Imatinib-induced Psoriasiform Drug Eruption in a Patient with a Gastrointestinal Stromal Tumor / 대한피부과학회지

Imatinib mesylate (Gleevec(R)) is a small-molecule inhibitor that selectively inhibits the tyrosine kinase family, including mutated KIT oncoproteins in gastrointestinal stromal tumors (GIST). However, cutaneous reactions to imatinib are common and occur in 7.0% to 88.9% of patients. Nonspecific skin rashes, facial edema, and pruritus are the most common adverse reactions. However, development of psoriasiform drug eruption owing to the drug has rarely been reported. Herein we report on a 66-year-old male patient with GIST who had taken imatinib (400 mg/day) for 2 months. He developed erythematous scaly macules and papules on the trunk and extremities. Histopathological findings were compatible with a psoriasiform drug eruption.

Dermatomyositis First Presenting as Panniculitis / 대한피부과학회지

Panniculitis is a rare cutaneous finding in dermatomyositis (DM), presenting as tender subcutaneous nodules. Because panniculitis may precede other symptoms of DM, and its complications, including pain, lipoatrophy and carcinosis, might be severe and irreversible, early diagnosis and treatment of panniculitis is important. We herein describe a case of dermatomyositis first presenting as panniculitis in a 45-year old man.

Fixed Drug Eruption due to Ciprofloxacin / 대한피부과학회지

Fixed drug eruption is a pattern of a drug-induced cutaneous reaction. It is characterized by skin erythematous plaques that recur at the same site each time the drug is administered. Now, we report the case of a 26-year-old woman who presented with 2 ill-defined erythematous patches on her back with itching sensation. The patient had a history of ciprofloxacin medication. The patch test with suspected drugs showed negative reactions, but intradermal tests were positive reactions. The patient was diagnosed with fixed-drug eruption due to ciprofloxacin.

A Clinical and Histopathological Study of 13 Cases of Facial Dermatofibroma / 대한피부과학회지

BACKGROUND: Dermatofibroma (DF) is one of the most common benign soft tissue tumors, and its diagnosis is not difficult if clinicopathologic features are typical. However, DF occurring on the face is very rare; therefore, it is usually missed clinically. OBJECTIVE: This study was conducted to obtain better understanding of the clinicopathologic features of dermatofibroma of the face. METHODS: This is a retrospective study of fibrous histiocytoma of the face at our center over a 23-year period (1989~2011). Clinicopathologic features of 13 patients were evaluated. RESULTS: Of the 13 patients, ten were female and three were male. The neoplasms presented with various and atypical features, such as nodule, ulceration and papules. Low-power examination revealed that most of the cases were extended beyond the subcutaneous fat layer, showing ill-defined diffuse infiltrative pattern. The most common histologic type was typical fibrocollagenous type, but some cases presented features of cellular or angiomatous type. Mitotic activity was not definite in majority of cases, and usually ranged 0~1 mitoses per 10 HPF and a few atypical cells were shown in 2 cases, but not accompanied by recurrence. Tumor cells in all cases tested were negative for desmin and CD34, but positive for Factor XIIIa and CD68 in majority of the cases. CONCLUSION: Because of its rare development on face and diverse clinical presentation, correct diagnosis with differential diagnosis is thought to be important. DF of the face usually presents with infiltration of deeper structures and still shows a benign behavior.

Lichen Scrofulosorum Occurring in Association with Tuberculous Salpingitis / 대한피부과학회지

Lichen scrofulosorum is a rare disease of children and young adults. The cutaneous lesions of LS are typically symptomless, tiny, flat-topped papular eruptions, which are skin-colored and follicular in distribution. Histopathologically, LS shows perifollicular noncaseating granulomas. LS is usually associated with extrapulmonary tuberculosis, especially of the lymph nodes and bones, and has also been reported in patients with pulmonary tuberculosis. However, the underlying focus is not always obvious, at the time of rash development, and could be diagnosed after the development of LS. Here, we describe a 43-year-old Korean woman with LS who developed tuberculous salpingitis 8 months later.

Granular Parakeratosis of Eccrine Ostia

Granular parakeratosis is a recently recognized disorder of keratinization that is usually confined to intertriginous areas. The histopathologic features are distinctive and diagnostic. Rarely, histopathologic variants such as follicular granular parakeratosis and granular parakeratosis of eccrine ostia have been described. In this report, we describe a rare case of granular parakeratosis mostly confined to eccrine ostia.

Subcutaneous Panniculitis-Like T-cell Lymphoma: A Clinical and Pathologic Study of 14 Korean Patients

BACKGROUND: Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a distinctive skin lymphoma characterized by neoplastic T-cell infiltration of the subcutaneous tissue, mimicking panniculitis. OBJECTIVE: To describe the clinical and pathologic features of SPTL in Korean patients. METHODS: Fourteen SPTL patients evaluated over 15 years were retrospectively reviewed. RESULTS: The mean patient age was 35 years (range: 7~73 years), with male predominance (2.5:1). Most patients presented with either nodules or plaques, occurring most commonly on the trunk, with two patients (14%) having hemophagocytic syndrome. Histopathologically, all patients showed infiltrates of small-to-medium pleomorphic cells mimicking panniculitis, with some also showing rimming, bean-bag cells, and fat necrosis. Most patients were positive for CD3 (14/14), CD8 (12/13), TIA-1 (9/9) and betaf1 (5/5), but were negative for CD4 (11/12), CD20 (8/8), CD56 (14/14) and Epstein-Barr virus (8/8). Ten patients (71%) received chemotherapy and 2 (14%) died due to the disease, with an average survival time of 4 months. Survival analysis did not reveal any significant prognostic factors. CONCLUSION: This is the first series of patients with SPTL in Korea. Due to its indolent clinical course and relatively high survival rate, SPTL should be differentiated from cutaneous gammadelta T-cell lymphoma.

Clinical Study of 13 Cases with Subcutaneous Sweet's Syndrome / 대한피부과학회지

BACKGROUND: Sweet's syndrome is a neutrophilic dermatosis that has various clinical characteristics. Since its original description in 1964, many reports have expanded the clinical and pathological features of this condition. New histopathological variants, such as subcutaneous Sweet's syndrome, have also attracted particular attention. OBJECTIVE: This study was conducted to obtain a better understanding of the clinical features of subcutaneous Sweet's syndrome in Korea. METHODS: This was a retrospective study of subcutaneous Sweet's syndrome observed at our center over an 11-year period. Clinical manifestations and histopathological features of 13 patients with subcutaneous Sweet's syndrome were evaluated. RESULTS: Age varied from 24 to 64 years, averaging 42.3 years. The male to female ratio was 1 : 5.5. The site of predilection was the extremities, and the most commonly involved site was the lower extremities. Multiple erythematous subcutaneous nodules with tenderness were the most common manifestation. General symptoms, such as fever, arthralgia, and myalgia, were associated with subcutaneous Sweet's syndrome in varying frequencies. In laboratory examinations, increased erythrocyte sedimentation rate, leukocytosis, and neutrophilia occurred in some patients. An associated systemic disease was found in 69.2% of the patients, and acute myeloid leukemia was the most common. The majority of patients were treated with oral or topical steroids, and recurrence was observed in 25% of the patients. CONCLUSION: We demonstrated that most clinical features of subcutaneous Sweet's syndrome, including an association with hematological malignancy, were similarly encountered in classic Sweet's syndrome. But, some features such as preferred sites and skin manifestations were similar to other panniculitis diseases.

Bullous Dermatomyositis Associated with Squamous Cell Carcinoma of the Lung / 대한피부과학회지

Dermatomyositis (DM) is a rare progressive autoimmune disease characterized by inflammatory myopathy, which classically manifests as several characteristic cutaneous features, including Gottron's papules, periorbital heliotrope rashes, poikiloderma, and reticular telangiectasis. Vesicle or bulla formation in dermatomyositis was first reported in 1903, and a few similar cases have been reported since then. Bullous DM has been associated with internal malignancies. We herein describe a case of bullous DM with squamous cell carcinoma of the lung in a 69-year old man.

A Case of Tumor of the Follicular Infundibulum with Sebaceous Differentiation

Tumor of the follicular infundibulum (TFI) is an uncommon benign adnexal tumor that usually presents as a solitary keratotic papule on the face or scalp of elderly patients. Histopathologically, it typically manifests as a plate-like fenestrated proliferation of monomorphic pale-staining cells. A 76-year-old male presented with about a 2 cm, well-defined, yellowish to brownish, slightly elevated, twisted and bent, interrupted, cord-like plaque on his left lower abdomen. Microscopic examination revealed a sharply demarcated plate-like proliferation of pale cells localized in the papillary dermis with multiple connections to the overlying epidermis. The histopathological features were compatible with TFI, except for foci of sebaceous differentiation. There has been one previous case report of TFI with sebaceous differentiation in the English medical literature. Herein, we report on a singular case of TFI with sebaceous differentiation.

Exaggeration of Wrinkles after Botulinum Toxin Injection for Forehead Horizontal Lines

There have been no long-term complications or life-threatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications.

Plantar Dermatofibroma Misdiagnosed as Viral Warts / 대한피부과학회지

Dermatofibroma is a common benign fibrohistiocytic tumor. It can occur anywhere on the body surface, but it has a propensity for the extremities. However, dermatofibroma may show a wide variety of clinicopathologic variants and so it is often misdiagnosed. Our case was a 13-year-old male who presented with a 1-year history of a solitary skin-colored hyperkeratotic nodule on the right sole. The nodule had recurred after topical therapy for viral wart. Histopathologic examination of the patient's lesion revealed a poorly circumscribed nodular tumor composed of collagen bundles, fibroblasts and histocytes, which was all consistent with plantar dermatofibroma.