Morgellons Disease.

Morgellons disease is a rare disease with unknown etiology. Herein, we report the first case of Morgellons disease in Korea. A 30-year-old woman presented with a 2-month history of pruritic erythematous patches and erosions on the arms, hands, and chin. She insisted that she had fiber-like materials under her skin, which she had observed through a magnifying device. We performed skin biopsy, and observed a fiber extruding from the dermal side of the specimen. Histopathological examination showed only mild lymphocytic infiltration, and failed to reveal evidence of any microorganism. The polymerase chain reaction for Borrelia burgdorferi was negative in her serum.

Comparison of Efficacy and Safety Between Propranolol and Steroid for Infantile Hemangioma: A Randomized Clinical Trial.

Importance: There are limited data from randomized clinical trials comparing propranolol and steroid medication for treatment of infantile hemangioma (IH). Objective: To determine the efficacy and safety of propranolol compared with steroid as a first-line treatment for IH. Design, Setting, and Participants: This randomized clinical noninferiority trial tested the efficacy and safety of propranolol vs steroid treatment for IH at a single academic hospital. All participants were diagnosed with IH between June 2013 and October 2014, had normal heart function, and had not been previously treated for IH. Interventions: The participants were randomly assigned to either the propranolol group or the steroid group. In the propranolol group, the patients were admitted, observed for adverse effects for 3 days after treatment initiation, and then released and treated as outpatients for 16 weeks (2 mg/kg/d). In the steroid group, the patients were seen as outpatients from the beginning and were also treated for 16 weeks (2 mg/kg/d). Main Outcomes and Measures: The primary efficacy variable was the response to treatment at 16 weeks, which was evaluated by the hemangioma volume using magnetic resonance imaging before and at 16 weeks after treatment initiation. While comparing the effect of medication between the groups, we monitored the adverse effects of both drugs. Results: A total of 34 patients (15 boys, 19 girls; mean age, 3.3 months; range, 0.3-8.2 months) were randomized to receive either propranolol or steroid treatment (17 in each treatment group). Guardians for 2 patients in the steroid group withdrew their consent, and 1 patient in the propranolol group did not complete the efficacy test. The intention-to-treat analysis, applying multiple imputations, found the treatment response rate in the propranolol group to be 95.65%, and that of the steroid group was 91.94%. Because the difference in response rate between the groups was 3.71%, propranolol was considered noninferior. We found that there was no difference between the groups in safety outcomes. Conclusions and Relevance: Our trial demonstrated that propranolol was not inferior to steroid with respect to therapeutic effects in IH. Trial Registration: clinicaltrials.gov Identifier: NCT01908972.

Dermoscopic patterns of fungal melanonychia: A comparative study with other causes of melanonychia.

BACKGROUND: Diagnosing fungal melanonychia (FM) is often difficult because it mimics melanonychia caused by other factors. Dermoscopy is helpful in the setting of nail pigmentation. However, the diagnostic characteristics of FM on dermoscopy are not fully elucidated. OBJECTIVE: We sought to determine the dermoscopic characteristics of FM. METHODS: We evaluated the dermoscopic patterns of FM diagnosed at 2 university hospitals from January 2010 to February 2016. We included nail matrix melanocytic activation, nail matrix nevi, and nail unit malignant melanomas as control groups for comparison. RESULTS: In all, 18 FM, 24 melanocytic activation of the nail matrix, 27 nail matrix nevi, and 11 malignant melanoma cases were analyzed. Statistical analysis revealed that yellow color, multicolor pattern, nonlongitudinal homogenous pattern, reverse triangular pattern, subungual keratosis, white or yellow streaks, and scales on the nail were more frequent in FM. However, gray color, longitudinal pattern, and pseudo-Hutchinson sign were less frequent in FM than in controls. LIMITATIONS: This was a retrospective study from 2 university hospitals, with a small sample size. CONCLUSION: The results revealed distinctive dermoscopic patterns for FM. Therefore, dermoscopy can be a useful ancillary tool for diagnosing FM.

Dermoscopic features of nail matrix nevus (NMN) in adults and children: A comparative analysis.

BACKGROUND: Nail matrix nevus (NMN) is one cause of longitudinal melanonychia. The typical dermoscopic patterns of NMNs are well established. However, little is known about how the dermoscopic characteristics of NMNs differ between adults and children. OBJECTIVE: We sought to compare the dermoscopic characteristics of NMNs between adults and children. METHODS: We retrospectively reviewed the medical records of patients in whom NMN was diagnosed between 2005 and 2014. RESULTS: The dermoscopic findings of 58 NMNs from 56 children and 35 NMNs from 34 adults were analyzed. Pigmentation tended to be broader in children, without statistical significance (P = .062). Moreover, NMNs in children were darker and multicolored (P < .001). Pseudo-Hutchinson sign (P = .004), triangular sign (P = .001), and dots/globules (P = .004) were detected more commonly in children. An irregular pattern and Hutchinson sign were also found more frequently in children, without statistical significance (P = .071 and P = .249, respectively). LIMITATIONS: This was a retrospective study in a tertiary-level hospital. CONCLUSION: The dermoscopic findings showed that NMNs have more melanoma-associated features in children than in adults.

Alternative method for creating fine hairs with hair removal laser in hair transplantation for hairline correction.

BACKGROUND: Foremost fine hairs in the frontal hairline region are critical in hair transplantation for hairline correction (HTHC) in women. However, there are few studies on a nonsurgical revisionary method for improving an unnatural foremost hairline with thick donor hairs resulting from a previous HTHC. OBJECTIVE: To investigate the efficacy and safety of using a hair removal laser (HRL) system to create fine hairs in Asian women with thick donor hairs. METHODS: Through a retrospective chart review, the HRL parameters, hair diameter (measured with a micrometer before and after the procedures), subjective results after the procedures, adverse effects, and the number of procedures were investigated. The reduction rate of the hair diameter was calculated. RESULTS: Twenty-four women who received long-pulse Neodymium-Doped:Yttrium Aluminum Garnet therapy after HTHC were included. The parameters were as follows: delivered laser energy, 35~36 J/cm(2); pulse duration, 6 ms; and spot size, 10 mm. The mean number of laser sessions was 2.6. The mean hair diameter significantly decreased from 80.0±11.5 µm to 58.4±13.2 µm (p=0.00). The mean rate of hair diameter reduction was -25.7% (range, -44.6% to 5.7%). The number of laser sessions and the hair diameter after the procedures showed a negative correlation (r=-0.410, p=0.046). Most of the patients (87.5%) reported subjective improvement of their hairlines. Most complications were transient and mild. CONCLUSION: HRL can be an alternative method for creating fine hairs and revising foremost hairline in Asian women with thick donor hairs.

A Novel Approach for Full-Thickness Defect of the Nasal Alar Rim: Primary Closure of the Defect and Reduction of the Contralateral Normal Ala for Symmetry.

In full-thickness defects of the nasal alar rim, to achieve projection and maintain airway patency, cartilage graft is frequently needed. However, cartilage graft presents a challenge in considerations such as appropriate donor site, skeletal shape and size, and healing of the donor area. To avoid these demerits, we tried primary closure of alar rim defects by also making the contralateral normal ala smaller. We treated two patients who had a full-thickness nasal alar defect after tumor excision. Cartilage graft was considered for the reconstruction. However, their alar rims were overly curved and their nostril openings were large. To utilize their nasal shape, we did primary closure of the defect rather than cartilage graft, and then downsized the contralateral nasal ala by means of wedge resection to make the alae symmetric. Both patients were satisfied with their aesthetic results, which showed a smaller nostril and nearly straight alar rims. Moreover, functionally, there was no discomfort during breathing in both patients. We propose our idea as one of the reconstruction options for nasal alar defects. It is a simple and easy-to-perform procedure, in addition to enhancing the nasal contour. This method would be useful for patients with a large nostril and an overly curved alar rim.

Remission period in psoriasis after multiple cycles of narrowband ultraviolet B phototherapy.

The aim of this study was to investigate the duration of remission periods in psoriasis after narrowband ultraviolet B (NB-UVB) phototherapy, especially during multiple cycles of treatment. We analyzed 63 patients (101 cases) demonstrating marked improvement after NB-UVB phototherapy. The remission period was defined as the duration of time from the end of phototherapy until treatment using either phototherapy or systemic treatments was required again. It was found that an age of 60 years or older, history of systemic therapy within 6 months and three or more phototherapy cycles were significantly associated with shorter remission periods. Furthermore, multivariate analysis confirmed that three or more phototherapy cycles (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.73-9.33; P = 0.001) and a history of systemic therapy (OR, 2.2; 95% CI, 1.27-3.95; P = 0.005) were independently associated with the shorter remission period. In conclusion, when planning NB-UVB phototherapy for psoriatic patients who have undergone multiple phototherapy cycles, clinicians should consider the possibility of shorter remission periods.