A novel fractional solid-state 585 nm laser on facial verruca plana: A report of three cases.

A novel fractional laser system with differential-wavelength modified optically pumped semiconductor technology can produce a pure 585 nm wavelength as pulsed dye laser, which has been used to treat vascular, pigmented skin lesions. Besides, this new laser modality also showed promising results for verruca plana in our experience. In this brief report, we present three cases of facial flat warts treated by this novel 585 nm diode laser.

Primary cutaneous CD30 anaplastic large cell lymphoma with keratoacanthoma-like pseudocarcinomatous hyperplasia and marked eosinophilia and neutrophilia.

BACKGROUND: Pseudocarcinomatous hyperplasia (PCH) and marked tissue neutrophilia have been observed in cutaneous CD30(+) anaplastic large cell lymphoma (ALCL) occasionally and may cause misdiagnosis. METHODS: An unusual case of CD30(+) ALCL of the skin resembling keratoacanthoma (KA) both clinically and pathologically was described. Histologic examination and immunostaining were performed. RESULTS: A 55-year-old woman presented with a 3-month history of an enlarging hyperkeratotic tumor on the forehead with a central keratinous plug. Microscopic examination showed epithelial hyperplasia resembling KA and a diffuse background infiltrate of large atypical lymphoid cells in the dermis. The atypical cells resembled epithelial cells and were obscured by a massive infiltrate of eosinophils and neutrophils. Immunostaining confirmed the presence of a diffuse infiltrate of CD30(+) cells; these cells were negative for CD45RO, CD20, CD15, epithelial membrane antigen, anaplastic lymphoma kinase-1, and cytokeratin. There was no evidence of extracutaneous involvement. The findings were consistent with primary cutaneous CD30(+) ALCL of null cell phenotype with KA-like epithelial hyperplasia and marked eosinophilia and neutrophilia. CONCLUSIONS: Our case illustrates that primary cutaneous ALCL may be associated with KA-like PCH and concurrent marked tissue eosinophilia and neutrophilia. Diagnosis in such cases is challenging both clinically and histologically because the large atypical lymphoid cells may easily be obscured by the massive infiltrates of eosinophils and neutrophils or confused with invasive squamous cell carcinoma.

De novo mutation of keratin 9 gene in two Taiwanese patients with epidermolytic palmoplantar keratoderma.

Epidermolytic palmoplantar keratoderma (EPPK) is an autosomal dominant hereditary disorder of keratinization. Recent molecular studies have shown that EPPK is caused by mutations in keratin 9 gene (K9). We report 2 unrelated sporadic cases of EPPK in Taiwanese, confirmed by histopathology and electron microscopy. A de novo mutation with a C to T transition at the first nucleotide of codon 162 in K9 was detected in both patients, but not in their parents. The mutation is expected to result in an arginine to tryptophan substitution (R162W) in the beginning region of the alpha-helical 1A domain of K9. Mutations in this region could disrupt keratin filament assembly, leading to degeneration or cytolysis of keratinocytes. Mutations of this arginine codon (R162W, R162Q) are common in pedigrees with EPPK. Our mutation analysis suggests that codon 162 in K9 gene is an important hot spot for mutation in EPPK.

Finasteride in the treatment of Taiwanese men with androgenetic alopecia: a 12-month open-label study.

Finasteride 1 mg/day is effective in the treatment of androgenetic alopecia (AGA). Our open-label study assessed the efficacy and safety of finasteride for the treatment of Taiwanese men with AGA. We enrolled 34 Taiwanese men (aged 18-40 yr) with AGA of modified Norwood/Hamilton scale (MNHS) grade II-V. In investigator assessments at 12 months, five of 21 subjects (23.8%) had two-grade improvement in MNHS grade and 12 of 21 subjects (57.1%) had one-grade improvement; the others remained at the same grade. In global photographic evaluation, five of 31 subjects (15.1%) had observable hair growth at 6 months and 11 of 21 subjects (52.4%) had observable hair growth at 12 months. Patient self-assessment of hair growth was favorable across all questions in the treatment course, more significantly at 12 months than at 6 months; nine of 21 subjects (42.9%) were satisfied with their overall appearance at 12 months. Serum prostate specific antigen levels had decreased by 23.4% at 12 months. Adverse effects, including abnormal liver function (5/34), were minimal, and the causal relationship with finasteride could not be established. Thus, in Taiwanese men with AGA, finasteride 1 mg/day for 1 year slowed the progression of hair loss and increased hair growth.

Acute generalized exanthematous pustulosis with erythema multiforme-like lesions.

Acute generalized exanthematous pustulosis (AGEP) resembles generalized pustular psoriasis, but may manifest targetoid lesions, purpura, and blisters in addition to pustules. We describe a case of AGEP with erythema multiforme (EM)-like features in a 35-year-old woman who presented with acute onset of high fever and a strikingly polymorphic eruption consisting of numerous tiny pustules on erythematous bases, marked facial edema, oral and genital erosions, targetoid vesicular and purpuric lesions, pustules in string-of-pearl configuration and ring-like vesicles. The histology revealed, in addition to subcorneal pustules, vacuolar interface dermatitis with involvement of eccrine glands, and microabscesses in pilosebaceous structures. Systemic corticorsteroid and antibiotics were initiated, resulting in rapid resolution without recurrence. Recognition of EM-like lesions on a background of generalized pustular eruption could facilitate the diagnosis of AGEP and the institution of appropriate treatment.

DKC1 gene mutation in a Taiwanese kindred with X-linked dyskeratosis congenita.

Dyskeratosis congenita (DKC) is a rare inherited disease characterized by the triad of abnormal skin pigmentation, nail dystrophy, and mucosal leukoplakia. Recent studies demonstrated mutations in the DKC1 gene encoding a protein named dyskerin, which is a component of human telomerase. In addition to the hypothesized function of pseudouridination in rRNA biosynthesis, ribosomal subunit assembly, and/or centromere/ microtubule binding, lower levels of telomerase activity in cells from patients with X-linked DKC have been observed. We report the mutation analysis of a Taiwanese family with X-linked DKC. The patient was a 19-year-old man who presented with progressive reticulate hyperpigmentation, nail dystrophy, alopecia, leukoplakia of the tongue, and pancytopenia. He died of enterocolitis and Escherichia coli sepsis at the age of 20 years. Only his mother's DNA was available for mutation analysis, which revealed a nucleotide transition of C to T (1058 C --> T), a hotspot mutation in DKC, resulting in an amino acid change from alanine to valine (A353V) in the DKC1 gene. Recent advances in the research of telomerase and its implications in the human aging process and cancer are discussed.