Contamination of Slippers in Operating Room by Dermatophytes and Effect of Antifungal Agent (Terbinafine) Disinfection / 대한의진균학회지

BACKGROUND: It is known that floor, clothes, shoes and slippers of common uses are the sources of infection by dermatophytes. However there hasn't been any report about the culture of dermatopytes from slippers in operating room. OBJECTIVE: The purpose of this study was to evaluate the contamination status of the slippers in operating room by dermatophytes and the effect of antifungal agent disinfection. METHODS: The samples were collected from 240 pairs of slippers that were used in common at operating room of Daegu Catholic University Medical Center with scrapping method. The collected samples were cultured on the media with chloramphenicol (500 mg/L) and cycloheximide (500 mg/L) to control the growth of nondermatophytic fungi. The same collection and culture was done again after the antifungal agent (terbinafine) disinfection. RESULTS: Dermatophytes were isolated from 22 (9.2%) pairs of slippers from a total of 240 pairs before the treatment, and 9 (3.8%) pairs after the treatment. There was significant difference in isolation rate between the slippers before the treatment and after the treatment (p=0.016). Trichophyton (T.) mentagrophytes and T. rubrum were isolated from the slippers and T. mentagrophytes (54.8%) was the most common isolated fungus. CONCLUSION: About ten percent of slippers in operation room were contaminated by dermatophytes. Regular antifungal agent disinfection on slippers in operating room will help to decrease in the prevalence of dermatophytes growth and prevent the nosocomial infection.

Two Cases of Cutaneous Infection by Alternaria alternata on Senile Purpura Site / 대한의진균학회지

Genus Alternaria is a species of dematiaceous fungi that is commonly found in the atmosphere or in the soil. It can cause hypersensitivity pneumonitis, bronchial asthma, or allergic rhinitis in immunocompromised host such as patient with organ transplantation or long-term steroid using patient. It can rarely cause skin infection. Case 1 was a 74-year-old man with well demarcated and elevated erythematous plaque with irregular scattered pustules on his right forearm. Case 2 was a 77-year-old woman with well demarcated elevated erythematous nodules within erythematous patch on her right forearm. In both cases, the lesions started at the senile purpura site. Herein, we report 2 rare cases of Alternaria alternata on senile purpura site to share the experience.

Erythema Multiforme-like Skin Lesions as an Initial Sign in Bullous Systemic Lupus Erythematosus / 대한피부과학회지

Bullous systemic lupus erythematosus (bullous SLE) is uncommon; distinctive clinical variant of SLE that is characterized by tense vesicles and bullae filled with fluid that occurs on either erythematous or normal skin. Although bullous SLE can accompany erythematous plaque with annular configuration, urticarial papules, and erythema multiforme (EM)-like lesions initially, there is no report of EM-like lesions as an initial sign of bullous SLE in the Korean literatures. Herein, we describe 31-year-old women with bullous SLE that showed EM-like skin lesions as the initial sign.

Erythema Multiforme-like Skin Lesions as an Initial Sign in Bullous Systemic Lupus Erythematosus / 대한피부과학회지

Bullous systemic lupus erythematosus (bullous SLE) is uncommon; distinctive clinical variant of SLE that is characterized by tense vesicles and bullae filled with fluid that occurs on either erythematous or normal skin. Although bullous SLE can accompany erythematous plaque with annular configuration, urticarial papules, and erythema multiforme (EM)-like lesions initially, there is no report of EM-like lesions as an initial sign of bullous SLE in the Korean literatures. Herein, we describe 31-year-old women with bullous SLE that showed EM-like skin lesions as the initial sign.

Allergic Contact Dermatitis due to a Topical Antipruritic Containing Dibucaine / 대한피부과학회지

Dibucaine hydrochloride is an amide-type local anesthetic and it is well known to be a contact allergen. Although there are some reports of allergic contact dermatitis due to over-the-counter medications containing dibucaine in the foreign literature, there is only one report of it in the Korean literature. We report here on a case of allergic contact dermatitis due to an over-the-counter drug containing dibucaine in a 41-year-old-woman. The patch test with the preparation that she had used and the TRUE(R) test revealed positive reactions to the dibucaine mix and Moscool(R).

Persistent Pemphigus Vulgaris Showing Features of Tufted Hair Folliculitis

Pemphigus vulgaris is an autoimmune blistering disease that commonly involves the scalp. Lesions of pemphigus vulgaris that persist on the scalp for a long period may be accompanied by tufted hair folliculitis. Only two previous accounts of tufted hair folliculitis developing in a lesion of pemphigus vulgaris have been reported. We report a 51-year-old-man with erosions and clusters of hair on the scalp. The scalp lesion had persisted for about 20 years. A histopathological examination of the skin lesion on the scalp revealed separation of the epidermis and clusters of several adjacent hair follicles. The patient was diagnosed with persistent pemphigus vulgaris of the scalp showing features of tufted hair folliculitis.

Myxoid Neurofibroma in the Right Inguinal Area / 대한피부과학회지

Myxoid neurofibroma is a histological variant of neurofibroma and represent a conventional neurofibroma with extensive deposition of stromal mucin. Myxoid neurofibroma may present as a sporadic lesion or in the context of neurofibromatosis I. The most common locations of the myxoid neurofibroma are the face, shoulders, arms, periungual area and in the feet. To the best of our knowledge, location in an inguinal area has been rarely reported. We report a case of a 37-year-old man with a solitary myxoid neurofibroma in the right inguinal area.

Multiple Endocrine Neoplasia Type 2B: Early Diagnosis by Multiple Mucosal Neuroma and Its DNA Analysis

Multiple endocrine neoplasia type 2B (MEN 2B) is a rare disease caused by germline mutations in the RET proto-oncogene and is transmitted in an autosomal dominant fashion. It is characterized by medullary thyroid carcinoma, pheochromocytoma and mucosal neuroma developing in the tongue, lip, intestinal tract, palate etc. Among these neoplasias, mucosal neuroma generally develops from early childhood. Therefore, early detection and proper treatment can minimize the disease course. Here we describe a 9-year-old male who presented with multiple verrucous papules and nodules on his lips, tongue and gingiva that were there since birth. Histologic findings of his lips and tongue showed well-defined nerve bundles and DNA analysis revealed a M918T mutation at codon 918 of the RET oncogene. He was diagnosed early as having MEN 2B according to his genetic and phenotypic features.

Congenital Melanocytic Nevus Combined with Cystic Change due to Recurrent Folliculitis / 대한피부과학회지

Nevus with cyst is defined as a single lesion in which there is the coexistence of an epidermoid cyst and a melanocytic nevus. Similar clinical and histopathologic changes can be observed when a hair follicle ruptures and subsequent folliculitis with supprative granulomatous reaction occurs beneath a melanocytic nevus. This cystic change due to inflammation is a different pathologic phenomenon from the formation of an epidermal cyst. Hence, it is necessary to differentiate between these two conditions. We report here on a case of congenital melanocytic nevus combined with cystic change due to inflammation in a 39-year-old man.

A Case of Norwegian Scabies in a Patient with Chronic Kidney Disease and Down Syndrome / 대한신장학회지

Norwegian or crusted scabies is a rare, highly contagious atypical form of scabies caused by the mite Sarcoptes scabiei var. homonis. It is usually associated with advanced age, immunosuppression, physical debility, and developmental disabilities. We report here a case of Norwegian scabies in an institutionalized patient with chronic kidney disease (CKD) and Down syndrome. A 56-year-old male presented at our department with pruritic rash and general weakness of 2 months' duration. Examination showed hyperkeratotic, scaly, crusted erythematous plaques on the hands, trunk, and back of the patient. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites. The patient was treated with hemodialysis and repeated applications of 1% lindane lotion for 2 weeks. He reported significant relief of pruritus and resolution of the skin lesions after the treatment. In addition to uremic pruritus, infectious skin diseases such as Norwegian scabies should be considered in the institutionalized patients with advanced CKD and resistant pruritus.

Agminated Lentiginosis with a Family History / 대한피부과학회지

Agminated lentiginosis (AL) is a rare pigmented disorder that is characterized by numerous lentigines in a unilateral distribution or often in a segmental pattern corresponding to one or more dermatomes. AL coexists with other several diseases and some researchers have suggested it is a variant of dermatomal neurofibromatosis if AL is accompanied by cafe-au-lait (CAL) macules or neurofibromas. We report here on a case of a 12-year-old female who presented with multiple lentigines on her right neck and shoulder (the C2 and C3 dermatomes) combined with CAL macule and ipsilateral axillary freckling. On checking the family history, her mother had grouped lentigines on her right chest (the T4, T5 dermatomes). But there were no neurofibromas, Lisch nodules and neurologic or skeletal abnormalities in both of them.

Supernumerary Nipple Associated with Unilateral Renal Agenesis / 대한피부과학회지

Supernumerary nipple is a developmental anomaly that occurs along the course of the embryological milk lines. The prevalence appears to be higher in women and a wide range of congenital and hereditary anomalies have been described in association with supernumerary nipple, including cardiovascular, gastrointestinal, skeletal and neurologic anomalies, and especially renal and urinary tract anomalies. However, there has been no report of supernumerary nipple with renal anomalies in the Korean dermatologic literature. Herein, we report on an interesting case of a supernumerary nipple with unilateral renal agenesis in a 15-year old man.

Kappa Chain Monoclonal Primary Cutaneous Plasmacytoma / 대한피부과학회지

Primary cutaneous plasmacytoma is a rare type of cutaneous B-cell lymphoma that arises primarily in the skin, and this is derived from clonally expanded plasma cells with various degrees of maturation and atypia. A 72-year-old man had an asymptomatic, solitary reddish to violaceous nodule on the back for about 4 months. The histologic finding of the skin biopsy specimen demonstrated an infiltration of variably matured plasma cells in the dermis, and these cells showed a monotypic expression of immunoglobulin kappa chains on immunohistochemical staining. Staging investigations excluded any extracutaneous manifestations of the disease. Only a few cases of primary cutaneous plasmacytoma have been published in the Korean dermatologic literature. Herein, we report on an interesting case of primary cutaneous plasmacytoma with monoclonality of kappa chains.

Two Cases of Trichophyton rubrum Syndrome / 대한의진균학회지

Trychophyton (T.) rubrum is the most prevalent pathogen among causative fungi of dermatophytosis. Primary infection of T. rubrum can be spread by autoinoculation or other reason and some suggests this generalized infection can be a syndrome. We report two cases of T. rubrum syndrome. The first patient, a 43-year-old male, had a tinea pedis with tinea unguium, tinea corporis, tinea cruris, and tinea manus. The second patient, a 73-year-old female, had a tinea pedis with tinea unguium, tinea manus, tinea corporis, tinea capitis, and tinea faciale. Causative pathogens were T. rubrum.

A Case of Nevus Lipomatosus Cutaneous Superficialis on the Palm / 대한피부과학회지

Nevus lipomatosus cutaneous superficialis (NLCS) is an idiopathic hamartoma that manifests with ectopic adipose tissue in the dermis. This disease is most frequent located on the lower trunk and gluteal region. Although NLCS can affect any region of a skin, it has not been previously described in the palm in the Korean Dermatologic literature. Herein, we describe a patient with NLCS on the left palm and discuss this rare case. We also review the relevant medical literature.

Tinea Unguium Hidden by Norwegian Scabies / 대한의진균학회지

Norwegian, or crusted scabies, is a fulminant and highly infectious form of scabies in which a large number of Sarcoptes scabiei mites infest the epidermis. This is often seen in the physically or mentally handicapped, immunocompromised, and institutionalized persons. The characteristic skin lesions in this form are gross scaling and hyperkeratotic plaques with erythematous papules, especially on hands, feet, elbow, and subungual area with varying degrees of pruritus. It may be difficult to differentiate Norwegian scabies from tinea unguium when Norwegian scabies involves nail and subungual area. We report a case of tinea unguium hidden by Norwegian scabies with nail involvement in a 71-year-old patient. This is the first report of such a case in Korea.