Nasal Reconstruction of a Frontonasal Dysplasia Deformity Using Aesthetic Rhinoplasty Techniques

No abstract available.

The Increased Expression of Matrix Metalloproteinase-9 Messenger RNA in the Non-lesional Skin of Patients with Large Plaque Psoriasis Vulgaris

BACKGROUND: A difference of the interleukin-18 (IL-18) mRNA expression among several proinflammatory genes was previously observed between large plaque (LP) psoriasis patients (more than 5 cm lesions are typical) and small plaque (SP) psoriasis patients (1~2 cm lesions are typical). Therefore, it is necessary to test whether there is any difference in the expression of the genes that activate IL-18 or the expression of genes that are induced by IL-18. OBJECTIVE: To test the differential mRNA expressions of caspase-1, STAT-6, MMP-1, MMP-2, MMP-9 and TIMP-1 according to the clinical types of psoriasis vulgaris lesions in Korean patients, we have analyzed the skin samples of psoriasis vulgaris patients. METHODS: The total cellular RNA of skin samples from groups of patient with LP and SP psoriasis was analyzed by performing real-time PCR (the Taqman method) to compare the differences in the mRNA expressions. RESULTS: The caspase-1 and STAT-6 mRNA expression levels from the SP lesional skin of the patients were increased compared with the caspase-1 and STAT-6 mRNA expression levels from SP non-lesional skin or normal skin, but these expression levels from the SP non-lesional skin were not significantly different from those of the LP non-lesional skin. Among MMP-1, MMP-2, MMP-9 and TIMP-1, the expressions of MMP-1, MMP-2 and MMP-9 mRNA were increased in the SP lesional skin compared with those of the SP non-lesional skin. The MMP-1 mRNA expressions in both the LP and SP lesional skin were increased compared with those in the normal skin (p=0.028 and p=0.007 respectively). The MMP-9 mRNA expression in the LP non-lesional skin was elevated compared with the MMP-9 mRNA expression in the SP non-lesional skin (p=0.047). The TIMP-1 mRNA expression levels from the non-lesional skin and the lesional skin of the psoriasis patients and the normal skin samples were not significantly different. CONCLUSION: The increased expression of MMP-9 mRNA in the LP non-lesional skin compared to that of the SP non-lesional skin in the psoriatic skin suggests that the increased MMP-9 mRNA expression is related to the large size type of lesion.

A Case of Psoriasis with a Chronic Oral Ulcer / 대한피부과학회지

Psoriasis is a chronic inflammatory disease with epidermal hyperplasia. Th 1 cells are thought to be important in the pathogenesis of psoriasis and Behcet's disease. However, both diseases rarely develop in the same patient. We report here a case of a 50-year-old man who was diagnosed with psoriasis 15 years prior. During the last three years, ulcers and erosions had recurrently developed on the perianal area and oral mucosa. In addition, the patient had mild arthralgia on the both knees and hand for two years. In this case, Behcet's disease accompanying psoriasis was suspected.

Docetaxel-Induced Onycholysis: The Role of Subungual Hemorrhage and Suppuration

Nail changes are common side effects of taxane chemotherapeutic agents. Docetaxel (Taxotere(R)) is known to cause a great incidence of nail change. Various types of nail changes have previously been reported as a result of treatment with taxanes. We describe 2 cases of severe nail changes induced by docetaxel. The patients had previously been diagnosed with breast cancer and advanced gastric cancer, respectively. During the course of treatment with docetaxel, nail changes became apparent in both patients. Initially, they complained of nail bed purpura. Subungual hematomas with hemopurulent discharge were later observed in several fingers. Drainage of the hemopurulent material occurred spontaneously in our cases, leading to onycholysis. Following drainage, the pain in the nail with subungual hemoprulent material was relieved immediately and spontaneous healing of the patients' nails was noticed after few months. Subungual hemorrhage and suppuration therefore are considered causes of onycholysis and the pain in these patients. Although systemic or topical antibiotics were not used to treat these patients, antibiotics may be also worthwhile to hasten the drainage of the subungual hematomas and suppuration in patients for quick relief of pain.

A Case of Melanocytic Nevus Associated with Epidermal Cyst / 대한피부과학회지

Nevus with a cyst is characterized by a melanocytic nevus that is closely associated anatomically with an epidermal cyst. It is important to recognize this common benign condition because the growth of these lesions is sometimes misinterpreted by the patient and clinicians as presenting either a new melanoma or malignant transformation of a preexisting lesion. We report a case of intradermal melanocytic nevus associated with an epidermal cyst which developed in a 68-year-old man.

A Case of Radiation Recall Dermatitis which Developed in a Patient with Kaposi Sarcoma / 대한피부과학회지

Radiation recall dermatitis is a rare skin reaction, occurring subsequent to drug administration, and has all the clinical signs of inflammation, which develop in a previously irradiated area, days to years after exposure to ionizing radiation. A 41-year-old woman was diagnosed with Kaposi sarcoma. The patient was treated by radiotherapy, followed by a 1st chemotherapy session with doxorubicin and ifosfamide, 20 days after the radiotherapy. However, the patient developed erythema of the skin, accompanied by pruritus and pain in the previously irradiated area, 3 to 4 days after the chemotherapy. The erythema resolved almost completely after systemic and topical steroid therapy. The patient received a 2nd chemotherapy session with the same regimen, but there was no recurrence of radiation recall dermatitis. We report a case of an uncommon skin reaction after chemotherapy in a patient with kaposi sarcoma, which was identified as radiation recall dermatitis.

A Case of Radiation Recall Dermatitis which Developed in a Patient with Kaposi Sarcoma / 대한피부과학회지

Radiation recall dermatitis is a rare skin reaction, occurring subsequent to drug administration, and has all the clinical signs of inflammation, which develop in a previously irradiated area, days to years after exposure to ionizing radiation. A 41-year-old woman was diagnosed with Kaposi sarcoma. The patient was treated by radiotherapy, followed by a 1st chemotherapy session with doxorubicin and ifosfamide, 20 days after the radiotherapy. However, the patient developed erythema of the skin, accompanied by pruritus and pain in the previously irradiated area, 3 to 4 days after the chemotherapy. The erythema resolved almost completely after systemic and topical steroid therapy. The patient received a 2nd chemotherapy session with the same regimen, but there was no recurrence of radiation recall dermatitis. We report a case of an uncommon skin reaction after chemotherapy in a patient with kaposi sarcoma, which was identified as radiation recall dermatitis.

Analysis of Increased Xerosis in Intensive Care Unit Patients

BACKGROUND: Xerosis is commonly seen in patients in intensive care units (ICU), and is sometimes accompanied by itching sensation and dermatitis. However, xerosis in ICU patients is often missed by doctors who are trained to attend to the more serious conditions that can become life-threatening. OBJECTIVE: The purpose of this study is to evaluate xerosis of ICU patients objectively, by measuring hydration levels of the skin. METHOD: To investigate hydration levels of the skin in ICU patients, a corneometer was used to measure the skin's capacitance. The experimental group consisted of 106 ICU patients, while the control group was made up of 53 outpatients visiting the dermatology department. RESULTS: ICU patients showed decreased skin surface hydration, and its level was inversely correlated with the duration of ICU admission. However, no correlation between age and skin surface hydration was observed in either the ICU patients or the control group. The actual humidity of the ICU was 5% lower than that of the outpatient dermatologic clinic. The severity of systemic diseases can also influence the development of xerosis. CONCLUSION: The decreased skin surface hydration in ICU patients correlated with the prolonged ICU stay, which seemed to be associated with the dry environment of the ICU or the severity of the systemic diseases causing dry skin. The increased incidence of xerosis in ICU patients can be explained by the decreased skin surface hydration.

A Case of Psoriasiform Sarcoidosis as Early Manifestation of Systemic Sarcoidosis / 대한피부과학회지

Sarcoidosis is a granulomatous disease with undetermined etiology, and shows variable skin manifestations. Although there have been numerous reports on cutaneous sarcoidosis, the early manifestations of systemic sarcoidosis are not clearly defined. Occurrence of both psoriasiform lesions and subcutaneous nodules in the same patient is rarely seen. A 39-year-old woman had psoriasiform lesions on her extremities for 1 year, and was treated with a topical steroid and calcipotriol ointment. One and half years after the initial skin lesions, pulmonary lesions were developed and treated with anti-tuberculosis medication for three months without any improvement. Since then, subcutaneous nodules on the upper extremities subsequently developed. Histopathological examination revealed non-caseous epithelioid granulomas in subcutaneous tissue and psoriasiform lesions. Furthermore, routine laboratory tests revealed anemia, leukopenia, hypercalcemia and elevated serum level of angiotensin converting enzyme (ACE), and chest X-ray revealed disseminated air space nodules on both lungs with non-segmental distribution. Considering initial poor response to anti-tuberculosis medication and subsequent good response to systemic steroid treatment, this condition was diagnosed as systemic sarcoidosis. Since we considered psoriasiform sarcoidosis as the early cutaneous manifestation of systemic sarcoidosis, we herein reported the case.

Analysis of the Cutaneous Manifestations of Patients in the Intensive Care Unit / 대한피부과학회지

BACKGROUND: Although primary dermatological conditions requiring intensive care unit (ICU) admission is rare, skin lesions due to manifestations of systemic diseases or complications in the critically ill patients are relatively common. During the process of critical care for the significant illness, the skin lesions are often ignored in daily clinical examination. OBJECTIVE: We have analyzed the skin manifestations of patients in the ICU and to correlate them with ventilator care, nutrition and the period of admission. METHODS: Among 113 patients in the ICU, 83 with ventilator care and 30 without ventilator care were examined for their skin lesions. The dermatologic conditions were classified into 5 groups: (1) primary skin diseases requiring intensive care; (2) dermatologic disorders due to multi-system disorders; (3) skin diseases as complications of intensive care; (4) previously acquired coincidental dermatologic diseases; and (5) nonspecific cutaneous manifestations. Dermatologic conditions in each category between the ventilator group and the non-ventilator group were compared. RESULTS: The study results are summarized as follows: 1. The incidence of cutaneous manifestations was 80.5% (91/113) in total, 80.7% (67/83) in the ventilator group and 80.0% (24/30) in the non-ventilator group. 2. The skin manifestations of ICU patients were classified into primary dermatological conditions, multi-system disorders with cutaneous signs, skin conditions developing as the complications of intensive care, previous dermatologic disorders, and nonspecific cutaneous symptoms which were 0 cases (0%), 25 cases (22.1%), 32 cases (28.3%), 37 cases (32.7%) and 45 cases (39.8%) respectively. Twenty-two patients had no skin lesions. These manifestations were not significantly different between the ventilator group and the non-ventilator group. 3. The incidence of xerosis was elevated in proportion to the period of admission. 4. Nonspecific cutaneous manifestations such as edema on the extremities and xerotic skin were not correlated with the nutritional status of the patients. CONCLUSION: The most common dermatologic manifestation in ICU patients is nonspecific skin lesion such as peripheral edema and xerotic skin. The incidence of xerosis was related with the periods of admission, it is considered that the longer the duration of hospitalization was, the dryness of the ICU environment and the exposed skin of patients were increased. Therefore the dryness should be corrected and the exposure of the skin should be avoided.

Thoracocervicofacial Purpura Occurred After Epileptic Seizure / 대한피부과학회지

The thoracocervicofacial pupura is an obstructive pupura, which occurs in the various conditions with elevated pressure in the thoracic cavity. This pupura can occur as an unusual consequence of epileptic seizure. A 28-year-old man visited due to the syncope and the thoracocervicofacial pupura. His creatine kinase level was elevated. Therefore the cutaneous manifestation is thought to be due to epileptic seizure. Here we report a case of thoracocervicofacial pupura as the unique manifestation of epileptic seizure.

A Case of Focal Acantholytic Dyskeratosis Occurring on both the Lip and the Anal Canal

Focal acantholytic dyskeratosis has a distinctive histological pattern that is associated with various clinical expressions. It rarely occurs on the lip or the perianal area. We report a patient with focal acantholytic dyskeratosis occurring on both the upper lip and the anal canal. Histopathologically, the lesions showed hyperkeratosis, suprabasilar clefting, epidermal acantholysis and dyskeratosis. This case represents the first report of a focal acantholytic dyskeratosis occurring on both the lip and the anal canal.

A Case of Superficial Epithelioma with Sebaceous Differentiation

Superficial epithelioma with sebaceous differentiation (SESD) is a rare benign neoplasm with peculiar histopathologic characteristics, which occurs in aged skin. We report upon a case of SESD occurring on the left upper back, which histopathologically is a superficial, multilobular tumor with numerous basaloid cells mixed with sebaceous cells attached to the overlying epidermis. This case represents a solitary benign neoplasm without any associated malignancy.

Psoriasis as a T-cell-mediated Immunologic Disease

Although the exact mechanism responsible for the pathogenesis of psoriasis is unclear, interferon-gamma producing type 1 T cells have been reported to play a significant role. Infiltrating activated type 1 T cells in the lesions are believed to be responsible for stimulating keratinocytes, which produce many cytokines and growth factors. The hyperproliferative epidermis is understood to be the result of either the cytokines produced by the intraepidermal T cells or the reactive phenomenon after keratinocyte damage. The microenvironment in psoriatic lesions deviates toward the type 1 status, because of the increased type 1 cytokines and either the decreased or unchanged type 2 cytokines observed in psoriatic lesions. Therefore, this review focused on a T-cell-mediated immunological basis for the current hypothesis of the psoriasis pathogenesis.

Serum Levels of Type 2 Chemokines in Lepromatous Leprosy Patients

BACKGROUND: The type 2 deviated immunological state is predominant in lepromatous leprosy. Erythema nodosum leprosum (ENL) is an immune-complex mediated reaction that typically occurs in lepromatous leprosy. To date, the serum levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-2 receptor, IL-10, IL-1beta, IL-1 receptor antagonist and monocyte chemoattractant protein-1 (MCP-1) were reported to be higher in lepromatous leprosy. TNF-alpha is also known to be higher in ENL, which is reduced after thalidomide treatment. However the serum type 2 chemokine levels in lepromatous leprosy patients have not been reported. METHODS: The serum levels of the type 2 chemokines such as thymus and activation-regulated chemokine (TARC), macrophage-derived chemokine (MDC) and eotaxin together with IL-12 and IL-10 in the sera from leprosy patients were detected using an enzyme-linked solvent assay (ELISA) method. RESULTS: The Serum TARC, MDC, eotaxin, IL-10 and IL-12 levels in lepromatous leprosy patients were not significantly different from the normal control levels. The serum levels were not significantly different between the paucibacillary group and multibacillary group. The serum TARC or MDC levels in the ENL patients were more reduced after a treatment containing thalidomide. CONCLUSION: The type 2 chemokines are not related to the severity of lepromatous leprosy. The larger reducing effect of the TARC or MDC levels in ENL patients by a treatment containing thalidomide suggests the potential role of these chemokines in the development of ENL and the therapeutic mechanism of thalidomide.

Immunologic Mechanism of Experimental and Therapeutic Ultraviolet B Responses

The immunological mechanism of the responses to ultraviolet (UV) B radiation in mouse models were investigated by the suppression of contact hypersensitivity (CHS) and delayed type hypersensitivity (DTH), and susceptibility to infection. However, there are some differences in immune suppression according to the different models as well as the irradiation protocols. Therefore, this review focused on the differences in the suppressive effects on CHS and DTH, and susceptibility to infection in relation to the different in vivo models. Recent advances in cytokine knockout mice experiments have the reexamination of the role of the critical cytokines in UVB-induced immune suppression, which was investigated previously by blocking antibodies. The characteristics of the suppressor cells responsible for UVB-induced tolerance were determined. The subcellular mechanism of UVB-induced immune suppression was also explained by the induction of apoptotic cells through the Fas and Fas-ligand interaction. The phagocytosis of the apoptotic cells is believed to induce the production of the immune suppressive cytokine like interleukin-10 by macrophages. Therefore, the therapeutic UVB response to a skin disease, such as psoriasis, by the depletion of infiltrating T cells could be considered in the extension line of apoptosis and immune suppression.

A Case of Drug Eruption Caused by Quinolones / 대한피부과학회지

The drug eruptions caused by quinolones are rarely reported. The patient took norfloxacin for several days prior to admission and was admitted due to systemic erythematous maculopapular eruptions. For the treatment of urinary tract infection, he was treated with pefloxacin via intravenous route, and then the symptom of drug eruption became aggravated. After termination of treatment, the symptom reduced. The causative agent was identified by intradermal test and confirmed by accidental rechallenge with levofloxacin which is an another quinolone. We report herein the case of drug eruption caused by several quinolones which was confirmed by intradermal test and incidental administration of the drug.

Multiple pagetoid Bowen's disease

A 61-year-old male was presented with oozing crusted erythematous skin lesions on the ex-tensor site of the right forearm, the extensor site of the left forearm, left calf, right shin, and the right portion of the buttock. He was diagnosed as having multiple pagetoid Bowen's disease by H&E staining, special staining and by an electron microscopic examination. He was treated with a topical application of 5-flurouracil cream and cryosurgery. The skin lesions were mostly healed after 7 months. We herein report a case of multiple pagetoid Bowen's disease on the sun-protected area that may be caused by arsenic ingestion.

Serum Interleukin-8 Levels in Leprosy Patients

BACKGROUND: Interleukin(IL)-8 is a potent chemotactic factor for neutrophils which was induced by tumor necrosis factor-a and IL-1. Serum IL-8 level was known to be associated with the poor prognosis of tuberculosis and IL-8 mRNA was increased in the tissue of erythema nodosum leprosum. OBJECTIVE: Our purpose was to investigate whether the serum IL-8 levels of leprosy patients are different from those of controls and whether the severity of the leprosy is associated with the serum IL-8 level. METHODS: Twenty eight patients with leprosy and fourteen healthy adults were used in this study. Serum IL-8 levels were detected by enzyme immunoassay. RESULTS: There were no statistically significant differences in the serum IL-8 levels between the twenty eight leprosy patients and the fourteen healthy control serums (29.99±53.14 vs 2.52±7.53) nor was the detection rate between the groups (9/28 vs 1/14) significant. There were also no statistically significant differences between the serum IL-8 concentrations of the patients with high bacterial indexes and the patients with low bacterial indexes (30.22±63.64 vs 29.73±41.14). CONCLUSION: Serum levels and the detection rate of IL-8 in the leprosy patients were not different from the control group and the severity of the disease was not associated with the IL-8 levels.

The Effect of Ultraviolet lrradiation on Susceptibility of Listeria monocytogenes lnfection and the Production of Cytokines / 대한면역학회지

Although the effect of ultraviolet (UV) irradiation on immune response was reported to supress cellular immune response, the exact mechanism was not elucidated. As recent development in cytokine research progress, it is well-known that immune response is regulated by cytokines and especially cellular immune response is induced by interferon (IFN)-r and interleukin (IL)-12 which is mainly produced from lymphocytes and macrophages respectively. Therefore our purpose was to elucidate the UV effect on cellular immune response and its mechanism. We have investigated the changes of host resistance by injection of Listeria monocytogenes which is an intracellular parasite after UVB irradiation in C57BL/6 mice which is known to have relatively strong cellular immune response. In addition we also have investigated the changes in the production of IFN-r from lymphocytes and the production of tumor necrosis factor (TNF)-a and IL-12 from macrophages in mice by UVB irradiation. The increase of mouse spleen index and susceptibility of iisteria monocytogenes infection was correlated with the decreased production of IFN-r, TNF-a and IL-12, which was known to induce the suppression of cellular imrnune response.