A Case of Cephalic Brain-like Heterotopia / 대한피부과학회지

Cephalic brain-like heterotopias, so called nasal gliomas, are masses of mature glial tissue resulted from an error in embryonic development and are frequently located on the bridge of the nose. They often give rise to the clinical suspicion of dermoid cyst, hemangioma, or lipoma. Histologically, they are composed of fibrillary neuroglial cells, mainly large astrocytes, which are interlaced with a variable amount of fibrous and vascular connective tissue. Mitoses are rare. The possible tumor stalk is usually fibrous without glial elements. Due to the occasional presence of connection to the intracranial space it deserves a careful preoperative evaluation including imaging studies. We report a case of cephalic brain-like heterotopia. A sixteen day-old infant presented a mass which was suspended to the forehead by a fibrous stalk. Th excised lesion showed characteristic pathologic features of cephalic brain-like heterotopia.

Air Cooling Effect on Pain Sensation during Dermatologic Laser Treatment / 대한피부과학회지

BACKGROUND: Although most dermatologic laser systems were developed to damage target tissue selectively, the epidermal injury has been a major problem in treating skin lesions of colored people. Recently, to minimize the epidermal damage during laser treatment, superficial cooling is being used. Cooling is one of the well known methods to reduce pain sensation. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of an air cooling in reducing pain associated with Q-switched Nd:YAG laser and pulsed dye laser treatment. METHODS: We measured the temperature of normal skin during air cooling and studied 13 patients treated with a 1064 nm Q-switched Nd:YAG laser or 585 nm pulsed dye laser treatment with and without air cooling system. The degrees of pain reduction rates with and without cooling were assessed by the visual analogue scales. RESULTS: 1. It was shown that cold air flow from 2 cm distance for 10 sec decreased skin temperature about 10.6 degreeC to 17.2 degreeC depending on the body sites. 2. The average of the pain scores was 38.08+/-21.05 on the cooled site as compared to 70.77+/-15.76 on the uncooled site. CONCLUSIONS: The cold air decreased the skin surface temperature like the other epidermal cooling system and it was very effective to reduce the pain on the cooled site associated with dermatologic laser treatment.

Air Cooling Effect on Pain Sensation during Dermatologic Laser Treatment / 대한피부과학회지

BACKGROUND: Although most dermatologic laser systems were developed to damage target tissue selectively, the epidermal injury has been a major problem in treating skin lesions of colored people. Recently, to minimize the epidermal damage during laser treatment, superficial cooling is being used. Cooling is one of the well known methods to reduce pain sensation. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of an air cooling in reducing pain associated with Q-switched Nd:YAG laser and pulsed dye laser treatment. METHODS: We measured the temperature of normal skin during air cooling and studied 13 patients treated with a 1064 nm Q-switched Nd:YAG laser or 585 nm pulsed dye laser treatment with and without air cooling system. The degrees of pain reduction rates with and without cooling were assessed by the visual analogue scales. RESULTS: 1. It was shown that cold air flow from 2 cm distance for 10 sec decreased skin temperature about 10.6 degreeC to 17.2 degreeC depending on the body sites. 2. The average of the pain scores was 38.08+/-21.05 on the cooled site as compared to 70.77+/-15.76 on the uncooled site. CONCLUSIONS: The cold air decreased the skin surface temperature like the other epidermal cooling system and it was very effective to reduce the pain on the cooled site associated with dermatologic laser treatment.

A Case of Childhood Granulomatous Perioral Dermatitis / 대한피부과학회지

Childhood granulomatous perioral dermatitis(CGPD) is a distinctive granulomatous form of perioral dermatitis of unknown cause with a benign and self-limited course and no associated systemic manif estations. It is characterized by an asymptomatic monomorphous papular eruption, with or without scale or pustules, around the mouth, nose, and eyes primarily in prepubertal children. This condition may resemble sarcoidosis both clinically and histologically. A 3-year-old boy first presented with a month-history of mildly pruritic rash around the mouth. When he returned for follow-up after an eight-week period of topical corticosteroid therapy, multiple new follicular papules and pustules developed. Histopathologic examination revealed that a granulomatous lesion consisted of nodular infiltration of multiple histiocytes admixed with lymphocytes in the dermis. The condition resolved in about three weeks after using an unknown topical agent prescribed by a private practicing dermatologist.

Clinical and Histopathological Study of Benign Melanocytic Neoplasms on the Palm and Sole / 대한피부과학회지

BACKGROUND: The incidence of malignant melanoma in oriental countries is lower than that in western countries. But recently the incidence of malignant melanoma and related death rate are increasing in the world. Malignant melanoma on the palm and sole is known to have worse prognosis and sometimes radical surgery such as amputation is necessary. It is important to exclude malignant melanoma when pigmented patch is encountered, and biopsy is necessary in most cases. But histopathological features of benign melanocytic neoplasms occurring at palm or sole are known to be confusing, because they can resemble the features of malignant melanoma. But there has been no report on this item in Korean dermatological literature, to our knowledge. OBJECTIVE: We investigated the histopathological features of benign melanocytic neoplasms on the palm and sole with their clinical features. MATERIALS AND METHODS: A total of 23 benign melanocytic neoplasms that had been excised from the palm and sole at Inje University Sanggye Paik Hospital and Seoul National University Hospital between July 1991 and April 1998 were evaluated. The retrospective analysis of the clinical manifestation was performed. Histologically, hematoxylin and eosin stained tissue sections were reviewed with the following criteria: symmetry, circumscription, lentiginous hyperplasia, anastomosing rete ridges, pagetoid spread, papillary dermal fibroplasia, lymphocytic infiltrate, pigment in the dermis and the stratum corneum, cytologic atypia, and mitotic activity. RESULTS: Five patients were male and eighteen were female; the mean age was 27.6 years with a peak incidence in the fourth decades. Six lesions had asymmetric, irregular and geographic borders. The diameter of the lesions varied; 3 cases were larger than 9 mm in maximum diameter. Clinically, we suspected 7 cases to be malignant melanoma before biopsy. Histological diagnoses of 23 benign melanocytic neoplasms were as follows: 12 junctional nevi, 3 compound nevi, 1 intradermal nevus, 2 lentigines, 3 benign melanocytic hyperplasias, and 2 congenital melanocytic nevi. Microscopic findings showed single melanocytic proliferation at the dermo-epidermal junction in 17 cases(73.9%), lentiginous hyperplasia in 8 cases, upward migration of melanocytes in 8 cases(34.7%), and ill-defined lateral circumscription in 6 cases(26.0%). Mitotic figures and cytologic atypia were not present. Pigments were variously seen in the stratum corneum in all cases and conspicuous amounts of melanin where the melanocytes upwardly migrated were found in 8 cases. CONCLUSION: There has been a report that the diameter of lesions is very important in differential diagnosis of malignant melanoma when a pigmented lesion is present on the palm and sole and 9mm is the critical maximum diameter. But we encountered 3 cases of benign melanocytic neoplasm which were larger than 9mm in their diameters. We think 9mm is not a reliable critical diameter in the differential diagnosis of malignant melanoma. Histological analysis showed some features resembling malignant melanoma, such as single melanocytic hyperplasia, upward migration of melanocytes in epidermis, ill-defined lateral margin, abundant pigments in the stratum corneum, and lymphocytic infiltration in dermis. There was no case with cytological atypia or mitoses and we think this is an important feature to be studied in the future in the differentiation of malignant melanoma.

A Case of Angioedema Probably Induced by Captopril / 대한피부과학회지

Angioedema is a disorder characterized by well-demarcated nonpitting edema involving the tongue, floor of the mouth, larynx, lips, and face. The incidence of angiotensin converting enzyme(ACE) inhibitor related angioedema has been reported to be about 0.1% to 0.2%, and the time of onset is usually during the first week of therapy. These ACE inhibitors include captopril, enalapril, and lisinopril. A 53-year old man with an 8 month history of hypertension previously controlled with atenolol, was presented to the dermatologic department with angioedema of the face and tongue. He had begun therapy with captopril one day before this episode. Even though he was treated with epinephrine and methylprednisolone sodium succinate, the edema gradually progressed and finally dyspnea developed. He was urgently intubated and treated with steroids and pheniramine maleate in the intensive care unit. The edema resolved after 24 hours.

Two Cases of Rudimentary Meningocele / 대한피부과학회지

Rudimentary meningoceles represent a developmental anomaly in which meningothelial elements are found in the skin. The majority of rudimentary meningoceles occur on the scalp over the occiput or along cranial suture lines. They are present as a pink papule, nodule or an area of alopecia. Histologically, the lesion consists of scattered foci of meningothelial cells, an anastomosing network of empty spaces with psammoma bodies and collagen bodies, and small vessels, which may be located from the dermis to the subcutis. Immunohistochemically, the meningothelial cells are commonly positive for vimentin and often positive for EMA. We report the cases of two infants who were noted at birth to have scalp hair anomalies. One had a translucent, bald, slightly atrophic patch on the midline of the vertex and the other had a subcutaneous nodule surrounded by long hairs, so called "hair collar sign" on the midline of the occipital area. The latter had an underlying skull defect without a communication with intracranial spaces. Due to the occasional presence of connection to the central nervous system, any midline lesion in an infant, including rudimentary meningocele, deserves careful preoperative evaluation including imaging studies.