An Uncommon Presentation of Human Otoacariasis by Haemaphysalis longicornis.

Ticks are obligate parasites on animals and sometimes humans. They usually suck the blood of the hosts and can carry various infectious diseases as a vector. Otoacariasis is the presence of ticks and mites within the ear canal and relatively common in domestic and wild animals. However, tick infestations of human ear canals are rarely reported in the scientific literature and hardly occur in developed countries. Herein, we report a rare case of otoaracariasis involving Haemaphysalis longicornis . A 9-year-old girl living in a suburb presented with otalgia of left ear for 1 day. Otoscopic examination revealed a huge insect occluding the tympanic membrane. Tick removal and washing of external auditory canal was done successfully. The causative tick was identified as the H. longicornis. To our knowledge, this is the first reported case of human otoacariasis by a H. longicornis in Korea.

Clinical characteristics of acquired ungual fibrokeratoma.

BACKGROUND: Acquired ungual fibrokeratomas are uncommon fibrous tissue tumors located in the ungual area. Though there are many reports of this entity, only some reports have reviewed the clinical features of the tumor. AIMS: The aim of this study was to clarify the clinical characteristics of acquired ungual fibrokeratomas. METHODS: We reviewed twenty patients who were treated surgically at our clinic from 2003 to 2014 for acquired ungual fibrokeratomas confirmed on histopathological examination. Our study was conducted by retrospective analysis of charts, clinical pictures and patient records. Cases of tuberous sclerosis were not included. RESULTS: Acquired ungual fibrokeratomas occurred on toenails in 16 (80%) patients and on fingernails in 4 (20%) patients. Periungual lesions were noted in 15 (75%) patients followed by intraungual lesions in 4 (20%) patients and subungual lesions in 1 (5%) patient. A longitudinal groove was observed in 80% of patients. Surgical resection was performed in all cases for both medical and cosmetic reasons. After excision, recurrence occurred in three cases. LIMITATIONS: This was a retrospective study of a limited number of patients. CONCLUSIONS: Acquired ungual fibrokeratomas occurred more commonly on toenails than on fingernails and were located in the periungual area in most patients. A longitudinal groove in the nail plate was a frequent finding. Surgical resection led to medical and cosmetic improvement with a recurrence in 3 (15%) patients.

Onychomatricoma: A Rare Tumor of Nail Matrix.

Onychomatricoma is a rare tumor of the nail matrix. Until now, few cases of onychomatricoma have been reported in the literature. Immunohistochemically, CD10, a marker of the onychodermis, is expressed in the stroma of the onychomatricoma. In the present case, a 27-year-old woman presented with an 8-year history of a yellowish, thickened, and overcurved nail plate of the right index finger, mimicking onychomycosis. She had been treated for 4 years with antifungal agents by general physicians, without improvement. The nail was surgically removed, and the tumor at the nail matrix was excised. The nail plate continued to grow in the 2 months after the excision. This is a case of onychomatricoma in South Korea, which was initially misdiagnosed as onychomycosis. In addition, we present a review of the literature regarding clinical, sonographic, and histological features, differential diagnoses, and treatment of onychomatricoma.

Nail lichen striatus: report of seven cases and review of the literature.

BACKGROUND: Nail involvement in lichen striatus (LS) is rare and has not been documented extensively. OBJECTIVES: This study describes the clinical and histological features, response to treatment, and follow-up in seven patients with nail LS. METHODS: We reviewed seven cases of nail LS between 2006 and 2012 at the Dermatology Department, Yeouido St Mary's Hospital, Seoul, South Korea. RESULTS: The median patient age was 11 years (range: 4-33 years), and the female:male ratio was 3:4. All patients had both typical skin lesions and nail abnormalities. In these cases, LS usually involved a single digit (n = 5). The most common nail change was longitudinal fissuring (n = 4). We actively treated both skin and nail lesions from the time of diagnosis. Most nail lesions resolved within a mean of four months of the initiation of treatment. CONCLUSIONS: Nail involvement in LS is rare; this case series highlights the associated nail changes. We emphasize that early accurate diagnosis and treatment may be beneficial in reducing nail deformities in patients with nail involvement.

Epidemiology of deep cutaneous fungal infections in Korea (2006-2010).

Deep cutaneous fungal infections (DCFI) occur worldwide and their prevalence is influenced by personal factors of the affected patients and the geographic and cultural features. Surveillance studies of DCFI with respect to the various clinical backgrounds of affected patients can ultimately help to improve their outcome. Expanding on our previous study, we performed a retrospective analysis of patients with DCFI who were treated in a group of university teaching hospitals in Korea to determine the trends within a 5-year period. A retrospective medical record review of patients with DCFI treated between 2006 and 2010 at 16 university teaching hospitals located throughout Korea was performed. Among the 51 cases of DCFI (median patient age, 47.0 years), opportunistic infections in immunocompromised hosts accounted for half. Patients in this group included 11 who were transplant recipients and 12 with malignancies. Overall, Candida (13/51) was the most common causative organism, followed by Sporothrix (12) and Aspergillus (6). Papuloplaques and nodular lesions were the typical presentation, with maculopatches and ulcers also occurring in considerable numbers. Ten patients had systemic involvement. Eight immunocompromised patients did not recover from the disease despite systemic antifungal treatment. Our results highlight the equal involvement of opportunistic and primary pathogens in DCFI, as determined in cases from a 5-year period. Especially in immunocompromised hosts with non-specific skin findings, clinical suspicion is important because failure to diagnose a DCFI causes significant morbidity and possibly even death.

Great toenail dystrophy: a single-center experience and review of the literature.

BACKGROUND: There have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND. METHODS: Twenty-one patients with acquired GTND who visited Yeouido St. Mary's Hospital between June 2005 and August 2012 were retrospectively reviewed. RESULTS: The mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case. CONCLUSION: This study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.

Anaplastic lymphoma kinase-positive anaplastic large cell lymphoma arising in a patient with hypersensitivity to mosquito bites.

Hypersensitivity to mosquito bites is defined as the appearance of intense skin reactive lesions and systemic symptoms subsequent to mosquito bites. Most cases of hypersensitivity to mosquito bites reported thus far have been associated with chronic Epstein-Barr virus infection or natural killer cell leukemia/lymphoma. In this study, we describe the case of an 18-year-old Korean boy who had hypersensitivity to mosquito bites associated with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. After a mosquito bite, the patient developed a progressive cutaneous nodule on his left lower leg and regional lymphadenopathy in the left inguinal area. The histopathological and immunohistochemical findings suggested anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Positron emission tomography-computed tomography revealed increased fluorodeoxyglucose uptake in the left T4 vertebrae, left external iliac lymph nodes, left inguinal lymph nodes, and lateral subcutaneous region of the left lower leg. According to the clinical, histopathological, and immunohistochemical findings, as well as the imaging data, the patient was diagnosed with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Consequently, the patient received a total of 6 cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone chemotherapy at 3-week intervals, after which the lesions regressed.

Subungual soft tissue chondroma with nail deformity in a child.

Soft tissue chondroma is a rare benign tumor of the cartilage. It occurs commonly in distal extremities of middle-aged patients. It is usually asymptomatic and grows slowly, making early diagnosis difficult. We report a 10-year-old patient with a 1-year history of a subungual soft tissue chondroma on her left fifth finger. The lesion arose from nail bed and distal nail matrix, resulting in nail dystrophy. Magnetic resonance imaging revealed a soft tissue tumor in the subungual region and soft tissue chondroma was diagnosed, based on histopathologic findings. Dermatologists should consider soft tissue chondroma in the differential diagnosis of subungual tumors of children.

Expression of insulin-like growth factor-1 receptor in conventional cutaneous squamous cell carcinoma with different histological grades of differentiation.

BACKGROUND: Insulin-like growth factor-1 receptor (IGF-1R) is a key regulator of cell transformation and controls the expression of genes that governs cell cycling and cell survival. The aim of this pilot study was to gain insight into the expression pattern of IGF-1R in conventional cutaneous squamous cell carcinoma (CSCC) using immunohistochemical analysis. MATERIALS AND METHODS: Five cases of normal human paraffin-embedded skin sections, 4 cases of actinic keratosis, and 28 cases of paraffin-embedded sections of different histological subtypes of CSCC were selected for immunohistochemical analysis. RESULTS: In normal skin, IGF-1R expression was detected in the epidermal basal cell layer. In actinic keratosis, IGF-1R was expressed in the lower part of the epidermis. IGF-1R was detected in the cell surface membrane of well-differentiated CSCC. In moderately differentiated CSCC, IGF-1R was expressed predominantly in the cytoplasm. Interestingly, IGF-1R was expressed in the nuclei of tumor cells of poorly differentiated CSCC. CONCLUSIONS: The strong and differential expression of IGF-1R in different histological degrees of CSCC indicates a possible role for IGF-insulin receptor in the carcinogenesis and differentiation of this disease and identifies IGF-1R as an interesting target for prevention and treatment of CSCC that deserves further investigation.