Effectiveness of radiotherapy for head and neck skin cancers: a single-institution study

PURPOSE: External beam radiotherapy (EBRT) is a useful option to treat head and neck skin cancer patients who are not indicated for surgery. In this study, we evaluated the treatment outcomes of EBRT in an Asian population.MATERIALS AND METHODS: The records from 19 head and neck skin cancer patients (10 with squamous cell carcinoma and 9 with basal cell carcinoma) who were treated with definitive or adjuvant EBRT from 2009 to 2017 were retrospectively reviewed. The radiotherapy doses administered ranged from 50 to 66 Gy (median, 55 Gy) with 2.0–2.75 Gy per daily fraction (median, 2.5 Gy). The T stage at presentation was as follows: Tis (1 patient), T1 (11 patients), T2 (6 patients), and T3 (1 patient). None had regional lymph node disease or distant metastasis at presentation. The local failure-free survival (LFFS) rates, toxicity, and cosmetic results were analyzed.RESULTS: The median age was 75.5 years (range, 52.6 to 92.5 years). The median follow-up duration from the completion of radiotherapy was 44.9 months (range, 5.8 to 82.6 months). One local failure occurred in a patient with a 2.1-cm posterior neck squamous cell carcinoma at 32.5 months after radiotherapy (1/19, 5.3%). The 3-year LFFS rate was 91.7%. No patients died from skin cancer during follow-up, and no grade 3 complications occurred. The cosmetic outcomes were excellent for 16 (84.2%) and good for 3 (15.8%) of the 19 patients.CONCLUSION: EBRT offers good local control and cosmetic outcomes in patients with head and neck skin cancer, with no grade 3 complications.

Experience of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a Regional Hospital: 70 Cases in 7 Years / 대한내과학회지

BACKGROUND/AIMS: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions that frequently result in fatal outcomes. We investigated cases of SJS and TEN in a regional hospital. METHODS: From 2008 to 2014, SJS and TEN cases were enrolled retrospectively by allergy and dermatology specialists, and their clinical features and severity-of-illness score for TEN (SCORTEN) were assessed. RESULTS: During the 7-year study period, 56 SJS and 14 TEN cases were recruited. The majority (71%) were 40-70 years of age (mean age of male and female patients, 55 and 54 years, respectively). Regarding drugs, anticonvulsants (42.8%) were the most frequently causative, followed by carbonic anhydrase inhibitors (20.0%), antimicrobials (15.7%), allopurinol (7.1%), and non-steroidal anti-inflammatory drugs (7.1%). No fatal case of SJS was seen. However, 7 of the 14 patients with TEN died (50%; mean age, 67 years; 1 of 5 [20%] males and 6 of 9 females [66.7%]). The mortality rate was reflected in the SCORTEN values. Vancomycin, allopurinol, methazolamide (two cases each) and megestrol (one case) were the causative drugs in the seven fatal TEN cases. Treatment modality did not affect the likelihood of death due to TEN. CONCLUSIONS: The causative drugs of, and frequency of mortality due to, SJS and TEN should be recognized by physicians. Elderly females with TEN are at high risk of mortality. SCORTEN values reflect the mortality rate of TEN patients. Early recognition and proper management of SJS and TEN may reduce the mortality rate.

Tuberculosis Verrucosa Cutis Confirmed by Culture / 대한피부과학회지

Tuberculosis verrucosa cutis is a warty form of cutaneous tuberculosis. It is a paucibacillary disorder caused by external reinfection of mycobacteria into the skin of previously sensitized individuals with moderate to strong cell-mediated immunity. Inoculation arises at sites of minor wounds, or rarely from the patient's sputum. Tuberculosis verrucosa cutis begins as a small papule and grows slowly by peripheral expansion, sometimes reaching a size of several centimeters or more in diameter. For definitive diagnosis of cutaneous tuberculosis, the demonstration of Mycobacterium tuberculosis is essential. However, the laboratory diagnosis of paucibacillary cutaneous tuberculosis is very difficult owing to the poor sensitivity of routine available methods. Herein, we report two cases of tuberculosis verrucosa cutis definitively confirmed by mycobacterial culture in Korean patients who had received bacille Calmette-Guerin vaccination earlier in life.

Severe Fever with Thrombocytopenia Syndrome Mimicking Scrub Typhus: Three Case Reports

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in South Korea with clinical features similar to those of scrub typhus. Infected patients with these two diseases usually visited the emergency department (ED) complaining of fever that was not responsive to treatment in a local clinic. Aggressive management of SFTS is required in order to prevent rapid progression and human-to-human transmission, thus rapid and accurate differential diagnosis of the two diseases in the ED is important. We reported three laboratory confirmed cases of SFTS during 2013-2014 in a single center, with fever, skin lesions, and history of outdoor activities in order to help in differential diagnosis between SFTS and scrub typhus in the ED.

A Cross-sectional Epidemiological Study on Trends in the Prevalence of Allergic Diseases among Children and Adolescents in the Jeju Area in 2008 and 2013

PURPOSE: This study was to find epidemiological trends in the prevalence of allergic diseases among children and adolescents in Jeju Province, Korea. METHODS: Two questionnaire surveys of the same method were conducted, respectively, in 2008 and in 2013 with five years' interval with 1,296 participants in 2008 and 878 in 2013 who were elementary and secondary students sampled at random from the same five schools. 'International Study of Asthma and Allergies in Childhood (ISAAC)' was applied to the parents with their written consent to the survey. RESULTS: The results of analysis showed an increasing trend in the prevalence of lifetime asthma (8.6% in 2008 and 10.4% in 2013) and in the prevalence of lifetime allergic rhinitis (25.3% in 2008 and 31.1% in 2013) (p=.003), and a decreasing trend in the prevalence of lifetime atopic dermatitis (32.0% in 2008 and 26.8% in 2013) (p=.011). CONCLUSION: This research showed an increasing trend in the prevalence of asthma and allergic rhinitis among children and adolescents in Jeju Province compared to that 5 years ago, but represented a declining trend in the prevalence of atopic dermatitis.

Four Cases of Severe Fever with Thrombocytopenia Syndrome Occurring in Jeju / 대한피부과학회지

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel SFTS bunyavirus (SFTSV), a member of the genus Phlebovirus in the family Bunyaviridae. SFTSV is believed to be transmitted by Haemaphysalis longicornis. Common symptoms of SFTS include high fever, vomiting, diarrhea, thrombocytopenia, leukocytopenia, and multi-organ failure with an average case-fatality rate of 12~30%. In 2009, SFTS was firstly reported in China. In 2013, 27 cases of SFTS were documented in Korea, and 6 cases were confirmed on Jeju Island. Although the pathogenesis and transmission mode of SFTS remain unclear, SFTS is now considered endemic in East Asia. Accordingly, SFTS needs to be differentiated from scrub typhus, leptospirosis, and hemorrhagic fever with renal syndrome. We here report 4 cases of SFTS preceded by a tick bite, which were in need of a differential diagnosis of scrub typhus.

Complete enumeration for the prevalence of allergic disease in Udo Isle's inhabitants

PURPOSE: This study is to estimate the prevalence of allergic disease for the entire inhabitants living in Udo Isle, one of the islands of Jeju. METHODS: The complete enumeration using International Study of Asthma and Allergies in Childhood group was applied to the 1,090 people residing in the Isle. This survey was performed for 2 months from June to July, 2012. For children, their parents' responses were collected, and for adults, their self-reports and interview were performed simultaneously. Of the 1,003 questionnaires (92.0%) were collected, 925 questionnaires were finally analyzed, excluding those of insufficient responses for questionnaires and inhabitants residing in Udo Isle less than one year. RESULTS: For asthma, the prevalence of "wheeze, last 12 months" was 6.6%. The prevalence of "allergic rhinitis, last 12 months" was 17.9%. The prevalence of "itchy eczema, last 12 months" was 8.1%. The prevalence of "allergic conjunctivitis, last 12 months" was 8.1%. The prevalence of "food allergy, last 12 months" was 2.3%. The prevalence of "drug allergy, last 12 months" was 0.8%. CONCLUSION: The inhabitants of Udo Isle had lower prevalence of atopic dermatitis than that of in the entire Jeju Island. However, compared with other regions, it showed higher prevalence, and it tended to be decreased with aging. The prevalence of asthma, allergic rhinitis, allergic conjunctivitis, food allergy and drug allergy, presented no difference by age.

Dengue Hemorrhagic Fever Developed after Traveling Vietnam / 대한피부과학회지

Dengue is an acute febrile mosquito-transmitted viral disease which is endemic throughout tropical and subtropical regions around the world. Dengue leads to a spectrum of clinical presentations that comprise dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome. DHF usually begins with fever, rash and other symptoms resembling dengue fever. However, DHF is a potentially fatal syndrome that can evolve into dengue shock syndrome. DHF is characterized by fever, hemorrhagic tendency, thrombocytopenia and plasma leakage. Although the number of imported cases of DHF are steadily increasing in Korea, DHF has been rarely described in the Korean dermatologic literature. Herein, we report a case of DHF developed after traveling to Vietnam.

Secondary Syphilis with Nodular Vasculitis Mimicking Behcet's Disease / 감염과화학요법

Although, erythema nodosum is a common skin manifestation associated with syphilis, nodular vasculitis is a rare feature. Here, we describe a case of a 22-year-old, human immunedeficiency virus negative, non-immunocompromised man who developed recurrent oral and scrotal ulcers with nodular lesions of the lower extremitie. Behcet's disease was initially suspected, however, his serologic test for syphilis was positive, and he was thus diagnosed with secondary syphilis, with a skin biopsy showing nodular vasculitis. The patient was treated with benzathine penicillin, and the skin lesions disappeared after treatment.

Skin and Soft Tissue Infection due to Rapidly Growing Mycobacteria: Case Series and Literature Review / 감염과화학요법

BACKGROUND: Nontuberculous mycobacteria (NTM) are ubiquitous in soil and water. Most NTM cause disease in humans only rarely unless some aspect of host defense is impaired. Recently, rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. RGM causes a wide spectrum of pulmonary and extrapulmonary diseases and has been shown as an important source for opportunistic infection. MATERIALS AND METHODS: We report 5 patients of skin and soft tissue infection due to RGM in tertiary medical center in Jeju Island and analyzed 21 patients of skin and soft tissue infection due to RGM in Republic of Korea. Clinical, microbiological and epidemiological data were collected from each patient. NTM isolates were identified using conventional and molecular methods including 16S rDNA gene sequencing. RESULTS: The mean age of the RGM patients (n=26) was 54.9 +/- 15.9 years and 73% were women. Mycobacterium fortuitum complex was the most common (12/26). Antimicrobial resistance for clarithromycin and quinolone were 12% and 60%, respectively. Clarithromycin based therapy was done in 46%. The mean duration of treatment was 21.2 +/- 8.7 weeks. CONCLUSIONS: Many cases can be cured after therapy for 4-7 month with at least 2 or 3 antibiotics according to in vitro susceptibility. Recent increasing of NTM cases suggests that species and subspecies identification is epidemiologically important, especially related to medical procedure, and surgery.

A Case of Hypersensitivity Reaction Induced by Abacavir in an AIDS Patient / 대한내과학회지

Abacavir is a nucleoside reverse transcriptase inhibitor that is commonly used in HIV-infected patients. A well-known and potentially life-threatening side effect of abacavir is allergic hypersensitivity reaction. A screening test for the HLA-B*5701 allele is currently used to predict the risk of hypersensitivity reaction to abacavir. This test, however, may be less useful in Korea, because of the low prevalence of HLA-B*5701. A 52-year-old male with HIV infection was referred to our hospital because of suspected side-effects of antiviral agents and lymph node enlargement of the neck. He suffered from a fever, generalized edema, skin rash of the whole body, and difficulty breathing after starting antiviral agents. Suspected as a hypersensitivity reaction resulting from drug side-effects, prescription of abacavir was stopped. The patient subsequently recovered. The presence of the HLA-B*5701 allele was confirmed by polymerase chain reaction-sequencing based typing (PCR-SBT).

The Prevalence of Allergic Diseases in Children Living In Jeju / 소아알레르기및호흡기학회지

PURPOSE: We investigated the prevalence of allergic diseases in preschoolers and children attending elementary, middle and high schools in Seogwipo city, Jeju, South Korea. METHODS: A cross-sectional survey in November 2008 was conducted, using questionnaires, translated in Korean, from the International Study of Asthma and Allergies in Childhood group. All the attendees, 29,606, in 136 nurseries and kindergartens, 47 elementary schools, 15 middle schools and 10 high schools in Seogwipo city were surveyed in this study. RESULTS: Of the 25,312 (85.5%) questionnaires retrieved, 25,024 were appropriately completed and analyzed. For asthma, the prevalence of "wheeze, last 12 months" was 15.4% for the preschool children, 6.4% for the elementary school students, 5.3% for the middle school students and 5.8% for the high school students. The prevalence of "allergic rhinitis, last 12 months" was 23.9%, 30.0%, 31.4% and 34.2%, respectively. The prevalence of "atopic dermatitis, last 12 months" was 19.0%, 17.4%, 12.3% and 11.4%, respectively. The prevalence of "allergic conjunctivitis, last 12 months" was 8.5%, 12.3%, 20.3% and 23.4%, respectively. The prevalence of "food allergy, last 12 months" was 5.4%, 4.2%, 4.2% and 5.1%, respectively. The prevalence of "drug allergy, last 12 months" was 0.7%, 0.3%, 0.6%, and 0.8% for each group. CONCLUSION: In Seogwipo city, the prevalence of asthma and atopic dermatitis decreases with age. However, allergic rhinitis and allergic conjunctivitis are increasing by age. The prevalence of food allergy and drug allergy showed no difference by age.

Stevens-Johnson Syndrome Caused by Dapsone / 대한피부과학회지

Dapsone (4,4'-diaminodiphenylsulfone) has been widely used in the treatment of leprosy and for a variety of dermatoses. It rarely may result in unpredictable fatal effects such as agranulocytosis, dapsone syndrome, fulminant hepatitis or Stevens-Johnson syndrome (SJS). SJS is a life-threatening, acute hypersensitivity reaction to drugs characterized by atypical targetoid lesions, confluent erythematous purpuric macules and mucocutaneous blisterings. More than 100 medications have been implicated in the pathogenesis of SJS. To the best of our knowledge, there have been only a few reports in the literature of SJS caused by dapsone. Herein we present two cases of SJS that were likely induced by administration of dapsone.

The Influence of the Residential Environment on the Sensitization Rates to Aeroallergens and the Prevalence of Allergic Disorders in the School Children in Jeju / 소아알레르기및호흡기학회지

PURPOSE: This study is to investigate the influence of the residential environment on the sensitization rates to aeroallergens and the prevalences of atopic disorders in the school children. METHODS: Two elementary schools in Jeju, Korea were selected according to their distinctive residential environment, one located in the area surrounded by the tangerine farms and Japanese cedar forests (tangerine farming community) and the other rarely with them (non-tangerine farming community). All the school children (1,550 students) from the two school were enrolled in this study. Under their parents' informed consent, surveys based on International Study of Asthma and Allergies in Childhood questionnaire were answered by the parents and skin prick tests with 16 common aeroallergens were performed. RESULTS: The questionnaire is responded from 1,290 parents (83.2%) and the skin test was done in 1,284 students (82.8%). The sensitization rates to more than one aeroallergen was 41.9%, increasing by age. The children residing in the tangerine farming community showed significantly higher sensitization rates than those from non-farming one (47.5% vs. 38.4%, P=0.004). The former were sensitized more frequently to house dust mite, citrus red mite and Japanese cedar pollen, while the others to outdoor moulds. However, the prevalence of atopic disorders had no difference between the two groups. CONCLUSION: The residential environment might influence the sensitization rates to prevalent aeroallergens in the environment among school children, but there is no difference in the prevalence of the atopic disorders.

Acquired Secondary Syphilis in Early Childhood / 대한피부과학회지

A gradual increase of symptomatic syphilis in youngsters has been reported in the last few years. Although most cases of syphilis in childhood result from congenital syphilis, acquired syphilis in children may occur. Transmission of syphilis to children is usually related to sexual abuse. However, children may acquire syphilis by non-venereal contact. Acquired syphilis in a child has rarely been described in the current medical literature. Herein, we present a case of acquired secondary syphilis occurring in a 10-year-old girl in which non-sexual transmission is likely.

Munchausen's Syndrome Presenting as Dermatitis Artefacta / 대한피부과학회지

Dermatitis artefacta is defined as self-inflicted skin lesions that the patient denies having caused. Munchausen's syndrome (MS) is characterized by pathological lying, the intentional production of physical symptoms, and a restless wandering from hospital to hospital to obtain hospitalization or extensive interventions. MS, presenting as dermatitis artefacta, should be cautiously differentiated from classic dermatitis artefacta by psychoanalytic approaches. In pediatric groups, MS is extremely rare. Thus, a pediatric case of MS should be differentiated from child abuse by caregivers. Herein, we describe an unusual case of MS in a 10-year-old boy, who presented with multifocal facial ulcerations. In addition, a case of MS in a 40 year-old man will be described.

Familial systemic lupus erythematosus in two Korean male siblings / 소아과

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease characterized by the production of a wide range of autoantibodies, resulting in tissue damage. Although the susceptibility to SLE has been attributed to complex interactions between genetic and environmental factors, the influence of a genetic predisposition to SLE is supported by observations of familial aggregations. Family studies have found that siblings with an SLE-affected relative have a 20-fold higher risk of developing SLE compared with the general population. Here, we present a rare case of two male siblings with SLE. The clinical, laboratory, and histopathological findings of these individuals showed the characteristic features of SLE. Human leukocyte antigen (HLA) typing revealed that the brothers and their mother shared the common HLA haplotype of DRB1*1501 and DQB1*0602, which is significantly associated with disease susceptibility in both family-based and casecontrol studies. This report provides an opportunity to reveal the role of genetic factors in the development of SLE.

Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome Caused by Topical Ophthalmic Use of Dorzolamide / 대한피부과학회지

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the potentially life-threatening, acute hypersensitivity reaction to inciting drugs. These diseases have been often associated with systemic carbonic anhydrase inhibitor such as acetazolamide or methazolamide in Korean and Japanese patients. Dorzolamide is a recently developed topical carbonic anhydrase inhibitor with few significant systemic adverse effects. To the best of our knowledge, there have been only a few reports of SJS or TEN caused by topical dorzolamide in the literature. We herein present two cases of TEN and one case of SJS related with topical use of dorzolamide. It should be emphasized that although rarely, topical dorzolamide may cause serious sulfonamide hypersensitivity such as SJS or TEN in the susceptible patient through the systemic absorption.

Neuro-Sweet's Syndrome with Central Nervous System Involvement / 대한피부과학회지

Sweet's syndrome is an acute reactive condition that is characterized by fever, neutrophilic leukocytosis, erythematous tender edematous plaques or papules, and a dense dermal infiltrate of mature neutrophils. Although the extracutaneous manifestations of Sweet's syndrome are commonly seen in the joints and eyes, the central nervous system is rarely involved. A novel concept designated "Neuro-Sweet's syndrome" has recently been proposed for those cases of Sweet's syndrome that involve the central nervous system. It is essential to evaluate the skin eruptions in patients with recurrent meningoencephalitis of an unknown origin in order to avoid unnecessary empiric therapy. Herein, we report on two men who suffered from acute recurrent meningoencephalitis and they were subsequently diagnosed as having Neuro-Sweet's syndrome.

Staphylococcal Scalded Skin Syndrome in an Immunocompetent Adult / 대한피부과학회지

Staphylococcal scalded skin syndrome (SSSS) is an exfoliative infectious disorder caused by the exfoliative toxins of Staphylococcus aureus. The condition usually affects infants and children younger than 5 years of age. However, SSSS is rarely observed in adults. Adult SSSS is usually associated with renal failure, immunosuppression, malignancy, alcohol abuse, or HIV infection. In contrast to infant cases, adult SSSS is often accompanied with a high mortality rate, sepsis and poor prognosis. We report a rare case of SSSS in an immunocompetent 34-year-old man without renal failure.