47 years of my contribution for the Society of Korean Leprologists. With congratulations to 60th anniversary of the Foundation of the Soeiety / 나학회지

No abstract available.

Pattern Alopecia during Hormonal Anticancer Therapy in Patients with Breast Cancer

We report five cases of pattern alopecia in female patients who are undergoing hormonal anticancer therapy for the prevention of recurrence of breast cancer after surgery. Three patients demonstrated male pattern alopecia with receding frontal hairlines, and two patients demonstrated female pattern alopecia without receding hairlines. The detailed clinical history showed that the pattern alopecia of the patients developed after the full recovery of global hair loss of the entire scalp due to previous cytotoxic chemotherapy. All of the adjuvant hormonal anticancer drugs that were used in the patients are antiestrogenic agents, either aromatase inhibitors or selective estrogen receptor modulators. Considering androgen effect on the hair follicles of the fronto-parietal scalp, the androgen-estrogen imbalance caused by the drugs was thought to be the reason for the onset of pattern alopecia in the patients. In general, alopecia that develops during cytotoxic chemotherapy is well known to both physicians and patients; however, the diagnosis of pattern alopecia during hormonal anticancer therapy in breast cancer patients seems to be overlooked.

The Three Dimensional Conformal Radiotherapy for Hyperkeratotic Plantar Mycosis Fungoides

The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.

A Case of Neurofibromatosis with Multiple Pseudoatrophic Macules / 대한피부과학회지

Neurofibroma usually manifests as a soft nodule that protrudes from the skin surface of patients with neurofibromatosis. Pseudoatrophic macule is a rare variant of neurofibroma, and it is described as a slightly depressed macular lesion. To the best of our knowledge, only one case of neurofibromatosis associated with pseudoatrophic macules has been reported in the Korean dermatologic literature. A 20-year-old man presented with multiple round shaped macules scattered on the trunk. The surface of the skin lesion was slightly depressed compared with the normal adjacent skin. He had multiple cafe-au-lait macules on the body and freckles in the axillae and inguinal areas. Histopathologic examination of the depressed macule demonstrated a relatively well-demarcated mass that was composed of spindle cells intermingled with loosely arranged collagen fibers in the dermis. The spindle cells showed a positive reaction for S-100 protein. Herein, we report on a rare case of type 1 neurofibromatosis with multiple pseudoatrophic macules.

Clinicohistopathological Study of Recurrent Basal Cell Carcinomas after Surgical Excision / 대한피부과학회지

BACKGROUND: Basal cell carcinoma in Korea is the most common skin cancer and its incidence is increasing at a steady rate. It is not unusual for dermatologists to experience the recurrence of tumor after surgery but there is no data on recurrent basal cell carcinoma in Korea. OBJECTIVE: The aim of this retrospective survey was to determine the clinical and histopathological characteristics of recurrent basal cell carcinoma after surgical excision in Korean patients. METHODS: We analyzed clinical findings and histopathologic subtypes of 21 cases of recurrent basal cell carcinoma after surgical excision among 480 cases diagnosed between January of 1980 and December of 2006 at the Department of Dermatology, Chonbuk National University Hospital. RESULTS: Overall recurrence rate was 4.38%. The average interval between the surgical excision of the primary tumor and recurrence was 40.8 months. The mean age of the patients was 65.1 years old and the ratio of men to women was 1 : 2. The most frequent location of the tumor recurrence was the nose and the mean size was 1.2 cm. There were no immunocompromised patients with underlying disorders, but two patients had taken corticosteroid for an extended period of time. The most common histological subtype of the primary and the recurrent basal cell carcinoma was nodular type. Six cases of primary basal cell carcinomas of nodular type transformed to aggressive subtype when they recurred. Perineural involvement of the primary basal cell carcinoma was found in 5 cases. CONCLUSION: This study demonstrates the clinicopathological features of recurrent basal cell carcinoma in the Korean population and we hope this data would be of help to dermatologists when treating Korean patients with basal cell carcinoma.

A Case of Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) / 대한피부과학회지

Paraneoplastic autoimmune multiorgan syndrome (PAMS) is also known as paraneoplastic pemphigus, and this is a heterogenous autoimmune syndrome involving the skin, mucosa and internal organs and it is caused by autoantibodies related to the underlying neoplasm. Painful stomatitis is the earliest and most constant feature. The cutaneous lesions of this disease are polymorphic. The majority of cases of this syndrome are associated with a lymphoproliferative disorder such as non-Hodgkin lymphoma, chronic lymphocytic leukemia and Castleman disease. A 40-year-old woman presented with a 1-month history of a pruritic erythematous papulomacular rash on the trunk and extremities. She also had a 4-month history of painful oral stomatitis that had failed to respond to steroid therapy. Despite the vigorous treatment, the skin lesions progressed to generalized polymorphic lesions with persistent oral lesions. The histopathologic findings of these lesions revealed polymorphous characteristics according to the clinical features, and they mimicked erythema multiforme, graft-versus-host disease, lichen planus and pemphigus vegetans. Finally, a mass of lymphatic tissue 7.2 cm in diameter and that was diagnosed as Castleman disease was found in her retroperitoneal pelvic cavity. With removal of the lymphatic mass, her skin lesions subsided except for the glossal lesion.

Evaluation of the Scalp Hair Mass of Koreans / 대한피부과학회지

BACKGROUND: Hair researchers in medical science have focused on the biology of a hair, but the general population and the patients with alopecia are concerned about their total external hair mass or the hair volume of the head. There have been many reported papers on hair, yet it is difficult to find papers that have evaluated the total hair mass of the head of normal persons. Objective: We wanted to assess the total scalp hair mass and its parameters by which the hair mass is made. METHODS: For 42 volunteers (22 males and 20 females, age range: 23 to 31 years old), the volume of total scalp hair mass was assessed by its total number of hairs, its density and the diameter of the hair via a unit area trichogram with performing dermoscopy and light microscopy. The proportions of terminal/intermediate/vellus hair, the anagen/non-anagen ratio and the growth rate of the scalp hairs were also assessed. The correlations of the hair length and the diameter were measured for 603 hairs taken from 14 alopecia areata patients only when they showed regrowth of normal hair. RESULTS: The results are summarized as follows. The total number of scalp hairs was 112,000 (males: 116,000, females: 106,000) with no statistical difference between genders. The average size of the scalp was 694.4 cm2 (727.4 cm2 in males and 658.0 cm2 in females) with a statistically larger size for the males. The average scalp hair density of the males and females was 159.7/cm2 (153.0/cm2 at the temporal area (T) and 166.5/cm2 at the parieto-occipital area (PO)) with no statistical difference according to gender. The average diameter of the scalp hair was 87.0micrometer: 84.9micrometer (86.0micrometer in males and 83.6micrometer in females) in the T and 89.0micrometer (89.4micrometer in males and 88.5micrometer in females) in the PO with no statistical difference according to the area of the scalp area or gender. The proportions of terminal/intermediate/vellus hair (%) were 86.5/8.8/4.7 and the proportions of anagen/non-anagen (%) hairs were 89.6%/10.4% with no statistical difference according to the area of the scalp area or gender. The time for new hair to emerge on the surface of the scalp after epilation was about 68.5 days with no statistical difference according to the area of the scalp or gender. After the hair emerged on the skin surface, the average growth rate for the first 1 month was 0.172 mm/day and 0.248 mm/day during the following month, and 0.35 mm/day thereafter. It took about 4 months for the newly emerging hair to reach 1 cm from the scalp surface. The correlation between the length and diameter of hair with assessing 603 hairs of the 14 alopecia areata patients in their recovery phase was as follows: the hair less than 10 mm in length showed a diameter of 20~40micrometer. It reached 60micrometer when the hair grew up to 18 mm in length. The diameter reached around 87micrometer when the length of the hair exceeded 35 mm and then the diameter kept its value. CONCLUSION: We numerically measured the various parameters of the hair mass of the head of normal Koreans in their twenties.

Evaluation of the Scalp Hair Mass of Koreans / 대한피부과학회지

BACKGROUND: Hair researchers in medical science have focused on the biology of a hair, but the general population and the patients with alopecia are concerned about their total external hair mass or the hair volume of the head. There have been many reported papers on hair, yet it is difficult to find papers that have evaluated the total hair mass of the head of normal persons. Objective: We wanted to assess the total scalp hair mass and its parameters by which the hair mass is made. METHODS: For 42 volunteers (22 males and 20 females, age range: 23 to 31 years old), the volume of total scalp hair mass was assessed by its total number of hairs, its density and the diameter of the hair via a unit area trichogram with performing dermoscopy and light microscopy. The proportions of terminal/intermediate/vellus hair, the anagen/non-anagen ratio and the growth rate of the scalp hairs were also assessed. The correlations of the hair length and the diameter were measured for 603 hairs taken from 14 alopecia areata patients only when they showed regrowth of normal hair. RESULTS: The results are summarized as follows. The total number of scalp hairs was 112,000 (males: 116,000, females: 106,000) with no statistical difference between genders. The average size of the scalp was 694.4 cm2 (727.4 cm2 in males and 658.0 cm2 in females) with a statistically larger size for the males. The average scalp hair density of the males and females was 159.7/cm2 (153.0/cm2 at the temporal area (T) and 166.5/cm2 at the parieto-occipital area (PO)) with no statistical difference according to gender. The average diameter of the scalp hair was 87.0micrometer: 84.9micrometer (86.0micrometer in males and 83.6micrometer in females) in the T and 89.0micrometer (89.4micrometer in males and 88.5micrometer in females) in the PO with no statistical difference according to the area of the scalp area or gender. The proportions of terminal/intermediate/vellus hair (%) were 86.5/8.8/4.7 and the proportions of anagen/non-anagen (%) hairs were 89.6%/10.4% with no statistical difference according to the area of the scalp area or gender. The time for new hair to emerge on the surface of the scalp after epilation was about 68.5 days with no statistical difference according to the area of the scalp or gender. After the hair emerged on the skin surface, the average growth rate for the first 1 month was 0.172 mm/day and 0.248 mm/day during the following month, and 0.35 mm/day thereafter. It took about 4 months for the newly emerging hair to reach 1 cm from the scalp surface. The correlation between the length and diameter of hair with assessing 603 hairs of the 14 alopecia areata patients in their recovery phase was as follows: the hair less than 10 mm in length showed a diameter of 20~40micrometer. It reached 60micrometer when the hair grew up to 18 mm in length. The diameter reached around 87micrometer when the length of the hair exceeded 35 mm and then the diameter kept its value. CONCLUSION: We numerically measured the various parameters of the hair mass of the head of normal Koreans in their twenties.

Magic Perm Alopecia / 대한피부과학회지

A 7 year-old girl had developed multiple bald patches on her scalp for two months and was treated as alopecia areata or trichotillomania at another institution. Biopsy findings of the scalp lesion showed catagen follicles, trichomalacia and pigment clumps in the hair canals with little inflammatory cell infiltrates. Careful history revealed the patient had had "a magic perm" - a hair-straightening perm - one month before the bald patch began to develop. The condition could be called "a magic perm alopecia" as a form of cosmetic traumatic alopecia. The alopecic lesions showed further extension for three to four months. The lesions were beginning to recover five months after they first developed.

Two Cases of Pityriasis Amiantacea / 대한피부과학회지

Pityriasis amiantacea is a distinct scalp disease characterized by asbestos-like, thick, adherent scales that engulf and bind down tufts of hair. Herein, we report two cases of pityriasis amiantacea. One case was a 75-year-old female who showed simultaneous keratotic follicular papules and psoriasiform dermatitis on her body. The other case was a 14 year old female showing seborrheic dermatitis on her face. Previously, only one case of pityriasis amiantacea had been reported in Korea.

Two Cases of Pityriasis Amiantacea / 대한피부과학회지

Pityriasis amiantacea is a distinct scalp disease characterized by asbestos-like, thick, adherent scales that engulf and bind down tufts of hair. Herein, we report two cases of pityriasis amiantacea. One case was a 75-year-old female who showed simultaneous keratotic follicular papules and psoriasiform dermatitis on her body. The other case was a 14 year old female showing seborrheic dermatitis on her face. Previously, only one case of pityriasis amiantacea had been reported in Korea.

A Case of Sclerosing Panniculitis / 대한피부과학회지

Sclerosing panniculitis is a subcutaneous disorder characterized by marked woody induration, erythema, edema, telangiectasia, and hyperpigmentation on the lower legs. It often occurs in patients who have venous insufficiency. The histologic features of sclerosing panniculitis are lobular panniculitis with membranocystic fat necrosis and variable septal fibrosis. We report a case of sclerosing panniculitis on the medial side of the left lower leg in a 51-year-old woman.

A Case of Borderline Lepromatous Leprosy Presenting in a Immigrant Woman / 나학회지

A 36 year-old woman immigrated from Nepal showed erythematous plaques on her face, buttock and legs one month after the immigration. Before the correct diagnosis was made, the patient had been erroneously treated as anallergic dermatitis for three months. Clinico-pathologically, her skin lesion was borderline lepromatous type leprosy with bacilli positive. We report the case to keep the high index of suspicion for leprosy when we meet with patients from the countries where leprosy is still epidemic.

Clinical and Pathological Features of Generalized Granuloma Annulare with Their Correlation: A Retrospective Multicenter Study in Korea

BACKGROUND: Generalized granuloma annulare (GGA) is a benign skin disorder of an unknown etiology. Though some cases of GGA have been reported, few systemic reviews of the clinical and pathological features of GGA have been performed. OBJECTIVE: The purpose of this study is to analyze and correlate the clinical and pathological characteristics of GGA in Korean patients. METHODS: We conducted a retrospective study that included 54 biopsy specimens of Korean GGA patients, and the clinical and pathological features of GGA were reviewed and analyzed for their correlation. RESULTS: The cutaneous lesions could be divided into the annular (24, 44%) and nonannular types (30, 56%), and the lesions were more common in males than in females (29 males and 25 females). The incidence of GGA showed a bimodal age distribution. The number of patients who presented within the first decade was 24 cases (44%), and 24 cases (44%) were over the fifth decade. Eight patients (15%) had systemic diseases. Especially, diabetes mellitus (DM) occurred only in the adult GGA patients over forty years old. The pathological findings showed dermal granulomatous lesions that consisted of either a palisading pattern (28, 52%) or an interstitial pattern (26, 48%). CONCLUSION: In contrast to the previously reported studies, the age of GGA onset showed a bimodal distribution, and GGA was observed more often in males. The prevalence of DM in the GGA affected individuals was higher than that found in the general Korean population. Therefore, it is recommended to perform a work-up for DM in the GGA affected patients who are over forty years old.

Clinical and Pathological Features of Generalized Granuloma Annulare with Their Correlation: A Retrospective Multicenter Study in Korea

BACKGROUND: Generalized granuloma annulare (GGA) is a benign skin disorder of an unknown etiology. Though some cases of GGA have been reported, few systemic reviews of the clinical and pathological features of GGA have been performed. OBJECTIVE: The purpose of this study is to analyze and correlate the clinical and pathological characteristics of GGA in Korean patients. METHODS: We conducted a retrospective study that included 54 biopsy specimens of Korean GGA patients, and the clinical and pathological features of GGA were reviewed and analyzed for their correlation. RESULTS: The cutaneous lesions could be divided into the annular (24, 44%) and nonannular types (30, 56%), and the lesions were more common in males than in females (29 males and 25 females). The incidence of GGA showed a bimodal age distribution. The number of patients who presented within the first decade was 24 cases (44%), and 24 cases (44%) were over the fifth decade. Eight patients (15%) had systemic diseases. Especially, diabetes mellitus (DM) occurred only in the adult GGA patients over forty years old. The pathological findings showed dermal granulomatous lesions that consisted of either a palisading pattern (28, 52%) or an interstitial pattern (26, 48%). CONCLUSION: In contrast to the previously reported studies, the age of GGA onset showed a bimodal distribution, and GGA was observed more often in males. The prevalence of DM in the GGA affected individuals was higher than that found in the general Korean population. Therefore, it is recommended to perform a work-up for DM in the GGA affected patients who are over forty years old.

Two Cases of Linear Alopecia on the Occipital Scalp

Alopecia of a scalp shows various shapes and extents of hair loss, from a small round patch to polymorphous patches or total global alopecia. But alopecia of a linear shape is very rare. Only a few such cases have currently been reported in the medical literature. We recently had the chance to observe and treat two cases of linear alopecia that developed on the occipital scalp. The lesions themselves were like alopecia areata that shows a smooth bald area without any abnormality except the hair loss, but histopathologically, the lesions were compatible with lupus erythematosus profundus.

Two Cases of Linear Alopecia on the Occipital Scalp

Alopecia of a scalp shows various shapes and extents of hair loss, from a small round patch to polymorphous patches or total global alopecia. But alopecia of a linear shape is very rare. Only a few such cases have currently been reported in the medical literature. We recently had the chance to observe and treat two cases of linear alopecia that developed on the occipital scalp. The lesions themselves were like alopecia areata that shows a smooth bald area without any abnormality except the hair loss, but histopathologically, the lesions were compatible with lupus erythematosus profundus.

Proper Concentration of Diphenylcyclopropenone Solution according to the Anatomical Location and Application Time Interval for the Treatment of Warts / 대한피부과학회지

BACKGROUND: Topical diphenylcyclopropenone (DPCP) application on a daily or weekly basis has been used for the treatment of warts that affect different sites of the body. The concentration of DPCP for the treatment of warts needs to be determined according to the body site. In addition, the therapeutic response to DPCP application intervals needs to be evaluated for the treatment of warts. OBJECTIVE: The purpose of this study was to determine the minimal DPCP concentration required to induce an elicitation reaction in different body sites of patients with warts and to assess the therapeutic response of wart treatment with daily and weekly applications of DPCP. METHODS: Thirty patients with warts were divided into two groups. Each patient in the two groups was sensitized with 0.1% or 0.2% DPCP. After sensitization, in the first group of patients, DPCP was applied to warts daily. In the second group of patients, DPCP was applied to warts weekly. The initial concentration of DPCP was 0.01% for warts located on the palmoplantar area, periungual area and the dorsum of the hand, knee and upper arm. The initial concentration of DPCP was 0.004% for warts on the face. If no reaction was observed, the DPCP concentration (0.01%, 0.025%, 0.05%, 0.1%, 0.25%, 0.5%, 1% and 2%) was increased stepwise. The minimal concentration of DPCP to induce an elicitation reaction and treatment results were evaluated. RESULTS: The minimal concentrations of DPCP to induce an elicitation reaction were as follows: 0.004~0.01% for the face, 0.01~0.025% for the dorsum of the hand, 0.25~1% for the periungual area and 0.5~2% for the palmoplantar area. The results of weekly application of DPCP were similar as compared to the daily application of DPCP for the treatment of warts. CONCLUSION: Although further studies are needed, our study suggests that the DPCP concentration needs to be adjusted according to the body site and that the weekly use of DPCP may be a convenient alternative to daily use to treat warts.

A Case of Papular Granuloma Annulare Occurringon the Site of Herpes Zoster: Isotopic Response / 대한피부과학회지

Isotopic response describes the occurrence of a new skin disorder on the site of another, unrelated, and already healed skin disease. The most common cause of isotopic response in the skin is the herpes zoster virus. Variable cutaneous lesions including granulomatous reactions may occur at sites of herpes zoster infections. We report a case of papular granuloma annulare occurring on the site of herpes zoster.

Current View upon Permanent Impairment of Outward Appearance / 대한피부과학회지

No abstract available.