Therapeutic Efficacy of Bipolar Radiofrequency Thermotherapy for Patients with Chronic Prostatitis: A Retrospective Analysis of 26 Cases

PURPOSE: Chronic prostatitis (CP) does not yet have a universally successful therapy. Alternative treatments including thermotherapy have been adopted in the multimodal management of pain and voiding dysfunction. We retrospectively analyzed the therapeutic efficacy of bipolar radiofrequency thermotherapy for patients who were unsatisfied with conventional medication for CP. MATERIALS AND METHODS: A retrospective study between October 2009 and September 2010 of 26 patients who were under 50 years old and diagnosed with CP (National Institutes of Health [NIH]-category III) was performed. Twenty patients were diagnosed with inflammatory CP (NIH-category IIIa) and the rest with noninflammatory CP (NIH-category IIIb). We used the Tempro system at an intraprostatic temperature of 55degrees C for 50 minutes with a medium heating rate. All patients also completed the NIH-Chronic Prostatitis Symptom Index (CPSI) before and after treatment. RESULTS: In the patients diagnosed with CP, the mean serum prostate-specific antigen (PSA) level was 0.9+/-0.3 ng/ml, the prostate volume was 27.1+/-5.5 g, and the average score for all 3 domains on the NIH-CPSI significantly decreased. The total scores decreased from 19.8+/-7.1 to 11.1+/-7.0, the pain domain decreased from 8.6+/-3.1 to 4.8+/-3.1, the voiding symptom domain decreased from 5.1+/-1.8 to 2.9+/-1.8, and the effect on the quality of life decreased from 6.1+/-2.2 to 3.4+/-2.2 (p<0.05). CONCLUSIONS: Bipolar radiofrequency thermotherapy for patients with CP intractable to conventional medication can provide significant improvement in the NIH-CPSI. Large, randomized controlled trials will also be required to confirm the efficacy of this therapy.

A Case of Paraneoplastic Pemphigus Presenting with Generalized Exfoliative Dermatitis / 대한피부과학회지

We describe a 56-year-old Korean man with paraneoplastic pemphigus (PNP) associated with persistent generalized exfoliative dermatitis (GED). He developed multiple scattered flaccid bullae on the erythematous base with scales over his face, upper trunk and extremities, with mucosal involvement for 4 months. Due to myasthenia gravis he also suffered from ptosis, general weakness, and weight loss of 10 kg for a month. A computed tomography and histopathological examination of the chest revealed a mass in the anterior mediastinum which was confirmed as thymoma. During the course of disease, his erythematous patch with crust lesions became confluent, and then GED developed. After total thymectomy, GED waxed and waned for 2-years and eventually disappeared. Herein, we report an interesting case of PNP associated with persistent GED for at least 2 years, even though the patient had been treated with surgery and medication.

Nested PCR for Detection of Malassezia Species from Patient Skin Scales and Clinical Strains / 대한피부과학회지

BACKGROUND: Due to recent identification of new Malassezia (M.) species, M. dermatis, and M. equi, the genus Malassezia was revised into eleven species that have been isolated from human and animal skin. This has further substantiated the need for molecular techniques to distinguish the various Malassezia species. OBJECTIVE: We aimed to make the nested polymerase chain reaction (PCR) using species-specific primers with specificity and sensitivity as a diagnostic tool for differentiating the various Malassezia species from skin scales and fungal cells rapidly and accurately. In addition, we evaluated the common causative Malassezia species in the patients with seborreheic dermatitis, pityriasis versicolor or pityrisporum folliculitis. METHODS: Malassezia species-specific primers were designed based on DNA sequencing of the ribosomal RNA gene. The standard strains of eight members of the genus Malassezia such M. pachydermatis, M. furfur, M. sympodialis, M. globosa, M. obtuse, M. restricta, M. slooffiae, and M. dermatis were used for positive control. Each Malassezia species was cultured separately and two or three standard species were cultured together on Modified Leeming and Notman agar (MLNA) media plates. In addition, twenty-five clinical strains of Malassezia species isolated from the skin of patients with dermatological conditions and twenty-three samples of skin scale were used as well. RESULTS: The nested PCR assay with primers for all eight Malassezia species were species-specific since it amplified DNA only from the target Malassezia species, and could differentiate mixed, that is, the two or three Malassezia species of all standard strains grown on MLNA medium precisely. Detection of Malassezia species from clinical strains and patient skin scales using the nested PCR assay was 96% (24/25) and 87% (20/23), respectively. M. globosa, M. sympodialis, M. restricta were the most common causative Malassezia species in patients with pityriasis versicolor, pityrosporum folliculitis, seborrheic dermatitis, respectively. CONCLUSION: Nested PCR using species-specific primers is useful and reliable in the detection of various Malassezia species from patient skin scales as well as cultured fungal cells.

A Study of Clinical Features of 50 Patients with Pustulosis Palmaris et Plantaris / 대한피부과학회지

BACKGROUND: Pustulosis palmaris et plantaris is a chronic inflammatory disease of the palms and soles, but its pathomechanism is still unclear. OBJECTIVE: The purpose of this study was to review the clinical features of patients with pustulosis palmaris et plantaris. METHODS: This study included 50 patients with pustulosis palmaris et plantaris who had visited the Department of Dermatology, Chonnam National University Hospital from April 1998 through to April 2003. We reviewed the medical records and biopsies, and analyzed information from patients by questionnaire. RESULTS: Among the 50 patients with pustulosis palmaris et plantaris, 34 patients (68%) were male and 16 patients (32%) were female, thus the ratio was approximately 2.1 : 1. The age of onset of lesions ranged from 16 to 71 years, and the mean age of onset was 43.9 years in males and 43.3 years in females. The prevalent age of onset was the fourth decade in males and the fifth decade in females. The frequent sites of involvement were the bilateral hands and feet. Psoriasis-like skin lesions were observed in 15 gap (30%) of patients, and nail involvement in 15 gap (30%) of the patients. The seasonal change did not influence the severity of the skin lesion. No direct relationship could be found between pustular eruptions and focal infections, such as tonsilitis. Fourteen males (41.2%) and 2 female patients (12.5%) had a history of smoking. Improvement of the lesions was obtained in all the patients, however, complete remission of the disease was achieved in only 6 gap (12%) of patients. All other patients experienced periodic relapses, despite treatment. CONCLUSION: Pustulosis palmaris et plantaris is a chronic relapsing disease that can greatly impair patient's quality of life, because of its chronic course and poor response to treatment.

A Case of Intractable Generalized Eczema Associated with Lymphoma / 대한피부과학회지

The common causes of eczema are known as contactant, drug, infection, atopy, and so on. Although various clinical manifestations of paraneoplastic syndrome have been described, especially in leukemia or lymphoma, intractable eczema is rarely reported to be associated with malignancy.A 55-year-old female presented with a 3-month history of pruritic erythematous papules and plaques. Oozing on the scalp, face, neck, both inguinal and inframammary areas were seen. Histopathological studies revealed a nonspecific subacute spongiotic dermatitis. The patient had been treated with prednisolone, antihistamines and antibiotics, but the skin lesions were aggravated. During the early course of eczema, laboratory findings were within the normal limits except for mild leukocytosis. Three months later, however, severe leukocytosis and cervical and inguinal lymphadenopathies developed abruptly. Computed tomography (CT) of the neck, chest, and abdomen revealed multiple lymphadenopathies to suggest lymphoma, which was confirmed later by lymph node and bone marrow biopsies, showing atypical lymphocytes extended to the bone marrow. This case shows that generalized eczema recalcitrant to conventional therapy may be associated with underlying lymphoma or leukemia.

Immunoblot Analysis Using Epidermal Extract and 180kD Bullous Pemphigoid Antigen NC16a Domain in the Diagnosis of Subepidermal Bullous Diseases / 대한피부과학회지

BACKGROUND: The 180kD bullous pemphigoid antigen (BP180) is known to be recognized by sera from patients with bullous pemphigoid (BP), herpes gestationis (HG), and cicatricial pemphigoid (CP). A series of previous studies using BP180 recombinant proteins has shown that most sera from patients with BP and HG react with the NC16a domain of BP180. OBJECTIVE: This study was performed to compare the immunoblotting results by using human epidermal extracts and by using recombinant protein of BP180 NC16a domain in the diagnosis of subepidermal bullous skin diseases. METHOD: We observed the reactivity with the epidermal extract of normal human foreskin and recombinant protein of BP180 NC16a domain in immunoblotting assay. RESULTS: In immunoblotting with epidermal extract, 7(78%) and 6(67%) of the 9 BP sera reacted with BP230 and BP180, respectively. 1(50%) of the 2 HG and 2(100%) of the 2 CP sera reacted with BP180. In immunoblotting with recombinant protein of BP180 NC16a domain, 8(89%) of the 9 BP sera and 2(100%) of the 2 HG sera were immunoreactive. But, none of the CP and pemphigus sera reacted with the recombinant protein. CONCLUSION: The immunoblotting analysis using BP180 NC16a domain is a highly sensitive method without ambiguity in the diagnosis of subepidermal bullous skin diseases, and also is useful for the differential diagnosis of BP and HG from CP.

A Case of Systemic Sarcoidosis Related with Foreign Body Injection for Wrinkle Correction / 대한피부과학회지

Sarcoidosis is a generalized granulomatous disease involving many organs such as the lungs, eyes, liver, skin, and lymph nodes. The cutaneous involvement in systemic sarcoidosis appears as various clinical manifestations, being in 9-37% of systemic sarcoidosis. The etiology is uncertain, but many contributing factors such as infection, foreign body reaction, trauma, genetic and environmental influences have been reported. A 54-year-old female presented with a 5-year history of asymptomatic violaceous papules and nodules on the forehead, where she received an injection of unknown material to improve wrinkles 10 years ago. She also complained of general symptoms such as fatigue, weight loss, and intermittent hemoptysis at visit. Chest X-ray revealed multiple ill defined nodular lesions in both lungs. Sarcoidal granulomas consisted of many epithelioid tubercles were found in open lung biopsy. Histopathological study of skin lesion also revealed multiple naked tubercles composed of large epithelioid histiocytes, multinucleated giant cells, few lymphocytes in the dermis. No foreign body was found on the polarized light microscopic examination. Although the exact nature of foreign material is unknown, it is suggested that a foreign body reaction by injected material is related to cutaneous sarcoidosis as well as subsequent systemic development in view of clinical and histological background.