A Proposal to Prevent the "Mephisto Sign" Side Effect of Botulinum Toxin Type A Injection in Chronic Migraine

Botulinum toxin type A (BoNT-A) has been reported as an effective treatment for chronic migraine. When BoNT-A is injected on the frontalis muscle for chronic migraine, an unexpected clinical side effect called the "Mephisto sign" may occur. The aim of this article is to propose a method to eliminate or prevent the Mephisto sign side effect. A 25-year-old female patient visited the hospital and was diagnosed with chronic migraine. A total of 155 U of BoNT-A was injected into 31 sites. 2-weeks later, and the patient developed the Mephisto sign. An additional 2-U dose was administered bilaterally to the lateral-most point of the frontalis muscles, and the eyebrow morphology returned to normal within 2-3 weeks. We propose that the development of the Mephisto sign may be prevented with an additional BoNT-A injection of 2-4 U bilaterally to the lateral most point of the frontalis muscles during the primary injection process.

Efficacy and Safety of 1,064 nm Q-switched Nd:YAG Laser Treatment for Removing Melanocytic Nevi

BACKGROUND: Until recently, the removal of melanocytic nevi has been performed with a CO2 laser or Er:YAG laser. These lasers have been useful for removing affected spots. However, enlargement of spots or some sequelae, including depressed or hypertrophic scars, could develop as unwanted results. The Q-switched Nd:YAG laser has been used to remove deep-seated melanocytes, such as Ota nevus or tattoos. However, there have been no previous experiments performed to test the efficacy and safety of this laser treatment for melanocytic nevi. OBJECTIVE: The objective of this study was to investigate the efficacy and safety of the 1,064 nm Q-switched Nd:YAG laser for removing melanocytic nevi, including congenital nevomelanocytic and acquired nevomelanocytic nevi. METHODS: Two thousand and sixty four Korean patients with small melanocytic nevi were treated with a Q-switched Nd:YAG laser from 2005 to 2009. High-resolution photographs were taken in identical lighting and positions before and after the six weeks of treatment to observe the procedural efficacy. RESULTS: About 70% of the nevi treated using a 1,064 nm Q-switched Nd:YAG laser were completely removed after one session. The other 30% were completely treated within three sessions. The appearance of sequelae such as hollow scars noticeably decreased compared to the results seen in CO2 or Er:YAG laser treatments. CONCLUSION: Use of the 1,064 nm Q-switched Nd:YAG laser is a safe and effective treatment modality for melanocytic nevi.

Botulinum Toxin Type A for Facial Wrinkles and Benign Masseter Hypertrophy in Korean Patients / 대한피부과학회지

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.

A Case of Acquired Tufted Angioma / 대한피부과학회지

Acquired tufted angioma is a benign, progressive vascular lesion that has a distinctive histopathologic appearance. We report a 31-year-old man with acquireed tufted angioma. Several reddish papules and plaque were present on the neck. The lesion had been present for 6 months. They had enlarged slowly, and were slightly tender. Histopathologic examination of the biopsy specimen showed round to ovoid cellular tufts of capillaries, most prominent in the middle to lower dermis.

A Case of Congenital Self Healing Reticulohistiocytosis / 대한피부과학회지

Congenital self healing reticulohistiocytosis was described by Hashimoto and Pritzker in 1973. Hundreds of cases were reported in America and Europe, but cases reported in Korea are rare especially in cases with multiple skin lesions. We present a case of multiple congenital self healing reticulohistiocytosis in a full termed, normal spontaneous vagina1 delivered male neonate. He had erythematous to reklish colored nodules or bullae on his whole body and some of them were hemorrhagic in its appearance. The oral and anogenital mucosae had no lesions. Laboratory tests showed no evidence of intrauterine infections and systemic involvement. The histopathologic examination revealed densley aggregated dermal histiocytes and an absence of epidermis, Infiltrated histiocytes showed a positivity for S-100 protein. About 15% of infiltrated cells had Birbeck granules on an electron microscopic study, Four months later, the skin lesions cleared and there was no evidence of systemic involvement.

The Effects of Endothlin-1 Receptor Antagonists on the Human Melanocyte / 대한피부과학회지

BACKGROUND: Melanocytes synthesize melanin pigment by the action of specific enzyme tyrosinase. In normal skin, melanocytes maintain their constant population and steady melanogenic activity. But several stimuli to the skin such as UV irradiation and chemical irritation may accelerate the proliferation and differentiation of melanocytes and subsequently lead to hyperpigmentation of the skin. Endothelin-1(ET-1), produced by human keratinocyte acts as a strong mitogen on human melanocyte and has an effect on paracrine linkage between keratinocytes and melanocytes, and plays an important role in UVB induced hyperpigmentation as an intrinsic factor. OBJECTIVE: In this study, the role of ET-1 on melanocyte proliferation and melanogenesis was investigated, and the effects of ETRA(endothelin receptor antagonist) in cultured melanocyte was also evaluated. METHODS: Primary melanocytes from neonatal foreskins were cultured in complete MCDB 154 medium. To examine the effects of ET-1 on melanocytes, cultuled melanocytes were treated with ET-1 at various concentration(5nM, 10nM, 15nM, 20nM). Three days later, melanocyte proliferation and melanin content were measured. Also, we examined the effects of ETRA on ET-1 treated melanocytes. Five kinds of ETRA were added into 10nM of ET-1 treated melanocyte. After three days cultuviation, inhibitory effect of ETRA on ET-1 activity was measured. RESULTS: 1. The number of melanocytes increased in the groups of incubation with melanocyte medium of concentration in 10nM ET-1 than others. 2. The melanin contents increased most in the groups of incubation with melanocyte medium of concentration in 10nM ET-1 than others. 3. The number of melanocytes decreased in the groups of inhibited with ETRA I. 4. The melanin contents decreased in the groups of inhibited with ETRA II. CONCLUSION: This study provided an important confirmation of the proposal that ET-1 is intrinsic factor for proliferation and differentiation of human melanocytes, and ETRA has inhibitory effect on ET-1 induced melanogenesis and melanocyte proliferation. These findings suggest that ET-1 is an important mediator in epidermal pigmentation, and we will be able to use ETRA as a new whitening agent.

Cutaneous Horn Arising from Keratoacanthoma / 대한피부과학회지

Cutaneous horn is a clinica) diagnosis based upon the presence of a large protuberant mass of keratin. We report a case of cutaneous horn arising from keratoacanthoma in a 76-year old woman. The patient showed a dome-shaped nodule 2n in diameter with a central crater on thc right temple area. A yellow brown colored cornical hyperkeratotic protruding lesion(0.7* 0.7cm size) from the central crater of the nodule was also observed. Histopathological findings of the lesions showed charaeteristic findings of keratoacanfhoma and cutaneous horn. The lesion was removed by surgical excision.

Acute Generalized Exanthematous Pustulosis Probably Induced by Ampicillin / 대한피부과학회지

Generalized pustular skin eruptions as a form of drug eruption is a rare entity. Recently this unique pustular dermatosis has been termed as acute generalized exanthematous pustulosis. We report on a 19-year-old man with acute generalized exanthematous pustulosis probably induced by ampicillin. The patient presented with erythematous and pinhead-sized subcorneal pustules after taking ampicillin for abdomimal pain. The patient complained of high fever and malaise. On further review of his history, generalized skin eruptions had been noted on at least three other occasions. Each episode occured following oral administration of antibiotics. A histological examination of a skin biposy specimen showed a subcorneal pustules with a few neutrophils, dermal edema and necrotic keratinocytes. After discontinuation of ampicillin, the eruption cleared within 4 days.

Statitical Techniques Reported in Korean Dermatology Journals During 1990-1994

BACKGROUND: Effective evaluation of an article's scientific merit requires familiarity with the methodology described, especially when quantitative techniques, such as statistical procedures, are invoked to clarify research findings or to summarize data. OBJECTIVE: The purpose of this study was to describe the frequency with which various statistical concepts were reported in journals important to dermatology. From these results, dermatologists can identify the major statistical skills needed to critically evaluate their literature. METHODS: All 376 original articles of the Korean Journal of Dermatology(KJD) and the Annals of Dermatology(KAD) during 1990-1994 were chosen for review. Each article was re-viewed to determine the statistical content. RESULTS: The two most commonly used statistical techniques in the two journals were mean and standard deviation. The t-test was the next most frequently used statistical technique in the reviewed journals, followed by non-parametric, chi-square test, orphan p, ANOVA, and correlation/regression. CONCLUSION: These results indicate the need for wider education about the use of descriptive and basic comparative statistics. It is impossible to evaluate the dermatological literature critically without these skills.

Lipoma Arborescens of Hip Joint: A Case Report / 대한정형외과학회잡지

Lipoma Arborescens is rarely encountered in hip joint. This term was first used by Mueller in 1838, to describe a fatty trmor of the knee which presented branched villous-like projection. The etiology is unknown, Suggests its probable reationship to tuberculosis, rheumatoid arthitis, trauma, chronic inflammation, diabetes mellitus and degenerative arthritis. It frequently involves knee joint, hand, wrist, foot, ankle, tendon sheath and hip joint. It usually presents bilaterally. Their nonspecific symptoms and signs are mild pain, joint swelling with minimum effusion, festriction of joint motion, redness, local heating and crepitus. We experienced a case of lipoma arborescens of hip joint, which was treated by synovectomy with excision of lesion.