Magnesium Ascorbyl Phosphate Regulates the Expression of Inflammatory Biomarkers in Cultured Sebocytes

BACKGROUND: Acne is an inflammatory skin disorder caused by inflammatory biomarkers. Magnesium ascorbyl phosphate (MAP) is a stable precursor of vitamin C. It achieves a constant delivery of vitamin C into the skin and has antioxidative effects. OBJECTIVE: We performed this study to evaluate the effect of MAP on the expression of inflammatory biomarkers in cultured sebocytes. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay were performed for inflammatory cytokines and matrix metalloproteinases (MMPs) before and after treatment of cultured sebocytes with MAP (10(-2) M), lipopolysaccharide (LPS) (5 microg/ml) and a combination of MAP and LPS. RT-PCR and western blotting were also performed for antimicrobial peptides (AMPs) and Toll-like receptor (TLR)-4 before and after treatment of cultured sebocytes with MAP, LPS, and a combination of MAP and LPS. Quantification of lipid peroxidation was also conducted. RESULTS: The increased expression of inflammatory cytokines after treatment of cultured sebocytes with LPS was decreased after treatment with MAP. MMPs, AMPs, and TLR-4 were decreased after treatment of cultured sebocytes with MAP and a combination of MAP and LPS, and increased after treatment of cultured sebocytes with LPS alone. Lipid peroxidation was significantly decreased after treatment of cultured sebocytes with MAP and a combination of MAP and LPS. MAP decreased the increased lipid peroxidation after treatment of cultured sebocytes with LPS. CONCLUSION: MAP may be an effective alternative agent to improve inflammatory reactions in acne.

A Case of Xanthoma Disseminatum Accentuating over the Eyelids

Xanthoma disseminatum (XD) is a rare, benign non-familial mucocutaneous disorder, which is a subset of non-Langerhans cell histiocytosis. It is characterized by mucocutaneous xanthomas in a disseminated form typically involving the eyelids, trunk, face, and proximal extremities and occurs in flexures and folds such as axillae and the groin. Mucosal involvement of the respiratory or gastrointestinal tracts may lead to hoarseness or intestinal obstruction from a mechanical mass effect. This paper outlines the case of a 47-year-old female with progressive yellow-to-brown confluent nodules and plaques of various sizes on her scalp, face, oral mucosa, neck, shoulder, axillary folds, and perianal area. Xanthomas accentuating over the eyelids and eyelashes led to partial obstruction of her visual field and interfered with blinking. Further, she suffered from xerophthalmia. The presentation of histopathological features including foamy histiocytes, inflammatory cells, and Touton giant cells in conjunction with her clinical findings indicated a diagnosis of XD. Evaluations for extracutaneous involvement including the central nervous system, respiratory tract, gastrointestinal tract, and bone resulted in nonspecific findings. Although she has been treated with surgical excisions, CO2 laser therapy, and oral prednisolone, new lesions are still emerging.

Comparative Study of a Combination of Intralesional Corticosteroid, 5-fluorouracil and/or Pulsed Dye Laser for the Treatment of Keloids and Hypertrophic Scars / 대한피부과학회지

BACKGROUND: Despite the physical disfigurement, bothersome symptoms and psychological problemsfrom the proliferative scarring process of keloids and hypertrophic scars, there is currently no consensus regarding the best management of these lesions. OBJECTIVE: The purpose of this study was to determine the therapeutic efficacy and safety of intralesional corticosteroid injection combined with 5-fluorouracil (5-FU) and/or pulsed dye laser (PDL) in Koreans with keloids or hypertrophic scars. METHODS: Twenty-five patients with keloids and/or hypertrophic scars over 2 cm in size or who had more than 3 separated lesions were included in this study. Each scar was divided equally into 2 or more segments and these were treated with 1 of the following 3 different modalities: (1) intralesional injection of triamcinolone acetonide (TCA: 20 mg/ml weekly), (2) intralesional injection of TCA 0.1 ml (40 mg/ml) mixed with 5-FU 0.9 ml (50 mg/ml) weekly and (3) treatment #2 combined with PDL (585 nm, 5~7.5 J/cm2) at baseline and at the 3rd and 7th weeks. We estimated the change of the height, the erythema, the pliability, the pruritus, the pain/tenderness scores, the patient-self assessment and the complications. This study was an 8-week prospective study and the assessment of relapse was done at 4 and 12 weeks after the last treatment. RESULTS: There was a statistically significant improvement of the clinical signs and symptoms in all the treated groups. However, the 5-FU-treated groups had more sustained effects compared to the group that underwent TCA monotherapy with respect to flattening and pliability. Complications such as ulcerations, crusts and hyperpigmentation were more frequent in the 5-FU-treated groups. CONCLUSION: Although 5-FU may be preferable to TCA for improving the symptoms of keloids and hypertrophic scars, we believe it is prone to induce more complications in Koreans.

Verrucous Hemangioma and Angiokeratoma: Their Similarilities and Differences according to the Clinicopathological Features / 대한피부과학회지

BACKGROUND: Verrucous hemangioma (VH) and angiokeratoma (AK) are vascular birthmarks of an unclear nosology and these birthmarks commonly show a superficial hyperkeratotic vascular component. There are both similarilities and differences between VH and AK with some confusion concerning their overlapping features. OBJECTIVE: This study was undertaken to review the clinicopathological features of VHs and AKs and to determine the similarilities and differences between them. METHODS:We retrospectively reviewed 11 VHs and 7 AKs at the Vascular Anomaly Clinic of our hospital over the past 10 years. They were evaluated from the clinicopathologic point of view for factors such as the age of onset, location, size, symptoms, the histopathological epithelial change and involvement of deeper tissue. RESULTS: These birthmarks share common clinical features with the exception of gender and lesion size. Histopathologically, hyperkeratosis, acanthosis and capillary dilatation in the upper dermis were commonly seen. Yet lobular proliferation and dilatation of blood vessels in the deep dermis, or more importantly, the subcutis were detected in VH only. Furthermore there was a case of VH that showed diffusely scattered increased blood vessels in the subcutis, suggesting an evolving stage of VH and there was another case of VH that was erroneously diagnosed as AK via the initial biopsy, and the final diagnosis was changed according to the excised lesion. CONCLUSION:The two diseases share most of their clinicopathological features, but small parts of features like gender, the clinical size and the histological deep dermis/subcutis involvement were differences. Making the correct differential diagnosis between VH and AK through a deep biopsy with appropriate timing and long-term follow-up and/or radiological examination is helpful to avoid erroneous management.

A Case of Fatal Wegener's Granulomatosis without Anti-neutrophil Cytoplasmic Antibody (ANCA) / 대한피부과학회지

Wegener's granulomatosis (WG) is a systemic necrotizing vasculitis belonging to the small- to medium-sized vessel. A 46-year-old male presented with erythematous hard plaque on chest, calf and multiple subcutaneous nodules on buttock, upper arm. Incisional biopsy was done and the histopathologic finding revealed the features of necrotizing vasculitis with focal granulomatous inflammation in subcutaneous tissue. PNS MRI showed abnormal meningeal enhancement and lung HRCT imaging showed mild infiltration. Inspite of severe systemic involvement, serum tests about ANCA showed negative result. He was treated with systemic corticosteroid and cyclophosphamide pulse therapy. Initially his condition showed improvement but later the disease worsened.

Sclerotherapy in the Treatment of Congenital Venous and Lymphatic Malformation: Efficacy and Safety with Long-term Follow-up / 대한피부과학회지

BACKGROUND: Surgical excision and alcohol sclerotherapy have been used to treat congenital vascular malformations (CVM) with a significant success rate but the methods have also left marked morbidity. The alternative, sclerotherapy using ordinary sclerosants, although resulting in trivial complications, has a relatively low cure rate and is rarely used in Korea for CVM management. OBJECTIVE: To evaluate the effects and side effects of sclerotherapy using ordinary sclerosants such as polidocanol (POL) and sodium tetradecyl sulfate (STS) for the treatment of CVM of a venous and lymphatic type. METHODS: To confirm the long-term effects and safety with at least a 3-year follow-up, we chose a total of 26 patients who had undergone sclerotherapy between 2000 to 2004. There were 22 venous malformations (VMs) and 4 lymphatic malformations (LMs) which were rather small and superficial, not beyond muscular fascia. Sclerotherapy using POL and STS was performed by blind intraluminal and/or intralesional injection without the aid of imaging methods such as ultrasound examination. The results were evaluated by the patients' subjective satisfaction, physical examination, comparison of photographs and/or radiological examinations, then they were classified into 4 groups; excellent (improvement >75%), good (50~75%), fair (25~49%) and poor (<25%). RESULTS: Twenty two VMs comprised 14 in the excellent group (66.7%), 6 in the good group (25.0%), 1 in the fair group (4.2%) and 1 in the poor group (4.2%). Two LMs of macrocystic type revealed excellent results but the other two showing microcystic type revealed poor results. The dose of sclerosant was 0.1 to 2 ml in every session and a total of 1 to 6 sessions (average: 2.2) were performed. Only one VM showed hyperpigmentation as a side effect. CONCLUSION: Sclerosants for ordinary varicose vein eradication can be used on the treatment of small and superficial venous malformations and macrocystic-lymphatic malformations with relative efficacy and safety.

Reconstruction of Defects on the Lower Part of the Nose using Nasalis Island Pedicle Flap / 대한피부과학회지

Reconstruction of surgical defects of the nose, particularly the lower one third, is often challenging. The skin of this area is less mobile and fixed on lower structures without a subcutaneous fatty layer. Thus, dissection of tissues is rather difficult and more bleeding can occur during dissection. Furthermore, flap surgery will fail if the flap extends too far. Local flap surgery is one of the more useful techniques that maintains the function and aesthetics of a normal nose. Among these, the nasalis muscle is relatively easy and provides better outcomes. More importantly, vascular supplies from the underlying muscular structure provide greater viability. Additional movement can be achieved by either dissecting under the transverse nasalis or by dividing the transverse nasalis beyond the midline. We report 5 cases of nasalis island pedicle flaps using nasalis muscles. The final results were relatively satisfactory for both functional and cosmetic aspects.

A Case of Squamous Cell Carcinoma with Nodal MetastasisConfirmed by Sentinel Lymph Node Biopsy / 대한피부과학회지

Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer and the majority of such patients can be easily treated with a relatively low risk of recurrence and metastasis. However, there are subgroups of SCC that are at a higher risk, depending on patient's or tumor's characteristics. A greater part of the metastases from these high-risked SCCs spread towards the regional lymph nodes, whereas distant metastases are relatively uncommon. Early identification of nodal metastasis can allow the selective and timely inclusion of possible high-risked SCC patients into more aggressive treatments and meticulous follow-up protocols for achieving potential survival benefit. Therefore, sentinel lymph node biopsy (SLNB) is popular in the management of malignant melanoma, and it may also be useful to detect regional metastasis of high-risked SCCs. This procedure could also spare node-negative patients the morbidity of unnecessary additional therapy, like elective lymph node dissection. We report herein on a case of SCC with regional nodal metastasis, which is confirmed by SLNB.

A Case of Squamous Cell Carcinoma with Nodal MetastasisConfirmed by Sentinel Lymph Node Biopsy / 대한피부과학회지

Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer and the majority of such patients can be easily treated with a relatively low risk of recurrence and metastasis. However, there are subgroups of SCC that are at a higher risk, depending on patient's or tumor's characteristics. A greater part of the metastases from these high-risked SCCs spread towards the regional lymph nodes, whereas distant metastases are relatively uncommon. Early identification of nodal metastasis can allow the selective and timely inclusion of possible high-risked SCC patients into more aggressive treatments and meticulous follow-up protocols for achieving potential survival benefit. Therefore, sentinel lymph node biopsy (SLNB) is popular in the management of malignant melanoma, and it may also be useful to detect regional metastasis of high-risked SCCs. This procedure could also spare node-negative patients the morbidity of unnecessary additional therapy, like elective lymph node dissection. We report herein on a case of SCC with regional nodal metastasis, which is confirmed by SLNB.

Two Cases of Mnckeberg's Medial Sclerosis on the Face

Monckeberg's medial sclerosis is a degenerative process related to age, and is particularly associated with long-standing diabetes mellitus. The media of small and medium-sized muscular arteries are usually involved. Although its pathogenesis is still unknown, its presence can predict the risk of cardiovascular events and leg amputation in diabetic patients. In our two cases, Mnckeberg's medial sclerosis was shown as a bean-sized, pulsatile mass which occurred from an inferior labial branch of the facial artery. Neither paient had a history of diabetes mellitus or calcification in any part of the body, nor an abnormality with their calcium metabolism. Herein, we report a case of a man and a woman with Mnckeberg's medial sclerosis. This condition is so rare that it has not been reported in the Korean dermatologic literature before. Moreover, Mckeberg's medial sclerosis is very rarely found without diabetes mellitus.

The Clinical Observation of Trichophyton verrucosum Infections During the Last 19 Years (1986~2004) / 대한의진균학회지

BACKGROUND: Trichophyton verrucosum (T. verrucosum) is a zoophilic dermatophyte distributed all around the world. In Korea, kerion celsi caused by T. verrucosum was first reported by Kim et al in the southeast province of Korea. Since then, many patients infected with T. verrucosum have been reported in Young-nam, Chungcheong province, and so on. OBJECTIVE: There have been few reports on the T. verrucosum in Korea, yet. Authors tried to offer the information on dermatophytosis due to T. verrucosum in the various aspects such as prevalence of each year, epidemiology, onset time of the year and season, distribution and characteristics of the regions, sex and age distribution, the clinical types, onset site of the body, and the relation between human beings and infected cattle and so on. METHOD: A total of 218 patients who visited Catholic Dermatologic Clinic in Daegu, Korea from 1986 to 2004, were finally diagnosed as T. verrucosum infection by KOH and fungal culture. The data were based on a retrospective survey of hospital records. However, whenever the information was lacking, we called patients to ask lists of questions for the investigation. RESULTS: The number of patients had increased every year since the first report in 1986. In 1988, the number was up to 44, which was the most. After the year 2000, the number of patients had been decreasing so continuously that there was no case in the year 2003 and 2004. As we see the distribution of province, 47 cases were from Daegu, 137 cases from Kyungsang bukdo, 29 cases from Kyungsang namdo, 5 cases from other provinces and cyties. In the distribution of season, 81 cases appeared in the spring, which was the most. Female to male ratio showed about a 1.2-fold predominance for male. And less than 15-year-old group was 41.3% of total patients. The most frequent onset site was face (36 cases, 16.5%), and the next were arm, trunk, head, leg, neck in the decreasing orders. Classifying the patients by the clinical type, 150 cases (68.8%) were in the tinea circinata type, and the next were kerion celsi type, tinea barbae type, agminated folliculitis type in the decreasing orders. Among 126 cases, 99 patients raised cattle with lesions caused by T. verrucosum, 8 patients raise cattle without lesions, 19 patients didn't breed cattle. CONCLUSION: This investigation is expected to help understand and obtain more information on T. verrucosum infection in Korea.

A Case of Pyoderma-Pyostomatitis Vegetans / 대한피부과학회지

Pyoderma-pyostomatitis vegetans (PD-PSV) is a rare, benign, eosinophilic pustular and vegetating mucocutaneous disease characterized by skin lesions which typically involve the axillary and genital regions, the face and the scalp. PD-PSV was at first regarded as a subtype of bullous disease. However, due to the lack of abnormality under a immunofluorescent microscope, it could be diffentiated from bullous disease. A 48-year woman presented with a 6-month history of sharply-outlined, exudative, papillomatous and vesiculopustular vegetating plaques on the perioral, umbilicus and nasal mucosa, tips of her fingers and toes and perianal region. A skin biopsy taken from the lip and umbilicus showed papillary dermal edema and focal inflammatory cell infiltration composed of many eosinophils, intraepithelial microabscesses, focal spongiosis, and exocytosis. No abnormalities were found during an immunofluorescence study. The lesions were almost cleared with 20 mg of triamcinolone and 200 mg of cyclosporin medication during a 3-month treatment period.

The Effect of Medications Used in Mesotherapy on Hair Organ Culture and Culture of Dermal Papilla Cells / 대한피부과학회지

BACKGROUND: Hair loss including androgenetic alopecia and chronic telogen effluvium is recognized increasingly as a physically and psychologically harmful medical condition. Mesotherapy is considered as a new therapeutic modality for hair loss. OBJECTIVE: We studied to determine the effect of medications used in mesotherapy on hair organ culture and culture of dermal papilla cells. METHODS: First, occipital hair follicles were collected from patients with androgentic alopecia and separated into single hair follicles. The single hair follicles were cultured in William E media mixed with mesotherapy medications such as lidocaine, placental extract, Pondil(R), CRP-1000(R), and mixture of all these medications at different concentrations (1, 10, 50 microliter). On the 8th day, the cultured single hairs were stained with H&E and the length of those was measured under a microscope to compare with control group. Immunofluorescent study was performed to check expression of Ki-67, Bcl-2 and Bax on the hairs. Second, dermal papilla cells were isolated from occipital anagen hairs of patients with androgenetic alopecia and cultured in Dulbeco's modified Eagle's medium (DMEM). The mesotherapy medicines were added to the medium with one and two thousand dermal papilla cells, respectively. At the 3rd day, survival of the cells was evaluated with ELISA method comparing with control group. RESULTS: There were no statistical differences of the length of the hairs and the survival of the dermal papilla cells between experimental and control groups. With Bcl-2, we couldn't see any differences between experimental and control groups. With Ki-67, experimental groups showed less expression than control group. On the contrary, experimental groups showed more expression than control group in case of Bax. CONCLUSION: We can conclude from the results that the four medications used in mesotherapy are not effective for growth of cultured hair follicles and survival of cultured dermal papilla cells. However, more study would be needed for the establishment of objective and scientific evidences supporting mesotherapy and we should be in search for new medications for mesotherapy.

Clinical Study on Dermatologic Disease of the Elderly / 대한피부과학회지

BACKGROUND: With the advance of socioeconomy and medical sciences, geriatric health care has become a world wide concern and disease of the skin is no exception. OBJECTIVE: The aim of this study was to investigate the epidemiology, past history and the prevalence of various skin disorders of the elderly. METHODS: In this trial, a total of 1082 new patients older than 65 years, who visited the Department of Dermatology, Kyungpook National University Hospital in Daegu, Korea in the last 3 years (2002~2004), were selected. The data was studied on the basis of a retrospective survey of hospital records. RESULTS: Of total patients who were seen at the dermatologic outpatient department, 10.1% were 65 years and older. The male to female ratio was 1 to 1.01. The patients between 65 and 74 years old compromised the majority (72.8%), and the patients older than 85 years old were 4.1%. They visited hospital most frequently in summer. Of the common complaints recorded, pruritic rash was the most frequent. The commonly diagnosed disorders were herpes zoster followed by senile pruritus, tinea/onychomycosis, and seborrheic dermatitis in decreasing order. The most common dermatologic disease was hespes zoster and postherpetic neuralgia for all three age groups : 65~74 years old, 75~84 years old, and over 85 years old. A total of 901 patients, which constituted 83.3% of the total patients, had at least more than one underlying disease, of which cardiovascular disease was the most common. CONCLUSION: This study is expected to be of help to understand the characteristics and the distribution of dermatologic diseases in the elderly.

Clinical Study on Nummula Eczema / 대한피부과학회지

BACKGROUND: Nummular eczema, known as nummular dermatitis or discoid eczema, is an idiopathic disease that manifests coin-shaped, circular, or oval-shaped plaques with definite margins. These plaques can be exudative, erythematous, or edematous. The plaques are composed of tiny vesicles in the early stage, and later tend to be more scaly, dry, lichenified and thickened. It is a chronic condition which exhibits long periods of recurrence and relapse, plus changes depending on environmental conditions. For example, it is known that the eczema worsens in low humidity, or during winter. OBJECTIVE: Since there has been an absence of studies conducted since the 1970's, we investigated epidemiology, etiology, aggravation factors, family and past history, associated diseases such as atopic dermatitis, clinical menifestations, laboratory abnormalities, and course and prognosis with statistical analysis. METHOD: A total of 211 individuals, who had visited the Department of Dermatology, Kyungpook National University Hospital in Daegu, Korea between 2000-2004 with a diagnosis of nummular eczema, were selected. The data was based on a retrospective survey of hospital records. However, whenever the information was lacking, we called patients to ask lists of questions for this investigation. To clarify the prognosis and course of nummular dermatitis, we classified the course of the disease into 5 groups; "healed" (cleared completely), "almost healed" (more than 90% cleared), "improved" (from 50 to 90% cleared), "stationary" (less than 50% improvement), and "wax & waned" (repetitive recurrence). RESULTS: The male to female distribution showed about a 1.4-fold predominance for males. The onset of the disease in patients was often in their twenties, which correlated with previous reports which noted that onset of lesions in patients occurred in their twenties and sixties. Nummular eczema was most frequently aggravated in summer. Thirty five of the 211 patients had atopic dermatitis, and 53 had dry skin. Thirty five of 103 patients showed an elevated serum Ig E level (more than 250 IU/ml). Seventeen of 120 patients had an elevated eosiophil count (more than 7%). If the patients had had the eczema for a short duration, these seemed to be a better chance of the condition healing. CONCLUSION: This investigation is expected to help understand and obtain more information on nummular eczema.