The Treatment Effects of Ultrasonic Surgical Aspiration for Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is a distressing and uncomfortable condition that can be a serious handicap in a person's personal and social life. There are many different surgical methods to treat axillary osmidrosis. However, they have caused frequently marked complications. OBJECTIVE: The purpose of this study was to evaluate the effect of ultrasonic surgical aspiration for the treatment of axillary osmidrosis. METHODS: From January 2007 to September 2008, a total of 62 patients was treated for axillary osmidrosis using ultrasonic surgical aspiration. RESULTS: Fifty-three (85.4%) patients had excellent to good results. Postoperative complications were seen in 5 (4.1%) patients out of 124 axillae. All of them were hematoma. The axillary scars are small and nearly negligible. The average recovery period was 5 days. CONCLUSION: Ultrasonic surgical aspiration displayed satisfactory therapeutic efficacy. This operation has many advantages with a high success rate, small and short scars, a low complication rate and a rapid recovery period.

The Utility of HMFG-1 and GCDFP-15 to Discriminate the Differentiation of Eccrine and Apocrine Neoplasms / 대한피부과학회지

The discrimination of eccrine and apocrine neoplasms is still in dispute among researchers. To discriminate the differentiation of eccrine and apocrine neoplasms, immunohistochemical stainings with HMFG-1 and GCDFP-15 were performed on 12 specimens of eccrine and apocrine neoplasms, 3 of normal palmar tissues, and 3 of normal axillary tissues. The 12 cases of eccrine and apocrine neoplasms included 3 cases of syringoma, 2 cases of eccrine poroma, 2 cases of hidradenoma, 2 cases of apocrine hidrocystoma, 2 cases of syringocystadenoma papilliferum, and 1 case of spiradenoma. The 3 specimens of palmar tissue were used as the positive control of eccrine unit, and the 3 specimens of axillary tissue as that of apocrine unit. The results are as follows; HMFG-1 was positive in the cytoplasm and luminal surface of normal apocrine units, and also positive in those of eccrine units. Still more, HMFG-1 was documented as positive even in the eccrine poroma which is originated from eccrine unit. GCDFP-1 was positive in both normal eccrine and apocrine units, and glandular structure was stained stronger than ductal structure. In all of eccrine and apocrine neoplasms, syringoma, eccrine poroma, and spiradenoma which were known to differentiate to ductal structure were negative in GCDFP-15, but hidradenoma, apocrine hidrocystoma, and syringocystadenoma papilliferum which were known to differentiate to glandular structure were positive, partially. All these findings suggest that GCDFP-15 might be a useful marker for glandular differentiation rather than ductal differentiation, and both HMFG-1 and GCDFP-15 might not be useful to discriminate eccrine and apocrine neoplasms. Further intensive studies about normal eccrine and apocrine unit should be performed to determine if HMFG-1 could be used as a significant marker of apocrine unit, and it is necessary to develop new methods for the discrimination of eccrine and apocrine neoplasms.

A Case of Coexistent Lichen Sclerosus et Atrophicus and Morphea / 영남의대학술지

Cases of coexistent lichen sclerosus et artrophicus and morphea have been reported. It is controversial that both diseases are single disease-spectrum or entirely separated. We encounterd a forty five year old female with a hypopigmented firm plaque on the left neck. Its histologic feature showed compact orthokeratosis, follicular plugging, atrophy of the stratum malpighii with vacuolar alteration of basal layer, and homogenization of the collagen in the upper dermis (lichen sclerosus et atrophicus). Increased thick collagen bundles were seen in the lower dermis (morphea).

A Case of Multiple Mondor's Disease / 대한피부과학회지

Mondor's disease is an uncommon superficial thrombophlebitis of the anterolateral thoraco-ab dominal wall. It's cause is unknown, but it is often associated with recent local trauma, muscular strain, and strenuous exercise. It has clinical features of a palpable, tender, linear cutaneous nodule and is always almost unilateral, and solitary, but rarely multiple. A 39-year-old man presented multiple cord-like tender subcutaneous linear lesions on the left ventrolateral thoracoabdominal wall for 3 weeks. He had done strenuous exercise and stretching for 2 months prior to his visit. Histologic finding revealed thrombophlebitis. The lesion did not involute with systemic and intralesional steroids, but three months later, it disappeared.

A Case of Self-healing Langerhans Cell Histiocytosis / 대한피부과학회지

Langerhans cell histiocytosis is a proliferative disease in which Langerhans cells accumulate in various body sites and cause damage to the affected organs. We report a 7-month-old infant who had only cutaneous lesions and healed spontaneously without treatment. There were rice grain to corn sized erythematous papules and crusted lesions in the chest, abdomen, and back for 2 months. The histologic finding of the lesion showed that the dyscohesive infiltrate, predominantly of histiocytes, were present and extravasated erythrocytes and eosinophils were also found in edematous papillary dermis. Careful examination showed histiocytes with coffee bean or kidney-shaped nucleus which was positive for S-100 protein. The infant had no systemic involvement, and healed spontaneously after 1 month without relapse.

The Compliance of Oral Antifungal Therapy in the Patients with Toenail Onychomycosis in Daegu Area: Comparison between Terbinafine Continuous Therapy and Itraconazole Pulse Therapy / 대한의진균학회지

BACKGROUND: The treatment of toenail onychomycosis requires a long term oral medication of antifungal agent, and its compliance is one of the important factors for the treatment of toenail onychomycosis. OBJECTIVE: The purpose of this study was to evaluate compliance of terbinafine continuous therapy group (C group) and itraconazole pulse therapy group (P group), and to analyze the causes of stopping the treatment. METHODS: The medical records of 387 patients (C group: 177, P group: 210) with toenail onychomycosis were analyzed. The cause to stop the treatment was investigated among the drop-out patients by selfassessment questionnaires or phone calls. RESULTS: One hundred and fifty eight patients (40.8%) of the 387 patients with toenail onychomycosis completed their treatment courses, and compliance was higher in university hospital group (59.5%) than in private clinic group (20.9%). The compliance of P group (50.9%) was significantly higher than that of C group (28.8%, p<0.05). As to age group, compliance was relatively low at age group of the fourth and fifth decade in total patients and C group, and at age group of the third, fourth and fifth decade in P group. There were no significant differences between male and female patients in P group, but the compliance of the male patients (34.7%) was higher than that of female patients (21.5%) in C group. The compliance of the patients who had toenail onychomycosis for a year and more than one year (58.3%) was higher than that of patients for less than one year duration (37.5%). One hundred and seventy nine patients out of the 229 patients (C group: 101, P group: 78) who stopped the treatment, responded to self-assessment questionnaire or phone calls. Among 101 patients who responded in C group, 64 patients (63.4%) stopped the treatment within 1 month, 32 patients (31.7%) within 2 months. Among 78 patients who responded in P group, 68 patients (87.2%) stopped the treatment within 1 month, and 10 patients (12.8%) within 2 months. The causes of stopping the treatment were "lack of time to visit clinic" (29.4%), good response (24.9%), far a long distance to the clinic (18.1%), etc., in order. CONCLUSION: For the better choice of therapy, dermatologist must consider age, sex, and disease duration, select the treatment method, and explain the course of treatment to the patients. So do that, we can increase the compliance of patients with toenail onychomycosis.

The Compliance of Oral Antifungal Therapy in the Patients with Toenail Onychomycosis in Daegu Area: Comparison between Terbinafine Continuous Therapy and Itraconazole Pulse Therapy / 대한의진균학회지

BACKGROUND: The treatment of toenail onychomycosis requires a long term oral medication of antifungal agent, and its compliance is one of the important factors for the treatment of toenail onychomycosis. OBJECTIVE: The purpose of this study was to evaluate compliance of terbinafine continuous therapy group (C group) and itraconazole pulse therapy group (P group), and to analyze the causes of stopping the treatment. METHODS: The medical records of 387 patients (C group: 177, P group: 210) with toenail onychomycosis were analyzed. The cause to stop the treatment was investigated among the drop-out patients by selfassessment questionnaires or phone calls. RESULTS: One hundred and fifty eight patients (40.8%) of the 387 patients with toenail onychomycosis completed their treatment courses, and compliance was higher in university hospital group (59.5%) than in private clinic group (20.9%). The compliance of P group (50.9%) was significantly higher than that of C group (28.8%, p<0.05). As to age group, compliance was relatively low at age group of the fourth and fifth decade in total patients and C group, and at age group of the third, fourth and fifth decade in P group. There were no significant differences between male and female patients in P group, but the compliance of the male patients (34.7%) was higher than that of female patients (21.5%) in C group. The compliance of the patients who had toenail onychomycosis for a year and more than one year (58.3%) was higher than that of patients for less than one year duration (37.5%). One hundred and seventy nine patients out of the 229 patients (C group: 101, P group: 78) who stopped the treatment, responded to self-assessment questionnaire or phone calls. Among 101 patients who responded in C group, 64 patients (63.4%) stopped the treatment within 1 month, 32 patients (31.7%) within 2 months. Among 78 patients who responded in P group, 68 patients (87.2%) stopped the treatment within 1 month, and 10 patients (12.8%) within 2 months. The causes of stopping the treatment were "lack of time to visit clinic" (29.4%), good response (24.9%), far a long distance to the clinic (18.1%), etc., in order. CONCLUSION: For the better choice of therapy, dermatologist must consider age, sex, and disease duration, select the treatment method, and explain the course of treatment to the patients. So do that, we can increase the compliance of patients with toenail onychomycosis.

A Clinical Observation of Cutaneous Premalignant and Malignant Tumors / 대한피부과학회지

BACKGROUND: There has been a concern about the incidence of the cutaneous premalignant and malignant tumors. It has increased recently and has varied according to social and environmental influence. OBJECTIVE: The purpose of our study was to clarify the recent trends in cutaneous premalignant and malignant tumors, and to compare them with other reports. METHODS: The 175 cases out of the total number of 34,333 new outpatients were diagnosed cutaneous premalignant and malignant tumors from January, 1990 to December, 2000 at the Department of Dermatology, Yeungnam University Hospital. Incidence and its change, age and sex distribution, and anatomical site were investigated. RESULT: 1. The incidence of cutaneous premalignant and malignant tumors was 0.51%, and increased lately. 2. Among the 175 cases of premalignant and malignant tumors, basal cell carcinoma(30.9%) was the most common, followed by squamous cell carcinoma(22.9%), actinic keratosis(12.6%), Bowen's disease(10.9%). 3. The premalignant lesions were increased and outnumbered squamous cell carcinoma since 1996. 4. Basal cell carcinoma was the most common skin cancer that had markedly increased in comparison with squamous cell carcinoma. 5. Actinic keratosis, Bowen's disease, basal cell carcinoma, squamous cell carcinoma, malignant melanoma on sun exposed areas were much more increased than on non exposed areas. 6. The mean age of patients was 65.3+/-15.0 years, and the age of the majority of cases(94.3%) was over 40 years. 7. The ratio of male to female was 1.01 : 1. The number of females increased relatively in comparison with previous reports. 8. The most common site was the face(55.4%), followed by scalp(12.0%), trunk (12.0%).

A Case of Cutaneous Cryptococcosis Clinically Mimicking Keratoachantoma / 대한의진균학회지

Cutaneous involvement of patient with systemic cryptococcosis occur in 10% to 15% of the case reported in literature. We report a case of cutaneous cryptococcosis clinically mimiking keratoacanthoma in a 70-year-old male. The lesions showed multiple erythematous papules and elevated central crusted nodules with peripheral telangiectasia on the face, and he had been treated with chemotherapy for peripheral T-cell lymphoma. The skin biopsy specimen showed granulomatous reaction with lympohistiocytic infiltration and many round spores. The fungus culture from skin lesion showed mucoid creamy colored colonies and revealed microscopically thick encapsulated spores in India ink preparation. The culture on Christensen urea agar at 25degrees C for 1 week was positive. The patient was treated with intravenous administration of fluconazole 200 mg/day for a week with partial improvement. But he refused further treatment, and died after a month of discharge.