Clinical Characteristics and Prognostic Factors in Early-Onset Alopecia Totalis and Alopecia Universalis

Alopecia totalis (AT) and alopecia universalis (AU), severe forms of alopecia areata (AA), show distinguishable clinical characteristics from those of patch AA. In this study, we investigated the clinical characteristics of AT/AU according to the onset age. Based on the onset age around adolescence ( or = 13 yr), 108 patients were classified in an early-onset group and the other 179 patients in a late-onset group. We found that more patients in the early-onset group had a family history of AA, nail dystrophy, and history of atopic dermatitis than those in the late-onset group. These clinical differences were more prominent in patients with AU than in those with AT. In addition, significantly more patients with concomitant medical disorders, especially allergic diseases were found in the early-onset group (45.8%) than in the late-onset group (31.2%). All treatment modalities failed to show any association with the present hair condition of patients. In the early-onset group, patients with AU or a family history of AA showed worse prognosis, whereas this trend was not observed in the late-onset group. Systemic evaluations might be needed in early-onset patients due to the higher incidence of comorbid diseases. It is suggested that patients with AU or family history of AA make worse progress in the early-onset group than in the late-onset group.

Physiological Characteristics of Skin of Normal Mongolian Subjects Determined by Non-invasive Bioengineering Methods / 대한피부과학회지

BACKGROUND: Physiological parameters of the skin measured by non-invasive methods have been considerably developed. It is known that there are some differences in physiologic parameters between different races. OBJECTIVE: The purpose of this study is to understand the differences between the races. METHODS: A total of 757 Mongolian participated in this study. All subjects had no major history of skin diseases requiring medical treatment. Several instruments were used such as Sebumeter, Corneometer, Mexameter for measuring sebum excretion rate, values of capacitance, melanin index and erythema index respectively. These were measured on various areas of the skin such as cheek, forehead, palm, outer arm, inner arm, back and buttock. RESULTS: The sebum excretion rates showed higher in males than in females on the cheek and forehead in Mongolian. However, they showed higher in the females on the palm. There were good correlation between the skin sebum level and the capacitance in males and females. The melanin index and erythema index showed higher in males than in females at all sites. When we compared this with the data published in other countries, many data were similar to Korean rather than a western country's. However, the capacitance data were lower than those of Korean. CONCLUSION: Although, this study has some limit for direct comparison between each race, our results can be used as basic data for the comparison between Mongolian and other races in the future.

Treatment of Keratoacanthoma with 5% Imiquimod Cream and Review of the Previous Report

Keratoacanthoma (KA) is a benign epidermal tumor, characterized by rapid and abundant growth, a tendency toward spontaneous regression and histopathologic similarity to squamous cell carcinoma (SCC). Because KA can be easily misdiagnosed as SCC, surgery is considered the treatment of choice. Recently, regression of KAs following application of 5% imiquimod cream (Aldara(R)) has been reported. We present 4 cases of KA treated with topical imiquimod, applied 3 to 4 times a week. Obvious improvement was observed after 4 to 6 weeks of application and the lesions were almost cleared leaving scars after 9 to 11 weeks. These results show that topical imiquimod can be an effective option for the conservative management of KA as previously reported. We also suggest that lesions treated with imiquimod cream should be considered for biopsy to judge histopathological remission after 5 to 8 weeks of application to shorten the duration of the treatment.

A Case of Assisted Reproductive Therapy-induced Erythema Nodosum

Erythema nodosum is a common variant of panniculitis. It is characterized by tender erythematous nodule and plaque on the anterior aspect of the leg. The etiology is not fully understood. It may be associated with a variety of disorders, including infection, medication, autoimmune disorders, pregnancy, and malignancy. A 33-year-old Korean woman presented with 1 week history of painful erythematous plaques on both knees. She was 7 weeks pregnant with assisted reproductive therapy, and had been maintained on daily intramuscular progesterone injection for 4 weeks. Histological examination of the lesions revealed septal panniculitis without vasculitis. Two days after discontinuing progesterone injection, the symptoms and lesions started to resolve. Herein we present a case of erythema nodosum caused by progesterone injection for endometrial preparation.

Four Cases of Lobulated Intradermal Nevus: A Sign of Aging Melanocytic Nevus

Melanocytic nevi are subject to change with age in both clinical and histopathologic findings. In 1991, Cho et al. first reported three cases of lobulated intradermal nevi and suggested their cases represented an unusual form of regressing melanocytic nevus. Herein we report four cases of lobulated intradermal nevus and review previous literature.

Prognostic Factors for Cure and Recurrence of Onychomycosis / 대한의진균학회지

BACKGROUND: The cure of onychomycosis (OM) requires long-term oral antifungal treatment, and recurrences after successful treatment are relatively common (10~53%). OBJECTIVE: We sought to determine the factors affecting the duration of treatment and identify risk factors for recurrence. METHODS: We retrospectively reviewed successfully treated consecutive cases of onychomycosis between January 2006 and February 2010. We classified the patients into 7 groups: distal subungual onychomycosis (DSO) type I (~25% involved), type II (25~50%), type III (50~75%), type IV (75~100%), proximal subungual onychomycosis (PSO), superficial white onychomycosis (SWO), and candidal OM. The patients were treated with systemic agents including terbinafine, fluconazole and itraconazole. We analyzed the clinical data for factors affecting the duration of treatement and recurrence of onychomycosis. The factors included age, sex, subtype of onychomycosis, type of systemic antifungal agent as well as the existence of comorbidities. RESULTS: A total of 227 patients were enrolled: their mean age was 56.9 years (range, 11~90); mean duration of treatment was 7.2 months (range, 1~24). The duration of treatment of DSO type I (6.2 months) was shorter than that of DSO III (8.5 months) and IV (9.0 months). The other factors including age, sex, the existence of diabetes or vascular disease, and the type of systemic agents did not affect the duration of treatment. The recurrence rates after successful treatment were 12.5% in the patients with diabetes and 2.6% in the patients without diabetes (p = 0.026). There was no difference in recurrence rates of the patients with or without vascular diseases. CONCLUSION: The duration of treatment to cure OM increased with the degree of involvement of DSO. No other factors affected the treatment duration significantly. recurrence rate was significantly higher in patients with diabetes.

Congenital and Multiple Hobnail Hemangiomas

Hobnail hemangioma (targetoid hemosiderotic hemangioma) is a vascular tumor affecting the limbs or trunk. Characteristically, the lesion has a "targetoid" clinical feature and dilated vascular spaces lined by hobnail endothelial cells at histologic examination. The age of onset is widely variable, form 5~67 years, typically occurring in young or middle-aged persons. It is usually apparent as a small solitary lesion. However, multiple lesions are identified sometimes. Herein, we report two cases of hobnail hemangioma in 7-year-old and 15-year-old males. Of note, the former case had a congenital lesion and the latter, multiple acquired lesions, which are both rare atypical presentations of the disease.