Langerhans Cell Histiocytosis That Improved with Oral Isotretinoin Therapy / 대한피부과학회지

Langerhans cell histiocytosis (LCH) is a reactive disease in which abnormal Langerhans cells accumulate in various body sites. We report here on a 51-year-old male patient with LCH that was classified as single-system disease (restricted LCH). The skin lesions were a small, deep ulcer in the right inguinal area and multiple erythematous papules scattered on the lower abdomen, and the patient had these lesions for 1 year. The histopathologic examination revealed a dense histiocytic infiltration in the dermis, and most of the cells showed the characteristics of "LCH" cells. The immunohistochemistry for S-100 protein and CD1a complex all showed positive results. The patient was much improved after surgical excision of the inguinal ulcer and administering oral isotretinoin (20 mg daily) for 8 months, and there was no recurrence. We think retinoid is an effective treatment option for LCH, especially for single system disease.

A Case of Desmoplastic Trichilemmoma / 대한피부과학회지

Desmoplastic trichilemmoma is a rare variant of trichilemmoma characterized by typical features of trichilemmoma with abundant desmoplastic stroma. We report herein a 54-year-old man presented with 2-year history of a solitary bean sized verrucous nodule on the occipital scalp. Histologically, the tumor showed a well-defined lobular growth extending from the epidermis into the dermis with abundant central desmoplastic stroma. Epithelial lobules at the margins of the neoplasm showed the typical features of trichilemmoma composed of glycogen-rich clear cells and peripheral palisading columnar cells. In contrast, at the center the cells assume a more random pattern of cords and strands traversed by the hyaline stroma, mimicking invasive carcinoma. It was diagnosed desmoplastic trichilemmoma by the distinctive histologic appearance and totally excised.

A Clinical Study of Skin Problems of The Amputee / 대한피부과학회지

BACKGROUND: There has been no clinical study of skin problems of the amputee in Korea and at Veterans Hospital, we have experienced so many skin problems of amputees. OBJECTIVE: We tried to observe skin problems of amputees and to relate them with sweating, poor hygiene, poor fit of socket, mechanical trauma, and duration of wearing prosthesis. METHODS: 125 extremity amputees who visited the Seoul Veterans Hospital during the period of 5 years from Jan. 1994 to Dec. 1998 were analyzed clinically. RESULTS: The study results are summarized as follows: 1. Among the 125 extremity amputees, the number of male patients was 124(99.2%) and that of female patients was 1(0.8%). The age distribution showed a peak incidence in the 7th decade(30.4%), followed by the 5th decade(28.8%), 6th decade(24.8%), and the mean age was 56.4 years. 2. The most common type of amputation was below the knee amputation(74 cases), the second was above the knee amputation(37 cases). 3. The duration of wearing prosthesis was above 20 years in 88 patients(70.4%), 16-20 years in 15(12%), 11-15 years in 11(8.8%), and 1-5 years in 6(4.8%). 4. The skin problems of the amputees were superficial fungal infection, chronic ulcer, intertriginous dermatitis, callus, corn, verrucous hyperplasia, verruca which were 63 cases(50.4%), 26 cases(20.80%), 17 cases(13.6%), 6 cases(4.8%), 5 cases(4%), 5 cases(4%), 3 cases(2.4%) respectively. 5. The predisposing factors of the dermatoses were mechanical trauma(84 cases) which acted as a cause of the chronic ulcer, intertriginous dermatitis, corn and callus, sweating(80 cases) and poor hygiene(11 cases) as those of superficial fungal infection, and poor fitting(6 cases) as that of verrucous hyperplasia. CONCLUSION: Superficial fungal infection and chronic ulcer were the main skin problems of the amputee. The longer the duration of wearing prosthesis, the more skin problems developed. The mechanical trauma and sweating were the major predisposing factors of stump dermatoses, especially of chronic ulcer and superficial fungal infection. Amputation is only the beginning of a long period of rehabilitation, and the treatment of the patient and the affected skin goes on for the rest of the patient's life. This clinical study suggests that the dermatologist must be concerned of the care of amputee's skin problems.