Comparison of the Efficacy of Systemic Antibiotics and Systemic Retinoids in Hidradenitis Suppurativa / 대한피부과학회지

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease showing recurrent painful nodules and abscesses. Many treatment modalities, such as topical antibiotics, systemic antibiotics, retinoids, immunomodulators, biologics, and surgical treatment are used to treat the disease, but there is no single effective treatment for hidradenitis suppurativa. OBJECTIVE: We conducted this study to compare the clinical outcomes of treatment with systemic antibiotics and systemic retinoids. METHODS: We analyzed the clinical features, treatment modalities, and clinical outcomes of patients with hidradenitis suppurativa and compared the clinical outcomes of treatment modalities. RESULTS: A total of 77 patients were enrolled. Male patients were predominant, and the mean age was 28.1 years. Buttock (42.0%) was the most commonly affected site and 63 patients (81.8%) had lesions at Hurley stage I. Forty-eight patients (62.3%) were treated with systemic antibiotics and 29 (37.7%) with systemic retinoid. Seventy-one patients (92.2%) showed improvement after a mean treatment duration of 8.3 weeks, and 69 (89.6%) experienced recurrence after improvement. Systemic antibiotics showed a relatively high improvement rate, short mean treatment duration, and low recurrence rate compared with systemic retinoids, but the differences were not statistically significant. Among systemic antibiotics, both tetracycline and macrolide showed good therapeutic effects for HS, but the differences were also not statistically significant. CONCLUSION: In this study, systemic antibiotics were associated with superior treatment outcomes compared to systemic retinoids, though without statistical significance. In the case of mild lesions, treatment with systemic retinoids appears to show comparable effectiveness to systemic antibiotics.

Cowden Syndrome with a Novel Germline PTEN Mutation and an Unusual Clinical Course

Here, we report a case of Cowden syndrome with an unusual clinical course of late-onset oral papillomatosis and a novel germline PTEN mutation. Cowden syndrome is the most common phosphatase and tensin homolog hamartomatous tumor syndrome. It is characterized by multiple hamartomas in the gastrointestinal tract and mucocutaneous lesions such as trichilemmomas, oral papillomatosis, facial papules, and acral keratoses. Patients with Cowden syndrome have a higher risk of malignancies, especially breast, colon, and thyroid cancers. A 53-year-old female presented with cobblestone-like papillomatous papules on the lower gums that developed 1 year earlier. She had no other mucocutaneous lesions besides oral papillomatosis. Gastrointestinal endoscopy and colonoscopy revealed multiple hamartomas in the stomach and colon. The patient had a history of breast cancer and multinodular goiter diagnosed 4 and 5 years ago, respectively. She was diagnosed with Cowden syndrome and a novel PTEN mutation was confirmed by direct sequencing.

A Survey to Understand Acne Patients in Busan / 대한피부과학회지

BACKGROUND: Acne vulgaris is a common dermatologic disease that can largely affect psychosocial aspects of the patient. OBJECTIVE: This study was performed to survey the perception of acne vulgaris, including the cause of acne vulgaris, and patient attitude towards the disease, as well as preference for treatment methods in Busan. METHODS: A total of 170 patients with acne vulgaris, seeking treatment at 1st-, 2nd-, and 3rd-grade hospitals in Busan, were surveyed by questionnaire. Patient informed consent was obtained. RESULTS: With regards to the cause of acne, increased sebum secretion was the most selected answer, followed by stress and eating habits. Most of the patients believed that all of the acne treatment modalities were effective; however, negative recognition about the safety and durability of each treatment was also reported by a majority of the patients. Acne extraction and laser therapy were the most preferred treatment methods, and the most important reason to choose the treatment method was effectiveness. CONCLUSION: In this study, we could recognize a patients' overall perception about acne vulgaris. It is suggested that dermatologists should try not only to help patients gain a better understanding about acne but also to cope with their demands.

A Survey to Understand Acne Patients in Busan / 대한피부과학회지

BACKGROUND: Acne vulgaris is a common dermatologic disease that can largely affect psychosocial aspects of the patient. OBJECTIVE: This study was performed to survey the perception of acne vulgaris, including the cause of acne vulgaris, and patient attitude towards the disease, as well as preference for treatment methods in Busan. METHODS: A total of 170 patients with acne vulgaris, seeking treatment at 1st-, 2nd-, and 3rd-grade hospitals in Busan, were surveyed by questionnaire. Patient informed consent was obtained. RESULTS: With regards to the cause of acne, increased sebum secretion was the most selected answer, followed by stress and eating habits. Most of the patients believed that all of the acne treatment modalities were effective; however, negative recognition about the safety and durability of each treatment was also reported by a majority of the patients. Acne extraction and laser therapy were the most preferred treatment methods, and the most important reason to choose the treatment method was effectiveness. CONCLUSION: In this study, we could recognize a patients' overall perception about acne vulgaris. It is suggested that dermatologists should try not only to help patients gain a better understanding about acne but also to cope with their demands.

Fibrin Glue Fixation for Suction Blister Epidermal Grafting in Two Patients with Stable Vitiligo

Vitiligo is a chronic disorder characterized by depigmented macules which can slowly enlarge with the concurrent development of new lesions. Although autologous suction blister epidermal grafting is an established technique for the treatment of recalcitrant, stable vitiligo, the donor tissue graft is not easy to fix at the recipient site, especially in areas such as the joints, face, cutaneous folds, hands, feet, and hair-bearing areas. Therefore, various methods of donor tissue fixation have been attempted. We report two cases of vitiligo treated with suction blister epidermal grafting, with fibrin tissue adhesion. The first case is that of 16-year-old female patient presented with hypopigmented patches on the forehead and frontal scalp area. The other case is that of 32-year-old female patient presented with hypopigmented patches on the chin. We treated them with phototherapy for 1~4 years; however, the lesions were recalcitrant. Therefore, we tried treatment with a suction blister epidermal graft. Because graft fixation is difficult at the recipient sites, fibrin glue was sprayed on the grafts. Thereafter, we applied a porous silicone wound contact layer over the graft area and applied sterile gauze dressing that was left for a week. One week after the procedure, firm fixation of the donor tissue was observed in both cases. Fibrin glue seemed to improve the graft fixation, providng protection against infection and an optimal environment for wound healing. This report suggests that the application of an epidermal graft with fibrin glufixation, can provide the best result in the surgical treatment of stable vitiligo.

Acute Generalized Exanthematous Pustulosis Induced by Parvovirus B19 Infection

No abstract available.

Evaluation of the Efficacy, Safety, and Treatment-Related Skin Irritation of Adapalene-Benzoyl Peroxide Combination Gel and Adapalene Gel in Acne Patients: A Randomized Comparative Study / 대한피부과학회지

BACKGROUND: While adapalene and benzoyl peroxide have both been demonstrated to be effective for the treatment of acne vulgaris, they can also cause skin irritation, resulting in patient incompliance. In addition, the irritation may be severe when adapalene is co-administered with benzoyl peroxide. OBJECTIVE: The intention of this study was to evaluate the efficacy and safety of adapalene 0.1%-benzoyl peroxide 2.5% fixed-dose combination gel, and adapalene 0.1% gel monotherapy, for the treatment of mild to moderate acne. Any changes in the skin barrier function were also measured. METHODS: A total of 52 patients applied adapalene-benzoyl peroxide gel or adapalene gel once daily. The changes in lesion counts, investigator's global assessment, patient satisfaction, and adverse events were recorded for 6 weeks. The biophysical profiles of the skin, including transepidermal water loss and redness, were measured for 3 weeks. RESULTS: Both agents were effective for the treatment of acne lesions. Adapalene-benzoyl peroxide showed a faster onset of action than adapalene, especially on inflammatory lesions. However, at week 6, both agents showed a similar effect in reducing lesion counts. While most patients in both groups experienced skin irritation from week 1, this gradually reduced. Likewise, the changes in transepidermal water loss and redness showed peak rates at week 1 and 2, but decreased over time. CONCLUSION: Adapalene-benzoyl peroxide gel is effective for the treatment of acne with a safety profile comparable to adapalene gel. The skin irritation experienced may be associated with the changes in skin barrier disruption, which lasts for 1~2 weeks.

A Case of Organoid Nevus on the Knee / 대한피부과학회지

No abstract available.

Rhamnogalacturonan II is a Toll-like receptor 4 agonist that inhibits tumor growth by activating dendritic cell-mediated CD8+ T cells

We evaluated the effectiveness of rhamnogalacturonan II (RG-II)-stimulated bone marrow-derived dendritic cells (BMDCs) vaccination on the induction of antitumor immunity in a mouse lymphoma model using EG7-lymphoma cells expressing ovalbumin (OVA). BMDCs treated with RG-II had an activated phenotype. RG-II induced interleukin (IL)-12, IL-1beta, tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) production during dendritic cell (DC) maturation. BMDCs stimulated with RG-II facilitate the proliferation of CD8+ T cells. Using BMDCs from the mice deficient in Toll-like receptors (TLRs), we revealed that RG-II activity is dependent on TLR4. RG-II showed a preventive effect of immunization with OVA-pulsed BMDCs against EG7 lymphoma. These results suggested that RG-II expedites the DC-based immune response through the TLR4 signaling pathway.

Kaposi Sarcoma in a Patient with Chronic Renal Failure Undergoing Dialysis

Kaposi sarcoma (KS) is a multicentric proliferative vascular tumor involving the skin and other organs. Human herpesvirus 8 (HHV-8) has been detected in KS lesions and is considered the putative causative agent of KS. The relationship between chronic renal failure, HHV-8, and KS is not clear. KS appears to develop in association with renal transplantation, but is unlikely with dialysis, and there have been few reports on this. Here, we report the case of a 51-year-old man, who underwent peritoneal dialysis to treat chronic renal failure, and presented with multiple brownish plaques on his soles. On histopathological examination, abnormally proliferated vessels, vascular slits, and spindle-shaped cells were seen in the dermis. Immunohistochemical staining for HHV-8 was positive. This case is another example in which factors other than immunosuppression contributed to the development of KS, due to activation of HHV-8.

Congenital Melanocytic Nevus with Asymptomatic Neurocutaneous Melanosis / 대한피부과학회지

Congenital melanocytic nevi (CMN) are benign pigmented lesions that are defined as a tissue malformation of the neuroectoderm. Giant melanocytic nevi with multifocal involvement show significantly greater risk of developing malignant melanomas and neurocutaneous melanocytosis, particularly those in a posterior axial location. Neurocutaneous melanosis is a rare, congenital, non-inherited disorder characterized by the presence of large, multiple congenital melanocytic nevi with proliferation of melanocytes in the central nervous system. Asymptomatic neurocutaneous melanosis can be detectable only by MRI. The patients who have clinical manifestations have an extremely poor prognosis. We present a patient with giant congenital melanocytic nevi involving a major portion of the back with multiple satellite nevi scattered over the whole body associated with asymptomatic neurocutaneous melanosis. We emphasize the importance of imaging study for detection of early neurological symptoms or melanomas. To our knowledge, this is the first case of giant congenital melanocytic nevi associated with asymptomatic neurocutaneous melanosis in Korean dermatologic literatures.

Keloids Treated with a Suction-Assisted Cartilage Shaver: A Report of Four Cases / 대한피부과학회지

Surgical excision of keloids is generally not accepted as a first treatment option, but many reports have described specialized surgical methods, such as intralesional and intramarginal excision. This operation preserves the active peripheral portion of the keloid and excises the central bulky lesion. The suprakeloidal flap technique and keloid core excision involve intralesional excision. These methods are known to be associated with a low probability of recurrence or lesion exacerbation because the remaining keloidal lesion acts as a barrier. However, several complications, such as partial necrosis and flap congestion, have been reported, especially in large lesions. We describe cases of four patients with keloids on the chest or abdomen. All patients complained of pain or itching due to the keloids. Patient age ranged from 20 years to 54 years, and the number of lesions ranged from one to seven. The largest lesion measured 10x8 cm. We treated the lesions by the dermal shaving method using a suction-assisted cartilage shaver, and the lesions were markedly flattened in all cases. Because this surgery is performed through an incision for a cannula, it allows more rapid healing and causes less postoperative pain with fewer severe complications. It also has the advantage of requiring less effort and time due to the use of motorized curettage with suction. The suction-assisted cartilage shaver using dermal shaving method seems to be an effective alternative treatment modality for reducing the lesional size of keloids.

A Case of Bowen Disease in the Finger Web / 대한피부과학회지

No abstract available.

Langerhans Cell Microgranulomas / 대한피부과학회지

No abstract available.

Tinea Incognito in Korea and Its Risk Factors: Nine-Year Multicenter Survey

Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 +/- 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.

Two Cases of Malignant Proliferating Trichilemmal Tumors: Large Tumors on the Scalp without Metastasis / 대한피부과학회지

Proliferating trichilemmal tumor (PTT) is an uncommon neoplasm originated from the outer root sheath of a hair follicle. Malignant transformation occurs occasionally in proliferating trichilemmal tumors, which can be manifested by sudden rapid growths. Histologically, the malignant proliferating trichilemmal tumors (MPTTs) have shown severe nuclear atypia, marked cellular pleomorphism with atypical mitoses, dyskeratotic cells and infiltrating margins. Squamous cell carcinoma (SCC) should be differentiated with MPTT which indicates characteristic trichilemmal keratinization. Large tumor is considered as a risk factor of metastasis in SCC, but the relationship between tumor size and metastasis in the MPTT is not yet clarified. In this report, two patients have large erythematous nodules with focal ulceration and necrosis on their scalps and were diagnosed as MPTT. Despite the large sizes of the tumors, there were no evidences of metastases. Herein, we report 2 cases of the large MPTT which are presented without metastasis.

Efficacy and Safety of Suction-assisted Cartilage Shaver with Fibrin Glue in Treating Axillary Osmidrosis / 대한피부과학회지

BACKGROUND: Axillary osmidrosis causes significant emotional distress and embarrassment. Although numerous surgical procedures have been developed for the treatment of axillary osmidrosis, there is no decisively effective one. OBJECTIVE: This paper is to assess the efficacy and safety of suction-assisted cartilage shaver with the use of fibrin glue to treat axillary osmidrosis. METHODS: 18 axillary osmidrosis patients were treated with suction-assisted cartilage shaver followed by injection of fibrin glue. The effectiveness of the treatment used in this study was evaluated by measurement of axillary malodor both pre- and postoperatively. Patient satisfaction was surveyed as well. RESULTS: The postoperative test demonstrated that there was remarkable decrease in axillary malodor. Of the 18 patients, 17 patients (94.4%) expressed positive satisfaction. Complications including postinflammatory hyper-pigmentation (27.8%), hematoma and skin necrosis (5.6%), scar (5.6%), infection (5.6%) and hidradenitis suppurativa (2.8%) were reported. CONCLUSION: The use of suction-assisted cartilage shaver with fibrin glue proved itself an effective and safe treatment for axillary ormidrosis.

A Case of Pyodermatitis-Pyostomatitis Vegetans Complicated by Gram-Negative Toe Web Infection / 대한피부과학회지

Pyodermatitis-pyostomatitis vegetans (PPV) is a rare eosinophilic inflammatory disorder characterized by pustules and vegetating lesions on the mucosa and skin. It usually occurs in the oral mucosa, axillae, genital area. Usually oral lesions (pyostomatitis) may precede the skin lesions (pyodermatitis), where it can also coincide or follow. A 54-year-old man is presented with a 3-month history of annular pustular plaques on the erythematous base affecting the dorsum of both feet. Pseudomonas aeruginosa was isolated from a culture of a wound in the foot. He was treated with antipseudomonal antibiotics for the initial two weeks, and the lesions improved slightly, but not completely. After that, erythematous vesicles, pustules and erosions developed on his oral mucosal and perianal area. The skin biopsy from right foot was done and he was diagnosed as PPV complicated by Pseudomonas aeruginosa infections. Herein, we report a case of PPV complicated by Pseudomonas aeruginosa infection.

Epidemiology and Clinical Features of Disseminated Herpes Zoster / 대한피부과학회지

BACKGROUND: There have been several studies about herpes zoster in the Korean dermatological literatures. However, there are few studies reported on disseminated herpes zoster. OBJECTIVE: The aim of this study is to determine the epidemiology and clinical features of the disseminated herpes zoster as compared with herpes zoster. METHODS: The authors retrospectively reviewed the medical records on 14 cases of disseminated herpes zoster and 402 cases of herpes zoster at the Department of Dermatology Busan Paik hospital during the 3 years from 2010 to 2012, and if necessary, telephone interviews were executed. RESULTS: The rate of new disseminated herpes zoster outpatients at our dermatology clinic was 0.11% with the mean age of 67.7 years and the males to females ratio was 2.5. The most frequent involved dermatome was the lumbar (42.9%) area. The rate of patients with underlying diseases or immunosuppression, the rates of postherpetic neuralgia and the frequency of narcotic analgesics uses were significantly higher in disseminated herpes zoster as compared with herpes zoster. The patient treatment satisfaction was significantly higher in herpes zoster as compared with disseminated herpes zoster. CONCLUSION: These results demonstrated that the disseminated herpes zoster is associated with higher rates of underlying diseases, immunosuppression, frequent incidences of postherpetic neuralgia, more uses of narcotic analgesics and lower patient treatment satisfactions as compared with herpes zoster.

Evaluation of Efficacy and Skin Irritation during Treatment of Nadifloxacin 1% Cream in Acne Vulgaris Patient / 대한피부과학회지

BACKGROUND: Nadifloxacin is a synthetic fluoroquinolone with a broad spectrum. It has been suggested to not only have antibacterial, but also anti-inflammatory actions. In addition, it is effective against antibiotic-resistant Propionibacterium acne. Upon review of the literature, however, no studies have been performed concerning the efficacy and safety in terms of irritation potential and skin barrier changes after applying nadifloxacin. OBJECTIVE: This study intended to evaluate the skin irritation and changes of the skin barrier function associated with the administration of nadifloxacin 1% cream for the treatment of acne vulgaris. Furthermore, the efficacy and safety of nadifloxacin 1% cream were also assessed. METHODS: The changes in the lesion counts, Korean Acne Grading System (KAGS) and adverse events were recorded. The biophysical profiles of the skin, including transepidermal water loss (TEWL), skin surface hydration and redness were measured by Tewameter(R), Corneometer(R) and Mexameter(R) for 3 weeks. RESULTS: At the end of the therapy, 69% of inflammatory lesions (p<0.0001) and 27% of noninflammatory lesions (p=0.26) resulting from acne were decreased from the baseline. Adverse events were reported in two patients, but they were transient and tolerable. The skin barrier function showed no changes during the treatment periods. CONCLUSION: Nadifloxacin 1% cream is effective for the treatment of acne vulgaris without the changes of skin barrier function.