Quality of Life in Melasma / 대한피부과학회지

BACKGROUND: Melasma is a common pigmentary disorder of facial skin. It can have significant emotional, social, and psychological effects. But little is known about the impact of melasma on the quality of life (QOL) in Korean patients. OBJECTIVE: The purpose of this study was to investigate the quality of life in patients with melasma. METHODS: A total of 100 patients with melasma were enrolled and interviewed against the Melasma Quality of Life scale (MELASQOL), which was recently developed by Balkrishnan et al. The patients were also evaluated by the investigator using the Melasma Area and Severity Index (MASI). RESULTS: The average score of MELASQOL was 41.2. A high score meant that melasma had a great effect on quality of life. It was high in patients with high MASI scores (p<0.01), young patients (p<0.01), and short duration of melasma (p<0.05). It was also high in those who had a high education level (p<0.05), or a previous treatment history (p<0.01). However, presence or absence of other skin diseases or preceding causes made no significant difference. CONCLUSION: This study shows that melasma has significant impact on the QOL of Korean melasma patients. Therefore, in addition to treating melasma, clinicians need to consider the psychosocial aspects of improving QOL in order to give patients optimal satisfaction.

Treatment of Striae Distensae by Thermage and 585-nm Pulsed Dye Laser(V-star(R)) / 대한피부과학회지

Striae Distensae is a very common cosmetic problem. The effectiveness of various lasers, such as the 585-nm pulsed dye laser on the treatment of striae distensae has recently been reported. However, the potential pigmentary alteration of dark skin by pulsed dye laser is known. Thermage is a radiofrequency capable of delivering higher energy fluences to a greater volume of tissue than nonablative lasers, with no epidermal injury. We report three patients who had striae distensae. They were treated with Thermage and 585-nm pulsed dye laser. The treatment was effective and safe for dark skin.

Three Cases of Facial Photorejuvenation by Intense Pulsed Light Quantum SR(TM) / 대한피부과학회지

Intense pulsed light (IPL) Quantum SR(TM) systems are high-intensity light sources, which emit polychromatic light. Unlike laser systems, these flashlamps work with noncoherent light in a broad wavelength spectrum of 560-1200 nm. IPL Quantum SR(TM) has been effective for the treatment of photoaging skin as a nonablative method. Three patients with photoaged skin were treated with fifth full-face treatments at 3-4 week intervals using IPL Quantum SR(TM). The cut-off filters of 560 nm and integrated contact cooling system were utilized for treatments. After the last treatments, the patients showed the overall improvement in clinical appearance, reduction in pigmentation and telangiectasia and fine wrinkle with smoothening of skin textures. Histological evaluations showed new collagen production after treatment. Full-face photorejuvenation using IPL Quantum SR(TM) can be an effective treatment modality for photoaged skin. We report herein IPL photorejuvenation is safe and effective in skin rejuvenation.

The Effect of Nerve Growth Factor on Cell Proliferation and Expression of Its Receptors in Cultured Human Keratinocytes / 대한피부과학회지

BACKGROUND: Nerve growth factor(NGF) is a neurotrophic polypeptide necessary for the survival and growth of some central neurons, as well as sensory afferent and sympathetic neurons. In addition to its actions on the nervous system, it also has a significant biologic effects on cells of the immune-inflammatory compartment. Recent studies suggest that NGF is an important autocrine growth factor and survival factor for keratinocytes which express both high- and low-affinity receptors for NGF. OBJECTIVE: The purpose of this study is to detect NFG receptors on cultured human keratinocytes and to evaluate the effect of NGF on proliferation of cultured human keratinocytes. METHODS: Cultured human keratinocytes were examined for the expression of high affinity receptor TrkA and low affinity receptor p75 by Northern blot, Western blot and immunocytochemistry. The effects of NGF on proliferation of cultured human keratinocytes were also evaluated. To specify the NGF effect on proliferation of human keratinocytes, excess of anti-NGF neutralizing polyclonal antibody was added. RESULTS: 1) NGF significantly stimulated the proliferation of keratinocytes in both 1% of keratinocyte growth supplement(KGS)-added medium(100ng/ml) and 0.2% KGS-added media(50, 100, 500ng/ml), (p<0.05). The cell number was dose-dependently increased in 0.2% KGS-added media. 2) Whenever we added 500 ng/ml of anti-NGF polyclonal antibody to the growth media, the cell number was statistically higher in 100ng/ml NGF-added group of 1% KGS-added medium, but there was not any statistical significance in 0.2% KGS-added media group. 3) Immunocytochemical staining with specific antibodies to TrkA and p75 revealed positive findings for these receptors, but TrkB and TrkC were not detected. 4) We could not detect both the mRNA and protein of TrkA and p75 by Northern and Western blot methods. CONCLUSION: These results suggest that both high affinity- and low affinity receptors for NGF are expressed in cultured human keratinocytes and NGF can induce keratinocyte proliferation.

Comparison of the human melanocyte culture in phorbol 12-myristate 13-acetate-contained medium and physiologic mitogens-contained medium / 대한피부과학회지

BACKGROUND: The growth of cells is closely related to components in a culture medium. There are many reports about cellular characteristics of melanocytes grown in a PMA-contained medium. However, only a few reports have been studied by using a physiologic mitogens-contained medium. To understand melanocyte in vivo, it is necessary to know the cellular biology of melanocytes grown in a physiologic mitogens-contained medium. OBJECTIVE: To investigate any differences between melanocytes grown in phorbol 12-myristate 13-acetate(PMA)-contained medium and in physiologic mitogens-contained medium. METHOD: We examined morphology, number and melanin contents of cultured human melanocytes grown in a PMA-contained medium and physiologic mitogens-, such as bFGF, ET-1 and a a-MSH contained medium. Result : The results are summarized as follows : 1. There were no significant morphologic differences between cells in PMA-contained medium and in physiologic mitogens-contained medium. 2. The number of melanocytes were significantly more numerous in PMA-contained medium on the 2nd day (p<0.05), but significantly less numerous in the same medium on the 6th day (p<0.05). So, the proliferation rate of melanocytes in PMA-contained medium became lower than in physiologic mitogens-contained medium as time went by. 3. Melanocytes grown in PMA-contained medium had significantly increased melanin contents regardless of the time (p<0.05). Conclusion : The proliferation of melanocytes was better in physiologic mitogens-contained medium, the melanization was higher in melanocytes of PMA-contained medium.

Two Cases of Cutaneous Metastasis from Small Cell Lung Cancer / 대한피부과학회지

The frequency of metastasis to the skin from lung cancer is 1-12%. The incidence of cutaneous metastasis was high in patients with large-cell lung cancer, whereas squamous cell and small-cell lung cancer showed the least tendency to extend to cutaneous sites. Adenocarcinoma was intermediate in the tendency to metastasize in the skin. Histological findings of small-cell lung cancer show solid, tumor cell nests composed of neoplastic cells with large, round nuclei. So, it is often difficult to distinguish small-cell lung cancer from other poorly differentiated small-cell tumors, such as Merkel cell carcinoma, metastatic carcinoid, lymphoma, etc. We report here two cases of skin metastasis from small-cell lung cancer. Case one was a 74-year-old man presenting with a single, round, dome-shaped nodule on the alar nasi which had been present for 1 month. The second case was a 73-year-old man who had found three, non-tender, freely movable subcutaneous nodules on the abdomen 3 days before. Both cases were diagnosed as small-cell lung cancer. On histopathological examination of the skin lesions, we could observe that small round to oval cells with dark staining nuclei and scant cytoplasms were arranged in anastomosing trabecular streams through the dermis, separated by strands of connective tissue in both cases. In the first case, the tumor cells were positive to cytokeratin and NSE, negative to neurofilament antiagen and LCA.

Subcutaneous Panniculitic T-cell Lymphoma

Subcutaneous panniculitic T-cell lymphoma(SPTCL) is a rare subtype of peripheral T-cell lymphoma that clinically and histologically mimics benign panniculitis. SPTCL is characterized by subcutaneous nodules on the extremities and trunk. It has a tendency to occur mainly in female adults with eosinophilia, pruritus or hemophagocytic syndromes. Histopathologically, typical lesions of SPTCL show moderate to dense lymphocytic infiltrates in the subcutaneous fat, primarily involving the lobules. Early lesions may show only focal lymphocytic atypia: later lesions display karyorrhexis, necrosis and cytophagia. A 34-year-old woman presented with multiple, recurrent, tender subcutaneous nodules on the abdomen and extremities which she had had for 13 years. There was no hepatosplenomegaly or lymphadenopathy. Skin biopsy specimens revealed atypical small and large lymphocytic infiltrations in the subcutaneous tissue. Occasionally, histiocytes contained erythrocytes and lymphocytes in their cytoplasm. Immunohistochemical staining showed positive reactions to CD45RO and CD43. Negative reactions were seen to CD20, Leu-7 and lysozyme antigen. On the basis of the clinical & histological findings, we established the diagnosis of SPTCL.

A Clinicopathological Study of Fixed Drug Eruptions / 대한피부과학회지

BACKGROUND: Fixed drug eruptions(FDE) are a cutaneous reaction characterized by one or more circumscribed lesions that recur at the same site in response to a given medication. OBJECTIVE: The purpose of this study was to find the clinical and histopathological characteristics of FDE and to compare early FDE with late FDE histopathologically. METHOD: We clinically investigated 54 cases of FDE that visited the department of dermatology at the Kyunghee medical center from January 1993 to December 1996. Among them, 31 patients had skin biopsies and were evaluated histopathologically on the basis of duration. RESULTS: The results were summarized as follows: 1. Development of FDE did not show any difference according to sex and was evenly distributed over all the ages. 2. The latent periods of FDE were diverse in appearance from 30 minutes to 10 days, but mostly, the skin lesions erupted within 4S hours. 3. The most common skin lesions were erythematous macules. 4. Distribution of the lesions came out as solitary: 20.4%, multiple: 79.6%. S3.7% of the multiple lesions were localized to a part of body, and 16.3% were distributed over the whole body. 5. The areas in which the eruptions developed were (in descending order): upper extremity(37.0%), hand(31.5%), trunk(24.1%), face(24.1%). 6. In most cases(68.6%), the size and the number of lesions were greater in recurrente, rather than in first attacks. 7. The histopathological findings commonly showed perivascular mononuclear cell(MNC) infiltration (100%), pigmentary incontinence(77.4%), basal hydrophic degeneration(71.0%), eosinophil infiltration in dermis(61.3%), etc. 8. The epidermal histopathological findings such as spongiosis, exocytosis of MNC, basal hydrophic degeneration, keratinocyte necrosis and subepidermal vesicles could be seen more frequently in early lesions than in late ones. CONCLUSION: In our study, we were able to obtain meaningful results based on data from the combination of clinical and histopathological investigations. This study may give help to understand the characteristics of fixed drug eruptions and to plan future studies.

Immunohistochemical Study of Glomus Tumors / 대한피부과학회지

BACKGROUND: Glomus tumor is a benign lesion composed of vessels and glomocytes in varying proportions. Although the histologic features of glomus tumors by light microscopy are characteristic and well recognized, there is controversy as to the histogenesis and cytological characterization of the glomus cell. OBJECTIVE: The aim of the present study was to verify the histopathological origin of a glornus tumor. Method: We investigated 1 cases of glomus tumors for immunohistochemical features. RESULTS: The glomus turnor cells were negative when stained for FactorVIII-related antigen and S-100 protein. Conversely, all materials were found to be positive for actin, vimentin, NSE. Sorne exhibited an equivocal reaction for desmin and CD34, the rest were negative. CONCLUSION: These findings support the hypothesis that the glomus cell is transitional-between smooth muscle and vascular ndothelium-being essentially a modified smooth muscle cell with some endothelial cell properties.

A Case of Granular Cell Tumor / 대한피부과학회지

Granular cell tumors were originally described in 1926 by Abrikossoff as myoblastic myomas. They usually occur as solitary tumors but can be multiple in about 10% of cases. They have a predilection for the head, neck and tongue, but also occur in many other organs. Authors experienced a 37 year-old male patient with a granular cell tumor which exhibited the distinctive histopathologic appearance on light microscopy and electromicroscopy Also, granular cells were S-100 protein, vimentin and CD68 immunoreactive, but desmin and GFAP showed negative immunostaining. This finding suggests a neural origin for grenular cell tumors.