Immunohistochemistry and Polymerase Chain Reaction for Detection Human Papilloma Virus in Warts: A Comparative Study.

BACKGROUND: Immunohistochemistry and polymerase chain reaction (PCR) are the most widely used methods for the detection of viruses. PCR is known to be a more sensitive and specific method than the immunohistochemical method at this time, but PCR has the disadvantages of high cost and skilled work to use widely. With the progress of technology, the immunohistochemical methods used in these days has come to be highly sensitive and actively used in the diagnostic fields. OBJECTIVE: To evaluate and compare the usefulness of immunohistochemistry and PCR for detection human papilloma virus (HPV) in wart lesions. METHODS: Nine biopsy samples of verruca vulgaris and 10 of condyloma accuminatum were examined. Immunohistochemical staining using monoclonal antibody to HPV L1 capsid protein and PCR were done for the samples. DNA sequencing of the PCR products and HPV genotyping were also done. RESULTS: HPV detection rate was 78.9% (88.9% in verruca vulgaris, 70.0% in condyloma accuminatum) on immunohistochemistry and 100.0% for PCR. HPV-6 genotype showed a lower positivity rate on immunohistochemistry (50.0%) as compared to that of the other HPV genotypes. CONCLUSION: Immunohistochemistry for HPV L1 capsid protein showed comparable sensitivity for detection HPV. Considering the high cost and great effort needed for the PCR methods, we can use immunohistochemistry for HPV L1 capsid protein with the advantage of lower cost and simple methods for HPV detection.

Status of primary liver cancer found through routine health check-up.

This study aimed to investigate the status of primary liver cancers found through a routine health check-up. The data of subjects who were diagnosed with primary liver cancer for the first time through a routine health check-up during a period of 8-yr were analyzed. Primary liver cancers were detected for the first time in 34 subjects among 91,219 routine health check-up subjects. Only 11.8% of primary liver cancer subjects had been under previous surveillance. Of them, 55.8% were positive for HBsAg, 17.7% were positive for anti-HCV, and 8.8% were heavy alcohol comsumers. However, 17.7% of the subjects were neither heavy alcohol consumers nor positive for both HBsAg and anti-HCV. Of the subjects, 50.0% had a single nodular tumor, 23.5% had multi-nodular tumors, and 26.5% had an infiltrative tumor. A routine health check-up may provide beneficial opportunities to detect a liver cancer in a very early stage. It is beneficial to start surveillance in high-risk subjects for liver cancer or to detect any liver cancer in subjects without risk factors of chronic viral hepatitis or heavy alcohol consumption.

Methimazole-induced bullous systemic lupus erythematosus: a case report.

Bullous systemic lupus erythematosus (SLE) is a kind of LE-non-specific bullous skin disease that is rarely induced by a medication. We describe the first case of bullous SLE to develop after administration of methimazole. A 31-yr-old woman presented with generalized erythematous patches, multiple bullae, arthralgia, fever, conjunctivitis, and hemolytic anemia. Biopsy of her bulla showed linear deposition of lgG, lgA, C3, fibrinogen, and C1q at dermo-epidermal junction. She was diagnosed as bullous SLE and treated with prednisolone, dapsone, hydroxychloroquine, and methotrexate. Our experience suggests that SLE should be considered as a differential diagnosis when bullous skin lesions develop in patients being treated for hyperthyroidism.

Lipid ingredients in moisturizers can modulate skin responses to UV in barrier-disrupted human skin in vivo.

BACKGROUND: Chemicals with a molecular weight <500 and adequate lipid solubility can penetrate the intact human skin. As many lipid ingredients in moisturizers have molecular weights <500, the lipid ingredients may penetrate into the skin and affect skin responses to UV; however, little is known about this phenomenon. OBJECTIVE: To evaluate the effects of major lipid ingredients in moisturizers on skin responses to UV in tape-stripped human skin in vivo. METHODS: We evaluated the effects of three major lipid ingredients in moisturizers (cholesterol, linoleic acid, and a synthetic ceramide, N-oleoyl-phytosphingosine) on skin responses to UV in the tape-stripped skin of healthy volunteers. After 2 days of lipid-application, the areas were irradiated with UV, and skin samples were obtained 24h after irradiation. Histologic features and the expression of the markers of collagen metabolism and inflammatory mediators were evaluated. RESULTS: Compared to vehicle, topical cholesterol significantly decreased the degree of dermal inflammatory infiltrates and exocytosis, and also decreased the expression of MMP-1, IL-6, and IL-1ß mRNA. In contrast, topical linoleic acid increased the induction of apoptotic cells, and the expression of MMP-1 and IL-6 mRNA. N-oleoyl-phytosphingosine increased the expression of MMP-1 and IL-6 mRNA, while decreasing the expression of COX-2 mRNA. CONCLUSIONS: Topical cholesterol can protect the barrier-disrupted skin against UV-induced damage, while linoleic acid or N-oleoyl-phytosphingosine alone has the potential to aggravate the damage.

A Case of Primary Cutaneous CD4 Positive Small/medium T Cell Lymphoma.

Primary cutaneous CD4 positive small/medium T cell lymphoma (PCSM-TCL) is a provisional entity in the new WHO-EORTC classification for cutaneous lymphoma, and it is a rare disease with a favorable clinical course. PCSM-TCL may present with different clinical and pathologic features associated with the biologic behavior of the disease. Herein we report on a 63-year-old woman with multiple, multifocal, erythematous to violaceous papules and plaques that progressed despite local radiotherapy.

Distribution of malassezia species on the scalp in korean seborrheic dermatitis patients.

BACKGROUND: Malassezia species play an important role in the pathogenesis of seborrheic dermatitis. In particular, M. restricta and M. globosa are considered to be the predominant organisms in seborrheic dermatitis of Western countries. However, species distribution of Malassezia in seborrheic dermatitis has not been clearly determined yet in Asia. OBJECTIVE: To identify the distribution of Malassezia species on the scalp of seborrheic dermatitis patients in Korea using 26S rDNA PCR-RFLP analysis. METHODS: A total of 40 seborrheic dermatitis patients and 100 normal healthy volunteers were included in this study. For the identification of Malassezia species, the scalp scales of the subjects were analyzed by 26S rDNA PCR-RFLP analysis. RESULTS: The most commonly identified Malassezia species were M. restricta in the seborrheic dermatitis patients, and M. globosa in the normal controls. In the seborrheic dermatitis group, M. restricta was identified in 47.5%, M. globosa in 27.5%, M. furfur in 7.5%, and M. sympodialis in 2.5% of patients. In the healthy control group, M. globosa was identified in 32.0%, M. restricta in 25.0%, M. furfur in 8.0%, M. obtusa in 6.0%, M. slooffiae in 6.0%, and M. sympodialis in 4.0% of subjects. CONCLUSION: M. restricta is considered to be the most important Malassezia species in Korean seborrheic dermatitis patients.

Clinical differentiation of acute cutaneous graft-versus-host disease from drug hypersensitivity reactions.

BACKGROUND: The early diagnosis of acute cutaneous graft-versus-host disease (GVHD) is challenging as there are no specific features. Drug hypersensitivity reaction (DHR) is the most frequently encountered condition to differentiate from GVHD. OBJECTIVES: We sought to investigate the clinical characteristics of acute cutaneous GVHD in comparison with DHR. METHODS: A retrospective chart review was conducted for allogeneic hemopoietic-cell transplantation recipients with maculopapular rashes who had undergone hemopoietic-cell transplantation less than 100 days earlier. We analyzed the clinical characteristics of 22 patients with acute cutaneous GVHD in comparison with 17 patients with DHR. RESULTS: Facial involvement was more frequent in the GVHD group (59%) than in the DHR group (24%). The difference was more significant when both the face and palms/soles were involved (36% in the GVHD group, no patients in the DHR group). Diarrhea was significantly more common in the GVHD group (73%) than in the DHR group (12%). The presence of both diarrhea and hyperbilirubinemia occurred only in the GVHD group (41%). In the GVHD group, the patients developed diarrhea and hyperbilirubinemia gradually with most patients exhibiting diarrhea and hyperbilirubinemia after 2 days. LIMITATIONS: A retrospective design, small number of patients, and single-center design are limitations. CONCLUSIONS: Facial involvement, and moreover involvement of the face and palms/soles, suggests the diagnosis of GVHD versus DHR. The presence of diarrhea, and diarrhea accompanied by hyperbilirubinemia is thought to favor the diagnosis of GVHD. Rashes with more than 2 to 3 days of duration and not accompanied by diarrhea and hyperbilirubinemia are less likely to be GVHD.

Metastatic hepatocellular carcinoma presenting as facial nerve palsy and facial pain.

Facial nerve palsy due to temporal bone metastasis of hepatocellular carcinoma (HCC) has rarely been reported. We experienced a rare case of temporal bone metastasis of HCC that initially presented as facial nerve palsy and was diagnosed by surgical biopsy. This patient also discovered for the first time that he had chronic hepatitis B and C infections due to this facial nerve palsy. Radiation therapy greatly relieved the facial pain and facial nerve palsy. This report suggests that hepatologists should consider metastatic HCC as a rare but possible cause of new-onset cranial neuropathy in patients with chronic viral hepatitis.

Full-spectrum light phototherapy for atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a chronic skin disease resulting in a profound deterioration in quality of life. The FSL® is a newly developed phototherapy device generating full-spectrum light (FSL) with a continuous wavelength (320-5000 nm). This study aimed to evaluate the efficacy and safety of FSL® phototherapy in AD. METHODS: We enrolled 38 patients with moderate to severe AD in this open, randomized, controlled, prospective study. In the FSL-irradiated group (20 patients), irradiation was conducted twice per week for 4 consecutive weeks. In the control group (18 patients), only emollient application was allowed. SCORing Atopic Dermatis (SCORAD) values were obtained at baseline, week 4 and 8. Patients were asked to give subjective assessments of improvement and laboratory tests including serum eosinophil counts, ECP levels, IgE levels and 22 cytokine levels were performed. RESULTS: In the FSL-irradiated group, the mean SCORAD value decreased significantly after 4 weeks of phototherapy and remained reduced for a further 4 weeks after the cessation of treatment. In the control group, the mean SCORAD value did not change significantly over the study period. Patients' subjective assessments indicated good to excellent responses in 75% of the FSL-irradiated group, by contrast with 50% of the control group. The mean values for serum eosinophil counts, IL-4 and IL-5 levels decreased significantly after FLS phototherapy. No serious adverse effects were reported. CONCLUSIONS: In this study, we showed that FSL® phototherapy can be an effective and safe treatment option in AD.

A case of polypoid clear cell acanthoma on the nipple.

Clear cell acanthoma (CCA) is a rare benign epidermal tumor. It usually presents as a flat nodule or dome-shaped plaque and is often localized on the legs of the elderly. We observed an unusual case of polypoid CCA on the nipple of a 14-year-old girl. At present, a few cases of CCA on the nipple area have been reported in the literature. However, CCA presented as a polypoid tumor on the nipple area has been reported very rarely. We herein report the very rare case of polypoid CCA on the nipple and suggest that CCA should be included in the clinical differential diagnosis of polypoid lesions on the nipple.

Synergistic antifibrotic efficacy of statin and protein kinase C inhibitor in hepatic fibrosis.

Statin has antifibrotic efficacy in human fibrosing diseases, such as pulmonary and renal fibrosis, and is therefore implicated in hepatic fibrosis. However, statin can also activate protein kinase C (PKC), which augments hepatic fibrogenesis and is thereby likely to reduce the antifibrotic efficacy of statin. This study was designed to explore the hypothesis that simultaneous treatment with statin and PKC inhibitor may synergistically enhance antifibrotic efficacy in hepatic fibrosis. Hepatic fibrosis models were established in BALB/c mice by intraperitoneal injection of carbon tetrachloride or thioacetamide for 6 wk. Pravastatin and enzastaurin (PKC inhibitor) were administered by gavage for 5 wk. Cellular apoptosis was explored using 4',6-diamidino-2-phenylindole or terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick end-labeling (TUNEL) staining and immunoblot analysis. Hepatic fibrosis and hepatic stellate cell (HSC) activation were assessed by morphometric analysis of histological findings and immunohistochemistry for alpha-smooth muscle actin. In vitro, the addition of PKC inhibitor significantly increased statin-induced LX-2 cell apoptosis by enhancing the activation of mitochondrial apoptotic signals. TUNEL-positive HSCs were significantly increased in mice treated with statin + PKC inhibitor compared with those in control or single compound-treated mice. The percentage of area occupied by activated HSCs and the extent of collagen deposition were significantly decreased in mice treated with statin + PKC inhibitor compared with those in control or statin-treated mice. In conclusion, simultaneous treatment with statin and PKC inhibitor synergistically enhanced the antifibrotic efficacy in both in vitro and in vivo models of hepatic fibrosis and may therefore have therapeutic implication for reducing hepatic fibrosis.

Comparison of sebum secretion, skin type, pH in humans with and without acne.

Differences of skin type and pH between subjects with and without acne have not been investigated. In addition, the relationship between sebum secretion and pH in these populations has not been determined. This study assessed the differences in objective and subjective skin types between these two groups. Secondly, this study evaluated the difference in pH on five facial areas (forehead, nose, chin, right and left cheeks) between the two populations. Lastly, the relationship between pH and sebum secretion was analyzed in each population. Sebum casual levels (CL) of the five facial areas in 36 Koreans with acne and 47 Koreans without acne were measured by using a Sebumeter SM 815 and subjects were classified into objective skin types by CL. Subjects reported the type of skin they believed they had, which determined the subjective skin type. The pH levels of the five facial areas were measured by the Skin-pH-Meter PH 905. Data were assessed with adequate statistical tests depending on data type and distribution. Among the five areas, the nose of the subjects with acne showed a significantly higher CL, compared to the subjects without acne. This difference in CL on the nose resulted in the difference in CL on the T-zone and mean facial sebum excretions (MFSE). Although CL differed, objective skin types did not differ between the two groups (P > 0.05), but the subjective skin types differed significantly (P = 0.001). In addition, the objective skin types were significantly different than the subjective skin types in subjects with acne (P = 0.001), whereas the two skin types did not differ in subjects without acne. Subjects with acne actually overestimated their skin types and stated their skin types were "oilier" than they were. In respect to pH, none of the five areas differed significantly between the two groups. Among the five sites in subjects with acne, CL showed a significant negative correlation with pH on the left (r (2 )=0.12) and right (r ( 2 )=0.15) cheeks, which resulted in a significant negative correlation on the U-zone (r ( 2 )=0.14). In contrast, in subjects without acne, there was a significant negative correlation between CL and pH on the forehead (r ( 2 )=0.10) and chin (r ( 2 )=0.16), which led to a significant negative correlation on the T-zone (r ( 2 )=0.14).