Interferon-Gamma Release Assay in a Patient with Tuberculosis Verrucosa Cutis

No abstract available.

Auricular Composite Chondrocutaneous Grafts in the Repair of Nasal Alar Rim Defects

No abstract available.

The Reverse Nasolabial Flap with a Cartilage Graft for the Repair of a Full-Thickness Alar Defect: A Single-Stage Procedure

A 65-year-old woman with a deeply infiltrating basal cell carcinoma in the right ala underwent full-thickness excision of most of the ala, including the alar rim, crease, and the adjacent cheek, leaving a 'through-and-through' defect. Reconstruction was performed by using the reverse nasolabial flap and a cartilage graft across the alar defect, harvested from the concha, to prevent nostril collapse and to maintain the alar shape. The reverse or turnover nasolabial flap is a variant of the conventional nasolabial flap; however, it may be more suited for the repair of a full-thickness, lateral alar defect. The reverse nasolabial flap functions both as an inner liner and an outer cover and the repair is performed as a single-stage procedure. Furthermore, this flap can provide both excellent function and excellent cosmetic outcome.

Papular Elastorrhexis in Down's Syndrome / 대한피부과학회지

No abstract available.

Extramammary Paget Disease: Minimal Surgical Therapy

BACKGROUND: Extramammary Paget disease (EMPD) is an uncommon malignant neoplasm affecting apocrine gland-bearing skin which usually occurs in the anogenital area of patients older than 50 years. Although Mohs micrographic surgery (MMS) is recommended for the treatment of EMPD, wide local excision has also been performed by many other surgeons including dermatosurgeons. However, the extent of an adequate resection margin is still under debate. OBJECTIVE: The efficacy of minimal surgical therapy consisting of a wide excision combined with preoperative multiple scouting biopsies and postoperative topical imiquimod was investigated for the treatment of EMPD in Korean patients. METHODS: Between 2006 and 2012, 10 patients with primary EMPD were treated with wide surgical excision, with a surgical margin of less than 2.5 cm. Multiple preoperative scouting biopsies and postoperative topical imiquimod were also performed to delineate the lesional boundaries and to reduce the recurrence rate. RESULTS: During the 6-year follow-up period, complications and recurrences were not observed. CONCLUSION: Minimal surgical therapy may be an effective alternative when MMS is unavailable.

Surgical Treatment of Lip Hypertrophy Secondary to Port-wine Stain / 대한피부과학회지

BACKGROUND: Port-wine stain (PWS) is a congenital capillary malformations characterized by ectasia of capillaries and venules. These vascular channels progress gradually to hyperplasia of soft and hard tissues, manifested as hypertrophy of involved structures. Especially, when these lesions involve the lip, macrocheilia may develop with time. Usually vascular-specific laser treatment is used for PWS, however with no favorable effect with soft-tissue hypertrophy. Therefore, surgical treatment may be necessary in such cases. OBJECTIVE: The subjects were 9 patients who had PWS with lip hypertrophy, who were aged from 9 to 65 years. METHODS: The patients underwent cheiloplasty which include making an incision horizontally on a labial mucosa of the lip, and dissection of hypertrophied soft tissue in the front and back of the orbicularis oris muscle. RESULTS: Of the 9 patients, only 2 had postoperative complication such as mild chewing of the labial mucosa. After a minor revision surgery, these symptoms disappeared. Good to excellent results were achieved in all patients during the final postoperative cosmetic evaluation. CONCLUSION: Surgical correction is appropriate for treatment of three-dimensional tissue deformity such as lip hypertrophy with good cosmetic results and minimal complications.

Spontaneous Regression of Merkel Cell Carcinoma / 대한피부과학회지

Merkel cell carcinoma is a malignant neuroendocrine tumor with a high rate of recurrence and metastasis. However, approximately 23 cases of spontaneous regression have been reported. We report a case of Merkel cell carcinoma which showed spontaneous regression. The patient was an 84-year-old male with a large red-colored, hemispheric tumor on the left inner thigh which had been presented for a year. We planned to perform surgery, but the tumor suddenly started to regress spontaneously. The size of the tumor decreased, the surface was flattened, and the color changed from red to brown. The lesion finally appeared as a brownish flat plaque. Excision of the regressed tumor was performed; immunohistopathological analysis showed CD3+ T cells infiltrating around the regressed merkel cell carcinoma.

Immunohistochemical Study on the Expression of Desmocollin 1 during Skin Development / 대한피부과학회지

BACKGROUND: Desmocollins (Dsc) are calcium-dependent transmembrane glycoproteins of desmosomes that are important in the junction complex of epidermis and maintain structural integrity of the skin from external stressors. Among three Dscs (Dsc 1, 2, 3), Dsc 1 and 3 are distributed on skin. OBJECTIVE: The purpose of this study was to observe the Dsc 1 distribution pattern on the skin and oral mucosa during fetal development. METHODS: Skin was obtained from the sole and scalp of 33 fetuses, ranging from 10 to 37 weeks of gestational age. Immunohistochemical staining was performed on the paraffin-embedded tissue using a Dsc 1 monoclonal antibody. RESULTS: Dsc 1 was expressed in the suprabasal layer but not in the basal layer of the epidermis of the sole at the 10th week of gestation. Thereafter, Dsc 1 expression further increased in the suprabasal layer with initiation of stratification and increased gradually in the granular layers of the sole and scalp epidermis. Dsc 1 was strongly expressed in the superficial layer of the infundibulum and inner root sheath of the hair follicle but was not expressed in the sebaceous cells or other hair components. The eccrine duct epithelium was focally and weakly positive for Dsc 1 expression. Furthermore, Dsc 1 was not expressed in oral mucosa, although the oro-cutaneous portion was strongly expressed in the superficial layer. CONCLUSION: Dsc 1 was strongly expressed in the suprabasal cells of the epidermis during fetal skin development, and expression increased gradually in the granular layer and inner root sheath of the hair follicle. However, Dsc 1 was not expressed in basal cells or in oral mucosa. Dsc 1 may play a role in the maintenance of epithelial integrity as part of desmosomes.

Lymphoepithelioma-like Carcinoma of the Upper Eyelid / 대한피부과학회지

Lymphoepithelioma-like carcinoma is a neoplasm at extranasal sites with striking histological similarity to lymphoepithelioma arising in the nasopharynx. The tumor is composed of islands of pleomorphic cells with a lymphocytic infiltrate. The head and neck are the principal locations for this tumor, which occurs in the skin. Differential diagnoses include squamous cell carcinoma, Merkel cell tumor, lymphoma, cutaneous lymphadenoma, malignant melanoma, and metastatic lymphoepithelioma. Here, we report a case of lymphoepithelioma-like carcinoma of the skin in a 78 year-old male who had a firm nodule on the right upper eyelid. He was treated with wide excision and local flap coverage. The patient had been disease-free for more than 1 year.

Expression of Desmoglein-1 in Fetal Skin Development / 대한피부과학회지

BACKGROUND: Desmosomes are cell-cell adhesion complexes that provide mechanical integrity to keratinocytes by linking them to keratin intermediate filaments. Desmosomes are composed of two major transmembrane proteins, desmoglein and desmocollin. In humans, four desmoglein isoforms have been identified: Dsg1, Dsg2, Dsg3, and Dsg4. Desmogleins are Ca2+-dependent adhesion molecules and play important parts in the formation and maintenance of desmosomes. Desmoglein-1 is the main skin-associated desmosomal cadherin. It is expressed throughout the epidermis, but most prominently in the differentiated layers. OBJECTIVE: The purpose of this study was to observe the distribution pattern of desmoglein-1 in the skin and oral mucosa during fetal development. METHODS: Skin was obtained from the sole and scalp of 35 fetuses, ranging from 10 to 37 weeks of gestational age. Immunohistochemical staining was performed on paraffin embedded tissue using anti-human monoclonal antibody against desmoglein-1. RESULTS: Expression of desmoglein-1 in the epidermis appeared in the upper layer of the sole, but the basal layer was negative at the 10th gestational age. Thereafter, stratification began with stronger expression in the middle layer than in the basal layer of the sole and scalp epidermis. Expression in the middle spinous layer is stronger in the fetal period than in other layers of the epidermis. Expression in the superficial layer seemed to increase in later stages. Expression of desmoglein-1 in hair was strong in the infundibulum, inner root sheath, sebaceous glandular epithelium, and eccrine duct epithelium. Expression of desmoglein-1 in oral lip mucosa was very weak or negative in the upper half of the mucosal epithelium, though the lower half was strongly positive, while the skin side of the mucosa was similar with the sole skin. CONCLUSION: Desmoglein-1 may play a complementary role in the maintenance of epithelial integrity along with other desmogleins, because desmoglein-1 distribution is slightly different from that of desmoglein-3 in epidermis, hair and mucosa in fetal skin development.

Scleromyxedema with Monoclonal Gammopathy / 대한피부과학회지

Scleromyxedema is a rare disorder characterized by generalized papular and sclerodermoid eruption, increased fibroblast proliferation, mucin deposition, and monoclonal gammopathy in the absence of thyroid disease. It is a generalized subtype of lichen myxedematosus. A paraproteinemia, typically an IgG lambda, is observed in more than 80% of patients with scleromyxedema. Here, we report a 38-year-old woman with a 1-year history of a progressively spreading of eruption of small papules on the entire body, including the face, neck, arms, legs, and trunk. Laboratory tests were within normal limits, except lambda light chain monoclonal gammopathy. We administered oral retinoid and topical steroid with slight clinical improvement. To our knowledge, this is the first reported case of scleromyxedema in Korea.

Multiple, Giant Soft Fibromas in the Labium Majus / 대한피부과학회지

Soft fibromas are benign fibrous tissue tumors of the dermis. In general, they appear as small, soft, pedunculated or sessile tumors and they are mostly located on the axillae, lateral neck and inguinal region. Although large sized soft fibromas may occur in the groin or upper thighs, and especially in patients with diabetes, they rarely exceed 2 cm in size. We report herein a case of multiple giant soft fibromas, including an unusually huge, giant lesion in the labium majus of a healthy, middle-aged woman, and such fibromas on the labium majus are very rare.

A Case of Primary Cutaneous Mucinous Carcinoma with Neuroendocrine Differentiation

Primary cutaneous mucinous carcinoma is a rare malignant tumor that originates from the deepest portion of the eccrine sweat duct. Common sites of involvement are the face and scalp. Biopsy shows dermal epithelial cell islands embedded in mucin pools separated by fibrous septae. It is difficult to differentiate this tumor histologically from metastatic adenocarcinoma. Recurrence after excision is common but metastases are rare. We report a primary cutaneous mucinous carcinoma with neuroendocrine differentiation on the right cheek of a 63-year-old man.

A Case of Penile Cutaneous Metastasis from Gastric Carcinoma / 대한피부과학회지

Metastatic carcinoma of the penis is rare and in most cases is associated with primary malignancy of the pelvic organs with widespread metastasis. A 64-year-old man presented with a 2 month history of skin-colored papules on his penis. He also had a history of total gastrectomy and chemotherapy due to advanced gastric carcinoma. Skin biopsy from the lesion revealed atypical polygonal cells with hyperchromatic & pleomorphic nuclei in the dermis. Results of immunohistochemical staining showed a positive reaction of CK7, and a negative reaction of CK20, PSA, and CD68. We report herein a case of metastatic cancer of the penis from gastric carcinoma.

Immunohistochemical Study on the Expression of Desmoglein-3 in Fetal Skin Development / 대한피부과학회지

BACKGROUND: Desmogleins are calcium-dependent transmembrane glycoproteins of the desmosome that form an import component of the junction complexes of epithelial cells. Desmogleins are involved in maintaining the structural integrity of tissues. So far, four different desmogleins (Dsg1, Dsg2, Dsg3 and Dsg4) have been identified. OBJECTIVE: The purpose of this study was to observe the distribution pattern of desmoglein-3 in the fetal skin during development. METHODS: Skin was obtained from the sole, scalp and lip of 34 fetuses that ranged in age from 10 to 39 weeks of gestational age. Immunohistochemical staining was performed on the paraffin embedded tissue using anti-human monoclonal antibody against the desmoglein-3. RESULTS: The expression of desmoglein-3 in the epidermis appeared in the basal layer of the sole at the 10th week of gestation age. Thereafter, a stronger expression was noted in the middle layer of the sole and scalp epidermis. The basal layer had a stronger expression than did the other layers of the epidermis, followed by the middle and superficial layers. A stronger expression of desmoglein-3 in hair was noted in the outer root sheath, the bulge cells and the eccrine duct cells. The expression of desmoglein-3 in the lip mucosa was strong in both the basal and middle layers, while the skin side of the mucosa showed a stronger expression in basal layer. CONCLUSION: These results suggested that desmoglein-3 plays an important role in the development and differentiation of the epidermis and skin adnexa in the fetal stage, and especially in basal and suprabasal layers.

Phosphatidylcholine Formula for the Treatment of Lipoma / 대한피부과학회지

BACKGROUND: Lipomas are benign neoplasms composed of mature fat cells. Current treatments are invasive and carry the risk of scarring. For this reason, phosphatidylcholine (PPC) formula has been widely used to treat areas of localized fat accumulation. However, there are few reports on injection lipolysis with injection of PPC formula. OBJECTIVE: The purpose of this study was to investigate whether injection lipolysis with PPC formula is an effective therapeutic option for patients with lipoma. METHODS: Twenty-two lipomas in 7 patients were included. Three sessions at intervals of 6 to 8 weeks were done. Sonographic measurements of lipoma size were repeated before each session. Any side-effects and the patients' satisfaction were noted. In one lipoma, histological changes after lipolysis were described. RESULTS: After three sessions, a significant reduction in lipoma size of 47.4% was achieved. Histology showed a fibrosis with loss of adipocytes. Inflammation occurred in one case, so the patient was excluded from this study. Transient burning sensation and swelling at the injection site were the most common adverse effects. No severe side-effects or systemic reactions were observed. CONCLUSION: Treatment of lipoma with PPC formula has the potential to be a patient-friendly and well-tolerated therapy that can achieve cosmetically pleasing treatment outcomes.

A Clinical Study of Self-Inflicted Dermatosis / 대한피부과학회지

BACKGROUND: Self-inflicted dermatosis is a kind of self-inflicted skin disease. Most Vietnam veterans from Korea have visited the Veterans Hospitals for dermatological examination to determine the relationship between their skin diseases and Agent Orange. We were suspicious of the possibility that several Vietnam veterans intentionally produced their own skin lesions. OBJECTIVE: We conducted this study to determine the clinical characteristics of self-inflicted dermatoses of Korean Vietnam veterans. METHODS: From January, 1999 to December, 2007, a total 24 Vietnam veterans who were diagnosed as having self-inflicted dermatoses during their dermatological examinations at our hospital were included in this study. We investigated their clinical presentation, the laboratory examinations, the pathologic examinations, the medical records and the associated diseases. RESULTS: Itching was the most common subjective complaint and the duration of the itching was as follows; 20 to 30 yrs (50.0%), 1 to 10 yrs (25.0%), 10 to 20 yrs (20.8%) etc. The skin lesions were all multiple, and the involved area was as follows; upper extremities (83.3%), trunk (75.0%), lower extremities (70.8%) etc. There were two categories of clinical skin presentation. The first was the cases with lesion that were thought to be made by physical trauma such as stinging or excoriation, and the second more common cases had lesions that were thought to be made by chemical agents (70.8%). These cases resembled allergic or toxic irritant dermatitis and the lesions were composed of vesicles, erosions, ulcers and crusts that were within an arm's reach. Only 4 cases admitted to intentionally inflicting their skin lesions because of intense itching, and the others denied that they made the skin lesions by themselves. Skin biopsies were carried out in 19 of the total 24 cases, and the most common finding was spongiotic dermatitis (57.8%). CONCLUSION: This study showed the distribution and characteristics of self-inflicted dermatoses, and the study provides fundamental data for dermatologists to assess patients with self-inflicted dermatoses.

A Case of Syringoma Confined to Both Forearms and the Dorsa of the Hands / 대한피부과학회지

Syringomas confined to the distal extremities are very rare. A 62-year-old man presented with an 8-month history of multiple, light brown, flat-topped papules on both forearms and the dorsa of the hands. Histopathologic examination showed multiple dilated eccrine ducts lined by two rows of epithelial cells. There has currently been less than 10 reported cases of syringoma confined to both forearms and the dorsa of the hands in the world medical literature.

A Case of Malignant Fibrous Histiocytoma That Metastasized to the Skin / 대한피부과학회지

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma. It is regarded as an undifferentiated pleomorphic sarcoma with an unproven histogenesis. It most commonly occurs in the skeletal muscles of the extremities or the retroperitoneum of adults. It often metastasizes to the lungs, lymph nodes, bones and liver, but rarely to the skin. We report here a case of malignant fibrous histiocytoma that metastasized to the skin.

A Case of Leukocytoclastic Vasculitis after Use of Sorafenib (Nexavar(R)) / 대한피부과학회지

Sorafenib (Nexavar(R)) is an oral multikinase inhibitor that was recently approved for use in metastatic renal cancer. It is currently undergoing investigation for the treatment of locally advanced renal cancer and in other tumor types. It has a broad spectrum of activity in treating multiple tyrosine kinases, including angiogenic factors VEGFR and PDGFR. Common cutaneous toxicities experienced with sorafenib include facial and scalp erythema, hand-foot syndrome, splinter hemorrhages, and alopecia. We report a case of a 57 year-old man diagnosed as renal cell carcinoma with distant metastaisis, who developed a leukocytoclastic vasculitis on the extremities after use of sorafenib.