Study on the Comparison between Wide Excision and Mohs Micrographic Surgery for the Management of Dermatofibrosarcoma Protuberans: A Single Institution Experience / 대한피부과학회지

BACKGROUND: Dermatofibrosarcoma protuberans is a mesenchymal tumor of the skin of intermediate-grade which is a rare condition. The slow growing and aggressive invasion on local tissues are characteristic features of dermatofibrosarcoma protuberans. The treatment for dermatofibrosarcoma protuberans is mainly a surgical excision such as a wide excision and Mohs micrographic surgery. OBJECTIVE: The aim of this study was to compare the result of wide excision and Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans at a single institution in Korea. METHODS: A retrospective review was done for 24 patients diagnosed with dermatofibrosarcoma protuberans and treated surgically from 1999 to 2010 at Chonbuk National University Hospital. Patient demographics, tumor features, surgical features, and recurrence during the follow-up period were evaluated. RESULTS: 13 patients were treated with wide excision, and 11 with Mohs micrographic surgery. There was no metastasis for all the cases. Mean operation time for the wide excision group was 83 minutes whereas 182 minutes for the Mohs micrographic surgery group, and it was a statistically significant difference. However, no significant difference was observed in post-operative defect size, advanced surgical repair and local recurrence in our study. CONCLUSION: We suggest that wide excision and Mohs micrographic surgery are both successful modalities for the surgical treatment of dermatofibrosarcoma protuberans. Hence, individualized patient and tumor characteristics should be concerned when determining the surgical options for dermatofibrosarcoma protuberans.

Halo Congenital Nevus Associated with Extralesional Vitiligo / 대한피부과학회지

Halo nevus is a pigmented nevus surrounded by a round or oval depigmentation. Of patients with halo nevus, 18 to 26% patients have vitiligo, either involving the nevus or at a distant site. While the exact etiology of halo formation and vitiligo is unknown, several theories suggest that common immunologic mechanisms are involved in the destruction of melanocytes of both phenomena. Unlike common melanocytic nevus, congenital nevus associated with both halo formation and concurrent extralesional vitiligo is very uncommon and only one case has been reported in the Korean dermatological literature. A 19-year-old female presented with surrounding depigmentation around a congenital hairy nevus on the left forearm. Simultaneously, vitiligo appeared on the lowerabdomen and surrounding regions of both areola. The halo depigmented lesion around congenital nevus and the periareolar vitiliginous lesion shared some histological and immunohistochemical features. These findings further support common immunological mechanisms of pigment destruction in both phenomena.

Solid Facial Edema Following Acne Vulgaris / 대한피부과학회지

Solid facial edema is a rare skin condition characterized by persistent, non-pitting, and non-tender edema on the forehead, glabellar region, mid-face, nasolabial folds, and cheeks. Exact etiology is still unknown; however, it is suggested that it can be secondary inflammatory response due to acne vulgaris. A 21-year-old male presented with erythematous swollen patches on the forehead and glabellar region. He had been intermittently treated for his acne vulgaris for 5 years at the local clinic. Focal soft tissue swelling with thickening of the skin and subcutaneous tissue was identified radiologically. Histopathologically, lymphatic vessels were dilated with chronic inflammatory cell infiltration and dermal edema. To the best of our knowledge, this is the first reported case of solid facial edema caused by acne vulgaris in Korea.

Solid Facial Edema Following Acne Vulgaris / 대한피부과학회지

Solid facial edema is a rare skin condition characterized by persistent, non-pitting, and non-tender edema on the forehead, glabellar region, mid-face, nasolabial folds, and cheeks. Exact etiology is still unknown; however, it is suggested that it can be secondary inflammatory response due to acne vulgaris. A 21-year-old male presented with erythematous swollen patches on the forehead and glabellar region. He had been intermittently treated for his acne vulgaris for 5 years at the local clinic. Focal soft tissue swelling with thickening of the skin and subcutaneous tissue was identified radiologically. Histopathologically, lymphatic vessels were dilated with chronic inflammatory cell infiltration and dermal edema. To the best of our knowledge, this is the first reported case of solid facial edema caused by acne vulgaris in Korea.

A Case of Subungual Epidermal Inclusion Cyst / 대한피부과학회지

No abstract available.

Foreign Body Granuloma Following Dried Honey Bee Venom (Apitoxin Inj) Injection / 대한피부과학회지

Bee sting therapy is sometimes used for the treatment of chronic recalcitrant neuralgia and arthralgia in traditional Korean herbal medicine, but retained sting materials at the treatment site may induce granulomatous inflammation. Recently, dried honey bee venom (Apitoxin Inj, Guju Pharma. Co., Seoul, Korea) has been approved by the Korea Food and Drug Administration (KFDA) as an anti-inflammatory drug. The adverse events associated with dried honey bee venom injection include itching, edema, pain, headache, fever and myalgia, but foreign body granuloma caused by drug injection has not been previously reported. We herein report two interesting cases of foreign body granuloma induced by dried honey bee venom injection.

Nicolau Syndrome in Which Split-thickness Skin Graft Was Required for Reconstruction / 대한피부과학회지

Nicolau syndrome is a rare adverse reaction and characterized by the acute onset of necrosis of the skin and soft tissue following intramuscular drug injection. Conservative treatments with dressings, debridement, and pain control are the mainstay of therapy. Surgical intervention such as skin graft is rarely required. We report a case of 21-year-old man with this syndrome on the right buttock after an intramuscular injection of diclofenac in which skin graft was necessary. The lesion eventually required debridements and split-thickness skin graft for reconstruction because it was very extensive and not successfully treated by the conservative method for four months.

Tinea Incognito with Changes in Clinical Feature Related to Antifungal Treatment / 대한의진균학회지

Clinical features of the dermatophyte infections of the glabrous skin can be altered by inappropriate treatment such as topical steroid treatment. We describe a case of dermatophyte infection with changes in clinical feature related to antifungal treatment. A 23-year-old woman presented with reddish annular scaly lesions on her right forearm. On the basis of the detection of hyphae on KOH examination, oral terbinafine 250 mg/day in combination with topical isoconazole was used for 3 weeks, but scattered papulopustules on erythematous bases occurred. Histopathologic examination revealed the presence of hyphae within the follicular infundibulum. Oral itraconazole 100 mg/day was administered for 2 weeks in combination with topical flutrimazole and produced a good clinical response. At her visit about 7 weeks after stopping itraconazole, agminated papulopustules on erythematous bases were seen on her right forearm. Trichophyton mentagrophytes was isolated on the culture of skin scraping from the surface of agminated lesions. She was successfully treated with oral fluconazole 150 mg weekly for 6 weeks and topical flutrimazole and isoconazole.

Basal Cell Carcinoma on the Pubic Area: Report of a Case and Review of 19 Korean Cases of BCC from Non-sun-exposed Areas

Basal cell carcinoma (BCC) is one of the most commonly diagnosed malignant skin tumors and develops characteristically on sun-exposed areas, such as the head and neck. Ultraviolet light exposure is an important etiologic factor in BCCs, and BCCs arising from non-sun- exposed areas are, therefore, very rare. In particular, the axilla, nipple, the genital and perianal areas are not likely to be exposed to ultraviolet light; thus, if BCC develops in these areas, other predisposing factors should be considered. Herein, we report a case of BCC arising on the pubic area in a 70-year-old man. We also performed a survey of the literature and discussed the 19 cases of BCC from non-sun-exposed areas reported to date in Korea.

A Case of Neurofibromatosis with Multiple Pseudoatrophic Macules / 대한피부과학회지

Neurofibroma usually manifests as a soft nodule that protrudes from the skin surface of patients with neurofibromatosis. Pseudoatrophic macule is a rare variant of neurofibroma, and it is described as a slightly depressed macular lesion. To the best of our knowledge, only one case of neurofibromatosis associated with pseudoatrophic macules has been reported in the Korean dermatologic literature. A 20-year-old man presented with multiple round shaped macules scattered on the trunk. The surface of the skin lesion was slightly depressed compared with the normal adjacent skin. He had multiple cafe-au-lait macules on the body and freckles in the axillae and inguinal areas. Histopathologic examination of the depressed macule demonstrated a relatively well-demarcated mass that was composed of spindle cells intermingled with loosely arranged collagen fibers in the dermis. The spindle cells showed a positive reaction for S-100 protein. Herein, we report on a rare case of type 1 neurofibromatosis with multiple pseudoatrophic macules.

Magic Perm Alopecia / 대한피부과학회지

A 7 year-old girl had developed multiple bald patches on her scalp for two months and was treated as alopecia areata or trichotillomania at another institution. Biopsy findings of the scalp lesion showed catagen follicles, trichomalacia and pigment clumps in the hair canals with little inflammatory cell infiltrates. Careful history revealed the patient had had "a magic perm" - a hair-straightening perm - one month before the bald patch began to develop. The condition could be called "a magic perm alopecia" as a form of cosmetic traumatic alopecia. The alopecic lesions showed further extension for three to four months. The lesions were beginning to recover five months after they first developed.

A Case of Cutaneous Carcinosarcoma / 대한피부과학회지

Carcinosarcoma is a biphasic tumor that has both epithelial as well as mesenchymal components. It most commonly occurs at the esophagus, lung, upper respiratory tract and urinary bladder, however it rarely occurs on the skin. A 62-year-old men presented with a bean sized crusted ulcer on his right cheek. A biopsy specimen revealed atypical sqamous cells mixed with spindle-shaped cells with hyperchromatic nuclei. Furthermore, immunohistochemical study showed positive reactions for AE1/AE3, cytokeratin7, epithelial membrane antigen and vimentin, but negative reactions for S100 protein, CD34 and smooth muscle actin. Based on these histopathological and immunohistochemical findings, we diagnosed this case as cutaneous carcinosarcoma. The patient was treated with complete excision and a local flap.

Sutureless Burow's Graft Using Adhesive Skin Tape (Steri-strip(R)) / 대한피부과학회지

Immobilization of skin grafts on the recipient bed is essential for graft survival. There are several methods of securing skin grafts to the recipient wound bed. Classically, nylon basting sutures and a tie-over bolster dressing are commonly used. This method is currently recognized to ensure that the full thickness skin grafts "take"; however, this method is complicated and time-consuming. Moreover, suturing in this manner may also pull the edges of the skin with too much tension, cause elevation and crater-like deformity and suture marks. We experienced two cases of sutureless Burow's graft using skin tapes to reconstruct a skin defect after Moh's micrographic surgery. Instead of the conventional method, the Steri-strip(R) was used to fix the graft and a light compressive dressing with dry gauze and Tegaderm(R) was applied over the graft. This method has the advantage of being convenient to apply and remove, time-saving and inexpensive. Therefore, we recommend the use of the sutureless method using skin tape as an alternative to suturing small skin grafts, and particularly for the relatively immobile areas on the face.

A Case of Cutaneous Alternariosis Treated with Fluconazole / 대한의진균학회지

Alternaria is a common saprophytic fungus found in the environment such as soil, air, and a variety of objects. The cutaneous infection caused by this fungus occurs more frequent in patients with immunocompromission than in immunocompetent people. We report a case of cutaneous alternariosis in a 63-year-old woman presented with a tender erythematous patch on the right forearm. She was on medication only for hypertension. Histopathologic examination showed a dermal mixed-cell infiltrate including multinucleated giant cells. PAS staining revealed fungal elements in the dermis. Microscopic examination of the colonies showed muriform conidia. A diagnosis of cutaneous infection due to Alternaria species was made on the basis of the above mentioned findings. Oral administration of fluconazole revealed resolution of her cutaneous lesion.

Seroepidemiology of Hepatitis A in Taejon, Korea 1996

PURPOSE: We experienced an outbreak of hepatitis A in Taejon, Korea for the summer of 1996. Recently a shift in hepatitis A incidence from children to adults has been well noted in Korea. For the purpose of possible measures in preventing hepatitis A, we studied a seroepidemiology of hepatitis A in Taejon. METHODS: We measured IgG anti-HAV antibody (HAVAB MEIA, Abbott) from 722 randomly collected sera of neonates (cord blood) to 70-years-olds and older. RESULTS: The prevalence of anti-HAV in neonates was 90.2%, 80.0% in 1-6 months, 34.7% in 7-12 months, 8.7% in 1-5 years, 0% in 6-10 years, 1.8% in 11-15 years, 29.3% in 16-20 years, 62.6% in 21-30 years, and nearly 100% in 31 years and older. In order to evaluate the time lossed transferring anti-HAV IgG from the mother, we analyzed 142 children aged 1 month to 24 months with 2-month intervals. The results were 81.3% in 1-2 months, 84.2% in 3-4 months, 80.0% in 5-6 months, 55.6% in 7-8 months, 23.1% in 9-10 months, 33.3% in 11-12 months, 8.3% in 13-14 months, 16.7% in 15-16 months, 0% in 17-18 months, 0% 19-20 months, 14.3% in 21-22 months, and 0% in 23-24 months. In order to estimate the rough conversion time of anti-HAV in the Taejon population, we analyzed 99 adults in their twenties with 2-year intervals. The positive rate of anti-HAV was 41.7% in 21-22 years, 69.2% 23-24 years, 63.0% in 25-26 years, 61.5% in 27-28 years,and 100% in 29-30 years. CONCLUSION: This study showed that the prevalence of hepatitis A in children has changed compare to the past 10-20 years and the possibility of another outbreak and/or increasing incidence of apparent hepatitis A in adults in the Taejon area or any other place in Korea is possible. The preventive modalities including hepatitis A vaccination or immune serum globulin against children and young adults at risk is necessary.

Sexual Precocity:Sex Incidence and Etiology / 대한소아내분비학회지

PURPOSE:Differential diagnosis of sexual precocity has been aided by new imaging techniques and endocrine evaluation. Sexual precocity, defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys, was studied to evaluate the sex incidence and etiology of sexual precocity. METHODS:A total 95 children(87 girls and 8 boys) who were diagnosed with sexual precocity at St. Mary's Hospital, Catholic University Medical College from 1984 to 1996, were studied. All underwent standard anthropometric measures. They were assinged to diagnostic categories on the basis of clinical assessment, endocrine evaluation, radiologic imaging, and pelvic ultrasonography. RESULTS: 1) The most common cause of sexual precocity was premature thelarche, 50 cases(52.6%) of all children. 2) Central precocious puberty was noted in 7 girls and 3 boys(female to male ratio 2.3:1). The causes were not identified in 6 cases(85.7%) in girls, but the causes were not found in 1 cases(33.3%) in boys. The idiopathic central precocious puberty occurs at least two fold more frequently in girls than in boys. 3) Incomplete precocious puberty was noted in 29 girls and 5 boys(female to male ratio 5.8:1). In the causes of 29 girls with incomplete precocious puberty, congenital adrenal hyperplasia were found in 23 cases, autonomous functional ovarian cyst in 5 cases and McCune-Albright syndrome in 1 case. In the causes of 5 boys with incomplete precocious puberty, virilizing adrenal cortical tumor were found in 3 cases, congenital adrenal hyperplasia in 1 case, and hepatoblastoma in 1 case. CONCLUSION: Sexual precocity occurs at least ten fold more frequently in girls than in boys. Premature thelarche is the most common form of sexual precocity.

A Case of Pena-Shokeir Phenotype in Trisomy 18 Syndrome

Pena-Shokeir syndrome is a rare, often lethal disease, characterized by intrauterine growth retardation, craniofacial anomalies, limb ankylosis, polyhydramnios and pulmonary hypoplasia. This autosomal recessive disease should be differentiated from trisomy 18, which the second most common multiple congenital malformation syndrome. It is therefore clear that the two syndromes have certain features in common, the most consistent being craniofacial and limb abnormalities and intrathoracic pathology. Therefore, final diagnosis should be based on chromosome study. The case that we experienced had typical Pena-Shokeir phenotype, but chromosomal study show 47, XY, +18.