Clinicopathologic Features and Outcomes of Extramammary Paget's Disease / 대한피부과학회지

BACKGROUND: Extramammary Paget's disease (EMPD) is a relatively rare cutaneous disorder. There are a few studies regarding the clinical features and prognostic factors of EMPD in Korean patients. OBJECTIVE: The aim of this study was to identify in detail the clinical findings and prognostic factors of EMPD in Korean patients. METHODS: A total of 19 patients with confirmed EMPD at our institution were included from January 2005 to December 2014. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS: Patients' ages ranged from 50 to 87 years (median, 64.5 years), and incidence of EMPD was higher in men than in women (17:2, male:female). The most common predilection site was the penoscrotal area in men and the vulva in women. All patients with EMPD had no underlying malignancy. Four of 19 patients treated with wide excision had local recurrence during the follow-up period. Two patients with deep dermal invasion died due to multiple metastases. CONCLUSION: EMPD in Korea is characterized by its male predominance and penoscrotal location. Disease recurrence is common regardless of the surgical margin. Its prognosis could be associated with depth of invasion and lymph node metastasis.

Clinical Features and Awareness of Hand Eczema in Korea

BACKGROUND: Hand eczema is one of the most common skin disorders and negatively affects quality of life. However, a large-scale multicenter study investigating the clinical features of patients with hand eczema has not yet been conducted in Korea. OBJECTIVE: To identify the prevalence of various hand diseases, which is defined as all cutaneous disease occurring in hands, and to investigate the clinical features of patients with hand eczema and the awareness about hand eczema in the general population and to compare the prevalence of hand eczema between health care providers and non-health care providers. METHODS: To estimate the prevalence of hand diseases, we analyzed the medical records of patients from 24 medical centers. Patients were assessed by online and offline questionnaires. A 1,000 from general population and 913 hand eczema patients answered the questionnaire, for a total of 1,913 subjects. RESULTS: The most common hand disease was irritant contact dermatitis. In an online survey, the lifetime prevalence of hand eczema was 31.2%. Hand eczema was more likely to occur in females (66.0%) and younger (20~39 years, 53.9%). Health care providers and housewives were the occupations most frequently associated with hand eczema. Winter (33.6%) was the most common season which people experienced aggravation. The 63.0% and 67.0% answered that hand eczema hinders their personal relationship and negatively affects daily living activities, respectively. CONCLUSION: Hand eczema is a very common disease and hinders the quality of life. The appropriate identification of hand eczema is necessary to implement effective and efficient treatment.

Abdominal Pseudohernia Following Herpes Zoster

Herpes zoster is a common disease of the dorsal root ganglia and sensory nerve fibers that is clinically characterized by a painful unilateral vesicular eruption of the skin in a dermatomal distribution. Segmental motor weakness is a rare complication that occurs in 0-5% of patients and is associated with an excellent prognosis for recovery. We herein present a case of herpes zoster complicated by segmental motor paresis of the abdominal musculature resulting in a pseudohernia. This rare complication of herpes zoster, which has an excellent prognosis for recovery, should be recognized by physicians as it can save costly consultations and evaluations.

The Epithelial-Mesenchymal Transition and E-cadherin and Vimentin Expression in Basal Cell Carcinoma and Squamous Cell Carcinoma / 대한피부과학회지

BACKGROUND: The epithelial-mesenchymal transition (EMT) in epithelial tumor cells plays a key role in tumor invasion and metastasis. The reduction or loss of E-cadherin and the acquisition of vimentin are two critical steps in the EMT. However, the roles of EMT-related proteins in basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) have not been fully elucidated. OBJECTIVE: The purpose of this study was to investigate the immunohistochemical expressions of E-cadherin and vimentin in BCC and SCC, and to demonstrate the EMT and its role in tumor invasion. METHODS: Paraffin-embedded tissues from 30 BCC and 20 SCC cases were incubated with primary antibodies to E-cadherin and vimentin. The co-expression of the biomarkers and the biomarkers' correlations with the histopathological grades were analyzed. RESULTS: E-cadherin expression reduced by 90.0% and 95.0% in BCC and SCC, respectively, and the expression of vimentin increased by 10.0% and 55.0% in BCC and SCC, respectively. The expression of vimentin was significantly different in BCC and SCC (p0.05), or between the expression of E-cadherin and the expression of vimentin in SCC (p>0.05). CONCLUSION: These results suggest that the EMT affects the pathophysiology of both BCC and SCC. The greater aberrance in the expression of vimentin in SCC compared with that in BCC might be one factor that underlies the greater aggression of SCC clinically.

A Case of Premature Sebaceous Hyperplasia in an Infant / 대한피부과학회지

No abstract available.

Curettage as an Effective Treatment for Gouty Tophi on the Ear / 대한피부과학회지

No abstract available.

A Case of Tuberculoid Leprosy without Sensory Loss in a Male Immigrant / 대한피부과학회지

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. The prevalence and number of new cases have recently markedly decreased in Korea, and the possibility of leprosy can therefore be clinically overlooked. However, leprosy is still endemic in various regions of the world. A 30 year-old male immigrant from Indonesia presented with an erythematous plaque without sensory loss on his face six months after immigration. The skin lesion was diagnosed as tuberculoid leprosy based on clinico-pathology.

Intertriginous Xanthoma in an Infant with Familial Hypercholesterolemia / 대한피부과학회지

Familial hypercholesterolemia is an autosomal dominant inherited metabolic disease characterized by high serum low-density lipoprotein (LDL) cholesterol concentrations, and xanthoma formation. There are multiple types of xanthomas, such as eruptive, tendinous, tuberous, and planar. Intertriginous xanthomas are rare, but, if present, are typically associated with familial homozygous hypercholesterolemia. We here report on a 15-month-old infant who presented with multiple yellowish linear patches and plaques on the intertriginous areas. Serum lipoprotein electrophoresis showed a marked increase in beta-fraction, suggesting type IIa hyperlipoproteinemia. Histopathology showed numerous aggregates of foam cells in the dermis. We performed DNA analysis and revealed the presence of an LDL receptor gene mutation. In summary, we here report an interesting case of an infant with intertriginous xanthoma. This condition is so rare that it has not been reported in the Korean dermatologic literature before.

TRUE Test in Patients with Contact Dermatitis: A Multicenter Study / 대한피부과학회지

BACKGROUND: The TRUE test is a commercially available ready-to-apply patch test widely used in many countries, but no large-scale study is available on the TRUE test in Korea. OBJECTIVE: The purpose of this study was to analyze the type, frequency, and changes in the common contact allergens in Korea using the TRUE test. METHODS: From January 2009 to March 2010, TRUE tests were performed on patients with contact dermatitis at the Departments of Dermatology of 15 hospitals. The epidemiological findings of patients, and the results of the patch tests were analyzed. RESULTS: In total, 795 patch tested cases (246 males, 549 females) were compiled and analyzed. The oldest age distribution was the third decade in both males and females, and housewives and office-workers were the most common jobs, comprising 29.7% and 19.8% of the occupations, respectively. Overall, 65.1% of patients had at least one positive reaction, and the most common allergens were nickel sulfate (34.1%), thimerosal (12.6%), cobalt chloride (11.1%), and p-phenylenediamine (8.4%), in order of frequency. A univariate analysis of multiple variables including age, gender, occupation, and affected sites was conducted and a comparison with a previous multicenter study was also analyzed. CONCLUSION: These results provide the basis for use of the TRUE test in patients with contact dermatitis in Korea.

Clinical Aspects of Scabies / 대한피부과학회지

BACKGROUND: Scabies is an ectoparasite caused by the mite Sarcoptesscabiei var. hominis, an obligate human parasite. Although the incidence of scabies is decreased nowadays, it is not rare and it is difficult to diagnose without experience. OBJECTIVE: We conducted this study to evaluate clinical aspects of patients diagnosed with scabies in the last 4 years. METHODS: We evaluated 56 patients who were diagnosed with scabies with a skin biopsy or with the mineral oil test. Medical records and telephone-interviews were used for more information. RESULTS: There were 56 scabies patients, 28 males and 28 females. The mean age of the patients was 54 (male; 44.4/ female; 62.9) and 39.3% of patients were over 65 years. The most common affected site was the groin; common cutaneous lesions were pruritic papules and burrow. There was no seasonal variation in occurrence. The majority of suspected routes of infection were unknown but, nosocomial infection and communal living were also major causes. On average, 102 days were required to confirm scabies, which suggests the difficulty in early diagnosis of scabies. CONCLUSION: We suggest that dermatologists should consider scabies infection in patients who show pruritis that does not improve with ordinary treatment.

A Case of Granulomatous Rosacea Localized on Both Eyelids / 대한피부과학회지

Granulomatous rosacea is considered as the only true rosacea variant. Granuloma formation is a histologic feature of this condition. The clinical features of granulomatous rosacea include yellow-brown or red papules or nodules that are monomorphic and located on the cheeks and periorificial facial skin. The background facial skin is otherwise normal. Other signs and symptoms of rosacea are not required to make a diagnosis of granulomatous rosacea. We report on a case of granulomatous rosacea that was localized on the both eyelids as an unusual clinical presentation.

Eccrine Hidrocystoma in a Child: An Atypical Presentation

Eccrine hidrocystomas are small benign cystic lesions that normally affect only adult females. Eccrine hidrocystoma is characterized by tense vesicles that are predominately located on the face and particularly on the periorbital areas. Histologically, eccrine hidrocystoma consists of one or more partially collapsed unilocular cysts in the dermis, and these cysts are often situated adjacent to normal eccrine ducts. An 8-year-old boy presented with multiple skin-colored to bluish tiny papules on his nose. Histopathologically, the dilated partial cystic structures in the middermis were lined by one or two layers of flattened or cuboidal epithelial cells. We report here on an atypical presentation of multiple eccrine hidrocystomas that were localized on the nose of a child.

A Case of AIDS-associated Kaposi's Sarcoma on the Site ofHealed Herpes Zoster as an Isotopic Response / 대한피부과학회지

Kaposi's sarcoma (KS) is a neoplastic, vascular tumor that involves the skin or internal organs. KS is an extremely common tumor in tropical Africa and it is also a prime marker of acquired immunodeficiency syndrome (AIDS). An isotopic response describes the occurrence of a new skin disorder on the site of another, unrelated and already healed skin disease. The most common cause of an isotopic response in the skin is the herpes zoster virus. We report here on a rather interesting case of Kaposi's sarcoma distributed on a dermatome that was previously involved by herpes zoster.

A Case of Traumatic Panniculitis Following Fractional Laser Therapy / 대한피부과학회지

Traumatic panniculitis can be induced through the injection of various substances into the subcutaneous fat, especially in patients with psychiatric problems. This condition can also be caused through the subcutaneous implantation of different materials for cosmetic or therapeutic reasons or through mechanical or physical means. The diagnosis is always worth considering in those patients with bizarre clinical lesions and inflammatory changes in the subcutaneous fat that defy ready classification. There have been reported cases of traumatic panniculitis induced by acupuncture, but no reported cases associated with laser therapy. Fractional photothermolysis is the newest approach to laser therapy, with multiple micro-laser beams that target water-containing tissues to cause photocoagulation of narrow columns of skin. The penetration depth of the multiple micro-laser beams is up to 900microgram, generally to the reticular dermis level. A 19-year-old female patient presented with a tender 4x7 cm sized erythematous to brownish, irregularly shaped, atrophic plaque on the right shin. She was treated for a leg scar using a 1,550 nm erbium fiber laser. Histopathologic examination showed moderate inflammatory infiltration and lipomembranous fat necrosis in the subcutaneous septa with mild inflammation in the overlying dermis. The tissue proved to be infiltrated by lymphohistiocytic cells and a few eosinophils. The patient was treated with systemic and topical corticosteroids; she has experienced no recurrence. We report an interesting case of traumatic panniculitis following fractional laser therapy.

A Case of Eccrine Porocarcinoma That Showed Squamous Differentiation on the Palm / 대한피부과학회지

Eccrine porocarcinoma is an uncommon malignant skin appendage tumor that is thought to evolve from the intraepidermal segment of the eccrine sweat duct. It usually affects elderly patients in both sexes and it is usually found on the lower extremities and the head. We report here on a case of eccrine porocarcinoma that showed squamous differentiation, and this developed on the palm of a 71-year-old woman. Wide excision and secondary intention were performed successfully and there was no recurrence at 6 months of postoperative follow up.

A Case of Extraocular Sebaceous Carcinoma Arising from Nevus Sebaceus / 대한피부과학회지

Sebaceous carcinoma (SC) is a slow-growing, locally aggressive tumor with the high potency of metastatic spread. This neoplasm frequently arises from the sebaceous glands of the eyelid and exceptionally from extraocular sites. Approximately one-quarter of all reported cases of SC are extraocular. We observed a 42-year-old woman with an crusted erythematous to brownish plaque on her scalp. The biopsy specimen showed that multiple lobules were composed of foamy-cytoplasmic cells and sebocytes which show pleomorphism and atypia. For the immunohistochemistry, abundant tumor cells (with the expressions of epithelial membrane antigens and cytokeratin) were found within the masses. We present here a case of SC of the scalp arising from a previous lesion clinically compatible with a nevus sebaceous.

A Study on Intra-lesional Excision of Keloids / 대한피부과학회지

BACKGROUND: Keloid is one of the most frustrating clinical problems in wound healing. There are numerous treatments for keloids such as surgical excision, steroid injection, radiation therapy, laser, silicone gel application and so on. Surgical excision of a keloid is generally not accepted as a first treatment of choice. However, there have been many reports of successful cosmetic results from specialized surgical treatments such as intra-lesional/intra- marginal excision with or without post surgical adjuvant treatments. OBJECTIVE: The aims of this study areto evaluate the effectiveness of intralesional excision of keloids, the optimal surgical conditions and the proper adjuvant therapy after surgery. METHODS: We analyzed the medical records and clinical photographs of 20 patients who underwent intra-lesional excision of their keloids and who had regular follow-ups for at least for 3 months. The clinical outcomes were assessed by three independent physicians based on their interpretation of the photographs before and after surgery with using a global assessment 5 point scale that ranged from bad, poor, fair and good to excellent. RESULTS: General surgical outcomes after intra-lesional excision: the average improvement score was 4.05 after intra-lesional excision and adjuvant therapy. The average improvement score after intra-lesional excision was 4.71 for ear keloids and 2.83 for keloids in other areas (p=0.000). The average improvement score after intra-lesional excision was 5 for earlobe keloids and 4.42 for ear-helix keloids (p=0.014). The average improvement score was 3.92 for the steroid intra-lesional injection and topical silicone gel combination treatment group after intra-lesional excision and the average improvement score was 4.29 for the single topical silicone gel treatment group (p=0.858). CONCLUSION: Although surgery is not a first treatment of choice for the management of keloids, large recalcitrant keloids need massive surgical removal for faster clinical results. In this study, we found that surgery, and especially intra-lesional excision, is not an absolute contraindication for treating keloids and this is sometimes considered as the first treatment of choice, and especially for ear keloids. However, a more careful surgical approach is necessary for the case of keloids that develop in other areas. Further studies about the optimal surgical indications for keloids and the recommended adjuvant therapy after surgery are necessary.

A Case of Spindle Cell Hemangioma / 대한피부과학회지

Spindle cell hemangioma is an uncommon variant of vascular tumor, and it was first described as a unique vascular lesion that's characterized by cavernous blood vessels separated by spindle cells. It is recently thought to be a benign hemangioma with a reactive process. It mostly affects the distal extremities and it present as single or multiple lesions that are often painful. Histologically, thin-walled cavernous vessels are seen to be intermixed with varying proportions of bland spindle cells with vesicular nuclei. We report here on an interesting case of spindle cell hemangioma in a 39-year-old woman.

A Case of Angiokeratoma Treated with a 532 nm KTP (Potassium-titanyl-phosphate) Laser / 대한피부과학회지

Angiokeratomas are cutaneous vascular lesions that are characterized by dilated thin-walled blood vessels that lay in the upper part of the dermis, and this condition is mostly associated with epidermal reactions such as acanthosis, hyperkeratosis and elongation of rete ridges. Four variants have been described (angiokeratoma of Fordyce, angiokeratoma of Mibelli, angiokeratoma corporis diffusum, and solitary or multiple angiokeratomas). Among these variants, angiokeratoma of Fordyce develops mainly in elderly Caucasian men and it is common on the genitalia. Angiokeratomas are blue to purple, smooth, 2- to 5-mm papules on the scrotum, penile shaft or glans. They generally appear to multiply during life, but they occasionally present as single lesions. They may bleed after trauma and they may be mistaken for a nevus, melanoma or Kaposi sarcoma. Electrocautery or laser ablation can be offered for treatment. Various studies have recently reported successful treatment with argon laser, copper vapor laser, variable pulse width 532 nm neodymium:yttrium-aluminium-garnet (Nd:YAG) laser, 532 nm KTP (potassium-titanyl-phosphate) laser and flashlamp-pumped pulsed dye laser (PDL). We report here on a case of angiokeratoma that was treated with a 532nm KTP laser.

A Case of Toxic Epidermal Necrolysis Associated with Chronic Pulmonary Complications / 대한피부과학회지

Toxic epidermal necrolysis (TEN) is an unpredictable, acute inflammatory systemic condition that involves injury to the skin, mucous membranes, and bowel and respiratory epithelium. Pulmonary complications are often observed and usually show an acute form. However, chronic pulmonary complications are rare and little is known about the clinical manifestations. We herein report a 51-year-old woman who presented with chronic pulmonary complications after recovery from TEN. A diagnosis of chronic bronchiolitis obliterans was made with upper respiratory tract obstruction and bronchiectasis.