Change in Antimicrobial Susceptibility of Skin-Colonizing Staphylococcus aureus in Korean Patients with Atopic Dermatitis during Ten-Year Period

BACKGROUND: A small subset of adolescents atopic dermatitis (AD) tends to persist. This also leads to get more antibiotics exposure with advancing years. Antibiotic resistance has been regarded as a serious problem during Staphylococcus aureus treatment, especially methicillin-resistant S. aureus (MRSA). OBJECTIVE: It was investigated the S. aureus colonization frequency in the skin lesions and anterior nares of adolescent AD patients and evaluated the changes in S. aureus antimicrobial susceptibility for years. METHODS: Patients who visited our clinic from September 2003 to August 2005 were classified into group A, and patients who visited from August 2010 to March 2012 were classified into group B. To investigate the differences with regard to patients' age and disease duration, the patients were subdivided into groups according to age. Lesional and nasal specimens were examined. RESULTS: Among the 295 AD patients, the total S. aureus colonization rate in skin lesions was 66.9% (95/142) for group A and 78.4% (120/153) for group B. No significant changes in the systemic antimicrobial susceptibilities of S. aureus strains isolated from adolescent AD patients were observed during about 10-year period. The increased trend of MRSA isolation in recent adolescent AD outpatients suggest that the community including school could be the source of S. aureus antibiotic resistance and higher fusidic acid resistance rates provides evidence of imprudent topical use. CONCLUSION: Relatively high MRSA isolation and fusidic acid resistance rates in recent AD patients suggest that the community harbors antibiotic-resistant S. aureus.

A case of Linear IgA Bullous Dermatosis Probably Caused by Vancomycin / 대한피부과학회지

Linear IgA bullous dermatosis (LABD) is an uncommon acquired autoimmune subepidermal bullous disease characterized by the linear deposition of IgA at the basement membrane zone. Although LABD is most often idiopathic, drug-induced LABD may, occur in rare occasions. We report a case of vancomycin-induced LABD in a 70-year-old woman with septic arthritis on the right knee.

Two Cases of Early Stage Mycosis Fungoides Treated with Acitretin and Narrow Band UVB Phototherapy / 대한피부과학회지

Early stage mycosis fungoides (MF) has been treated with skin directed therapies including topical steroids, phototherapy (UVB), photochemotherapy (PUVA), topical nitrogen mustard, or total skin electron beam therapy. Recently, several studies have been reported that treat early-stage MF with narrow band UVB (NBUVB), which is an effective and convenient modality compared to other alternatives. Herein, we describe two cases of early stage MF treated with NBUVB. During the remission induction therapy, oral acitretin combined with NBUVB was used for several weeks to clear the MF, followed by treatment with only NBUVB for maintenance.

A Case of Biphasic Amyloidosis in Systemic Sclerosis / 대한피부과학회지

Primary cutaneous amyloidosis is a disorder in which amyloid deposition occurs in the skin without associated deposits in internal organs. The most common types are macular amyloidosis and lichen amyloidosis. The co-occurrence of both types is termed biphasic amyloidosis and has rarely been reported so far. Moreover, only a few cases of amyloidosis development in the patients of systemic sclerosis have been reported. e report a 42-year-old female with systemic sclerosis, presented with pruritic skin lesions with hyperpigmentation on the back and lower extremities. Histopathologic examination revealed amyloid deposits which were restricted to the upper dermis and confirmed by Congo red staining, polarizing microscopy and transmission electron microscopy. There was no evidence of systemic amyloidosis.

A Study on Utilization of Alternative Medicine for Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Alternative medicine - sometimes called complementary or supplementary medicine - may be defined as forms of therapy or examination that have no scientific basis and whose effect or diagnostic reliability has not been demonstrated by scientific methods. Recently, alternative medicine has been used in various chronic diseases including atopic dermatitis (AD) and has attracted attention in the mass media. Several studies on the use of alternative medicine in patients with AD have been performed in western countries, however only a few studies have been conducted in Korea. OBJECTIVE: The purpose of this study was to investigate the use of alternative medicine in AD patients. METHOD: A total of 100 patients with AD were enrolled on the study, and interviewed with a questionnaire about their past history of AD and the use of alternative medicine. RESULTS: The results obtained are summarized as follows: 1. 84 out of 100 patients (84.0%) reported previous or current use of more than one type of alternative medicine. 2. The most common type of alternative medicine used was herbal remedies (73.8%). Spa and bath therapies (47.6%), health food preparations (39.3%) and diet therapy (25.0%) were also commonly used. 3. The frequency of alternative medicine used was related to onset and severity of AD. 4. The most common reason for using alternative medicine was `I wish to try everything' (60.2%), and the most common source of information on alternative medicine was relatives and friends who did not have the disease (41.4%). 5. The therapeutic effect of alternative medicine was found to be excellent in 25.3% of patients, but no change was seen in 58.6% of patients. 6. The most common side effect of alternative medicine was aggravation of symptoms. Other side effects included urticaria, diarrhea, fever and chills. 7. The average monthly cost for alternative medicine was 210, 000 won/person. CONCLUSION: The use of various types of alternative medicine in patients with AD is very common. However, these tend to be used impulsively and without caution or adequate knowledge. Therefore, dermatologists need to be aware of the benefits and adverse effects of alternative medicines.

A Case of Squamous Cell Carcinoma Arising From an Inverted Papilloma in the Nasal Septum / 대한피부과학회지

Inverted papillomas are uncommon benign epithelial tumors which typically occur on the lateral wall of the nose or paranasal sinuses. Inverted papilloma of the nasal septum account for between 5.5% and 16.7% of inverted papilloma. Histopathologically, these tumors show inversion of the neoplastic epithelium into the underlying stroma, rather than proliferating outwards. The tumors also demonstrate local aggressiveness, a high recurrence rate and the possibility of malignant transformation. Malignant transformation rate varies from 2% to 53%. But there is no clinical prognostic indicator to show the malignant potency of tumors. Therefore, early diagnosis and careful follow-up is very important. Some cases of this condition have been reported in otolaryngologic literature, but there are no reports of it in dermatologic literature. Herein we report a case of squamous cell carcinoma arising from an inverted papilloma in the nasal septum of a 78-year-old man.

Assessment of the Quality of Life in Patients with Varicose Veins for Evaluation of Treatment Effect / 대한피부과학회지

BACKGROUND: Varicose veins are the most common venous condition of the lower extremities. Treatment for varicose veins varies from surgery to minimally invasive techniques such as radiofrequency endovenous occlusion (RFEO), ambulatory phlebectomy (AP), sclerotherapy and endovenous laser treatment (EVLT). However, there is no method to assess the quality of life (QOL) of patients with varicose veins and the effect of treatment on the QOL. OBJECTIVE: The purpose of this study was to assess the QOL of patients with varicose veins and to evaluate the effect of treatment on the QOL. METHOD: A total of 72 patients with varicose veins were interviewed with the Aberdeen varicose vein questionnaire (AVVQ), was asked 25 questions relating to the symptoms and concerns of their condition. Follow-up was done with questionnaires again, 8 weeks after treatment. RESULTS: The results obtained are summarized as follows: 1. Of the 32 patients the distribution of age was 40-49 years of age (37.5%), followed by 50-59 years of age (27.8%) and 30-39 years of age (19.4%). The mean age was 47.7 years old. 2. 30 patients (41.8%) had suffered with varicose veins for less than 5 years, and 24 patients (33.3%) for 6-10 years. 3. According to the CEAP classification, the most common type of varicose vein was the C1AEPAS (31.9%). 4. Treatment method of varicose veins were sclerotherapy in 60 patients (83.3%), AP in 10 patients (13.9%), and RFEO in 2 patients (2.8%). 5. AVVQ scores correlated with symptoms and concern scores, and also with the clinical grade. 6. After treatment, AVVQ scores demonstrated a highly significant increase. CONCLUSION: This study confirms that varicose veins have a significant impact on the overall QOL, and that QOL shows a significant improvement after treatment. Therefore, assessment of QOL in patients with varicose veins can be a valid measure for the evaluation of treatment effect.

An Unusual Case of Porokeratotic Eccrine Ostial and Dermal Duct Nevus on the knee and the perianal region / 대한피부과학회지

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare, benign congenital hamartoma involving the eccrine sweat duct. Histologically, the distinctive feature of PEODDN is the existence of keratinous plugs that represent cornoid lamellae overlying dilated infundibula of eccrine ducts. Lesions are typically asymptomatic papules or plaques that are located on the distal extremities, including palms, fingers and soles. We report a case of a 7-year old girl with PEODDN who exhibited lesions on the left knee and the perianal region.

The Significance of Prophylactic Antibiotics in Skin Biopsy / 대한피부과학회지

BACKGROUND: Many dermatologists usually prescribe antibiotics postoperatively to prevent the wound infection, but there are no definite guidelines for the use of prophylactic antibiotics in skin biopsy. OBJECTIVE: The purpose of this study is to evaluate the efficacy of prophylactic antibiotics after skin biopsy. METHODS: We performed the prospective study of 200 patients in skin biopsy. We excluded patients who have a risk factor of infective endocarditis, replacement of articular prosthesis within 6 months, chronic renal failure, chronic hepatic failure, anemia, internal malignancy, untreated diabetes, immune suppression, taken antibiotic within 1 week, hypersensitivity to antibiotics and infected wound. They were classified randomly into two groups, each 100 patients with or without antibiotic prophylaxis. All patient received the wound dressing. All biopsy wounds were evaluated in a blinded fashion at the time of suture removal and scored according to a standardized assessment based on erythema, edema and discharge. RESULTS: Of the 100 patients who received the wound dressing and the prophylactic antibiotics postoperatively, no one had surgical wound infection. Of the 100 patients who received only the wound dressing, one patient had surgical wound infection. CONCLUSION: The infection rates were not significantly different between two groups. Therefore prophylactic antibiotics after skin biopsy may not be necessary to prevent wound infection in healthy patients.

A Case of Fibroadenoma Arising in the Accessory Breast Tissue of the Axilla / 대한피부과학회지

Accessory breast tissue of the axilla is one of the varieties of supernumerary breast tissue, which is observed after puberty. The tissue is capable of developing identical pathophysiologic changes as normal breast tissue. The pathologic findings of the accessory breast tissue were classified as normal breast tissue, cystic disease, chronic mastitis, atypical ductal hyperplasia, and fibroadenoma. Among these, the fibroadenoma is relatively uncommon. We have experienced a case of fibroadenoma arising in the accessory breast tissue of the axilla. A 28-year-old woman had a 8-month history of 1.5x1.3cm and 1.1x1.2cm sized firm nodules, deeply located in subcutaneous tissue on the left axilla. The size of the lesion was constant. However, she complained of mild tenderness at every premenstrual period. The histopathologic finding of the lesion revealed the typical features of fibroadenoma with accessory breast tissue.

A Case of Carcinoma En Cuirasse of Which Primary Origin is Supposed to be Male Breast Cancer / 대한피부과학회지

Metastases to the skin from internal malignancy is rare condition which range from 0.7 to 9%. Because skin metastases sometimes represent the first sign of malignancy from an unknown primary origin and managing primary carcinoma may be mandated by detection of cutaneous metastases, it is important to recognize the clinical and histopathologic features of the metastatic skin cancer. Male breast cancer is uncommon disorder and cutaneous involvements in male breast cancer show various clinicopathologic types. We report 49-year-old man presented with a diffuse morphea-like induration on neck, chest and upper back which turned out to be carcinoma en cuirasse originating from breast cancer.

Sclerotherapy for Primary Varicose Vein / 대한피부과학회지

BACKGROUND: Varicose vein is the most common venous disease of the lower extremities. The treatment of varicose vein is commonly performed for cosmetic improvement, although most patients are symptomatic as well. Sclerotherapy is a useful adjunct to large vein surgery as well as a highly effective primary treatment for telangiectasia and reticular vein. OBJECTIVE: The purpose of this study was to elucidate the clinical characteristics of varicose vein of Korean and to evaluate the efficacy and the side effect of sclerotherapy. METHODS: We reviewed 100 outpatients treated by sclerotherapy for varicose vein at department of dermatology of Pusan National University Hospital from January, 1999 to December, 2000. RESULTS: The results obtained were summarized as follows; 1) The distribution of age was the first 5th decade(44%), followed by 4th decade and 6th decade. The median age was 47.6 years-old. 2)The duration of illness was less than 5 years in 34 patients(34%), and 6 to 10 years in 25 patients(25%). 3) Presumed etiologic factors were occupations requiring long period of standing in 43 patients(43%), and pregnancy in 28 patients(28%). 4) The aims in treating varicose vein were cosmetic problem(88%), pain(47%) and fatigue(32%). 5) According to the CEAP classification, the most common type of varicose vein was C1sEpAs(46%). 6) The frequency of injections were 2 times in 31 patients(31%), 3 times in 30 patients(30%), and one in 22 patients(22%). 7) Most of the patients were satisfied with the results and the clinical efficacy in varicose vein was more than moderate clearance in 64 patients(64%). Transient adverse effects were observed in a few patients. CONCLUSION: Sclerotherapy is a simple, safe, and cosmetically acceptable alternative treatment for varicose vein and can be easily performed in outpatient fields.

Effects of Estrogens and Isoflavones on the Collagen Synthesis / 대한피부과학회지

BACKGROUND: The aging of skin is influenced by genetic, environmental, and hormonal factors. Estrogens are the "missing" player in the skin of postmenopausal women. In postmenopausal women, loss of collagen was related to decreased estrogen level. Phytoestrogens, i.e. isoflavone, are plant compounds with estrogen-like biologic activities. OBJECTIVE: The effects of 18beta-estradiol, and isoflavones on production of type I collagen in the fibroblast of postmenopausal woman, keloid and Detroit cell line were examined. METHODS: Type I collagen was measured with procollagen type I C-peptide EIA KIT. RESULTS: 18beta-estradiol and isoflavone enhanced the production of type I collagen in cultured fibroblast of postmenopausal woman and keloid. But isoflavone inhibited the production of collagen in cultured fibroblast of Detroit cell. CONCLUSION: 18beta-estradiol and isoflavone can prevent and improve the cutaneous alterations caused by loss of collagen of postmenopausal women.

A Case of Menkes Syndrome / 대한피부과학회지

Menkes syndrome is a rare fatal neurodegenerative disease with X-linked recessive inheritance. The clinical characteristic features are progressive neurological disturbances, arterial degeneration, connective tissue and hair abnormalities. This syndrome is a disorder of copper transport caused by mutations in a gene for a copper-transporting P-type ATPase. We have experienced a case of Menkes syndrome in an eight-month old male patient, who manifested seizure, developmental delay and characteristic pili torti. He was diagnosed by clinical features, laboratory tests such as low serum copper and ceruloplasmin level, cerebral atropy in brain magnetic resonance(MR) image and arterial abnormality in MR angiography. We review literatures and describe the distinctive features of this rare disorder.

Two Cases of Bullous Systemic Lupus Erythematosus / 대한피부과학회지

Bullous systemic lupus erythematosus (bullous SLE) is an uncommon, distinctive clinical variant of systemic lupus erythematosus (SLE), histopathologically characterized by subepidermal blisters with neutrophil infiltration and immunopathologically linear IgG depositon at the dermoepidermal junction. A blistering eruption may occur during flares of SLE such as lupus nephritis. We report two cases of bullous SLE, confirmed by the clinical, histopathological and immunopathological features. In one patient who has been diagnosed as SLE with diffuse proliferative lupus nephritis (WHO class IV), a blistering eruption occurred during the course of treatment of SLE. In the other patient, the bullous eruption was the initial manifestation of SLE and then she was diagnosed as SLE. We review the recent literature and describe the distinctive features of this rare disorder.

A Case of Neonatal Purpura Fulminans Due to a Homozygous Protein C Deficiency / 대한피부과학회지

Homozygous protein C deficiency is a rare hereditary coagulation disorder that occurs most often in childhood and is characterized by widespread thrombosis of capillaries and venules, abrupt onset of ecchymoses and necrosis. The hematological feature corresponds with disseminated intravascular coagulation. Protein C is a natural anticoagulant and also has important anti-inflammatory activity. For confirmation of homozygous protein C deficiency, the infant should have undetectable protein C activity and both parents should be heterozygous for protein C deficiency. We experienced a case of purpura fulminans in the newborn infant in whom we identifed homozygosity for familial protein C deficiency. Fresh frozen plasma for replacement of protein C, early debridement and full-thickness skin graft induced a remission. Administration of warfarin was used to prevent recurrence of attacks. This report emphasizes the need for early diagnosis and adequate replacement therapy in patient with purpura fulminans.

A Case of Kerion Celsi Caused by Trichophyton mentagrophytes / 대한의진균학회지

Kerion celsi is an inflammatory type of tinea capitis, which occurs chiefly in children between the ages of 4 and 14 years. We report a case of kerion celsi caused by Trichophyton(T.) mentagrophytes in 69 year-old man, who showed a 8x8 cm sized, erythematous boggy mass with pustules and crusts on the right occipital scalp. Cultures from scalp lesion and infected hair on Sabouraud dextrose agar media showed T. mentagrophytes. Histopathologic findings showed inflammatory cell infiltration in entire dermis and many spores around the hair shaft. The skin lesion was successfully treated with terbinafine (250 mg/ day) for 8 weeks. This case is reported with three interesting facts: Kerion celsi caused by T. mentagrophytes has been rarely reported in Korean literatures; Kerion celsi is occuring in an aged man with decreased cellular immunity after chemotherapy; Kerion celsi caused by T. mentagrophytes responded well to oral terbinafine.

Significance of Expression of p16 protein, p53 protein, Ki-67 antigen, and Factor VIII-related Antigen and Their Correlation with the Clinicopathologic Prognostic Factors in Malignant Melanoma / 대한피부과학회지

BACKGROUND: Biologic markers such as the p16 protein, p53 protein and Ki-67 antigen, as well as factor VIII-related antigen have been explored in various malignancies as potential prognostic factors. OBJECTIVE: The aims of this study are to examine the expression of biologic markers and to assess their correlation with conventional clinicopathological prognostic factors in malignant melanoma. METHODS: Immunohistochemical stains for p16, p53, Ki-67 and factor VIII-related antigen were performed in twenty formalin-fixed, paraffin-embedded tissues of primary and metastatic malignant melanomas. We compared the expression of biologic markers with conventional clinicopathologic factors, such as the presence of metastasis, ulceration, Breslow thickness, Clark level and American Joint Commission on Cancer(AJCC) TNM staging. RESULTS: Loss of p16 expression was significantly higher for the metastatic melanomas(90%) than the nonmetastatic(50%). But the results were not correlated with the clinicopathologic prognostic factors. The p53 expression was found in 7/10(70%) of the metastatic melanomas and in 3/10(30%) of the primary melanomas. Statistically, p53 expression was positively correlated with Breslow thickness(p=0.017), Clark level(p=0.003) and TNM staging(p=0.009). Furthermore, statistically significant trends were observed towards increasing expression of Ki-67 with metastatic dissemination(p=0.014), increasing Breslow thickness(p=0.008), Clark level(p=0.012) and TNM staging(p=0.009). Positive correlation was present between TNM staging and factor VIII-related antigen expression(p=0.014). CONCLUSION: p53 protein and Ki-67 antigen may be more useful independent predictors than p16 protein and factor VIII-related antigen in Korean patients with malignant melanoma.

A Case of Keratosis Follicularis Squamosa(Dohi) / 대한피부과학회지

Keratosis follicularis squamosa(Dohi) is an acquired keratinizing disorder , which is particularly common among Japanese and rarely reported in other countries . It is characterized by multiple small brownish atrophic patches with follicular plug and collarette scales on the trunk and thighs . The scaly patches, which look like lotus leaves on the water as described by Dohi in the first report, is very characteristic. We report a case of keratosis follicularis squamosa(Dohi) in a 39-year-old woman, who showed a clearance of the skin lesion after 4-week minocycline administration.

Detection of Telomerase Activity in Psoriasis Lesional Skin and Correlaton with Ki-67 Expression and Suppression by Retinoic Acid

Telomerase activity is usually detected in most tumor tissues but not in normal tissues. Recently, there is increasing evidence that telomerase activity is associated with cell proliferation without malignancy, whereas there is little information about telomerase activity and its relationship with cell proliferation in chronic hyperproliferative skin diseases. Thus, we studied telomerase activity in skins from 10 patients with psoriasis and compared telomerase activity with the expression of Ki-67, a proliferation marker, using immunohistochemical staining. The effect of retinoic acid on the telomerase activity in HaCaT cells was also evaluated. Telomerase activity was detected in 7 (70%) of 10 lesional skins of psoriasis and none of the nonlesional skin. Telomerase activity in lesional skin was significantly associated with Ki-67 labelling index. Retinoic acid treatment on HaCaT cells inhibited telomerase activity, which correlated with inhibition of cell proliferation by the agent. The results of our study represent another example that shows telomerase activity correlates with cellular proliferation. Further studies on the regulation of the telomerase are needed to understand the cellular factors involved in controlling telomerase activity.