A Case of Osteoma Caused by Filler Injection / 대한피부과학회지

No abstract available.

A Case of Dermatomyositis with Acute Interstitial Pneumonitis Manifested as Antisynthetase Syndrome / 대한피부과학회지

Dermatomyositis is a systemic inflammatory disease affecting the skin, skeletal muscle, and occasionally, other organs, such as the lung. Interstitial lung disease (ILD) is a serious lung complication, which can occur in patients with dermatomyositis. It affects the prognosis of the disease and requires a more aggressive therapeutic approach. Interstitial lung disease (ILD) may be associated with systemic inflammatory disorders and autoantibody production. In particular, anti Jo-1 antibody has long been recognized as an important predictive factor in systemic manifestations of ILD in dermatomyositis. We report here a case of a 42 year old woman with cutaneous lesions typical of dermatomyositis, showing clinical features of antisynthetase syndrome, which showed rapid progression to acute respiratory distress syndrome.

Multiple Trichoepithelioma Improved by Intralesional Bleomycin Injection / 대한피부과학회지

Multiple trichoepithelioma is a benign adnexal neoplasm characterized by the presence of many small papules that appear predominantly on the face. Clinical improvement have been demonstrated after several treatments such as carbon dioxide laser, cryotherapy, dermabrasion, and argon laser. However, these destructive methods have various disadvantages. We report a case of multiple trichoepithelioma treated with an intralesional bleomycin injection. Fewer lesions without scars and cosmetic improvements were observed. Bleomycin is a cytotoxic antitumor antibiotic that can be injected intralesionally by transcutaneous administration and displays excellent results for treating malignancies including skin tumors. We believe that intralesional bleomycin injection is an effective treatment option for this condition, and an easy method to conduct at the outpatient clinic.

Ulcerative Necrobiosis Lipoidica Improved by Hydroxychloroquine / 대한피부과학회지

Necrobiosis lipoidica (NL) is a chronic granulomatous skin disease of unknown etiology, which can be seen in patients with diabetes mellitus. Typical lesions of NL appear on the pretibial skin as painful yellow-brown inflammatory plaques with raised borders and atrophic centers. Ulceration occurs in approximately 35% of cases, leading to increased risk of secondary bacterial infection and scarring. Although there have been many proposed therapies for ulcerative NL, the response to treatment is often met with limited success. Here, we report a case of a 19-year-old girl with ulcerative NL, which showed improvements with oral hydroxychloroquine, an antimalarial agent.

Blastomycosis-like Pyoderma with Good Response to Acitretin

Blastomycosis-like pyoderma is a rare, vegetating skin lesion that is an unusual exaggerated tissue reaction possibly to prolonged primary or secondary bacterial infection. We report a case of blastomycosis-like pyoderma in a man with Down syndrome, diabetes mellitus and hypothyroidism who responsed poorly to conventional therapies, including antibiotics and correction of predisposing factors for a long time, but experienced dramatic improvement after 3 months of acitretin treatment.

Actinomycosis of the Upper Lip

Actinomycotic infections are known to have an association with difficulties in diagnosis and treatment. These infections usually involve the head, neck, thorax, and abdomen. Actinomycosis of the upper lip is a rare condition and an important one as well, because it can imitate other diseases. As the initial impression, it can easily be mistaken for a mucocele, venous lake, or benign neoplasm. An 82-year-old man presented with an asymptomatic normal skin colored nodule on the upper lip. Histopathologic findings showed an abscess and sulfur granules in the dermis. Gram staining results showed a mesh of branching rods. In this report, we present an unusual case of actinomycosis of the upper lip and discuss its characteristics and therapeutic modalities.

Cutaneous Adverse Reactions Associated with Epidermal Growth Factor Receptor Inhibitors / 대한피부과학회지

BACKGROUND: Cutaneous adverse reactions are often observed during chemotherapy with epidermal growth factor receptor (EGFR) inhibitors including papulopustular eruptions, xerosis and paronychia. OBJECTIVE: To investigate and compare the cutaneous adverse reactions induced by EGFR inhibitors including erlotinib, gefitinib and cetuximab which have commonly been used as chemotherapeutic agents in Korea. METHODS: We reviewed cutaneous adverse effects through the medical records and clinical photographs of 43 Korean patients who had been treated with erlotinib, gefitinib or cetuximab at Pusan Paik Hospital between June 2003 and January 2010. RESULTS: Papulopustular eruptions occurred in 28 patients (65.1%); they were easily controlled by topical benzoyl peroxide, clindamycin and a retinoid, or by oral minocycline and tetracycline. There were no significant differences in incidence, duration and severity grades of papulopustular eruptions among EGFR inhibitors. In contrast to previous studies, the frequency and severity of papulopustular eruptions were not significantly correlated with treatment responses to EGFR inhibitors. Xerosis appeared in 14 patients (41%), and was easily controlled by topical emollients and steroids, and by systemic steroids and antihistamines. Paronychia occurred in 8 patients (18.6%) and were controlled by conservative treatments. CONCLUSION: Papulopustular eruptions, xerosis and paronychia are common cutaneous adverse reactions associated with EGFR inhibitors and there are no significant differences in adverse cutaneous reactions among EGFR inhibitors. As these cutaneous adverse reactions are relatively easily controlled with treatment, it will be helpful to detect and treat these adverse reactions early, including reassuring the patients, which should increase compliance of patients during treatment with EGFR inhibitors.

Generalized Discoid Lupus Erythematosus Occurring in a Systemic Lupus Erythematosus Patient / 대한피부과학회지

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem involvement. Skin is the second most frequently affected organ in SLE, and various forms of cutaneous LE (CLE), such as acute, subacute, and chronic CLE, are observed in higher than 75% of patients with SLE. Discoid LE (DLE) is the most common form of chronic CLE, and a small subset of patients with SLE also has concomitant DLE. A 32-year-old woman diagnosed with SLE 6 years ago visited our clinic with a 2-month history of multiple hyperpigmented macules and patches over the entire body. She also complained of arthralgia, auditory, and visual hallucinations. Her clinical presentation, laboratory findings, and histopathologic features were consistent with generalized DLE and aggravation of her SLE. Herein, we report an unusual case of generalized DLE occurring in a patient with SLE.

Multiple Eccrine Hidrocystomas Treated with Botulinum Toxin Type-A / 대한피부과학회지

Eccrine hidrocystomas are benign tumors of the sweat glands that arise from cystic dilatation of the excretory sweat ducts. They may be solitary or multiple. Multiple lesions are observed as small papulonodules having prominent surfaces with a translucent intense bluish dome, localized predominantly to periorbital and malar areas. The diagnosis of multiple eccrine hidrocystomas is clinical, and surgery is the treatment of choice in the case of a single lesion. However, the treatment of multiple eccrine hidrocystomas is challenging and the outcome of conventional therapies varies. Botulinum toxin type-A (BTA) causes chemodenervation at the cholinergic nerve terminal of eccrine glands; accordingly our patient was given intradermal injections of BTA and the result was successful. Herein, we report a case of multiple eccrine hidrocystomas treated successfully with BTA; we believe that BTA can be a novel treatment option for this condition.

Acute Localized Exanthematous Pustulosis on the Face

Acute localized exanthematous pustulosis (ALEP) is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 26-year-old woman presented with multiple erythematous pustules on her face, which had appeared three days after taking antibiotics. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules were resolved within 2 weeks after the patient discontinued the antibiotics. Herein, we present a case of a woman with a cutaneous drug reaction consistent with ALEP that occurred subsequent to administration of antibiotics.

Gynecomastia Treated with Tumescent Liposuction and the Pull-Through Technique / 대한피부과학회지

Gynecomastia is the most common condition affecting the male breast due to enlargement of both ductal and stromal tissue. Growth of the male breast can be manifested at any age, but 40% of cases present in adolescent boys. The condition depends mainly on the balance between serum estrogens and androgens. Gynecomastia represents a source of embarrassment, and optimal correction is difficult to achieve. Numerous methods of gynecomastia repair are available. Our method is a combination of liposuction and the pull-through technique. The purpose of this treatment is to resect excess tissue and restore the normal chest contour with minimal scarring. We report a case of gynecomastia treated with a combination of tumescent liposuction and the pull-through technique.

Clinical Study of Motor Paresis in In-patients with Herpes Zoster / 대한피부과학회지

BACKGROUND: Although herpes zoster primarily affects afferent sensory neurons, it may complicated by motor nerve involvement in 0.5% to 5% of cases. However herpes zoster-induced muscle paresis is still under-recognized by dermatologists, and there has been insufficient clinical investigation of these conditions. OBJECTIVE: This study was conducted to investigate the clinical aspects of motor nerve involvement of herpes zoster. METHODS: We retrospectively reviewed the data of 711 patients with herpes zoster who had been admitted to our hospital in the departments of dermatology, ophthalmology, otorhinolaryngology, neurology, neurosurgery and rehabilitation medicine between 2005 and 2010. RESULTS: Among the 711 patients with herpes zoster, 15 patients had motor paresis (2.1%). 11 patients (73.3%) had facial nerve palsy including one patient who had accompanying vagus nerve palsy. Besides, one case of trochlear nerve palsy, one case of hypoglossal nerve palsy, one case of upper limb paresis and one case of lower limb paresis were noted. Associated underlying diseases were observed in nine patients (60.0%). Duration of motor weakness ranged from 1 month to 4 years. Twelve patients (80.0%) achieved complete recovery. CONCLUSION: In our patient population, the incidence of motor involvement of herpes zoster was higher in cranial nerves, especially the facial nerve, than in spinal nerves. Although motor nerves are usually involved in relation to dermatome, cranial nerve palsy may occur regardless of its dermatome because of complicated anatomical association. The majority of cases recovered completely without any complications. Further prospective investigation with a large group of patients is necessary to better understand the epidemiology of motor nerve involvement of herpes zoster.

Effect of Allopurinol on Foreign Body Granuloma / 대한피부과학회지

A 68-year-old woman presented with erythematous indurated plaques on both her eyebrows. The skin lesions appeared 3 months after she was tattooed on both eyebrows. On histopathologic examination, a granulomatous infiltration was observed in the dermis with no evidence of any fungal, mycobacterial organisms. She was treated with intralesional injection of triamcinolon acetonide, but there was no improvement. After she started to take allopurinol for 5 months, the skin lesion improved without side effects. To the best of our knowledge, this is the first case of foreign body granuloma that was successfully treated with allopurinol in the Korean dermatologic literature.

Multiple Annular Tufted Angioma / 대한피부과학회지

Tufted angioma is a rare, slow-growing, benign, vascular tumor that usually occurs in children. It appeared as an erythematous to red-brown, indurated papule on the trunk or neck. Histopathologic examination shows multiple capillary lobules in a cannon ball appearance scattered throughout the dermis. We present here a 32-year-old woman with multiple annular lesions on her right thigh, which started as red papules and they progressed with annular extension and central regression for 3 years. The histopathologic findings were compatible with tufted angioma. The lesions were treated with 3 sessions of sclerotherapy. We report here on an unusual tufted angioma that occurred as multiple lesions which showed annular extension with central regression.

A Study of the Effectiveness in the Treatment of Mild to Moderate Severity Acne with Adapalene-benzoyl Peroxide Fixed-dose Combination Gel (Epiduo(R)) / 대한피부과학회지

BACKGROUND: A fixed-dose combination gel with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% has been developed for once-daily treatment of acne. It is known to be effective to reduce inflammatory and non-inflammatory lesions, but there have been no study in Korean yet. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of adapalene 0.1%-BPO 2.5% fixed-dose combination gel (adapalene-BPO) for the treatment of mild to moderate severity acne in Korean. METHODS: In total, 64 patients with mild to moderate severity acne were enrolled. Adapalene-BPO was applied to face once daily at night. The efficacy assessment was performed at baseline and monthly for 3 months: inflammatory lesions (IL), non-inflammatory lesions (NIL), total lesions (TL) were counted and median percentage changes of each lesion were measured for 3 months with patient satisfaction and adverse events questionnaire. RESULTS: Of the 64 patients enrolled, 58 have completed 3-month treatments. Adapalene-BPO showed early onset of action with significant reduction in inflammatory, non-inflammatory, and total lesion counts. The median percentage reduction of mild group from baseline to 3rd month was greater than moderate group in IL, NIL, and TL counts (71.1% vs 65%/61.4% vs 56.4%/67.7% vs 62% reduction). Also, patient satisfaction score improved and significant reduction of Korea Acne Grading System (KAGS) was noted in both groups. All the reported adverse events were mild. CONCLUSION: This study shows that adapalene-BPO is an effective and safe treatment regimen for both mild and moderate acne. It has a better effect for treating mild severity acne than moderate acne with reduction of the IL, NIL, and TL counts and greater patient satisfaction.

Inflammatory Disseminated Superficial Porokeratosis / 대한피부과학회지

Inflammatory disseminated superficial porokeratosis is an unusual pruritic variant of disseminated superficial porokeratosis, and this was first described by Kanzaki in 1992 as eruptive pruritic papular porokeratosis. Since the first report, 8 cases of inflammatory disseminated superficial porokeratosis have been reported in English language dermatologic literature and only one case has been reported in the Korean dermatologic literature. The condition is clinically characterized by an acute pruritic exacerbation of disseminated superficial porokeratosis, which had been asymptomatic for several years. Usually the skin lesions show improvement after several months, leaving brownish atrophic lesions. Histopathologic examination reveals the cornoid lamella with an infiltration of eosinophils and lymphocytes in the upper dermis. Herein, we report on an 81-year-old Korean man with inflammatory disseminated superficial porokeratosis, and this was clinically and histopathologically diagnosed.

Infantile Hemangioma Treated with Dermal Injection of Ethanolamine Oleate / 대한피부과학회지

Infantile hemangiomas are benign vascular tumors that commonly occur in infants. The management of hemangiomas ranges from simple observation and assurance to surgical resection. The commonly used treatment modalities include topical, intralesional and systemic steroids, pulsed dye laser and surgical excision. There are several reports of infantile hemangiomas treated with direct percutaneous injections of sclerosing agents such as ethanol, polidocanol or ethanolamine oleate. We report here on a case of infantile hemangioma that was treated with ethanolamine oleate by dermal injection. We think this is the first report of a dermal injection of ethanolamine oleate, and not intraluminal injection, for treating infantile hemangioma.

Seborrheic Keratosis That Developed Along the Frictional Areas of the Inguinal Skin / 대한피부과학회지

Seborrheic keratosis is a common benign epidermal tumor. Although the etiology of seborrheic keratosis is unknown, a genetic predisposition, sun exposure and viral infection are possible factors. It also can be associated with auto-inoculation or chronic stimuli by friction. We experienced two cases of seborrheic keratosis with continuous arrangement along the frictional areas of the inguinal skin. Because there were no triggering factors, including sun exposure or human papilloma virus infection, we thought repetitive frictions or auto-inoculation might be related to these cases. Herein, we report on two cases of seborrheic keratosis that developed along the frictional areas of the inguinal skin.

A Clinical Study on Uremic Pruritus in Hemodialysis Patients / 대한피부과학회지

BACKGROUND: Uremic pruritus is a common disabling problem in patients with end-stage renal disease (ESRD). Not many studies have focused on evaluating the clinical characteristics of uremic pruritus. OBJECTIVE: The aim of this study was to identify the prevalence and clinical characteristics of uremic pruritus in hemodialysis patients. METHODS: A detailed questionnaire was used to evaluate the pruritus of 75 patients who were treated at the hemodialysis unit in Maryknoll Medical Center. We examined the relationship of the quality of dialysis and various factors and medical parameters with uremic pruritus. RESULTS: Pruritus was a common symptom in the study population. Twenty two point seven percent of the patients had severe pruritus in the past, and 36% were affected by it at the time of the study. There was no correlation between the occurrence of pruritus and the demographic or medical parameters of the patients (gender, age, the cause of ESRD, the duration of ESRD and hemodialysis, previous treatment of ESRD, the dialysis efficacy as expressed by Kt/V, and the transfusion and laboratory parameters such as blood urea nitrogen, creatinine, calcium, phosphorus, parathyroid hormone and uric acid). Skin dryness was found in 14 (18.7%) patients. It was assessed as slightly dry skin in 9 (12.0%) patients and as rough skin in 5 (6.7%) patients. A significant relationship was demonstrated between the intensity of xerosis and the frequency of uremic pruritus (p=0.042). The intensity of xerosis was greater in the severe pruritic patients, but any statistically significant correlation was not found. The major factors found to exacerbate pruritus included sleep disturbance, heat, dry skin and dialysis. The major factors found to reduce pruritus included taking a shower or bath, sleeping, dialysis and physical activity. CONCLUSION: There was a significant relationship between the intensity of xerosis and the frequency of uremic pruritus. A better understanding of the clinical characteristics of uremic pruritus will afford clinicians the necessary elementary tools to discover its origin and the possible effective treatments.

A Case of Lichen Spinulosus Arising at the Site of Antecedent Seborrheic Dermatitis / 대한피부과학회지

Lichen spinulosus (LS), a disorder of keratinization, is characterized by 1 to 3 mm sized follicular keratotic papules with a central horny spine that are grouped into large patches. Involved lesions were symmetrically distributed over extensor surfaces of the arms and legs, back, chest, face and neck. Although the exact etiology is unknown, several factors such as atopic dermatitis, infections and genetic components have been proposed as playing a role in LS. Additional associations reported in the literature include Crohn's disease, Hodgkin's disease, HIV infection, administration of omeprazole, and seborrheic dermatitis. Herein, we report a case of wide spread lichen spinulosus occurring on a preexisting seborrheic dermatitis lesion in a 50-year-old woman.