Perianal Pseudoverrucous Papules and Nodules in an Elderly Patient.

Pseudoverrucous papules and nodules is a reaction to irritation usually associated with urostomies. We report a case of perianal pseudoverrucous papules and nodules in an elderly patient who developed a characteristic diaper dermatitis after infrequent diaper change. The perianal papulonodular lesions improved after saline wet dressing and topical steroid application. These perianal pseudoverrucous papules and nodules indicate a unique type of irritant diaper dermatitis, which can be distinguished from Jacquet erosive diaper dermatitis and granuloma gluteale adultorum. Identifying this condition is important because pseudoverrucous papules and nodules can resemble more serious dermatoses, leading to unnecessary investigations being carried out.

Perifollicular Xanthoma Occurring in Patients after Erlotinib Treatment.

Erlotinib (Tarceva®) is a drug used for the treatment of non-small cell lung cancer in patients with epidermal growth factor receptor (EGFR) mutations. Since EGFR is expressed in the skin, EGFR inhibitors commonly develop cutaneous side effects such as acneiform eruption, paronychia, telangiectasias, and abnormal eyelash growth. A 56-year-old man and a 46-year-old man visited the dermatology clinic complaining of yellowish papuloplaques and acneiform eruption on the face. They had been treated with erlotinib for lung cancer. Since patients using EGFR inhibitors are increasing, physicians should be aware that xanthomatous change can occur in severe acneiform eruptions after erlotinib treatment.

A Case Report of Necrotizing Eosinophilic Folliculitis Occurring After Rhus Ingestion.

Necrotizing eosinophilic folliculitis is known as a rare variant of eosinophilic folliculitis (EF). It differs from classic EF because of its necrotizing ulcerative clinical course. We report a case of necrotizing eosinophilic folliculitis accompanied by pathergic phenomenon that may be the result of a delayed type hypersensitivity reaction occurring after Rhus consumption. Painful pyodermic plaques developed in a 48-year-old man, over a 5-day period, which was associated with facial edema. The lesions appeared 2 days after ingestion of Rhus. His face showed multiple painful pruritic papules that coalesced into crusted plaque accompanied by hemorrhagic eschars. At the periphery of the plaques, multiple erythematous papules and pustules were noticed. Prominent tissue eosinophilia was noticed from the skin biopsy samples. Also, there were areas of follicular mucinosis and eosinophilic folliculitis as well as hemorrhagic scale crust over the surface. Based on the clinical and histologic findings, the patient was diagnosed as necrotizing eosinophilic folliculitis occurring after Rhus ingestion. The lesions rapidly cleared after starting treatment with systemic steroid and dapsone. Clinicians should be aware that necrotizing eosinophilic folliculitis may occur after Rhus contact or consumption, in order to diagnose and treat patients promptly and reduce patient discomfort and skin scarring.

Anti-Inflammatory Effects of Heat-Processed Artemisia capillaris Thunberg by Regulating IκBα/NF-κB Complex and 15-PGDH in Mouse Macrophage Cells.

Growing evidence suggests that dietary nutrients in herbs and plants are beneficial in improving inflammatory disorders. Artemisia capillaris Thunberg (AC) is a traditional herbal medicine widely used in East Asia to treat pain, hepatotoxicity, and inflammatory disorders. Heat processing is a unique pharmaceutical method used in traditional herbal medicine to enhance the pharmacological effects and safety of medicinal plants. This study demonstrates the anti-inflammatory effects of heat-processed AC (HPAC) in lipopolysaccharide- (LPS-) treated mouse macrophage cells. HPAC reduced LPS-induced inflammatory mediators such as IL-6, IL-1ß, TNF-α, NO, and PGE2 in RAW 264.7 cells. Interestingly, 15-PGDH appears to play a pivotal role rather than COX-2 and mPGES-1 when HPAC regulated PGE2 levels. Meanwhile, HPAC showed anti-inflammatory effects by blocking IκBα phosphorylation and NF-κB nuclear translocalization. Also, we found that HO-1 upregulation was mediated by the mitogen-activated protein kinase (MAPK) pathways in HPAC-treated RAW 264.7 cells. And, in RAW 264.7 cells challenged with LPS, HPAC restored HO-1 expression, leading to NF-κB inhibition. Through further experiments using specific MAPK inhibitors, we found that, in response to LPS, the phosphorylated IκBα and activated NF-κB were attenuated by p38 MAPK/HO-1 pathway. Therefore, HPAC targeting both the IκBα/NF-κB complex and 15-PGDH may be considered as a potential novel anti-inflammatory agent derived from a natural source.

Post Treatment Application of Jaungo after a Combined Therapy of Carbon Dioxide Laser and Trichloroacetic Acid in a Case of Vulvar Syringoma.

Syringoma is a benign eccrine sweat gland tumor that predominantly appears in females during puberty with multiple smooth papules measuring 1-2 mm in diameter. Common locations are on lower eyelids and cheeks. Vulvar syringoma is quite a rare, occurring condition with only a few cases reported. Here, we are reporting a case of 31-year-old female with vulvar syringoma associated with pruritus. The lesion was treated with carbon dioxide (CO2) laser ablation and 50% trichloroacetic acid (TCA) chemical peeling. Jaungo was used for wound care after laser abrasion. The combination treatment was effective for removing syringoma lesions. Post laser management with fusidic acid cream and jaungo cream was sufficient to prevent infection and promote wound healing.

An Insight into Ginsenoside Metabolite Compound K as a Potential Tool for Skin Disorder.

Ginsenosides are the major bioactive natural compounds derived from Panax ginseng. Several studies report the pharmaceutical benefits of several ginsenosides, including antidementia, antitumor, and anti-inflammatory activity. Biotransformations by gut microbiome contribute to the biological function of these ginsenosides. After ingestion ginsenosides are hydrolyzed to Rg2, Rg3, compound K, and others by human gut flora. Compound K is considered the representative active metabolite after oral administration of ginseng or ginsenosides. Various studies report the diverse biological functions of compound K, such as antitumor, antidiabetic, antiallergic, and anti-inflammatory activity. Recent clinical trial and in vitro studies demonstrate the antiaging activities of ginsenosides in human skin. Ginsenosides have been considered as an important natural dermatological agent. In this review, we will cover the modern tools and techniques to understand biotransformation and delivery of compound K. Also the biological function of compound K on skin disorder and its potential dermatological application will be discussed.

A Case of Facial Partial Unilateral Lentiginosis Treated with Low-Fluence 1,064 nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser.

Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder characterized by numerous lentigines grouped within an area of normal skin. Although treatment is not necessary, many patients with facial PUL seek medical help for cosmetic reasons. There is no established standard treatment for PUL. Conventional lasers may cause postinflammatory hyperpigmentation because keratinocytes are injured during the process. Also, scarring, long downtime, and pain are important issues. A 19-year-old patient with facial PUL was successfully treated with low-fluence 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG) laser. Although the exact mechanism by which low-fluence 1,064-nm QS Nd:YAG laser improves pigmentary lesions is unclear, the terms "subcellular selective photothermolysis" and "melanocyte apoptosis and replacement" have been proposed. If appropriate measures are taken to monitor patient response during and after the procedure, low-fluence 1,064-nm QS Nd:YAG laser may achieve good cosmetic results in the treatment of PUL with a very safe and effective profile.

Pruritic Urticarial Papules and Plaques of Pregnancy Occurring Postpartum Treated with Intramuscular Injection of Autologous Whole Blood.

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is one of the most common diseases associated with pregnancy. In most cases, the skin lesions develop in the third trimester of primigravidas. There are no systemic alterations seen in PUPPP; however, most patients report severe pruritus. A 34-year-old woman presented 1 week postpartum with typical clinical features of PUPPP. The patient showed good response to intramuscular injection of autologous whole blood with no adverse effects to the patient or her baby. Presentation of PUPPP in the postpartum period is rare. Conservative management with topical corticosteroids and oral antihistamines is commonly used to relieve pruritus. In severe cases, skin lesions and symptoms are controlled with a brief course of systemic corticosteroids. Investigation of new treatment options has been limited by patient concerns about the negative effects of medication on the fetus or breastfeeding. Intramuscular injection of autologous whole blood could be an alternative treatment option for PUPPP, especially for women who worry about the use of medications during pregnancy or breastfeeding.

Increased expression of the NLRP3 inflammasome components in patients with Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a systemic inflammatory disease with manifestations including recurrent oral and genital ulcerations, and vasculitis involving the skin, mucosa, joints, eyes, veins, arteries, nervous and gastrointestinal systems. BD is seen as a disease at the crossroad between autoimmune and autoinflammatory syndromes, possibly triggered by an aberrant response to infectious stimuli. The relevance of Gram negative bacteria-mediated oral inflammation with the increased expression of NACHT, LRR, and PYD domains-containing protein 3 (NLRP3), leading to systemic inflammation, prompted us to investigate the expression of NLRP3 inflammasome components and its link with IL-1ß hypersecretion. FINDINGS: When peripheral blood mononuclear cells (PBMCs) from 15 active, 15 stable BD patients and 15 healthy volunteers were stimulated, the basal and LPS-induced expressions of NLRP3 inflammasome components were significantly increased at both mRNA and protein levels in BD patients compared to healthy controls. Also, increased expression of NLRP3 and ASC was observed in 25 BD skin lesions compared to 25 erythema nodosum patients. Compatible with this, secretion of IL-1ß by PBMCs stimulated with LPS alone or LPS plus ATP was increased in BD compared to healthy controls, which was suppressed by caspase-1 inhibitor. CONCLUSION: Our findings suggest the possible link between increased IL-1ß secretion and increased expression of NLRP3 inflammasome components in BD patients with skin manifestations.

Comprehensive understanding of idiopathic guttate hypomelanosis: clinical and histopathological correlation.

BACKGROUND: The histological findings associated with idiopathic guttate hypomelanosis (IGH) are hyperkeratosis, an atrophic epidermis, and flattened rete ridges. In addition, a decreased melanin content and reduced numbers of melanocytes are reported features. However, there are few recent studies that have been published on the histopathology of IGH and no comparative studies are available on the skin lesions and perilesional skin of patients with IGH. OBJECTIVES: The goals of this study were to identify the clinical and histopathological features of IGH and determine their correlation. We evaluated the clinical features and the histopathological differences between the skin lesions and the perilesional skin in patients with IGH. METHODS: A clinical survey was carried out on 47 patients with IGH. Specimens from skin lesions and perilesional skin were stained with hematoxylin-eosin, Fontana-Masson, MART-1, and NKI/beteb. We also studied the ultrastructure of four cases. RESULTS: About 30% of the patients had their initial lesions prior to 20 years of age. The arm was the most commonly affected site (53%). Histologically, we found hyperkeratosis in 18 cases (38.3%), but epidermal atrophy was present in only five cases (10.6%), and flattened rete ridges in seven cases (14.9%) compared to the normal skin. Epidermal atrophy was more frequently found at nonsun-exposed areas. The IGH lesions demonstrated decreased melanin pigment and reduced numbers of melanocytes by NKI/beteb and MART-1. The ultrastructural evaluation showed degenerative melanocytes and decreased melanosomes. One specimen had normal melanocytes with decreased melanosomes. CONCLUSIONS: Idiopathic guttate hypomelanosis is a disorder with multifactorial etiology; its pathogenesis may depend on various factors such as patient age and sun-exposure. Histopathologically, hyperkeratosis was frequently found; however, the other characteristic findings such as epidermal atrophy and flattened rete ridges were relatively rare.

A case of Birt-Hogg-Dubé syndrome.

Birt-Hogg-Dubé syndrome (BHDS) is an autosomal dominant genodermatosis characterized by cutaneous hair follicle tumors (fibrofolliculoma or trichodiscoma), pulmonary cysts, and increased risk of renal neoplasia. The genetic alteration for BHDS has been mapped to chromosome 17p12q11, and the gene in this region has been cloned and believed to be responsible for the BHDS. Mutations in the BHD gene (also known as FLCN) have been described in the patients with BHDS. We present a case of a 30-yr-old Korean woman with multiple mildly pruritic papules on her face and neck area. The patient had several firm, flesh-colored, dome-shaped, papular lesions measuring between 2 to 5 mm. Except for a history of pneumothorax her medical records were not remarkable. Mutation analysis of the BHD gene was performed, and a novel deletion mutation (p.F519LfsX17 [c.1557delT]) causing truncation of the gene product, folliculin, was found in the exon 14. The actual incidence of BHDS is unknown, but it is most likely underdiagnosed. So it is imperative that doctors recognize the skin lesions of BHDS and institute proper screening to detect other manifestations of the disease. Here, we report a case of BHDS with a novel mutation, which is the first report in Korea.

A Case of Idiopathic Eruptive Macular Pigmentation Limited to Flexural Areas.

Idiopathic eruptive macular pigmentation is a rare condition characterized by asymptomatic pigmented macules involving the neck, trunk, and proximal portions of the extremities. On histopathologic examination, there was increased pigmentation of the basal layer in otherwise normal epidermis and scattered melanophages in the papillary dermis. We report a case of a 26-year-old woman with idiopathic eruptive macular pigmentation involving only the flexural areas of the body. This condition should be considered in the differential diagnosis of flexural hyperpigmented skin lesions.

A Case of Atrophia Maculosa Varioliformis Cutis.

Atrophia maculosa varioliformis cutis (AMVC) is a type of idiopathic noninflammatory macular atrophy that occurs in young individuals. It is clinically characterized by shallow, sharply demaracated depressions of various shapes. Considering that atrophia maculosa varioliformis cutis can be mistaken as scarring and artifact dermatitis, it is important for physicians to distinguish this condition and to diagnose it correctly.

Erythema nodosum: clinicopathologic correlations and their use in differential diagnosis.

PURPOSE: Typically, a diagnosis of erythema nodosum (EN) is based on clinical features. However, other diseases manifest with inflammatory nodules of the lower limbs in addition to EN, such as the EN-like lesions of Behcet's disease (BD). The purpose of this retrospective study was to investigate the frequency of histologically proven EN among diseases diagnosed clinically as EN, to determine underlying causes of EN, and to compare clinical and histologic features between EN and other diseases. PATIENTS AND METHODS: We selected 99 patients diagnosed clinically with EN and performed skin biopsies. All pathologic slides were evaluated and diagnosed; and after histologic diagnoses were made we reviewed the patients' medical records. RESULTS: Among the 99 patients diagnosed clinically with EN, 47 were biopsy-verified EN. The EN-like lesions of BD and nodular vasculitis were both in the primary differential diagnosis of EN. No definite difference in clinical features exists among these three diseases. Histologically, EN demonstrated septal panniculitis in the majority of patients. Lobular panniculitis was frequently observed in NV, and mixed or mostly lobular panniculitis was observed in the EN-like lesion. Vasculitis was rarely observed in EN; however lymphocytic vasculitis was observed frequently in EN-like lesions and neutrophilic vasculitis was observed in NV. The frequency of granulomatous inflammation was highest in NV. Some cases of patients with typical BD demonstrated classic EN lesions. CONCLUSION: It was extremely difficult to clinically differentiate EN from EN-like lesions or NV. We feel skin biopsy is mandatory for the diagnosis of lower extremity erythematous nodular lesions.