A Case of Concurrent Vitiligo and Psoriasis

Vitiligo and psoriasis are common dermatoses that occur in 1~3% and 0.5% of the general population, respectively. There have been several reports of the concurrence of these diseases in the English medical literature. Yet the pathogenesis of the association between these two dermatoses is still unknown. Psoriasis may occur coincidentally with vitiligo and it may be strictly confined to the vitiliginous patches or it may occur elsewhere. Despite the reports in the English literature, there has been only one case of vitiligo and psoriasis coexisting in the same patient and these diseases occurred in separate sites in the Korean dermatologic literature. A 30-year-old man recently presented with spreading vitiligo on the right forearm and a 3-month history of guttate psoriasis on the left forearm. He had a family history of psoriasis without any history of associated autoimmune disease. Herein, we report on a case of coexisting vitiligo and psoriasis in the same individual at different sites and we review the relevant literature.

A Case of Eccrine Angiomatous Hamartoma with Unusual Lipomatous Involvement / 대한피부과학회지

Eccrine angiomatous hamartoma (EAH) is a benign, uncommon cutaneous lesion, often localized to the distal extremities of children. It usually presents as a solitary, asymptomatic lesion that appears as a nodule or plaque, but sometimes it can occur as multiple lesions. Varying degrees of hyperhidrosis and pain have been reported. The histological feature is characterized by a proliferation of eccrine sweat glands and angiomatous channels. Occasionally, other elements are involved, such as mucin-secreting cells, adipose tissue, bony structures, apocrine glands or hair structures. We describe a case of eccrine angiomatous hamartoma with unusual lipomatous involvement.

A Case of Psoriasiform Eruption Triggered by Tumor Necrosis Factor-alpha Antagonist Therapy / 대한피부과학회지

Tumor necrosis factor-alpha antagonists include monoclonal antibodies, infliximab, adalimumab, etanercept and golimumab. Clinical trials of these agents have shown that they are remarkably effective for psoriasis, but cutaneous adverse reactions of these agents including paradoxical aggravation of psoriasiform eruption have been also reported. We present a case of psoriasiform eruption triggered by golimumab therapy in a patient with rheumatoid arthritis. A 53-year-old woman presented with a skin lesion on the sole. She had been treated by golimumab every 4 weeks for rheumatoid arthritis from September 2006. 16 weeks after the treatment, she developed a erythematous and scaly patch on the sole. She had a history of palmoplantar pustulosis, but the skin lesions had not appeared for a long time, recurring when she started golimumab treatment. The skin lesion improved with topical steroid treatment, but as golimumab was re-administrated, the skin lesion exacerbated.

A clinical analysis of pelvic actinomycosis / 대한산부인과학회지

OBJECT: Pelvic actinomycosis is a relatively rare chronic suppurative and granulomatous infectious disease, caused by a gram-positive anaerobic bacteria. Actinomyces israelli is the most common subtype in human disease commonly associated with intrauterine device (IUD). This study was designed to analyze clinical and laboratory characteristics of patients with pelvic actinomycosis. METHODS: We reviewed medical records of 12 patients with pelvic actinomycosis who were admitted between January 1, 1995 and December 31, 2005. The clinical characteristics, diagnostic evaluation and surgical treatment results were retrospectively analyzed. RESULTS: The ages of the cases varied between 30 and 53 years old. Of the 12 patients, 11 patients had been using an IUD. Two cases had hydronephrosis due to infection. All our cases involved ovary and/or uterus and had predisposing factors of disease progression, including IUD, dilatation and curretage. Most common presenting symptom of patients were abdominal pain (75%). Preoperatively, 5 cases were diagnosed as actinomycosis, but 7 cases misconceived as a pelvic malignancy, secondary degenerated myoma and tuboovarian abscess. Exploration were performed in all patients. All cases were cured following surgery with subsequent antibiotics. CONCLUSION: Actinomycosis should be considered preoperatively, especially in long-term IUD usage, fever and laboratory findings that indicate the presence of pelvic infection. Radiologic findings (CT) can assist in making the diagnosis of pelvic actinomycosis. Appropriate antibiotics, as well as surgery, are important in the treatment of pelvic actinomycosis.

A Case of Inflammatory Vitiligo

Vitiligo is common dermatologic disorder, but inflammatory vitiligo is a rare occurrence that is characterized by erythematous rim at the periphery of a patch of hypopigmented skin. Since the initial description of inflammatory vitiligo, only about 20 cases have been identified via a review of the literature. We herein report the first Korean case of inflammatory vitiligo developed in an 56-year-old male.

Therapeutic Effects of 308 nm Excimer Laser in the Treatment of Vitiligo on the Head and Neck Area / 대한피부과학회지

BACKGROUND: The excimer laser has recently been introduced as a new therapeutic modality for vitiligo. However, to date, there have only been a few clinical reports evaluating the therapeutic effects of excimer laser treatment for vitiligo of the head and neck area. OBJECTIVE: This study was conducted to evaluate the effects of excimer laser therapy on vitiligo of the head and neck area against various clinical parameters. METHODS: The 87 patients enrolled in this study were treated with excimer laser monotherapy. We observed the grade of repigmentation after 20 sessions of treatment, and analyzed mean grade of repigmentation with regard to various clinical parameters, to discover determinant factors on therapeutic outcome. RESULTS: Thirty-four of the 87 patients (39.1%) achieved more than 50% repigmentation after or within 20 sessions. The response to treatment was related to the duration of evolution of the vitiligo, type of vitiligo, history of previous treatments, and existence of poliosis within the lesion (respectively, p=0.006, 0.001, <0.001, 0.004). No relationship could be established between response to the treatment and the following variables: localization of the treated lesion and age of onset (respectively, p=0.42, 0.99). Peri-lesional hyperpigmentation was a relatively common side effect, but other adverse effects were limited and transient. CONCLUSION: Excimer laser therapy is an effective and safe therapy for vitiligo of the face and neck area. Promising results from excimer laser therapy can be expected in patients who have a short duration of evolution of the vitiligo below 1 year, a focal or generalized type of vitiligo, no previous history of treatment, and a vitiliginous lesion without poliosis.

A Case of Hypopigmented Mycosis Fungoides / 대한피부과학회지

Hypopigmented mycosis fungoides has been infrequently described as a variant of mycosis fungoides. It mostly occurs in dark-skinned or Asian patients, particularly children, and is often misdiagnosed as a different condition, such as vitiligo, chronic lichenoid pityriasis or postinflammatory hypopigmentation because of its non-specific manifestations. We herein describe a Korean case of hypopigmented mycosis fungoides which was misdiagnosed as a vitiligo. We also emphasize the importance of a biopsy on any persistent or unusual hypopigmented lesion to avoid delay in the diagnosis of mycosis fungoides.

Therapeutic Effects of Narrow-band UVB Phototherapy in the Treatment of Vitiligo / 대한피부과학회지

BACKGROUND: Recently, narrow-band UVB phototherapy is introduced for vitiligo treatment. It is easier to be applicable because of no need for topical and/or systemic photosensitizers, and comparably or more effective than PUVA without systemic side effects. Moreover, it is more safely applicable to children and pregnant women. However, to date, there is not so large series of clinical reports about its use in vitiligo treatment as to evaluate therapeutic effects. OBJECTIVE: This study was to evaluate the effects of narrow-band UVB phototherapy for vitiligo in various aspects of clinical parameters. METHODS: Treatment of patients in this study with narrow-band UVB was started between November 2001 and November 2002. Narrow-band UVB phototherapy was given as monotherapy once or twice a week. The starting dose was 280-300mJ/cm2, with dose increments at each subsequent treatment. RESULTS: 78 patients were able to be evaluated in this study. Their ages ranged from 3 to 67 years (mean, 33.7 years). 69 patients had Fitzpatrick skin type IV, 5 had skin type III and 4 had skin type V. 36 of the 78 patients (46.2%) achieved more than 75% repigmentation (grade 4). The better repigmentation grade, the shorter vitiligo duration (p=0.0464). Compared with other sites, lesions on the hands and feet showed poorer improvement(grade 1: 10/13 and 4/4 respectively, p= 0.0015). Adverse effects were limited and transient. CONCLUSION: Narrow-band UVB therapy is an effective and safe therapy for vitiligo. Long-term adverse and therapeutic effects compared to other treatment modalities remain to be determined.

The Analysis of Epidermal Proteins in Patients with Psoriasis by Two-Dimensional Gel Electrophoresis / 대한피부과학회지

BACKGROUND: Psoriasis is a common, chronic, recurrent, inflammatory disease of the skin characterized by circumscribed, erythematous, thick plaques covered by silvery white scales. Although many researchers are working hard on the topic, we are still in search of its exact pathophysiology. Proteomics is a new emerging field of research for understanding cell physiology and pathophysiology of diseases, based on the protein measurement by high resolution two-dimensional gel electrophoresis followed by the protein identification and characterization by mass spectrometry. OBJECTIVE: The purpose of this study was to identify the specific epidermal proteins in patients with psoriasis. METHODS: We compared the proteome maps obtained from uninvolved and involved psoriatic epidermis by isoelectric focusing in 3-10 non-linear immobilzed pH gradients strips and two- dimensional electrophoresis. RESULTS: The significant differences in protein expressions between two groups were found as evidenced by many increased or decreased protein spots. We found that 15 spots showed changes in the involved psoriatic epidermis as compared to the uninvolved psoriatic epidermis. Protein spots with 6.8 kDa/pI 7.3, 6.9 kDa/pI 6.9, 7.3 kDa/pI 7.8, 8.8 kDa/pI 6.6, 11.5 kDa/pI 6.7, 11.6 kDa/pI 6.9, 13.1 kDa/pI 5.9, 13.2 kDa/pI 6.1, 13.8 kDa/pI 5.6, 15.2 kDa/pI 5.9, 48.3 kDa/pI 4.8, 49.7 kDa/pI 4.8, 49.9 kDa/pI 4.9, 29.7 kDa/pI 7.3 were increased in 100% of involved psoriatic epidermis and protein spots with 70.9 kDa/pI 5.3 decreased in 80% of involved psoriatic epidermis as compared to uninvolved psoriatic epidermis. CONCLUSION: The significant changes in many protein spots were observed in involved psoriatic epidermis as compared with uninvolved psoriatic epidermis. The proteomics in psoriasis may be helpful for the understanding its pathophysiology and treatment.

A Case of Cutaneous Cryptococcosis Resembling Verrucous Granuloma / 대한의진균학회지

We report a case of cutaneous cryptococcosis resembling verrucous granuloma on the lower lip in a 18-year-old female. She presented with a 3x1.5 cm sized painful verrucous granuloma with white, yellowish crust on the lower lip for 1 year. She had gotten many shunt operations for unexplained hydrocephalus. Histopathological examination showed numerous encapsulated round spores, epithelioid cells and giant cells in the dermis. A tissue culture on Sabouraud's dextrose agar without cycloheximide showed whitish creamy colonies. The organism was identified as Cryptococcus neoformans. The lesion disappeared with the treatment of oral itraconazole (100 mg/day) for 12 weeks.

Effect of Ultraviolet Light on the Expression of Adhesion Molecules and T Lymphocyte Adhesion to Human Dermal Microvascular Endothelial Cells

In order to determine the effect of ultraviolet radiation (UVR) on the cell adhesion molecules expressed in human dermal microvascular endothelial cells (HDMEC), the cells were exposed to varying UVR doses and the cell surface was examined for expression of intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM- 1), and E-selectin. The effect of UVB irradiation on the binding of T lymphocytes to HDMEC was also examined. UVA irradiation did not affect the surface expression of ICAM-1, VCAM-1, or E-selectin on the HDMEC. However, following UVB exposure, ELISA demonstrated a significant increase in the baseline ICAM-1 cell surface expression on the HDMEC. However, no induction of either E-selectin or VCAM-1 was noted. UVB also significantly augmented ICAM-1 induction by IL-1 alpha and TNF- alpha. VCAM-1 was induced by stimulating HDMEC with IL-1alpha following a UVB irradiation dose of 100 mJ/cm2. Flow cytometric analysis of the HDMEC stimulated with IL-1 alpha for 24h demonstrated that 12% of the cells expressed VCAM-1 but either IL-1 alpha or UVB irradiation alone failed to induce VCAM-1 expression. Enhancement of T cell-HDMEC binding by IL-1 alpha; or TNF- alpha treatment was not significantly affected after UVB irradiation. This study demonstrated that UVB irradiation can alter ICAM-1 and VCAM-1 expression on the HDMEC surface and that augmentation of ICAM-1 expression and the IL-1 alpha -dependent induction of VCAM-1 following UVB exposure might be important steps in the pathogenesis of sunburn.

Loss of Fhit Expression in Cervical Intraepithelial lesion and Invasive Cervical Carcinoma / 대한산부인과학회잡지

OBJECTIVE: The author evaluated the relationship between the loss of Fhit and prognostic factors of invasive cervical carcinomas. METHODS: The formalin prepared tissue specimens of 64 CINs and 27 invasive cervical carcinomas patients diagnosed and treated at the department of obstetrics and gynecology, Yeungnam university hospital from June 1977 to February 2001 were obtained. And then the tissue specimens were analysed & measured by immunohistochemical methods. RESULTS: The loss of Fhit was significantly reduced in invasive cervical carcinomas compared to CINs. But we found there is no relationships between the loss of Fhit and prognostic factors, stage, tumor marker, lymphatic spread and radiation therapy of invasive cervical carcinomas. CONCLUSIONS: Although the loss of Fhit was not related to the precancerous lesion of cervix, we could confirm that the loss of Fhit was important in the progression of precancerous lesions to invasive cervical carcinomas.

Whitening Effect of Cosmetics Containing Magnesium L-Ascorbyl-2-Phosphate(VC-PMG, Vitamin C Derivatives) Assessed by Colorimeter

BACKGROUNDS: An inhibitory effect of magnesium L-ascorbyl-2-phosphate (VC-PMG, a stable derivative of ascorbic acid) on melanogenesis has been described. Furthermore, glabridin in licorice is known to have inhibitory effects on melanogenesis and widely used for raw materials for depigmenting agents. OBJECTIVE: The purposes of this study are to provide objective data by measuring the visual clinical effects of VC-PMG with the colorimeter and to promote the development of de-pigmenting agents. METHODS: 20 volunteers joined the study. With an artificial UVB irradiation, eight tanned areas were made on the inner side of the forearm. During two months, each tanned area was treated with five whitening cosmetics with 3% VC-PMG and increasing concentration of licorice from 0% to 3%. Darkness degree of each area was measured weekly by the colorimeter and the visual assessment. RESULTS: For all cosmetics, whitening effect was measured by colorimeter and visual as-sessment. The cosmetic containing VC-PMG 3% and licorice 1% had more whitening effect than any other cosmetics of different concentrations. Moreover, VC-PMG 3% alone also had whitening effect in some volunteers. CONCLUSION: VC-PMG was clinically found to have whitening effect.

Clinical Study of Nevus Anemicus / 대한피부과학회지

Nevus anemicus is a congenital anomaly characterized by pale macules of varying size and shape, and it is due to the increased sensitivity of blood vessels to catecholamines. However, the clinical features of nevus anemicus are not yet fully established. A clinical observation was made analyzing 26 cases of nevus anemicus over a 10-year period. Histopathological investigation in 6 cases, stain with Fontana-Masson in 4 cases, irradiation of ultraviolet B in 5 cases, digital infrared thermal imaging in 5 cases and color analysis using true-color imaging in 12 cases were also performed. The results were as follows: 1. The ratio of men to women was 1.2:1. The lesions were mostly(80%) present before the age of 18, but only 15% of the patients' lesions were present at birth. 2. The lesions were most frequently found on the face(33.3%) and neck(33.3%), followed by the chest(14.8%), lower extremities(7.4%) and back(7.4%). 3. Most patients(92.3%) had a single lesion. The extent of the lesions did not exceed 10% of the body surface area and the lesions did not show any progression or resolution. 4. The stainability of Fontana-Masson in nevus anemicus lesions showed no significant change compared with perilesional normal skin. 5. Irradiation of ultraviolet B ray(minimal erythemal dose to 80mJ/cm2) did not induce erythema on nevus anemicus lesions. 6. There was no significant temperature difference between nevus anemicus lesions and perilesional normal skin. 7. There was no significant correlation between chrominance and age. In conclusion, nevus anemicus in Korea shows the same incidence in both sexes, it usually arises at birth or childhood, but it may also develop later in life. Most patients show focal lesions that do not progress or resolve.

The Fitzpatrick skin type in Korean people / 대한피부과학회지

BACKGROUND: The Fitzpatrick skin type has been a simple and useful method to categorize cutaneous sensitivities to ultraviolet radiation. OBJECTIVE: In this study, we intended to know the distribution of Fitzpatrick skin type in Korean by interview method using questionnaire. METHODS: A total of 1296 Koreans from various districts were included in this study. Each subject was interviewed about their skin reactions to ultraviolet radiation and determined their skin type by interview method. To evaluate the statistical significance, we used generalized logit model. RESULTS: 1. The order of frequency of skin type was type III(48.8%), IV(22.2%), V(17.8%) by the interview method, with the sun sensitive categories(type I and type II) reported for 11.2%. 2. The skin type III was the predominant skin type in both men and women. However, skin type IV was found more frequently in men and it was statistically significant. 3. There is a tendency that frequency of skin type IV and V were increasing with advancement of age. 4. The Fitzpatrick skin type has some relationship with each individual`s occupation, the degree of sun exposure and their own skin color in Korean. CONCLUSION: This study included relative large numbers of subjects from various districts in Korea. It can be used as basic data for various studies related to cutaneous reactions to ultraviolet radiation.

The Fitzpatrick skin type in Korean people / 대한피부과학회지

BACKGROUND: The Fitzpatrick skin type has been a simple and useful method to categorize cutaneous sensitivities to ultraviolet radiation. OBJECTIVE: In this study, we intended to know the distribution of Fitzpatrick skin type in Korean by interview method using questionnaire. METHODS: A total of 1296 Koreans from various districts were included in this study. Each subject was interviewed about their skin reactions to ultraviolet radiation and determined their skin type by interview method. To evaluate the statistical significance, we used generalized logit model. RESULTS: 1. The order of frequency of skin type was type III(48.8%), IV(22.2%), V(17.8%) by the interview method, with the sun sensitive categories(type I and type II) reported for 11.2%. 2. The skin type III was the predominant skin type in both men and women. However, skin type IV was found more frequently in men and it was statistically significant. 3. There is a tendency that frequency of skin type IV and V were increasing with advancement of age. 4. The Fitzpatrick skin type has some relationship with each individual`s occupation, the degree of sun exposure and their own skin color in Korean. CONCLUSION: This study included relative large numbers of subjects from various districts in Korea. It can be used as basic data for various studies related to cutaneous reactions to ultraviolet radiation.

Antioxidative Activity and Anti-melanogenic Effect of the Extract from the Leaves of Robinia Pseudo-acacia L

BACKGROUND: Plant extracts have been widely used as important therapeutic drugs for many centuries all over the world. There have been many reports that natural products have various kinds of biological activities such as anti-allergy, anti-inflammatory and antimicrobial activities. Recently, the screening for the efficacy and safety of natural products has been extensively performed. OBJECTIVE: This study was carried out to find a beneficial plant extract possessing excellent antioxidative and anti-melanogenic activities. We have found that the leaf of Robinia pseudo-acacia L. has active substances which are involved in those activities. METHODS: To confirm the antioxidative activity of the extract obtained from the leaves of Robinia pseudo-acacia L., scavenging ability of the extract on DPPH free radicals and its inhibitory effects on lipid autoxidation and peroxidation were investigated. In addition, inhibitory effects of the extract on mushroom tyrosinase as well as melanin biosynthesis in cultured B16 melanoma cells were evaluated. RESULTS: The acacia extract showed not only powerful antioxidative activity but also antimelanogenic acitivity as strong as that of arbutin which is a well known inhibitor of melanogenesis. CONCLUSION: These resulis suggest that the extract from the leaves of Robinia pseudo-acacia L. could be used as a 4ghtening and antioxidative agent for the skin.

Photoallergic Dermatitis due to 8-Methoxypsoralen

One adverse effect of PUVA therapy is the development of severe dermatitis. Only a few cases of photoallergy to psoralens during PUVA therapy have been reported. We describe herein a patient with photoallergic dermatitis induced by PUVA with 8-methoxypsoralen(8-MOP). A 38-year old woman with generalized vitiligo had acute pruritic exanthematous maculopapular lesions in the treated areas after PUVA therapy with 8-MOP. A patch test and photopatch test were performed with 8-MOP, 5-MOP, and 4,5,8-trimethylpsoralen(TMP). The patch test carried out with these psoralen derivatives were all negative, but the photopatch test showed a positive reaction to 8-MOP. The patient consequently had PUVA therapy with 5-MOP and she had no further experience of a photoallergic reaction.

Differences in Expression of HLA Antigens among Subtypes of Vitiligo / 대한피부과학회지

BACKGROUND: Vitiligo is an acquired disorder with destruction of melanocytes and is clinically characterized by depigmented patches of skin. The pathogenesis of vitiligo is still unclear, but melanocyte self destruction, neurohumoral factors, autoimmunity and inherent cellular defects have all been proposed as possible etiological factors. OBJECTIVE: The purpose of this study was to find out the differences in expression of HLA antigens among subtypes of vitiligo according to classification, onset and family history and then to disclose the pathogenesis of vitiligo in view of genetic and autoimmunological aspects. METHODS: We investigated HLA-A, B, C, DR in subgroups of 87 vitiligo patients according to type, onset, and family history. Results : 1. There were no HLA antigens with significantly increased frequency in vitiligo patients compared to the control group. 2. There was a significant increase in frequency of HLA-DRl2 in patients of non-segmental vitiligo with a family history ; an increase in frequency of HLA Cw2 in patients without a family history ; and a significant increase in frequency of HLA-DRl2 in all patients of non-segmental vitiligo compared to the control group.(p(c)<0.05). 3. The frequency of HLA-B63 was significantly increased in all patients of segmental vitiligo compared to the control group(p(c)<0.05), but there were no HLA antigens with significantly increased frequency in patients of subgroups of segmental vitiligo divided by the presence or absence of a family history of vitiligo. 4. The frequency of HLA-B54 was significantly increased in all vitiligo patients with a family history(p(c)0.05) but there were no HLA antigens with significantly increased frequency in all vitiligo patients without a family history. 5. There were no HLA antigens with significantly increased frequency in vitiligo patients subgrouped by age of onset (less or over 16 years) of disease. Conclusion : From the above results, we can assume that non-segmental vitiligo may have autoimmune mechanisms in the pathogenesis, as there was a significant increase in HLA-DRl2 in patients with non-segmental vitiligo.

The Effects of Ultraviolet Radiation on Aging and p53 Expression in Human Skin / 대한피부과학회지

BACKGROUND: Long-term phototherapy can induce the changes of photoaging and it is reported that there is an increased chance of cutaneous squamous cell carcinomas in patients exposed to large amounts of UV radiation. OBJECTIVE: The main objective was to investigate the degree of photoaging and the presence of p53 mutations in normal skin in patients undergoing long-term phototherapy. METHOD: We performed hematoxylin-eosin and special stains, p53 and p21 immunohistochemical stains and polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) on the normal skin of patients subject to long-term UV therapy. RESULT: 1. The typical features of photoaging were not observed in patients undergoing long-term UV therapy. 2. In p53 immunohistochemical staining performed at 1 week after cessation of long-term PUVA treatment, the patient group with a culmulated UV dosage of more than 1,000J/cm2 demonstrated an increased number of p53 positive epidermal cells compared to exposed as well as unexposed normal skins. 3. The patterns of p21 immunohistochemical staining performed at 1 week after cessation of long-term PUVA and UVB treatments were similar to that of p53 immunohistochemical staining performed at 1 week after cessation of phototherapy. 4. In p53 immunohistochemical staining performed at 4 months after cessation of UV treatment, the number of p53 positive epidermal cells decreased significantly compared to that of p53 positive epidermal cells found at 1 week after cessation of UV treatment. 5. The mutation of p53 genes was not found in PCR-SSCP analysis of biopsied skins done at 1 week after cessation of long-term PUVA and UVB treatment. CONCLUSION: Long-term phototherapy did not induce the typical changes of photoaging and p53 overexpression in the epidermis of UV treated skin was a reactive process. Therefore, UV therapy can be a relatively safe treatment modality, although a closer observation for cutaneous malignancy is warrented in the patients whose cumulated UV dosage is much higher than 1,000J/cm2.