Three Cases of Recalcitrant Pediatric Tinea Capitis Successfully Treated with Griseofulvin

Tinea capitis is an infection of the scalp hair follicles and surrounding skin that primarily occurs in prepubertal children. Microsporum canis remains the most common pathogen causing tinea capitis in Asian countries, including South Korea, although the causative organism of this condition varies across geographical regions and time periods. Systemic antifungal agents are the mainstay treatments for tinea capitis; however, the therapeutic responses to antifungal drugs may vary depending on the causative species, and treatment failure may occur owing to drug resistance. Although dermatophytosis resistant to clinical treatment have been increasingly encountered, recalcitrant tinea capitis cases have rarely been reported. Herein, we report three cases of tinea capitis caused by M. canis in children. All three patients showed unsatisfactory clinical responses to prolonged courses of oral terbinafine or itraconazole without achieving mycological cure; however, they were successfully treated with oral griseofulvin. Although griseofulvin is not currently available or licensed for use in many countries, including South Korea, it is one of the most effective agents against Microsporum species and remains the most widely used first-line treatment for tinea capitis in children, based on dermatology textbooks and reliable treatment guidelines.

Clinical, Pathological, and Dermoscopic Features of Pityriasis Rotunda / 대한피부과학회지

Background@#Pityriasis rotunda (PR) is a rare dermatosis characterized by the presence of multiple, strikingly circular or oval-shaped, sharply demarcated, and scaly hyperpigmented patches. Its etiology remains poorly understood. To date, there have been no comprehensive analyses of PR in Koreans. @*Objective@#To investigate the clinical, pathological, and dermoscopic features of PR. @*Methods@#Sixteen patients with PR were evaluated. @*Results@#A female preponderance was observed (male:female ratio 1:7), and the mean age of the patients was 33.2±16.1 years (range, 15∼68 years), with the peak incidence observed in patients in their 20s. Notably, all the lesions developed on the trunk. The most common clinical diagnosis is PR. Histologically, PR appears similar to ichthyosis vulgaris. Hyperkeratosis was mainly ortho-keratotic, with plugs observed within hair follicles, elongated rete ridges, diminished stratum granulosum, enhanced pigmentation of the basal layer, pigmentary incontinence, and sparse superficial perivascular lymphoid cell inflammatory infiltrate. Periodic acid-Schiff staining was negative for fungi. Hyperpigmented patches with occasional scales were separated from each other by paler striae on dermoscopy. @*Conclusion@#PR commonly presents as multiple round lesions of variable sizes on the trunk of patients in their 20s. They showed characteristic findings, including hyperkeratosis with relative focal hypogranulosis, histopathologically, and some lesions showed dark and light brown polygonal patches with paler striae arranged dermoscopically, in a mosaic pattern. This was a retrospective single-center study with a small sample size; however, we believe that this paper will contribute to the clarification and understanding of PR.

Sarcomatoid Squamous Cell Carcinoma of the Lower Lip: A Case Report / 대한피부과학회지

Sarcomatoid squamous cell carcinoma (SSCC) is a rare malignancy with distinct carcinomatous and sarcomatous features. SSCCs involving the lung, esophagus bladder, and skin have been reported as rare case reports. It may also occur infrequently in the oral region. Moreover, the lower lip is still one of the rare sites, and such a case has not been reported in Korean literature. An 82-year-old man presented an exophytic protruding, huge, warty crusted lesion on the entire lower lip. The lesion started as a small, tender, erosive papule and suddenly enlarged in recent months.His medical history was unremarkable. A biopsy revealed atypical squamous and sarcomatous components with transition zones between the two cell types. These two cell types also showed characteristic immunohistochemical features. Based on these findings, the lesion was diagnosed as SSCC. The study, including positron emission tomography-computed tomography, showed no metastasis. We recommended surgical excision, but the patient refused therapy.

Sarcomatoid Squamous Cell Carcinoma of the Lower Lip: A Case Report / 대한피부과학회지

Sarcomatoid squamous cell carcinoma (SSCC) is a rare malignancy with distinct carcinomatous and sarcomatous features. SSCCs involving the lung, esophagus bladder, and skin have been reported as rare case reports. It may also occur infrequently in the oral region. Moreover, the lower lip is still one of the rare sites, and such a case has not been reported in Korean literature. An 82-year-old man presented an exophytic protruding, huge, warty crusted lesion on the entire lower lip. The lesion started as a small, tender, erosive papule and suddenly enlarged in recent months.His medical history was unremarkable. A biopsy revealed atypical squamous and sarcomatous components with transition zones between the two cell types. These two cell types also showed characteristic immunohistochemical features. Based on these findings, the lesion was diagnosed as SSCC. The study, including positron emission tomography-computed tomography, showed no metastasis. We recommended surgical excision, but the patient refused therapy.

Clinicopathological and Dermoscopic Features of Clear Cell Acanthoma / 대한피부과학회지

Background@#Clear cell acanthoma is a rare benign epidermal tumor that is considered a nonspecific reactive dermatosis. To date, no reports have described systematic analyses of clear cell acanthoma in Koreans. @*Objective@#We investigated the clinical, histopathological, and dermoscopic features of clear cell acanthoma. @*Methods@#In this study, we evaluated 14 lesions of clear cell acanthoma. @*Results@#We observed female predominance (male:female ratio 1:1.3), and the mean patient age was 55.8±18.0 years (range 15∼76 years), with the peak incidence observed in patients in their 60s. Notably, 57.1% of lesions developed on the lower extremities. The lesion was most commonly misdiagnosed as seborrheic keratosis. Histopathological examination revealed a well-demarcated area of keratinocytes with pale-staining cytoplasm and psoriasiform epidermal hyperplasia and mild spongiosis, exocytosis of neutrophils, and thinned suprapapillary plates. Dermoscopic examination showed a clear cell acanthoma with characteristic vascular findings, including pinpoint red dots, globular red dots, and glomeruloid structures with linear or reticular patterns. @*Conclusion@#Clear cell acanthoma commonly presents as a small solitary lesion measuring <1 cm in diameter that occurs on the lower extremities in women in their 60s. Histopathological characteristics of this lesion include Periodic acid Schiff-positive with pale cytoplasm, and dotted, globular, and glomeruloid vessels with a linear or reticular pattern on dermoscopy. This was a single-center, small-sized retrospective study; however, in our view, the results of this study would contribute to the literature by providing a better understanding of clear cell acanthoma in Koreans.

Basal Cell Carcinoma Arising on the Palm / 대한피부과학회지

Basal cell carcinoma (BCC) is the most common type of skin cancer. It typically develops on sun-exposed and hair-containing areas of the body, such as the head and neck regions. The occurrence on the palms and soles is very rare. A 66-year-old Korean woman presented with a red elliptical ulcerative nodule on her left palm. Biopsy revealed basaloid cell mass and nests in the dermis with basal cells containing dark and elongated nuclei. She was diagnosed with basal cell carcinoma, and wide excision with full-thickness skin graft was performed. To the best of our knowledge, no case of basal cell carcinoma on the palm without basal cell nevus syndrome has been reported in Korean literature. Herein, we report this case owing to its rare occurrence on such location.

Case of a Male Newborn with Incontinentia Pigmenti Initially Misdiagnosed as a Recurrent Skin Infection

Incontinentia pigmenti (IP), also known as Bloch-Sulzberger syndrome, is a rare X-linked dominant disorder that is generally lethal to males and almost always leads to death in utero. This disorder is a genodermatosis with characteristic cutaneous lesions and manifestations affecting the eyes, teeth, hair, and central nervous system. Genodermatosis is a hereditary disease caused by mutations in the nuclear factor-kappa B essential modulator gene mapped to chromosome Xq28. This gene encodes a variety of cytokines and chemokine regulators and is indispensable for protecting cells from tumor necrosis factor-induced apoptosis. Here we describe a case of male newborn with vesiculobullous cutaneous lesions over the left thigh and leg. We first considered the cutaneous lesions a skin infection, as they improved with intravenous antibiotics. However, recurrence and the need for repeated hospitali zations made us consider the differential diagnosis of IP, for which we performed a skin biopsy and chromosome analysis. The histology results were compatible with IP, that is, eosinophilic infiltration in the dermis and epidermis, and individual cell dyskeratinization. The chromosome analysis result was a normal 46, XY karyotype.Here we report the case of a male newborn with IP that manifested as multiple vesiculobullous skin lesions and was initially misdiagnosed as a recurrent skin infection.

Subungual Exostosis of the Little Finger: A Case Report and Review of the Literature in Korea / 대한피부과학회지

No abstract available.

Squamous Cell Carcinoma Arising in an Amputation Stump / 대한피부과학회지

Amputation of the lower extremities followed by the use of an artificial leg is very common. However, malignancy arising in an amputation stump is an extremely rare event. In this report, we describe a case of squamous cell carcinoma arising in the amputation stump of a 56-year-old Korean man. To the best of our knowledge, similar cases have not been previously reported in Korea.

Spontaneous Healing of Multiple Penetration Wounds Induced by Cactus Spines / 대한피부과학회지

Cactus spines can easily puncture the skin with only minor pressure. Removal of the offending cactus spine is the treatment of choice; however, it is very difficult, even with tweezers. A 17-year-old Korean girl presented for evaluation of multiple purple-colored macules and papules on the left cheek and left thumb. Two months earlier, she had pricked her finger and face on cactus spines while volunteering in Haiti. An ultrasound identified wedge-shaped echogenic materials suspected as cactus spines. We recommended surgical removal of the spines, but she vehemently refused. We then advised her to take amoxicillin/clavulanic acid and undergo regular follow-up. During the follow-up period, the spines dislodged spontaneously for easy removal and the patient removed them with tweezers. The lesions actually improved over the next several months. Here, we report this rare and interesting case for educational purposes because such a case has never been previously reported in Korea.

Cutaneous Carcinosarcoma: a Clinicopathologic and Immunohistochemical Analysis of 11 Korean Cases

BACKGROUND: Cutaneous carcinosarcoma is a rare biphasic tumor comprising malignant epithelial and heterologous mesenchymal elements. Data on the clinical and histopathologic characteristics of this tumor in Asian populations are not available. The purpose of this study was to investigate the clinicopathologic and immunohistochemical features of cutaneous carcinosarcoma in the Korean population. METHODS: We retrospectively reviewed the records of 11 patients with cutaneous carcinosarcoma who were diagnosed from 2006 to 2016. RESULTS: The mean patient age at diagnosis was 71.5 years (range, 43–96 years) and there was a men predilection. The most common site of cutaneous carcinosarcoma was the head and neck (8/11, 72.7%). Histopathologically, most tumors showed a characteristic morphology consisting of two types of tumor cells, varied differentiated epithelial cells (such as basal or squamous cells) and spindle cells with transition zones between the two components. These two cell types also demonstrated variable immunohistochemical characteristics. CONCLUSION: Although the number of cases in this study was limited, our results provide valuable insight into the clinical and histopathologic characteristics of cutaneous carcinosarcoma in the Korean population.

A Plaque-type Blue Nevus on the Trunk / 대한피부과학회지

No abstract available.

A Case of Subungual Epidermal Inclusion Cyst / 대한피부과학회지

No abstract available.

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.

The Three Dimensional Conformal Radiotherapy for Hyperkeratotic Plantar Mycosis Fungoides

The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.

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.

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.

A Case of Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) / 대한피부과학회지

Paraneoplastic autoimmune multiorgan syndrome (PAMS) is also known as paraneoplastic pemphigus, and this is a heterogenous autoimmune syndrome involving the skin, mucosa and internal organs and it is caused by autoantibodies related to the underlying neoplasm. Painful stomatitis is the earliest and most constant feature. The cutaneous lesions of this disease are polymorphic. The majority of cases of this syndrome are associated with a lymphoproliferative disorder such as non-Hodgkin lymphoma, chronic lymphocytic leukemia and Castleman disease. A 40-year-old woman presented with a 1-month history of a pruritic erythematous papulomacular rash on the trunk and extremities. She also had a 4-month history of painful oral stomatitis that had failed to respond to steroid therapy. Despite the vigorous treatment, the skin lesions progressed to generalized polymorphic lesions with persistent oral lesions. The histopathologic findings of these lesions revealed polymorphous characteristics according to the clinical features, and they mimicked erythema multiforme, graft-versus-host disease, lichen planus and pemphigus vegetans. Finally, a mass of lymphatic tissue 7.2 cm in diameter and that was diagnosed as Castleman disease was found in her retroperitoneal pelvic cavity. With removal of the lymphatic mass, her skin lesions subsided except for the glossal lesion.

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.