Botulinum Toxin Type A for Facial Wrinkles and Benign Masseter Hypertrophy in Korean Patients / 대한피부과학회지

BACKGROUND: The utilization of botulinum toxin has rapidly expanded into various aesthetic applications. Achieving success with the aesthetic use of neurotoxins depends on several factors, including an understanding of the anatomy, the methods of dilution and the injection technique. Any guidelines representing a consensus for aesthetic treatments using botulinum toxin type A (BTA) have not been published in Korea. OBJECTIVE: We wanted to provide consensus recommendations on the treatment of facial wrinkles and benign masseter hypertrophy using BTA in Korean patients. METHODS: A panel of experienced Korean dermatologists was convened to develop a clinical consensus. The clinical consensus was comprised of the recommendations of the panel and the guidelines on general issues, such as the reconstitution and handling of the BTA, the procedural considerations, the dosing and injection-site standardizations, and the prevention and treatment of unwanted effects. Specific recommendations were provided according to the area of treatment, including glabellar lines, horizontal forehead lines, lateral periorbital wrinkles and benign masseter hypertrophy. RESULTS: The recommended final concentration of BTA was 50 units/ml (5 units/0.1 ml) after reconstitution with physiologic saline. For glabellar lines, the members recommend three injection points (a total of 8 units). For forehead wrinkles, the members recommend nine injections in two rows into the frontalis with 1 unit/point. For crow's feet, the members recommend three injections per side (7 units/side) at the lateral part of the orbicularis oculi. For benign masseter hypertrophy, three injections per side (24~30 units/side) were recommended. CONCLUSION: These consensus recommendations will provide a framework for Korean dermatologists who wish to perform safe and efficacious injection of BTA for facial rejuvenation.

Fatal Pancreatic Panniculitis Associated with Acute Pancreatitis: A Case Report

Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple tender skin nodules, abdominal pain and distension. Laboratory and radiologic findings revealed acute pancreatitis, and skin biopsy showed pancreatic panniculitis. Despite intensive medical care, he died of multi-organ failure 3 weeks after presentation.

A Case of Acquired Blaschko Dermatitis in a Child; A Variant of Lichen Striatus, or Not?

Acquired Blaschko dermatitis is a rare inflammatory linear eruption that presents as multiple lines of itching papules and vesicles following the Blaschko's lines. Only ten cases have been reported in literatures since Grosshans' first description in 1990 and all cases have been in adults. A 2-year-old girl presented with a 4-month history of a slightly pruritic papulovesicular eruption, which was limited to the left side of her body, along the Blaschko's line. A skin biopsy revealed interface dermatitis. The eruption initially failed to respond to treatment with topical steroids but responded to systemic steroids. We present the first case of acquired Blaschko dermatitis in a child with a review of the relevant literature.

A Case of Giant Acquired Digital Fibrokeratoma Resembling Supernumerary Digit / 대한피부과학회지

Acquired digital fibrokeratomas are rare, benign, fibrous and hyperkeratotic skin tumors. The tumors usually occur in adults as solitary, dome-shaped lesions. Fingers and toes are the most frequent localization. We report a case of acquired digital fibrokeratoma in a 62-year-old male who presented with a 1x1x3 cm sized, firm, hyperkeratotic, protruding mass on his left 5th toe. Histologically, an increase collagen bundles with neovascularization in the dermis and overlying acanthosis and orthokeratosis were noted. The patient showed no recurrence 6 months after surgical resection.

A Case of Cutaneous Protothecosis / 대한피부과학회지

Protothecosis is an unusual human infection caused by the achlorophyllic algae Prototheca, and most commonly by Prototheca wickerhamii. A 65-year-old man presented with a 2-month history of a painful, erythematous, non-healing, ulcerative plaque on the extensor surface of his left forearm. He was previously diagnosed with diabetes and iatrogenic Cushing syndrome. A skin biopsy specimen revealed characteristic morula-like sporangia in the dermis by PAS positive staining. Prototheca wickerhamii was identified by culture and biochemical studies. Initially, itraconazole was administered for 8 weeks, followed by fluconazole, and the patient's condition was greatly improved.

A Case of Linear Focal Elastosis on the Lower Extremities / 대한피부과학회지

Linear focal elastosis is an uncommon disorder which clinically manifests as band-like striae, and typically occur on the back. Histologically and ultrastructurally, there is a focal increase of elastic fibers. We report an unusual case of linear focal elastosis occurring exclusively on the legs of a 22-year-old man with psoriasis.

A Case of Cutaneous Neurofibroma Intimately Contacted with Intrathoracic and Chest Wall Plexiform Neurofibroma in Von Recklinghausen's Disease

Congenital neurofibromatosis type 1, or Von Recklinghausen's disease is an autosomal dominant disorder characterized by neurofibroma, pigmented skin lesions (Cafe-au-lait macules), iris hamartomas and meningeal tumors, but rarely, by autonomic ganglia tumors, such as pheochromocytomas. We have experienced an intrathoracic and chest wall plexiform neurofibroma intimately contacted with collagenoma-like, dome-shaped skin lesions of type 1 neurofibromatosis, which are relatively rare and interesting, but can be regarded as typical findings in neurofibromatosis. Although intrathoracic neurogenic tumors are not uncommon, cases like ours are interesting, as the feature of collagenoma-like skin neurofibroma was very closely apposited with chest wall neurofibroma. Our case had no aypical features of malignancy and the patient was clinically followed up without recurrence.

A Case of Acrosyringeal Lichen Planus / 대한피부과학회지

Acrosyringeal lichen planus is a rare variant of lichen planus, and is characterized by dermal lymphocytic infiltration juxtaposition to the acrosyringium, plus liquefaction degeneration of the acrosyringeal basal cell layer. We report a case of acrosyringeal lichen planus in a 37-year-old man who had multiple erythematous hyperkeratotic papules on his hands and feet.

A Case of Leukemia Cutis Showing Rosacea-like Cutaneous Lesions / 대한피부과학회지

Leukemia cutis, the specific infiltration of leukemia, can be seen in any leukemia, but, are especially common in the acute myelogenous leukemia M4 and M5 variants. It may clinically mimic many inflammatory dermatoses. We herein report a case of a 59-year-old man with acute monocytic leukemia who concurrently presented with various cutaneous manifestations that clinically resembled benign skin lesions such as rosacea, contact dermatitis, and milium. Histologic study of all the lesions revealed leukemia cutis of the monocytic type. We presented this case to illustrate how leukemia cutis can masquerade as clinically benign-appearing, cutaneous eruptions.

The Study of Wound Healing Using Cultured Autologous Dermal Fibroblast of Guinea Pig / 대한피부과학회지

BACKGROUND: Autologous cultured dermal fibroblasts can be transplanted to the full thickness of skin wounds and this successfully accelerates the early wound healing of epidermis and dermis with less inflammation and scarring than allogeneic transplantations. The wound-healing effect of dermal fibroblasts is thought to be due to their growth factor and extracellular matrix releasing effects. Fibroblasts could therefore help chronic wound healing, where lower concentration of growth factors have been observed. OBJECTIVE: The purpose of this study was to examine the early wound healing effects of the autologous cultured dermal fibroblasts and to confirm that several growth factors and fibroblasts are closely associated in the mechanism of wound healing. METHODS: Suspensions of cultured autologous dermal fibroblasts were transplanted to full thickness wounds in 15 guinea pigs, and the wounds were then covered with transparent membrane. Wound biopsy materials were excised and collected from 9 guinea pigs at 7, 14, 21 and 28 days after wounding. Comparisons of the clinical wound healings between the experimental and control groups at the 3rd, 7th and 14th day after fibroblast transplantations were made in 8 guinea pigs, in which continuous clinical observation was possible in the same guinea pigs. Samples were processed for routine hematoxylin and eosin stains, immunohistochemical stains for fibroblast growth factor (FGF), transforming growth factor beta (TGF-beta), vascular endothelial growth factors (VEGF), and insulin like growth factors (IGF). RESULTS: The experimental groups showed decreased wound surface area at 3 and 7 days after transplantations, and more vascular, granulomatous wounds and fibroplasia responses compared with the control groups. Immunohistochemal stains revealed increased positive staining for FGF, TGF beta, and VEGF at the 1st, 2nd and 3rd weeks, compared with the controls. CONCLUSION: Transplantations of autologous cultured dermal fibroblasts proved to be clinically effective in the early wound healing of full thickness wounds of guinea pigs, and growth factors such as FGF, TGF VEGF must have some role in the mechanism of wound healing by autologous dermal fibroblasts.

A Case of Right Ovarian Vein Syndrome / 대한비뇨기과학회지

A case of right ovarian vein syndrome is reported with a review of literature. The patient presented was a 29 year-old multipara and eighth month of pregnancy. The extirpation of entire right ovarian vein, including it's all tributaries produced a good result and has not caused interruption of pregnancy. The clinical situation due to aberrant right ovarian vein is probably more frequent than heretofore suspected, by reason of a frown of X-rays during pregnancy and also an unawareness of the condition. Therefore, if clinical observations and X-ray studies are performed, more cases of such a condition. will be expected.