Antifungal Susceptibility Testing of Dermatophytes / 대한의진균학회지

BACKGROUND: A standardized reference method for dermatophytes in vitro susceptibility testing is lacking. However, with increasing variety of drugs available to treat dermatophytosis, the need for a reference method for dermatophytes testing has become apparent. OBJECTIVE: To evaluate a method of quantifying dermatophytes, the standards for broth microdilution method and evaluation of the availability of disk diffusion method in antifungal susceptibility testing for dermatophytes. METHODS: 14 Candida species (sp.), 30 Trichophyton(T.) mentagrophytes, 9 T. raubitschekii and 11 T. rubrum were tested for fluconazole susceptibility by the broth microdilution method and disc diffusion method. Candida sp. was tested according to National Committee for Clinical Laboratory Standards (NCCLS) M27-A and M44-A. Broth microdilution method for T. mentagrophytes, T. raubitschekii and T. rubrum was operated according to NCCLS M38-A. Disk diffusion method for T. mentagrophytes, T. raubitschekii and T. rubrum was tested refer to NCCLS M44-A. RESULTS: The disk diffusion method showed 50% correlation rate with the broth microdilution method for antifungal susceptibility testing for Candida species. The MIC reading point and incubation time of the broth microdilution method for T. mentagrophytes, T. raubitschekii and T. rubrum are Spec-50 and from 7, 6 and 9 days. Relation between the broth microdilution method and disk diffusion method for dermatophytes is poor. CONCLUSIONS: The good method for quantifying dermatophytes is using vortexing only or liquid nitrogen and homogenizer. Standards of MIC reading point and incubation time of microdilution method for dermatophytes are Spec-50 and from 6 to 9 days. It appears that the disk diffusion method is not recommended method for the antifungal susceptibility testing of dermatophytes.

A Case of Pityriasis Rotunda with Nephrotic Syndrome / 대한피부과학회지

Pityriasis rotunda is characterized by asymptomatic, multiple, brownish, round or oval shaped, isolated or confluent, fine scaly patches. It has been associated with a variety of underlying systemic diseases. We report a case of pityriasis rotunda occurring in a 15-year-old female patient with nephrotic syndrome and pulmonary tuberculosis.

A Case of Tumid Lupus Erythematosus / 대한피부과학회지

Tumid lupus erythematosus is a rare subtype of chronic cutaneous lupus erythematosus. We report a case of tumid lupus erythematosus. A 51-year-old female patient, presented with a solitary walnut sized tender erythematous nodule on the left forehead. Histopathologic findings showed dense perivascular and periadnexal lymphocytic infiltration, mucin deposition between the dermal collagen fibers like cutaneous lupus erythematosus. But there was no involvement of epidermis or dermoepidermal junction. Those histopathologic findings suggest polymorphous light eruption, Jessner lymphocytic infiltration and reticulated erythematous mucinosis. Mucin deposition is seen in reticulated erythematous mucinosis and tumid lupus erythematosus. To distinguish tumid lupus erythematosus from reticulated erythematous mucinosis, clinicopathologic correlation is essential.

A Case of Cutaneous Spindle Cell Squamous Cell Carcinoma / 대한피부과학회지

Spindle cell squamous cell carcinoma (SCSCC) is rare. As in many rare cases, the dignity is difficult to determine. A comprehensive immunohistochemical analysis was conducted, and histopathological findings were also assessed prior to diagnosis. A 77-year-old female patient presented with a dome-shaped ulcerative nodule on her left cheek which was 1.5 cm in diameter and expanding slowly. After resection, conventional histopathological investigation showed spindle-shaped cells with hyperchromatic nuclei infiltrating the dermis in a whorl-like pattern. Furthermore, immunohistochemical investigation revealed SCSCC was positive for cytokeratins (cam 5.2, 34betaE12), and mesenchymal marker (vimentin), but was negative for pancytokeratin (AE1/3). The SCSCC was surgically removed 12 months ago and no relapse has been observed since the removal. Comprehensive immunohistochemical analysis is essential, along with assessment of morphological findings prior to diagnosis. In addition, more case reports on SCSCC should be cumulated to determine a precise prognosis.

Two Cases of Dermatophytosis in Patients with Psoriasis / 대한의진균학회지

Psoriasis and tinea corporis have similar lesions that scaly erythematous patches, plaques and papules, and dermatophytosis have been considered rare in psoriasis. So, when the psoriatic lesion is resistant to conventional treatments, we regard worsening condition of psoriasis. It is difficult for us to diagnose dermatophytosis in the patient with psoriasis, when the lesion is atypical by steroid application. We report two cases of dermatophytosis in psoriatic patients. They had scaly lesions that suggested worsening of psoriasis but were not respond to conventional treatments. We found many hyphae on KOH examination from the lesions and isolated and identified Trichophyton rubrum on fungal culture. It is necessary for physicians to check dermatophytosis in patients who had atypical lesions or not better with conventional treatments.

A Case of Acantholytic Acanthoma / 대한피부과학회지

Acantholytic acanthoma is a benign neoplasm of the epidermal keratinocytes. It presents as a solitary, asympomatic, keratotic papule or nodule. The histopathologic features are outstanding acantholysis throughout the malpighian layer, hyperkeratosis, papillomatosis, and acanthosis. It is usually seen in older men, most commonly on the trunk. It has a tendency to be diagnosed clinically as a keratosis. Only 4 cases of acantholytic acanthoma have been reported in Korea. We report a case of acantholytic acanthoma in a 70-year-old man who presented with keratotic papules on his back.

A Case of Varicella Pneumonia in Healthy Adult / 대한피부과학회지

Varicella (chicken pox) is a common and contagious childhood disease. Varicella is uncommon in adults but potentially life-threatening because of serious complications such as pneumonia, hepatitis, disseminated intravascular coagulation and encephalitis. Among them, varicella pneumonia is the most common and serious complication of varicella infection in adults, with a reported incidence in healthy adults that is 25-fold greater than in children. Herein, we described a case of varicella pneumonia in a 36 year old healthy male patient. The patient presented with disseminated vesicular lesions, a fever, cough and mild dyspnea. A Tzanck smear of a vesicle showed multinucleated giant cells. A chest radiograph showed multiple, tiny nodules in both lungs and lymphadenopathy in the perihilar area. The patient was successfully treated with systemic acyclovir and corticosteroid for 15 days.

A Case of Herpetic Folliculitis / 대한피부과학회지

The histopathological findings of herpes virus infection of the skin are characterized as an intraepidermal vesicle formed by acantholysis with ballooning degeneration of keratinocytes and multinucleated keratinocytes. Involvement of follicular epithelium is known to occur as herpetic folliculitis. Although herpetic skin infection is very common, herpetic folliculitis is infrequently reported in the literature. It is important to confirm the diagnosis by histopathologic finding because of its atypically clinical manifestation. We report an unusual case in which typical clinical features of herpes virus infection were absent and histopathologically characterized by herpetic folliculitis without surface epithelium change.

A Case of Pancreatic Panniculitis / 대한피부과학회지

Pancreatic panniculitis is a subcutaneous fat necrosis associated with pancreatic disease. We report a case of pancreatic panniculitis associated with chronic pancreatitis. The patient was a 47-year-old man who was a severe alcoholic. He was diagnosed with chronic pancreatitis and inferior vena cava thrombosis 2 months before. He presented with multiple, tender, erythematous, subcutaneous nodules on both lower legs, and also had pitting edema with tenderness on the left ankle. Laboratory examination showed an increase in serum blood amylase and lipase. Histopathologic findings showed subcutaneous focal fat necrosis, dense neutrophil infiltration and anucleated "ghost cells". Stippled basophilic material was deposited in and around the necrotic subcutaneous fat tissue. The lesions subsided gradually with improvement of the chronic pancreatitis.

A Case of Acquired Smooth Muscle Hamartoma on the Sole / 대한피부과학회지

Smooth muscle hamartoma (SMH) is a benign proliferation of smooth muscle bundles within the dermis. It arises from either the arrector pili muscles, dartos muscles, smooth muscle cells in blood vessels and lymphatics, muscularis mamillae and areola, or cutaneous adnexa. Acquired smooth muscle hamartoma is very rare, and only 12 cases have been published to date. All reported cases are originated from arrector pili or dartos muscles. Herein, we describe a case of acquired smooth muscle hamartoma which originated from the smooth muscle cells in blood vessels of the right sole. To our knowledge, this is the first reported case which has originated from the smooth muscle cells in blood vessels.

Two Cases of Alopecia Totalis treated with Diphenylcyclopropenone (DPCP) Immunotherapy / 영남의대학술지

Treatments for alopecia areata include topical corticosteroid treatment, corticosteroid intralesional injection, systemic corticosteroid treatment, PUVA(psoralen-UVA) and topical immunotherapy. The therapeutic effects are variable. Alopecia totalis is hard to treat completely. Topical immunotherapy with dinitrochlorobenzene (DNCB), squaric acid dibutyl ester (SADBE) or diphenylcyclopropenone (diphencyprone, DPCP) represents the most accepted therapeutic modality for the treatment of extensive alopecia areata. We report two cases of alopecia totalis treated with DPCP. After DPCP treatment, total scalp hair was completely recovered.

A Clinical and Mycological Study of Tinea Pedis / 대한의진균학회지

BACKGROUND: Tinea pedis is the most common dermatophytosis in Korea. It has been increased gradually with time. Its characteristics may change with social environments. OBJECTIVE: The purpose of this study is to evaluate the clinical characteristics of tinea pedis according to clinical type and its mycologic findings. METHODS: We performed clinical and mycological studies on 74 patients with tinea pedis among outpatients clinic of Department of Dermatology in Yeungnam University Hospital and Catholic Skin Clinic for 3 months, from January 2005 to March 2005. RESULTS AND CONCLUSIONS: 1. The age distribution showed patients in their 60s and older than 60s to be most common. The ratio of male to female was 1.32:1 2. According to clinical types, the ratio of interdigital type was the highest (50%), followed by interdigital combined hyperkeratotic type (44.6%), interdigital combined with vesicular type (4%) and vesicular type (1.4%). There are no hyperkeratotic type and hyperkeratotic combined vesicular type. 3. The duration of longer than 5 years of tinea pedis was 73%. The proportion of interdigital combined with vesicular type was more common in its duration of longer than 10 years than its duration of less than 10 years. The durations of vesicular type and interdigital combined vesicular type were more than 5 years. 4. The rate of family history of tinea pedis was 52.7%. The broader area of involved site in the patients was, the higher the positivity in family history. 5. The rate of coexistent dermatophytosis with tinea pedis was 82.5%, and tinea unguium was the most common (79.7%). 6. The positive rate of culture was 68.9%, and Trichophyton(T.) rubrum was the most common isolates (96%) followed by T. mentagrophytes (4%). Compared with previous studies, age of patients with tinea pedis was older and duration was longer, the rate of coexistent dermatophytosis was increased, especially in tinea unguium.

Prevalence of Tinea Pedis and Onychomycosis in the Aged / 대한의진균학회지

BACKGROUND: Tinea pedis and onychomycosis is a common disease and the proportion of that in the aged has been significantly increased. Although there have been many reports about tinea pedis and onychomycosis, very few studies about that in the aged have yet been conducted. OBJECTIVE: The purpose of this study is to evaluate the prevalence and clinical features of tinea pedis and onychomycosis in the aged. METHODS: One hundred twenty-six persons over 65 years old who visited the Daegu public aged welfare center (57 persons), Seongju public health center (38 persons) and hospitalized Yeungnam University Yeongcheon hospital (31 persons) from September 20, 2005 to October 7, 2005 were examined clinically and evaluated tinea pedis and onychomycosis. Their clinical lesions were confirmed by KOH preparation and fungal culture. RESULT: Among 126 examined, 62 persons (49.2%) had tinea pedis and/or onychomycosis. Prevalence of the tinea pedis and/or onychomycosis of male (53.2%) was higher than that of female (38.2%). There was no difference in the prevalence between the living area or age. Most common clinical type of tinea pedis was hyperkeratotic type (n=21/66.7%). All patients with onychomycosis were distal subungual onychomycosis. In this study common underlying disease was hypertension (22.6%), diabetes mellitus (8.1%) and cerebrovascular accident (8.1%), however, there was no correlation between underlying diseases and the prevalence of tinea pedis and/or onychomycosis. Among 87 persons, 21 strains of dermatophytes were isolated. They were 19 strains of Trichophyton(T.) rubrum, 2 strains of T. mentagrophytes. The rate of previous treatment for this problem was 32.6%. CONCLUSIONS: All this finding suggest that the prevalence of tinea pedis and/or onychomycosis in the aged was high and they did not know about the disease. Tinea pedis and/or onychomycosis in the aged could become a source of infection and complication. Therefore, it is necessary to educate them and support to treat the disease effectively. Future studies including a large number of examinee and correlation of other diseases will be needed.