A case of basaloid follicular hamartoma.

Basaloid follicular hamartoma (BFH), uncommon rare benign neoplasm connected to the adnexal structures, presents with multiple clinical manifestations that can develop into basal cell carcinoma. BFH may be congenital or acquired, and the congenital form can be further divided into the generalized and unilateral type, and the acquired form may present as localized and solitary lesions. Congenital, generalized BFH is associated with systemic diseases such as alopecia, cystic fibrosis, hypohidrosis, and myasthenia gravis. In contrast, sporadic cases are observed as unilateral or localized lesions. BFH shows thick cords and thin strands of anastomosing basaloid proliferations that arise from hair follicles and are enclosed by loose fibrous stroma. Here, we report a 70-year-old man with an acquired, solitary form of BFH.

Atrophic acne scar treatment using triple combination therapy: dot peeling, subcision and fractional laser.

Atrophic scars are a common complication of acne. Many modalities are proposed but each does not yield satisfactory clinical outcomes. Thus, a new combination therapy is suggested that incorporates (i) dot peeling, the focal application and tattooing of higher trichloroacetic acid concentrations; (ii) subcision, the process by which there is separation of the acne scar from the underlying skin; and (iii) fractional laser irradiation. In this pilot study, the efficacy and safety of this method was investigated for the treatment of acne scars. Ten patients received this therapy for a year. Dot peeling and subcision were performed twice 2-3 months apart and fractional laser irradiation was performed every 3-4 weeks. Outcomes were assessed using scar severity scores and patients' subjective ratings. Acne scarring improved in all of the patients completing this study. Acne scar severity scores decreased by a mean of 55.3%. Eighty percent of the patients felt significant or marked improvement. There were no significant complications at the treatment sites. It would appear that triple combination therapy is a safe and very effective combination treatment modality for a variety of atrophic acne scars.

Pigmented trichoblastoma arising from the nevus sebaceous: a rare case in Korea.

Trichoblastoma is occasionally observed in association with a pre-existing nevus sebaceous in the Korean literature. However, there has been no report on the pigmented type. Herein, we report the first Korean case of a pigmented trichoblastoma arising from the nevus sebaceous on the forehead. A 28-year-old male presented with a dark nodular lesion within a yellowish plaque on the forehead. The surrounding yellowish plaque on the forehead had existed since birth. The central, dark-pigmented nodule began to appear three years ago and enlarged gradually. Histopathologic findings of central pigmented lesion showed heavy melanin deposits within and around the tumor nests. Complete excision was made as treatment.

A Case of Vitiligo after Kawasaki's Disease.

Vitiligo is a common skin disease, but its pathogenesis has not been fully determined, though an autoimmune etiology is considered likely. Kawasaki disease (KD) is an acute multisystem vasculitis of childhood associated with coronary arteriopathy, and is diagnosed based on clinical criteria. Furthermore, vitiligo has been associated with several other diseases, but no report has been issued about the relationship between vitiligo and Kawasaki's disease. The author's report the case of an 8-year-old male child that presented with depigmented lesions, which developed from the desquamative skin lesions of Kawasaki's disease.

Two cases of melasma with unusual histopathologic findings.

We reported two cases of clinically typical melasma presenting with unusual histopathologic findings. In one case, the epidermal melanocytes were markedly increased in number and protruded into the dermis, and in the other case, increased epidermal pigmentation as well as dermal melanocytosis were found. We suggested that the various treatment modalities of melasma should be applied depend on its histopathologic finding.

Treatment of congenital nevi with the Q-switched Alexandrite laser.

Q-switched mode lasers have been utilized for treatment of many pigmentary lesions. Because of their short pulse durations (1-100 ns), these lasers selectively destroy pigment laden cells while sparing the surrounding normal tissues. To determine if the Q-switched alexandrite laser (QSAL) is effective in the treatment of congenital melanocytic nevi, 53 patients with these lesions were treated with QSAL; of these, 16 also received CO(2) laser treatment between QSAL treatments. We observed an average improvement score in the 53 treated patients of 2.623 + 1.13, corresponding to a 72% improvement. Treatment with the combination of QSAL and a CO(2) laser resulted in a significant enhancement of improvement score (3.06 +/- 1.18) compared to patients treated with the QSAL alone (2.43 +/- 1.07; p = 0.0393). Complications were mild, with 35 nevi (67.3%) showing textural change of skin after treatment, 2 (3.8%) showing depressed scar formation, and 4 (7.5%) showing hypertrophic changes, while 12 nevi (23%) showed no changes. Hypopigmentation was observed in 16 patients (30%), and hyperpigmentation was observed in 15 patients (28%) 48 weeks after the final QSAL treatment. Repigmentation to a brown to black spot was observed in 44/53 (83%) patients within an average of 5.45 +/- 3.93 months. These results indicate that the QSAL was as effective as other Q switch mode lasers in the treatment of congenital melanocytic nevi, but repigmentation is a problem.

Comparison of characteristics of acquired bilateral nevus of Ota-like macules and nevus of Ota according to therapeutic outcome.

Both acquired bilateral nevus of Ota-like macules (ABNOM) and nevus of Ota are characterized by the presence of dermal melanocytes. There are no differences in the method of treatment, however, postinflammatory hyperpigmentation (PIH) develops more often in ABNOM than in nevus of Ota following treatment. We investigated the differences in the development of PIH after treatment between ABNOM and nevus of Ota, and the histopathologic differences in the PIH. A total of 82 patients with ABNOM (n=47) and nevus of Ota (n=35) were treated with Q-switched alexandrite laser and followed up 2 weeks and 3 months later. Biopsies were performed on lesional skin before treatment. The distribution and the amount of melanin pigments were visualized with Fontana-Masson stain, and the distribution and the depth of melanocytes were measured by GP-100 (NK1-beteb) stain. Clinically, there was more erythema and PIH in ABNOM than in nevus of Ota. Histopathologically, intradermal melanocytes were clustered in groups and dispersed perivascularly in ABNOM, while melanocytes were scattered evenly throughout the dermis in nevus of Ota. Both groups show that when there is a statistically significant number of melanocytes in the perivascular area, erythema and PIH occur after laser therapy. In conclusion, indirect vessel injury in addition to perivascular clustering melanocytes might be considered the cause of increased PIH after treatment in ABNOM.

Leukomelanoderma following acute cutaneous graft-versus-host disease.

Acute graft versus host disease (GVHD) is characterized by a selective epithelial inflammation that can affect the skin, digestive tract, and liver. Development of pigmentary abnormalities can be observed in sites where acute cutaneous GVHD has occurred, and usually consists of hyperpigmented spots. We observed atypical pigmetary changes consisting of a combination of hyper- and hypopigmentation, so called leukomelanoderma, in a young allogeneic bone marrow recipient who suffered repetitive acute GVHD. The histopathological examinations showed features of a post-inflammatory process. Because keratinocytes produce inflammatory cytokines including tumor necrosis factor (TNF)-alpha and interleukin (IL)-1alpha, which may be implicated in the inflammatory phenomena seen in acute GVHD, we studied whether these inflammatory cytokines might be implicated in these pigmentary changes. The cytokines tested were IL-1alpha, IL-2, TNF-alpha and IL-10. The expression of TNF-alpha increased in the hyperpigmented skin relative to normal and hypopigmented skin. While TNF-alpha was variably distributed in proportion to different degrees of pigmentation, other molecules were detected at minimal levels in all samples. This observation may indicate that the production of TNF-alpha by epidermal microenvironment may be involved in postinflammatory pigmentary changes.

Recurrent pigmented macules after q-switched alexandrite laser treatment of congenital melanocytic nevus.

BACKGROUND: Q-switch-mode laser treatment of congenital nevi does not result in complete histological clearance, and many patients have partial repigmentation within several months. In addition, the number of recurrent pigmented macules (RPMs) may increase, a major drawback to good cosmetic results. While the mechanism of recurrence is not known. OBJECTIVE: To help elucidate the mechanism of RPM development, we evaluated the expression of TNF-alpha and E-cadherin on RPM after treatment of congenital nevi with a Q-switched alexandrite laser (QSAL). METHODS: Thirteen Korean subjects with congenital nevi received QSAL treatment at intervals ranging from 2 to 6 months (mean, 4.5 treatments). Two-millimeter punch biopsy specimens were obtained at their first visit and from RPMs 3-6 months after the last treatment. Expression of E-cadherin and TNF-alpha were determined histochemically in the original nevi and RPM. In addition, one RPM was examined by electron microscopy. RESULTS: Reduced pigmentation in the treated areas was seen in all cases, but partial repigmentaion was seen as black spots within 6 months after the last QSAL treatment. Compared to the original nevi, the RPMs had increased numbers of melanocytes in the epidermis and reduced nevomelanocytic nests in the dermis. The expression of TNF-alpha and E-cadherin was downregulated in the RPMs compared to the original nevi. Electron microscopy confirmed the increase in melanocytes in the epidermis of RPMs. CONCLUSION: Our findings suggest that the down-regulation of E-cadherin and TNF-alpha may induce the proliferation of melanocytes, resulting in the formation of RPMs.

Effect of cyclosporin A on melanogenesis in cultured human melanocytes.

Cyclosporin A (CsA) is a widely used immunosuppressant. Reports on the effect of CsA on hyperpigmentation in patients appear inconsistent, and the effect of CsA on skin pigment cells (melanocytes) in vitro is unknown. We examined the effect of CsA on human melanocyte proliferation and melanogenesis in vitro. Melanocyte proliferation was dose-dependently inhibited by 0.1-10 microM CsA, with no effect on cell viability. Melanocytes incubated with 10 microM CsA for 6 days showed decreased pigmentation and tyrosinase activity. Western blot analysis using an anti-tyrosinase antibody revealed that CsA (0.1-10 microM) decreased tyrosinase protein levels in a dose-dependent manner. Northern blot analysis showed similar effects on tyrosinase mRNA levels. These effects of CsA on melanogenesis in vitro are not consistent with suggestions that systemic CsA therapy causes patient skin hyperpigmentation.

Bilateral type of nevus of Ota presenting as agminated lentigines.

We report a 30-year-old female patient with a history of hyperpigmented macules of the face since the age of 7 years. The clinical appearance, brown macules in multiple segmental or grouped patterns, was suggested to be agminated lentigines. However, histologic examination of the pigmented macule revealed scattered melanocytes within the dermis. We diagnosed this lesion as a bilateral type of nevus of Ota presenting as agminated lentigines. The differential diagnosis from acquired bilateral nevus of Ota-like macules was made.

Role of dermal melanocytes in cutaneous pigmentation of stasis dermatitis: a histopathological study of 20 cases.

Stasis dermatitis is an itchy, scaly, and hyperpigmented condition of the lower leg due to venous insufficiency. Hemosiderin and/or melanin have been considered responsible for the brown pigmentation. However, there are not sufficient histopathologic studies. In this retrospective study the hospital records and biopsy slides of 20 patients were reviewed to determine the pathogenetic mechanisms of brown pigmentation in stasis dermatitis. Fifteen were men (75%) and 5 were women (25%) with a mean age of 46.2+/-8.2 yr (18-76), mean age at onset of 43.4+/-18.0 yr (17-73), and a mean duration of the disease 2.8+/-2.5 yr (0.25-10). All patients had varicose vein and complained of pruritus. On histopathologic evaluation, two cases out of 20 (3 skin biopsy specimens from 25 samples) showed dermal melanocytes containing melanin, and incontinence of melanin pigment was observed in 5 cases, which indicates that melanin pigments from epidermis could contribute to cutaneous pigmentation in stasis dermatitis. However, the existence of dermal melanocytes in two cases cannot be explained because normally the dermis contains no melanocytes. Further studies concerning the role of iron or inflammatory cytokines on the development of dermal melanocytes should be conducted.

Donor specific response of estrogen and progesterone on cultured human melanocytes.

The mechanisms of estrogen and progesterone in human cutaneous pigmentation are largely unknown. The molecular identification of estrogen receptor (ER) and progesterone receptor (PR) in the human melanocytes is of great importance to understand the mechanisms. We performed immunocytochemistry analysis and demonstrated that ER and PR were expressed in the cytoplasms and nuclei of human melanocytes. Reverse transcriptase-polymerase chain reaction (RT-PCR) and sequence analysis confirmed the expression of ER and PR at the transcriptional level. Despite of the presence of ER and PR, the physiological and pregnant levels of estrogen and progesterone showed inconsistent effects on the proliferation and tyrosinase activity of cultured human melanocytes. These results suggest that human melanocytes express ER and PR, which have a donor-specific action in human pigmentation. Further studies are needed to elucidate the induction mechanism and functions of these receptors, and the role of estrogen and progesterone in melanocytes.