Giant Acquired Digital Fibrokeratoma Occurring on the Left Great Toe

Acquired digital fibrokeratoma is an uncommon, benign fibrous tumor which usually occurs in adults as a solitary lesion. The most frequent locations are fingers and toes and the size of the tumor is generally small, around 3~5 mm. An 18-year-old female presented with a solitary, skin-colored, round and protruded nodule of the left great toe. The size of nodule was 2.5x1.6x1.4 cm. Histopathologic examination revealed typical findings of acquired digital fibrokeratoma. Herein, we report a giant acquired digital fibrokeratoma.

Detection of a Novel Missense Mutations in Atrichia with Papular Lesions

BACKGROUND: Atrichia with papular lesions (APL) is a rare inherited disease characterized by early onset of total hair loss, followed by papular lesions over the extensor areas of the body. Recently, mutations in the human hairless (HR) gene have been implicated in its pathogenesis. The identification of mutations in the HR gene is important for differentiating between APL and alopecia universalis (AU). OBJECTIVE: We compared the HR genes of patients with presumed AU who showed minimal or no response to treatment with the HR genes of healthy controls. METHODS: The subjects were 11 patients with presumed AU who had not responded to treatments. Fifty healthy people were included as controls for molecular analysis. To screen for mutations, polymerase chain reaction was performed. RESULTS: DNA analysis identified a novel heterozygous G-to-A transition at nucleotide position 191 in exon 5. The mutation was not found in the controls, other AU patients, or any unaffected family members except for the patients' mother and maternal grandfather, who were heterozygous HR gene carriers. CONCLUSION: Our study identifies a novel missense mutation in exon 5 of the HR gene in a Korean APL patient previously diagnosed as AU.

A Case of Superficial Acral Fibromyxoma Occurring after Trauma in a Childhood Patient / 대한피부과학회지

Superficial acral fibromyxoma is a rare, distinctive soft tissue neoplasm most often located in the periungal region of the fingers and toes. This tumor was recently recognized as a distinct clinicopathological entity and since then quite a few cases have been reported. These tumors are composed of stellate and spindle cells arranged in a loose form, with a fascicular growth pattern, and occur mostly in middle-aged adults. However in our case, the lesion developed in 9-year-old male, who had a history trauma. Although the exact pathogenesis of superficial acral fibromyxoma has not yet been clarified, it is possible that the fibroblast hyperplasia in the lesion could be triggered by trauma. We suggest this case which occurred in a 9-year-old patient, triggered by trauma, is a peculiar and interesting event.

Retronychia, a Proximal In-growth of the Nail Plate / 대한피부과학회지

Retronychia is a process of a nail embedding itself into the proximal nail fold due to an incomplete shedding of the nail, and this usually occurs after physical trauma. Retronychia causes persistent paronychia and defective nail growth on the patients. Simple avulsion of the superimposed nail is curative. A 17-year-old man presented with tender erythema and swelling on the proximal nail fold of the right 3rd and 4th fingers for 2 months after an operation that was performed due to metacarpal bone fracture. The second patient was a 25-year-old male who presented with a 1-month history of persistent paronychia on his right great toe after blunt trauma. For both patients, simple avulsion of the damaged nail was curative and underlying new nails were revealed. We report here on two cases of retronychia that could be easily overlooked and such cases have not been previously reported in the Korean dermatologic literature.

Fibroepithelioma of Pinkus Resembling Seborrheic Keratosis on the Thigh / 대한피부과학회지

Fibroepithelioma of Pinkus (FEP) is an uncommon variant of basal cell carcinoma and this typically appears as single or multiple nodular lesions on the lower back of the elderly. We report here on a case of a 59-year-old woman who presented with an asymptomatic erythematous sessile plaque on the lateral side of her right thigh, and she'd had this lesion for 8 years. Histologic examination showed anastomosing strands of basaloid cells extending from the overlying epidermis into the dermis. The tumor cells with large, oval nuclei and relatively little cytoplasms were grouped in a palisade pattern at the periphery of the tumor mass. The tumor was completely excised with a clear resection margin. The patient showed no recurrence for 10 months. For an elderly patient with a long-standing nodule found anywhere on the body, performing a skin biopsy should be considered to exclude malignancy, including FEP.

A Case of Linear Focal Elastosis with a Family History

Linear focal elastosis is an uncommon disorder typically occurring in the back region, which clinically presents as band-like striae, having a histological focal increase in abnormal elastic fibers. Until now, linear focal elastosis occurring in patients with a family history have been rarely reported. Here, we present one such case, of linear focal elastosis which occurred in a brother and sister.

The Correlation between SCORAD Index and Instrumental Assessment in Evaluation of Atopic Dermatitis Severity / 대한피부과학회지

BACKGROUND: Atopic dermatitis is a chronic relapsing inflammatory skin disease characterized by dry skin, pruritus, and typical distribution of the lesions. Because an objective tool for the assessment of disease severity of atopic dermatitis has yet to be agreed upon, many dermatologists are dependent on subjective history and clinical scoring. Recently, instrumental measurements have been used for the assessment of skin barrier function. OBJECTIVE: The purpose of this study was to assess the correlation between SCORAD (scoring of atopic Dermatitis) index and the results of instrumental assessments of disease severity in atopic dermatitis. Additionally, we compared the values of instrumental measurements on normal and lesional skin. METHODS: From February to April 2007, 44 patients with atopic dermatitis were treated with topical steroids, topical calcineurine inhibitors, oral antihistamine agents and systemic steroids. At initial visit, and after 1, 2, 3, and 4 weeks of treatment, the SCORAD index was measured, and instrumental measurements of skin surface hydration (SSH), transepidermal water loss (TEWL), and pH were performed on the antecubital fossa (lesional skin) and flank (normal skin) of the patients by Corneometer(R), Tewameter(R), and skin-pH-meter(R). RESULTS: Significant correlation was found between SCORAD index and SSH (p<0.0001), TEWL (p<0.0001), and pH (p=0.1680). SSH and TEWL improved within 1 week of treatment but pH improved after 2 weeks of treatment. Instrumental assessments showed lesional skin had lower SSH, higher TEWL, and more alkaline pH than normal skin. CONCLUSION: Instrumental measurements showed correlation with SCORAD index. Therefore, we can use instrumental assessments as well as SCORAD index in the assessment of disease severity of AD.

Dermatologic Diseases Associated with Atopic Dermatitis in Koreans: Multicenter Study / 대한피부과학회지

BACKGROUND: Dermatological diseases can occur with atopic dermatitis. OBJECTIVE: The purpose of this study was to analyze diseases associated with atopic dermatitis in Koreans. METHODS: From November, 2007, to May, 2008, 948 patients with atopic dermatitis who visited the department of dermatology at 19 hospitals were evaluated for associated diseases. RESULTS: Of 948 patients, 53.8% (510) had symptoms associated with other dermatological diseases. In order of frequency, diseases associated with atopic dermatitis included acne, hand/foot eczema, seborrheic dermatitis, urticaria, warts, and recurrent herpes simplex. The number of associated diseases did not change significantly with the severity of atopic dermatitis. However, the incidence of hand/foot eczema and eczema herpeticum correlated significantly with the severity of atopic dermatitis. CONCLUSION: There is a distinct pattern of diseases associated with atopic dermatitis in Koreans.

O-X Flap; Quadripolar Advancement Flap / 대한피부과학회지

Large surgical defects are often difficult to repair and extensive adjacent skin transfer may be necessary. The purse-string suture can be used to reduce the size of large defects, but a second intervention may be necessary and requires several weeks for complete healing. Therefore, reconstruction of large defects is a challenge to the dermatologist. We report a case of basal cell carcinoma on the back in which the skin defect was reconstructed by a quadripolar advancement flap. Because the large O-shaped defect resulted in an X-shaped closure, we named this flap the O-X flap.

Vitiligo Coexistent with Nevus Depigmentosus: This Was Treated with Narrow-Band UVB and These Lesions Were Followed Using the Mexameter(R), a Pigment-Measuring Device

Nevus depigmentosus (ND) is a congenital, non-progressive, hypopigmented lesion that is usually stable throughout an affected individual's lifetime. The clinical features of vitiligo are similar to those of ND, but the two diseases have different treatment responses and prognoses. We report here on a rare case of vitiligo that was coexistent with ND. Both conditions were treated with narrow-band UVB. An 11-year-old boy presented with two distinct types of hypopigmented lesions, one on the forehead and the other on his back. The first was a hypopigmented patch with leukotrichia, and it was incidentally discovered 3 months before the child was examined at our clinic and it had rapidly increased in size. The second hypopigmented patch was detected at birth and it had slowly been increasing in size. The hypopigmented lesion on the child's forehead was diagnosed as vitiligo, and the one on his back as ND. Once- or twice-weekly narrow-band UVB treatment was initiated. Improvements in the two lesions were assessed with clinical photography and using a Mexameter(R) (Courage-Khazaka Electronic, Germany), which is a pigment-measuring device.

A Case of Adams-Oliver Syndrome

Adams-Oliver syndrome (AOS) is a congenital condition characterized by aplasia cutis congenita, transverse limb defects, and cutis marmorata telangiectatica. AOS can also be associated with extensive lethal anomalies of internal organs, including the central nervous, cardiopulmonary, gastrourointestinal, and genitourinary systems. Generally, the more severe these interrelated anomalies are, the poorer the prognosis becomes. In the relevant literature on this topic, it is somewhat unclear as to whether the prognosis of AOS without lethal anomalies alters the lifespan. We report a case of AOS with typical skin defects only, and no internal organ anomalies.

A Hydroxyurea-induced Leg Ulcer

Hydroxyurea is a cytostatic agent that has recently become the drug of choice in the treatment of various myeloproliferative diseases. The cutaneous side effects of hydroxyurea include xerosis, hyperpigmentation, nail discoloration, and scaling. Leg ulcers have only rarely been reported in association with hydroxyurea treatment. A 75-year-old woman presented with leg ulcers, nail discoloration, and xerosis. The leg ulcers were refractory to conventional treatment. She had been taking oral hydroxyurea since being diagnosed with essential thrombocytosis in 2002. Hence, we suspected hydroxyurea-induced leg ulcers and discontinued her hydroxyurea treatment; the ulcers gradually healed thereafter. We present a rare case of hydroxyurea-induced leg ulcers in Korea.

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 Herpetic Whitlow / 대한피부과학회지

Herpetic whitlow is a painful cutaneous infection that occurs on the fingers and toes, and it is caused by herpes simplex virus (HSV)-1 or -2. It is correlated with the immunocompromised state of patients or with occupations that are in frequent contact with the secretions or mucous membranes infected by HSV. We present here a 29-year-old woman who was referred to our department with recurrent vesicles and ulcerative lesion of the right 3rd finger. She was immunocompetent and did not have any occupational hazard of herpetic whitlow. We made the diagnosis of herpetic whitlow by the clinical features and the histopathologic examinations. In addition, we used polymerase chain reaction assay to detect the type of HSV and we confirmed she suffered with herpetic whitlow that was caused by HSV-2.

A Case of Acquired Tufted Angioma That Mimicked Pyogenic Granuloma and It Was Precipitated by Trauma / 대한피부과학회지

Tufted angioma (TA) is a rare benign vascular tumor that is histologically characterized by circumscribed angiomatous vascular aggregates in the dermis and its "cannon-ball" pattern. The acquired type is known as angioblastoma of Nakagawa and it was first described in 1949. TA usually occurs on the trunk and neck in children, but TA sometimes occurs at birth or adulthood. The cutaneous manifestations include slowly spreading erythematous macules, papules and nodules that are generally without any other symptoms. We examined a 75-year old man with a bean sized solitary hemorrhagic crusted nodule on the tip of his 3rd finger, and the lesion was clinically similar to the pyogenic granuloma. The nodule developed at the site of a local injury that happened 6 months ago. The histopathological findings were consistent with tufted angioma. He was treated with surgical excision and it did not recur during the next 12 months. We report here on a case of tufted angioma that mimicked pyogenic granuloma, and this lesion occurred at an unusual location and it was precipitated by trauma.

A Case of Allergic Contact Dermatitis Caused by a Duoderm Extrathin? Dressing / 대한피부과학회지

Allergic reaction to different fruits and vegetables has frequently been described, but an allergic reaction to mango fruit, including its sap, pericarp, stems and leaves, has rarely reported in the literature. Mango dermatitis, although not common, is the term for allergic contact dermatitis caused by mango. The Mango plant is found worldwide, and the plant shares chemical compounds that are similar to other substances of the Anacardiaceae plant. The substances uroshiol and cardol cause the allergic contact dermatitis. Any case of allergic contact dermatitis with eating mango fruit has not been reported in the Korean dermatologic literature. Here we report the first case of mango contact dermatitis in a 20-years-old female and this happened when she drank mango juice.

The Therapeutic Effect of Photodynamic Therapy with Aminolevulinic Acid Topical Solution and Blue Light for Actinic Keratosis / 대한피부과학회지

BACKGROUND: Actinic keratoses (AKs) are precancerous lesions that are treated with local liquid nitrogen cryotherapy, topical fluorouracil or topical chemotherapeutic agents. Photodynamic therapy (PDT) with various kinds of light sources has recently been tried for treating actinic keratoses. There have been no studies in the Korean literature about the effectiveness of aminolevulinic acid (ALA)-PDT combined with blue light for treating actinic keratoses. OBJECTIVE: We examined the safety and efficacy of PDT (using topical 20% ALA solution and blue light) for the treatment of actinic keratoses. METHODS: Twenty five AKs lesions of 17 patients were enrolled in the study. They were prepared with the application of topical 20% ALA solution for 2 hours and this was followed by exposure to 417+/-5 nm blue light at 10 J/cm2. The lesions were assessed at 48 hours and 2 and 4 weeks following PDT. Those target lesions remaining at week 4 were re-treated. Skin biopsies were done at 8 weeks to evaluate the response to ALA-PDT. RESULTS: Complete remissions were achieved for 64.0% of the AKs lesions after 2 treatment sessions. Only two patients suffered from a stinging sensation when exposed to the light therapy. CONCLUSION: Topical ALA-PDT with using a blue light source could be an effective treatment modality for actinic keratoses

A Case of Acquired Reactive Perforating Collagenosis Triggered by an Insect Bite / 대한피부과학회지

Reactive perforating collagenosis (RPC) is one of a range of essential perforating disorders. Two types have been recognized: the childhood or inherited form, and the adult or acquired form. Acquired RPC is usually associated with systemic diseases, especially diabetes mellitus, and/or renal failure. We present a case of a 47-year-old female with umbilicated skin lesions triggered by an insect bite. Histology from the lesion revealed transepidermal elimination of collagen.

A Case of Allergic Contact Dermatitis to Duoderm Extrathin(R) Dressing / 대한피부과학회지

Even though hydrocolloid dressings have been widely used for the past 15 years in the treatment of various types of wounds; allergic contact dermatitis to these dressings have been rarely reported. Duoderm(R) is representative agent of hydrocolloid dressing, and Duoderm Extrathin(R) is a new formulation of Duoderm(R) that contains pentaerythritol ester as a tacking agent, a substance used in several other adhesives. In Korean dermatologic literature, only 1 case of the allergic contact dermatitis due to Duoderm CGF(R) has been reported. However allergic contact dermatitis due to Duoderm Extrathin(R) has not been reported. We report a case of allergic contact dermatitis in a 22-year-old female during wound management using Duoderm Extrathin(R).

Pruritic Urticarial Papules and Plaques of Pregnancy: Clinical Experience with 22 Patients / 대한피부과학회지

BACKGROUND: Pruritic urticarial papules and plaques of pregnancy is a common benign dermatosis of pregnancy. It occurs mainly in primigravidas in the third trimester, it resolves spontaneously or with delivery, and it is usually responsive to topical treatment. The morphological spectrum of pruritic urticarial papules and plaques of pregnancy includes (1) urticarial papules and plaque (type I), (2) non-urticarial erythematous patches that are discrete or confluent and they are surrounded by tiny papules or vesicles, or clusters or sheets of 1-mm to 2-mm erythematous papules (type II) and (3) a combination of these features (type III). OBJECTIVE: This study evaluated our clinical experience with 22 Korean patients with pruritic urticarial papules and plaques of pregnancy. METHODS: From June 1997 to August 2008, 22 patients with pruritic urticarial papules and plaques of pregnancy were evaluated. The clinical manifestations, the lesion distribution and the obstetric and pediatric findings were retrospectively investigated with using the patients' medical records and clinical photographs. RESULTS: There were 9, 11 and 2 patients with types I to III, respectively. Many patients (n=14) were primigravida and the mean time of onset was a gestational age of 29.8 weeks. There were no pediatric problems such as intra-uterine growth retardation, or a small or large size for the gestational age.Most of the patients (n=20) were treated with topical corticosteroid or antihistamine; there was one case of recurrent pruritic urticarial papules and plaques of pregnancy. CONCLUSION: Pruritic urticarial papules and plaques of pregnancy usually occur in primigravidas, but this can also occur in multigravida patients. The number of patients with pruritic urticarial papules and plaques of pregnancy and who had obstetric obesity, a multiple pregnancy or pregnancy-induced hypertension was fewer than we expected. Pruritic urticarial papules and plaques of pregnancy can be divided into three categories, although this is rather redundant because the disease prognosis and treatments are not different according to the type.