The Effect of Photodynamic Therapy Using Indole-3-Acetic Acid and Green Light on Acne Vulgaris

BACKGROUND: Photodynamic therapy (PDT) using topical aminolevulinic acid (ALA) has increasingly been used for the treatment of acne vulgaris and several studies have shown its clinical efficacy. However, ALA-PDT needs a relatively long incubation period and is frequently associated with adverse effects. Indole-3-acetic acid (IAA) has been introduced as a new photosensitizer for the treatment of acne in recent study. IAA-PDT requires only a short incubation period and the procedure is relatively painless in contrast to ALA-PDT. OBJECTIVE: To investigate the efficacy and safety of IAA- PDT in the treatment of acne. METHODS: Twenty-five patients with facial acne lesions were enrolled in this study. IAA-PDT was performed for five sessions at 1-week intervals (week 0~4). IAA was treated with 15 minute occlusion, and green light was given for 15 minutes. Clinical efficacy was determined by evaluating acne lesion counts, severity grading, and the Dermatology Life Quality Index (DLQI) at week 0, 2, 4, and 5. Sebum secretion and erythema index was measured by Sebumeter and Mexameter, respectively, at baseline and one week after each treatment session (week 1~5). Histopathological examination was performed at baseline and week 5. Adverse effects were recorded throughout the study. RESULTS: All the patients completed the study. Numbers of both inflammatory and non-inflammatory acne lesions were significantly decreased. Acne severity grade and the DLQI showed significant reduction. Sebum secretion and erythema were also reduced. Histopathological examination showed a reduction in inflammatory reactions. No adverse effects were observed except for transient pruritus in one patient. CONCLUSION: PDT using IAA and green light was an effective, simple and safe treatment for acne.

Efficacy of Tranexamic Acid Containing Oral Medication on Melasma / 대한피부과학회지

BACKGROUND: Melasma causes considerable cosmetic disfigurement and none of the existing treatment modalities are satisfactory. Recently tranexamic acid has been reported to reduce hyperpigmentation in patients with melasma. OBJECTIVE: The purpose of the study was to evaluate the efficacy and safety of tranexamic acid containing oral medication for the treatment of melasma. METHODS: Forty-five female volunteers who had been diagnosed with melasma were enrolled in the present study. Patients were instructed to take medication for 8 weeks. The melanin index (MI) and erythema index (EI) were measured at baseline, and at 4 and 8 weeks. The melasma area and severity index (MASI) was scored at 0, 4, and 8 weeks. Self-satisfaction and safety evaluations were also performed at each visit. RESULTS: The mean MI measured on the lesional skin was decreased at 4 and 8 weeks compared with baseline (p80% of patients were satisfied with the medication. Adverse effects were minimal and two patients dropped out of the study due to drug-related urticaria and unexpected pregnancy. CONCLUSION: Tranexamic acid-containing oral medication is an effective and safe therapeutic modality for the treatment of melasma.

Neonatal Erythema Multiforme: A Case Report

Erythema multiforme (EM) is an extremely rare condition in infancy. To the best of our knowledge, there have been only three cases of neonatal EM described in the literature, and no such cases have been reported in Korea. A preterm neonate born at 35 weeks and six days of gestation presented with multiple annular erythematous patches with a targetoid shape over his entire body at 36 days of age (corrected age of 7 days). He had no systemic symptoms except for transient mild fever. No triggering factor except for hepatitis B and BCG vaccination was found. Neutropenia was noted upon laboratory analysis. Skin biopsy specimens showed findings suggestive of erythema multiforme. The skin lesions improved rapidly upon administration of intravenous methylprednisolone; however, neutropenia continued for a much longer period. The significance of neutropenia with respect to the development of EM was not clarified. There has been no recurrence of skin lesions over a one-year follow-up period.

A Case of Mycosis Fungoides Concurrent with Lymphomatoid Papulosis / 대한피부과학회지

Mycosis fungoides (MF) is the most frequent cutaneous T cell lymphoma (CTCL). Since the major tumor cell of MF is the helper T cell, positive markers are usually CD3, CD4 and CD45RO. Some MFs show CD30 positivity and the major differential diagnosis for MF with CD30 positivity includes transformed MF and MF concurrent with primary cutaneous anaplastic large cell lymphoma and lymphomatoid papulosis. As each disease shows a different prognosis, an exact diagnosis is crucial for proper treatment. We now report a case of 44-year-old male patient with mycosis fungoides which developed several papules on preexisting MF patches. On biopsy of the newly formed papules, CD 30 positive cells were observed and the histologic features were consistent with lymphomatoid papulosis. Both the lesions of lymphomatoid papulosis and MF responded well to narrow band ultraviolet B phototherapy.

Multiple Congenital Melanocytic Nevi Associated with Developmental Delay / 대한피부과학회지

Multiple congenital melanocytic nevi (MCMN), defined as the distribution of more than three small- or medium- sized congenital melanocytic nevi (CMN) on the body without a giant CMN, is a rare disease comprising about 4% of patients with CMN. Because MCMN accompanies neurodevelopmental delay, including seizures in 25% of patients as well as the risk of malignant melanoma, it must be carefully followed-up. We report a case of MCMN with developmental delay in a 19-month-old Korean boy. He had a history of febrile seizure when he was 18 months old. He showed a speech delay after the 1-year-follow up, even though there was no evidence of neurocutaneous melanosis (NCM) on brain magnetic resonance imaging (MRI) at the first visit. As MRI has a low sensitivity for detecting NCM in patients with MCMN older than 4-months, close neurodevelopmental assessments should be considered to provide a chance for early rehabilitation.

A Case of Complication after Matridex(R) Injection

Matridex(R) is an injectable skin filler that's composed of a mixture of cross linked hyaluronic acid and dextranomer particles, and it was recently developed for soft tissue augmentation. To the best of our knowledge, there have been few previous reports on complications associated with Matridex. We report here on a delayed inflammatory reaction to an injection of Matridex in the glabellar fold, and this developed five weeks after the injection and it lasted more than a year. The patient was treated with oral doxycycline and intralesional injection of triamcinolone acetonide; this resulted in almost complete resolution of the lesion. The patient should be informed of the potential complications with the use of injectable fillers before treatment, for it could lead to undesirable aesthetic consequences.

Erythrocyte Malondialdehyde and Glutathione Levels in Vitiligo Patients

BACKGROUND: Vitiligo is an acquired and progressive hypomelanotic disease that manifests as circumscribed depigmented patches on the skin. Although the precise mechanism remains to be elucidated, an imbalance of the oxidant/antioxidant system has been proposed as an important etiologic mechanism. OBJECTIVE: The objective of this study was to evaluate the oxidant/antioxidant status of vitiligo patients at the erythrocyte level. METHODS: Fifty-three vitiligo patients and 65 phototype-, age-, and sex-matched healthy controls were included in this study. Blood samples were collected from all subjects, and all patients were instructed to answer a questionnaire. RESULTS: Erythrocyte levels of malondialdehyde (MDA) and glutathione (GSH) were measured. All patients were told to answer a questionnaire regarding their habitual behavior, including frequency of smoking and type of diet. We observed significantly lower levels of GSH in vitiligo patients, but the levels of MDA did not differ between patients and controls. Vitiligo patients who smoked showed significantly lower GSH levels compared to non-smoking patients, but the levels of MDA were unchanged between the 2 groups. CONCLUSION: From our results, we conclude that reduced erythrocytic or systemic GSH levels constitute a distinctive feature in vitiligo patients regardless of disease activity.

The Efficacy and Safety of 4-n-butylresorcinol 0.1% Cream for the Treatment of Melasma: A Randomized Controlled Split-face Trial

BACKGROUND: Melasma is a common acquired symmetrical hypermelanosis that occurs on sun-exposed areas, and it is frequently observed among women. Various treatment modalities have been tried, but none are completely satisfactory. 4-n-butylresorcinol, which is a resorcinol derivative that has an inhibitory effect on both tyrosinase and tyrosinase-related protein-1, was introduced in 1995 and it has received increasing attention as a new hypopigmenting agent. However, the hypopigmenting effect of 4-n-butylresorcinol in human subjects has only been shown in a few studies. OBJECTIVE: The aim of this study was to investigate the hypopigmenting efficacy and safety of 4-n-butylresorcinol 0.1% cream for the treatment of melasma. METHODS: Twenty patients with melasma were enrolled to this randomized, double-blind, vehicle-controlled, split-face comparative study. The patients were instructed to apply 4-n-butylresorcinol 0.1% cream or vehicle to each side of the face twice daily for 8 weeks. Mexameter measurements were performed along with photography at baseline, 4 weeks and 8 weeks. Adverse events were observed and recorded throughout the study. RESULTS: All the patients completed the study. Mexameter measurements demonstrated that the melanin index of the treated side showed a significant decrease when compared with that of the vehicle-treated side after 4 weeks (p=0.006) and after 8 weeks (p<0.0005). All the adverse reactions were mild and transient. CONCLUSION: 4-n-butylresorcinol 0.1% cream showed rapid efficacy and it was well tolerated when used for the treatment of melasma.

A Case of Subungual Osteochondroma / 대한피부과학회지

Subungual osteochonroma is a benign bone tumor of the fingers and toes. Clinically it may present as a slow-growing firm mass causing deformity of the overlying nail. It must be differentiated from other subungual masses such as verruca vulgaris, subungual exostosis and enchondroma. Here we present a case of subungual osteochondroma of the right 1st toe presenting as a verrucous skin lesion in an 11-year-old male. Radiographic examination showed an outgrowth of the bony tissue on the dorsum of the distal phalangeal bone beneath the nail. Histopathologic examination revealed a characteristic trabecular bone formation covered with a hyaline cartilage cap. The lesion was successfully treated by total excision and curettage of the underlying bony surface.

Lipoblastoma Mimicking a Hemangioma / 대한피부과학회지

Lipoblastomas are rare benign tumors of infancy originating from embryonic fat cells that continue to proliferate in the postnatal period. Lipoblastomas usually affect children younger than 3 years of age. Lipoblastomas may mimic other infantile tumors, including hemangiomas, lymphangiomas, lipomas, and liposarcomas. A correct diagnosis is necessary to ensure appropriate treatment. We witnessed a case of a 5-month-old boy who presented with a very firm, round, well-circumscribed mass on the posterior part of the right lower leg. On magnetic resonance imaging, a hemangioma was suspected. However, histopathological examination revealed a lobulated adipose tissue composed of a mixture of immature multivacuolated lipoblasts and mature adipocytes without nuclear atypia. Based on the clinical and histopathological findings, the diagnosis of benign lipoblastoma was made.

A Case of Epstein-Barr Virus-associated Hydroa Vacciniforme

Hydroa vacciniforme (HV) is a photosensitivity disorder characterized by recurrent necrotic vesiculopapules on sun-exposed areas, which heal spontaneously during adolescence. Recently, an association has been reported between latent Epstein-Barr virus (EBV) infection and atypical HV-like eruption and malignant potential. However, latent EBV infection has also been reported in the setting of typical HV. An 11-year-old girl presented with recurrent, scattered, discrete vesicular eruptions with scarring on the face and the extensor surfaces of both forearms. In-situ hybridization was carried out to detect latent EBV infection. Based on the clinical and histopathological findings, typical EBV-associated HV was suspected.