A Case of Epidermolysis Bullosa Acquisita Associated with Psoriasis / 대한피부과학회지

Epidermolysis bullosa acquisita (EBA) is an autoimmune subepidermal blistering disease characterized by the presence of circulating IgG autoantibodies to type VII collagen. Various types of autoimmune blistering disease have been reported in association with psoriasis. A 58-year-old man with a 5-year history of psoriasis vulgaris presented with painful and mildly pruritic erythematous multiple bullae and vesicles. Histopathologically, there was a subepidermal bulla with infiltration of inflammatory cells composed of neutrophils and eosinophils. The salt-split skin indirect immunofluorescence test showed IgG binding to the dermal side of the separation, and immunoblotting using normal human dermal extract revealed antibodies directed against a 290-kDa polypeptide. He was diagnosed with EBA and started medication of oral prednisolone and mycophenolate mofetil. Skin lesions were continuously regressed. Of all the autoimmune blistering diseases coexisting with psoriasis, bullous pemphigoid is the most frequent. However, a few cases of EBA associated with psoriasis have been reported in the literature. We report a rare case of EBA coexisting with psoriasis vulgaris.

A Case of Foreign Body Granuloma Caused by Subcutaneous Injection of Leuprorelin Acetate / 대한피부과학회지

Leuprorelin acetate is a synthetic analog of luteinizing hormone-releasing hormone (LHRH). Recently, hormone-dependent tumors (prostate cancer and breast cancer) have been treated without surgery using this LHRH agonist. A 74-year-old man presented with a subcutaneous tumor in the abdomen. He had received a subcutaneous injection of depot leuprorelin acetate 2 months previously and radiotherapy for prostate cancer. The subcutaneous tumor was totally excised. Histopathologic findings revealed necrosis of fat tissue, many granulomatous nodules composed of giant cells with vacuoles in the dermis and subcutis, and inflammatory cell infiltrates, including mainly lymphohistiocytes. A diagnosis of foreign body granuloma due to depot injection of leuprorelin acetate was made. He revisited our hospital after 1 month with a subcutaneous tumor on his Lt. upper arm. He had received a subcutaneous injection of leuprorelin acetate 1 week ago on that site. We treated it with intralesional triamcinolone injection. Here, we report a case of granulomatous reaction due to leuprorelin acetate injection, which produced subcutaneous nodules.

Proposal of the New Term 'Leukoderma Nuchae' to Describe the Whitish Patch in the Spared Zone of Poikiloderma of Civatte to Differentiate It from Vitiligo / 대한피부과학회지

Poikiloderma of Civatte (PC) is a common, acquired condition that affects the face, neck, and upper chest of elderly persons due to life-long sun exposure. Poikiloderma describes skin manifestations of atrophic and telangiectatic lesions with pigmentary changes. We experienced three cases of patients who visited our department due to whitish patches on the anterior neck, which had been treated as vitiligo at private dermatological clinics. The patches mimicked vitiligo to the naked eye due to their color and relatively well-demarcated margin, but they were not accentuated under Wood's light. On MART-1 staining, there was no loss of melanocytes in the basal cell layer of the epidermis. Leukoderma on the anterior neck might be produced due to contrast with the neighboring skin showing PC. Based on our experiences, we propose a new dermatological term, 'leukoderma nuchae (LN)', to describe the spared zone of PC, to aid in differentiating this condition from vitiligo.

The Effectiveness of Light Emitting Diodes with 592 nm Yellow Light for Korean Photoaged Skin / 대한피부과학회지

BACKGROUND: As aging occurs, the skin develops more wrinkles and pigmentation, becomes drier, and loses its elasticity. In previous reports, light-emitting diode (LED) phototherapy was proven to stimulate collagen synthesis and accelerate fibroblast-myofibroblast transformation, which has a composite rejuvenation effect. OBJECTIVE: To evaluate the effectiveness and safety of LED phototherapy with 592 nm yellow light for photoaged skin. METHODS: Forty patients with photoaged skin (Korean photographic scale; grade 4approximately7) were enrolled and treated with an LED device producing 592+/-10 nm yellow light for 5 minutes twice a week for 4 weeks. The skin changes were assessed at 0, 2, 4, and 8 weeks by clinical photographs and the Cutometer(R) & Mexameter(R) (MPA 580, Courage+Khazaka Electronic GmbH, Koln, Germany). Measurements were made on the cheek, periorbital area, nasolabial fold, and glabella. RESULTS: At the final visit at 8 weeks, the Cutometer(R) parameters R4 and R6 decreased significantly compared to before treatment, from 0.118 to 0.099 for the periorbital (p=0.017) and 0.517 to 0.425 for the nasolabial fold (p=0.003). The average melanin index decreased significantly, from 133.65 to 124.55 (p<0.005). Fine improvement of wrinkles was shown grossly by reviewing follow-up clinical photographs. No adverse reactions occurred. LED phototherapy with 592+/-10 nm wavelength can be effective and safe in the treatment of photoaged skin. CONCLUSION: The findings suggest the LED with 592 nm yellow light might be an adjuvant therapeutic tool for photoaged skin.