An Easy Method of Masseter muscle sling for lower lip paralysis in senile Hansen Patients / 나학회지

Background@#One of the Sequelae of facial nerve paralysis in leprosy patients is severe eye and lip deformity. Eye deformities are most common, followed by unilateral lip deviation. When there is bilateral failal nerve paralysis, the lower lip drooping may occur. The lower lip drooping makes mouth closure incomplete, so the fluid or saliva may flow out when eating. And the teeth may be exposed or even the gum may be visible, which causes serious cosmetic and functional impairments. @*Objective@#It is to evaluate the masseter muscle sling (MMS) method in the treatment of the recurrent lower lip drooping in patients with Hansen's disease. @*Methods@#In the case of masseter muscle sling, there is a traditional method of detaching, separating and raising anterior masseter muscle in half from the mandibular jaw line and fixing it to the lip muscle. However, the authors observed a 3cm gap between the anterior border of masseter muscle and the lateral edge of orbicularis oris muscle. Under the local anesthesia the nasolabial line was incised and 3-4 places were pulled up between both musle edges and plicated with a 2/0 PDS??threads the gap-space. @*Results@#During 5 years (2016-2020), there were 17 recurrent lower lip palsy patients. The mean age was 71.3 years and the ratio of male and female was 9:8. Of 17 patents, 12 received temporal muscle transfer (TMT) attached with tensor fascia lata (TFL), 2 received temporal muscle transfer attached with Alloderm, and 3 received masseter muscle sling alone. The postoperative results of corrective masseter muscle sling were satisfactory in all 17 patients and there were no serious complication and recurrence during follow-up. @*Conclusion@#Masseter muscle sling is effective method in correction of recurrent lower lip drooping in patient with leprosy who treated previously with temporal muscle transfer attached with tensor fascia lata or temporal muscle transfer attached with Alloderm. In addition, masseter muscle sling may be considered as the first-line treatment in the lower lip paralysis.

An Easy Method of Masseter muscle sling for lower lip paralysis in senile Hansen Patients / 나학회지

Background@#One of the Sequelae of facial nerve paralysis in leprosy patients is severe eye and lip deformity. Eye deformities are most common, followed by unilateral lip deviation. When there is bilateral failal nerve paralysis, the lower lip drooping may occur. The lower lip drooping makes mouth closure incomplete, so the fluid or saliva may flow out when eating. And the teeth may be exposed or even the gum may be visible, which causes serious cosmetic and functional impairments. @*Objective@#It is to evaluate the masseter muscle sling (MMS) method in the treatment of the recurrent lower lip drooping in patients with Hansen's disease. @*Methods@#In the case of masseter muscle sling, there is a traditional method of detaching, separating and raising anterior masseter muscle in half from the mandibular jaw line and fixing it to the lip muscle. However, the authors observed a 3cm gap between the anterior border of masseter muscle and the lateral edge of orbicularis oris muscle. Under the local anesthesia the nasolabial line was incised and 3-4 places were pulled up between both musle edges and plicated with a 2/0 PDS??threads the gap-space. @*Results@#During 5 years (2016-2020), there were 17 recurrent lower lip palsy patients. The mean age was 71.3 years and the ratio of male and female was 9:8. Of 17 patents, 12 received temporal muscle transfer (TMT) attached with tensor fascia lata (TFL), 2 received temporal muscle transfer attached with Alloderm, and 3 received masseter muscle sling alone. The postoperative results of corrective masseter muscle sling were satisfactory in all 17 patients and there were no serious complication and recurrence during follow-up. @*Conclusion@#Masseter muscle sling is effective method in correction of recurrent lower lip drooping in patient with leprosy who treated previously with temporal muscle transfer attached with tensor fascia lata or temporal muscle transfer attached with Alloderm. In addition, masseter muscle sling may be considered as the first-line treatment in the lower lip paralysis.

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.

The Reappraisal of the Slide-Swing Skin Flap: A Versatile Technique for Surgical Defects

BACKGROUND: The slide-swing skin flap is a combination of transposition and adjacent skin sliding and can be used to close large, round defects with a flap that is smaller than the primary defect to produce aesthetically good results. OBJECTIVE: To evaluate the efficacy and safety of the slide-swing skin flap for various surgical defects caused by skin tumor excisions. METHODS: This retrospective case series, which includes 33 Asian patients between the ages of 25 and 86 years, describes the slide-swing skin flap after primary excision for malignant or premalignant skin conditions. The outcomes were assessed 12 weeks after surgery using the patient and observer scar assessment scale (POSAS). RESULTS: Patients were 25 male and 8 female, and the causes of surgery were various malignant skin tumors including malignant melanoma, dermatofibrosarcoma protuberans, and malignant nodular hidradenoma. Tumors were on the lower limb in eleven patients, back in nine patients, chest in five patients, face in three patients, buttock in three patients and two patients had tumors in other locations. The mean defect size was 3.5×3.1±1.9×2.2 cm (range, 1.4×0.9~9.0×12.0 cm). The mean patient POSAS total score was 9.7±3.0 and mean patient overall opinion score was 1.8±0.7. The mean observer POSAS total score was 11.0±2.7 and mean observer overall opinion score was 1.9±0.5. All flaps survived and postoperative recoveries were uneventful. CONCLUSION: The slide-swing skin flap is highly versatile and can be used to cover various surgical defects, irrespective of size and location, with excellent functional and cosmetic results.

Three Cases of Pachydermodactyly / 대한피부과학회지

Pachydermodactyly (PDD) is a rare, benign form of digital fibromatosis that is characterized by asymptomatic soft tissue swellings on the back and side of the proximal interphalangeal joint areas of the fingers. We report three cases of young male patients who presented with bilateral swelling of the fingers. Histopathologic examination showed epidermal hyperplasia with acanthosis and hyperkeratosis. Collagen fibers in the reticular dermis were thickened and irregularly arranged, and deposition of mucin in the dermis was observed. Since pachydermodactyly usually affects adolescent males with joint swelling, it is often confused with rheumatologic diseases. Here, we report three cases diagnosed with pachydermodactyly based on clinical manifestations and histopathological examination.

Cutaneous squamous cell carcinoma: High risk factors, staging and management / 나학회지

Cutaneous squamous cell carconoma(cSCC) is a malignant neoplasm derived from suprabasal epidermal keratinocytes, which is one of the nonmelanoma skin cancers that represent the most common malignancies in humans. Although most of cSCCs are small low-risk cancers easily treated by minor surgical procedures, some cSCCs continue to grow to be invasive SCC. They can cause not only significant morbidity and cosmetic deformity but also even metastases and death. In leprosy, chronic, recurrent ulceration and resultant scars associated with peripheral neuropathy are one of the main complications, which can give rise to cSCCs.The primary goal of cSCC treatment is complete tumor eradication with preservation of function and good cosmesis. However, prior to treatment, the preoperative workup is performed properly and tumor risk factors influencing on the treatment and prognosis are taken into consideration.

Easy method for Upper lid blepharoplasty in elderly Hansen affected persons / 나학회지

BACKGROUND@#The average age of Korean Hansen affected persons who have become less than 10,000 is 76 years old.The upper eyelid lesions of these patients coexist with senile lesions and paralytic lesions due to facial paralysis.This senile change includes skin laxity, eyebrow drooping, eyelid drooping, medial and lateral canthal relaxation and paralytic changes include wrinkle disappearance in the forehead, eyebrows asymmetry, eyelash drooping in the upper eyelid, and simultaneously symptoms of lower eyelid such as ectropion and lapophthalmos.@*OBJECTIVE@#Authors want to present a prescribed method of treatment that makes it easier to fix changes in senile and paralytic eyelids in elderly Hanson affected persons.@*METHODS@#For senile blepharochalasis, if the distance between eye blow and eyelash (brow-lash distance) is to the 2.5 cm or more the sub-brow resection should be done.However, if brow-lash distance is less than 2.5 cm, the supra-brow resection should be done. For paralytic cases if there is a difference in height on the eyebrow. the skin is removed to create the same level as the eyebrow height on the healthy side.if both eyes are paralyzed the supra blow skin excision are done with prudence not to make the lagophthalmos.RESULT: In recent 2 years of 2018–2019we treated 32 cases of blepharochalasis, Blephnaroptosis, paralylic eyebrow droping and lash-laden eyelid margin excision for trichiasis correction. Satisfactory results were obtained in all patients who underwent surgery.@*CONCLUSION@#The authors report our experience of treating various upper eyelid lesions in the past 2 years in 32 cases of Hansen affected persons a history of Hansen's disease, together with literature review.

Two cases of calcinosis cutis treated with surgical excision / 나학회지

Calcinosis cutis is an uncommon disorder and defined as the deposit of insoluble calcium salts in the skin. It is classified as dystrophic, metastatic, idiopathic, and iatrogenic according to etiology. The dystrophic type is the most common and occurs in the previously damaged tissue, including connective tissue diseases, panniculitis, inherited disorders, benign and malignant tumors, a variety of scarring caused by burn, radiation, trauma, surgery, and keloid. Treatment options are limited. Whereas medical therapy is usually not very effective, surgical intervention has shown to be beneficial and is indicated when painful masses, recurrent infection, ulcerations, functional impairment, and cosmetic concerns exist. Herein, we report two cases of dystrophic calcinosis cutis associated with longstanding, painful, ulcerated cutaneous lesions in the extremities successfully treated with surgical excision.

The Lateral Tarsal Strip for Paralytic Ectropion in Patients with Leprosy

BACKGROUND: In patients with leprosy, paralysis of the facial nerve results in the lower eyelid ectropion and lagophthalmos as a sequela even when the leprosy is cured. Paralytic ectropion causes many functional and cosmetic eye problems, leading to blindness if left untreated. OBJECTIVE: The purpose of this retrospective study is to evaluate the efficacy of surgical correction of paralytic ectropion, the lateral tarsal strip, in patients with leprosy. METHODS: Between 2010 and 2015, 40 Korean patients (44 eyelids) with paralytic ectropion who had visited Korean Hansen Welfare Association Hospital were treated with the lateral tarsal strip. Four-point patients' global assessment scale, local complications, and recurrence were assessed at the end of follow-up period. The average follow-up period was 12 months. RESULTS: In the 44 eyelids, recurrence was observed in 5 cases (5/44, 11.4%). There were no serious postoperative complications except mild size discrepancy of both eyes. Most patients were satisfied with the results and mean satisfaction scale was 2.6/3. CONCLUSION: The lateral tarsal strip is a simple, safe, and effective treatment method for the dermatologic surgeon to correct paralytic ectropion of mild to moderate degree in patients with leprosy.

Cutaneous Atypical Mycobacterial Infection in a Body Scrubber (“Ddaemirri”) / 대한피부과학회지

No abstract available.

Aesthetic Surgical Treatment of the Peri-orbital area in Hansen's Patients / 나학회지

BACKGROUND: Upper eyelid blepharoplasty has become one of the commonly practiced aesthetic operation. This upper eyelid blepharoplasty primarily conducted in aged person, while also addressing aesthetic concerns, include methods to rejuvenate the peri-orbital area and provide unobstructed eyesight. OBJECTIVE: Methods to affect rejuvenation of the peri-orbital area are variable and depend heavily on the patients. This makes evaluation of the patient a critically important component of the treatment process. Upper eyelid blepharoplasty requires treatment of the anterior and posterior lamella structures. Anterior lamella undergone a resection of the skin and orbicularis muscle to reduce the sagging appearance on the anterior surface of the upper eyelid. The retractor structures of the posterior lamella, especially the levator aponeurosis and the Müller's muscle, are advanced, tucked and plicated to the tarsus to add tension as needed to correct the blepharoptosis. This procedure, while also addressing aesthetic concerns, primarily adds tension to reduce or eliminate eyesight obstruction. Methods & Conclusion: These operation methods include : The plication procedures of posterior membranous septum and turn-over orbital septum to 2mm below the tarsus and traditional levartor complex tucking including levator aponeurosis and Müller muscle added. In addition to blepharoplasty and blepharoptosis in aged persons the brow-ptosis may also experience. This drooping of the eyebrow also contribute to eyesight obstruction and should be corrected. In general, treatment consists of a subbrow resection when the brow-lash distance is 25mm or more. When the brow-lash distance is less that 25mm, a supra-brow excision is required to prevent an angry or harsh appearance. However, when using the supra-brow method the possibility of an unwanted visible scar is more likely, a short incision direct brow-lift could be another alternative. But short incision brow-lift procedure can only use under the normal forehead muscle function.

Cutaneous Plasmacytoma: Metastasis of Multiple Myeloma at the Fracture Site

Multiple myeloma (MM) can be defined as a malignancy with monoclonal plasma cell proliferation. A 66-year-old man presented with pruritic erythematous to purplish plaque grouped nodule with black pigmentations and purpura on the right forearm. The patient was diagnosed with MM about five years prior to the visit at our hospital. Erythematous plaque on his right arm grew rapidly in size over one month and appeared about seven months after the fracture surgery. Skin biopsy showed multiple plasma cell infiltration with monoclonality for lambda light chain, which was consistent with cutaneous plasmacytoma. The patient refused to be treated and died two months later. We herein report an interesting case of cutaneous plasmacytoma at the surgical site of fracture repair.

Digital Mucous Cyst: A Clinical-Surgical Study

BACKGROUND: It has been suggested digital mucous cysts (DMCs) are associated with osteoarthritis and osteophytes in the elderly, and usually have a communicating pedicle with the joint. Surgical excision is a standard therapy with a high cure rate. OBJECTIVE: The purpose of this prospective study is to evaluate the features of DMCs via clinical, radiological and pathological examination and the efficacy of surgical excision of DMCs. METHODS: Between 2010 and 2014, 24 Korean patients were treated with the resection of the cyst and the pedicle. Preoperative X-ray and ultrasonography were performed to detect the presence of the osteophyte and the connection to the joint space. Postoperative patients' satisfaction score was assessed by the visual analogue scale (0~10). RESULTS: The osteophytes were found in 15.8%. In ultrasonographic findings, there were prominent flow signals between the cyst and the joint space in 13.6%. There were no serious postoperative complications, and recurrences were observed in 16.7%. Mean postoperative satisfaction score was 8.3. CONCLUSION: It seems that preoperative X-ray for osteophytes and ultrasonographic study for connection are not always helpful for the treatment of DMCs, and that the surgical excision with a pedicle ligation and electrocoagulation is an effective treatment modality.

Digital Mucous Cyst: A Clinical-Surgical Study

BACKGROUND: It has been suggested digital mucous cysts (DMCs) are associated with osteoarthritis and osteophytes in the elderly, and usually have a communicating pedicle with the joint. Surgical excision is a standard therapy with a high cure rate. OBJECTIVE: The purpose of this prospective study is to evaluate the features of DMCs via clinical, radiological and pathological examination and the efficacy of surgical excision of DMCs. METHODS: Between 2010 and 2014, 24 Korean patients were treated with the resection of the cyst and the pedicle. Preoperative X-ray and ultrasonography were performed to detect the presence of the osteophyte and the connection to the joint space. Postoperative patients' satisfaction score was assessed by the visual analogue scale (0~10). RESULTS: The osteophytes were found in 15.8%. In ultrasonographic findings, there were prominent flow signals between the cyst and the joint space in 13.6%. There were no serious postoperative complications, and recurrences were observed in 16.7%. Mean postoperative satisfaction score was 8.3. CONCLUSION: It seems that preoperative X-ray for osteophytes and ultrasonographic study for connection are not always helpful for the treatment of DMCs, and that the surgical excision with a pedicle ligation and electrocoagulation is an effective treatment modality.

Giant Basal Cell Carcinoma Treated with a Paramedian Forehead Flap in a Patient with Leprosy / 대한피부과학회지

No abstract available.

Eccrine Squamous Syringometaplasia Associated with Pelubiprofen Therapy

Eccrine squamous syringometaplasia (ESS) is a histologically distinctive skin eruption occurring predominantly in acral or intertriginous areas presenting as erythematous macules, papules or patches. The etiology of ESS remains unclear, but it is usually reported in patients receiving chemotherapy for various malignant neoplasms. To date, only two cases of ESS associated with non-steroidal anti-inflammatory drugs (NSAIDs), which has distinctive clinical features and pathogenesis, have been reported in the literature. Herein, we report a rare and interesting case of ESS associated with pelubiprofen, a recently developed NSAID, which appeared after pelubiprofen therapy and resolved spontaneously after discontinuing the medication.

An effect of Masseter muscle transfer in recurred cases following temporalis transfer for lower lip paralysis / 나학회지

BACKGROUND: Facial nerve palsy in patients with leprosy brings a variety of discomfort functionally and cosmetically. Although the distortion of the lips is less frequent than that of the eyes, when it occurs, it happens either unilaterally or bilaterally and shows a different dynamic from that in eyes. The lower lip droop causes saliva to flow out of the mouth when eating and exposes the gum and teeth. MATERIALS AND METHODS: All patients were previously treated using the TMT procedure yet symptoms recurred within an unacceptable timeframe. Therefore, we retreated patients using the masseter muscle plication. We performed the masseter muscle plication to the lateral portion of the lower lip muscle to give it power without dividing the anterior segment of masster muscle from mandibular border. RESULTS: Complete closure of the mouth was observed in 6 patients with a moderate degree of lower lip droop. One patient that presented with severe lower lip droop bilaterally showed only partial closure. CONCLUSIONS: Without dividing anterior half segment of masseter muscle from mandibular border, the direct plication of the anterior border of masseter muscle and lower lip muscles was very effective method to correct the lower lip droop and to close the mouth in recurrent patients after temporal muscle transfer.

Hidden Pictures of Kaposi's Sarcoma in Psoriatic Lesions: A Diagnostic Challenge

Kaposi's sarcoma is a multifocal proliferative vascular tumor involving the skin and other organ and psoriasis is a chronic cutaneous disease with papules and plaques with white scale. Development of Kaposi's sarcoma in psoriasis patients has been reported rarely. A 71-year-old man presented with multiple brownish to violaceous plaques on both feet and arms which were found 4 months ago. The biopsy confirmed Kaposi's sarcoma. The patient was diagnosed with psoriasis vulgaris 10 years ago and Kaposi's sarcoma lesions developed between psoriatic plaques. We herein report a rare case of simultaneous occurrence of Kaposi's sarcoma and psoriasis vulgaris which need quite different treatment.

A Clinicopathological Study of Pilomatricomas in Patients over 50 Years of Age / 대한피부과학회지

BACKGROUND: Pilomatricoma is a benign, appendageal tumor differentiating towards the normal hair follicles and is characterized by basaloid, transitional, and shadow cells. It is most frequently seen in children; however, a bimodal onset distribution is observed in the first and sixth decades. OBJECTIVE: The purpose of this study was to analyze the clinical and histopathological features of pilomatricomas in patients over 50 years of age, and to compare these features with those occurring in patients under 20 years of age. METHODS: We retrospectively reviewed the medical records and histopathological findings of 73 patients under 20 years and above 50 years of age. The morphological stages of the tumors were analyzed through histopathological findings. RESULTS: The age of patients in the over 50-year age group ranged from 50 to 82 years, with a mean age of 60 years. The male-to-female ratio was 1.1:1. The duration of lesions was from 1 month to several years, with half of the patients having the tumors for over 12 months. The predilection sites were the head (51%), followed by the upper extremities (21%), neck (15%), trunk (6%), and lower extremities (6%). In 73% of the patients over 50 years of age, pilomatricoma was less likely the suspected diagnosis compared with that in the under 20-year age group. Epidermal cysts were most likely suspected in patients over 50 years of age. Histopathologically, half of the tumors were located in the subcutis, which was not significantly different when compared with pilomatricomas in the under 20-year age group. The most common evolutional stage of tumors was early regressive (52%), followed by late regressive (27%), fully developed (15%), and early stage (6%). Capsulation (9%), inflammatory cell infiltration (60%), multinucleated giant cells (36%), calcification (33%), and ossification (12%) were observed. With the exception of capsulation, there were no significant differences in these histopathological features in pilomatricomas in patients over 50 years of age compared with those in patients under 20 years of age. CONCLUSION: Pilomatrichomas in patients over 50 years of age show no pain, are located in the head and neck, are present for a long duration, and have various clinical presentations when compared with those in patients under 20 years of age. However, they are not rare tumors in adults. Accordingly, pilomatricomas should be included in the clinical differential diagnosis of a solitary, deep skin tumors presenting in adults, especially when they occur on the head.

Late-onset Segmental Neurofibromatosis on the Face / 대한피부과학회지

Segmental neurofibromatosis is a rare form of neurofibromatosis that is characterized by neurofibromas and/or café au lait macules, limited to one region of the body. The neurofibromas of segmental neurofibromatosis are most commonly occupied by either a cervical or a thoracic dermatome. Segmental neurofibromatosis on the face is extremely rare, and only 10 cases have been described so far. Herein, we report a case of segmental neurofibromatosis on the V1 dermatome for its rarity and unusual location.