Treatment and Classification of Nevus of Ota: A Seven-Year Review of a Single Institution's Experience

BACKGROUND: Nevus of Ota (NO) is a relatively common pigmentary disorder in Asians. Tanino's classification is an old but tacit consensus to delineate the disease. Various treatment options have been presented. However, a few studies have been conducted on available laser options and current treatment strategies or the classification of NO. OBJECTIVE: To investigate current laser options and their effectiveness for the treatment of NO, contributing factors to clinical outcomes, and verification of classification. METHODS: A retrospective study of NO was conducted by reviewing medical charts and photographs of sixty-seven patients. Statistical analysis was used to compare excellent and poor outcomes and determine contributing factors. RESULTS: The median age of onset was below the age of 1 (interquartile range [IQR], 0~1). Tanino's and PUMCH classification systems failed to classify patients in 24 (35.8%) and 6 (9.0%) of patients, respectively. A 1,064 nm Q-switched Nd:YAG laser without additional lasers was used most frequently in 42 patients (62.7%). The frequency of treatment was 19.0 (IQR, 10.0~23.0) in the cured group defined as subjects showing 95% improvement or above, compared to 10.0 (IQR, 6.25~13.75) in the unattained group defined as subjects showing less than 95% improvement (p=0.001). CONCLUSION: A 1,064 nm Q-switched Nd:YAG laser is a reliable treatment armamentarium, functioning as a single infallible modality as well as a combination treatment modality for NO. Repetitive laser treatments without interruption seems to be the most suitable in clearing NO. The current classification systems of NO are defective. Thus, a new classification should be developed.

Erratum: Treatment and Classification of Nevus of Ota: A Seven-Year Review of a Single Institution's Experience

In the originally published version of this article, the last line of footnotes was omitted in Table 2.

Identifying Skin Type using the Baumann Skin Type Questionnaire in Korean Women Who Visited a Dermatologic Clinic / 대한피부과학회지

BACKGROUND: Skin types vary, making it difficult to identify them at a glance. To effectively understand skin type, analysis based on a questionnaire could be helpful. OBJECTIVE: The purpose of this study was to identify the accuracy and effectiveness of the Baumann skin type questionnaire (BSTQ) compared with an interview with a dermatologic specialist. In addition, we aimed to identify differences in skin type proportions according to age and develop a modified BSTQ. METHODS: Subjects included 202 women (19~64 years of age) who visited the dermatologic clinic of our hospital. They completed both the BSTQ and an interview with a dermatologic specialist. A modified BSTQ was developed by removing similar and racial questions and adjusting grading scores. RESULTS: The agreement between skin type proportions analyzed by the BSTQ and an interview was not reasonable (κ=0.428, 95% confidence interval [CI]: 0.363~0.493). There was a correlation between the proportion of dryness and age (R2=0.029, p<0.05). However, other skin type proportions (sensitivity, pigmentation, and wrinkles) were not significantly correlated with age. The modified BSTQ showed substantial agreement with the BSTQ in skin type proportions (κ=0.691, 95% CI: 0.641~0.740). CONCLUSION: We identified the skin types of Korean women of various ages using the BSTQ and an interview. Furthermore, the modified BSTQ might be helpful for accurately recognizing skin types.

A Case of Xanthoma Dissemiantum with Laryngeal and Stomach Mucosal Involvement / 대한피부과학회지

No abstract available.

Representative Trichoscopic Findings of Outpatients with Androgenetic Alopecia and Alopecia Areata / 대한피부과학회지

BACKGROUND: By magnifying the scalp and structure of hair, trichoscopy enables easy differentiation among various hair loss diseases. OBJECTIVE: To measure the frequency of representative trichoscopic findings in outpatients with androgenetic alopecia and alopecia areata and the frequency of various trichoscopic findings depending on the disease severity of androgenetic alopecia. METHODS: This cross-sectional study included 87 patients with androgenetic alopecia (n=57) and alopecia areata (n=30) treated over a year (2014∼2015). Three dermatologists assessed the trichoscopic findings (hair shaft, hair follicle opening, and perifollicular epidermis) in these patients. RESULTS: Vellus hair was observed in 21 of the 30 patients (70%) with alopecia areata and 20 of the 57 patients (35%) with androgenetic alopecia. Among the patients with androgenetic alopecia, as the disease severity increased, the portion of patients with vellus hair, thickness heterogeneity, and honeycomb pigmentation also increased (p<0.05). CONCLUSION: Trichoscopy is very useful for the diagnosis of androgenetic alopecia and alopecia areata. Additionally, the severity of androgenetic alopecia can be assessed using trichoscopy.

Representative Trichoscopic Findings of Outpatients with Androgenetic Alopecia and Alopecia Areata / 대한피부과학회지

BACKGROUND: By magnifying the scalp and structure of hair, trichoscopy enables easy differentiation among various hair loss diseases. OBJECTIVE: To measure the frequency of representative trichoscopic findings in outpatients with androgenetic alopecia and alopecia areata and the frequency of various trichoscopic findings depending on the disease severity of androgenetic alopecia. METHODS: This cross-sectional study included 87 patients with androgenetic alopecia (n=57) and alopecia areata (n=30) treated over a year (2014∼2015). Three dermatologists assessed the trichoscopic findings (hair shaft, hair follicle opening, and perifollicular epidermis) in these patients. RESULTS: Vellus hair was observed in 21 of the 30 patients (70%) with alopecia areata and 20 of the 57 patients (35%) with androgenetic alopecia. Among the patients with androgenetic alopecia, as the disease severity increased, the portion of patients with vellus hair, thickness heterogeneity, and honeycomb pigmentation also increased (p<0.05). CONCLUSION: Trichoscopy is very useful for the diagnosis of androgenetic alopecia and alopecia areata. Additionally, the severity of androgenetic alopecia can be assessed using trichoscopy.

A Case of Local and Generalized Skin Adverse Reactions after Pneumococcal Vaccination / 대한피부과학회지

Pneumococcus is the most frequently encountered causative pathogen in community-acquired pneumonia in elderly patients. The pneumococcal polysaccharide vaccine (PPV23) is widely used for preventing pneumococcal diseases in adults. PPV23 is relatively safe; however, some cutaneous adverse reactions, including localized mild inflammation associated with erythema, a sensation of heat, and tenderness, have been reported. Systemic reactions such as myalgia, arthralgia, and headache have also been reported, though severe adverse reactions are rare. In the Korean literature, a case of localized toxic reaction near the injection site after pneumococcal conjugate vaccine (PCV13) administration was previously reported. However, there are no published reports of a generalized skin rash after PPV23. Herein, we report a case of PPV23-induced generalized skin rash on the face, neck, upper trunk, and both arms with a local adverse reaction at the injection site after vaccination.

Cutaneous Metastasis of Small Cell Lung Cancer Masquerading as Lipomatosis / 대한피부과학회지

No abstract available.

A Statistical Analysis of Dermatology Patients Visiting the Emergency Department in the Recent 3 Years (2010~2012) / 대한피부과학회지

BACKGROUND: An increasing number of patients visit the emergency department (ED) for dermatological complaints. However, there is a paucity of data regarding the skin conditions presenting to the ED. OBJECTIVE: This study aimed to describe the characteristics of skin complaints seen in the ED of a tertiary hospital in Korea. METHODS: We retrospectively reviewed 1,663 new dermatological emergency patients who visited the ED of our hospital from January 2010 to December 2012. All skin conditions were diagnosed by a dermatologist and not by an emergency medicine specialist. RESULTS: A total of 1,663 patients with skin problem were seen, corresponding to 1.5% of total ED visits. The mean age was 41.8 years and there was a slight female predominance (61.2%). The peak arrival time was between 9 pm and midnight. In terms of visit length, 68.9% of patients stayed less than 2 hours. Patients most commonly presented with urticaria/angioedema (53.8%) followed by herpes zoster (14.0%), contact dermatitis (7.2%), drug eruption (6.5%), and cellulitis/erysipelas (4.0%). Urticaria/angioedema patients were most commonly aged 21 to 40 years and herpes zoster patients were most commonly aged 51 to 70 years. Admissions occurred in 8.1% of cases, most frequently for herpes zoster. CONCLUSION: This retrospective study provides insight into the types of cases being evaluated by dermatologists in the ED of a tertiary hospital. An awareness of these characteristics may assist physicians working in the ED in evaluating patients who present to the ED with skin disease.

A Case of Primary Cutaneous CD30+ Anaplastic Large Cell Lymphoma, Small Cell Variant / 대한피부과학회지

Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare cutaneous T-cell lymphoma. Most cases are composed of large anaplastic cells. However, it presents a wide spectrum of histologic patterns. In the small cell variant, a small-sized pleomorphic cell morphology can be seen. A 74-year-old woman presented with an 8-month history of asymptomatic ulcerative plaque and satellite nodule on the right calf. Her past medical history was not specific. The histologic findings on punch biopsy specimens showed a malignant small round cell tumor on both lesions. The tumor cells had large pleomorphic nuclei with multinucleation and some eosinophilic cytoplasm. We performed immunohistochemical staining to rule out neuroectodermal tumor, neuroendocrine tumor, melanoma, lymphoma, and so on. However, the staining results were negative for pancytokeratin, CD3, CD20, CD99, chromogranin A, synaptophysin, CD56, ALK, HMB45, desmin, kappa, lambda, myoglobin, and S-100 protein. CT, MRI, and PET-CT were negative for extracutaneous involvement. Total excision was done, and additional immunohistochemical staining was performed to confirm the origin of the tumor. Staining results for vimentin, LCA, CD4, and CD30 were positive. We concluded that these findings were consistent with the small cell variant CD30+ PCALCL, which occurs rarely.

A Case of Primary Cutaneous CD30+ Anaplastic Large Cell Lymphoma, Small Cell Variant / 대한피부과학회지

Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare cutaneous T-cell lymphoma. Most cases are composed of large anaplastic cells. However, it presents a wide spectrum of histologic patterns. In the small cell variant, a small-sized pleomorphic cell morphology can be seen. A 74-year-old woman presented with an 8-month history of asymptomatic ulcerative plaque and satellite nodule on the right calf. Her past medical history was not specific. The histologic findings on punch biopsy specimens showed a malignant small round cell tumor on both lesions. The tumor cells had large pleomorphic nuclei with multinucleation and some eosinophilic cytoplasm. We performed immunohistochemical staining to rule out neuroectodermal tumor, neuroendocrine tumor, melanoma, lymphoma, and so on. However, the staining results were negative for pancytokeratin, CD3, CD20, CD99, chromogranin A, synaptophysin, CD56, ALK, HMB45, desmin, kappa, lambda, myoglobin, and S-100 protein. CT, MRI, and PET-CT were negative for extracutaneous involvement. Total excision was done, and additional immunohistochemical staining was performed to confirm the origin of the tumor. Staining results for vimentin, LCA, CD4, and CD30 were positive. We concluded that these findings were consistent with the small cell variant CD30+ PCALCL, which occurs rarely.

A Clinical Study of Inpatients with Cellulitis over the Recent 5 Years / 대한피부과학회지

BACKGROUND: Cellulitis is an acute infection of the dermal and subcutaneous layers of the skin, which is commonly treated by a dermatologist but there are few reports about clinical data on cellulitis in Korean literature. OBJECTIVE: This study evaluated the clinical characteristics of inpatients diagnosed as cellulitis in the recent 5 years. METHODS: We reviewed the medical records of 77 patients who were diagnosed as cellulitis and hospitalized at the Kangbuk Samsung Hospital from March 2008 to February 2013. RESULTS: The study included data from 77 patients with cellulitis (mean age, 51.7 years; 44 men, 33 women). There was a positive correlation between age and hospitalized days (p0.05). Systemic steroid was administered in 21 patients (27.3%), and was not significantly related to hospitalized days (p>0.05). CONCLUSION: The clinical course of cellulitis was inversely correlated to the elevation of patient's age, WBC count, and CRP.

Quality of Life in Patients with Keloids and Hypertrophic Scars / 대한피부과학회지

BACKGROUND: Keloids and hypertrophic scars (HTS) are chronic disfiguring dermatoses and can cause functional impairment and psychosocial burdens, both of which affect quality of life. OBJECTIVE: Our purpose of this study was to compare the quality of life using the Dermatology Life Quality Index (DLQI) scores in patients with keloids and HTS to those of normal controls. METHODS: A total 31 patients with keloids and HTS attending our dermatology outpatient clinic as well as 30 healthy controls completed the DLQI. The relationship between quality of life and clinical characteristics of patients with keloids and HTS was investigated using the Vancouver Scar Scale (VSS). RESULTS: Total average DLQI scores of patients with keloids and HTS (mean 5.48+/-6.23) were significantly higher than those of healthy controls (mean 2.43+/-3.96) (p<0.05). There was a significant positive relationship between the DLQI and the VSS in patients with keloids and HTS (r=0.372, p=0.040). Pliability (r=0.416, p=0.020) and height (r=0.496, p=0.005) independently showed a positive association with the DLQI. There was no association between the DLQI and the duration and location of keloids and HTS. CONCLUSION: In our study, the quality of life of patients with keloids and HTS was impaired and poorer than that of the healthy controls.

A Case of Subungual Bowen's Disease / 대한피부과학회지

No abstract available.

Cutaneous Infection Caused by Klebsiella pneumonia in a Patient with Aplastic Anemia / 대한피부과학회지

Klebsiella pneumonia is an opportunistic pathogen that can lead to severe diseases such as septicemia, pneumonia, urinary and hepatobiliary track infection, in mainly hospitalized, immunocompromised patients. It has been reported to produce cellulitis, ecthyma gangrenosum in cutaneous manifestions, which are more commonly induced by bacteremia and spreading from other internal organs than primary inoculation. Herein, we present a case of a 75-year-old man with aplastic anemia, which progressed to septic shock and secondary cutaneous infection caused by Klebsiella pneumonia, but showed similar skin lesions to systemic fungal infection with dispersed erythematous macules and vesicular change on the center of his erythema.

A Case of Mild Rhinophyma Treated with Intense Pulsed Light and Topical Metronidazol / 대한피부과학회지

No abstract available.

A Study of Patch Test Results in Patients with Facial Dermatitis / 대한피부과학회지

BACKGROUND: Patch test is usually performed in order to differentiate allergic contact dermatitis from other facial skin diseases; however, there are only infrequent comparative studies regarding the positive allergens patch tested between allergic contact dermatitis and other facial skin diseases. OBJECTIVE: The purpose of this study was to investigate the positivity of patch test in patients with facial dermatitis and to analyze the valid positive allergen patch tested in allergic contact dermatitis compared to other facial skin diseases. In addition, we evaluated the difference of positive allergen according to clinical features, such as age, sex, site of the lesion and duration of disease, in patients with allergic contact dermatitis. METHODS: A total of 409 patients tested with facial dermatitis patch were retrospectively reviewed for medical recordings, including clinical features, occupational history, clinical photos and the results of a Korean standard series of patch tests. RESULTS: Compared with other facial skin disease, patients diagnosed with allergic contact dermatitis showed higher rate in the patch test, responding to 2 or more allergens. They also had more statistically valid positive allergens, such as phenylendiamine base, cobalt, colophony, thimerosal and isothizolinone. In addition, there were a few allergens which revealed significant differences in the positivity of the patch test according to the clinical features in patients diagnosed with allergic contact dermatitis. CONCLUSION: Based on these results, we could receive help in order to classify the positive allergens as relevant allergens in the patch test for the differentiation of allergic contact dermatitis from other facial skin disease.

A Case of Pemphigus Erythematosus / 대한피부과학회지

No abstract available.

Eruptive Xanthoma in a Child with Type 2 Diabetes Mellitus / 대한피부과학회지

Diabetes mellitus (DM) can be complicated by a variety of cutaneous manifestations. Various xanthoma can appear, according to different subtypes of hyperlipopoteinemia, which is caused by only primary causes, like familial hyperlipoproteinemia, but also secondary causes that is DM, thyroid gland disorder, and diet. Dermatologic findings may even precede any clinical or biological evidence of DM. Thus, cognition of specific dermatologic findings, like xanthoma, can help identify DM, especially in children. We report a case of type IV hyperlipoproteinemia and eruptive xanthoma, associated with DM in a 12-year-old female. She was diagnosed of type IV hyperlipoproteinemia, through a lipid profile, electrophoresis and eruptive xanthoma from a skin biopsy. Although she showed overweight in BMI and had a mother with Type 2 DM, she was too little to have DM, and showed normal urine test. We examined thyroid function test and fasting blood sugar to rule out secondary hyperlipoproteinemia. Fasting blood sugar was increased enough to diagnose her with DM.

Case of Hansen's Disease with vitiligo and xanthelasma / 나학회지

Hansens' disease is well known chronic inflammatory granulomatous disease by Macobacterium leprae., and occur rarely in these days. The wide range of clinical manifestations develop by status of the host resistant. These are from mild sensory change, erythematous macular patches, diffuse infiltrating plaque, and nodules to severe destruction of peripheral nerve and internal organ involvements. Vitilgo and xanthelasma rarely may occur in the lepromatous leprosy. The patient was a 60-year-old a farmer who complained erythematous diffuse ill defined infiltrative plaques or nodules on the face, trunk. He was diagnosed as lepromatous leprosy by skin biopsy and fite staining and had taken the standard 3 multidrug (dapsone, rifampicin, lamprene)therapy. About 3 months during the therapy, the existing skin lesions became erythematous and mild edematous, some of which show vitiligo like change, and severe general aching and neuralgia developed. Type 1 lepra reaction with upgrading was diagnosed by clinical symptoms and skin biopsy feature. The vitiligo lesions also appeared on the normal looking skin without previous lepromatous lesion. At that time, yellowish plaque appeared on both eyelid and diagnosed as xanthelasma without hypolipoproteinemia. The mutidrug therapy for lepsory continued and oral predinsolone was given for the general aching of neuralgia. The lepra skin lesions had been improved gradually and the vitiligo lesions also disappeared. Presenting case is very interesting in point of view that he had vitiligo related to type 1 lepra reaction, and simultaneously developed xanthelasma palpebrum.