Effect of infosheet for topical tacrolimus 0.1% and its efficacy and compliance in the treatment of atopic dermatitis

PURPOSE: Topical calcineurin inhibitor is recently developed topical immunomodulator, and preliminary studies showed its effectiveness in the treatment of atopic dermatitis (AD). However, some side effects including transient irritation can influence the patient compliance. So, there are some needs to improve the patient compliance. The purpose of this study was to evaluate the efficacy, safety and patient compliance with using topical tacrolimus 0.1% to treat AD when the correct information about topical tacrolimus are properly given to patients. METHODS: We examined the medical recordings, clinical severity scoring of total 194 AD patients at 9 general hospitals in Seoul, Korea from September 2010 to August 2011. We offered an infosheet of topical tacrolimus 0.1% and the patients applied it twice a day for 2 weeks. And we measured the efficacy of the topical tacrolimus 0.1% with SCORing atopic dermatitis (SCORAD) index, patient's global assessment (PGA), and investigator's global assessment (IGA). RESULTS: Topical tacrolimus 0.1% effectively controlled AD with a reduction of the SCORAD index from baseline 31.9 to 20.2 at 2 weeks of application. In IGA results showed 98% got improvement and in PGA, results showed 96% got improvement after treatment. Although 42.3% of the patients complained of adverse effects, these were all transient. The effect of information on topical tacrolimus 0.1% showed 34% patients could predict the side effect, 35% patients could feel safety to use, and 18% patients experienced side effect but could maintain topical calcineurin inhibitor. CONCLUSION: Topical tacrolimus 0.1% may be an effective treatment modality for AD when patients show good compliance for applying the ointment. And properly given, the correct information may increase the patient compliance.

Clinicopathological Study of Pyogenic Granuloma / 대한피부과학회지

BACKGROUND: Pyogenic granuloma is a common vascular neoplasm of the skin and mucous membranes. However, few comprehensive studies are available on the clinical and histopathological characteristics of pyogenic granuloma. OBJECTIVE: To analyze the clinical and histopathological characteristics of pyogenic granuloma. METHODS: Patients with pyogenic granuloma diagnosed clinically and histopathologically were reviewed retrospectively. RESULTS: Fifty patients (17 males and 33 females) were enrolled, and the mean age of onset was 33.6 years old. The mean lesion size was 6.7 mm. Forty-eight patients had a solitary lesion, whereas two patients had multiple lesions on the skin and mucosa. The most common area for lesions was the head and neck followed by the hands, trunk, and lower extremities. Patient complained of easy bleeding, pain, tenderness, and pruritus. Dermoscopic findings of nine lesions showed patterns of a reddish homogenous area, white scaly collarette, white rail lines, and a hemorrhagic crust. Histopathological findings of all biopsy cases showed a lobular pattern of angiomatous tissue with numerous congested capillaries, a flattened epidermis, a well-formed epidermal collarette, and CD34-positive endothelial cells. Various treatment modalities including surgery and laser have been used, but lesions recurred following a single laser treatment with a pulsed dye laser or long-pulsed Nd:YAG laser. CONCLUSION: A correlation between clinicopathological and dermoscopic findings was useful for the differential diagnosis of other diseases mimicking pyogenic granuloma and to detect recurrence after treatment. Laser treatments were less invasive therapy, but the recurrence rate was higher than that of other surgical modalities when used alone. Additional prospective studies are needed to determine the effectiveness of the various treatment modalities.

Morphea Developing at the Site of Healed Herpes Zoster

Wolf's isotopic response describes the occurrence of a new, unrelated disease that appears at the same location as a previously healed skin disease, and the most common primary skin disease of this phenomenon is herpes zoster. Several cutaneous lesions have been described to occur at the site of healed herpes zoster, and granulomatous dermatitis and granuloma annulare have been reported to be the most common second diseases. The pathogenesis of the isotopic response is still unclear. Morphea can develop at the site of regressed herpes zoster and a few such cases have been reported. We present here an additional case of morphea that developed at the site of previously healed herpes zoster, and we review the relevant literature.

A Clinical Study of Herpes Zoster in Children / 대한피부과학회지

BACKGROUND: Herpes zoster is a common dermatologic disorder. However, there has been no reported study of herpes zoster in children exclusively in the Korean literature. OBJECTIVE: The purpose of this study was to analyze epidemiological features and clinical characteristics of herpes zoster in children. METHODS: A retrospective study was performed by reviewing the medical records of 64 patients who were under 12 years old and who had herpes zoster. We searched for cases occurring during a 10-year-period from January 2000 to December 2009. We analyzed for age, gender, accompanying symptoms, dermatomal distribution, underlying disease, treatment and complications. RESULTS: Children under 12 years old account for 2.48% of all herpes zoster patients. The ratio of males to females is 1:1. The number of enrolled patients was increasing according to age (p=0.0004). The number (p=0.0009) and the proportion (p=0.0187) of pediatric patients has been increasing year by year. Underlying diseases were observed in 17.2%, and included asthma, atopic dermatitis, chronic sinusitis, epilepsy and tic disorder. There was no patient with immunocompression. Lesions of herpes zoster were most frequently found in the trigeminal dermatome (35.9%), followed by the thoracic (34.4%), cervical (14.1%), lumbar (9.4%), and sacral (4.7%) dermatomes, and multiple involvement (1.16%). Pain accompanying herpes zoster was reported in 54.7% and pruritus in 71.9%. Complications were observed in 14.1%; the most common one was eye involvement. CONCLUSION: The incidence of accompanying pain in children with herpes zoster is lower than in adults with this disease. However, the incidence of accompanying pruritus was higher in children than in adults. Postherpetic neuralgia did not developed in children.

A Case of Adenoid Cystic Carcinoma on the Nipple with Axillary Lymph Node Metastasis / 대한피부과학회지

Adenoid cystic carcinoma of the breast is an uncommon type of breast cancer, and it accounts for 0.1% of all breast cancer. In contrast to the aggressive nature of extramammary adenoid cystic carcinoma, adenoid cystic carcinoma of the breast has a more favorable prognosis. A 55-year-old female patient presented with a 6-month history of a tender mass confined to the nipple of the left breast. A skin biopsy showed a linear and tubular pattern of atypical cells, which was consistent with adenoid cystic carcinoma. Left breast conserving surgery with axillary lymph node dissection was performed. The histopathology of the specimen showed a 1.5 cm sized mass localized to the nipple, and the axillary lymph nodes were positive for tumor metastasis.

Lichen Planus Pigmentosus-inversus / 대한피부과학회지

Lichen planus pigmentosus (LPP) is a rare variant of lichen planus, and it is characterized by hyperpigmented, dark brown to violaceous colored macules or patches on the sun exposed areas of the skin. The term of LPP-inversus was proposed to describe some cases with LPP arising on the intertriginous areas. Clinically, LPP-inversus is characterized by well defined dark brown to violaceous macules or patches with minimal symptoms and it is predominantly confined on the flexural areas. The histological characteristics are a lichenoid inflammatory infiltrate on the upper dermis, melanophages and pigmentary incontinence. The clinical course can vary. We present here an additional case of LPP-inversus that developed on the both inguinal folds and we review the relevant literature.

A Case of Woringer-Kolopp Disease on the Leg / 대한피부과학회지

Woringer-Kolopp disease is a rare variant of mycosis fungoides and it is also known as localized pagetoid reticulosis. It presents as a solitary, localized hyperkeratotic patch or plaque on the extremities with a slowly progressive course. A 51-year-old female presented with a 6-year history of a well-defined erythematous plaque with an indurate border on the left leg. The lesion was asymptomatic and it had gradually enlarged. A skin biopsy showed hyperkeratosis and acanthotic epidermis with an infiltration of atypical pagetoid cells, and these cells were revealed to be the cytotoxic T cell phenotype on immunohistochemical staining. We report here on a case of Woringer-Kolopp disease along with a review of the relevant literature.

Kikuchi's Disease Presented with Cutaneous Lesion Showing Diffuse Erythematous Maculopatches / 대한피부과학회지

Kikuchi's disease, or histiocytic necrotizing lymphadenopathy is an idiopathic, benign self-limiting lymphadenitis usually affecting young women. Cutaneous findings in Kikuchi's disease have been reported in 16~40% of cases. A 29-year-old woman presented with pruritic diffuse erythematous maculopatches on whole body accompanied by long-lasting fever and cervical lymphadenopathy. Skin biopsy showed vacuolar degeneration of the basal layer and dermal infiltration of CD68-positive histiocytes. Lymph node fine needle aspiration specimens showed abundant lymphocytes, histiocytes, karyorrhectic debris without neutrophils, consistent with Kikuchi's disease. We present a case of Kikuchi's disease showing generalized skin eruption with a review of literature that describes patterns of skin involvement.

A Case of Blaschkitis / 대한피부과학회지

Blaschkitis is an acquired inflammatory dermatosis that develops along the line of Blaschko. It has a similar appearance to lichen striatus but, shows a somewhat different clinical course and histopathologic findings. Spongiotic dermatitis-like histopathology, good response to glucocorticoid therapy and frequent relapses are the characteristic features that can differentiate it from lichen striatus and other dermatoses which follows the line of Blaschko. We report a case of Blaschkitis that showed a typical clinical course and histopathologic findings.

A Case of Palmar Lichen Nitidus Presenting as a Clinical Feature of Pompholyx

Lichen nitidus (LN) is an uncommon chronic eruption of an unknown cause, and it is characterized by tiny, discrete, flesh-colored papules. The sites of predilection are the genitalia, trunk and extremities. Unilateral palmar involvement with pruritus is infrequent. We report here on a case of LN confined to the right palm, and the patient presented with multiple, pruritic, erythematous to flesh-colored, tiny papules and vesicles that mimicked pompholyx. The histopathological examination of a skin biopsy specimen showed the typical findings of LN.

Dermoscopic Patterns of Acral Melanocytic Nevi in Koreans / 대한피부과학회지

BACKGROUND: Melanocytic nevi are frequently found in acral skin. Benign melanocytic lesions on acral sites may be difficult to differentiate from early acral melanoma by visual examination even for experienced dermatologists. Dermoscopy is a noninvasive method for evaluating pigmented skin lesions. OBJECTIVE: The purpose of this study was to investigate the clinical and dermoscopic features of acral melanocytic nevi in Koreans. METHODS: We studied 57 patients with acral melanocytic lesions using standard clinical assessment and dermoscopy. The patients were examined for acral melanocytic nevi clinically and by using a dermoscope with a digital imaging system, and the acral nevi larger than 7 mm and the suspicious lesions were excised and examined histopathologically. RESULTS: Sixty five acral melanocytic nevi were observed in 57 patients. Individual lesions were located on the soles (n=32), palms (n=11), and volar aspect of the fingers or toes (n=22). The most common dermoscopic pattern was the parallel furrow pattern (52.3%). The other patterns seen were a latticelike pattern (21.6%), a fibrillar pattern (9.2%), a reticular pattern (6.2%), a globular pattern (4.6%), a nontypical pattern (4.6%) and a transition pattern (1.5%). The frequency of distribution of the fibrillar and reticular patterns was significantly different (p=0.033, p=0.015). CONCLUSION: Dermoscopy proved to be a useful instrument for the evaluation of acral melanocytic lesions. In our series of acral nevi, we observed 7 dermoscopic patterns with varying distributions on anatomical sites. We think that further studies on acral melanocytic nevi with digital follow-up are needed to clarify their evolution.

A Case of Postirradiation Morphea / 대한피부과학회지

A 58-year-old female with breast cancer, who had undergone breast conserving surgery and radiotherapy, presented with a 7-month history of erythematous to brown, indurated plaque confined to the previous radiation field. The patient had no constitutional symptoms. A skin biopsy showed thickened, hyalinized collagen bundles in the dermis, which was consistent with morphea. Postirradiation morphea is a rare complication of radiotherapy. The clinical feature of postirradiation morphea may be similar to cellulitis or cutaneous metastasis, and the diagnosis of this disease is given histopathologically. We present a case of postirradiation morphea and a review of the literature.

A Case of Hobnail Hemangioma That Occurred Together with Angiolipoma / 대한피부과학회지

Hobnail hemangioma is a benign vascular tumor that typically presents as a small, solitary lesion on the trunk or limbs of young or middle-aged persons. Characteristically,the tumor has a targetoid appearance where a violaceous papule is surrounded by an ecchymotic rim. Hobnail hemangioma is characterized by a biphasic growth pattern of the neoplastic vascular structures and prominent matchstick-like endothelial cells. Based on the positivity of the endothelial cells for monoclonal antibody D2-40, it has been proposed that this tumor displays lymphatic differentiation. Angiolipomas are benign subcutaneous tumors that consist of mature adipocytes and blood vessels. They are usually multiple and they typically occur in young adults with an obvious male predilection. We describe here a case of hobnail hemangioma that occurred together with angiolipoma in an 8-year-old girl, who had a violaceous papule encircled by a peripheral ecchymotic halo on the left heel.

A Case of Erythrodermic Dermatomyositis Associated with Gastric Cancer

Erythroderma is an unusual cutaneous finding associated with dermatomyositis. There are only five cases of erythrodermic dermatomyositis reported in the English literature. We treated a case of erythrodermic dermatomyositis associated with a Bormann type 1 gastric cancer. The patient had a generalized, erythematous scaly eruption consistent with erythroderma and Gottron's papules as well as a heliotrope rash; these are the hallmark skin manifestations of dermatomyositis.

Treatment of Linear Lichen Planus with Oral Methylprednisolone / 대한피부과학회지

BACKGROUND: Lichen planus is a chronic papulosquamous disease characterized by various clinical manifestations of the skin, mucosa, hair, and nails. Various drugs or physical treatments for lichen planus have been proposed, but the efficacies are often disappointing and controversial. Linear lichen planus is a rare variant of lichen planus, which accounts for 0.2~0.6% of all patients with lichen planus. Systemic corticosteroids remain the most widely used treatment for lichen planus. However, there have been no clinical studies on the effectiveness of this therapy on linear lichen planus despite the fact that linear lichen planus usually lasts for more than 1 year and occasionally results in cosmetic problems. OBJECTIVE: This study evaluated the efficacy and safety of oral methylprednisolone therapy for linear lichen planus. METHODS: Retrospective study was performed by reviewing the medical records and clinical photographs of 12 linear lichen planus patients treated with oral methylprednisolone. The analyses of treatment response to oral methylprednisolone therapy, adverse effects, and recurrence were performed. RESULTS: All the 12 patients who completed the oral methylprednisolone therapy achieved complete response. Most patients showed a marked improvement 1 to 2 weeks after starting oral methylprednisolone therapy. Three of the 12 patients showed recurrence at 9 to 14 weeks after cessation of the treatment. Oral methylprednisolone therapy was generally well-tolerated and no serious adverse effects were observed. CONCLUSION: Oral methylprednisolone therapy is an efficacious, safe, and tolerable treatment modality for linear lichen planus.

A Case of Cutaneous Metastases to the Face and Scalp from Colon Adenocarcinoma / 대한피부과학회지

Cutaneous metastases occur uncommonly with a reported incidence of 0.7% to 10% in all patients with internal organ malignancy. Cutaneous metastases in the face occur in less than 0.5% of patients with metastatic skin cancer. Cutaneous metastases occur in less than 4% of colon adenocarcinoma patients and the most frequent site is the abdominal skin, especially the scar of previous surgical incision. But metastases to the skin of the head and neck region from colon adenocarcinoma are rare and especially, facial skin metastases are very rare. We report a case of cutaneous metastasis to the face and scalp from colon adenocarcinoma.

Detection of HPV Genotypes in Non-genital SeborrheicKeratosis by HPV DNA Chip Analysis / 대한피부과학회지

BACKGROUND: The precise etiology of seborrheic keratosis (SK) is unknown. Genetics, sun exposure and infection have all been implicated as possible factors. Because of its clinical and histopathological similarities to verrucae vulgaris and condyloma acuminatum, human papillomavirus (HPV) has been suggested as a possible causative agent. In the previous studies, HPV were frequently detected in the genital lesions or hair follicles of immunocompromised hosts. OBJECTIVE: A newly introduced HPV detection technique, the HPV DNA Chip analysis, contains 24 HPV probes and it has the advantage of being able to detect 24 types of HPV at once. The purpose of this study was to evaluate the presence of HPV DNA in the nongenital SK of immunocompetant individuals. METHODS: We analyzed 31 biopsy specimens that were taken from patients with nongenital SK, and these specimens were compared with genital warts (the positive control) and distilled water in place of DNA (the negative control) with using HPV DNA Chip analysis and a polymerase chain reaction-based DNA microarray system as the HPV genotyping method. RESULTS: By polymerase chain reaction (PCR), HPV DNA was detected in 2 of the 31 nongenital SK biopsies (6.5%). HPV DNA Chip analysis revealed that 3 of 31 nongenital SKs (9.7%) contained HPV DNA. Two distinct HPV genotypes were detected: HPV type 16 (n=2) and HPV type 42 (n=1). The duration of SK in the HPV positive group was longer than that of the SK in the negative group. The mean age of the patients in the HPV positive group was also older than the mean age of the negative group. There were no different histopathologic findings between the HPV positive and negative SK. CONCLUSION: This study did not provide any concrete evidence that HPV infection might directly play a part in the pathogenesis of nongenital SK. However, two distinct HPV DNA types were identified as types that have never been reported before. Further studies with a larger number of cases of SK are needed to confirm the presence of HPV DNA in nongenital SK and also to determine the role of HPV in the origin of nongenital SK.

Detection of HPV Genotypes in Non-genital SeborrheicKeratosis by HPV DNA Chip Analysis / 대한피부과학회지

BACKGROUND: The precise etiology of seborrheic keratosis (SK) is unknown. Genetics, sun exposure and infection have all been implicated as possible factors. Because of its clinical and histopathological similarities to verrucae vulgaris and condyloma acuminatum, human papillomavirus (HPV) has been suggested as a possible causative agent. In the previous studies, HPV were frequently detected in the genital lesions or hair follicles of immunocompromised hosts. OBJECTIVE: A newly introduced HPV detection technique, the HPV DNA Chip analysis, contains 24 HPV probes and it has the advantage of being able to detect 24 types of HPV at once. The purpose of this study was to evaluate the presence of HPV DNA in the nongenital SK of immunocompetant individuals. METHODS: We analyzed 31 biopsy specimens that were taken from patients with nongenital SK, and these specimens were compared with genital warts (the positive control) and distilled water in place of DNA (the negative control) with using HPV DNA Chip analysis and a polymerase chain reaction-based DNA microarray system as the HPV genotyping method. RESULTS: By polymerase chain reaction (PCR), HPV DNA was detected in 2 of the 31 nongenital SK biopsies (6.5%). HPV DNA Chip analysis revealed that 3 of 31 nongenital SKs (9.7%) contained HPV DNA. Two distinct HPV genotypes were detected: HPV type 16 (n=2) and HPV type 42 (n=1). The duration of SK in the HPV positive group was longer than that of the SK in the negative group. The mean age of the patients in the HPV positive group was also older than the mean age of the negative group. There were no different histopathologic findings between the HPV positive and negative SK. CONCLUSION: This study did not provide any concrete evidence that HPV infection might directly play a part in the pathogenesis of nongenital SK. However, two distinct HPV DNA types were identified as types that have never been reported before. Further studies with a larger number of cases of SK are needed to confirm the presence of HPV DNA in nongenital SK and also to determine the role of HPV in the origin of nongenital SK.

A Case of Multiple Angiomyxolipoma / 대한피부과학회지

Angiomyxolipoma is a rare variant of lipoma and seven cases have been reported in the English literature. The reported cases mostly presented with a well-demarcated, asymptomatic, solitary, subcutaneous mass on the scalp or extremities. Histopathologic features of this tumor are characteristic and consist of the paucicellular myxoid areas and the mature fat tissue, with numerous thin, dilated blood vessels. The important histopathological differential diagnoses include myxoid spindle cell lipoma, myxoid lipoma, angiolipoma, angiomyolipoma, superficial angiomyxoma, myxoid liposarcoma and low-grade myxofibrosarcoma. We describe a 38-year-old man with multiple angiomyxolipoma on the gluteal area and the upper and lower extremities.

A Case of Piloleiomyoma Arising in a BCG Vaccination Site / 대한피부과학회지

BCG is a live attenuated vaccine derived from Mycobacterium bovis. It can give rise to several cutaneous complications including benign and malignant tumors. There are many reports about tumors arising in vaccination sites, especially those of small pox and BCG vaccinations. Reported tumors are basal cell carcinoma, dermatofibroma, melanoma, pilomatricoma and so on. Piloleiomyoma is a rare soft tissue tumor arising from arrector pili muscles. Clinically, piloleiomyomas appear as firm dermal papules and nodules with skin colored, pink, or reddish-brown surfaces. We experienced a case of piloleiomyma arising in a BCG vaccination site, which has not been reported in previous literature. Although several hypotheses have been propsed, there are no identified causes of leiomyoma. Trauma by the vaccination, persistent inflammation, wound healing process, or antigenic stimulation of the innoculation agent could be the possible causes in this case.