Immediate Distal Digit Reconstruction with Short Vascular Pedicled Partial Toe Transfer

We studied the results of the immediate microsurgical reconstruction of the distal digit injury with short vascular pedicled partial toe transfer. Thirteen patients with amputation or crush injury of the distal digit who underwent partial toe transfer at the authors' institute over 8-year period were reviewed. Delay between initial injury and reconstruction ranged from 1 to 9 days. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a proximal interphalangeal joint level on the fingers and metacarpophalangeal joint level on the thumbs. Good to excellent cosmetic and functional results were obtained in all cases, with nearly normal-looking fingertip. The mean static two point discrimination was 10 mm. Immediate reconstruction with short vascular pedicled partial toe transfer is an excellent option for the reconstruction of the compostie defect of the distal digit.

Reconstruction of the Digit Using Anterolateral Thigh Perforator Flap

PURPOSE: We reported the results of the digit reconstruction using anterolateral thigh perforator flap followed by delayed debulking operation. METHODS: We retrospectively reviewed all patients with digital injury who underwent anterolateral thigh perforator flap and delayed debulking operation. Ten digits in 8 patients were included. Three months after the last operation, the circumferences of the reconstructed digits were measured. RESULTS: There were no partial or complete flap necrosis. Average circumferences of the reconstructed digits were 111 percent (range: 104-120 percent) of those of the normal digits. CONCLUSION: Anterolateral thigh perforater flap and delayed debulking operation is a good option for the reconstruction of the large soft tissue defect of the digit.

Therapeutic Effect of Bleomycin Intralesional Injection on Keloids & Hypertrophic Scars / 대한피부과학회지

BACKGROUND: Keloids and hypertrophic scars are benign growths of dermal collagen that usually cause major physical, psychological, and cosmetic problems. Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established. OBJECTIVE: The purpose of this study is to investigate whether bleomycin intralesional injection has an therapeutic effect on both keloids and hypertrophic scars. METHODS: Thirteen patients with keloids or hypertrophic scars were administered with intralesional injection of bleomycin (1.5 IU/ml). Scar height was measured, and scar pliability and erythema were scored at baseline and then monthly during the treatment and follow-up period. Patient's self-assessments of subjective symptoms (pruritus and pain) were also scored. Pre- and post-treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared. RESULTS: The clinical response was positive in all cases: highly significant flattening in one case, significant flattening in one case, moderate flattening in five cases and minimal flattening in six cases. The mean scores for pruritus and pain also improved. The observed side-effects were hyperpigmentation (two cases), hypopigmentation (one case) and skin infection (one case). No exacerbation was noted during follow-up period of 4 months. CONCLUSION: Bleomycin intralesional injecton may be one of the effective and safe method of treating keloids and hypertrophic scars.

Efficacy and Safety of Fexofenadine in the Treatment of Pruritus Associated with Eczema / 대한피부과학회지

BACKGROUND: Fexofenadine (Allegra(R)) is a H1-receptor selective antihistamine which exhibits consistent efficacy and safety in the treatment of allergic diseases. We thought that fexofenadine may be useful in treatment of the pruritus associated with eczema. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of fexofenadine in the treatment of pruritus associated with eczema. METHODS: In this study, patients with atopic and allergic contact dermatitis were divided into a group given fexofenadine 180 mg once daily with topical prednicarbate treatment group or a topical prednicarbate treatment only group, for 1 week. The primary efficacy parameter was the mean change from baseline in pruritus score, and the secondary parameters were the mean change in the incidence of scratching, the mean change in visual analogue scale (0~100 mm) of pruritus, and a comparison of patient satisfaction. RESULTS: 435 patients were included and the mean age was 32.9 years old. The mean pruritus score at baseline was 3.55 point in fexofenadine group and 3.51 point in the control group. Regarding the mean change in pruritus score, fexofenadine significantly decreased the severity of pruritus compared with the control group (p<0.05). There were no significant differences in the decrease in the incidence of scratching between the two groups. A decrease in pruritus levels utilizing visual analogue scale was significant in the fexofenadine group (p<0.05) and patient satisfaction was significantly higher in the fexofenadine group (p=0.0192). There was no significant difference in the incidence of adverse events between two groups (p=0.6237). CONCLUSION: Fexofenadine administered 180 mg once daily in combination with topical prednicarbate treatment was effective and well tolerated in this study.

Soft Tissue Reconstruction of Children's Extremity with Perforator free Flap

Perforator free flap (PFF) is currently a major reconstructive option for soft tissue reconstruction in adults. Although PFFs have been used commonly, most reconstructive surgeons still hesitate to perform PFFs in children. The main cause of concern is the perceived high failure rate related to the small diameter of children's perforator vessels. We present 8 consecutive cases of successful transfer of thoracodorsal artery (TDA) & anterolateral thigh (ALT) perforator flap in children. Between 2003 and 2005, 8 children(4 to 13 years old) with soft tissue defects of the extremities were reconstructed with TDA & ALT PFFs. All flaps completely survived. There were no problems relating to vascular spasm or occlusion. Range of motion of reconstructed extremities were fully recovered. Among 8 patients, only 1 patient was performed an additional flap thinning procedure. 8 cases of TDA & ALT perforator flaps were successfully transferred in children. PFF is an excellent option in reconstruction of children as well as in adults because of its thinness, long pedicle length, least donor site morbidity and acceptable donor site scar.

A Case of Vitamin K1 Dermatitis due to Intralesional Injection for Cosmetic Purpose / 대한피부과학회지

Vitamin K is a lipid-soluble vitamin used in the treatment of hypoprothrombinemia found in diseases of the liver, biliary tract and small intestine. Vitamin K1 (Phytonadione) is the natural form of vitamin K. Recently, a cream containing vitamin K1 has been marketed for topical use in the treatment of periorbital hyperpigmentation, telangiectasia and rosacea. Vitamin K1 dermatitis is a cutaneous adverse reaction to vitamin K1 and can cause acute pruritic, erythematous, eczematoid, indulated plaques or slowly-appearing sclerodermatous plaques. We present a case of dermatitis caused by a vitamin K1 intralesional injection for treatment of facial telangiectasia and flushing.

A Clinical Study of Postoperative Efficacy of Superficial Liposuction in Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is characterized by unpleasant odor, profuse sweating and occasionally staining of clothes. Classical surgical treatment of axillary osmidrosis may result in many complications, such as scarring, hematoma and necrosis. OBJECTIVE: The purpose of this study is to evaluate the effect of superficial liposuction in the treatment of axillary osmidrosis. METHODS: Through two 5 mm sized incisional windows, liposuction can be done in a two directional criss-cross pattern. Fifteen patients received this surgery for bilateral axillae on an outpatient basis. The follow-up period ranged from 8 months to 18 months, the mean follow-up period was 12.5 months. RESULTS: Of the 30 axillae, 28 axillae (93%) had excellent to good results. The axillary scars were short and nearly negligible (90%). Complications including one minor wound infection (3.3%) and one hematoma (3.3%), were improved with proper post-operative treatment. Four patients experienced transient fibrotic bands. All of these complications disappeared after 1~2 months. CONCLUSION: In axillary osmidrosis, superficial liposuction has the merits of high success rates, short scars, minimal postoperative care with a short term of compressive dressing and rapid recovery to normal life.

Topical Aminolaevulinic Acid-Photodynamic Therapy for the Treatment of Mild to Moderate Inflammatory Acne

BACKGROUND: Photodynamic therapy (PDT) using aminolevulinic acid (ALA) is a new technique. PDT is being studied extensively and is used in a variety of dermatology settings. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of topical ALA-PDT in patients with mild to moderate inflammatory acne. METHOD: Ten patients were enrolled in a clinical trial to evaluate ALA-PDT with activation by intense pulsed light. They were given a 20% topical ALA photosensitizing agent that remained in contact with the skin for 60 minutes before irradiation. No additional treatment was provided after PDT. RESULTS: The Korean acne grading system was used for clinical assessment. Our results showed a statistically significant clinical improvement of the inflammatory acne at eight weeks after two sessions of treatment. Side effects such as slight discomfort, burning and stinging were reported during the irradiation. CONCLUSION: ALA-PDT is a safe and effective treatment modality for inflammatory acne.

A Case of Leukocytoclastic Vasculitis Associated with Pulmonary Tuberculosis / 대한피부과학회지

Leukocytoclastic vasculitis is characterized by palpable purpura, showing microscopically necrotizing vasculitis of the small dermal blood vessels. Although various causes have been suggested, cases of leukocytoclastic vasculitis associated with tuberculosis have rarely been reported. A 40-year old man presented with palpable purpura on both ankles, an intermittent cough, low-grade fever and recent weight loss. A skin biopsy showed characteristic features of leukocytoclastic vasculitis, and the findings of radiology and sputum examinations were compatible with active pulmonary tuberculosis. The purpuric lesions gradually subsided after antituberculous medication. The findings suggested cutaneous leukocytoclastic vasculitis accompanied by pulmonary tuberculosis.

A Case of Anagen Effluvium Induced by INH (Isonicotinic Acid Hydrazide) / 대한피부과학회지

We report a case of a 30 year-old woman who presented with acute scalp hair loss induced by isonicotinic acid hydrazide gap (INH). Considerable hair loss started within 4 weeks of INH administration. There was no evidence of dermatitis, allergic reaction, or any other cause for the hair loss. INH was discontinued, and the hair loss stopped within 4 weeks, with new hair growth seen. There was complete recovery of hair loss after 12 weeks of alopecia. Medication-induced hair loss is an occasional adverse effect of many drugs, however hair loss induced by INH has been reported in only 1 case. The complete recovery from anagen effluvium is difficult to explain, but it could have been due to the early discontinuance of INH.

A Case of Milia-like Idiopathic Calcinosis Cutis in Healthy Boy / 대한피부과학회지

Milia-like idiopathic calcinosis cutis (MICC) is a peculiar subtype of idiopathic calcinosis cutis, characterized by clinically resembling milia, and the majority of the cases are associated with Down syndrome. We report a rare case of MICC which was not associated with Down syndrome. A healthy 10-year-old boy presented with whitish papules surrounded by erythema on the back. Some of the papules were umbilicated or crusted, therefore, they gave a clinical impression as molluscum contagiosum. Histopathologic findings of the papule showed calcium deposits as amorphous, basophilic mass on the upper dermis and focal transepidermal elimination of calcium, which were compatible with MICC.

A Case of Pityriasis Amiantacea / 대한피부과학회지

Pityriasis amiantacea is a scaly condition of the scalp. This is usually seen in women or children. It is associated with various underlying primary dermatoses, such as psoriasis, atopic dermatitis, seborrheic dermatitis, tinea capitis, pyoderma, pediculosis, alopecia areata, lichen simplex chronicus and lichen planus. To our knowledge, there have been no other reports of pityriasis amiantacea in Korea. With scanning electron microscopy (SEM) image of the disease, we report a typical case of pityriasis amiantacea.

Efficacy of Interferon-alpha2b in Treatment of Warts / 대한피부과학회지

BACKGOUND: Interferon-alpha2b has already proven to be effective in the clinical treatment of virus-originated diseases such as hairy cell leukemia, condyloma acuminatum, and AIDS-related Kaposi's sarcoma. The use of recombinant interferon-alpha2b may allow various types of wart to be treated relatively atraumatically and with less incidence of recurrence. OBJECTIVE: We tried to compare the effectiveness and safety of intralesional injections of recombinant interferon-alpha2b with natural interferon-alpha2b in the treatment of patients with various types of wart. METHOD: Patients with more than two warts were treated by injecting the different warts with 0.5 to 1.0X105 IU/1mm3 of recombinant and natural interferon-alpha2b, twice per week for 4 to 20 weeks. The response to treatment was followed up at 36 weeks. RESULTS: At the end of treatment, clearing of the treated warts had occurred in 83.3% of the recombinant interferon-alpha2b group and 91.6% of the natural interferon-alpha2b group. A more rapid cure rate was observed in the natural interferon-alpha2b group than in the recombinant interferon-alpha2b group. The rest showed partial improvement. With evaluation for relapse up to 16 weeks after treatment, warts were found to relapse in 11.1% of both the recombinant and natural interferon groups. CONCLUSION: Intralesional natural interferon-alpha2b has a better therapeutic effect than recombinant interferon-alpha2b, and may be considered as a therapeutic modality of recalcitrant verruca or when it can be anticipated that destructive techniques or blistering agents will not be tolerated.

A Case of Familial Annular Erythema / 대한피부과학회지

The cause of most cases of erythema annulare centrifugum (EAC) is unknown. There have been extremely rare reports, clinicopathologically compatible with EAC, occurring in a family. A case of annular erythema, which was indistinguishable from EAC, occurred in a 5-month-old girl and her mother. We propose to consider this a separate entity, `familial annular erythema', rather than take into any familial cause of EAC.

Three-dimensional Culture Model of the Conjunctival Epithelium

PURPOSE: To reconstruct a cultured conjunctival equivalent that closely resembles normal conjunctival epithelium in three-dimensional culture systems. METHODS: Human conjunctival epithelial cells were cultured on dead de-epidermized dermis in the air-exposed state. After 2 weeks of culture, the sections were stained with hematoxylin and eosin. Immunohistochemical and electron microscopic studies were performed. The results were compared with those of normal conjunctiva and cultured eyelid skin equivalent. RESULTS: In the cultured conjunctival equivalent, nonkeratinizing stratified epithelium was formed similarly to normal conjunctival epithelium. Keratin 13 was expressed, but not keratin 10, in the cultured conjunctival equivalent, similarly to normal conjunctival epithelium. However, in the cultured eyelid skin equivalent, keratinizing stratified epithelium was formed. In addition, keratin 10 was expressed, but not keratin 13, contrary to those of the cultured conjunctival equivalent. In the cultured conjunctival equivalent, ultrastructurally, keratin intermediate filaments and desmosomes were found. In addition, microvilli were seen in the uppermost epithelial cells. CONCLUSIONS: These findings demonstrate that the cultured conjunctival equivalent resembles normal conjunctival epithelium morphologically, biochemically and ultrastructurally, thereby suggesting that the cultured conjunctival equivalent may have a great potential in the study of conjunctival epithelium.

Linear Focal Elastosis / 대한피부과학회지

Linear focal elastosis is characterized clinically by horizontal yellowish palpable striae on the lower back and histologically fragmentation or aggregation of elastic fibers. We herein report four cases of linear focal elastosis in male patients. They were 12 to 17 years old and the disease duration was 1 to 3 years. We suggest linear focal elastosis is a variant of striae distensae affecting elastic fibers.

A Case of Erythropoietic Protoporphyria Screened by RBC Fluorescence Microscopy / 대한피부과학회지

Erythropoietic protoporphyria (EPP), caused by decreased activity of the enzyme ferrochelatase, is characterized clinically by burning photosensitivity beginning from childhood, and chemically by excessive amounts of red blood cell protoporphyrins. 1-10% of EPP patients develop potentially fatal protoporphyric hepatic failure. The diagnosis of EPP had been missed in many cases when traditional solvent extraction qualitative screening test was used for blood porphyrins, and use of fluorescence microscopy improved this problem. We report a case of EPP screened by fluorescence microscopy of erythrocytes in a 50-year-old man complaining of photosensitivity. We recommend fluorescence microscopy could be the screening test of choice for the detection of increased red blood cell porphyrins.

A case of Hereditary Epidermolytic Palmoplantar Keratoderma / 대한피부과학회지

The hereditary epidermolytic palmoplantar keratoderma (Vorner"s kerato derma) is characterized by autosomal dominantly inherited, marked, symmetrical thickening of the palms and soles. The presence of epidermolytic hyperkeratosis in skin biopsy differentiates hereditary epidermolytic palmoplantar keratoderma from Unna-Thost keratoderma. We report a case of hereditary epidermolytic palmoplantar keratoderma with literature reviews focused on the differential points from other palmoplantar keratodermas.

An Unusual Case of Angiolymphoid Hyperplasia with eosinophilia: Chronic Ulcerative Lesion on the Lower Lip / 대한피부과학회지

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign uncommon disorder of uncertain etiology. It presents as solitary or multiple intradermal or subcutaneous red to brown papules or nodules usually on the head and neck. Overlying epidermis is usually intact. Oral involvement such as lip or oral mucosa is quite rare, and presents as a nodule, macule, plaque, tumor, and ulcer. We report a 68-year-old female patient presenting erythematous ulcerated and crusted patch on the lower lip. Histopathological diagnosis was ALHE and overlying actinic cheilitis.

Effect of Spherical Lens Induced Anisometropia on Dynamic Stereoacuity

we investigated the effect of spherical lens-induced anisometropia on dynamic stereoacuity. Twenty subjects with normal binocular function without past ophthalmic disease history were examined for the effect of anisometropia on the viasual acuity, static and dynamic stereoacuity created with spherical lenses in 0.5D stepwise manner before dominant eye from -2.0D to +2.0D. Dynamic stereoacuity was measured by new computer program. And we investigated the effect of anisometropia on dynamic stereoacuity as the power of the lenses was increased and the effect of plus lens vs minus lens on the dynamic stereoacuity. As a result, dynamic stereoacuity decreased statistically significantly as the power of the spherical lenses increased. And the plus 1.5D and 2.0D lens showed more deteriorating effects on dynamic stereoacuity than the corresponding minus power lenses, respectively. No statistically significant correlation was found between static and dynamic stereoacuity at each spherical lens diopter.