Cutaneous Sarcoidosis on Bilateral Upper Eyelids Misdiagnosed as Cutaneous Tuberculosis / 대한피부과학회지

A 52-year-old woman presented with erythematous nodules and swelling on both upper eyelids. She had a surgical history of blepharoplasty about 10 years previously. Skin biopsy revealed non-caseating granulomas in the dermis. Mycobacterium tuberculosis (MTB) polymerase chain reaction (PCR) testing of the tissue sample was positive. In addition, the serum interferon gamma release assay (IGRAs) result was positive. Based on the positive result of MTB PCR and IGRAs, a diagnosis of tuberculosis was made. Despite a 2-month treatment with anti-tuberculosis medication, the skin lesions worsened. An additional skin biopsy was taken and AFB stain, AFB culture, and MTB PCR of the tissue were all negative. Four months after systemic corticosteroid treatment, the skin lesion had almost cleared. Considering that there have been many reports of positive results of MTB PCR in sarcoidosis tissue and IGRAs, a diagnosis of tuberculosis based on the results of PCR and IGRAs needs to be interpreted with caution. Also, evaluation of other organ involvement including the lungs can be helpful in making a correct diagnosis.

Primary Merkel cell carcinoma of the earlobe in a young healthy man

Merkel cell carcinoma (MCC) is an uncommon neuroendocrine cutaneous tumor with poor prognosis. It has the high rate of recurrence, mortality, regional nodal involvement, and distant metastases. It is difficult to diagnose MCC because of its non-specific clinical findings. It usually occurs on sun-exposed areas of the skin, mostly at head and neck. There is a difference in the incidence and prognosis according to site in the head and neck. However, there is no consented site-specific diagnosis, treatment or follow-up protocol for MCC at the head and neck. We herein report a case of MCC arising in the right earlobe of an otherwise healthy young man who has been diagnosed early, thereby successfully treated. With our closed follow-up, there was no tumor recurrence or complication at 33 months after diagnosis.

Metastatic Blue Nevus-Like Melanoma Detected by Liquid-Based Catheterized Urine Cytology

Primary or metastatic malignant melanoma can mimic benign blue nevus in rare cases, making the diagnosis challenging. Herein, we report an exceptionally rare case of blue nevus-like melanoma and its blue nevus-like metastasis which was detected by catheterized urine cytology. The patient presented with blue-colored papuloplaques on his temple which were diagnosed as blue nevus-like melanoma on punch biopsies. While he was admitted for administration of chemotherapy, hematuria was detected. Catheterized urine cytology revealed singly scattered oval to spindle-shaped pigmented cells with a moderate degree of variation in shape and size. Many of them had small nuclei with indiscernible to inconspicuous nucleoli while only a few cells showed nuclear enlargement and nuclear hyperchromasia, which could be diagnostic pitfalls. Most of the cells on the smear were positive for HMB45 immunostaining, which confirmed the diagnosis of metastatic blue nevus-like melanoma. To the best of our knowledge, the present case is the first report describing cytomorphologic findings of blue nevus-like metastasis of melanoma in the urine specimen.

Low Level Light Therapy Using an 830-nm Light Emitting Diode Promotes Wound Healing via TGF-β/SMAD Pathway Activation / 대한피부과학회지

BACKGROUND: The transforming growth factor-β/SMAD (TGF-β/SMAD) pathway plays an important role in tissue repair and collagen synthesis. Low-level light therapy (LLLT) is increasingly used to alleviate pain and inflammation and promote wound healing. However, few studies have directly compared the effects of different wavelengths of light-emitting diodes (LEDs) or examined their individual effects at the molecular level. OBJECTIVE: Here we used a mouse model to investigate the effect of blue (410 nm), red (630 nm), and infrared (830 nm) LEDs on wound closure and assessed the underlying changes in a signal transduction pathway. METHODS: A full-thickness wound was created on the dorsal skin of mice using a 6-mm-diameter punch. In part I, the wounds were irradiated using blue, red, and infrared LEDs. In part II, the wounds were irradiated at different time points. Photo documentation, serial skin biopsies, wound measurements, and immunohistochemical staining using TGF-β/SMAD pathway-related molecules were performed. RESULTS: The overall wound closure percentage was highest during the first 10 days when an 830-nm LED was used. The wound closure process was accelerated when the irradiation was initiated immediately after wounding. Irradiation using 830-nm LED upregulated TGF-β and collagen-1 but downregulated SMAD7. CONCLUSION: Our findings show that LLLT using an 830-nm wavelength LED delivered immediately after wound formation may have the best effect on wound healing by upregulating the TGF-β/SMAD signaling pathway.

Low-Level Light Therapy with 410 nm Light Emitting Diode Suppresses Collagen Synthesis in Human Keloid Fibroblasts: An In Vitro Study

BACKGROUND: Keloids are characterized by excessive collagen deposition in the dermis, in which transforming growth factor β (TGF-β)/Smad signaling plays an important role. Low-level light therapy (LLLT) is reported as effective in preventing keloids in clinical reports, recently. To date, studies investigating the effect of LLLT on keloid fibroblasts are extremely rare. OBJECTIVE: We investigated the effect of LLLT with blue (410 nm), red (630 nm), and infrared (830 nm) light on the collagen synthesis in keloid fibroblasts. METHODS: Keloid fibroblasts were isolated from keloid-revision surgery samples and irradiated using 410-, 630-, 830-nm light emitting diode twice, with a 24-hour interval at 10 J/cm². After irradiation, cells were incubated for 24 and 48 hours and real-time quantitative reverse transcription polymerase chain reaction was performed. Western blot analysis was also performed in 48 hours after last irradiation. The genes and proteins of collagen type I, TGF-β1, Smad3, and Smad7 were analyzed. RESULTS: We observed no statistically significant change in the viability of keloid fibroblasts after irradiation. Collagen type I was the only gene whose expression significantly decreased after irradiation at 410 nm when compared to the non-irradiated control. Western blot analysis showed that LLLT at 410 nm lowered the protein levels of collagen type I compared to the control. CONCLUSION: LLLT at 410 nm decreased the expression of collagen type I in keloid fibroblasts and might be effective in preventing keloid formation in their initial stage.

Concurrent Linear Immunoglobulin A Dermatosis, Hashimoto Thyroiditis, and Immunoglobulin A Nephropathy in an Adult

No abstract available.

Prurigo Pigmentosa after Injection Lypolysis with Phosphatidylcholine and Deoxycholate / 대한피부과학회지

No abstract available.

Photodynamic Therapy in Bowen Disease of the First Web Space of the Hand

Bowen disease (BD), or intraepithelial squamous cell carcinoma (SCC), may progress to an invasive SCC. Although surgery is preferred because of the low recurrence rate, it can result in hypertrophic scarringor contracture, particularly in lesions on the hands. We report a case of BD in the first web space of the hand, which was treated with ablative fractional laser-assisted photodynamic therapy (AFXL-assisted PDT). After multiple AFXL-assisted PDT sessions, the lesion showed no clinical or pathological abnormalities. Thus, we believe that PDT can be an alternative treatment for BD occurring in the web space of the hand.

Basal Cell Carcinoma Presenting as a Perianal Ulcer and Treated with Radiotherapy

No abstract available.

Comparison between Malassezia Folliculitis and Non-Malassezia Folliculitis

BACKGROUND: Among the various types of folliculitis, differentiation of Malassezia folliculitis (MF) from other forms of folliculitis is important because it is usually treated with antifungal agents. OBJECTIVE: We attempted to find a method to enhance the detection rate of MF, and examined the differences in the clinical manifestation between MF and non-MF (NMF). METHODS: We performed a retrospective study involving patients with folliculitis who were previously diagnosed with MF or NMF on the basis of serial tissue sectioning and diastase-Periodic acid-Schiff (d-PAS) staining findings. The clinical features of MF and NMF were compared. RESULTS: Among a total of 100 folliculitis patients, 20 were diagnosed with MF and 80 with NMF. Tissues from the 80 patients with NMF were sectioned serially into 10 slices and stained with hematoxylin and eosin stain; among these, 10 had many round-to-oval yeast organisms in the hair follicles that confirmed MF. Finally, d-PAS staining was used to detect the presence of yeast in the NMF slides. Notably, among the 70 d-PAS-stained samples, yeast organisms were found in 6 samples, confirming MF. As a result, the diagnosis of 16 patients changed from NMF to MF. Compared with NMF, MF showed major involvement of the trunk and low involvement of the face and legs as well as male predilection. CONCLUSION: Physicians should consider serial sectioning and/or d-PAS staining of folliculitis lesions, particularly of those on the trunk of male patients, even if no yeast organisms are detected initially.

Congenital Form of Isolated Benign Primary Cutaneous Plasmacytosis in a Child

No abstract available.

Photodynamic Therapy with Ablative Carbon Dioxide Fractional Laser for Treating Bowen Disease

BACKGROUND: Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT. OBJECTIVE: We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO2 fractional laser pretreatment for treating Bowen disease. METHODS: Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO2 fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded. RESULTS: Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70+/-1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events. CONCLUSION: The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.

Photodynamic Therapy with Ablative Carbon Dioxide Fractional Laser for Treating Bowen Disease

BACKGROUND: Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT. OBJECTIVE: We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO2 fractional laser pretreatment for treating Bowen disease. METHODS: Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO2 fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded. RESULTS: Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70+/-1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events. CONCLUSION: The results suggest that pretreatment with an ablative fractional CO2 laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.

Nodular Basal Cell Carcinoma Successfully Treated with Intralesional 5-Aminolevulinic Acid Injection-Photodynamic Therapy

No abstract available.

Orofacial Granulomatosis Associated with Crohn's Disease

Orofacial granulomatosis (OFG) is a term used to describe swelling of the orofacial area, mainly in the lips, secondary to an underlying granulomatous inflammatory process. OFG has been reported in association with systemic conditions such as sarcoidosis and Crohn's disease (CD). OFG may precede gastrointestinal disease, such as CD, by several years and may be the only obvious focus of the disease. Herein, we report a patient with OFG and non-symptomatic ulcerations of the ileocecal valve. The patient received intralesional triamcinolone injections every 2 weeks. After 6 weeks, all oral lesions showed marked improvement. The favourable treatment response of this patient suggests that intralesional triamcinolone can be used as a treatment option for patients with CD that have oral lesions. In addition, patients presenting with OFG should be carefully evaluated for gastrointestinal signs and symptoms.

Toll-like Receptors and Antimicrobial Peptides Expressions of Psoriasis: Correlation with Serum Vitamin D Level

To evaluate the association of Toll-like receptors (TLRs), antimicrobial peptides (AMPs) and vitamin D receptors (VDRs) in psoriasis, lesional (PP) and perilesional skin (PN) from psoriasis, atopic dermatitis (AD) patients and healthy controls (NN) were studied by immunohistochemistry. Compared with PN, AD and NN skin, dysregulated expression of TLRs, AMPs and VDR was detected in PP skin. Noteworthy, our results showed altered correlation between TLR2 and VDR expression in PP and PN skin. Human beta defensin 2 (HBD2) and cathelicidin (LL-37) expressions in the PP skin were higher in serum vitamin D sufficient (VDS) groups than serum vitamin D deficient (VDD) groups. Negative correlation was found between TLR2 and VDR expression in the PP skin of VDD groups. However, positive correlation was noted in the PP skin of VDS groups. Based on the present results, therapies targeting the activity of TLRs, AMPs and vitamin D, including modulation of the TLR-VDR pathways, might provide new therapeutic approaches to the psoriasis and other inflammatory skin diseases.

Neurocristic Cutaneous Hamartoma of the Scalp

Neurocristic cutaneous hamartomas (NCHs) result from aberrant development of the neuromesenchyme. In addition to a dermal melanocytic component, these tumors can contain neuro sustentacular and fibrogenic components. The clinical importance of these lesions includes the potential for misdiagnosis as well as the development of malignant melanomas over a poorly described period of time. We present a rare case of NCH of the scalp in a 1-year-old female.

Fordyce's Spots on the Penile Shaft: An Unusual Localization / 대한피부과학회지

Fordyce's spots are ectopically located sebaceous glands, and these are clinically characterized by multiple pinhead- sized whitish or yellowish papules. Although the condition is not generally considered to be pathological, there are some problematic cases that have significant cosmetic concerns. These spots are usually located at different sites inside the oral cavity, and mainly at the upper lip and buccal mucosa. However, they occasionally occur on the areola, glans penis and labia minor. We herein report on a case of Fordyce's spots on the penile shaft because this condition should be considered in the differential diagnosis of lichen nitidus.