Rosacea: Clinical Study of 67 Cases

BACKGROUND: Rosacea is a chronic skin disease which primarily affects the face. There have been many basic and clinical studies on rosacea in the West, but little in Korea. OBJECTIVE: This study was to investigate clinical features of rosacea in Korea and to compare them with those in the West. METHODS: During a 20-month period, 67 patients diagnosed as having rosacea were examined for their clinical presentations by means of personal interview. RESULTS: Erythema and telangiectasia were found in almost all of the 67 patients. Comparing with the results in the West, flushing and telangiectasia were more common whereas papules, pustules, and rhinophyma were less common with no case of ocular complaints or migraine. CONCLUSION: Because early detection and treatment is necessary to prevent the progression of rosacea, it is important to realize that rosacea is not uncommon in Korea and to recognize its somewhat different clinical manifestations from those in the West.

A Case of Childhood Granulomatous Perioral Dermatitis / 대한피부과학회지

Childhood granulomatous perioral dermatitis(CGPD) is a distinctive granulomatous form of perioral dermatitis of unknown cause with a benign and self-limited course and no associated systemic manif estations. It is characterized by an asymptomatic monomorphous papular eruption, with or without scale or pustules, around the mouth, nose, and eyes primarily in prepubertal children. This condition may resemble sarcoidosis both clinically and histologically. A 3-year-old boy first presented with a month-history of mildly pruritic rash around the mouth. When he returned for follow-up after an eight-week period of topical corticosteroid therapy, multiple new follicular papules and pustules developed. Histopathologic examination revealed that a granulomatous lesion consisted of nodular infiltration of multiple histiocytes admixed with lymphocytes in the dermis. The condition resolved in about three weeks after using an unknown topical agent prescribed by a private practicing dermatologist.

Clinical Features of Nervus Depigmentosus in 104 patients / 대한피부과학회지

No Abstract Available.

Air Cooling Effect on Pain Sensation during Dermatologic Laser Treatment / 대한피부과학회지

BACKGROUND: Although most dermatologic laser systems were developed to damage target tissue selectively, the epidermal injury has been a major problem in treating skin lesions of colored people. Recently, to minimize the epidermal damage during laser treatment, superficial cooling is being used. Cooling is one of the well known methods to reduce pain sensation. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of an air cooling in reducing pain associated with Q-switched Nd:YAG laser and pulsed dye laser treatment. METHODS: We measured the temperature of normal skin during air cooling and studied 13 patients treated with a 1064 nm Q-switched Nd:YAG laser or 585 nm pulsed dye laser treatment with and without air cooling system. The degrees of pain reduction rates with and without cooling were assessed by the visual analogue scales. RESULTS: 1. It was shown that cold air flow from 2 cm distance for 10 sec decreased skin temperature about 10.6 degreeC to 17.2 degreeC depending on the body sites. 2. The average of the pain scores was 38.08+/-21.05 on the cooled site as compared to 70.77+/-15.76 on the uncooled site. CONCLUSIONS: The cold air decreased the skin surface temperature like the other epidermal cooling system and it was very effective to reduce the pain on the cooled site associated with dermatologic laser treatment.

Air Cooling Effect on Pain Sensation during Dermatologic Laser Treatment / 대한피부과학회지

BACKGROUND: Although most dermatologic laser systems were developed to damage target tissue selectively, the epidermal injury has been a major problem in treating skin lesions of colored people. Recently, to minimize the epidermal damage during laser treatment, superficial cooling is being used. Cooling is one of the well known methods to reduce pain sensation. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of an air cooling in reducing pain associated with Q-switched Nd:YAG laser and pulsed dye laser treatment. METHODS: We measured the temperature of normal skin during air cooling and studied 13 patients treated with a 1064 nm Q-switched Nd:YAG laser or 585 nm pulsed dye laser treatment with and without air cooling system. The degrees of pain reduction rates with and without cooling were assessed by the visual analogue scales. RESULTS: 1. It was shown that cold air flow from 2 cm distance for 10 sec decreased skin temperature about 10.6 degreeC to 17.2 degreeC depending on the body sites. 2. The average of the pain scores was 38.08+/-21.05 on the cooled site as compared to 70.77+/-15.76 on the uncooled site. CONCLUSIONS: The cold air decreased the skin surface temperature like the other epidermal cooling system and it was very effective to reduce the pain on the cooled site associated with dermatologic laser treatment.

The Evaluation on Medical Knowledge of Physicians About Common Dermatoses / 한국의학교육

Proper education about dermatology in medical college would have physicians appropriately diagnose and treat common dermatoses without referring patients to dermatologists. However, physicians who are not dermatologists have difficulty in diagnosing and treating common dermatoses. We have made up a questionnaire about treatment and a slide test for clinical diagnosis of common dermatoses in order to evaluate the knowledge of physicians about common dermatoses, which reflects indirectly the current status of medical education of dermatology in Korea and can be used as a basic data for modifying directions for education in medical college. Total 654 physicians answered the questionnaire, including 125 just graduated general physicians, 111 general physicians who had just finished internship and 418 medical specialists. 11 data from dermatologists were analyzed as a control for evaluation. The result showed that 84%(545) of them have difficulty in diagnosing dermatologic diseases. The probable causes answered by them are lack of easy illustrative textbook for general physician(48%), inadequate education of dermatology in their medical colleges(27%) and so on. In the field of therapy in the questionnaire, only 53% of them had proper knowledge about indication of topical steroids, 56% about acne therapy, 22% about treatment of tinea pedis, 35% about scabies and 41% about urticaria. The average score was 53%. The score of family medicine group and urologist group was 69% and 66% each, which were significantly higher than that of other major groups except 98% of dermatologist group. In the slide test for clinical diagnosis, the average score was 71%. The score of family medicine group which had received postgraduate education on dermatology in their resident training was 84%, also significantly higher than that of other major groups except 100% of dermatologist group. The percentage of correct responders about tinea faciei is only 13%, tinea versicolor 42%, tinea cruris 49%, impetigo 53%, pityriasis rosea 60%, atopic dermatitis 67%, psoriasis 72% and fixed drug eruption 74%, etc. The average score was 71%. In conclusion, this study showed that physicians who are not dermatologists have difficulty in diagnosing and treating even common dermatoses. We think it is important to put stress on the common dermatoses in the field of dermatologic education in medical college. Moreover we could find the importance and need of postgraduate education on dermatology in the resident training of primary care physicians such as not only family medicine doctors but also internists and pediatricians.

A Case of Angioedema Probably Induced by Captopril / 대한피부과학회지

Angioedema is a disorder characterized by well-demarcated nonpitting edema involving the tongue, floor of the mouth, larynx, lips, and face. The incidence of angiotensin converting enzyme(ACE) inhibitor related angioedema has been reported to be about 0.1% to 0.2%, and the time of onset is usually during the first week of therapy. These ACE inhibitors include captopril, enalapril, and lisinopril. A 53-year old man with an 8 month history of hypertension previously controlled with atenolol, was presented to the dermatologic department with angioedema of the face and tongue. He had begun therapy with captopril one day before this episode. Even though he was treated with epinephrine and methylprednisolone sodium succinate, the edema gradually progressed and finally dyspnea developed. He was urgently intubated and treated with steroids and pheniramine maleate in the intensive care unit. The edema resolved after 24 hours.

Two Cases of Rudimentary Meningocele / 대한피부과학회지

Rudimentary meningoceles represent a developmental anomaly in which meningothelial elements are found in the skin. The majority of rudimentary meningoceles occur on the scalp over the occiput or along cranial suture lines. They are present as a pink papule, nodule or an area of alopecia. Histologically, the lesion consists of scattered foci of meningothelial cells, an anastomosing network of empty spaces with psammoma bodies and collagen bodies, and small vessels, which may be located from the dermis to the subcutis. Immunohistochemically, the meningothelial cells are commonly positive for vimentin and often positive for EMA. We report the cases of two infants who were noted at birth to have scalp hair anomalies. One had a translucent, bald, slightly atrophic patch on the midline of the vertex and the other had a subcutaneous nodule surrounded by long hairs, so called "hair collar sign" on the midline of the occipital area. The latter had an underlying skull defect without a communication with intracranial spaces. Due to the occasional presence of connection to the central nervous system, any midline lesion in an infant, including rudimentary meningocele, deserves careful preoperative evaluation including imaging studies.

A Clinical observation on Skin Disease of Elderly patients / 대한피부과학회지

BACKGROUND: It is a trend that the average life span is prolonged in proportion to the advance of socio-economy and medical science. Consequently, the number of elderly patients with skin diseases is increasing. OBJECTIVE: This study was performed to see the change of patterns of skin diseases in elderly patients. METHODS: One thousand four hundred and twenty elderly patients, over the age of 65, who visited the departments of dermatology and in five hospitals, from January 1, 1997 to December 31, 1997 were selected. We surveyed the frequeney of skin disease by types and the distributions by month, season and age.

A Case of Multicentric Reticulohistiocytosis / 대한피부과학회지

Multicentric reticulohistiocytosis(MR) is a rare systemic disease of unknown etiology, characterized by destructive polyarthritis and mucocutaneous eruptions in various locations. In most cases rapidly progressive destructive polyarthritis is the presenting symptom, followed by typical skin eruptions. Skin lesions are characterized clinically by erythematous to brownish nodular lesions on the face, periungual areas and the trunk. The biopsy demonstrating the characteristic granulomatous infiltration of multinucleated giant cells and histiocytes with a ground-glass appearance is diagnostic. We report a case of multicentric reticulohistiocytosis in a 57-year-old female patient, who had skin lesions with polyarthritis and cardiac problem. To our knowledge, this is the first case report in Korea.

Clinical Study of Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired depigmentary disorder of the skin and hair. The etiology is unknown, however an autoimmune hypothesis is favored. OBJECTIVE: We performed this study to develop a better understanding of the clinical features of vitiligo patients. METHOD: We evaluated clinical manifestations of 1203 vitiligo patients(556 males and 647 females). RESULTS AND CONCLUSIONS: 1. The mean age of onset and that of the first visits made by patients were 22.9+/-18 and 27.9+/-19 years, respectively. 2. The face(37.4%) was the most common site of initial involvement. In decreasing order of frequency, the common sites of involvement were the face and neck(65.9%), thorax and abdomen(42.9%), upper extremities(42.3%). 44.5% of the cases had the vulgaris type, 26.1% the focal type, and 21.1% the segmental type. During the three months before a visit, 44% of patients experienced progression of disease. Within one year, about 75% of patients reported that the disease had progressed. 3. Precipitating or aggravating factors such as trauma(13.1%), psychological stress(9.2%), sun light (2.8%) and pregnancy(2.5%), were found in 30.9% of patients. Thyroid disease was the most common associated disease.

The Effect of Sympathetic Blocks in the Prevention of Postherpetic Neuralgia / 대한피부과학회지

BACKGROUND: Many investigators have advocated neural and especially regional sympathetic blockade for acute herpe. zoster pain. Some believe that nerve blocks not only relieve acute pain but also, if given early in the course of clinical disease, prevent progression to postherpetic neuralgia. OBJECTIVE: The purpose of this study was to evaluate the preventive effect of sympathetic blockade on herpes zoster METHODS: Fifteen patients with herpes zoster were treated with sympathetic blocks according to the severity of pain. RESULTS: The total score of pain degree decreased from 3.4 to 1.1 with sympathetic blocks in 15 patients in 2 months. Sympathetic blocks prevented or relieved postherpetic neuralgia in more than 90% of patients treated within 2 weeks of the onset of the acute phase of the disease and in more than 85% of patients over 60. CONCLUSION: Sympathetic blocks are effective in preventing postherpetic neuralgia if applied soon after the onset of the acute phase of herpes zoster.

Early Phase of UVB-induced GM-CSF Upregulation in Epithelial Cell Line is not Totally Dependent on IL-1α

BACKGROUND: It was demonstrated that ultraviolet(UV) B light induces the release of IL-1α in cultured human epithelial cell line and augmentation of GM-CSF production by UVB is reported to be mediated by IL-1α in the murine keratinocyte cell line Pam 212. OBJECTIVE: The purpose of this study was to evaluate the effects of UVB on kinetic profile of IL-1 and GM-CSF mRNA expression and to see whether synthesis of GM-CSF by UVB can be completely inhibited by blocking IL-1α mediated pathway. METHODS: We used a competitive RT-PCR for measuring cytokine gene expression in epithelial cell line after UV radiation. RESULTS: The IL-1α mRNA increased as early as 1h after UV irradiation, and then decreased at 3h after the irradiation. Thereafter, the response of IL-1α mRNA was upregulated with a second peak at 6h after the UV irradiation. However, mRNA for GM-CSF increased at 1h after UV light exposure and anti-IL-1α antibodies could only partially inhibit UV-augmented GM- CSF production. CONCLUSION: UVB induced GM-CSF production seemed to be mainly mediated by UVB induced IL-1α but these results suggest that UVB may also induce GM-CSF production through an IL-1α independent pathway.

Three Cases of Sarcoidosis / 대한피부과학회지

We report three cases of sarcoidosis with pulmonary involvement. The skin lesions showed three types of cutaneous manifestations which were erythema nodosum, pruritic maculopapular eruptions, and subcutaneous nodules respectively. Erythema nodosum in our cases accompanied by arthralgia and bilateral hilar adenopathy, so we call it Lofgrens syndrome. Histopathologic findings of the case with eythema nodosum revealed septal panniculitis and the others showed characteristic histopathologic findings of sarcoidosis so-called naked tubercle. Regressions of the skin lesions were obtained with systemic and/or topical corticosteroid therapy except for subcutaneous nodules. Subcutaneous nodules initially improved but new lesions have been found.

Comparison of PUVA and Retinoid-PUVA in the Treatment of Psoriasis in Korean Patients

BACKGROUND: Although treament with PUVA or etretinate is effective for psoriasis, both treatment regimens have limitation because of the risk of long-term toxicity. OBJECTIVE: The present study was performed to compare the clinical effects of PUVA and retinoid-PUVA. METHODS: Twenty five chronic plaque psoriasis patients with more than 20% involvement of the skin suface were included in this study. Sixteen patiens were treated with the PUVA therapy and nine patients were treated with retinoid-PUVA. RESULTS: the number of phototherapy and cumulative UVA doses of retinoid-PUVA were significantly smaller than those of PUVA therapy. CONCLUSION: Combining PUVA with etretinate in the tretment of psoriasis may lead to lowering of total number of PUVA treatments and the cumulative dosage and it may be possible to shorten the duration of using etretinate.

UVB Induced Minimal Erythema Dose ( MED ) and Minimal Melanogenic Dose ( MMD ) in Young Adult Koreans / 대한피부과학회지

BACKGROUND: The erythemal response and delayed tanning of the skin to UV radiations which are used as diagnostic phototest and guideline of phototherapy are different according to the races and light sources. OBJECTIVE: The MED and MMD induced by UVB radiation were measured in 130 normal young adult Koreans. METHODS: In this study, a high pressure mercury are lamp(Burdick UV-800) and a sunlight fluorescent lamp(Waldmann UV 800) were used as UVB light sources. Multiple sites of the lower baek or buttock skin were irradiated with an increasing dose by a constant, anount. The minimal doses of erythema response and delayed tanning of the skin were assessed visaually at 24 hours and 7 days after irradiation, respectively. RESULTS: MED and MMD of Burdick UV-800 are 18.0+/-9.8mJ/cm2 (mean+/-S.D.), 29.7+/-12.5mJ/cm2, respectively. MED and MMD of Waldmann UV 800 are 70.8+/-28.5mJ/cm2 and 91.2+/-33.1mJ/cm2, respecively. The most frequent MED by Burdick UV-800 is 10mJ/cm2 and those by Waldmann UV 800 are 50m J/cm2 and 60m J/cm2. CONCLUSION: In this study MED and MMD of young adult Koreans by two kinds of UVB light sources were assessed. The RESULTS: how that MED is less than MMD and the levels of MED under which the photosensitivity is suggested are 5.6mJ/cm2 by Burdick UV-800 anr 32.4mJ/cm2 by Waldmann UV 800.

Calcipotriol ( MC903 ) Ointment in the Treatment of Psoriasis / 대한피부과학회지

BACKGROUND: Topical vitamine D analogues have been reported to bean effective treatment in patients with psoriasis. Calcipotriol, a new vitamin D analogue, is effect ve and at least 100 times less calcemic than calcitriol. OBJECTIVE: Our purpose was to study the clinical efficacy, safety and tolerability of calcipotriol ointment in the treatment of psoriasis. METHODS: Twenty five patients with chronic poriasis were treated with calcipotriol ointment(50pg/g) twice daily. Efficacy as meaaured by the clinical degree of erythcimor, scale and thickness of the lesions, and safety were assessecl every 2 weeks. RESULTS: The total score of erythema, scale and thickness of the lesions decreased in 6 weeks from 8.52+0.76 to 3.80+1.7 with calcipotriol. Some patients developed mild and transient local side effects. The laboratory tests including serum calcium remained unchanged. CONCLUSION: Topical applicalion of calcipotriol ointment for 6 week was found to bean effective and safe treatment of psoriasis vulgaris.

Calcipotriol ( MC903 ) Ointment in the Treatment of Psoriasis / 대한피부과학회지

BACKGROUND: Topical vitamine D analogues have been reported to bean effective treatment in patients with psoriasis. Calcipotriol, a new vitamin D analogue, is effect ve and at least 100 times less calcemic than calcitriol. OBJECTIVE: Our purpose was to study the clinical efficacy, safety and tolerability of calcipotriol ointment in the treatment of psoriasis. METHODS: Twenty five patients with chronic poriasis were treated with calcipotriol ointment(50pg/g) twice daily. Efficacy as meaaured by the clinical degree of erythcimor, scale and thickness of the lesions, and safety were assessecl every 2 weeks. RESULTS: The total score of erythema, scale and thickness of the lesions decreased in 6 weeks from 8.52+0.76 to 3.80+1.7 with calcipotriol. Some patients developed mild and transient local side effects. The laboratory tests including serum calcium remained unchanged. CONCLUSION: Topical applicalion of calcipotriol ointment for 6 week was found to bean effective and safe treatment of psoriasis vulgaris.

Effects of Power Output and Energy Density on the Histologic Change of Guinea pig Skin Following Copper Vapor Laser Irradiation / 대한피부과학회지

BACKGROUND: Recentliy copper vapor laser(CVL) has been applied with encouraging results in the treatment of port wine stain. The CVL emits yellow light(578nm) in a sequence of about 10,000 to 15,000 pulses/second(10-15kHz) with a pulse duration of 15-50 cases. One of the basic methods of evaluationg the effects of laser lights is to study histologic changes after laser irradiation. OBJECTIVE: The effects of power output and energy density on the histologic change of guinea pig skin following CVL irradiation was evaluted to suggest a way of deciding parameters of CVL to achieve the best clinical results. METHODS: After setting the power output for one of 0.8W, 1.6W and 2.4W, the laser was irradiated with an energy density of 10, 12, 14, 16, 18, 20J/cm. A biopsy was done 15 minutes after irradiation and the biopsy specimens was stained with H&E and NBTC histocberr ical method. RESULTS: 1. At the power of 0.8W, specimens irradiated with an energy density above 14J/cm showed diffuse nonspecific coagulation necrosis of the epidermis and upper dermis. 2. At the power of 1.6W, specimens irradiated with energy density of 14, 16J/cm showed coagulation necrosis of dermal vessel and perivascular collagen. With energe density of 18, 20J/cm, diffuse nonspecific coagulat,ion necrosis of epidermis and upper dermis were observed. 3. At the power of 2.4W, specimens irradiated with an anergy density of 12, 14, 16, 18J/cm showed coagulation necrosis of the dermal vessel and perivascular collagen. With an energy density of 20J/cm, diffuse nonspecific coagulation necrosis of the epidermis and upper dermis was observed. CONCLUSIONS : With the above results it was found that t,he higher power output of CVL enlarged the range of energy density confining thermal damage to the dermal v-ssels and perivascular collagen. Additionally the higher power raised the upper limit of energy density with which t,he epidermis was viable.

Effects of Power Output and Energy Density on the Histologic Change of Guinea pig Skin Following Copper Vapor Laser Irradiation / 대한피부과학회지

BACKGROUND: Recentliy copper vapor laser(CVL) has been applied with encouraging results in the treatment of port wine stain. The CVL emits yellow light(578nm) in a sequence of about 10,000 to 15,000 pulses/second(10-15kHz) with a pulse duration of 15-50 cases. One of the basic methods of evaluationg the effects of laser lights is to study histologic changes after laser irradiation. OBJECTIVE: The effects of power output and energy density on the histologic change of guinea pig skin following CVL irradiation was evaluted to suggest a way of deciding parameters of CVL to achieve the best clinical results. METHODS: After setting the power output for one of 0.8W, 1.6W and 2.4W, the laser was irradiated with an energy density of 10, 12, 14, 16, 18, 20J/cm. A biopsy was done 15 minutes after irradiation and the biopsy specimens was stained with H&E and NBTC histocberr ical method. RESULTS: 1. At the power of 0.8W, specimens irradiated with an energy density above 14J/cm showed diffuse nonspecific coagulation necrosis of the epidermis and upper dermis. 2. At the power of 1.6W, specimens irradiated with energy density of 14, 16J/cm showed coagulation necrosis of dermal vessel and perivascular collagen. With energe density of 18, 20J/cm, diffuse nonspecific coagulat,ion necrosis of epidermis and upper dermis were observed. 3. At the power of 2.4W, specimens irradiated with an anergy density of 12, 14, 16, 18J/cm showed coagulation necrosis of the dermal vessel and perivascular collagen. With an energy density of 20J/cm, diffuse nonspecific coagulation necrosis of the epidermis and upper dermis was observed. CONCLUSIONS : With the above results it was found that t,he higher power output of CVL enlarged the range of energy density confining thermal damage to the dermal v-ssels and perivascular collagen. Additionally the higher power raised the upper limit of energy density with which t,he epidermis was viable.