Two-Week Repeated Dose Toxicity of Atractylodis Rhizoma Alba in F344 Rats

This research is to estimate the toxicity of Atractylodis Rhizoma Alba (ARA) in F344 rats and to find a dose level for the 13 weeks toxicity study. A hot water extract of ARA (ARWE) was administered orally to F344 rats at dose levels of 0 (vehicle control), 500, 1000, 2000, 3500, and 5000 mg/kg/day for 2 weeks. Each group was composed to five male and five female F344 rats. According to the result, there were no ARWE-related adverse changes in mortality, body weights, food consumption, urinalysis, hematology, clinical chemistry, gross finding at necropsy, and organ weight examination. Salivation was observed in 3500 and 5000 mg/kg/day in male and female rats but it could not have found any relationship with ARWE administration. Based on our findings, ARWE may not cause toxicity in rats under the experimental conditions. Therefore, dose level of 5000 mg/kg/day as a highest treatment group in 13-week exposure study is recommended for further toxicity assessment.

A 14-Day Repeated Dose Toxicity of Epimedii Herba Aqueous Extract Administered by Oral Gavage in F344 Rats

The objective of this study is to characterize a toxicity of Epimedii Herba (EH) in F344 rats and to find a dose levels for the 13 weeks toxicity study. EH is well known as medicinal herb in many Asian countries for traditional medicines of antibacterial and antiviral effects, estrogenic and antiestrogenic effects, and for treatment of osteoporosis, hypotensives, fatigue, kidney disorders, and related complications. However, the indispensable and basic information of toxicological evaluation of EH extract is insufficient to support its safe use. Therefore, we conducted toxicological evaluation of this drug in compliance with OECD and MFDS guideline in this study. The extract of EH was administered orally to F344 rats at dose levels of 0, 500, 1000, 2000, 3500, and 5000 mg/kg/day for 2 weeks. Each group was composed of 5 male and female rats. In this study, there were no treatment of EH-related adverse changes in clinical observations, mortality, body weights, food consumption, urinalysis, gross finding at necropsy, and organ weight examination. Total red blood cell count, hematocrit, mean corpuscular hemoglobin concentration, total cholesterol, and phospholipid were decreased in males and females at 5000 mg/kg/day compared to the control animals. Mean corpuscular volume and reticulocyte counts were increased in males and females at 5000 mg/kg/day compared to control animals. Therefore, we recommend that dose level of 5000 mg/kg/day is a highest treatment group in 13-week EH extract exposure study for further toxicity assessment.

Wegener's Granulomatosis Presenting as Pyoderma Gangrenosum / 대한피부과학회지

Wegener's granulomatosis (WG) is a systemic disease of unknown origin characterized by necrotizing granulomatous inflammation and vasculitis. Dermatological symptoms occur in up to 50% of cases, mostly in the form of cutaneous vasculitis or pyoderma gangrenosum. A 51-year-old female presented with multiple ulcerative patches and erythematous nodules on both legs. Histopathological findings showed extensive ill-defined granulomatous lesions and necrotizing vasculitis. Lung biopsy findings were consistent with WG. Nasopharyngeal and gastrointestinal involvement developed later. Skin lesions are improving with systemic corticosteroid and cyclophosphamide. We herein report a case of WG presenting as pyoderma gangrenosum-like cutaneous manifestation with other systemic involvements.

A Case of Verrucous Carcinoma Treated by 5% Imiquimod Cream / 대한피부과학회지

Verrucous carcinoma is a slow-growing, well-differentiated, low grade squamous cell carcinoma with little tendency to metastasize. The best treatment for verrucous carcinoma is excision, and Mohs microsurgery may also be a helpful technique. But some people can not undergo surgical excision because of poor general condition of the site and the size of the tumor. Herein, we report a case of verrucous carcinoma treated by 5% imiquimod cream. A 71-year-old male patient presented with a large hyperkeratotic verrucous plaque on the Rt. buttock. Diagnosis of verrucous carcinoma was based on typical clinical and histologic features. Surgical excision could not be performed due to the size of the tumor. Treatment with 5% imiquimod cream, a topical immune response modifier, applied every other day for 16 weeks, led to tumor regression. Four weeks after the end of treatment, the lesion was evaluated by punch biopsy. The histology just showed scar tissue change. This case demonstrates that the imiquimod cream might be an alternative treatment option for verrucous carcinoma.

A Clinical and Histopathological Study of 324 Cases of Epidermal Cyst / 대한피부과학회지

BACKGROUND: Epidermal cysts are a common occurrence. But there have been few studies to determine the clinical and histopathological characteristics of epidermal cysts. OBJECTIVE: To evaluate the clinicopathological characteristics of 324 cases of epidermal cyst. METHODS: We evaluated the clinical and histopathologic features of 324 cases of epidermal cyst at the Department of Dermatology at Korea University Anam Hospital over 5 years, from January 2001 to December 2005. RESULTS: The ratio of male to female patients was 1.7 : 1. Age distribution ranged from 7 to 91 years old. The duration of lesions was variable with mean duration of 29.3 months. The most common site of occurrence was the face. Histopathologic changes of cystic walls were atropy, acanthosis, hypergranulosis, vacuolation and parakeratosis. We identified parakeratotic cells, red blood cells, calcifications and bacterial colonies in the cystic contents. We also found verrucous architectures in the cystic walls of 23 cases. Initially, some cases were clinically diagnosed as epidermal cysts, but histopathological findings then discovered only inflammation, granulation, pilomatrichoma or lipoma, rather than an epidermal cyst. We discovered that there was also a close relation between erythema and rupture of the cystic wall. CONCLUSION: Our clinical and histopathologic findings of the epidermal cysts were similar to previous reports. However, we did find verrucous architectures on not only the palmoplantar area, but also many other areas of the body. Quite a few cases which had initially been clinically diagnosed as epidermal cysts, turned out not to be upon histopathologic investigation.

A Case of Atypical Lipomatous Tumor / 대한피부과학회지

Liposarcoma is the second most common soft tissue sarcoma next to malignant fibrous histiocytoma and occurs almost exclusively in adults. It is thought to originate from primitive mesenchymal cells rather than from mature adipose tissue. Most liposarcomas usually occur in the deep soft tissue of the extremities and the retroperitoneum, and rarely occur in the cutaneous or subcutaneous tissue. We report a case of an atypical lipomatous tumor in a 63-year-old male, who presented with an asymptomatic, subcutaneous mass on his right axilla.

A Case of Acral Persistent Papular Mucinosis in Patient with HIV Infection / 대한피부과학회지

Acral persistent papular mucinosis (APPM) is a rare subtype of localized lichen myxedematosus, which involves only the extensor surfaces of the hands, wrists and the distal part of forearms. Some subtypes of lichen myxedematosus including APPM have been reported with increased frequency in a patient with human immunodeficiency virus (HIV) infection. We describe a 31 year-old male patient with an HIV infection who presented with discrete, flesh-colored papules on the extensor surfaces of the wrists and the distal part of the forearms. Histopathologic findings revealed focal deposition of mucin in papillary and mid dermis that spared a small grenz zone. The lesions showed spontaneous regression after starting highly active antiretroviral therapy (HAART). We report a rare case of APPM in a patient with HIV infection which showed spontaneous regression with HAART, suggesting that APPM may represent one of the cutaneous markers of HIV infection.

Descriptive Study of Dermatologic Issues Appeared on Television over Seventeen Months (Jan. 2004~May 2005) / 대한피부과학회지

BACKGROUND: Recently, the number of television programs dealing with dermatologic issues has rapidly increased. Since these television programs have great impact on the general public, scientific exactitude of these programs is extremely important. OBJECTIVE: The purpose of this study was to analyze the television programs about dermatologic issues over a 17 months period, form January 2004 to May 2005. METHODS: From all the programs broadcast between January 2004 and May 2005 on the major public and cable television channels such as MBC, KBS, SBS, EBS and MediTV, programs about dermatological issues were selected by internet search and collated. The programs were then categorized and studied by purpose and theme of the programs, running time, and correctness of dermatologic information. RESULTS: The number of programs about dermatologic issues by type were as follows: 80 on news programs (58.0%), 33 on health care programs (23.9%), 19 on daily information programs (13.8%) and 5 on current issues programs (3.6%). Programs dealing with skin cosmetic information were shown most frequently on the television (44 times, 31.9%), followed by those with information about atopic dermatitis (32 times, 28.6%). Of 197 consultants in 138 television programs, dermatologists could account for only 113 (57.4%), and medical specialists of other fields except dermatology as 24 (12.2%). Thirty two percent of dermatology-related television programs were made without the advice of dermatologists. In most cases, information from dermatologists was accurate or reliable (96.5%), however, the information from oriental herbal-medicinal doctors or non-medical specialists was very difficult to check for accuracy. CONCLUSION: Until now, dermatologists have taken the leading role in programs dealing with dermatologic issues. However, the number of unqualified advisors without sufficient dermatologic knowledge in the programs surveyed was found to be surprisingly high. Therefore, we suggest that more dermatologists need to increase their public health role in the mass media.

A Case of Telangiectasia Macularis Eruptiva Perstans / 대한피부과학회지

Telangiectasia macularis eruptiva pestans is one of the mastocytosis. It appears most frequently in adults and only rarely affects young children or infants, unlike other mastocytosis. The clinical diagnosis of telangiectasia macularis eruptive perstans can be difficult because it does not usually present as a typical childhood mast cell disease. We report a case of telagiectasia macularis eruptiva perstans, a rare form of mastocytosis.

A Statistical Study on Histopathologic Diagnoses of Skin Diseases / 대한피부과학회지

BACKGROUND: Skin biopsy is an effective diagnostic tool commonly used in dermatology practice. Clinicopathologic correlation is important for diagnostic accuracy. OBJECTIVE: The purpose of this study was to investigate the distribution of skin biopsy specimens, and compare the pathologic diagnosis with the final dermatologic diagnosis. METHODS: This study included 4,018 skin biopsy specimens taken during a period of 10 years from June 1995 to May 2005 at the Department of Dermatology, Korea University Anam Hospital. RESULTS & CONCLUSION: Of all biopsy specimens, 61.49% were diagnosed as tumors, and 38.51% were diagnosed as non-tumors. For the tumors, 87.15% were benign, 4.23% were premalignant and 8.62% were malignant. The rate of concordance between pathologic diagnosis and final dermatologic diagnosis was 76.69%, and the rate of discordance between them was 4.18%. The rate of description without a pathologic diagnosis in pathologic reports was 18.94%. The rate of concordance was higher in tumors (89.65%) than in non-tumors (56.00%), and the rate of description in pathologic reports was higher in non-tumors (39.08%) than in tumors (6.32%). There was no significant difference in the rates of discordance between tumors and non-tumors. The rate of concordance was higher in malignant tumors (95.72%) than in benign tumors (89.77%) or premalignant tumors (74.76%). The rate of description in pathologic reports was higher in premalignant tumors (18.45%) than in benign tumors (6.27%) or malignant tumors (0.95%). There was no significant difference in the rates of discordance between the three groups.

A Case of Eccrine Porocarcinoma on the Scalp / 대한피부과학회지

Eccrine porocarcinoma is a very rare, locally-aggressive, potentially fatal tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. It usually affects older people and is located most commonly on the lower extremities. We report a case of eccrine porocarcinoma which developed on the scalp of an 82-year-old woman. There was no evidence of metastasis, and the tumor was successfully removed by Mohs micrographic surgery.

Three Cases of Lymphangiectatic Pilomatricoma / 대한피부과학회지

Pilomatricoma is a benign adnexal tumor, differentiating towards elements of the hair matrix and shaft. The tumor typically presents as a solitary, deep-seated, firm nodule with overlying normal epidermis. Herein, we report three cases of pilomatricomas with the dermal bullae overlying tumors. Histopathological examination of the lesions showed marked lymphatic dilatations, edema, and attenuated collagen and elastic fibers above the pilomatricomas in the upper dermis. We diagnosed them as lymphangiectatic pilomatricomas.

Three Cases of Lymphangiectatic Pilomatricoma / 대한피부과학회지

Pilomatricoma is a benign adnexal tumor, differentiating towards elements of the hair matrix and shaft. The tumor typically presents as a solitary, deep-seated, firm nodule with overlying normal epidermis. Herein, we report three cases of pilomatricomas with the dermal bullae overlying tumors. Histopathological examination of the lesions showed marked lymphatic dilatations, edema, and attenuated collagen and elastic fibers above the pilomatricomas in the upper dermis. We diagnosed them as lymphangiectatic pilomatricomas.

Statistical Methods Used in Articles of the Korean Journal of Dermatology / 대한피부과학회지

BACKGROUND: The Korean Journal of Dermatology, a well-known dermatology journal in Korea, has been an es-sential medium for dermatologists and a symbol of the Korean Dermatological Association. The members of the associa-tion have an obligation to improve the quality of the journal. The statistical analysis is associated directly with the study design and completeness of an article. However, there has been no report on the statistical analyses used in the articles of the Korean Journal of Dermatology. OBJECTIVE: To investigate the usage of statistical methods in the journal and evaluate their accuracy and correctness. METHODS: A total of 264 original articles from 30 recent volumes of the Korean Journal of Dermatology (2003, vol.1 to 2005, vol.6) were collected and analyzed for statistical methods. The descriptive statistics were excluded from the study. The methods were con-sidered as 'correct', 'not-correct', or 'impossible to determine' in order to evaluate the correctness of the analyses. RESULTS: Of the 264 original articles, 126 (47.7%) articles included statistical analysis. The authors most frequently the used t-test and contingency table method. The incorrect analyses appeared in 30 (23.8%) articles, and their most frequently cited reason was their unwillingness to use the nonparametric analysis. CONCLUSION: Recently, the statistical methods in about one fourth of inferentially analyzed original articles of the Korean Journal of Dermatology have been found to be incorrect, and the reasons for the incorrectness appear not to be so difficult for authors to rectify.

A Case of Spitz Nevus on the Ear Helix / 대한피부과학회지

Spitz nevi, benign melanocytic tumors, have some histologic resemblance to malignant melanoma. They usually appear as asymptomatic, solitary, reddish to pinkish, hairless, dome-shaped, round to oval, smooth-surfaced papules or nodules, measuring less than 1.0 cm in diameter. Histologically, these lesions display striking nests of large spindle cells and epithelioid cells, usually extending from the epidermis to the reticular dermis. Here in, we report a case of Spitz nevus on the helix of the right ear of a 23-year-old man which was treated with Er:YAG laser.

A Clinicopathologic Study on Eccrine Tumors / 대한피부과학회지

BACKGROUND: Various eccrine tumors are rather common diseases in clinicians. However, data on the clinicopathologic features of eccrine tumors in Korea are limited. OBJECTIVE: The purpose of this study was to investigate the clinicopathologic characteristics of eccrine tumors in Korea. METHODS: Two hundred and sixty five cases of eccrine tumors, seen from 2002 to 2004 in Korea, were retrospectively analyzed clinically and histopathologically. RESULTS: The most common eccrine tumors identified within Koreans were syringoma (61%), followed by eccrine poroma (13%), eccrine hidrocystoma (9%), and nodular hidradenoma (6%). Moreover, eccrine tumors were usually found to occur in middle-aged woman as multiple asymptomatic skin-colored papules. The most common site of occurrence was the face (45%), followed by the neck (9%), scalp (5%), foot (5%), abdomen (4%), and vulvar (3%). CONCLUSION: The results of this study will be useful and fundamental data on eccrine tumors for clinicians and pathologists.

Three Cases of Basal Cell Carcinoma of the Axilla / 대한피부과학회지

Basal cell carcinoma (BCC) is the most common skin cancer of humans. The incidence of BCC is closely correlated with sun exposure, as well as older age. Because of this, BCCs are frequently found on sun-exposed areas of fair-skinned, older individuals. The axilla is one of the sun-protected sites where BCC rarely develops. We herein report three unusual cases of primary BCC which arose from the axilla.

Local Flaps for Reconstruction of Nasal Defects / 대한피부과학회지

BACKGROUND: The skin over the nose is not relatively less mobile for primary closure of nasal defects. In addition to skin grafts and secondary intention healing, there are various local flap techniques available for the reconstruction of nasal defects. OBJECTIVE: The aim of this study was to assess the effectiveness and the cosmetic consequences of various local flap techniques in reconstructing nasal defects. METHODS: Between December 2002 and April 2004, 18 patients were treated with a local flap technique for the reconstruction of a nasal skin defect following Mohs micrographic surgery. The post-operative result of each case was rated with serial clinical photographs and medical records by two independent physicians. RESULTS: The nasal skin defects were reconstructed with various local flaps, such as the nasolabial interpolation flap, bilobed flap, glabellar flap, median forehead flap, and subcutaneous island pedicle flap. The cosmetic and functional results of the nasal reconstructions were judged to be generally satisfactory, excluding a trapdoor deformity in one patient, and eyebrow distortion and cancer recurrence in another patient. The cosmetic results of the cases reconstructed with a subcutaneous island pedicle flap were favorable in color and texture of the flaps, and incision scar formation, compared to the other techniques used. CONCLUSION: There are various local flap techniques which can be used in the reconstruction of nasal defects, and each of them has its own merits and drawbacks. The reconstructive plan should be customized to the patient considering not only the size, depth and location of the defect but also the medical history of the patient, the patients expectations, and the surgeons experience. Reconstruction with a subcutaneous island pedicle flap has been found to be one of the most effective methods, and allows the surgeon to spend a relatively short time in reconstructing defects of the upper and lower part of the nose. Furthermore, it has many advantages over the skin graft and other local flap techniques, especially with the aesthetic result.

A Case of Cutaneous Sinus Tract of Dental Origin / 대한피부과학회지

Cutaneous sinus tract of dental origin is a syndrome rather than a disease entity, and is composed of a periapical abscess, sinus tract and granulomatous skin change at the opening of the tract. The presence of an intermittently-draining, granulomatous lesion on the face or neck should alert clinicians to the necessity of a routine dental examination, including radiographic studies. Early correct diagnosis and appropriate dental treatment can prevent unnecessary and ineffective antibiotic therapy or surgical treatment. We report a case of a 68 year-old woman with a cutaneous sinus tract on the right nasolabial fold, secondary to infection of eight maxillary remnant teeth.

Histopathological and Immunohistochemical Study of Lichen Nitidus and Lichen Striatus / 대한피부과학회지

BACKGROUND: Lichen nitidus and lichen striatus are often confused because they are thought to share similar clinical and histopathologic features. OBJECTIVE: The purpose of this study was to histopathologically and immunohistochemically evaluate the characteristic differences and common features between the two disorders. METHOD: Histopathological and immunohistochemical slides of 14 patients with lichen nitidus and 14 patients with lichen striatus were reviewed. Immunohistochemical staining with anti CD45RO, CD68, CD4, CD8 and CD20 antibodies was performed. RESULTS: 1) In lichen nitidus, the frequent histopathologic findings were liquefaction degeneration of the basal layer (100%), edema of the dermis within the areas of the infiltate (100%), and claw-like rete ridges (96.8%). 2) In lichen striatus, the frequent histopathologic findings were edema of the dermis within the areas of the infiltate (100%), liquefaction degeneration of the basal layer (92.9%), and perivascular inflammatory cell infiltrate (92.9%). 3) The majority of the cells in the infiltrate of lichen nitidus were T lymphocytes mixed with histiocytes. In most cases, CD4+ T lymphocytes predominated CD8+ T lymphocytes. 4) However, in lichen striatus, infiltrating cells in the dermis were composed dominantly of T lymphocytes, with a minority of histiocytes. CD8+ T lymphocytes were also found to outnumber CD4+ T lymphocytes. CONCLUSION: Our study did differentiate each disease as having distinctive characteristics and differences. Furthermore, the immunologic pathophysiology of lichen nitidus and lichen striatus was proved to be distinctive. Therefore, we conclude that these two diseases are not in the spectrum of the same disease, but separate disease entities which are indeed different from each other.