Dermoscopic features of an unusual case of targetoid hemosiderotic nevus / 고신대학교의과대학학술지

Targetoid hemosiderotic nevus (THN) is a rare variant of melanocytic nevus, characterized by a sudden development of a targetoid ecchymotic halo around a pre-existing nevus. THN clinically raises concern for malignant transformation due to its abrupt change in color and size. THN should be distinguished from other diseases showing a peripheral halo, including targetoid hemosiderotic hemangioma, halo nevus, and Meyerson nevus. Dermoscopy can help clinicians to differentiate THN from these diseases. The typical dermoscopic features of THN are known to be divided into two distinctive areas: the central melanocytic area and the peripheral ecchymotic area. In our case, dermoscopy revealed a novel bull’s eye pattern composed of a central area with characteristic features of benign melanocytic nevus, an intermediated white circular ring, and a peripheral milky red area. When a sudden change occurs in a pre-existing nodule showing targetoid features, dermoscopy should be considered before conducting a biopsy or surgical intervention.

A Clinicopathologic Study of Lichenoid Drug Eruption / 대한피부과학회지

Background@#Lichenoid drug eruption (LDE) is a relatively rare form of cutaneous drug eruption and that resembles lichen planus on a clinical and histological basis. Although there are some studies on histopathological findings of LDE, studies on clinical findings of LDE are limited. @*Objective@#To investigate the clinical and histopathologic findings and prognosis of LDE. @*Methods@#We retrospectively investigated the clinicopathologic findings of LDE patients who visited Kosin University Gospel Hospital between 1990 and 2020. @*Results@#This study included 44 LDE patients (male:female=1.4:1). The most common causative drug was anti-tuberculous drugs (52.3%), followed by 5-fluorouracil (11.4%), and captopril (9.1%). There were pruritic erythematous scaly or lichenoid patches and plaques in all cases. The most frequently involved sites were trunk and extremities. Notably, 15 cases (34.1%) involving the scalp and 3 cases (6.8%) involving the oral mucosa. Treatment modalities included oral, topical corticosteroid, and oral antihistamines. Among 44 cases, 28 patients discontinued the causative agent, and 16 patients continued to use it after diagnosis of LDE. The mean duration of treatment for patients who discontinued or did not discontinue the causative drugs was 4, 10 weeks, respectively. The most commonly observed histopathologic findings were superficial and deep perivascular infiltration of inflammatory cells (100.0%) and eosinophil infiltration (93.2%). @*Conclusion@#LDE can be differentiated from idiopathic lichen planus by clinicopathologic findings. LDE appears to be a mild form of drug eruption in which symptoms can be controlled with conservative treatment, even without the cessation of causative drugs for the treatment of the underlying disease.

Relation between Lichen Planus and Hepatitis C Virus Infection / 대한피부과학회지

Background@#The etiology and pathogenesis of lichen planus (LP) are not fully understood. Several studies have reported varying prevalence of anti-hepatitis C virus antibody (anti-HCV Ab) in LP. The relationship between LP and HCV infection remains controversial. @*Objective@#To investigate the relationship between LP and HCV infection in Busan and Gyeongnam, Korea. @*Methods@#We reviewed the medical records of 84 outpatients with LP and 84 control subjects (age- and sex-matched) from 2000 to 2020. Data on age, sex, duration of disease, distribution, shape, systemic diseases, and serology of anti-HCV Ab were collected. @*Results@#The prevalence of anti-HCV Ab was 1.2% and 9.5% in the control group and patients with LP, respectively. Compared with the control group, patients with LP had a higher risk of HCV infection with an odds ratio of 8.737 (p=0.034). The mean duration of disease for the eight patients with HCV-associated LP was 5.8 months, which was shorter than 15.8 months in 84 patients with LP alone. Mucosal erosive LP was observed most frequently in HCV-associated LP with an odds ratio of 9.273 (p=0.003). @*Conclusion@#HCV infection may be clinically relevant to the development of LP. Furthermore, HCV infection may accelerate the progression of LP and is possibly related to the mucosal erosive subtype. Therefore, dermatologists should perform an anti-HCV Ab screening test for patients with LP, disclosing the potential association between LP and HCV infection.

A Case Report on the Dermoscopic Features of Spark’s Nevus

Spark’s nevus is a compound word composed of Spitz nevus and Clark’s nevus. It is one of the combined melanocytic nevi which is more common in female and usually presents as a sharp circumscribed hyperpigmented macule on the lower extremities. On histopathologic findings, both cytologic features of Spitz nevus characterized as large spindle or epithelioid melanocytes containing large nuclei with abundant cytoplasm, and architecture of Clark’s nevus characterized as elongation of rete ridges, bridging of the nests, concentric and lamellar fibrosis can be seen. A 24-year-old female presented with an asymptomatic, solitary, dark-brown-colored papule surrounded by brownish patch that looked similar to dysplastic nevus or malignant melanoma on the buttock. On dermoscopic examination, it showed brown-to-black globules, diffuse homogenous pigmentation with blue-white structures, and a surrounding brownish reticular pattern that faded away. On histopathologic findings, overall asymmetrical structure, epithelioid large melanocytes containing large nuclei with abundant cytoplasm, and Kamino body were seen in the central portion. Also, lentiginous hyperplasia, bridging of the nests composed of melanocytes containing foamy cytoplasm, concentric and lamellar fibrosis along with the elongation of rete ridge, and perivascular lymphocytic infiltration were seen in the peripheral portion. The diagnosis of Spark’s nevus was made. Following its definition, this combined nevus is diagnosed histopathologically, but the clinicodermoscopic features have not been well described. Herein, we report a case of Spark’s nevus in which dermoscopy was helpful for differentiating it from malignant melanoma.

Relation between Lichen Planus and Hepatitis C Virus Infection / 대한피부과학회지

Background@#The etiology and pathogenesis of lichen planus (LP) are not fully understood. Several studies have reported varying prevalence of anti-hepatitis C virus antibody (anti-HCV Ab) in LP. The relationship between LP and HCV infection remains controversial. @*Objective@#To investigate the relationship between LP and HCV infection in Busan and Gyeongnam, Korea. @*Methods@#We reviewed the medical records of 84 outpatients with LP and 84 control subjects (age- and sex-matched) from 2000 to 2020. Data on age, sex, duration of disease, distribution, shape, systemic diseases, and serology of anti-HCV Ab were collected. @*Results@#The prevalence of anti-HCV Ab was 1.2% and 9.5% in the control group and patients with LP, respectively. Compared with the control group, patients with LP had a higher risk of HCV infection with an odds ratio of 8.737 (p=0.034). The mean duration of disease for the eight patients with HCV-associated LP was 5.8 months, which was shorter than 15.8 months in 84 patients with LP alone. Mucosal erosive LP was observed most frequently in HCV-associated LP with an odds ratio of 9.273 (p=0.003). @*Conclusion@#HCV infection may be clinically relevant to the development of LP. Furthermore, HCV infection may accelerate the progression of LP and is possibly related to the mucosal erosive subtype. Therefore, dermatologists should perform an anti-HCV Ab screening test for patients with LP, disclosing the potential association between LP and HCV infection.

Erratum: Folliculotropic Mycosis Fungoides in 20 Korean Cases: Clinical and Histopathologic Features and Response to Ultraviolet A-1 and/or Photodynamic Therapy

In the originally published version of this article, complete anonymity was not achieved.

Folliculotropic Mycosis Fungoides in 20 Korean Cases: Clinical and Histopathologic Features and Response to Ultraviolet A-1 and/or Photodynamic Therapy

BACKGROUND: Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides (MF) that is characterized clinically by variable types of skin eruptions, including plaques, acneiform lesions, and alopecic patches. Histopathologically, FMF is characterized by folliculotropic infiltrates. OBJECTIVE: This study was conducted to scrutinize the clinical and histopathologic features of FMF in Koreans and the responses to phototherapy. METHODS: Twenty Koreans diagnosed with MF who had histopathologic evidence of folliculotropism were enrolled. RESULTS: Eighteen patients had head-and-neck-region infiltration, while five had solitary lesion. In all patients, the atypical lymphocytic infiltrate had a perifollicular distribution. Twelve patients were treated with ultraviolet A (UVA)-1. Eleven of these 12 patients with early-stage FMF experienced >80% improvement (8: complete remission; 3: partial remission). Four patients, including 2 who relapsed after UVA-1, were treated with photodynamic therapy (PDT), reaching complete remission after PDT. CONCLUSION: As FMF has variable clinical presentations, skin biopsy is required to confirm the diagnosis. And both UVA-1 and methyl aminolevulinate-PDT are clinically effective in treatment of early-stage FMF.

Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. OBJECTIVE: To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. RESULTS: With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p0.05), no vascular structure, and arborizing telangiectasia (p0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). CONCLUSION: Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.

Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. OBJECTIVE: To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. RESULTS: With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p0.05), no vascular structure, and arborizing telangiectasia (p0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). CONCLUSION: Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.

Degos-Like Lesions Associated with Systemic Lupus Erythematosus

Degos disease, also referred to as malignant atrophic papulosis, was first described in 1941 by Köhlmeier and was independently described by Degos in 1942. Degos disease is characterized by diffuse, papular skin eruptions with porcelain-white centers and slightly raised erythematous telangiectatic rims associated with bowel infarction. Although the etiology of Degos disease is unknown, autoimmune diseases, coagulation disorders, and vasculitis have all been considered as underlying pathogenic mechanisms. Approximately 15% of Degos disease have a benign course limited to the skin and no history of gastrointestinal or central nervous system (CNS) involvement. A 29-year-old female with history of systemic lupus erythematosus (SLE) presented with a 2-year history of asymptomatic lesions on the dorsum of all fingers and both knees. The patient had only skin lesions and no gastrointestinal or CNS vasculitis symptoms. Her skin lesions were umbilicated, atrophic porcelain-white lesions with a rim of erythema. On the basis of clinical, histologic, and laboratory findings, a diagnosis of Degos-like lesions associated with SLE was made. The patient had been treated for SLE for 7 years. Her treatment regimen was maintained over a 2 month follow-up period, and the skin lesions improved slightly with no development of new lesions.

Granulocyte Colony-Stimulating Factor-Induced Psoriasiform Dermatitis Improved by Narrowband Ultraviolet B

No abstract available.

Pityriasis Lichenoides-like Mycosis Fungoides: Clinical and Histologic Features and Response to Phototherapy

BACKGROUND: Pityriasis lichenoides (PL)-like skin lesions rarely appear as a specific manifestation of mycosis fungoides (MF). OBJECTIVE: We investigated the clinicopathological features, immunophenotypes, and treatments of PL-like MF. METHODS: This study included 15 patients with PL-like lesions selected from a population of 316 patients diagnosed with MF at one institution. RESULTS: The patients were between 4 and 59 years of age. Four patients were older than 20 years of age. All of the patients had early-stage MF. In all patients, the atypical lymphocytic infiltrate had a perivascular distribution with epidermotropism. The CD4/CD8 ratio was <1 in 12 patients. Thirteen patients were treated with either narrowband ultraviolet B (NBUVB) or psoralen+ultraviolet A (PUVA), and all of them had complete responses. CONCLUSION: PL-like MF appears to have a favorable prognosis and occurrence of this variant in adults is uncommon. MF should be suspected in the case of a PL-like skin eruption. Therefore, biopsy is required to confirm the diagnosis of PL-like MF, and NBUVB is a clinically effective treatment.

Porphyria Cutanea Tarda in a Hemodialysis Patient / 대한피부과학회지

No abstract available.

Usefulness of Ultrasonography in Differential Diagnosis between Ruptured and Unruptured Epidermal Cysts / 대한피부과학회지

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, inflamed, or infected, then incision and drainage together with oral antibiotic therapy or intralesional steroid injection treatment is required. Identification of ruptured and unruptured cysts is important for treatment decisions. OBJECTIVE: The purpose of this study was to evaluate the usefulness of ultrasonography in the diagnosis of epidermal cysts, and to analyze distinctive features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: We reviewed the clinical and sonographic features of pathologically confirmed epidermal cysts from 2 subgroups of 66 patients: 30 with unruptured cysts and 36 with ruptured cysts. The sonographic features used in the analysis included tumor size, margin, shape, tumor texture, posterior echo, internal debris, and lesion vascularity on color Doppler sonography. RESULTS: The mean long diameter of the cysts was 10.95 mm in the unruptured cyst group and 12 mm in the ruptured cyst group. Some sonographic features, including heterogenous and hypoechoic echo texture, posterior echo enhancement, and internal hyperechoic and hypoechoic debris, showed no significant differences between the groups (p>0.05). The unruptured cyst group showed cysts with significantly higher frequencies of a well-circumscribed margin, an ovoid shape, and no vascular flow (p<0.05). In contrast, the ruptured cyst group usually had cysts with a poorly defined or slightly poorly defined margin, an irregular shape, peripheral vascular flow, and mild or moderate flow vascularity. CONCLUSION: The results of this study indicate that ultrasonography is helpful in differentiating between ruptured and unruptured epidermal cysts.

Usefulness of Ultrasonography in Differential Diagnosis between Ruptured and Unruptured Epidermal Cysts / 대한피부과학회지

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, inflamed, or infected, then incision and drainage together with oral antibiotic therapy or intralesional steroid injection treatment is required. Identification of ruptured and unruptured cysts is important for treatment decisions. OBJECTIVE: The purpose of this study was to evaluate the usefulness of ultrasonography in the diagnosis of epidermal cysts, and to analyze distinctive features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: We reviewed the clinical and sonographic features of pathologically confirmed epidermal cysts from 2 subgroups of 66 patients: 30 with unruptured cysts and 36 with ruptured cysts. The sonographic features used in the analysis included tumor size, margin, shape, tumor texture, posterior echo, internal debris, and lesion vascularity on color Doppler sonography. RESULTS: The mean long diameter of the cysts was 10.95 mm in the unruptured cyst group and 12 mm in the ruptured cyst group. Some sonographic features, including heterogenous and hypoechoic echo texture, posterior echo enhancement, and internal hyperechoic and hypoechoic debris, showed no significant differences between the groups (p>0.05). The unruptured cyst group showed cysts with significantly higher frequencies of a well-circumscribed margin, an ovoid shape, and no vascular flow (p<0.05). In contrast, the ruptured cyst group usually had cysts with a poorly defined or slightly poorly defined margin, an irregular shape, peripheral vascular flow, and mild or moderate flow vascularity. CONCLUSION: The results of this study indicate that ultrasonography is helpful in differentiating between ruptured and unruptured epidermal cysts.

Urticarial Vasculitis Associated with Mycoplasma pneumoniae / 대한피부과학회지

No abstract available.

Epidermotropic Metastatic Malignant Melanoma / 대한피부과학회지

Cutaneous metastases of malignant melanoma are usually confined to the dermis or subcutaneous fat. In some instances, however, they may involve the epidermis. A 68-year-old woman with a malignant melanoma on the subungual area of the right great toe presented with multiple blackish pinhead-sized macules surrounding an ulcerative lesion on the right great toe. Histopathological study of the macules showed atypical melanocytes and melanocytic nests in the papillary dermis and the dermoepidermal junction. A thinning of the epidermis, widening of the dermal papillae by aggregated atypical melanocytes, epidermal collarette formation, and angiotropism were also seen. A diagnosis of epidermotropic metastatic malignant melanoma (EMMM) was made. EMMM is a specific form of metastatic malignant melanoma that is associated with epidermotropism of melanoma cells and several histopathological features. The differential diagnosis between primary malignant melanoma and EMMM can be difficult because of their similar clinical and histological features. Here, we report a case demonstrating EMMM.

Pigmentary Changes Following Photodynamic Therapy with 5-aminolevulinic Acid or Methyl Aminolevulinate Cream / 대한피부과학회지

BACKGROUND: Several side effects such as pain, erythema, and hyperpigmentation have been reported following photodynamic therapy (PDT). OBJECTIVE: We sought to compare the pigmentary changes induced by PDT with 5-aminolevulinic acid (ALA) and those induced by PDT with methyl aminolevulinate (MAL) in people with skin phototypes III-IV over a 6 month period. METHODS: In ten healthy volunteers, six skin areas on the upper arm of each subject were treated with (A) ALA 20% in base cream without irradiation, (A1) MAL 16.8% without irradiation, (B), (B1) control vehicles, (C) ALA 20% in base cream, and (C1) MAL 16.8%. Areas (B), (B1), (C), and (C1) were irradiated at four hours after photosensitizer or vehicle application. Irradiation was administered twice with a 1 week interval. The effects on the skin were assessed by visual and colorimetric evaluations. RESULTS: On (C) and (C1) areas, erythema and pigmentation were most pronounced at 30 minutes after the second irradiation. Erythema rapidly diminished but pigmentation persisted throughout the study. Erythema and pigmentation on (C)-treated areas were more prominent and prolonged than those on (C1)-treated areas. CONCLUSION: In subjects with skin phototypes III-IV, pigmentation tends to last for more than 6 months after PDT. The ALA-treated skin areas developed more severe and prolonged erythema and pigmentation than the MAL-treated skin areas.

Eosinophilic Pustular Folliculitis with Palmoplantar Involvement / 대한피부과학회지

Eosinophilic pustular folliculitis (EPF) is an inflammatory disease characterized by pruritic follicular papulopustules of unknown etiology. EPF is clinically characterized by annular configurations on the face, trunk, and extremities. EPF rarely affects the palms and soles where hair follicles are absent. Histopathologically, a number of eosinophils infiltrate around and into hair follicles. A 44-year-old man visited us with pruritic plaques on the face, crusted patches and pustules on the both palms and soles. Histopathologic findings of the pustule on the palms and soles showed spongiosis and intraepidermal vesicular formations containing numerous eosinophils, with dermal perivascular infiltrates consisting of eosinophils and lymphocytes. Histopathologic findings of facial lesion showed dense eosinophils and lymphocytes around hair follicles. Another patient who 28-year-old man visited us with pruritic papules and pustules on the face, trunk, and soles. Histopathologic findings of the pustules on the sole and face were similar with those of the preceding patient. The diagnosis of EPF with palmoplantar involvement was made. The patients were treated with oral dapsone, resulting in a significant improvement in skin lesions. Herein we report two cases of EPF manifested on the face and palmoplantar areas.

Paraneoplastic Pemphigus Associated with Hepatocellular Carcinoma / 대한피부과학회지

PNP is a rare autoimmune mucocutaneous blistering disease associated with neoplasms, most frequently of the lymphoproliferative type. As PNP is clinically characterized by polymorphous mucosal lesions and cutaneous eruptions, it is important to differentiate it from erythema multiforme, Stevens-Johnson syndrome, lichen planus, and other bullous diseases. A diagnosis of PNP can be confirmed by immunologic studies such as direct and indirect immunofluorescence, immunoblotting, immunoprecipitation. Rare PNP cases related to nonhematological solid tumors have been reported. A 54-year-old male visited us with generalized pruritic scaly lichenoid lesions on the whole body from 5 weeks prior to his first visit. He also presented with extensive painful ulcers and erosions on the oral mucosa and lips for 2 months. Histopathologic findings showed lichenoid infiltration with vacuolar interface change, lichenoid interface dermatitis, keratinocyte apoptosis, and suprabasal acantholysis with cleft. Indirect immunofluorescence using normal human skin showed IgG deposition at the intercellular space. Immunoblotting using normal epidermal extracts in the serum of patient detected antibody to the 190 kDa (envoplakin), 210 kDa (periplakin) molecules polypeptides. He also had a hepatocellular carcinoma and chemoradiotherapy done before. The diagnosis of paraneoplastic pemphigus (PNP) was made. To our knowledge, there are only two reports of PNP associated with hepatocellular carcinoma worldwide, yet no report in Korean literature. Herein, we report the first case of PNP associated with hepatocellular carcinoma in Korea.