Bowenoid Papulosis of the Vulva and Subsequent Periungual Bowen's Disease Induced by the Same Mucosal HPVs.

We report the case of a 23-year-old woman who developed bowenoid papulosis of the vulva and subsequent periungual Bowen's disease. She had a history of a long standing periungual wart on her right thumb before the outbreak of periungual Bowen's disease. By HPV DNA chip, human papillomavirus (HPV) 11, 18 and 31 were identified from the periungual lesions, and HPV 11, 18 and 33 from the vulvar lesion. This case supports the theory of anogenital-digital spread of HPV, and proposes that the periungual wart may change into Bowen's disease by mucosal HPVs. To the best of our knowledge, this case is important as the first Korean case of periungual Bowen's disease concurrent with bowenoid papulosis of the vulva.

Colonizing features of Staphylococcus aureus in early childhood atopic dermatitis and in mothers: a cross-sectional comparative study done at four kindergartens in Daegu, South Korea.

BACKGROUND: Colonization of Staphylococcus aureus is well known to be an aggravating factor for the flare-up of atopic dermatitis (AD), yet few studies have been done on its spread in families with childhood AD. OBJECTIVE: To evaluate the characteristic features of skin-colonizing S aureus and to identify the source of S aureus in early childhood AD. METHODS: Forty-four subjects with AD, 51 borderline (BD) subjects, and 36 normal controls (NC) aged 3-6 years and their mothers were recruited from four different kindergartens. After comparing the positive culture rate of S aureus in three different groups of children and their mothers, we determined if there is a possibility of intrafamilial transmission between the children with AD and their mothers using polymerase chain reaction and pulsed-field gel electrophoresis. RESULTS: A high prevalence (72.7%) of S aureus colonization was found in the AD group compared with the BD and NC groups. However, the prevalence rate of S aureus in the mothers who had children with AD was not significantly higher than in the mothers from the BD and NC groups. Based on the pulsed-field gel electrophoresis results, the cutaneous re-colonization of S aureus in childhood AD appears to have been primarily originating from the patients' noses, and maternal origin does not appear to substantially contribute to S aureus transmission in early childhood AD. CONCLUSIONS: Since the cutaneous colonization of S aureus in early childhood AD predominantly originated from the patients' own noses, the maternal transmission route does not appear to contribute substantially to the colonization of S aureus in early childhood AD.

Recurrent basal cell carcinoma following ablative laser procedures.

BACKGROUND: In Korea, many patients diagnosed with basal cell carcinoma (BCC) have a history of laser ablations of undiagnosed lesions. OBJECTIVE: To evaluate the clinical/pathological and surgical features of BCC developing from undiagnosed lesions following laser ablations (not full-face cosmetic ablations) and to compare them with primary BCCs. METHODS: This study enrolled 359 patients with 373 biopsy-proven BCC lesions. All of the patients were treated by Mohs micrographic surgery (MMS) at the Department of Dermatology, Pusan National University Hospital from 1998 to 2008. BCC was classified by previous treatment history of lesion ablative laser: post-laser BCC vs primary BCC. We conducted a retrospective study through clinical photographs, pathology slides, and MMS sheets. RESULTS: Among 373 BCCs, 58 lesions (15.5%) were post-laser BCCs. The post-laser BCC group was younger (59.9 vs 65.4 years, P = .001), but had a longer disease interval until pathologic diagnosis (7.18 vs 3.33 years, P < .0001) than the primary BCC group. The post-laser BCC group had a greater frequency of the micronodular pattern (22.4% vs 10.8%, P = .01), required more stages of excision (2.69 ± 1.63 vs 2.15 ± 1.05, P < .001), and had fewer cases with one Mohs stage excision (10.3% vs 27%, P = .006) than the primary BCC group. LIMITATIONS: We could not identify the type of laser used in all 58 cases; instead, we supposed that most of the patients were likely treated with the carbon dioxide laser. CONCLUSIONS: The results demonstrated that the post-laser BCC group had a longer disease interval to diagnosis, a more aggressive histologic pattern, and required more stages of excision in MMS than the primary BCC group.

Oral zinc sulfate treatment for viral warts: an open-label study.

Viral warts, which are caused by the human papilloma virus, are a common problem in dermatology. Various modalities have been used to treat warts, but none are uniformly effective or directly antiviral. Recent studies show that oral zinc sulfate could be effective in the treatment of viral warts. Thirty-one patients with multiple, non-genital viral warts were recruited in this open-label clinical study. The patients were treated with oral zinc sulfate (10 mg/kg to a maximum dose of 600 mg/day) for 2 months and followed up with assessments for the resolution of their warts and for any evidence of recurrence after treatment. Among the 31 patients, 18 patients showed low serum zinc levels (58%). Of 26 patients who completed the study (84%), 13 (50%) showed complete resolution of their warts after 2 months of treatment. Complete responders remained free of lesions at 6-month follow-up. No serious side-effects were reported apart from nausea (16%), mild gastric pain (3%) and itching sensation (3%). Oral zinc sulfate was found to be a good option in the treatment of viral warts, as it was safe and effective without important side-effects.

Antibiotic susceptibility of Propionibacterium acnes isolated from acne vulgaris in Korea.

Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long-term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. Among 46 patients, 31 P. acnes strains were cultured. Isolated P. acnes was measured for minimum inhibitory concentration (MIC) of tetracycline, doxycycline, minocycline, erythromycin and clindamycin using an Epsilometer test. Age, disease duration and previous history of antibiotic therapy for acne were compared in relation to the MIC. The mean MIC of tetracycline, minocyclines, doxycycline, clindamycin and erythromycin were all below the breakpoint of antibiotic resistance. The patients with acne vulgaris with disease duration of more than 2 years documented higher MIC values in doxycycline, erythromycin, and clindamycin than those of less than 2 years. The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.

Clinical course of guttate psoriasis: long-term follow-up study.

Guttate psoriasis, known to have a better prognosis than other types of psoriasis, shows rapid involution and longer remission, but its clinical course has barely been studied. The aim of this study was to determine the clinical course and to compare the clinical and laboratory features of guttate psoriasis. This is a retrospective study of 26 patients with guttate psoriasis. The patients were divided into two groups; the good one with complete remission and long remission for at least 1 year (group A) and the poor one with incomplete remission and progression into chronic plaque psoriasis (group B). Among 36 patients, 22 patients (61.1%) were group A and 14 patients (38.9%) were group B. In group A, most of the skin lesions disappeared within 8 months. In group B, two patients without proper treatment progressed to plaque psoriasis. The onset age was younger and more frequent upper respiratory infection and high anti-streptolysin O (ASO) titer were found in group A, but family history of psoriasis was more common in group B. Patients had two distingushable clinical courses: rapid involuting course with long-term remission and chronic course without remission. There was a tendency toward younger age of onset with elevated ASO titer in patients with rapid involuting course.

Oral hairy leukoplakia which occurred as a presenting sign of acute myeloid leukemia in a child.

Oral hairy leukoplakia (OHL) is caused by the reactivation of a previous Epstein-Barr virus (EBV) infection in the epithelium of the tongue. Most lesions are characterized by corrugated whitish patches on the lateral border of the tongue. It is frequently associated with AIDS, but cases in patients with other immunosuppressed states have also been reported. In leukemia patients, OHL is rarely encountered, and appears only after chemotherapy. We report a case of OHL which occurred as a presenting sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child. A 15-year-old boy presented with a whitish patch on the left lateral border of the tongue. The biopsy specimen revealed papillomatosis, hyperkeratosis, acanthosis and ballooning degeneration in the stratum spinosum. The patient was EBV seropositive, and PCR analysis of EBV DNA in the lesional tissue was positive. After the diagnosis of OHL in dermatologic department, the patient was referred to pediatrics due to the abnormal peripheral blood smear, and was diagnosed with AML.

X-Linked reticulate pigmentary disorder in a female patient.

BACKGROUND: X-linked reticulate pigmentary disorder is a very rare cutaneous condition characterized by different clinical manifestations according to sex. METHODS: We report a 31-year-old woman with X-linked reticulate pigmentary disorder. RESULTS: On examination, there were multiple, asymptomatic, brownish macules in linear and whorled patterns over the trunk, axillae, groin, and extremities. The woman had not experienced any systemic manifestations involving the gastrointestinal, pulmonary, or ocular systems. Her hair, teeth, and nails were normal on close observation. All laboratory data were within the normal range. A genetic study was not performed. CONCLUSIONS: Although a genetic study was not performed, we believe that our patient can be diagnosed with X-linked reticulate pigmentary disorder according to the clinical and histopathologic findings.

Two cases of pyodermatitis-pyostomatitis vegetans.

Pyodermatitis-pyostomatitis vegetans (PPV) is a rare chronic pustular and vegetating mucocutaneous dermatosis. The oral lesions present as multiple, friable and yellowish pustules, which form "snail tracts" and rupture easily. The cutaneous lesions begin as crusted erythematous papulopustules that coalesce to form large vegetating plaques, usually in the axillae, genital area and scalp. Cutaneous lesions usually develop at the same time as the oral lesions or thereafter. PPV is usually considered as a specific marker for inflammatory bowel disease since the concurrence of PPV and inflammatory bowel disease has been reported in approximately 70% of cases. We report two patients who showed typical clinical and histopathological features of PPV, but were not accompanied by inflammatory bowel disease.

Surgical treatment of subungual glomus tumor: a unique and simple method.

BACKGROUND: The glomus tumor, described as a painful subcutaneous nodule, commonly occurs in subungual regions and is accompanied by tenderness and temperature sensitivity. In treatment of subungual glomus tumor, surgical excision is known to be the only curative method. Under surgical approach, it is challenging to minimize postoperative nail deformity and to reduce tumor recurrence. OBJECTIVE: To evaluate the efficacy and safety of surgical treatment of subungual glomus tumor using simple blunt dissection. MATERIALS AND METHODS: Twenty-three patients diagnosed with subungual glomus tumor underwent surgical procedure using a dorsal transungual approach. A single linear incision was made above the tumor, and the exposed mass was meticulously dissected with the opposite end of a single-end probe, and the tumor "popped up." Recurrence of symptom, tumor recurrence, and local complication were evaluated through long-term follow-up. RESULTS: After a mean follow-up period of 30 months, only one case recurred, and partial-thickness skin necrosis occurred around the tourniquet site. There was no postoperative nail deformity. CONCLUSIONS: In treatment of subungual glomus tumor, meticulous simple blunt dissection using a transungual approach led the tumor to "pop up" from the tumor bed. This unique and simple method of treating subungual glomus tumor showed low recurrence and minimal complications.

Trichloroacetic acid matricectomy in the treatment of ingrowing toenails.

BACKGROUND: Ingrowing toenails can be treated with conservative therapy or surgery, but frequent relapse can be a problem in conservative therapy and surgical therapy without matricectomy. Thus, permanent nail ablation by partial matricectomy is now accepted as the treatment of choice. OBJECTIVE: To evaluate the efficacy and safety of trichloroacetic acid (TCA) matricectomy in the treatment of ingrowing nail. MATERIALS AND METHODS: Forty ingrowing toenail edges in 25 patients were enrolled. TCA matricectomy with 100% trichloroacetic acid after partial nail avulsion was performed. For a few weeks after surgery, postoperative complications such as pain, discharge, and infection were assessed. After a mean follow-up period of 22.9 months, recurrence rate and cosmetic outcomes were investigated to evaluate the effects of the surgery. RESULTS: The wounds almost always healed within 2 weeks without prolonged exudative discharge. Pain was mild and transient. A case of secondary infection occurred. Recurrence was found in only two nails of one patient, and the success rate was 95%, with good cosmetic results. CONCLUSION: TCA matricectomy showed a low recurrence rate with minimal side effects and was easy to perform in outpatient clinic. Therefore, it may be a good alternative treatment of ingrowing toenails.

The Effect of Detergents on the Morphology and Immunomodulatory Activity of Malassezia furfur.

BACKGROUND: Several workers have found that Malassezia are capable of suppressing cytokine release and downregulating the phagocytic function of monocytes. But lipid-depleted Malassezia furfur (M. furfur) extracts have also been shown to induce increased production of TNF-alpha, IL-6 and IL-1beta in monocytes. We thought that the detergents in shampoos or soaps could change the composition of the lipid in the M. furfur cell wall. OBJECTIVE: We studied whether detergents affect the morphology of M. furfur and if the inflammatory cytokine profiles change in the monocytes treated with detergent-treated M. furfur. METHODS: Commonly used detergents such as sodium lauryl sulfate, ammonium lauryl sulfate and tween-80 were respectively added to the modified Leeming-Notman's media. M. furfur was cultivated in each media (detergent-added or untreated). Thereafter, the surface morphology of the yeast was evaluated by scanning and transmission electron microscopy. The cytokine profiles of monocytes, which were treated by M. furfur with or without detergents, were also evaluated. RESULTS: The detergent-treated M. furfur were similar to the lipid-extracted form of M. furfur on the electron microscopic study, with a recessed, withered surface and with thinner and rather electron transparent cell walls than the detergent-untreated M. furfur. The levels of TNF-alpha were higher in monocytes treated with detergent-treated Malassezia than that in the monocytes treated with the detergent-untreated Malassezia (p<0.05). CONCLUSION: According to the findings in this study, it could be inferred that the detergents in shampoos or soaps affect the lipid layers of the Malassezia cell wall and these lipid-extracted Malassezia induce or aggravate some inflammatory conditions. But to correlate the relationship between detergents and Malassezia-associated diseases, in vivo experiments that will focus on short-term contact with detergents in real life conditions should be done.

Angiomyxolipoma (vascular myxolipoma) of subcutaneous tissue.

Lipoma is the most common neoplasm of mesenchyme, and several subtypes have been described that vary according to their location and the presence of other tissue elements. Angiomyxolipoma is a very rare variant that consists of an admixture of adipose and myxoid elements with numerous vascular structures. It should be differentiated from other subtypes of benign and malignant lipomas. Here the case of a 69-year-old male is described who presented with a solitary asymptomatic mass on the left iliac crest. The histopathologic findings showed alternating nests of myxoid and adipose tissue containing dilated blood vessels, which was consistent with angiomyxolipoma.

Primary venous aneurysms of the superficial venous system.

Venous aneurysm can be classified into superficial or deep and secondary or primary. The aim of this study was to introduce primary venous aneurysm of the superficial venous system and to report the experiences treating it with sclerotherapy. A retrospective study with 120 cases of venous dilatation detects 4 patients. The clinical features, histopathology, and radiological findings were investigated. In 2 patients, sclerotherapy was performed. The patients had an asymptomatic, soft subcutaneous mass on the extremities or neck for 5.2 years on an average. Color duplex scanning showed a well-defined anechoic cystic structure with no arterial flow. Histopathologically, normal vein wall with varying degrees of thinning was observed. The patients who underwent sclerotherapy were treated successfully with no recurrence. Primary venous aneurysm of the superficial venous system should be included in the differential diagnosis of subcutaneous mass. In addition, it may be simply and effectively treated with sclerotherapy.

A Case of Digital Myxoid Cyst Coexisting with Epidermal Inclusion Cyst.

A 62-year-old male developed a solitary asymptomatic nodule on the lateral aspect of the distal interphalangeal joint of the right great toe. Histopathologic findings demonstrated a myxoid cyst with a concomitant epidermal inclusion cyst. To the best of our knowledge, this is the first case of concurrent occurrence of digital myxoid cyst and epidermal inclusion cyst. Although the exact mechanism for developing a digital myxoid cyst and an epidermal inclusion cyst simultaneously at the same site is not explained, trauma might be a possible cause.