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Rosai-Dorfman disease (RDD) is a rare and non-neoplastic histiocytic proliferative disorder, whose most common clinical presentation is massive but painless cervical lymphadenopathy. The cutaneous form of RDD is rare, and usually presents as erythematous to brown papules, plaques, or nodules. Most lesions are located on the face and trunk. We herein describe the case of a 52-year-old female patient with RDD clinically limited to the skin. The patient presented with asymptomatic multiple erythematous inflammatory nodules on the right flank and nasal area.Histopathologic findings showed multiple foamy histiocytic infiltrations in the dermis. On immunohistochemistry, the lesions were positive for CD68 and S-100, and negative for CD1a. The patient was treated with oral methylprednisolone, prednicarbate ointment and intralesional injection of triamcinolone acetonide. After 3 months, the lesions achieved almost complete remission, and the patient has been under observation without recurrence for the past 1 year.
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Acroangiodermatitis (AAD) is a rare reactive vasculo-proliferative disorder associated with chronic venous hypertension. Owing to its clinical and histological similarities to Kaposi sarcoma, AAD is also known as pseudo-Kaposi sarcoma. AAD is characterized by several clearly defined red-purple papules, plaques or ulcerations located on the dorsum of the foot and medial lower limbs. We describe the case of a 36-year-old woman who had multiple red-purple papules and plaques on the dorsum of the right foot area. A skin biopsy was performed, and histopathological examination revealed the presence of multiple capillaries lined by a single layer of endothelial cells surrounded by hemosiderin deposits. No specific histological features of Kaposi sarcoma were observed. Immunohistochemical analysis showed CD31＋ positivity in endothelial cells. The patient was diagnosed with AAD and the lesions have shown no remission for the past 7 years. Therefore, follow-up biopsies are performed every 2 or 3 years to monitor for any potential malignant changes.
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Marjolin’s ulcer is a malignant skin tumor that arises at the site of scars, chronic ulcerations, inflammations, and fistulas after a long latent period. These tumors are mostly squamous cell carcinomas; however, other types of malignancies, such as basal cell carcinoma, malignant melanoma, and sarcoma rarely occur. Marjolin’s ulcer have aggressive characteristics, and local recurrence and lymph node metastasis rates are higher than those of cutaneous primary tumors. Herein, we report an unusual case of squamous cell carcinoma at the site of an arteriovenous fistula ulcer treated with repeated radical operation and skin graft.
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Background@#Bier’s spots represent a distinct pattern of speckled vascular mottling composed of small, irregular anemic macules. This phenomenon is common and easily reproducible by placing an extremity in a dependent position when mild venous stasis is created. @*Objective@#This study aimed to investigate the clinical manifestations of multiple anemic macules, Bier’s spots, and analyze its association with other underlying conditions in hospital outpatients. @*Methods@#Between 2015∼2020, we reviewed clinical data of 18 patients diagnosed with Bier’s spots at our hospital. Analysis was performed to assess patient’s demographics, presentation, and treatment. @*Results@#A total of 18 patients were included, and 10 (55.6%) were males. Lesions on both sides of the extremities were more common in 11 patients (61.1%), with four (22.2%) and two (11.1%) only on the upper and lower sides, respectively. Symptoms included itching in six patients (33.3%), numbness in two (11.1%), tenderness in one (5.6%), and asymptomatic in 11 (61.1%). The symptoms often accompanied hypertension, atopic dermatitis, and dyslipidemia. Histopathologic findings showed perivascular inflammation in six biopsy specimens, lymphocytic infiltration in four (66.7%), and papillary dermal vascular dilatation in three (50.0%). Calcium channel blockers and antihistamines were used for treatment in 13 patients (72.2%). @*Conclusion@#The result shows clinical manifestations of Bier’s spots and a possibility of association with various underlying diseases. Optimum treatment for Bier’s spots has not been defined, and because most cases are asymptomatic, no treatment is required. Therefore, this study will be a valuable data of Bier’s spots for dermatologists.
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Leukemia cutis (LC) is a cutaneous condition caused by leukemia cells leaching into the skin, with various clinical manifestations. At times, skin lesions called aleukemic LC occur before leukemia cells appear in the bone marrow or peripheral blood. Proper diagnosis of such a condition is important for early detection, treatment, and prognosis of leukemia. In general, LC is usually associated with an unfavorable prognosis. Herein, we report a case of a 65-year-old male with LC who presented with multiple papular lesions on the trunk and extremities. Histopathological examination of the lesions revealed LC of the monocytic type. Additional laboratory tests of the peripheral blood were normal, but a bone marrow biopsy demonstrated a high proportion of leukemic cells. In conclusion, we present this case to highlight that early diagnosis and accurate management are crucial for the prognosis of patients affected with leukemia, especially when skin lesions are the first clinical symptom.
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Eosinophilic annular erythema (EAE) is an uncommon, recurrent eosinophilic cutaneous disease, and its etiology has not been clearly elucidated. Clinically, EAE occurs mainly in the form of annular or round erythematous, edematous plaques on the trunk or extremities. Histopathologically, it is characterized by superficial and deep perivascular inflammatory cell infiltration composed of lymphocytes and eosinophils. Based on this, some studies have stated that EAE is not an isolated rare disease but rather a spectrum that shares features similar to Wells syndrome. Herein, we report a case of EAE in a 28-year-old female patient. The clinical features were recurrent annular, erythematous patch on the both extremities. Histopathologic examination demonstrated superficial infiltrates of lymphocytes and eosinophils in the dermis. Based on the clinical and histological features, this case was diagnosed as EAE.
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Unlike classic pyoderma gangrenosum (PG), the bullous variant of PG is typically represented by a painful erythematous papule, plaque, and superficial bulla that progress into the ulceration with bullous margin. Generally, bullous PG is most commonly associated with myeloproliferative disorders, such as acute myeloid leukemia (AML). Bullous PG in AML patients rarely occurs, but once it does, it suggests a poor clinical prognosis. Although many cases of classic PG in AML patients have been reported, bullous PG is relatively rare. Therefore, we present a case of bullous PG that developed in a patient with AML and was successfully treated with high-dose systemic steroids.
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Rosacea fulminans is an extreme form of rosacea characterized by a rapid onset and fulminating course with prominent erythema, pustules,and cysts on the face. It can have an impact on obstetrical outcomes, and its treatments may have limitations during pregnancy. A 33-year-old woman and a 22-year-old woman presented with rosacea fulminans during the first pregnancy andwere treated with erythromycin and prednisone, respectively. After delivery, there was a significant improvement in the lesion. Rosacea fulminans recurred during the second pregnancy, but the skin lesions showed better progression. Rosacea fulminans can causesevere distress and different outcomes of pregnancy. It is recommended to consult about the risk of recurrence in future pregnancies.
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Acantholytic acanthoma is a rare benign neoplasm of epidermal keratinocytes that clinically presents as a solitary, asymptomatic keratotic papule or nodule on the trunk. A 40-year-old female visited our hospital with a 20-year history of a single papule on her right thigh. On physical examination, the lesion measured 0.5×0.4 cm in size and appeared brown in color with central hyperkeratosis. Histopathological evaluation showed hyperkeratosis, acanthosis, papillomatosis, dyskeratosis, and acantholysis. Only six cases of acantholytic acanthoma have been reported in Korea. We report a rare case of acantholytic acanthoma that occurred in a 40-year-old female who presented with a keratotic papule on her right thigh.
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Prurigo nodularis (PN) is a chronic cutaneous condition characterized by a papulonodular pruriginous eruption accompanied by pruritus. PN lesions are typically firm and itchy hyperkeratotic nodules and papules, which provoke a scratch response. PN may often represent an initial cutaneous manifestation of human immunodeficiency virus (HIV) infection. The association between PN and HIV is attributable to various etiopathogenetic mechanisms including cutaneous immunological abnormalities. Diagnosis of HIV infection in a patient with PN is challenging.We report a case of confirmed HIV infection in a patient with treatment-resistant PN, who was successfully treated using combination treatment that included HIV antiretroviral therapy and narrow-band ultraviolet-B radiation.
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Sweet syndrome is characterized by fever, tender, erythematous skin lesions, neutrophilia, high levels of serum inflammatory markers, and diffuse mature neutrophil infiltration typically localized to the upper dermis. Various drugs have been shown to be associated with Sweet syndrome. Bortezomib, a proteasome inhibitor approved for the treatment of multiple myeloma, has been reported to be associated with erythema, pruritus, eczemas, and, rarely, erythema multiforme-like skin changes or vasculitis. We describe a case involving a 65-year-old male who received bortezomib for the treatment of multiple myeloma. Over three cycles, multiple nodular lesions recurred through periods of aggravation and relief from symptoms. On the basis of the signs, symptoms, and biopsy results, the patient was diagnosed as showing Sweet syndrome. Skin lesions that occur during treatment of underlying disease can affect the patients’ treatment compliance. This case report indicates that a bortezomib rechallenge is an option for patients who develop sweet syndrome
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Primary cutaneous anaplastic large cell lymphoma is primary cutaneous lymphoma that is composed of large lymphoid cells with anaplastic and pleomorphic morphology and expresses the CD30 antigen. Generally, primary cutaneous anaplastic large cell lymphoma is represented by a single, erosive plaque located on the trunk or extremities, but rarely on the dorsum of the hand. A 36-year-old man visited our hospital with a plaque on the dorsum of his left hand for 2 months. The plaque was 6×5 cm in size and violet-colored, with erosion. Histopathological findings showed infiltration of large anaplastic cells in the dermis and subcutaneous fat tissue. Immunohistochemically, it showed positive results for CD3, CD4, and CD30 and negativity anaplastic lymphoma kinase. Imaging examination showed no additional lesions, and the diagnosis was confirmed as primary cutaneous anaplastic large cell lymphoma. The patient was treated with radiation therapy four times and the lesion completely disappeared.
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Trichophyton tonsurans is an anthropophilic endothrix dermatophyte that has been the main causative organism of tinea capitis in the United States, Canada, Mexico, and other Latin American countries. In Korea, tinea capitis caused by T. tonsurans has been reported since 1995, but kerion celsi caused by T. tonsurans is rare. Kerion celsi is an inflammatory suppurative dermatophytosis of the scalp associated with hair loss. In this study, we report a case of kerion celsi occurring on the parietal scalp of a 6-year-old child diagnosed in a mycological study. T. tonsurans was identified and treated with oral itraconazole and topical epiconazole.
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Background@#Stasis dermatitis is an inflammatory skin disease that occurs in the lower legs of patients with chronic venous insufficiency; however, data on combined vascular disease and stasis dermatitis are limited. @*Objective@#This study aimed to evaluate the clinical features of patients with stasis dermatitis and combined vascular diseases. @*Methods@#We retrospectively reviewed the clinical features and combined vascular diseases of 37 patients clinically diagnosed with stasis dermatitis who visited the dermatology department from January 2017 to December 2020. @*Results@#The average age of occurrence was 59.5 years, and the average duration of the disease was 3.2 years. Stasis dermatitis was more likely to occur in women than in men and more often in both lower legs. The major clinical features were erythematous patches. Asymptomatic symptoms were most common, followed by itching and tenderness. To evaluate vascular diseases, ultrasonography, venography computed tomography (CT), and angiography CT were performed. The most common combined vascular diseases were deep vein thrombosis, followed by varicose vein and thrombophlebitis. Most cases were treated with topical steroids and antihistamines, and anticoagulants/ antiplatelet agents were used to treat vascular diseases. @*Conclusion@#Stasis dermatitis is mainly associated with venous dysfunction in the lower legs. Early diagnosis and fundamental treatment of combined vascular diseases by evaluating vascular function in patients suspected of stasis dermatitis are important. This study will provide dermatologists with significant data on the clinical features of stasis dermatitis and combined vascular diseases.
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Acantholytic acanthoma is a rare benign neoplasm of epidermal keratinocytes that clinically presents as a solitary, asymptomatic keratotic papule or nodule on the trunk. A 40-year-old female visited our hospital with a 20-year history of a single papule on her right thigh. On physical examination, the lesion measured 0.5×0.4 cm in size and appeared brown in color with central hyperkeratosis. Histopathological evaluation showed hyperkeratosis, acanthosis, papillomatosis, dyskeratosis, and acantholysis. Only six cases of acantholytic acanthoma have been reported in Korea. We report a rare case of acantholytic acanthoma that occurred in a 40-year-old female who presented with a keratotic papule on her right thigh.
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Prurigo nodularis (PN) is a chronic cutaneous condition characterized by a papulonodular pruriginous eruption accompanied by pruritus. PN lesions are typically firm and itchy hyperkeratotic nodules and papules, which provoke a scratch response. PN may often represent an initial cutaneous manifestation of human immunodeficiency virus (HIV) infection. The association between PN and HIV is attributable to various etiopathogenetic mechanisms including cutaneous immunological abnormalities. Diagnosis of HIV infection in a patient with PN is challenging.We report a case of confirmed HIV infection in a patient with treatment-resistant PN, who was successfully treated using combination treatment that included HIV antiretroviral therapy and narrow-band ultraviolet-B radiation.
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Sweet syndrome is characterized by fever, tender, erythematous skin lesions, neutrophilia, high levels of serum inflammatory markers, and diffuse mature neutrophil infiltration typically localized to the upper dermis. Various drugs have been shown to be associated with Sweet syndrome. Bortezomib, a proteasome inhibitor approved for the treatment of multiple myeloma, has been reported to be associated with erythema, pruritus, eczemas, and, rarely, erythema multiforme-like skin changes or vasculitis. We describe a case involving a 65-year-old male who received bortezomib for the treatment of multiple myeloma. Over three cycles, multiple nodular lesions recurred through periods of aggravation and relief from symptoms. On the basis of the signs, symptoms, and biopsy results, the patient was diagnosed as showing Sweet syndrome. Skin lesions that occur during treatment of underlying disease can affect the patients’ treatment compliance. This case report indicates that a bortezomib rechallenge is an option for patients who develop sweet syndrome
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Primary cutaneous anaplastic large cell lymphoma is primary cutaneous lymphoma that is composed of large lymphoid cells with anaplastic and pleomorphic morphology and expresses the CD30 antigen. Generally, primary cutaneous anaplastic large cell lymphoma is represented by a single, erosive plaque located on the trunk or extremities, but rarely on the dorsum of the hand. A 36-year-old man visited our hospital with a plaque on the dorsum of his left hand for 2 months. The plaque was 6×5 cm in size and violet-colored, with erosion. Histopathological findings showed infiltration of large anaplastic cells in the dermis and subcutaneous fat tissue. Immunohistochemically, it showed positive results for CD3, CD4, and CD30 and negativity anaplastic lymphoma kinase. Imaging examination showed no additional lesions, and the diagnosis was confirmed as primary cutaneous anaplastic large cell lymphoma. The patient was treated with radiation therapy four times and the lesion completely disappeared.
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Background@#Lichen sclerosus et atrophicus is an uncommon, benign, chronic lymphocyte-mediated inflammatory dermatosis that occurs mainly in the genital area. It causes substantial discomfort and morbidity, mostly in adult women. @*Objective@#To investigate the clinicopathological characteristics of patients with vulvar lichen sclerosus et atrophicus. @*Methods@#We retrospectively reviewed the clinical and histopathological features of 25 patients diagnosed with vulvar lichen sclerosus et atrophicus, who visited the dermatologic department between January 2009 and June 2017. @*Results@#The average age was 54.2 years, and the disease duration was mostly less than 1 year. The major clinical features were diffuse patch, followed by diffuse plaque and multiple macules. It often presented with diabetes mellitus, thyroid disease, and hypertension. Itching was the most common symptom, followed by pain and burning sensations. Histopathological findings were hyperkeratosis with follicular plugging; atrophy and loss of rete ridge elongation in the epidermis; liquefaction degeneration and keratinocyte necrosis in the dermo-epidermal junction;collagen fibers hyalinization; and infiltration of inflammatory cells in the dermis. Antihistamines and topical steroids were used in most cases for treatment. @*Conclusion@#Vulvar lichen sclerosus et atrophicus causes discomfort and diminishes the quality of life in older women. Early diagnosis and prompt treatment are vital in preventing disease progression and complications. This study will provide valuable data on vulvar lichen sclerosus et atrophicus to dermatologists.
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Background@#Mobile applications are useful in the field of dermatology as diagnosis and treatment are based on visual inspection. However, in Korea, dermatology-related applications have not been developed effectively despite the high rate of mobile internet usage. In addition, there is no report on the current trends of dermatology-related mobile application. @*Objective@#This study aimed to identify and categorize the available dermatology-related mobile application and compare the current trends in Korea with those in the US. @*Methods@#Eight dermatologic terms were queried in two mobile platforms, Android and iOS. Applications were categorized by function based on their description. The number of reviews, rating, provider, target audience, and price of applications were recorded. @*Results@#A total of 213 dermatology-related applications were identified. Approximately 10.8% of the applications were related to skin diseases, 23.5% were related to skin care, and 65.7% were others. Among the applications related to skin diseases, 4.2% were self-surveillance/diagnosis apps, 3.3% were disease guide and reference apps, and 1.4% were dermoscopy apps. No applications were related to educational aid and photography search. Among the applications related to skin care, 12.7% were self-surveillance/diagnosis apps used for general skin care, 3.8% were skin care apps, and 2.8% were cosmetics apps. Other categories included shopping (24.9%), advertisements (15.0%), and hospital searches (15.0%). @*Conclusion@#The development and use of dermatology mobile applications can contribute to the efficient delivery of accurate information to patients, educate patients, and further reduce the prevalence of skin diseases. Therefore, dermatologists should play a leading role in presenting the direction for dermatology-related mobile application development.