A Case of Clear Cell Acanthoma on the Bilateral Areolae / 대한피부과학회지

Clear cell acanthoma is a rare benign tumor, which usually presents as a solitary erythematous to brown colored papule or nodule, with a predilection for the lower leg of t hemiddle-aged and older individuals. An 11-year-old male presented with a 1-month history of bilateral brownish colored and exudative plaques on the both areolae.Histopathologic examination showed psoriasiform proliferation of pale keratinocytes and neutrophil exocytosis. Therefore, the patient was diagnosed with clear cell acanthoma. Typically, clear cell acanthoma occurs as a unilateral lesion on the leg in an adult. However, our case shows a bilateral lesion as well as the uncommon age and site.To our knowledge, this case of bilateral clear cell acanthoma has been rarely reported in Korea. Herein, we report a case of clear cell acanthoma that occurred on both areolae in a child.

Epstein-Barr Virus Positive Diffuse Large B-Cell Lymphoma with Epidermotropism

Primary cutaneous B-cell lymphomas are rare diseases comprising nodular to diffuse lymphoid cell infiltration with an overlying grenz zone and no epidermal involvement upon histological analysis. Diagnostics can become challenging when lymphomas exhibit the characteristics of both B and T-cells. Differential diagnoses may include reactive proliferations, cutaneous composite lymphomas, and transformed mycosis fungoides. Immunohistochemistry and gene arrangement tests may be beneficial to clarify the diagnosis. Herein, we report a rare case of epidermotropic EBV-positive cutaneous B-cell lymphoma along with a literature review.

A Case of Lupus Miliaris Disseminatus Faciei Aggravated after Microneedle Radiofrequency Therapy / 대한피부과학회지

no abstract available.

A Case of Pleomorphic Dermal Sarcoma and Literature Review according to World Health Organization Reclassification Guideline / 대한피부과학회지

Pleomorphic dermal sarcoma (PDS), formerly known as malignant fibrous histiocytoma (MFH), is a rare mesenchymal tissue tumor. A 40-year-old male presented with a 2-month history of a well-defined, solitary, round, palpable protruding mass with central ulceration, 1.5 cm in diameter. Punch biopsy showed tumor cells of variable size and hyperchromatic nuclei with frequent bizarre atypical cells and atypical mitoses arranged in a storiform-pleomorphic pattern in the entire dermis. After complete resection, PDS was diagnosed because the lesion had invaded the deep subcutaneous fat. Because MFH has been renamed according to the World Health Organization new classification system, we reclassified the 10 cases that have been reported as MFH in Korea. Nine cases were renamed undifferentiated pleomorphic sarcoma, with only one being renamed mucofibrosarcoma. Herein, we report a rare case of PDS treated with surgical excision with a review of the literature.

A Rare Case of Pigmented Median Raphe Cyst / 대한피부과학회지

Median raphe cysts (MRCs) are rare benign lesions that occur as a result of congenital defects during the embryological development of the male genitalia in the fetal period. It can develop anywhere along the midline, from the meatus to the anus. Pigmented MRCs are rare subtypes that contain melanin pigments or melanocytes in the epithelium, and there are only eight such cases reported worldwide. We report herein a case of pigmented MRC in the perineum of a 3-year-old boy. The clinical features include a linear tubular structure and foreign body granuloma at the tip of the linear cystic lesion and rare histological findings of pigmented cuboidal epithelium and squamous epithelium. Immunohistochemical staining revealed strong positivity for c-kit in the pigmented cuboidal epithelium. In this report, we discuss a rare case of pigmented MRC with a mixed type of squamous epithelium and pigmented cuboidal epithelium and review the associated literature.

Poroid Hidradenoma: A Two-Case Report and Literature Review

Poroid hidradenoma (PH) is a rare benign tumor that shows differentiation of the eccrine sweat gland. It occurs mainly in adults, presenting as a 0.5 to 2 cm-sized intradermal nodule, mostly on the head, extremities, trunk and neck. We report two rare cases of PH, one on the face and the other on the heel. The first patient was a 50-year-old male who had a solitary, skin-colored nodule on his right temple for 6 months.The second patient was a 67-year-old female who presented with a solitary, bean-sized, tender nodule on her left heel for 1 year. The common histological examination finding was a well-circumscribed tumor composed of solid portions and large cystic spaces in the center. The tumor cells consisted of small, monomorphic poroid cells and large cuticular cells in both cases. To our knowledge, only few cases of PH have been reported. Herein, we report two rare cases of PHs with literature review

A Study on Leather in Korea as a Cause of Cobalt Allergic Contact Dermatitis / 대한피부과학회지

Background@#Cobalt is an important contact allergen and is contained mainly in metal products. Recent studies have reported an association between leather exposure and cobalt allergic contact dermatitis. However, there is no study on this subject in Korea. @*Objective@#The aim of this study is to examine cobalt content and release from leather sofas, shoes, watch straps, and gloves sold in Korea, and to investigate leather exposure in cobalt allergic contact dermatitis. @*Methods@#We collected 38 leather samples of leather sofa, 15 leather shoes, 8 leather watch straps, and 10 leather gloves sold in Korea. The cobalt spot test and inductively coupled plasma optical emission spectrometry were used to confirm cobalt content and release from leather samples. @*Results@#All 71 leather samples were negative for cobalt in the spot test. No cobalt was found in the 35 leathers tested by inductively coupled plasma optical emission spectrometry. @*Conclusion@#Unlike previous studies, cobalt was not identified in leather in this study. Therefore, the possibility of cobalt allergic contact dermatitis caused by leather is relatively low in Korea. However, further studies with larger numbers of leather samples are needed to obtain more accurate results.

Cutaneous Adverse Events of Anti-Programmed Cell Death Receptor-1 Antibody: Two Case Reports and a Literature Review / 대한피부과학회지

The introduction of immune checkpoint inhibitors, including anti-programmed cell death receptor-1 antibodies (anti-PD-1 Ab), such as nivolumab and pembrolizumab, represents a major breakthrough in cancer therapy. The PD-1 pathway inhibits T cell activation, maintaining a normal and balanced immune response. Anti-PD-1 Ab induces T cell activity by inhibiting the suppressive effect of PD-1 signaling on T cells. Excessive stimulation of T cells represents a potential mechanism for multiple skin lesions. To the best of our knowledge, reports on cutaneous adverse effects during treatment with anti-PD-1 Ab are limited in the dermatological literature of Korea. Herein, we report two rare cases of nivolumab-induced lichenoid drug eruption and pembrolizumab-induced psoriasis.

A Study of the Clinical Features of Rosacea and a Comparison of Its Classifications / 대한피부과학회지

Background@#Rosacea is a common chronic inflammatory skin disease, which primarily affects the central face. In 2002, the National Rosacea Society (NRS) committee developed the first diagnostic criteria for rosacea, based on its subtypes. The revised classification in 2017 prompted a proposal to transit from a subtyping to a phenotyping approach, reflecting current insights into rosacea pathogenesis, pathophysiology, and management. @*Objective@#This study aimed to elucidate the clinical features of rosacea and compare two diagnostic criteria in rosacea patients. @*Methods@#We performed a clinical study on 100 patients with rosacea diagnosed according to the 2002 NRS criteria. The age, sex, clinical features, subtypes, severity, and predisposing factors were evaluated using the questionnaire. In addition, we compared the 2002 and 2017 criteria, and evaluated patients if they met the revised criteria. @*Results@#According to the 2002 NRS classification, the erythematotelangiectatic type (88.0%) was the most frequent, followed by the papulopustular (43.0%), ocular (13.0%), and phymatous (6.0%) types. There were 44 overlapping cases, including 38 cases with 2 subtypes mixed and 6 cases with three subtypes. Six patients were diagnosed with rosacea using the 2002 NRS criteria but they did not satisfy the revised 2017 criteria. @*Conclusion@#We found that the diagnostic features of the 2002 criteria are too ambiguous for the diagnosis of rosacea. Therefore, we recommend that dermatologists recognize the necessity of a transition from a subtyping to a phenotyping approach, according to the 2017 criteria for the diagnosis of rosacea.

Poroid Hidradenoma: A Two-Case Report and Literature Review

Poroid hidradenoma (PH) is a rare benign tumor that shows differentiation of the eccrine sweat gland. It occurs mainly in adults, presenting as a 0.5 to 2 cm-sized intradermal nodule, mostly on the head, extremities, trunk and neck. We report two rare cases of PH, one on the face and the other on the heel. The first patient was a 50-year-old male who had a solitary, skin-colored nodule on his right temple for 6 months.The second patient was a 67-year-old female who presented with a solitary, bean-sized, tender nodule on her left heel for 1 year. The common histological examination finding was a well-circumscribed tumor composed of solid portions and large cystic spaces in the center. The tumor cells consisted of small, monomorphic poroid cells and large cuticular cells in both cases. To our knowledge, only few cases of PH have been reported. Herein, we report two rare cases of PHs with literature review

A Case of Clear Cell Hidradenoma with Aprocine and Eccrine Differentiation / 대한피부과학회지

Clear cell hidradenoma (CCH) is a rare benign tumor that shows differentiation toward the structure of a sweat gland. Recently, hidradenoma has been re-classified into apocrine and eccrine variants and CCH has been classified as apocrine differentiation. A 34-year-old man without any underlying diseases presented with an erythematous, papilliform, 1-cm exophytic nodule on the left neck that had been present for 3 years. Skin biopsy specimens were obtained by excision biopsy of his left neck. Histopathologic findings showed a well-circumscribed tumor composed of solid portions with polyhedral cells and clear cells, a tubular space with columnar cells, and decapitation secretion. Additionally, round, basophilic, poroid cells, tubular structures containing hyalinized material, and intercellular bridges were observed in the epidermis. Herein, we present a rare case of CCH with apocrine and eccrine differentiation.

Kikuchi’s Disease Manifested as Non-Specific Facial Skin Lesions: A Case Report / 대한피부과학회지

Kikuchi’s disease, also referred to as histiocytic necrotizing lymphadenopathy, is a benign self-limiting lymphadenitis accompanied by mild fever and night sweats. This disorder usually affects young women and presents with non-specific cutaneous findings. A 15-year-old female adolescent presented with erythematous papules and plaques on both cheeks accompanied by fever, night sweats, and right cervical lymphadenopathy. Histopathological evaluation of a skin biopsy specimen showed mild perivascular and periadnexal infiltration in the dermis.Fine-needle aspiration biopsy of lymph nodes revealed coagulative necrosis with lymphocytic, histiocytic, and karyorrhectic debris. We present a rare case of Kikuchi’s disease that was diagnosed based on histopathological evaluation of skin and lymph node specimens.

A Study on Leather in Korea as a Cause of Cobalt Allergic Contact Dermatitis / 대한피부과학회지

Background@#Cobalt is an important contact allergen and is contained mainly in metal products. Recent studies have reported an association between leather exposure and cobalt allergic contact dermatitis. However, there is no study on this subject in Korea. @*Objective@#The aim of this study is to examine cobalt content and release from leather sofas, shoes, watch straps, and gloves sold in Korea, and to investigate leather exposure in cobalt allergic contact dermatitis. @*Methods@#We collected 38 leather samples of leather sofa, 15 leather shoes, 8 leather watch straps, and 10 leather gloves sold in Korea. The cobalt spot test and inductively coupled plasma optical emission spectrometry were used to confirm cobalt content and release from leather samples. @*Results@#All 71 leather samples were negative for cobalt in the spot test. No cobalt was found in the 35 leathers tested by inductively coupled plasma optical emission spectrometry. @*Conclusion@#Unlike previous studies, cobalt was not identified in leather in this study. Therefore, the possibility of cobalt allergic contact dermatitis caused by leather is relatively low in Korea. However, further studies with larger numbers of leather samples are needed to obtain more accurate results.

Cutaneous Adverse Events of Anti-Programmed Cell Death Receptor-1 Antibody: Two Case Reports and a Literature Review / 대한피부과학회지

The introduction of immune checkpoint inhibitors, including anti-programmed cell death receptor-1 antibodies (anti-PD-1 Ab), such as nivolumab and pembrolizumab, represents a major breakthrough in cancer therapy. The PD-1 pathway inhibits T cell activation, maintaining a normal and balanced immune response. Anti-PD-1 Ab induces T cell activity by inhibiting the suppressive effect of PD-1 signaling on T cells. Excessive stimulation of T cells represents a potential mechanism for multiple skin lesions. To the best of our knowledge, reports on cutaneous adverse effects during treatment with anti-PD-1 Ab are limited in the dermatological literature of Korea. Herein, we report two rare cases of nivolumab-induced lichenoid drug eruption and pembrolizumab-induced psoriasis.

A Study of the Clinical Features of Rosacea and a Comparison of Its Classifications / 대한피부과학회지

Background@#Rosacea is a common chronic inflammatory skin disease, which primarily affects the central face. In 2002, the National Rosacea Society (NRS) committee developed the first diagnostic criteria for rosacea, based on its subtypes. The revised classification in 2017 prompted a proposal to transit from a subtyping to a phenotyping approach, reflecting current insights into rosacea pathogenesis, pathophysiology, and management. @*Objective@#This study aimed to elucidate the clinical features of rosacea and compare two diagnostic criteria in rosacea patients. @*Methods@#We performed a clinical study on 100 patients with rosacea diagnosed according to the 2002 NRS criteria. The age, sex, clinical features, subtypes, severity, and predisposing factors were evaluated using the questionnaire. In addition, we compared the 2002 and 2017 criteria, and evaluated patients if they met the revised criteria. @*Results@#According to the 2002 NRS classification, the erythematotelangiectatic type (88.0%) was the most frequent, followed by the papulopustular (43.0%), ocular (13.0%), and phymatous (6.0%) types. There were 44 overlapping cases, including 38 cases with 2 subtypes mixed and 6 cases with three subtypes. Six patients were diagnosed with rosacea using the 2002 NRS criteria but they did not satisfy the revised 2017 criteria. @*Conclusion@#We found that the diagnostic features of the 2002 criteria are too ambiguous for the diagnosis of rosacea. Therefore, we recommend that dermatologists recognize the necessity of a transition from a subtyping to a phenotyping approach, according to the 2017 criteria for the diagnosis of rosacea.

Multiple Giant Keratoacanthoma Treated with Acitretin / 대한피부과학회지

Giant keratoacanthoma is an uncommon variant of keratoacanthoma, which may increase to a diameter of several centimeters. Although keratoacanthomas usually resolve spontaneously, giant keratoacanthoma can be invasive and destructive. A 49-year-old man presented with a 5-year history of multiple large hyperkeratotic and crusted plaques and nodules on sun-exposed areas such as the face, ear, hand, and forearm. Some lesions involuted spontaneously, whereas others became rather enlarged. The biopsy specimen revealed horn-filled crater formation, epidermal extending resembling a buttress, and an eosinophilic glassy appearance in the keratinocytic cytoplasm. We treated the lesions with acitretin, and they almost completely resolved after 13 weeks. Here we describe a case of multiple giant keratoacanthoma treated with acitretin.

Systemic Lupus Erythematosus Presenting as Stevens-Johnson Syndrome: A Case Report / 대한피부과학회지

Acute cutaneous lupus erythematosus (ACLE) on the face is a usual pattern of presentation. However, it can rarely present with a generalized distribution. A hyperacute form of ACLE can mimic Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN). A 33-year-old man presented with erythematous eroded papules and patches on his head, neck, and upper chest over 2 months. Moreover, he showed hemorrhagic crusted erosions on his lips, and buccal and nasal mucosa, in addition to conjunctival injection. A skin biopsy from his cheek showed a mild degree of vacuolar alteration, thickening of the basement membrane, perivascular and periadnexal lymphohistiocytic infiltration, and stromal mucin deposition. Direct immunofluorescence (DIF) demonstrated IgG and IgM deposits along the basement membrane zone. Laboratory investigations demonstrated pancytopenia, positive antinuclear antibody (ANA), anti-double stranded DNA (anti-dsDNA), and anti-Ro antibodies. The patient was diagnosed with systemic lupus erythematosus (SLE) based on clinical, histological, and laboratory markers of autoimmune disease. We report a rare case of SLE presenting as SJS.

A Case of Disseminated Herpes Simplex Virus Infection in Immunocompromised Patient / 대한피부과학회지

No abstract available.

A Case of Systematized Nevus Sebaceous / 대한피부과학회지

A patient with nevus sebaceous showing linear or wide distribution can present with a triad of nevus sebaceous, seizures, and mental retardation. Most of those cases are classified as sebaceous nevus syndrome. Ophthalmological, skeletal, and other abnormalities may also be present. A male weighing 3,580 g was born at the gestational age of 38 weeks after a normal pregnancy. He was referred to the dermatologic department on the first day of life. He presented with yellow-orange and verrucous plaques on both sides of the temporal areas, face, neck, upper and lower extremities, and trunk. Skin biopsy specimens were taken from the scalp and right lower leg. Histologically, both specimens showed sebaceous gland hyperplasia, absence of mature hair follicles, infundibular cystic structures, and apocrine glands. Brain magnetic resonance imaging, transthoracic echocardiography, abdomen ultrasonography, and routine laboratory investigations were performed and showed nonspecific findings. The patient did not show seizure activity at 19 days of observation, and he is now on close observation. We herein report a very rare case of systematized nevus sebaceous presenting at birth.

A Study of Patch Test Results with 20 Fragrance Antigens / 대한피부과학회지

BACKGROUND: The TRUE test and Korean standard series are frequently used to determine the cause of allergic contact dermatitis. Although the TRUE test and Korean standard series have some fragrance antigens, they do not include all Korean Food & Drug Administration (KFDA) labeled fragrances. Moreover, there is no report regarding the patch test result of the KFDA-labeled fragrances in Korea. OBJECTIVE: This study aimed to investigate the prevalence of positive patch test reactions to the KFDA-labeled fragrances and compare the results of the TRUE test or Korean standard series. METHODS: The patch test was conducted on patients with suspected allergic contact dermatitis due to fragrances or cosmetics. The fragrance ingredients patch test comprised 20 KFDA-labeled fragrance antigens including fragrance mix (FM)1, FM2, etc. We reviewed the clinical information of patients using the MOAHLFA index. RESULTS: Of 237 patch-tested patients, 21 (8.9%) showed at least 1 positive reaction and 13 (5.5%) showed 2 or more positive reactions. The characteristics of the MOAHLFA index were not related to fragrance allergy. Eleven (4.5%) revealed a disagreement in the patch tests of FM and FM1 ingredients. Of 21 patients with fragrance allergy, 3 (14.3%) reacted solely to FM2. Cinnamyl alcohol and cinnamyl were the most common fragrance allergens. CONCLUSION: If the TRUE test or Korean standard series is solely employed to determine fragrance allergy, false negative cases and patients with contact allergy to fragrance ingredients not included in the FM1 fragrance can be missed. Therefore, it would be desirable to test the FM and fragrance ingredient antigens simultaneously.