Clinical Features and Awareness of Hand Eczema in Korea

BACKGROUND: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. OBJECTIVE: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. METHODS: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. RESULTS: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. CONCLUSION: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.

Analysis of Lifestyle in Androgenetic Alopecia Patients / 대한피부과학회지

BACKGROUND: Androgenetic alopecia (AGA) is the most common type of hair loss, and androgens and genetic predisposition are believed to be the major factors that influence the development of AGA. Although there have been previous reports about the relationship between family history, smoking and insulin resistance with AGA, no previous study has investigated lifestyle habits such as eating habits in AGA patients. OBJECTIVE: The aim of this study was to investigate family history, lifestyle including smoking and eating habits in AGA patients and to compare the results with data from Korea Health Statistics 2009: Korea National Health and Nutrition Examination Survey (KNHANESIV-3). METHODS: We retrospectively evaluated a total of 347 male patients with AGA who visited the Department of dermatology, Inha University School of medicine, from September 2010 to August 2012. RESULTS: AGA with paternal family history was the most common (49.9%), and both of maternal and paternal family history was the least (10.1%). Body mass index and smoking did not show significant differences but eating habits showed a statistically significant difference according to the duration of AGA. Patients with longer disease duration (> or =60 months) showed higher intake of meat but low intake of fish than those with shorter disease duration (<12 months). Also, AGA patients showed low intake of beef, bean and squid in comparison to the average Korean population. CONCLUSION: This was the first study which investigated lifestyle habits such as eating habits in AGA patients and compared the results with data from Korea Health Statistics. However, a further large scale Cohort study is needed to define the casual relationship between eating habits and the development of AGA. Also, a further study including the difference of serum and hair androgen levels in relation to different lifestyle habits should be done.

A Case of Pulmonary Sarcoidosis with Endobronchial Nodular Involvement / 결핵및호흡기질환

Sarcoidosis is a multisystemic disorder of unknown cause that is characterized pathologically by noncaseating granulomas. Diagnosis is based on the exclusion of other infectious, interstitial, and neoplastic diseases and on the typical pathology. Although the lungs and mediastinal lymph nodes are almost involved, endobronchial nodular lesions of sarcoidosis with lung involvements are rare. We report a case of sarcoidosis with lung involvements and endobronchial nodules as confirmed by bronchial biopsy.

Experience in 102 Non-melanoma Skin Cancer with Mohs Micrographic Surgery / 대한피부과학회지

BACKGROUND: Mohs micrographic surgery (MMS) is a specialized type of minimal marginal surgery, which offers superior cure rates to other options in the treatment of non-melanoma skin cancers. OBJECTIVE: The aim of this study is to investigate the clinical characteristics and recurrence rate of the non-melanoma skin cancer and to estimate the safeties of MMS. METHODS: We retrospectively evaluated 102 patients who had been diagnosed with non-melanoma skin cancer and treated by MMS from May 2008 to September 2011. RESULTS: The most common cancer was basal cell carcinoma (63.72%), followed by squamous cell carcinoma (31.38%). The local flap was the most common method to repair surgical defects (74.5%), followed by primary closure (17.64%). Cervical lymph node metastasis was confirmed in 1 case (0.98%). Recurrence after MMS was observed in 1 of 102 patients (0.98%). CONCLUSION: MMS is a safe method for the treatment of non-melanoma skin cancer.

TRUE Test in Patients with Contact Dermatitis: A Multicenter Study / 대한피부과학회지

BACKGROUND: The TRUE test is a commercially available ready-to-apply patch test widely used in many countries, but no large-scale study is available on the TRUE test in Korea. OBJECTIVE: The purpose of this study was to analyze the type, frequency, and changes in the common contact allergens in Korea using the TRUE test. METHODS: From January 2009 to March 2010, TRUE tests were performed on patients with contact dermatitis at the Departments of Dermatology of 15 hospitals. The epidemiological findings of patients, and the results of the patch tests were analyzed. RESULTS: In total, 795 patch tested cases (246 males, 549 females) were compiled and analyzed. The oldest age distribution was the third decade in both males and females, and housewives and office-workers were the most common jobs, comprising 29.7% and 19.8% of the occupations, respectively. Overall, 65.1% of patients had at least one positive reaction, and the most common allergens were nickel sulfate (34.1%), thimerosal (12.6%), cobalt chloride (11.1%), and p-phenylenediamine (8.4%), in order of frequency. A univariate analysis of multiple variables including age, gender, occupation, and affected sites was conducted and a comparison with a previous multicenter study was also analyzed. CONCLUSION: These results provide the basis for use of the TRUE test in patients with contact dermatitis in Korea.

A Case of Cicatricial Alopecia Associated with Erlotinib

Erlotinib is a small-molecule tyrosine kinase inhibitor (TKI) of the epidermal growth factor receptor (EGFR). Erlotinib has been used primarily to treat non-small cell lung cancer. In addition to its role in tumor cells, EGFR is also an important regulator of growth and differentiation in the skin and hair. Therefore, EGFR-TKIs have been associated with a number of cutaneous side effects including follicular acneiform eruptions, cutaneous xerosis, chronic paronychia, desquamation, seborrheic dermatitis, and hair texture changes. Herein, we report a rare case of a 61-year-old woman who was treated with erlotinib and experienced cicatricial alopecia.

Photodistributed Telangiectasia Induced by Amlodipine

Calcium channel blockers are widely used antihypertensive drugs, which are uncommonly associated with cutaneous reactions, such as pruritus, urticaria, or alopecia. Photosensitivity presenting with telangiectasia has rarely been described. We present here a case of photodistributed telangiectasia induced clinically by amlodipine and histologically by enlarged capillaries in the upper dermis without signs of vasculitis.

A Clinical Study on Herpes Zoster Meningoencephalitis / 대한피부과학회지

BACKGROUND: Herpes zoster meningoencephalitis is a rare neurological complication and the known risk factors include an immunocompromised status, infiltration into the trigeminal ganglion, disseminated herpes zoster and elderly patients. Serious complications may develop, including cerebral hemorrhage. OBJECTIVE: As early diagnostic detection is mandatory to prevent long-term sequelae, we wanted to determine what signs and symptoms we should focus on for diagnosing zoster meningoencephalitis at an early stage. We also investigated the descriptive statistics of the patients and compared them with the patients who had non-complicated herpes zoster. METHODS: We examined the medical records of 5114 herpes zoster patients who had visited our clinic from 1996 through 2009. Among them, 18 patients who were diagnosed with herpes zoster meningoencephalitis by cerebrospinal fluid tests were subject to examinations to assess the incidence rates, the age distribution, the ganglion distribution, the clinical aspects, the underlying diseases and the presence of complications. RESULTS: The ages of the patients with herpes zoster meningoencephalitis showed that 50% of the patients were under 30 years old. Infiltration into the trigeminal ganglion and immunocompromising underlying diseases accounted for 50% and 16.7% of the total patients, respectively. In the case of disseminated herpes zoster patients, no meningoencephalitis developed. The rates of neck stiffness and fever, which are the most common symptoms of meningoencephalitis, were lower in the patients with herpes zoster meningoencephalitis (33.3% and 11.1%, respectively). However, headaches accompanied with nausea or vomiting showed high sensitivity (88.9%), and a high positive predictive value (69.6%) (p<0.001). All the patients were treated with acyclovir for 10~14 days, and cerebral hemorrhage occurred in 1 of them (5.5%) after treatment. CONCLUSION: When a patient with herpes zoster has symptoms of headache and nausea or vomiting then herpes zoster meningoencephalitis should be considered even if neck stiffness and fever are not present.

A Clinical Study on Herpes Zoster Meningoencephalitis / 대한피부과학회지

BACKGROUND: Herpes zoster meningoencephalitis is a rare neurological complication and the known risk factors include an immunocompromised status, infiltration into the trigeminal ganglion, disseminated herpes zoster and elderly patients. Serious complications may develop, including cerebral hemorrhage. OBJECTIVE: As early diagnostic detection is mandatory to prevent long-term sequelae, we wanted to determine what signs and symptoms we should focus on for diagnosing zoster meningoencephalitis at an early stage. We also investigated the descriptive statistics of the patients and compared them with the patients who had non-complicated herpes zoster. METHODS: We examined the medical records of 5114 herpes zoster patients who had visited our clinic from 1996 through 2009. Among them, 18 patients who were diagnosed with herpes zoster meningoencephalitis by cerebrospinal fluid tests were subject to examinations to assess the incidence rates, the age distribution, the ganglion distribution, the clinical aspects, the underlying diseases and the presence of complications. RESULTS: The ages of the patients with herpes zoster meningoencephalitis showed that 50% of the patients were under 30 years old. Infiltration into the trigeminal ganglion and immunocompromising underlying diseases accounted for 50% and 16.7% of the total patients, respectively. In the case of disseminated herpes zoster patients, no meningoencephalitis developed. The rates of neck stiffness and fever, which are the most common symptoms of meningoencephalitis, were lower in the patients with herpes zoster meningoencephalitis (33.3% and 11.1%, respectively). However, headaches accompanied with nausea or vomiting showed high sensitivity (88.9%), and a high positive predictive value (69.6%) (p<0.001). All the patients were treated with acyclovir for 10~14 days, and cerebral hemorrhage occurred in 1 of them (5.5%) after treatment. CONCLUSION: When a patient with herpes zoster has symptoms of headache and nausea or vomiting then herpes zoster meningoencephalitis should be considered even if neck stiffness and fever are not present.

Cutaneous Granulomas Associated with Common Variable Immunodeficiency / 대한피부과학회지

Common variable immunodeficiency (CVID) is one of the primary immunodeficiency disorders, which is characterized by hypogammaglobulinemia, defect in antibody synthesis and recurrent sinorespiratory bacterial infections. Granuloma is an uncommon skin manifestation in primary immunodeficiency disorders. Here we present a 5-year-old girl who had asymptomatic erythematous plaques on the face and legs. She had a past medical history of recurrent sinorespiratory and gastrointestical bacterial infections since 2 years old. The histopathologic findings of the skin lesions showed sarcoid-like granulomas with focal necrobiosis. No specific organism was found with evaluation. Cells forming granulomas were strongly positive for CD3 or CD68. CD4/CD8 ratio was estimated less than 1. Laboratory examination showed low hemoglobin, low B cell and normal T cell number, low IgA and IgG levels.

Inflammatory Disseminated Superficial Porokeratosis Successfully Managed by Oral Isotretinoin / 대한피부과학회지

Disseminated superficial porokeratosis is a keratinization disorder characterized by multiple brown, atrophic patches with sharply demarcated and hypertrophic ridges. Atypical cases of disseminated superficial porokeratosis with acute exacerbation accompanied by severe pruritus have been reported as "eruptive pruritic papular porokeratosis" or "inflammatory disseminated superficial porokeratosis." We report a case of inflammatory disseminated superficial porokeratosis in a 53-year-old man who was successfully treated with oral isotretinoin.

A Case of Pseudoaneurysm Developed during Intensive Treatment of Status Asthmaticus: A Case Report / 대한구급학회지

Pseudoaneurysm formation in the pulmonary vasculature is a rare but fatal condition. Several etiologies have been described including trauma, complication after cardiac or other surgeries, tuberculosis, necrotizing pneumonia, congestive heart disease, atherosclerosis, cancer and vasculitis. We report a case of pseudoaneurysm found in a patient being treated with status asthmaticus, who developed complications of pneumonia and brain abscess secondary to sepsis.

A Case of Neutrophilic Dermatosis of the Dorsal Hands with Concomitant Involvement of the Lips

Neutrophilic dermatosis of the dorsal hands (NDDH) is a localized, pustular variant of acute febrile neutrophilic dermatosis (Sweet syndrome). The lesions of NDDH clinically resemble those of Sweet syndrome (SS), but they differ from classic SS according to their locations (NDDH is predominantly restricted to the dorsal hands) and the smaller number of accompanying systemic symptoms. The histology of the NDDH lesion shows a dense dermal neutrophilic infiltration. The lesions rapidly resolve after systemic corticosteroid and/or dapsone therapy. We herein report on a case of neutrophilic dermatosis of the dorsal hands in a 34-year-old woman. The patient also had skin changes with erythematous plaque on the right lips.

The Effect of Autophagy to Cell Death in Nutrient-Deprived H460 Cells / 결핵및호흡기질환

BACKGROUND: Autophagy is an important adaptive mechanism in normal development and in response to changing environmental stimuli in cancer. Previous papers have reported that different types of cancer underwent autophagy to obtain amino acids as energy source of dying cells in nutrient-deprived conditions. However, whether or not autophagy in the process of lung cancer causes death or survival is controversial. Therefore in this study, we investigated whether nutrient deprivation induces autophagy in human H460 lung cancer cells. METHODS: H460, lung cancer cells were incubated in RPMI 1640 medium, and the starved media, which are BME and RPMI media without serum, including 2-deoxyl-D-glucose according to time dependence. To evaluate the viability and find out the mechanism of cell death under nutrient-deprived conditions, the MTT assay and flow cytometry were done and analyzed the apoptotic and autophagic related proteins. It is also measured the development of acidic vascular organelles by acridine orange. RESULTS: The nutrient-deprived cancer cell is relatively sensitive to cell death rather than normal nutrition. Massive cytoplasmic vacuolization was seen under nutrient-deprived conditions. Autophagic vacuoles were visible at approximately 12 h and as time ran out, vacuoles became larger and denser with the increasing number of vacuoles. In addition, the proportion of acridine orange stain-positive cells increased according to time dependence. Localization of GFP-LC3 in cytoplasm and expression of LC-3II and Beclin 1 were increased according to time dependence on nutrient-deprived cells. CONCLUSION: Nutrient deprivation induces cell death through autophagy in H460 lung cancer cells.

Induction of Autophagy by Low Dose of Cisplatin in H460 Lung Cancer Cells / 결핵및호흡기질환

BACKGROUND: Most lung cancer patients receive systemic chemotherapy at an advanced stage disease. Cisplatin-based chemotherapy is the main regimen for treating advanced lung cancer. Recently, autophagy has become an important mechanism of cellular adaptation under starvation or cell oxidative stress. The purpose of this study was to determine whether or not autophagy can occurred in cisplatin-treated lung cancer cells. METHODS: H460 cells were incubated with RPMI 1640 and treated in 5 micrometer or 20 micrometer cisplatin concentrations at specific time intervals. Cells surviving cisplatin treatment were measured and compared using an MTT cell viability assay to cells that underwent apoptosis with autophagy by nuclear staining, apoptotic or autophagic related proteins, and autophagic vacuoles. The development of acidic vascular organelles was using acridine orange staining and fluorescent expression of GFP-LC3 protein in its transfected cells was observed to evaluate autophagy. RESULTS: Lung cancer cells treated with 5 micrometer cisplatin-treated were less sensitive to cell death than 20 micrometer cisplatin-treated cells in a time-dependent manner. Nuclear fragmentation at 5 micrometer was not detected, even though it was discovered at 20 micrometer. Poly (ADP-ribose) polymerase cleavages were not detected in 5 micrometer within 24 hours. Massive vacuolization in the cytoplasm of 5 micrometer treated cells were observed. Acridine orange stain-positive cells was increased according in time-dependence manner. The autophagosome-incorporated LC3 II protein expression was increased in 5 micrometer treated cells, but was not detected in 20 micrometer treated cells. The expression of GFP-LC3 were increased in 5 micrometer treated cells in a time-dependent manner. CONCLUSION: The induction of autophagy occurred in 5 micrometer dose of cisplatin-treated lung cancer cells.

Induction of Autophagy by Low Dose of Cisplatin in H460 Lung Cancer Cells / 결핵및호흡기질환

BACKGROUND: Most lung cancer patients receive systemic chemotherapy at an advanced stage disease. Cisplatin-based chemotherapy is the main regimen for treating advanced lung cancer. Recently, autophagy has become an important mechanism of cellular adaptation under starvation or cell oxidative stress. The purpose of this study was to determine whether or not autophagy can occurred in cisplatin-treated lung cancer cells. METHODS: H460 cells were incubated with RPMI 1640 and treated in 5 micrometer or 20 micrometer cisplatin concentrations at specific time intervals. Cells surviving cisplatin treatment were measured and compared using an MTT cell viability assay to cells that underwent apoptosis with autophagy by nuclear staining, apoptotic or autophagic related proteins, and autophagic vacuoles. The development of acidic vascular organelles was using acridine orange staining and fluorescent expression of GFP-LC3 protein in its transfected cells was observed to evaluate autophagy. RESULTS: Lung cancer cells treated with 5 micrometer cisplatin-treated were less sensitive to cell death than 20 micrometer cisplatin-treated cells in a time-dependent manner. Nuclear fragmentation at 5 micrometer was not detected, even though it was discovered at 20 micrometer. Poly (ADP-ribose) polymerase cleavages were not detected in 5 micrometer within 24 hours. Massive vacuolization in the cytoplasm of 5 micrometer treated cells were observed. Acridine orange stain-positive cells was increased according in time-dependence manner. The autophagosome-incorporated LC3 II protein expression was increased in 5 micrometer treated cells, but was not detected in 20 micrometer treated cells. The expression of GFP-LC3 were increased in 5 micrometer treated cells in a time-dependent manner. CONCLUSION: The induction of autophagy occurred in 5 micrometer dose of cisplatin-treated lung cancer cells.

Surgical Treatment for Acquired Malalignment of the Toenail / 대한피부과학회지

Malalignment of the toenail is a rare deformity that is characterized by lateral deviation of the nail plate with respect to the longitudinal axis of the distal phalanx. The condition may be congenital or acquired. The acquired forms of malalignment may result from trauma or surgical intervention. However, there are only a few reports that have focused on surgical treatment for this condition. We present here a case of a 24-year-old woman who had this nail problem for 1 year and she was successfully treated with the surgical approach. We also discuss the probable mechanism of iatrogenic malalignment.

Tumor Lysis Syndrome Induced by Radiotherapy in Non-Small Cell Lung Cancer

Tumor lysis syndrome (TLS) is an oncologic emergency that is characterized by numerous metabolic abnormalities, including hyperuricemic nephropathy, hyperphosphatemia, hypocalcemia, hyperkalemia and increased serum creatinine. This syndrome is common for tumors with rapid cell turnover and growth rates, and for bulky tumors with high sensitivity to anti-neoplastic treatments. Hence, TLS is a well-recognized clinical problem in hematologic malignancies. TLS is rarely observed to be induced in solid tumors by chemotherapy. Herein we present the second case of TLS that developed during radiotherapy in a patient with non-small cell lung cancer.

A Case of Blastic Plasmacytoid Dendritic Cell Neoplasm Initially Mimicking Cutaneous Lupus Erythematosus / Journal of the Korean Cancer Association, 대한암학회지

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare disease. The prognosis is poor in most cases with rapid progression despite administering chemotherapy. A 67-year-old man complained of skin rashes on his back and this spread to the trunk, face, arms and thighs, and he was initially diagnosed with cutaneous lupus erythematosus according to the skin biopsy. The skin rashes then became aggravated on a trial of low dose methylprednisolone for 3 months. Repeated skin biopsy revealed a diffuse infiltration of lymphoid cells with medium sized nuclei, positive for CD4 and CD56, negative for Epstein-Barr virus (EBV), indicating a diagnosis of BPDCN. Further workups confirmed stage IVA BPDCN involving the skin, multiple lymph nodes, the peripheral blood and the bone marrow. He was treated with six cycles of combination chemotherapy consisting of ifosphamide, methotrexate, etoposide, prednisolone and L-asparaginase, and he achieved a partial response. Herein we report on a rare case of BPDCN that was initially misinterpreted as cutaneous lupus erythematosus.

Two Cases of Chemical Pneumonitis Induced by Hydrocarbon Aspiration / 결핵및호흡기질환

Chemical pneumonitis induced by hydrocarbon aspiration is rare in Korea. Kerosene is a petroleum distillate with low viscosity and high volatility. We report two adult cases of chemical pneumonitis caused by the accidental aspiration of kerosene. They were treated successfully with antibiotics and systemic corticosteroids, and recovered without complications.