Benign Symmetric Lipomatosis in Korean Patients / 대한피부과학회지

Background@#Madelung’s disease (MD) is characterized by multiple symmetric deposits of unencapsulated adipose tissue in the head, neck, and upper trunk. However, the etiology of lipoma tissue in MD remains controversial. @*Objective@#This study determined the clinicopathological and epidemiological features of Korean patients with MD and re-examined the hypothesis that lipomas of MD originate from brown fat. @*Methods@#We performed a single-institution, retrospective medical record review of 20 patients diagnosed with MD between January 1997 and August 2017. Biopsy slides were stained with nuclear factor IA (NFIA) and uncoupling protein 1 (UCP-1). @*Results@#The patients included were 2 women and 18 men with an average age of 64 (range, 27∼75) years. Ten patients reported heavy alcohol intake, and the remaining 10 reported some degree of alcohol intake. Hepatic disease was present in 47.7% of patients, only 16.7% had a body mass index ＞30 kg/m2, and 80% underwent surgical intervention. @*Conclusion@#MD affected mainly alcoholic men in the fourth decade. Alcoholism, hepatic disease, or severe obesity accounted for less than half of the Korean patients with MD. Immunohistochemical staining supported the hypothesis that MD lipomas originate from brown fat. Although the adipose tissue of all patients was stained with NFIA and UCP-1, the staining intensity varied. NFIA, which is a transcription factor required for the induction and maintenance of brown fat-specific gene expression, was more sensitive than UCP-1 for the detection of brown fat.

A Skin Metastasis from a Gastric Signet-Ring Cell Carcinoma in an Adolescent that Mimicked Steatocystoma Multiplex / 대한피부과학회지

Cutaneous metastases of internal malignancies are relatively rare and originate most frequently from tumors of the breast and lung. Herein, we present an unusual clinical presentation of a skin metastasis from a gastric signet-ring cell carcinoma in an adolescent. A 19-year-old boy presented with asymptomatic subcutaneous nodules on his abdomen and back. Histopathological examination revealed signet-ring cells with cytoplasmic mucin in the dermis. A diagnosis of cutaneous metastasis of a signet-ring cell carcinoma was made and the patient died 12 days after his initial visit to our dermatology clinic. Gastric carcinomas have infrequently been reported in adolescents, and cutaneous metastases from carcinomas in this group are extremely rare. Clinicians should be aware that skin metastases of adolescent gastric carcinoma can be similar in presentation to steatocystoma multiplex and that a skin biopsy is necessary for suspicious skin lesions.

Allergen Sensitization Pattern by Sex: A Cluster Analysis in Korea

BACKGROUND: Allergens tend to sensitize simultaneously. Etiology of this phenomenon has been suggested to be allergen cross-reactivity or concurrent exposure. However, little is known about specific allergen sensitization patterns. OBJECTIVE: To investigate the allergen sensitization characteristics according to gender. METHODS: Multiple allergen simultaneous test (MAST) is widely used as a screening tool for detecting allergen sensitization in dermatologic clinics. We retrospectively reviewed the medical records of patients with MAST results between 2008 and 2014 in our Department of Dermatology. A cluster analysis was performed to elucidate the allergen-specific immunoglobulin (Ig)E cluster pattern. RESULTS: The results of MAST (39 allergen-specific IgEs) from 4,360 cases were analyzed. By cluster analysis, 39items were grouped into 8 clusters. Each cluster had characteristic features. When compared with female, the male group tended to be sensitized more frequently to all tested allergens, except for fungus allergens cluster. CONCLUSION: The cluster and comparative analysis results demonstrate that the allergen sensitization is clustered, manifesting allergen similarity or co-exposure. Only the fungus cluster allergens tend to sensitize female group more frequently than male group.

Tinea Incognito Simulating Herpes Simplex Virus Infection

No abstract available.

Efficacy and Safety of Pueraria lobata Extract in Gray Hair Prevention: A Randomized, Double-Blind, Placebo-Controlled Study

BACKGROUND: Graying of hair-a sign of aging-raises cosmetic concerns. Individuals with gray hair often look older than others their age; therefore, some dye their hair for aesthetic purposes. However, hair colorants can induce many problems including skin irritation, allergic reaction and hair-breakage. OBJECTIVE: This randomized, double-blind clinical trial was performed in order to examine the effects of APHG-1001, a compound including an extract from Pueraria lobata, on graying hair. METHODS: A total of 44 female subjects were randomly treated with either APHG-1001 or placebo twice daily for 24 weeks. Using the phototrichogram analysis, a count of newly developed gray hair was estimated. Investigator assessment and subject self-assessment were also performed in order to evaluate the efficacy of the compound. RESULTS: The mean number of newly developed gray hair at 24 weeks was 6.3/cm2 in the APHG-1001 group and 11.4/cm2 in the placebo group; the difference was statistically significant (p<0.05). However, the investigator assessment and subject self-assessment did not show any significant change in the gross appearance of hair grayness by the end of the study. No severe adverse events in either group were observed. Moreover, the incidence of adverse events did not differ between the groups. CONCLUSION: This clinical trial revealed that APHG-1001, which contains an extract of P. lobata, could prevent the development of new gray hair without any remarkable adverse effects. Thus, it can be considered as a viable treatment option for the prevention of gray hair.

The Pattern of Hair Dyeing in Koreans with Gray Hair

BACKGROUND: Hair graying is considered as a part of normal ageing process. Nonetheless, this process raises a significant cosmetic concern, especially among ethnic Korean elderly whose baseline hair color is black. For this reason, Korean elderly dye their hair with frequency despite the risk of dermatologic problems such as allergic contact dermatitis. OBJECTIVE: In this study, the authors investigate the prevalence and pattern of hair dyeing and its relation with scalp diseases in Korea. METHODS: Six hundred twenty subjects (330 men and 290 women) with graying hair were given a questionnaire survery and underwent a physical examination. RESULTS: Of the 620 total, 272 subjects (43.9%) dyed their hair. Hair dyeing was significantly more frequent among women than among men (p<0.001). Subjects from 50 to 69 years of age showed higher prevalence of hair dyeing when compared to either younger or older groups. Subjective self-assessment of the extent of hair graying was associated with increased prevalence of hair dyeing, that is, individuals who feel graying has advanced by more than 20% of the overall hair were much more likely to dye their hair (p<0.001). Hair dyeing did not correlate with either alopecia or scalp disease. CONCLUSION: Our survey has found that the prevalence of hair dyeing is higher among Korean women than men. People in their fifties and sixties and people with more than 20% extent of grayness were more likely to dye their hair than otherwise. Hair dyeing was not associated with any increase in the prevalence of scalp diseases.

Verruca Vulgaris on Top of a Melanocytic Nevus Simulating Melanoma / 대한피부과학회지

No abstract available.

Porokeratosis of Mibelli with Amyloid Deposits in Dermis / 대한피부과학회지

Porokeratosis of Mibelli, a chronic heritable disorder of the skin, presents with characteristic histopathological features including cornoid lamella as a result of faulty keratinization. Amyloid deposits are characterized by the accumulation of ultrastructually fibrillar material and have been observed in inflammatory and tumoral skin diseases. Some cases of amyloid deposits in the upper dermis in various subtypes of porokeratosis have been reported, but no porokeratosis of Mibelli reports are available in Korea. We report a case of a 26-year-old woman with three verrucous hyperkeratotic plaque lesions on her right popliteal fossa with histological feature of hyperkeratosis, cornoid lamella, and dermal amyloid deposits.

Clinical Characteristics and Prognostic Factors in Early-Onset Alopecia Totalis and Alopecia Universalis

Alopecia totalis (AT) and alopecia universalis (AU), severe forms of alopecia areata (AA), show distinguishable clinical characteristics from those of patch AA. In this study, we investigated the clinical characteristics of AT/AU according to the onset age. Based on the onset age around adolescence ( or = 13 yr), 108 patients were classified in an early-onset group and the other 179 patients in a late-onset group. We found that more patients in the early-onset group had a family history of AA, nail dystrophy, and history of atopic dermatitis than those in the late-onset group. These clinical differences were more prominent in patients with AU than in those with AT. In addition, significantly more patients with concomitant medical disorders, especially allergic diseases were found in the early-onset group (45.8%) than in the late-onset group (31.2%). All treatment modalities failed to show any association with the present hair condition of patients. In the early-onset group, patients with AU or a family history of AA showed worse prognosis, whereas this trend was not observed in the late-onset group. Systemic evaluations might be needed in early-onset patients due to the higher incidence of comorbid diseases. It is suggested that patients with AU or family history of AA make worse progress in the early-onset group than in the late-onset group.

Cutaneous Angiosarcoma Developed at Site of Herpes Zoster Scar: Wolf's Isotopic Response / 대한피부과학회지

Angiosarcoma is a rare malignant vascular tumor of endothelial origin. It can involve any organ, including the skin, soft tissue, liver, bone, spleen, and orbit. Skin is the most frequent site of primary angiosarcoma, however, metastatic skin involvement of angiosarcoma is exceptional. Wolf's isotopic response implies that the new disease appeared at the site of an already healed skin disease. Several types of cutaneous lesions have been described, occurring within cleared cutaneous herpes zoster, or herpes simplex lesions. These lesions include comedones, granulomatous diseases, tinea, furunculosis, wart, psoriasis, pseudolymphoma, leukemia, lymphoma, basal cell carcinoma, squamous cell carcinoma and cutaneous metastases, from internal carcinoma. Herein, we report a case of cutaneous angiosarcoma of unknown origin that has developed at the site of a scar, after herpes zoster in a 79-year-old man as isotopic response.

Physiological Characteristics of Skin of Normal Mongolian Subjects Determined by Non-invasive Bioengineering Methods / 대한피부과학회지

BACKGROUND: Physiological parameters of the skin measured by non-invasive methods have been considerably developed. It is known that there are some differences in physiologic parameters between different races. OBJECTIVE: The purpose of this study is to understand the differences between the races. METHODS: A total of 757 Mongolian participated in this study. All subjects had no major history of skin diseases requiring medical treatment. Several instruments were used such as Sebumeter, Corneometer, Mexameter for measuring sebum excretion rate, values of capacitance, melanin index and erythema index respectively. These were measured on various areas of the skin such as cheek, forehead, palm, outer arm, inner arm, back and buttock. RESULTS: The sebum excretion rates showed higher in males than in females on the cheek and forehead in Mongolian. However, they showed higher in the females on the palm. There were good correlation between the skin sebum level and the capacitance in males and females. The melanin index and erythema index showed higher in males than in females at all sites. When we compared this with the data published in other countries, many data were similar to Korean rather than a western country's. However, the capacitance data were lower than those of Korean. CONCLUSION: Although, this study has some limit for direct comparison between each race, our results can be used as basic data for the comparison between Mongolian and other races in the future.

Gene mapping study for constitutive skin color in an isolated Mongolian population

To elucidate the genes responsible for constitutive human skin color, we measured the extent of skin pigmentation in the buttock, representative of lifelong non-sun-exposed skin, and conducted a gene mapping study on skin color in an isolated Mongolian population composed of 344 individuals from 59 families who lived in Dashbalbar, Mongolia. The heritability of constitutive skin color was 0.82, indicating significant genetic association on this trait. Through the linkage analysis using 1,039 short tandem repeat (STR) microsatellite markers, we identified a novel genomic region regulating constitutive skin color on 11q24.2 with an logarithm of odds (LOD) score of 3.39. In addition, we also found other candidate regions on 17q23.2, 6q25.1, and 13q33.2 (LOD > or = 2). Family-based association tests on these regions with suggestive linkage peaks revealed ten and two significant single nucleotide polymorphisms (SNPs) on the linkage regions of chromosome 11 and 17, respectively. We were able to discover four possible candidate genes that would be implicated to regulate human skin color: ETS1, UBASH3B, ASAM, and CLTC.

Four Cases of Lobulated Intradermal Nevus: A Sign of Aging Melanocytic Nevus

Melanocytic nevi are subject to change with age in both clinical and histopathologic findings. In 1991, Cho et al. first reported three cases of lobulated intradermal nevi and suggested their cases represented an unusual form of regressing melanocytic nevus. Herein we report four cases of lobulated intradermal nevus and review previous literature.

Prognostic Factors for Cure and Recurrence of Onychomycosis / 대한의진균학회지

BACKGROUND: The cure of onychomycosis (OM) requires long-term oral antifungal treatment, and recurrences after successful treatment are relatively common (10~53%). OBJECTIVE: We sought to determine the factors affecting the duration of treatment and identify risk factors for recurrence. METHODS: We retrospectively reviewed successfully treated consecutive cases of onychomycosis between January 2006 and February 2010. We classified the patients into 7 groups: distal subungual onychomycosis (DSO) type I (~25% involved), type II (25~50%), type III (50~75%), type IV (75~100%), proximal subungual onychomycosis (PSO), superficial white onychomycosis (SWO), and candidal OM. The patients were treated with systemic agents including terbinafine, fluconazole and itraconazole. We analyzed the clinical data for factors affecting the duration of treatement and recurrence of onychomycosis. The factors included age, sex, subtype of onychomycosis, type of systemic antifungal agent as well as the existence of comorbidities. RESULTS: A total of 227 patients were enrolled: their mean age was 56.9 years (range, 11~90); mean duration of treatment was 7.2 months (range, 1~24). The duration of treatment of DSO type I (6.2 months) was shorter than that of DSO III (8.5 months) and IV (9.0 months). The other factors including age, sex, the existence of diabetes or vascular disease, and the type of systemic agents did not affect the duration of treatment. The recurrence rates after successful treatment were 12.5% in the patients with diabetes and 2.6% in the patients without diabetes (p = 0.026). There was no difference in recurrence rates of the patients with or without vascular diseases. CONCLUSION: The duration of treatment to cure OM increased with the degree of involvement of DSO. No other factors affected the treatment duration significantly. recurrence rate was significantly higher in patients with diabetes.

Treatment of Keratoacanthoma with 5% Imiquimod Cream and Review of the Previous Report

Keratoacanthoma (KA) is a benign epidermal tumor, characterized by rapid and abundant growth, a tendency toward spontaneous regression and histopathologic similarity to squamous cell carcinoma (SCC). Because KA can be easily misdiagnosed as SCC, surgery is considered the treatment of choice. Recently, regression of KAs following application of 5% imiquimod cream (Aldara(R)) has been reported. We present 4 cases of KA treated with topical imiquimod, applied 3 to 4 times a week. Obvious improvement was observed after 4 to 6 weeks of application and the lesions were almost cleared leaving scars after 9 to 11 weeks. These results show that topical imiquimod can be an effective option for the conservative management of KA as previously reported. We also suggest that lesions treated with imiquimod cream should be considered for biopsy to judge histopathological remission after 5 to 8 weeks of application to shorten the duration of the treatment.

A Case of Assisted Reproductive Therapy-induced Erythema Nodosum

Erythema nodosum is a common variant of panniculitis. It is characterized by tender erythematous nodule and plaque on the anterior aspect of the leg. The etiology is not fully understood. It may be associated with a variety of disorders, including infection, medication, autoimmune disorders, pregnancy, and malignancy. A 33-year-old Korean woman presented with 1 week history of painful erythematous plaques on both knees. She was 7 weeks pregnant with assisted reproductive therapy, and had been maintained on daily intramuscular progesterone injection for 4 weeks. Histological examination of the lesions revealed septal panniculitis without vasculitis. Two days after discontinuing progesterone injection, the symptoms and lesions started to resolve. Herein we present a case of erythema nodosum caused by progesterone injection for endometrial preparation.

Live Interactive Teledermatologic Consultation: Clinical Evaluation and the Patients' Satisfaction / 대한피부과학회지

BACKGROUND: Telemedicine is broadly defined as using telecommunication technology to transfer medical information. Teledermatology is defined as using telemedicine in the field of dermatology, and this can be divided into a storage-and-forward system and a live interactive system. The latter uses video-conferencing equipment and it is known to be more useful than the former. However, there have been few studies on live interactive teledermatologic consultation in Korea. OBJECTIVE: We wanted to describe and quantify teledematologic consultation and to assess patients' satisfaction with the live interactive consultation by using a questionnaire. METHODS: We retrospectively reviewed the records of the patients who were consulted through the teledermatologic system. To assess patients' satisfaction with the live interactive teledermatologic consultation, we asked the patients to complete a questionnaire after the consultation. RESULTS: A total of 98 patients were consulted for 112 skin problems. The most frequent skin problem was eczematous diseases (33.9%), followed by infectious diseases (25.0%). Concerning the treatment efficacy, 90.7% of the patients experienced improvement of their initial symptom. Only one main diagnosis was recorded for 64.3% of the cases, and one main diagnosis with one other possible diagnosis to be differentiated was recorded for 30.4% of the cases. For the aspect of the technical quality, 66.1% of the patients were satisfied or very satisfied with the performance of the instruments for live interactive communication. In addition, half of the patients were satisfied or very satisfied with the teledermatologic consultation, and 59.7% of the patients answered that they would use teledermatologic consultation system again if another skin problem develops. CONCLUSION: With its good performance, teledermatologic consultation seems to be helpful and satisfactory for the patients who are unable to visit the dermatologic out-patients clinic.