A Retrospective Clinical Epidemiological Study of the Health Care Utilization of the Outpatients in the Dermatologic Field after 1 year's Separation of Dispensary from Medical Practice / 대한피부과학회지

BACKGROUND: Despite 2 years' separation of dispensary from medical practice since year of 2000, many outpatients in Korea have a lack of understanding this separation. In addition, the illegal practices of pharmacists such as medical examination have contributed to the recent problematic situation. OBJECTIVE: We performed this study to evaluate the actual situation of the separation of dispensary from medical practice in the dermatologic field. METHODS: The clinico-epidemiologic analysis of 17 months' data of 18, 230 outpatients was conducted through the available medical records and serial questionnaires. RESULTS: The medical or non-medical institutions that 18, 230 outpatients with skin diseases had chosen at first, were as follows by the order of frequency; pharmacy(78.5%), folk remedies or self-medication(9.8%), dermatologic institutions(5.5%), non-dermatologic medical clinics(3.4%), herb clinics(2.8%). Accordingly, most(94.5%, 17, 223) of the new patients did not select a dermatologic institution for the care of their skin diseases. The patterns of health care utilization of the patients mostly(72.9%) showed a fixed tendency to visit the one particular institution or formula continuously prior to final visit to the research hospitals. Most of the patients(62.8%) firstly visited a pharmacy for their disease care and did not revisit another institution. Since the first visit to a pharmacy, 9.6% of the patients repetitively utilized one or more herb clinic(s) or folk remedies in addition to one or more medical institution(s). The patients utilizing non-dermatologic measures for skin disease care at first, were mostly in their fifties(25.3%). The patients seeking herb medicine or non-dermatologic medical clinics, were in their teens(27.3% and 24.3%, respectively). Of the cases misdiagnosed as another disease or aggravated in the patients choosing non-dermatologic care, fungal infections are most common(24.0%). In front of 97.1% of the patients seeking pharmacy at first, the pharmacists practiced medicine like a physician in a wrong way instead of dispensing a prescription. CONCLUSION: In Korea, the majority of dermatologic clinics has been deprived of a position as an institution for primary care of skin diseases. It is imperative that dermatologists should be granted independent and unconstrained authority in the medical profession for the benefit of their patients.

Two Cases of Cellulitis on the Saphenous Venectomy Scar after a Coronary Artery Bypass Graft / 대한피부과학회지

We report two cases of cellulitis on the saphenous venectomy scar which developed after a coronary artery bypass graft(CABG). A 68-year-old male and a 62-year-old female developed acute cellulitis in the saphenous vein donor extremity after CABG. The repeated bacterial cultures were negative in both cases. However, onychomycosis was confirmed in one patient. The intervals between CABG and the initial bout of cellulitis in the male and female patient were 10 and 22 months, respectively. Although the exact pathogenesis remains obscure, factors such as direct bacterial infection, hypersensitivity to streptococcal exotoxins, a local compromise of lymphatic and venous drainage, and fungal infection might have contributed to the development of cellulitis in these patients.

A Clinical Observation of Cutaneous Malignant Tumors over 10 Years ( 1987-1996, Chonnam Province ) / 대한피부과학회지

BACKGROUND: The incidence of Cutaneous malignant tumors has increased recently and they have varied in their developing patterns according to social and environmental influences. However, we have little clinical data about the cutaneous malignant tumors in the Chonnam provinee. OBJECTIVE: Our purpose was to analyze the clinical characteristics of cutaneous malignant tumors observed in the Chonnam province and to compare them with the data previously reported in Korea. METHOD: We clinically analyzed 427 cases of cutaneous malignant tumors during a 10 year period betwecn January 1987 and Oetober 1996, at the Department of Dermatology, Chonnam Univemity Hospital in Kwangju. RESULTS: 1. The average armual incidence of cutaneous malignant tumors among the total number of outpatients was 1.00+/- 0.25%. The incidence tended to increase with time from 0.90+/-0.29% in the first 5 year-period to 1.15+/-0.09% in the late 5 year-period. The increasing rate was most pronmient in basal cell carcinoma. 2. The most common tumor in the 427 patients with malignant tumor was basal cell carcinoma (52.5%), followed by squamous cell carcinoma (19.9%), malignant melanoma (13.3%), metastatic carcinoma (3.7%), malignant lymphoma (2.3%). 3. The mean age of onset was 60.7+/-16.0 years old (male; 59.6+/-15.0, female; 61.9+/-17.1) in the in the group as a whole; 63.9 in BCC, 63.3 in SCC and 55.8 in malignant melanoma. The ratio of men to women was 1.14:l. 4. The most common site of a11 malignant tumors was the head and neck (64.6%), where 89.3% of BCC, 58.8% of SCC, and 15.8% of malignant melanoma developed. The next common site was the lower exlremities and feet (15.7%) followed by the trunk (7,7%), and upper extremities and hands (7.3%).

Immunohistochemical Studies of bc1-2 Protein in a Skin Tumor of Neuroectodermal Origin / 대한피부과학회지

BACKGROUND: Protooncogene, bcl-2 is known to inhibit, apoptosis induced by various stimuli. Its expression has been reported in various fetal and adult tissues, and also in tumors of neural origin. OBJECTIVE: The purpose of this study was to evaluate the expression of bcl-2 in a skin tumor of neuroectodermal origin and to estimate whether this expression was useful in the different,ial diagnosis of tumors of neural origin or not. METHOD: Immunohistochemical stains by the LSAB(labelled streptavidin biotin) method for bcl-2 protein were performed in normal special nerve end-organs and a skin tumor of neural origin. RESULTS: The immunohistochemical findings revealed strong positive results in Meissners corpuscles, but weak week positive results in Vater-Pacini corpuscles. There were also strong positive results in neurilernmomas which were mostly composed of Schwann cells, but results were mostly negative in neurofibromas and neurofibrosarcomas which were composed primarily of endoneurial fibroblasts of mesodermal origin except a few cells of Schwann cell origin. Benign granular cell tumors arising from Schwann cells, and Merkel cell carcinoma known to arise from the Merkel cells of neural crest origin showed strong positive reactions. CONCLUSION: The strong expression of bcl-2 protein exclusively in the tumor of neuroectodermal origin suggests a useful indicator for the differential diagnosis of skin tumors of neural origin.

A Case of Pyoderma Gangrenosum on the Hand related to Myelofibrosis / 대한피부과학회지

Pyoderma gangrenosum is a rare neutrophilic dermatosis manifesting as painful pustules or bullae, which rapidly become necrotic to produce an ulceration. It is often associated with systemic disease, such as inflammatory bowel disease, rheumatoid arthritis, leukemia, but myelofibrosis is reported rarely for its underlying disease. The most common location is the lower extremities, and the pyoderma gangrenosum also occur infrequently on the hand and face. As in our case, bilateral involvement of the hands are rarely reported. We present a case of pyoderma gangrenosum that had developed on both hands in a 66 year old man who had macrocytic,anemia. A bone marrow biopsy revealed proliferation of fibroblasts and a dense reticulin network consistent with myelofibrosis, the association of which is very rare world wide.

Chronic Radiation Dermatitis Accompanied by Acrosclerosis and Loss of Digits due to Osteoradionecrosis / 대한피부과학회지

Chronic postirradiation changes of skin reflect the injury of dermal structures particularly the vasculature and connective tissue. The clinical signs include atrophy, partial or complete destruc tion of cutaneous appendatges, telangiectasis, sclerosis of underlying tissue, pigrnentary changes, and in rare instances, ulceration with or without var ious premalignant and malignant neoplasms. The patient, was a 65-year-old man, who had been exposed to a large amount. of X-ray irradi- ation on his hands incidentally or accidentally for a long time. The skin changes of his hand were thickening and hardening of all digits loss or focal consttict,ion of digits, and keratotic papules. Epidermal hyperplasia and fibrous thickening of collagen bundles were found on skin biopsy. Gradual narrowingal of the bony caliber with eventual resorption was noticed on radiologic examination. It has been rarely reported in the literature that chronic radiation dermatitis develops severe and unusal manifestions such as acrosclerosis and loss of digit due to osteoradionecrosis.

A Case of Lichen Planopilaris / 대한피부과학회지

Lichen planopilaris is believed to be a variant of lichen planus which is occasionally accompanied by classical lichen planus. A 68-year old male had asymptomatic skin colored or light violet colored papules and nodules on the occipital area followed by hair loss for 2 months. He had also violaceous pea to bean sized whitish scaly papules on the right lower extremity. Histopathological examination revealed the dilated follicles to be filled with horny material. There were also intense infiltrations of monocytes which were most prominent at the lower pole of the hair follicles on the scalp lesion. There was also hyperkeratosis, focal hypergranulosis and band-like infiltrations of lymphocytes at the dermo-epidermal junction on the lesion of the lower extremity. Direct immunofluorescence examination showed linear deposition of fibrin at the dermo-epidermal junction in the hair follicles. We had an opportunity to observe a man with lichen planopilaris who had loss of scalp hair which was accompanied by classical lichen planus on the lower extremity.

A Clinical and Histopathologic Observation of 79 Cases of Porokeratosis / 대한피부과학회지

BACKGROUND: Porokeratosis is a rare disorder characterized by an abnormal keratinization. Five different clinical types have been described, however most reports are on a small scale and rest,ricted to a particular type. OBJECTIVE: We tried to distinguish clinical and histopathologi'cal feat.ures of each type of porokeratosis. Methods: All patients with porokeratosis visiting the Dermatological Department of Chonnam University Hospital were retrospectively reviewed and finally 79 patients were evaluated. RESULTS: Disseminated superficial actinic porokeratosis(DSAP) was most common it was present in 44 patients(56%). This was f'ollowed by the plaque type(28%), linear type(14%) and punctate type(2%). The:;oungest average age of onset was in the linear type at 13 years old (range 2-34 years old), and the oldest in DSAP which appeared in all patients after the age of 20. The plaque type was predominant in males 2.6 times rnore than in females. The predilection sites were the trunk in the plaque type, the unilateral lower limbs in the linear type and the face lower limbs in DSAP. 1tching was a complaint in 71% of DSAP and pain was in 14% of t.he plaque type. DSAP revealed a family history in 23% and a solar exacervation in 41%. Three cases of the plaque type t ad a malignant change. The average number of cornoid lamella per section was 1.8(ranging from one to seven). The height and invagination depth of cornoid lamellae were most prominent in the plaque type, and the le~ast in DSAP. Dysk(ratotic cells and vacuolar cell degenerat,ion in t.he underlying epidermis were most frequent in the plaque type. However dermal melanophage were present in DSAP. The Epidermis inside ring of:o~rnoid lamella was acanthotic chiefly in the plague type and atrophic chiefly in DSAP. CONCLUSION: These resuts demonstrate that each type of porokeratosis is somewhat, different in clinical and histopathological features.

A Clinical and Histopathologic Observation of 79 Cases of Porokeratosis / 대한피부과학회지

BACKGROUND: Porokeratosis is a rare disorder characterized by an abnormal keratinization. Five different clinical types have been described, however most reports are on a small scale and rest,ricted to a particular type. OBJECTIVE: We tried to distinguish clinical and histopathologi'cal feat.ures of each type of porokeratosis. Methods: All patients with porokeratosis visiting the Dermatological Department of Chonnam University Hospital were retrospectively reviewed and finally 79 patients were evaluated. RESULTS: Disseminated superficial actinic porokeratosis(DSAP) was most common it was present in 44 patients(56%). This was f'ollowed by the plaque type(28%), linear type(14%) and punctate type(2%). The:;oungest average age of onset was in the linear type at 13 years old (range 2-34 years old), and the oldest in DSAP which appeared in all patients after the age of 20. The plaque type was predominant in males 2.6 times rnore than in females. The predilection sites were the trunk in the plaque type, the unilateral lower limbs in the linear type and the face lower limbs in DSAP. 1tching was a complaint in 71% of DSAP and pain was in 14% of t.he plaque type. DSAP revealed a family history in 23% and a solar exacervation in 41%. Three cases of the plaque type t ad a malignant change. The average number of cornoid lamella per section was 1.8(ranging from one to seven). The height and invagination depth of cornoid lamellae were most prominent in the plaque type, and the le~ast in DSAP. Dysk(ratotic cells and vacuolar cell degenerat,ion in t.he underlying epidermis were most frequent in the plaque type. However dermal melanophage were present in DSAP. The Epidermis inside ring of:o~rnoid lamella was acanthotic chiefly in the plague type and atrophic chiefly in DSAP. CONCLUSION: These resuts demonstrate that each type of porokeratosis is somewhat, different in clinical and histopathological features.

Familial Systemic Lupus Erythematosus Developed in Two Sisters / 대한피부과학회지

The pathogenesis of systemic lupus erythematosus (SLE) appears to be multifactorial, including both genetic and environmental influences. The genetic factor of SLE is well known to have an important role in the pathogenesis based on epidemiological analysis and studies of monozygotic twins. The disease occur. more commonly in first degree relatives and may affect multiple persons in single families. We report a family in which two sisters developed systernic lupus erythematosus. The clinical, laboratory and histopathological findings showed characteristic features of systemic lupus erythematosus. HLA testing revealed that the two sisters shared common HLA-DR15(2)and HLA-A2.

Congenital CMV Infection with Blueberry-muffin Skin Lesions Showing Dermal Erythropoiesis

Blueberry muffin rashes occur in various diseases including TORCH syndrome, transfusion reactions, leukemia, hereditary spherocytosis and neonatal sepsis. We report a case of congenital CMV(cytomegalovirus) infection showing blueberry muffin skin lesions which revealed dermal erythropoiesis. Even though these cutaneous findings were nonspecific, they could provide a valuable clue in approach the congenital viral infection in the perinatal period.

Comparative Studies in the Therapeutic Effects between DNCB and DPCP in the Verruca Plana / 대한피부과학회지

This stuc1y was conducted to evaluate the therapeutic effect of immunotherapy on verruca plana. Forty-four patients with verruca plana were tried with dinitrochlorobenzene(DNCB) and diphenylcyclopropenone(DPCP) by topical application on the norinal uninvolved skin of the inner arms for sensitization and challenge. The lesions were challenged in weekly intervals after sensitization. The results obtained in this study are as follows. 1. Mean age of our patients was 20-year-old and sex ratio was about 1:2 (14 of male, 30 of female). 2. Tbe sites of the lesion weve face (60.9%), neck (7.2%), trunk (2.9%), arm (li3.0%), hand (11.6% ), leg (4.3% ). 3. Thirty two patients (72.7%) from 44 cases were completely cured after DNCB (81.3%) and DPCP (67%) treatment and iesions on younger patients showed a better response than those of of older patients(p<0.05). 4. There were no statistic relationship between duration of the lesions and therapeutic response. 5. Average challenge number after sensitization was 3.77 in DNCB, 2.26 in DPCP, respectively. 6. Sensitization rates in the cured patients were to treat verruca plana 94.7% (18/19) in DNCB, 76.9% (10/13) in DPCP, respectively.

Congenital Anonychia of the Toes with Absence of Underlying Phalangeal Bones

Congenital absence of nails usually occur as a rare isolated anomaly or combined with other ectodermal defects. This anomaly is regarded as an inherited disorder either dominantly or recessively but quite a few cases were reported as sporadically developed. The patient was a 2-month-old girl who had no nails on both her 2nd, 3rd toes but had rudimentary nails on her left big toe and both 4th toes at birth. We could not find any other congenital deformity, any family history of inherited diseases related to anonychia. Radiological findings revealed no visualization of both 4th distal phalanges, only. We report this case as congenital anonychia of a sporadic type which may have developed independently from an underlying bone abnormality. We also review other reported cases in the literature.

The Effect of Alpha Hydroxy Acids (Glycolic and Lactic acid) on Hairless Mouse Skin

BACKGROUND: Alpha hydroxy acid containing products are now widely used as cosmetics or skin protectives because it is believed to have a favorable effect against the aging process of skin. OBJECTIVE: The study aimed to find the effects of AHAs (glycolic acid, lactic acid) on the skin of hairless mice. METHODS: Glycolic acid (10 %, pH 3.9), lactic acid (10 %, pH 6.0) and vehicle control were applied topically to the back skin of hairless mice for two weeks. The thickness of the skin was measured by histometric analysis in addition to Masson-trichrome staining, immunohistochemical staining for TGF-beta and a Northern blot assay for pro α-l(I) collagen mRNA. RESULTS: The change of the skin after topical treatment showed decreased mean epidermal thickness in the AHAs treated group, but the thickness of the dermis increased greatly compare to the controls (glycolic acid > lactic acid > control). Staining with Massontrichrome and TGF-beta showed a relatively increased expression in the AHAs treated specimens. These effects were correlated to the increased expression of pro a-1(I) collagen mR- NA from glycolic acid treated skin. CONCLUSION: It is suggested that the favorable effects of AHAs treatment are achieved by increased dermal thickness associated with prominent collagen synthesis.

An Effect of Pachydermoperiostosis Patients' Serum onthe Proliferation of Fibroblasts / 대한피부과학회지

BACKGROUND: Pachydermoperiostosis(PDP) is a rare genetic disease characterized by pachydermia, periostosis, arthralgia and finger clubbing. The pathogenesis of this disease is still unknown, but the concept that platelets and endothelial cells may play a major role in the developement of pachydermia is widely accepted nowadays, It is also suspected that several serum growth factors stimulate proliferation of soft tissue. OBJECTIVE: The purpose of this study was to investigate the pathogenesis of pachydermia in patients with pachydermoperiostosis through evaluating whether the fibroblasts from these patients have a higher proliferation rate than those from controls or whether the proliferation rate of those cells are affected by certain serum growth factors. METHOD: At first, we evaluated the proliferation rate of fibroblasts from patients and corntrols by the MTT colorimetric assay, and then the proliferation rate of fibroblasts from the prepuce of newborn infants under several conditions of media containing uncentrifuged patients serum, centrifuged patients serum, uncentrifuged control serum, or centrifuged control serum. RESULTS: The proliferation of fibroblasts from patients skin was slower than the control fibroblasts and fibroblasts derived from uninvolved skin of patients. The statistically significant highest proliferation rate was observed when fibroblasts were cultured in the uncentrifuged patients serum contained media and the order of proliferation was as follows: centrifuged patients serum, uncentrifuged control serum and centrifuged control serum condition at 20%, 10%, and 1% respectively. CONCLUSION: These results suggest that patients fibroblasts do not proliferate in vitro at a higher rate than control firoblasts. Fibroblasts in PDP may only play a role as target cells and certain serum factors are responsible for the pathogenesis of PDP.

Clinical Observation of 103 Cases of Sporotrichosis in Kwangju City and Chonnam Province during a Thirty-Year-Period (1967-1996) / 대한의진균학회지

BACKGROUND: Sporotrichosis is most common deep cutaneous fungal disease in Korea. It is markedly variable in incidence, distribution, and clinical pattern. The epidemiology have been well known to change over years, and to be influenced by environmental condition and geographic location. Sporotrichosis in Kwangiu and Chonnam area is more prevalent compared to other areas in Korea. OBJECTIVE: Our purpose was to describe the prevalence, epidemiological and clinical features, regional distribution and the change of the incidence according to the climate in different regions. METHOD: The observation of 103 sporotrichosis patients confirmed by clinical, histopathological and mycological studies had been made in the Department of Dermatology at Chonnam National University Hospital for thirty years from 1967 to 1996. RESULTS AND CONCLUSION: The sporotrichosis patient was 0.09% of 108,680 outpatients, prevalent at the age of tai.ties and forties (20%), and 3.2: 1 in the ratio between male and female. The 58% of the total cases visited us within 3 months after the beginning of skin lesion. Almost all initial lesions appeared on the exposed areas, especially upper extremities (68%). The 74% of the total cases was lymphocutaneous type, and the rest was fixed cutaneous type. Most popular occupation of patients was farmer (60%). The 69% of patients visited in spring and winter, especially in February (17%). The incidence of sporotrichosis per average 100,000 population in districts of Kwangju and Chonnam area revealed a difference with the amount of rainfall in winter; average 1.8 person in an area above 125mm, 0.8 person in an area between 100 mm and 125 mm, and 0.2 person in an area below 100 mm. These results suggest that the incidence and clinical features of sporotrichosis are influenced by occupations, leisure and occupational activities, living conditions, and the climate.

Atypical Papulonecrotic Skin Manifestation by Lepromatous Leprosy

Leprosy is a multisystemic infectious disease showing various cutaneous manifestations by the reaction between Mycobacterium leprae (M. leprae) and host immunity. We de-scribe a 20-year-old woman with clinical multiple papulonecrotic skin eruptions resembling papulonecrotic tuberculid (PNT) and pityriasis lichenoides et varioliformis acuta (PLEVA). This kind of skin eruption is a new manifestation which has not been reported so far in lepromatous leprosy (LL).

The Effect of Various Topical Agents on Sunburn Cell Formation by Ultraviolet Irradiation / 대한피부과학회지

BACKGROUND: The sunburn cell is an abnormal keratinocyte of the skin induced by ultraviolet (UV) irradiation, and is used as an indicator of cell damage. The sunburn cell is consideredas an apoptotic cell which has been caused by UV irradiation, and many studies have been performed to understand the mechanism of photodamage in relation to apoptosis. The mechanism of photodamage by UV irradiation is still unclear. However, it is suggested that oxygen stress by reactive oxygen species produced by the UV rays may play an important role. OBJECTIVE: This study was a med at evaluating whether various antioxidants and sunscreen can prevent sunburn cell formation. In addition, we studied whether or not the sunburn cell is identical to an apoptotic cell stained using the TUNEL method. METHODS: White mice (ICR strain) were used to test the potency of various topical agents which are used in the prevention of sunburn cell formation; the agents were various antioxidants of L-ascorbic acid, tocopherol, catalase, a reduced form of glutathione (GSH), and sunscreen PABA (para-amino benzoic acid). Each agent was topically applied daily for 5 consecutive days on the dorsal skin of the ears. 300 mJ/cm of UV-B was irradiated on the ears 30 mins after the final applicaion, and skin samples were taken 24 hrs after that. The sunburn cells in the H & E stain were counted per 1 mm under the microscope. Also, the same sections for the sunburn cell study were stained by the TUNEL method using the ApopTag In Situ Apoptosis Detection Kit (Oncor, Inc.). RESULTS: The number of sunburn cells increased in a UV-B dosage-dependent. manner up to 300 mJ/cm2. The potency in the reduction of sunburn cell formation was as follows in order,PABA (0.37 +/- 0,5), GSH (0.87 +/- 0.5), ascorbic acid (1.62 +/- 0.85) and tocopherol (1.75 +/- 1.12). However catalase (2.93 +/- 1.56) did not show any protective effect. Also, the finding that sunburn cells were the same as TUNEL-positive cells confirmed the notion that the sunburn cell is a kind of apototic cell. CONCLUSION: A sunburn cell is a kind of apoptotic cell that may be caused by reactive oxygen species induced by UV-B irradiation, in view of the fact that sunburn cell formation was inhibited by the topical application of various antioxidants. But the result that physical protection by PABA has the most potent protective effect in relation to sun damage suggests that protection using a combined physical and biochemical approach is important in the development of new topical agents which will inhibit sundamage to the skin.

A Case of Unilateral Keratosis Follicularis / 대한피부과학회지

Unilateral keratosis follicularis is considered a localized variant of Darier's disease and should be included in the differential diagnosis of diseases with zosteriform keratotic eruptions. It is characterized by the unilateral linear lesions in multiple locations, increased irritation by sweating, lack of solar aggravation, and negative family history. Histopathologic findings reveal acantholytic dyskeratosis similar to a generalized Darier's disease. We report a case of unilateral keratosis follicularis in a 68-year-old man, who presented with unilateral flesh-colored keratotic papules on the left axilla and inguinal area. He was effectively treated with oral 13-cis-retinoid acid (isotretinoin).

A Case of Squamous Cell Carcinoma of the Clitoris / 대한피부과학회지

Primary carcinoma of the vulva is predominantly a disease of elderly women, a somewhat infrequent entity, accounting for approximately 3-4% of all female genital cancer and less than 1% of all malignant disease. Many studies have pointed out the long delay in the diagnosis of the cancer. This is due not only to the reluctance of the older patient to seek attention for this "personal problem", but to the delay of the physician in taking a biopsy. Therefore physicians should carry out a biopsy in every patient when the diagnosis is uncertain or the lesion fails to resolve with topical therapy. We experienced a case of squamous cell carcinoma arising from the clitoris in 65 years old woman. She had had a pruritic erythematous patch on the external genitals for 20 years but never visited a clinic. One month before, she found a reddish papule on the clitoris which enlarged rapidly and reached a exophytic hard 1.5 * 2.1 cm sized mass. The patient was treated with a radical vulvectomy and bilateral lymph nodes dissection of the groin with oophorectomy. She had been followed for 20 months without any evidence of recurrence.