Comparative Study on the Effectiveness of Topical Recombinant Human Epidermal Growth Factor and Antibiotics on Herpes Zoster Skin Lesions / 대한피부과학회지

Background@#Topical recombinant human epidermal growth factor (rhEGF) is effective in the treatment of diabetic foot ulcers, surgical wounds, burns, and scars. Binding of EGF to EGF receptors results in cell proliferation and differentiation. @*Objective@#This study aimed to evaluate the efficacy of topical rhEGF ointment compared with that of topical mupirocin in healing herpes zoster (HZ) lesions. @*Methods@#Thirty patients diagnosed with typical HZ were recruited in August, 2018. The rats were randomly divided into two groups: topical mupirocin and topical rhEGF ointment. HZ lesions were evaluated using the Vancouver Scar Scale (VSS) at the initial visit, 1st, 2nd, and 4th weeks. @*Results@#The total number of recruited patients (n=30) included males (n=16, 53.3%) and females (n=14, 46.7%) with a mean age of 58.2. The proportion of patients with a 50% reduction in the VSS score (VSS 50) at 2nd week was significantly higher in the rhEGF group (33.0% vs. 72.0%, respectively, p=0.035). The complete resolution rate (VSS=0, 1) at 4th week was also higher in the rhEGF group (17.5% vs. 50.0%, p=0.03). @*Conclusion@#Topical rhEGF showed a more rapid treatment response and anti-scarring effect than topical mupirocin in patients with HZ lesions.

Risk of Cardiovascular Disease in Patients with Behçet Disease:A Population-based Retrospective Cohort Study in Korea / 대한피부과학회지

Background@#Few studies have investigated the association between Behçet disease (BD) and cardiovascular disease (CVD). The aim of this study was to investigate the risk of various CVDs in patients with BD. @*Objective@#The aim of this study was to investigate the risk of various CVD in patients with BD. @*Methods@#Between 2003 and 2015, we performed a retrospective cohort study involving patients with BD selected from Korea’s National Health Insurance Service-National Sample Cohort database and age- and sex-matched controls. Age- and sex-matched controls were selected randomly from the NHIS-NSC database at a frequency of 1:5. @*Results@#Among the 998 patients with BD and the 4,990 controls studied, patients with BD showed significantly higher risk for angina pectoris (adjusted Hazard Ratio [HR] 1.522, 95% confidence interval [CI] 1.020∼2.273;p=0.04) and peripheral arterial disease (adjusted HR 2.939, 95% CI 1.296∼6.664; p=0.01) than the controls. The cumulative incidence rates of these diseases in patients with BD were also significantly higher than those in the controls. @*Conclusion@#Patients with BD showed independent risk for angina pectoris and peripheral arterial disease.

A Correlation between Serum Level of Alkaline Phosphatase and Acne Severity in Children and Adolescents: A Retrospective Cross-Sectional Study

Background@#Acne is a chronic inflammatory disease of the pilosebaceous unit and usually affects adolescents when the peak concentrations of growth hormone, insulin-like growth factor 1, and androgen are demonstrated. The activity of alkaline phosphatase (ALP), which increases physiologically in growing children and adolescents, in the pilosebaceous unit has been reported. However, the correlation between the serum level of ALP and the number of acne lesions has not been studied. @*Objective@#The present cross-sectional study was designed to evaluate the correlation between serum level of ALP and the numbers of non-inflammatory and inflammatory acne lesions in children and adolescents. @*Methods@#For this study, 202 pediatric and adolescent patients clinically diagnosed with acne vulgaris were included. Age, sex, serum level of ALP, number of non-inflammatory acne lesions, number of inflammatory acne lesions, and number of total acne lesions were evaluated. Additionally, the serum level of dehydroepiandrosterone sulfate was evaluated in 117 patients. Multiple regression analysis was performed. Multicollinearity was quantified using the variance inflation factor. @*Results@#In the 202 patients, serum level of ALP was the only independent factor that significantly affected both the number of non-inflammatory acne lesions and of total acne lesions (regression coefficient=0.089 and 0.086, respectively, p＜ 0.001). @*Conclusion@#There was a significant correlation between serum level of ALP and the extent of acne (non-inflammatory acne lesions and total acne lesions).

Efficacy and Safety of Alitretinoin Therapy in Korean Elderly Patients with Chronic Hand Eczema: A Retrospective Single Center Study

BACKGROUND: Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that alitretinoin is an effective and well-tolerated treatment for CHE. However, there is a relative lack of data on the effectiveness of alitretinoin in elderly patients. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of oral alitretinoin in elderly patients with moderate to severe CHE in Korea. METHODS: We retrospectively investigated 46 CHE patients who were treated with either 10 mg or 30 mg of alitretinoin between June of 2016 and July of 2018. The physician's global assessment (PGA) was used to evaluate treatment efficacy. All adverse events were retrospectively evaluated with respect to laboratory testing, including complete blood cell count, fasting blood chemistry, lipid profile, and liver and thyroid function tests. RESULTS: The mean patient age in this study was 71.0±5.1 years. The treatment period was over eight weeks. A total of 38 of 46 patients (82.6%) exhibited clinical improvement with PGA ratings of ‘clear’ or ‘almost clear.’ There were 13 patients (28.3%) who experienced an adverse effect, with the most common being headache (13.0%) and gastrointestinal symptoms (8.7%) followed by xerosis (6.5%). A total of 13 patients developed or exhibited worsening hypertriglyceridemia (28.3%). CONCLUSION: Alitretinoin can be considered a safe and effective treatment option in elderly patients with moderate to severe CHE.

Concurrent Leukemia Cutis and Sweet Syndrome in a Patient with Acute Myeloid Leukemia / 대한피부과학회지

No abstract available.

Erbium-doped Yttrium Aluminum Garnet Laser to Treat Familial Acanthosis Nigricans / 대한피부과학회지

No abstract available.

Anetoderma Developing in Generalized Granuloma Annulare in an Infant

No abstract available.

Two Cases of CD34-positive Glomus Tumors with Myxoid Stromal Changes / 대한피부과학회지

Glomus tumors are benign cutaneous neoplasm, occurring in the vascular hamartomatous tubercles of the glomus body, which is a myoarterial apparatus typically found in the reticular dermis of the skin. Histopathologically, glomus tumors are composed of neoplastic cells that resemble normal glomus cells, arranged around a varying number of thin-walled, sometimes branching capillaries. Immunohistochemically, neoplastic cells in glomus tumors clearly exhibit smooth muscle characteristics with expression of muscle-specific actin and alpha-smooth muscle actin; whereas, the expression of CD34 is rare. In this report, we present two cases of benign glomus tumors on the subungual area and palm. Tumor cells of glomus tumor in two patients were both positive for smooth muscle actin (SMA) and CD34 immunohistochemical staining. We thought that coexpression of SMA and CD34 adds support to the interpretation of these lesions as a family of perivascular neoplasms.

Three Cases of 'Morsicatio Labiorum'

Morsicatio labiorum is a form of tissue alteration caused by self-induced injury, mostly occurring on the lips, and is considered to be a rarely encountered mucocutaneous disorder. Clinically, it is a macerated grey-white patch and plaque of the mucosa caused by external stimuli (self-induced injury) such as habitual biting, chewing, or sucking of the lip. It is often confused with other dermatological disorders involving the oral mucosa, which can lead to a misdiagnosis. We herein report three cases of morsicatio labiorum; two cases were misdiagnosed as exfoliative cheilitis at the time of the first visit.

Merkel Cell Carcinoma Concurrent with Bowen's Disease

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy of the elderly and immunocompromised patients. It is occasionally found coexisting with other diseases, such as squamous cell carcinoma, basal cell carcinoma, actinic keratosis, miscellaneous adnexal tumors, and rarely Bowen disease. A 75-year-old woman presented with a 6-month history of an irregularly shaped erythematous patch on the left mandibular angle. Three months later, a 1.5x1.0 cm sized painless and rapidly growing erythematous nodule developed on the patch. Microscopically, the patch lesion was consistent with that of Bowen disease. The nodular lesion showed a number of small uniform hyperchromatic cells with scanty cytoplasm. It showed dense small-cell like nodular infiltration in the dermis. Immunohistochemical staining for cytokeratin 20 showed a positive result with a dot-like perinuclear pattern. Additionally, the result for thyroid transcription factor-1 was negative, which is positive in small cell neuroendocrine carcinoma. From these findings, we diagnosed this lesion as MCC concurrent with Bowen disease.

A Case of Myopericytoma on the Lower Leg

Myopericytoma (MP) is a benign tumor composed of cells that show apparent differentiation towards putative perivascular myoid cells called myopericytes. It arises most commonly in the dermis or subcutaneous tissue of the extremities in adults. The most common presentation is a well-circumscribed, slow-growing painless firm mass. A 45-year-old woman presented with a 2-year history of a painless, slowly growing 0.9x0.7 cm sized firm mass in the subcutaneous tissue of the posterior side of the right lower leg. We presumed this lesion to be an epidermal cyst, pilomatricoma or calcinosis cutis and performed an excisional biopsy. The histologic examination showed that it was composed of spindle-shaped myoid-appearing cells in a concentric arrangement, intimately associated with thin-walled vascular channels. Lesional spindle cells were diffusely positive for smooth muscle actin and were negative for CD34, desmin and S100 protein. From these findings, we diagnosed this lesion as a myopericytoma.

A Case of Dowling-Degos Disease on the Vulva

Dowling-Degos disease (DDD) is an autosomal dominant genodermatosis and this disease is a genetically determined disturbance of epidermal proliferation. It is characterized by acquired, slowly progressive pigmented lesions that primarily involve the great skin folds and flexural areas such as the axilla, neck, limb flexures, the inframammary area and the inguinal folds. The vulva is an unusual location for DDD. A 41-year-old woman presented with a 10-year history of multiple, small, reticulated and brownish macules distributed symmetrically on the bilateral external genital regions. We found no other similarly pigmented skin lesions on her body, including the flexural areas. There was no known family history of similar eruptions or pigmentary changes. The histologic examination showed irregular rete ridge elongation with a filiform or antler-like pattern and basilar hyperpigmentation on the tips. Fontana-Masson staining showed increased pigmentation of the rete ridges and the S100 protein staining did not reveal an increased number of melanocytes in the epidermis. From these findings, we diagnosed this lesion as DDD.

Metastatic Cutaneous Adenosquamous Carcinoma in a Patient Undergoing Chemotherapy for Lung Adenocarcinoma / 대한피부과학회지

Cutaneous metastasis originating from lung cancer is relatively rare and accounts for only 0.5~6.7% of of lung cancer metastases. In general, there is a histomorphologic resemblance between primary carcinoma and cutaneous metastatic carcinoma. A 45-year-old woman presented with a painless 0.8 cm erythematous nodule on her left shoulder. During the past 3 years, she had been receiving chemotherapy for the treatment of lung adenocarcinoma with bone metastases. A histopathological examination of the skin lesion showed adenocarcinoma and squamous cell carcinoma components, which were compatible with adenosquamous carcinoma. Herein, we report an interesting case of adenosquamous carcinoma showing cutaneous metastasis, which is a different pathologic subtype from primary lung adenocarcinoma.

Calcifying Aponeurotic Fibroma with Gait Disturbance Caused by Trauma / 대한피부과학회지

A calcifying aponeurotic fibroma is a rare benign fibrous tumor with well-characterized histopathological features. Calcifying aponeurotic fibromas are generally slowly-growing lesions related to tendons and aponeuroses in the distal extremities of children and adolescents. While the neoplasm is usually asymptomatic, cases of progressive local discomfort have been reported. The exact etiology of this neoplasm is unknown, and there is frequently no history of trauma or local irritating factors. A 10-year-old female presented with a 2.5x2.0 cm, subcutaneous mass on the right sole 4 years after she bumped against a table. The histopathologic examination showed a poorly circumscribed fibrotic mass with foci of chondroid differentiation and calcification. These findings were consistent with the diagnosis of a calcifying aponeurotic fibroma. After total excision of the mass, there has been no recurrence of the lesion in 8 months of follow-up.

The Nature of Acute Pain in Herpes Zoster and Its Relationship to the Patients' Activities of Daily Living / 대한피부과학회지

BACKGROUND: Acute pain can severely interfere with the activities of daily living (ADL) of patients with herpes zoster, but until now, little has been published in the Korean medical literature about the impact of herpes zoster on the ADL. OBJECTIVE: The objective of this study was to identify the nature and severity of the acute pain of herpes zoster patients and its relationship to the patients' ADL. METHODS: 86 patients with herpes zoster and who visited our hospital from August 2009 to June 2010 were evaluated in regard to age, gender, the dermatomal distribution, the associated diseases, the severity and nature of the pain and the ADL. The nature of the pain was measured by the Short Form McGill Pain Questionnaire. To access interference of pain with the ADL, we used the Zoster Brief Pain Inventory (ZBPI) and the Zoster Impact Questionnaire (ZIQ). RESULTS: The mean onset of pain was 5.6+/-3.2 days before the visit, and the mean onset of skin lesion was 4.2+/-2.2 days before the visit. The most common nature of the pain of herpes zoster was shooting pain (55.8%), followed by stabbing pain (54.7%). But there was no significant difference of gender, age, the dermatomal distribution, the clinical severity and the associated disease according to the severity and nature of the pain. For every 1.0 point increase in the pain score, there was a 0.257 and 0.105 point increase in the ZBPI and ZIQ scores, respectively, on the multivariate linear regression model. CONCLUSION: This study will help to choose appropriate treatments to reduce the pain of patients who suffer with herpes zoster.

The Nature of Acute Pain in Herpes Zoster and Its Relationship to the Patients' Activities of Daily Living / 대한피부과학회지

BACKGROUND: Acute pain can severely interfere with the activities of daily living (ADL) of patients with herpes zoster, but until now, little has been published in the Korean medical literature about the impact of herpes zoster on the ADL. OBJECTIVE: The objective of this study was to identify the nature and severity of the acute pain of herpes zoster patients and its relationship to the patients' ADL. METHODS: 86 patients with herpes zoster and who visited our hospital from August 2009 to June 2010 were evaluated in regard to age, gender, the dermatomal distribution, the associated diseases, the severity and nature of the pain and the ADL. The nature of the pain was measured by the Short Form McGill Pain Questionnaire. To access interference of pain with the ADL, we used the Zoster Brief Pain Inventory (ZBPI) and the Zoster Impact Questionnaire (ZIQ). RESULTS: The mean onset of pain was 5.6+/-3.2 days before the visit, and the mean onset of skin lesion was 4.2+/-2.2 days before the visit. The most common nature of the pain of herpes zoster was shooting pain (55.8%), followed by stabbing pain (54.7%). But there was no significant difference of gender, age, the dermatomal distribution, the clinical severity and the associated disease according to the severity and nature of the pain. For every 1.0 point increase in the pain score, there was a 0.257 and 0.105 point increase in the ZBPI and ZIQ scores, respectively, on the multivariate linear regression model. CONCLUSION: This study will help to choose appropriate treatments to reduce the pain of patients who suffer with herpes zoster.

Hypertrophic Lichen Planus That Occurred in an Elderly Woman / 대한피부과학회지

Lichen planus is a chronic papulosquamous disease that affects the skin and mucous membranes. It is characterized by pruritic violaceous papules that are most commonly seen on the extremities of middle aged adults, but the elderly are rarely affected. Hypertrophic lichen planus usually occurs on the extremities and especially on the shins, and it tends to be the most pruritic variant. An 82-year-old female presented with severe pruritic multiple papules and plaques on the both the upper and lower extremities for 1 year. At first, the lesions began as small, polygonal papules that formed verrucous plaques over several months. Histopathologic examination showed marked hyperkeratosis, irregular acanthosis and wedge-shaped hypergranulosis. The vacuolar alteration and the lymphocytic inflammatory infiltrate were accentuated at the base of the rete ridge. From these findings, we diagnosed these lesions as hypertrophic lichen planus. The lesions were treated with topical steroid and intralesional injection of steroid, and they were slightly improved after 2 months of therapy.

Bullous Eosinophilic Cellulitis Caused by Trauma / 대한피부과학회지

Eosinophilic cellulitis is also called Wells' syndrome, and this is an acute pruritic dermatitis that resembles cellulitis. It usually appears as well-circumscribed erythematous plaques, but bullous lesions have rarely been reported. There are several precipitating factors, including drugs, arthropod bites, viral infections, parasitic infestations, leukemia and other malignancies. A 21-year-old male presented with a mildly pruritic vesiculobullous eruption on the dorsum of left foot after he had been pricked by a twig. Histopathologic examination showed intraepidermal blisters and spongiosis of the epidermis and a mixed inflammatory cell infiltration that consisted mostly of eosinophils throughout the dermis. These findings were consistent with the diagnosis of bullous eosinophilic cellulitis. He was treated daily with prednisolone 30 mg and the lesions rapidly resolved. There has been no recurrence of the lesions for 1 year of follow-up.