Multiple Actinic Keratoses within Vitiliginous Patches in a Patient with Non-segmental Vitiligo / 대한피부과학회지

A 74-year-old man visited our department with complaints of multiple asymptomatic erythematous scaly crusted patches on the scalp. He had non-segmental vitiligo with the extent of over 20% of the body surface area for 30 years. Biopsies showed hyperkeratosis, foci of atypical, pleomorphic keratinocytes along the basal cell layer, and marked solar elastosis, consistent with actinic keratosis (AK). Melan-A and Fontana-Masson staining showed absence of melanin and melanocytes. Despite conflicting data on the prevalence of skin cancers in patients with vitiligo, it is known that vitiligo does not increase nor decrease the risk of skin cancer. Recent studies have reported that patients with vitiligo lesions show increased epidermal expression of wild-type p53 protein than healthy controls. However, a few cases of skin cancer have been reported in patients with vitiligo. Here, we report a case of AK developing in vitiligo lesions. Dermatologists should not overlook the possible occurrence of AK or skin cancers in sun-exposed vitiliginous skin.

A Case of Multiple Canaliform Median Raphe Cysts Showing a Mixed Type Lining of Epithelium: A Case Report and Review of the Literature

No abstract available.

Prevalence of Vitiligo and Associated Comorbidities in Korea

PURPOSE: Vitiligo prevalence and its associated comorbidities rate have been reported variably among different populations. We aimed to determine the prevalence of vitiligo in Korea along with the baseline rate of comorbidities and compared the risks to the general population using hospital visit information of the total population in Korea. MATERIALS AND METHODS: We assessed demographic characteristics of vitiligo patients in Korean population from 2009 to 2011 in a nationwide data from Health Insurance Review Assessment Service. Patients who had at least one visit to Korea's primary, secondary, or tertiary referral hospitals with International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code for vitiligo were identified. As a supplementary study, comorbidities associated with vitiligo were selected for further review to calculate relative risks compared to the general population. RESULTS: The annual prevalence of vitiligo determined by hospital-visiting rate in Korea was 0.12% to 0.13% over a three year period. In sync with other previous epidemiological studies, there was bimodal distribution among the age groups and no difference between genders. Also, vitiligo in Korean population was associated with various autoimmune/non-autoimmune diseases such as thyroiditis, atopic dermatitis, and psoriasis. CONCLUSION: This study was by far the most comprehensive review on prevalence of vitiligo using a data of total population in Korea. The prevalence is within a range of those reported in previous literatures, and increased risk of comorbidities such as thyroid diseases and psoriasis in vitiligo might aid clinicians in the initial work up of vitiligo patients and concurrent follow ups.

Commemorating Dr.Bonghak Hyun - medical doctor, humanist, and Korean war hero

No abstract available.

A Multicenter Collaborative Study by the Korean Society of Vitiligo about Patients' Occupations and the Provoking Factors of Vitiligo

BACKGROUND: It was previously thought that persons with genetic predispositions to vitiligo develop the condition after exposure to various precipitating environmental factors. However, in many cases, the aggravating factors of vitiligo have not been clearly identified. OBJECTIVE: To identify the aggravating factors of vitiligo in the working environment and daily life. METHODS: A total of 489 vitiligo patients were recruited from 10 institutions in South Korea; patients were provided with a questionnaire about environmental factors and behavior patterns in the workplace and in daily life, and their association with vitiligo. RESULTS: Ninety-five of the 470 enrolled patients (20.2%) answered that environmental risk factors in daily life and in the workplace affected the development of vitiligo. The most frequently attributed causes were trauma and burn (13.6%), followed by sunlight (12.8%), stress (12.8%), cleaning products/disinfectant/chemicals (4.9%), and hair dye (2.1%). CONCLUSION: Vitiligo of the hand and foot was associated with frequent exposure to aggravating materials and overexposure to sunlight, along with frequent trauma of these areas, all of which could be considered important risk factors of vitiligo. The development of vitiligo could potentially be controlled through the early detection of aggravating factors.

Comparison of the Psychological Impacts of Asymptomatic and Symptomatic Cutaneous Diseases: Vitiligo and Atopic Dermatitis

BACKGROUND: Vitiligo and atopic dermatitis (AD) are common dermatological disorders which may cause significant psychological and social distress leading to impaired quality of life (QoL) in patients. OBJECTIVE: We evaluated the degree of psychological stress and impairment of QoL in vitiligo patients as compared with AD patients and normal controls (NCs). METHODS: A total of 60 patients from each group and 60 NCs were enrolled. Five questionnaires on depression (Beck depression inventory, BDI), state anxiety (SA) and trait anxiety (TA), interaction anxiousness (IAS), private body consciousness (PBC) and dermatologic QoL were used. RESULTS: The vitiligo patients had a significantly higher level of TA (p<0.01), PBC (p<0.001) and impaired QoL (p<0.001) than NCs, but not BDI, SA and IAS. The AD patients had significantly higher scores for all five questionnaire items compared with NCs. In the comparison between the AD and vitiligo groups, all of the indexes except body consciousness were higher in AD patients than in vitiligo patients: BDI (p<0.01), SA (p<0.05), TA (p<0.001), IAS (p<0.01) and impaired QoL (p<0.001). Exposure of vitiligo lesions was not a significant variable in the analysis of the contribution of clinical variables of vitiligo on psychological stress and QoL. CONCLUSION: Vitiligo, which is not accompanied by any symptoms, involves less psychological impact than AD, which is accompanied by itching. Compared to NCs, however, the elevated general anxiety and body consciousness in patients with vitiligo suggests that they may be more concerned with the aggravation of hypopigmented patches than difficulties in social interactions.

The Use of Medical Devices for Medical Skin Care and the Legal Issues / 대한피부과학회지

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.

Partial Unconstitutional Clauses in the Korean Public Sanitation Administration Law / 대한피부과학회지

In 2007, the Public Sanitation Administration Law in Korea was partially amended to subdivide cosmetology into general and skin cosmetology. Thus starting from 2008, a skin cosmetology qualification requirement license was newly created in Korea. Instead of improving the health standards concerning public health, the amendments have exaggerated the monopolistic right of trade of the Korean Central Esthetician's Association with the assistance of the Division of Sanitary Policy in the Korean Ministry for Health. In addition, the amended ordinances stipulate that cosmetologists can analyze skin conditions, hence allowing medical diagnostic procedures by non-medical personnel which has serious health problems causing serious conflict with Korean Medical Law. Legislation precedents from around the world demonstrate that medical supervision by physicians is absolutely necessary with fastidious requisitions in order to safeguard public health. However, in Korea there is a subversive attempt by some esthetician groups to limit the employment of estheticians by medical institutions in order to safeguard their private privileges. The newly amended Public Sanitation Administration Law should be revised in order to preserve the fundamental rights of the people, to enhance public health, and to uphold the well being of the people instead of catering to special interest groups.

A Survey on the Mode of Working of Estheticians in OECD Member Nations andSome Asian Countries in Relation to Medical Service / 대한피부과학회지

In 2008, Korea has enacted new ordinances about the role of estheticians, but this law can be interpreted ambiguously, restricting hiring of estheticians in medical clinics. The purpose of the study is to obtain information about medical-esthetic systems in other countries. We have taken a survey of this object from 30 OECD & Asian countries, and the questionnaires returned from a total of 22 countries (Australia, Austria, Canada, Denmark, Finland, France, Germany, Hungary, Japan, Netherlands, New Zealand, Norway, Portugal, Slovak Republic, Spain, Switzerland, Turkey, United Kingdom, United States, Singapore, Israel, and Thailand), were used for the final analysis. The results are summarized as follows. In most countries, estheticians working independently deal with only healthy, normal skin. In most countries, estheticians working independently have no right to operate any medical instruments. In all 17 countries that returned the questionnaires medical clinics can employ estheticians, and only theses estheticians who belong to the medical clinics can handle the non-invasive medical instruments under the supervision of doctors. In 17 countries that have related legal regulations, nurses, under the control of doctors, can perform wider range of duties in various settings than estheticians. The survey concludes that the duties of estheticians are closely related with medical skin care services and estheticians can perform various non-invasive medical procedures only under the control of doctors. From consulting a variety of medical-esthetic systems in other countries, we propose that the estheticians be allowed to work in medical clinics to provide better medical services for the patients and to make more chances of employment for themselves.

A Case of Inflammatory Vitiligo

Vitiligo is common dermatologic disorder, but inflammatory vitiligo is a rare occurrence that is characterized by erythematous rim at the periphery of a patch of hypopigmented skin. Since the initial description of inflammatory vitiligo, only about 20 cases have been identified via a review of the literature. We herein report the first Korean case of inflammatory vitiligo developed in an 56-year-old male.

A Case of Hypopigmented Mycosis Fungoides / 대한피부과학회지

Hypopigmented mycosis fungoides has been infrequently described as a variant of mycosis fungoides. It mostly occurs in dark-skinned or Asian patients, particularly children, and is often misdiagnosed as a different condition, such as vitiligo, chronic lichenoid pityriasis or postinflammatory hypopigmentation because of its non-specific manifestations. We herein describe a Korean case of hypopigmented mycosis fungoides which was misdiagnosed as a vitiligo. We also emphasize the importance of a biopsy on any persistent or unusual hypopigmented lesion to avoid delay in the diagnosis of mycosis fungoides.

Therapeutic Effects of 308 nm Excimer Laser in the Treatment of Vitiligo on the Head and Neck Area / 대한피부과학회지

BACKGROUND: The excimer laser has recently been introduced as a new therapeutic modality for vitiligo. However, to date, there have only been a few clinical reports evaluating the therapeutic effects of excimer laser treatment for vitiligo of the head and neck area. OBJECTIVE: This study was conducted to evaluate the effects of excimer laser therapy on vitiligo of the head and neck area against various clinical parameters. METHODS: The 87 patients enrolled in this study were treated with excimer laser monotherapy. We observed the grade of repigmentation after 20 sessions of treatment, and analyzed mean grade of repigmentation with regard to various clinical parameters, to discover determinant factors on therapeutic outcome. RESULTS: Thirty-four of the 87 patients (39.1%) achieved more than 50% repigmentation after or within 20 sessions. The response to treatment was related to the duration of evolution of the vitiligo, type of vitiligo, history of previous treatments, and existence of poliosis within the lesion (respectively, p=0.006, 0.001, <0.001, 0.004). No relationship could be established between response to the treatment and the following variables: localization of the treated lesion and age of onset (respectively, p=0.42, 0.99). Peri-lesional hyperpigmentation was a relatively common side effect, but other adverse effects were limited and transient. CONCLUSION: Excimer laser therapy is an effective and safe therapy for vitiligo of the face and neck area. Promising results from excimer laser therapy can be expected in patients who have a short duration of evolution of the vitiligo below 1 year, a focal or generalized type of vitiligo, no previous history of treatment, and a vitiliginous lesion without poliosis.

A Case of Vitiligo Repigmented with Topical Tacrolimus / 대한피부과학회지

Vitiligo is a common skin depigmentation disorder and treatment options are generally unsatisfactory and difficult. We report a case of vitiligo resistant to classic treatment showing remarkable repigmentation with topical tacrolimus ointment 0.03%.

A Case of Progressive Macular Hypomelanosis Treated with Narrow Band UVB / 대한피부과학회지

Progressive macular hypomelanosis is an idiopathic acquired hypopigmentary disorder first described in 1988. The disorder is characterized by ill-defined, non-scaly, round to oval, hypopigmented patches symmetrically localized on the trunk. No clinical symptoms have been observed. Currently, diagnosis is made on clinical grounds and any histological, laboratory investigations are not diagnostic. This disorder does not respond to conventional treatment and its clinical course is variable. We experienced a case of progressive macular hypomelanosis that was successfully treated with narrow band UVB phototherapy.

Clinico-Epidemiologic study on the Abuse, Misuse, and Adverse Effects of Topical Dermatologic Drugs / 대한피부과학회지

BACKGROUND: The abuse, misuse, and adverse effects to topical drugs have been widespread in Korea due to lack of awareness of seriousness of drug abuse and misuse, and improper designation of prescription and non-prescription drugs. OBJECTIVE: This study was conducted to bring Korean people to an awareness of the abuse, misuse, and adverse effects of topical drugs, and to stress the importance of proper designation of non-prescription drugs. METHODS: A multicenter, prospective, clinico-epidemiologic evaluation was made from patients with adverse effects to topical drugs who visited 31 dermatologic departments in university hospitals or private clinics nationwide from march, 2002 to December, 2002. RESULTS: The diagnostic incidence of adverse effects from topical drugs are abuse and misuse (40%), dermatophytosis incognito (29%), bacterial infection (14%), contact dermatitis (9%), acne (2.5%), skin atrophy (1.4%), telangiectasia (1%). Erghty three percent of adverse effects are caused by topical corticosteroids, and betamethasone valerate, prednicarbate and triamcinolone acetonide are commonly used topical corticosteroids that induce adverse effects frequently. The most common way to obtain topical drugs is purchase directly from pharmacist without prescriptions. CONCLUSION: From this study, we confirmed that adverse effects to topical corticosteroids are very common even after the enforcement of designation of prescription drugs and non-prescription drugs. The proper designation of prescripton drugs should be reevaluated and based on the safety of patients to protect people from adverse effects of topical drugs.

Two Cases of Alopecia Areata on Eyebrow Treated by Superficial Cryotherapy / 대한피부과학회지

Alopecia areata(AA) is a common skin disorder with no uniformly successful form of therapy. We experienced two cases of AA on eyebrow improved by superficial cryotherapy with liquid nitrogen. Superficial cryotherapy can be used for the treatment of AA on eyebrow with excellent results.

Side Effects of Suntan

Increased pigmentation of skin after sun exposure is a normal response to solar radiation. Like sunburn, suntan can also be produced by natural solar radiation and by artificial, narrow-spectrum ultraviolet B and ultraviolet A sources. The tanning response is a sign of ultraviolet damage. The western search for the suntan has led to an increased incidence of photoaging and skin cancer of light-skinned individuals. Photoaging is characterized by wrinkling, coarseness, dryness, mottled pigmentation, loss of elasticity, easy bruising, telangiectasias, and benign, premalignant and malignant growths on sun-exposed areas. Photoagings is a slow process, taking decades to become clinically apparent and even longer for all the manifestations to occur. Development of photoagings is determined both by genetic skin type and by the total lifetime radiation dose. Photoaging is more apparent in light-skinned Caucasians than in dark-skinned people. Although it is not possible to state what proportion is due to chronologic aging and what is due to photoaging, it has been estimated that photodamage may account for greater than 90 percent of the age- associated cosmetic problems of the skin. The proliferation of natural tanning and tanning salons should be discouraged by physicians. There is no safe tan.

Histological and Immunohistochemical Characteristics of Keratoacanthoma and Well Differentiated Squamous Cell Carcinoma

Keratoacanthoma (KA) is a rapidly growing cutaneous tumor and is difficult to distinguish from squamous cell carcinoma (SCC) on histomorphology alone. In the present study, we compared the clinicopathological and immunohistochemical findings using antibodies for p21 (WAF-1/CIP1), p53, laminin, and Ki-67 proteins in 27 cases of KA and 31 cases of well differentiated SCC. KA was characterized by occurrence in sun-exposed skin, shorter duration, and smaller size. Expression of p21 protein was increased according to the maturation and involution of KA, but there was no statistical significance. Expression of Ki-67 was decreased in the involutional stage of KA than in SCC (p<0.05). But p53 protein and Ki-67 were expressed in the cells at the periphery of both KA and SCC. The immunoexpression pattern of p53 and Ki-67 suggests that proliferative activities of the two lesions are similar. Laminin was present in the infiltrative cell nests of fully developed and involutional stages of KA, and it may be related to the healing process of KA. In conclusion, it is suggested that the degree of proliferative activity in the proliferative and fully developed stages of KA is similar to that of SCC and that p21 gene expression represents the differentiation property of KA and may be associated with its regression.

A Case of Primary Cutaneous Adenoid Cystic Carcinoma / 대한피부과학회지

We report a case of primary cutaneous adenoid cystic carcinoma in a 39-year-old male patient. It was a slightly erythematous hard nodule on left chin and composed of cribriform and tubular masses of basaloid cells. Lumina formed by neoplastic cells contained mucin and hyalin, and similar constituents were located between neoplastic cell masses and adjacent dermis. Immunohistochemically, the neoplastic cells stained only focally with S-100 protein and negative with carcinoembryonic antigen(CEA). Therapy should employ wide surgical excision that extends well beyond the clinical confines of the neoplasm.

Two Cases of progressive Macular Hypomelanosis of the Trunk / 대한피부과학회지

No Abstract Available.