Acute Generalized Exanthematous Pustulosis Induced by Parvovirus B19 Infection

No abstract available.

Congenital Melanocytic Nevus with Asymptomatic Neurocutaneous Melanosis / 대한피부과학회지

Congenital melanocytic nevi (CMN) are benign pigmented lesions that are defined as a tissue malformation of the neuroectoderm. Giant melanocytic nevi with multifocal involvement show significantly greater risk of developing malignant melanomas and neurocutaneous melanocytosis, particularly those in a posterior axial location. Neurocutaneous melanosis is a rare, congenital, non-inherited disorder characterized by the presence of large, multiple congenital melanocytic nevi with proliferation of melanocytes in the central nervous system. Asymptomatic neurocutaneous melanosis can be detectable only by MRI. The patients who have clinical manifestations have an extremely poor prognosis. We present a patient with giant congenital melanocytic nevi involving a major portion of the back with multiple satellite nevi scattered over the whole body associated with asymptomatic neurocutaneous melanosis. We emphasize the importance of imaging study for detection of early neurological symptoms or melanomas. To our knowledge, this is the first case of giant congenital melanocytic nevi associated with asymptomatic neurocutaneous melanosis in Korean dermatologic literatures.

Kaposi Sarcoma in a Patient with Chronic Renal Failure Undergoing Dialysis

Kaposi sarcoma (KS) is a multicentric proliferative vascular tumor involving the skin and other organs. Human herpesvirus 8 (HHV-8) has been detected in KS lesions and is considered the putative causative agent of KS. The relationship between chronic renal failure, HHV-8, and KS is not clear. KS appears to develop in association with renal transplantation, but is unlikely with dialysis, and there have been few reports on this. Here, we report the case of a 51-year-old man, who underwent peritoneal dialysis to treat chronic renal failure, and presented with multiple brownish plaques on his soles. On histopathological examination, abnormally proliferated vessels, vascular slits, and spindle-shaped cells were seen in the dermis. Immunohistochemical staining for HHV-8 was positive. This case is another example in which factors other than immunosuppression contributed to the development of KS, due to activation of HHV-8.

A Case of Bowen Disease in the Finger Web / 대한피부과학회지

No abstract available.

Evaluation of Efficacy and Skin Irritation during Treatment of Nadifloxacin 1% Cream in Acne Vulgaris Patient / 대한피부과학회지

BACKGROUND: Nadifloxacin is a synthetic fluoroquinolone with a broad spectrum. It has been suggested to not only have antibacterial, but also anti-inflammatory actions. In addition, it is effective against antibiotic-resistant Propionibacterium acne. Upon review of the literature, however, no studies have been performed concerning the efficacy and safety in terms of irritation potential and skin barrier changes after applying nadifloxacin. OBJECTIVE: This study intended to evaluate the skin irritation and changes of the skin barrier function associated with the administration of nadifloxacin 1% cream for the treatment of acne vulgaris. Furthermore, the efficacy and safety of nadifloxacin 1% cream were also assessed. METHODS: The changes in the lesion counts, Korean Acne Grading System (KAGS) and adverse events were recorded. The biophysical profiles of the skin, including transepidermal water loss (TEWL), skin surface hydration and redness were measured by Tewameter(R), Corneometer(R) and Mexameter(R) for 3 weeks. RESULTS: At the end of the therapy, 69% of inflammatory lesions (p<0.0001) and 27% of noninflammatory lesions (p=0.26) resulting from acne were decreased from the baseline. Adverse events were reported in two patients, but they were transient and tolerable. The skin barrier function showed no changes during the treatment periods. CONCLUSION: Nadifloxacin 1% cream is effective for the treatment of acne vulgaris without the changes of skin barrier function.

Multiple Piloleiomyoma Treated with a Suction-Assisted Cartilage Shaver / 대한피부과학회지

Piloleiomyoma is a benign neoplasm arising from the erector pili muscle in the skin. It occurs as linear or dermatomal arrangements of firm, red to brown intradermal nodules, which are fixed to the skin but not to the deeper tissues. Although various treatments have been attempted, they have shown limited success and several complications remain. A 21-year-old male presented with 3-year history of multiple, erythematous, firm 4 mm to 3 cm sized nodules on the chest. The histopathological examination was compatible with piloleiomyoma. The lesions were removed using the dermal shaving method with a suction-assisted cartilage shaver. Each lesion were markedly flattened. This treatment was quicker and caused less subjective pain to the patient compared with those of classic surgical excision. No signs of adverse events or recurrence have been observed.

Steatocystoma Multiplex Confined to the Scalp with Concurrent Alopecia

Steatocystoma multiplex (SM) is an uncommon disorder of the pilosebaceous unit characterized by the development of numerous sebum-containing dermal cysts which rarely involves the scalp. Here, we report a case of a 50-year-old man with multiple cystic nodules and alopecic patches on his scalp. On histopathological examination, the folded cyst was found to be lined by stratified squamous epithelium, while flattened sebaceous gland cells were identified in the cystic wall. Pigment casts were present in the hair papillae and perifollicular regions, suggesting trichotillomania as a possible cause of the observed alopecia. This case appears to represent an unusual clinical manifestation of SM.

Hidradenoma Papilliferum Occurring on the Nasal Skin

Hidradenoma papilliferum is a rare benign neoplasm that usually occurs in the female anogenital area. We present a 43-year-old female with a non-anogenital (ectopic) hidradenoma papilliferum on her nose. The patient had had a skin-colored subcutaneous nodule on her nose for 7 years. The histopathological findings showed variously shaped cystic spaces in the tumor. And the lumina were surrounded by a single or double layer of cell which showed decapitation secretion. In the English dermatological literature, only one case of ectopic hidradenoma papilliferum arising in nasal skin has been reported. Hence we suggest hidradenoma papilliferum occurring on the nasal skin is a peculiar and interesting event.

Cutaneous Adverse Reactions Associated with Epidermal Growth Factor Receptor Inhibitors / 대한피부과학회지

BACKGROUND: Cutaneous adverse reactions are often observed during chemotherapy with epidermal growth factor receptor (EGFR) inhibitors including papulopustular eruptions, xerosis and paronychia. OBJECTIVE: To investigate and compare the cutaneous adverse reactions induced by EGFR inhibitors including erlotinib, gefitinib and cetuximab which have commonly been used as chemotherapeutic agents in Korea. METHODS: We reviewed cutaneous adverse effects through the medical records and clinical photographs of 43 Korean patients who had been treated with erlotinib, gefitinib or cetuximab at Pusan Paik Hospital between June 2003 and January 2010. RESULTS: Papulopustular eruptions occurred in 28 patients (65.1%); they were easily controlled by topical benzoyl peroxide, clindamycin and a retinoid, or by oral minocycline and tetracycline. There were no significant differences in incidence, duration and severity grades of papulopustular eruptions among EGFR inhibitors. In contrast to previous studies, the frequency and severity of papulopustular eruptions were not significantly correlated with treatment responses to EGFR inhibitors. Xerosis appeared in 14 patients (41%), and was easily controlled by topical emollients and steroids, and by systemic steroids and antihistamines. Paronychia occurred in 8 patients (18.6%) and were controlled by conservative treatments. CONCLUSION: Papulopustular eruptions, xerosis and paronychia are common cutaneous adverse reactions associated with EGFR inhibitors and there are no significant differences in adverse cutaneous reactions among EGFR inhibitors. As these cutaneous adverse reactions are relatively easily controlled with treatment, it will be helpful to detect and treat these adverse reactions early, including reassuring the patients, which should increase compliance of patients during treatment with EGFR inhibitors.

Acute Localized Exanthematous Pustulosis on the Face

Acute localized exanthematous pustulosis (ALEP) is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 26-year-old woman presented with multiple erythematous pustules on her face, which had appeared three days after taking antibiotics. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules were resolved within 2 weeks after the patient discontinued the antibiotics. Herein, we present a case of a woman with a cutaneous drug reaction consistent with ALEP that occurred subsequent to administration of antibiotics.

Detection of a Novel Missense Mutations in Atrichia with Papular Lesions

BACKGROUND: Atrichia with papular lesions (APL) is a rare inherited disease characterized by early onset of total hair loss, followed by papular lesions over the extensor areas of the body. Recently, mutations in the human hairless (HR) gene have been implicated in its pathogenesis. The identification of mutations in the HR gene is important for differentiating between APL and alopecia universalis (AU). OBJECTIVE: We compared the HR genes of patients with presumed AU who showed minimal or no response to treatment with the HR genes of healthy controls. METHODS: The subjects were 11 patients with presumed AU who had not responded to treatments. Fifty healthy people were included as controls for molecular analysis. To screen for mutations, polymerase chain reaction was performed. RESULTS: DNA analysis identified a novel heterozygous G-to-A transition at nucleotide position 191 in exon 5. The mutation was not found in the controls, other AU patients, or any unaffected family members except for the patients' mother and maternal grandfather, who were heterozygous HR gene carriers. CONCLUSION: Our study identifies a novel missense mutation in exon 5 of the HR gene in a Korean APL patient previously diagnosed as AU.

A Case of Cutaneous Side Effect of Methotrexate Mimicking Behcet's Disease

Methotrexate (MTX) is an antimetabolite which interferes with DNA synthesis, and it is used for the treatment of moderate to severe psoriasis, atopic dermatitis and a wide variety of cutaneous diseases. Although many adverse effects of MTX, including cutaneous ulcerations, have been documented, multifocal mucosal ulceration mimicking Behcet's disease has not been reported. In our case, a 63-year-old female presented with oral, vaginal ulcer and multiple purpuric patches on both legs. Considering patient's clinical course and histopathologic findings, we presumed that these reactions may be the side effect of MTX administered for treatment of necrotizing scleritis. Herein we report the cutaneous side effect of MTX that manifested clinically like Behcet's disease.

Giant Acquired Digital Fibrokeratoma Occurring on the Left Great Toe

Acquired digital fibrokeratoma is an uncommon, benign fibrous tumor which usually occurs in adults as a solitary lesion. The most frequent locations are fingers and toes and the size of the tumor is generally small, around 3~5 mm. An 18-year-old female presented with a solitary, skin-colored, round and protruded nodule of the left great toe. The size of nodule was 2.5x1.6x1.4 cm. Histopathologic examination revealed typical findings of acquired digital fibrokeratoma. Herein, we report a giant acquired digital fibrokeratoma.

Generalized Discoid Lupus Erythematosus Occurring in a Systemic Lupus Erythematosus Patient / 대한피부과학회지

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem involvement. Skin is the second most frequently affected organ in SLE, and various forms of cutaneous LE (CLE), such as acute, subacute, and chronic CLE, are observed in higher than 75% of patients with SLE. Discoid LE (DLE) is the most common form of chronic CLE, and a small subset of patients with SLE also has concomitant DLE. A 32-year-old woman diagnosed with SLE 6 years ago visited our clinic with a 2-month history of multiple hyperpigmented macules and patches over the entire body. She also complained of arthralgia, auditory, and visual hallucinations. Her clinical presentation, laboratory findings, and histopathologic features were consistent with generalized DLE and aggravation of her SLE. Herein, we report an unusual case of generalized DLE occurring in a patient with SLE.

Steatocystoma Multiplex Treated with a Suction-assisted Cartilage Shaver / 대한피부과학회지

Steatocystoma multiplex is a rare autosomal-dominant disorder characterized by asymptomatic multiple, skin-colored to yellowish nodules on the trunk, proximal extremities, and axillae. Although surgical excision is the most effective method, treatment is difficult when lesions occur in multiple numbers. Therefore, various treatments such as CO2 laser therapy, needle aspiration, and oral isotretinoin have been attempted, but results are variable. A 37-year-old man presented with multiple skin-colored subcutaneous nodules on the abdomen and both axillae. A histopathological examination was consistent with steatocystoma multiplex. The lesions were removed by dermal shaving with a suction-assisted cartilage shaver. It was an effective therapeutic method for multiple lesions with no significant adverse events. Herein, we report a case of steatocystoma multiplex treated with a suction-assisted cartilage shaver.

Multiple Annular Tufted Angioma / 대한피부과학회지

Tufted angioma is a rare, slow-growing, benign, vascular tumor that usually occurs in children. It appeared as an erythematous to red-brown, indurated papule on the trunk or neck. Histopathologic examination shows multiple capillary lobules in a cannon ball appearance scattered throughout the dermis. We present here a 32-year-old woman with multiple annular lesions on her right thigh, which started as red papules and they progressed with annular extension and central regression for 3 years. The histopathologic findings were compatible with tufted angioma. The lesions were treated with 3 sessions of sclerotherapy. We report here on an unusual tufted angioma that occurred as multiple lesions which showed annular extension with central regression.

Effect of Allopurinol on Foreign Body Granuloma / 대한피부과학회지

A 68-year-old woman presented with erythematous indurated plaques on both her eyebrows. The skin lesions appeared 3 months after she was tattooed on both eyebrows. On histopathologic examination, a granulomatous infiltration was observed in the dermis with no evidence of any fungal, mycobacterial organisms. She was treated with intralesional injection of triamcinolon acetonide, but there was no improvement. After she started to take allopurinol for 5 months, the skin lesion improved without side effects. To the best of our knowledge, this is the first case of foreign body granuloma that was successfully treated with allopurinol in the Korean dermatologic literature.

Inflammatory Disseminated Superficial Porokeratosis / 대한피부과학회지

Inflammatory disseminated superficial porokeratosis is an unusual pruritic variant of disseminated superficial porokeratosis, and this was first described by Kanzaki in 1992 as eruptive pruritic papular porokeratosis. Since the first report, 8 cases of inflammatory disseminated superficial porokeratosis have been reported in English language dermatologic literature and only one case has been reported in the Korean dermatologic literature. The condition is clinically characterized by an acute pruritic exacerbation of disseminated superficial porokeratosis, which had been asymptomatic for several years. Usually the skin lesions show improvement after several months, leaving brownish atrophic lesions. Histopathologic examination reveals the cornoid lamella with an infiltration of eosinophils and lymphocytes in the upper dermis. Herein, we report on an 81-year-old Korean man with inflammatory disseminated superficial porokeratosis, and this was clinically and histopathologically diagnosed.

A Case of Linear Focal Elastosis with a Family History

Linear focal elastosis is an uncommon disorder typically occurring in the back region, which clinically presents as band-like striae, having a histological focal increase in abnormal elastic fibers. Until now, linear focal elastosis occurring in patients with a family history have been rarely reported. Here, we present one such case, of linear focal elastosis which occurred in a brother and sister.

Syringomas Treated by Intralesional Insulated Needles without Epidermal Damage

Syringoma is a benign adnexal tumor derived from intradermal eccrine ducts; it predominantly occurs in women at puberty or later in life. Although syringoma is a common benign neoplasm, there have been no effective therapies for its removal. Conventional therapies for syringomas, including surgical excision, electrodessication, chemical peeling, topical atropine or tretinoin, cryosurgery, and laser therapy, can lead to cosmetic defects such as hyperpigmentation or scarring due to epidermal damage. In contrast, treatment using intralesional insulated needles, which are insulated at the point of epidermal contact, has been shown to result in good cosmetic outcomes due to selective destruction of dermal lesions. This could be an effective and highly satisfying treatment for syringomas. We herein present 2 patients with syringomas treated with intralesional insulated needles.