubra Pilaris Treated with Infliximab / 대한피부과학회지

Pityriasis rubra pilaris (PRP) is a chronic papulosquamous disorder of unknown etiology, which may pose therapeutic challenges. There is currently no universally effective treatment for PRP, and some cases are resistant to multiple topical and systemic therapies. Systemic retinoids, methotrexate, several immunosuppressive agents and phototherapy have all been used with varying degrees of success. Recently, a few reports have appeared in the literature, concerning the use of biologics in combination therapies and/or in refractory PRP cases. We report a case of PRP similar to type II with juvenile onset, which was recalcitrant to traditional topical and systemic therapy. He was successfully treated with anti-TNF-alpha monoclonal antibody, infliximab. The patient showed resolution with minimal disease activity, and was maintained on acitretin and emollients. The response to infliximab in our patient and in the previously reported cases confirms a role of anti-TNF-alpha therapy as an effective option in the treatment of PRP.

Cheilitis Glandularis Limited to the Upper Lip / 대한피부과학회지

No abstract available.

Analysis of Risk Factors of Childhood Atopic Dermatitis, in Dong-gu, Incheon / 대한피부과학회지

BACKGROUND: Genetic predisposition and environmental aspects may act as triggering factors and influence the disease expression. Dong-gu, which is located on the west of Incheon, has a large harbor and industrial complex. Such environmental aspects of Dong-gu may play a role in AD. OBJECTIVE: We investigated the epidemiologic features of AD in preschool and elementary school children in Dong-gu. METHODS: This study was carried out among 2,760 preschool and elementary school children from June to October. A questionnaire survey is composed of clinical manifestations, genetic and environment factors and lifestyle. Two dermatologists examined the skin conditions of the subjects. The severity of AD was evaluated using the Eczema Area and Severity Index (EASI) score and the factors affecting the severity of the diseases were determined. RESULTS: The questionnaire suggested that there was 19.7% of the preschool childhood and elementary school students in Incheon with AD. But, the prevalence of AD evaluated by the two dermatologists was 13.2%. The average EASI score is 2.88 (+/-4.08). There was a statistical significance in parental past history, especially of atopic dermatitis and moving into a new house within a year after birth (p<0.05). CONCLUSION: These results suggest that there is strong correlation of genetic and environmental factors in the severity of atopic dermatitis in children.

Reed Syndrome / 대한피부과학회지

Reed syndrome is an autosomal dominantly inherited disease with incomplete penetrance that is characterized by uterine and cutaneous leiomyoma. While the skin tumors are relatively uncommon and benign, women of affected families often develop uterine leiomyoma with associated infertility, pain and bleeding. Here, we report a case of Reed syndrome in a family with multiple cutaneous and uterine leiomyomas. A 30-year-old woman had not only multiple cutaneous leiomyomatosis on cheek and neck, but also uterine multiple leiomyoma. Her mother had lesions that the multiple cutaneous leiomyomatosis on both shoulders and underwent myomectomy for a huge uterine leiomyoma at the age of 45. Her older sister also underwent myomectomy for uterine leiomyoma.

Pediatric Sweet Syndrome / 대한피부과학회지

Sweet syndrome or acute febrile neutrophilic dermatosis is characterized by abrupt onset of fever, leucocytosis, and tender erythematous nodules or plaques that respond to systemic corticosteroids. It occurs most commonly in middle aged women and is rare in children. We report a 2-year-old boy with Sweet syndrome who had fever, leukocytosis, neutrophilia and presented with erythematous maculopapules with tiny pustules over the whole body. Additionally he had an antecedent infection. Our evaluation and long term follow-up of this child failed to reveal evidence of an underlying malignancy or a chronic systemic illness.

Eccrine Angiomatous Hamartoma Mimicking a Traumatic Hemorrhage

Eccrine angiomatous hamartoma (EAH) is a rare benign disease that is characterized by an abnormal proliferation of eccrine glands and vascular elements. It is generally congenital, but it can appear before puberty. It usually presents as a single plaque or nodule, but multiple patch-like lesions are also possible. EAH is mostly asymptomatic, but it is sometimes associated with pain or hyperhidrosis. It generally does not require aggressive treatment, but the lesion can be excised due to pain, enlargement and cosmetic reasons. A 3-week-old Korean female presented with a hemorrhagic skin lesion on the right foot since birth. There was no specific birth history. The lesion first appeared on the third toe of the right foot and quickly spread to almost half of the right foot. Histopathology examination revealed acanthosis in the epidermis and a proliferation of eccrine ducts, glands and capillaries. The eccrine glands were immunohistochemically-positive for carcinoembryonic antigen.

The Neumann Type of Pemphigus Vegetans Treated with Combination of Dapsone and Steroid

Pemphigus vegetans is a rare variant of pemphigus vulgaris and is characterized by vegetating lesions in the inguinal folds and mouth and by the presence of autoantibodies against desmoglein 3. Two clinical subtypes of pemphigus vegetans exist, which are initially characterized by flaccid bullae and erosions (the Neumann subtype) or pustules (the Hallopeau subtype). Both subtypes subsequently develop into hyperpigmented vegetative plaques with pustules and hypertrophic granulation tissue at the periphery of the lesions. Oral administration of corticosteroids alone does not always induce disease remission in patients with pemphigus vegetans. We report here on a 63-year-old woman with pemphigs vegetans. She had a 2-year history of vegetating, papillomatous plaques on the inguinal folds and erosions of the oral mucosa. The enzyme-linked immunosorbent assay was positive for anti-desmoglein 3, but it was negative for anti-desmoglein 1. She was initially treated with systemic steroid, but no improvement was observed. The patient was then successfully treated with a combination of systemic steroid and dapsone with a good clinical response.

A Malignant Melanoma Associated with a Blue Nevus of the Lip

Blue nevi are characterized by a collection of pigment-producing melanocytes in the dermis. These lesions clinically present as well demarcated cerulean-blue or bluish black colored papules or plaques that usually measure less than 1 cm in diameter. They are typically found on the dorsal surface of the hands and feet or in the head and neck region; however, they are rarely found in the oral cavity. These lesions are usually benign and stable over time. However, malignant melanomas developing in or associated with a blue nevus (which is also called malignant blue nevus) have been only rarely reported. A malignant blue nevus might develop in a common blue or cellular blue nevus, a giant congenital nevus or in a nevus of Ota, or it may be malignant from the start. Malignant blue nevi most commonly are found on the scalp. A malignant blue nevus of the lip has not been previously reported in the medical literature. We report here on a patient with a malignant melanoma associated with a blue nevus of the lip. The malignant melanoma was presumed to have developed from a blue nevus that was present on the upper lip of a 50-year-old male.

Chromoblastomycosis Caused by Phialophora richardsiae

Chromoblastomycosis is a chronic fungal disease of the skin and subcutaneous tissues caused by a group of dematiaceous (black) fungi. The most common etiologic agents are Fonsecaea pedrosoi and Cladophialophora carrionii, both of which can be isolated from plant debris. The infection usually follows traumatic inoculation by a penetrating thorn or splinter wound. Several months after the injury, painless papules or nodules appear on the affected area; these papules then progress to scaly and verrucose plaques. We report a case of chromoblastomycosis caused by Phialophora richardsiae, which has been rarely associated with chromoblastomycosis. The case involved a 43-year-old male, who for the past 2 months had noted an erythematous, pustulous plaque that was somewhat dark brown in color on his right shin; the plaque also had intermittent purulent discharge and crust formation. On histopathological examination, chronic granulomatous inflammation and sclerotic cells were seen. The tissue fungus culture grew out the typical black fungi of P. richardsiae, which was confirmed by polymerase chain reaction. The patient has been treated with a combination of terbinafine and itraconazole for 3 months with a good clinical response.

Sweet Syndrome as an Initial Presentation in a Patient with Systemic Lupus Erythematosus / 대한피부과학회지

Sweet syndrome is also called acute febrile neutrophilic dermatosis and this malady is characterized by an abrupt onset of fever, leukocytosis and tender erythematous plaques that are infiltrated by neutrophils. It most commonly occurs in women who are between 30 to 50 years of age. About 50% of the cases are associated with autoimmune disease, sarcoidosis, Behcet's disease and pregnancy. We present here a 48-year-old woman who had tender erythematous tender plaque and nodules with vesicles and pustules over both extremities. She complained of general weakness, chills and arthralgia. We biopsied the nodule and performed laboratory tests. The results of the biopsy were compatible with Sweet syndrome and the laboratory test showed systemic lupus erythematosus. We report here on a case of Sweet syndrome as an initial presentation of systemic lupus erythematosus.

Three Cases of Pilomatricoma That Clinically Presented as Hemangioma on the Eyelid / 대한피부과학회지

Pilomatricoma is a common benign neoplasm that originates from the matrix of the hair root. The tumor usually presents as a deep-seated, solitary, firm nodule with overlying epidermis. It occurs more frequently in the head and neck region of children and adolescents, and it often involves the eyelid or eyebrow. Pilomatricoma is often misdiagnosed clinically and the correct diagnosis can be established only after excision and histological examination. The pathologic diagnosis of pilomatricoma is based on finding large masses of shadow cells, combined with basophilic cells, inflammation, foreign body giant cells, calcification and ossification. We report here on 3 cases of pilomatricoma that clinically presented as hemangioma on the eyelid. Punch and excisional biopsy were done after ultrasonography, and we diagnosed the lesions as eyelid pilomatricoma.

Metastatic Malignant Fibrous Histiocytoma Mimicking Keratoacanthoma / 대한피부과학회지

Malignant fibrous histiocytoma (MFH) has been considered to be the most common malignant soft tissue tumor of middle and late adulthood. This tumor is usually a skin-colored subcutaneous nodule. It metastasizes to the lung, lymph node, bone and liver. Metastasis to the skin is very rare. We present a case of a 69-year-old man who presented with an asymptomatic dome-shaped large nodule with central umbilical ulceration on his scalp that had grown abruptly over 3 months. The lesion clinically mimicked keratoacanthoma. Biopsy of the nodule was done to differentiate keratoacanthoma from MFH confirmed the latter. The result of biopsy was MFH. Diagnosis was MFH of unknown primary tumor origin. We report a case of metastatic MFH mimicking keratoacanthoma.