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After anaplastic large-cell lymphoma (ALCL) was first described by Stain in 1985, there have been several histological variants of ALCL reported. There are classified histological subtypes of ALCL, such as lymphohistiocytic, small cell, Hodgkin-like, composite pattern, and other less common variants including neutrophil-rich ALCL. A 63-year-old male patient presented with erythematous exophytic mass on the left lower leg. In the past, his condition had been diagnosed as abdominal primary cutaneous ALCL (pcALCL), which recurred as systemic ALCL (sALCL) in the left bronchus. After treatment, he achieved complete remission. Histopathologic examination showed large-sized pleomorphic, anaplastic mitotic tumor cells, several neutrophils, and a few lymphocytes. Neutrophil-rich ALCL is a rare histological variant of ALCL. It is characterized by the presence of CD30-positive anaplastic tumor cells with numerous neutrophil infiltrations. Neutrophil-rich ALCL responds well to treatment but tends to recur. There were four cases reported to have recurrent neutrophilrich ALCL. All cases were diagnosed with neutrophil-rich pcALCL prior to recurrence.Three cases had local recurrence, and only one case relapsed as sALCL. Herein, we present the first case of neutrophil-rich ALCL recurring as sALCL twice.
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Background@#Alopecia areata (AA) is common non-scarring hair loss disease. Sleep distrubance has been regarded as a triggering or aggravating factor for AA. However, objective evaluation of sleep disturbance and its clinical effect on AA has not been clearly demonstrated. @*Objective@#This study investigated objective sleep evaluation tool for AA patients and their clinical correlation. @*Methods@#Patients presenting with new-onset AA or recurrences of pre-existing AA were included, and those who reported sleep disturbance in the preliminary survey were designated as the sleep disturbance group (SD group). Sleep quality was investigated for them using three self-administered questionnaires: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleep Scale (ESS). Demographic information and clinical features of AA were analyzed according to sleep quality. @*Results@#A total of 400 participants were enrolled, and 53 were categorized into the SD group. The incidence of stressful events was significantly higher in the SD group (54.7%) than in the non-SD group (25.1%) (p<0.001). Based on the PSQI, 77.3% of participants were objective poor sleepers (score of 5 or more), and they showed a significantly higher incidence of stressful events compared to good sleepers (p=0.019). The proportion of poor sleepers was significantly lower in patients with mild AA (S1) than in those with moderate to severe AA (S2~S5) (p=0.045). @*Conclusion@#This study demonstrated a positive correlation among stress, SD, and AA. The degree of SD was objectively represented by the PSQI score, showing different scores according to AA severity.
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Background@#Vulvar dermatoses are common, but numerous obstacles impede their adequate clinical investigation. Many outpatient patients with vulvar dermatoses had inappropriate behavioral habits to manage their diseases. @*Objective@#This study was performed to investigate the clinical aspects of vulvar dermatoses and to evaluate the proper management for vulvar eczema and pruritus vulvae. @*Methods@#We retrospectively reviewed medical records from female patients presenting with vulvar dermatoses in a tertiary hospital and analyzed the age, clinical manifestation, diagnosis, and further evaluated treatment and clinical course of vulvar eczema and pruritus vulvae. @*Results@#A total of 163 patients were reviewed in this study. The most frequent type of skin manifestation was macule/patch, with itching as the most common symptom. Lichen simplex chronicus (35, 21.5%) was the most common dermatosis, followed by lichen sclerosus et atrophicus (21, 12.9%) and Behcet’s disease (18, 11.0%). In addition, 57 patients (35.0%) suffered from acute/chronic vulvar eczema or pruritus vulvae and over half of them had been misdiagnosed as fungal infection or had mistreated themselves with multiple self-products. These patients mostly showed good response to hygiene management plus low potency topical corticosteroids. @*Conclusion@#In this study, we identified clinically common vulvar dermatoses in a cohort of women visiting our dermatology clinic. We found that patients with vulvar eczema or pruritus vulvae suffered from misdiagnosis and inappropriate self-management sustained patients’ problems. They could be effectively controlled by education of hygiene management with/without steroids. Further prospective investigation with a larger group of patients would provide better understanding of the characteristics of vulvar dermatoses.
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Background@#Oral alitretinoin is effective in the treatment of chronic hand eczema (CHE), and ≥12 weeks of alitretinoin treatment has been shown to be effective in Korean patients.However, in the real world, a considerable number of patients discontinue alitretinoin, which leads to treatment failure. @*Objective@#To evaluate the compliance rate of alitretinoin treatment and explore common reasons for poor compliance in patients with CHE in the real world. @*Methods@#We retrospectively reviewed the electronic medical records of CHE patients treated with alitretinoin. We defined ‘poor-compliance’ as subjects who were treated with alitretinoin for ＜12 weeks and ‘good-compliance’ as subjects who were treated with alitretinoin for ≥12 weeks. We reviewed the demographics, dose, and duration of alitretinoin usage, efficacy, and reasons for poor compliance. @*Results@#A total of 137 subjects were enrolled, and 77 (56.2%) did not complete the 12-week treatment with alitretinoin. Among them, the non-improvement rate was significantly higher in the poor-compliance group than in the good-compliance group (p＜0.01). The main reasons for the alitretinoin cessation in the poor-compliance group were insufficient response (40.8%), followed by high cost (34.7%), and adverse events (24.5%). @*Conclusion@#Alitretinoin appears the preferred longterm treatment option for CHE. Although there are complaints about late efficacy, cost, and side effects, following proper explanation, these should not justify discontinuation. Physicians need to recognize the reasons for poor compliance with alitretinoin for each patient and suggest continuing alitretinoin for the successful treatment of CHE.
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Background@#Compliance has an important influence on treatment outcomes. It is likely that concerns about the use of oral medications prescribed for dermatologic disease are prevalent in Korea, which may result in non-compliance and, consequently, poor treatment response. @*Objective@#This study aimed to assess the level of concern among the general population in Korea about the use of oral medications for dermatologic diseases (OMD). @*Methods@#We used a structured questionnaire consisting of three categories, general knowledge of OMD, previous experience of using OMD, and comparison of OMD use with previous experience of using oral medications for non-dermatologic diseases (OMNDs). @*Results@#A total of 100 participants were enrolled, of whom 54 expressed their concerns about the use of OMD, and these participants were predominantly women (p=0.007). Among them, nearly half (46%) did not identify a specific drug class of concern, while corticosteroids were the most commonly identified drug class of concern (64.5%) among those who cited a particular class. The side effects of OMD that were of most concern were hepatic/renal toxicity and tachyphylaxis (31.7%). Friends/acquaintances (26.2%) were the most common sources of information in relation to concerns about the use of OMD. Approximately one-third of the participants (n=35) were more concerned about the use of OMD than the use of OMND, and only three did not show any concern about the use of OMDs. @*Conclusion@#Based on the results of the present study, concerns about the use of OMD seem to be prevalent in Korea, but the underlying details regarding target and related adverse reaction were neither concrete nor coherent. Regular checkups should also be performed to confirm the level of adherence to the treatment regime. In addition, providing qualified information in easily accessible way may be necessary in reducing unfounded concerns.
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Purpureocillium is a genus of saprophytic fungi that is commonly found in soil or rotting material. Although rarely a pathogen in humans, it can cause serious infections in immunocompromized patients. An 85-year-old woman presented with a 2-week history of pruritic erythematous plaques with yellowish crusts on her right forearm and dorsal hand. Histopathological analysis identified fungal hyphae and spores in the dermis, and Purpureocillium lilacinum was identified through tissue culture, polymerase chain reaction, and DNA sequencing. The skin lesion barely responded to 4 weeks of itraconazole treatment but improved upon the addition of terbinafine. The skin lesion was completely cured after 12 weeks, with no recurrence to date. Here, we report a rare deep cutaneous fungal infection caused by P. lilacinum in an immunocompetent patient and postulate that, in this case, the patient's agricultural lifestyle increased the possibility of P. lilacinum infection.
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Circumscribed palmar or plantar hypokeratosis is a rare condition characterized by the occurrence of an erythematous, well-circumscribed, and depressed macule or patch on the palms or soles. Histopathologically, it is characterized by sharp, stair-like abrupt thinning of the horny layer between the affected and unaffected skin. The pathogenesis of this condition remains unclear. Recently, the human papilloma virus has been implicated as a possible etiological contributor. Circumscribed palmar or plantar hypokeratosis usually shows a benign course. Previous reports have not described malignant changes in these lesions. However, its association with actinic keratosis has been reported in a previous case. We report a case of circumscribed palmar hypokeratosis showing bowenoid epidermal change with expression of the human papilloma virus types 6 and 16 in a patient who was successfully treated with ingenol mebutate gel and cryotherapy.
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Humanos , Crioterapia , Ceratose Actínica , Papillomaviridae , PeleRESUMO
Wells' syndrome or eosinophilic cellulitis is usually observed in adults who present with pruritic, erythematous and edematous plaques associated with papules or vesicles. It is a rare inflammatory dermatosis of unknown etiology showing an eosinophil-mediated immune response. Classical histopathological features observed in patients are eosinophil-predominant inflammatory infiltration and marked dermal edema, along with ‘flame figures’. An 11-year-old boy presented with edematous plaques surmounted by vesicles on his abdomen and lower extremities. A month prior to presentation, these skin lesions occurred on other parts of his abdomen; however, they resolved spontaneously within a week. Skin biopsies from the recurrent lesions showed features consistent with Wells' syndrome and a few molluscum bodies in the epidermis. Laboratory tests showed peripheral eosinophilia. We concluded that Wells' syndrome in this young patient was caused by preceding molluscum contagiosum infection.
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Adulto , Criança , Humanos , Masculino , Abdome , Biópsia , Celulite (Flegmão) , Edema , Eosinofilia , Eosinófilos , Epiderme , Extremidade Inferior , Molusco Contagioso , Pele , DermatopatiasRESUMO
Nocardia species are aerobic, gram-positive, filamentous, partially acid-fast actinomycetes which are found worldwide in soil and decaying organic plant matter. When they infect human beings, they generally enter through the respiratory tract and then disseminate systemically. Rarely has a primary infection occurred as the result of direct inoculation. Isolation of Nocardia from clinical specimens and identification of species are difficult. But, with the introduction of new genetic technologies, reports of novel species of Nocardia have increased. We describe a case of cutaneous nocardiosis caused by Nocardia takedensis in an 87-year-old woman who was diagnosed by bacterial culture and 16S ribosomal RNA sequencing. N. takedensis has been described as a new species. This report describes the first clinical isolate of N. takedensis from a skin specimen in Korea.