Recurrence Rate of Herpes Zoster and Its Risk Factors: a Population-based Cohort Study

BACKGROUND: Herpes zoster (HZ) is generally thought to occur once in a lifetime and recurrence is considered to be limited to immunocompromised individuals. Although HZ recurrence rates seem to be increasing, there have been few studies exploring these rates in the general population. We investigated the recurrence rate and associated risk factors in the general population. METHODS: We used the population-based samples of the National Health Insurance Service database to identify cases of initial HZ episodes from January 1, 2002 to December 31, 2013. We also followed up on these cases through December 31, 2013 to identify recurrence. RESULTS: Overall, the incidence rate of HZ is 5.1 per 1,000 person years and the recurrence rate is 12.0 per 1,000 person years. There were 2,100 recurrent cases out of 39,441 initial episodes with 4.4 years of the mean follow-up period. We identified significant risk factors for recurrence such as old age (51–70 years) (hazard ratio [HR], 1.447; 95% confidence interval [CI], 1.311–1.598), women (1.476; 1.345–1.619), zoster-related pain (ZRP) longer than 30 days (cases of ZRP lasting 31–90 days [1.200; 1.042–1.383], and ZRP lasting longer than 90 days [2.293; 1.990–2.643]). Concurrent hematologic malignancies (2.864; 1.929–4.251), autoimmune diseases (1.466; 1.252–1.715), dyslipidemia (1.390; 1.263–1.530), and hypertension (1.222; 1.107–1.350) were also significant risk factors. CONCLUSION: Our results suggest that the recurrence of HZ is much more common than generally expected, and that the associated risk factors can play an important role in predicting recurrence.

Population-Based Study of the Epidemiology of Herpes Zoster in Korea

General epidemiological data regarding herpes zoster (HZ) are necessary for treatment and prevention of this disease. In addition, epidemiological data can play an important role in evaluating the efficacy and impact of vaccination. Though several epidemiological studies of HZ in Korea have been conducted, they usually depend on hospital-based data and may not be representative of HZ characteristics all over Korea. The purpose of this study was to evaluate the incidence and other epidemiological features of HZ in the general Korean population. We used population-based medical records from the Health Insurance Review & Assessment Service, which includes 50,908,646 medical insurance subscribers, to calculate the incidence of HZ. Also, we analyzed an age-stratified random sample of 1,375,842 individuals to study descriptive epidemiologic characteristics of HZ in Korea in 2011. We observed that the incidence of HZ was 10.4 per 1,000 person-years and was strongly correlated with age. Sex had a major influence on HZ incidence; overall, there were 12.6 cases per 1,000 person years in women and 8.3 cases per 1,000 person years in men. There was no difference in incidence according to the locality and season.

A Case of Primary Cutaneous CD30+/ALK- Anaplastic Large Cell Lymphoma Presenting with Nodules and Numerous Eruptive Papules / 대한피부과학회지

Primary cutaneous CD30-positive, anaplastic large cell lymphoma (ALCL) is a rare cutaneous peripheral T cell lymphoma with a favorable prognosis. ALCL is characterized by a solitary or localized skin tumor composed of sheets of atypical lymphoid cells with pleomorphic or anaplastic nuclei. Herein we report a 67-year-old woman presented with tender nodules and severely pruritic numerous eruptive papules. Histopathologic examination revealed dense non-epidermotrophic infiltrates of atypical large cells with round, oval or irregularly shaped nuclei and abundant cytoplasm. Immunohistochemical studies demonstrated that most lymphoid cells in the dermis and subcutis were positive for CD30 and CD45RO, and negative for CD20 and CD56.

A Case of Pseudolymphoma Following Tick Bite / 대한피부과학회지

Pseudolymphoma refers to a heterogenous group of benign reactive T- or B-cell lymphoproliferative processes of diverse causes that simulate cutaneous lymphomas clinically and/or histologically. This condition may be caused by known stimuli such as medications, infections or the bites of arthropods, or may be idiopathic. Herein we report a 36-year-old woman who developed a red nodule on the left neck following a tick bite 7 months earlier. Biopsy specimen of the left neck showed diffuse infiltrate of lymphocytes admixed with many eosinophils arrayed throughout the reticular dermis. The infiltrating cells were positive for UCHL-1, L-26(CD20) and focal positive for lambda-chain and kappa-chain, but negative for Bcl-2 and Bcl-6.

A Case of Multinucleate Cell Angiohistiocytoma / 대한피부과학회지

Multinucleate cell angiohistiocytoma (MCAH) is a rare benign fibrohistiocytic vascular condition that usually occurs on the extremities of elderlies women as discrete, grouped, red-brown papules and coalescing plaques. MCAH is characterized histologically by dermal vascular proliferation, bizarre multinucleate cells, and a sparse lymphohistiocytic infiltrate. Herein, we report a 61-year-old man presented with an asymptomatic 1.6x3.3cm sized, erythematous verrucous plaque under the left lower eyelid for 5 months. Histopathologic examination revealed variable-sized, proliferative, dilated dermal vessels lined by plump endothelial cells and interspersed multinucleated cells among these vascular channels. Multinucleated cells were positive only for vimentin, but negative for S-100 protein and Factor VIII related antigen.

A Case of Pigmented Apocrine Poroma / 대한피부과학회지

A poroma has been thought to be derived from the peripheral cells of the eccrine duct. Nevertheless, there are some cases with sebaceous, follicular and apocrine differentiation, suggesting a possible apocrine origin. Herein, we report a 62-year-old man presented with a nodule surrounded by brownish plaque with hyperpigmented margin on the buttock for several months. Histopathologic examination revealed cords and broad columns of uniform poroid cells with sebaceous differentiation and melanin pigment.

A Case of Acrometastasis in Renal Cell Carcinoma / 대한피부과학회지

Acrometastasis is rare and accounts for 0.1% of all metastasis. Renal cell carcinoma accounts for only 10% of this infrequent site. It is usually the late manifestation of a disseminated tumor, but may also be the primary manifestation of an occult cancer. Clinically, it may mimic benign tumors or nonneoplastic osteoarthritic conditions, thus resulting in misdiagnosis and improper treatment. We reported a case of acrometastasis in a renal cell carcinoma in a 76-year-old man who had been diagnosed with a progressed renal cell carcinoma with metastasis of the lung and brain.

A Case of Steatocystoma Multiplex on the Face / 대한피부과학회지

Steatocystoma multiplex is a hamartomatous condition of the pilosebaceous junction. It is thought to be hereditary or non-hereditary and occurs on the face rarely. We report a case of steatocystoma multiplex located only on the face in an 82-year-old woman. Histologic findings showed relatively typical findings of steatocystoma multiplex such as a folded cyst consisting of several layers of epithelial cells, palisading basal layer, absence of granular layer and outer hyalin-like cuticle.

A Case of Irritant Contact Dermatitis due to Garlic / 대한피부과학회지

Garlic has been employed for thousands of years in virtually all cultures for the prevention and the treatment of a wide variety of ailments such as parasitic and fungal infections, chest pain and rheumatism. However, garlic may cause the allergic and irritant contact dermatitis. We experienced a case of irritant contact dermatitis on both legs after external application of garlic. The patient was treated successfully with systemic steroid and wet dressing. We insist the practice of direct application of fresh garlic onto the skin for treating infections should be discouraged.

A Case of Lyme Disease Presenting with Erythema (Chronicum) Migrans / 대한피부과학회지

Lyme disease (Lyme borreliosis) is a vector-borne infection primarily transmitted by Ixodes species and caused by a spirochete, Borrelia burgdorferi. This disease affects multiple areas such as skin, joints, eyes, nervous and cardiovascular systems. Erythema (chronicum) migrans, borrelial lymphocytoma and acrodermatitis chronica atrophicans are the cutaneous hallmarks of Lyme disease. A 31-year-old man presented with an annular centrifugally expanding erythematous plaque with central punctum on the left scapular area for about 2 months. He was bitten by a tick 3 months ago in Kangwondo. Serologic examinations revealed increased levels of Ig M and Ig G antibodies to borrelial antigen in consecutive tests performed at an interval of three weeks. Western blot for Borrelia burgdorferi was also positive. The skin lesion showed prompt response to the tetracycline therapy and was cured after 2 weeks.

A Case of Subcutaneous Juvenile Xanthogranuloma

Juvenile xanthogranuloma is a congenital or perinatal tumor, 1 to 2 cm in diameter, usually located on the head. The extracutaneous lesions can occur on the eye, the lung, the epicardium, the oral cavity or the testicles. Subcutaneous form of juvenile xanthogranuloma has been reported very rarely in the literature. We report a unique case of a subcutaneous juvenile xanthogranuloma that showed 4 × 4 cm sized plaque and located on the extremity of 9-year-old girl.

Annular Atrophic Lichen Planus

Annular atrophic lichen planus(AALP) is the most unusual variant of lichen planus that results from elastolytic activity of inflammatory cells. We report a case of AALP in 22-year-old man who had two annular pruritic plaques on the axilla. He had a two year history of skin lesions. Each lesion had elevated erythematous annular border with hyperpigmented atrophic macular center. Histopathologically, it showed typical features of lichen planus in the border of the lesion while a pattern of resolved lichen planus in its center. Elastic fibers was not found in the papillary dermis either at the border or at the center of the lesion.

Bilateral Segmental Neurofibromatosis Showing Different Dermatomal Distribution

A 43-year-old woman presented with numerous cutaneous neurofibromas, limited to the left anterior chest(T2-3) and the right lower back(L1-2). These had been present for 10 years. Neither cafe-au-lait spot, intertriginous freckle, nor Lisch nodule was found. The family history was negative for neurofibromatosis. Biopsy specimens showed circumscribed, nonencapsulated neurofibromas. The present case was a rare form of bilateral segmental neurofibromatosis in that while most of the reported cases involved the same dermatome bilaterally, she had bilaterally different dermatomal neurofibromas.

A Case of Infantile Acropustulosis Developed after Treatment of Scabies / 대한피부과학회지

Infantile acropustulosis is characterized by recurrent crops of pruritic vesicopustules that are found primarily on the distal extremities of infants. Herein we report a 20-month-old female baby, who had a past history of scabies, with recurrent episodes of 1-2 mm sized, intensely pruritic vesicopustules on both hands and feet. The mite smear for scabietic mites, Gram stain for bacteria, and KOH smear for dermatophytes of lesion were all negative. Tzank test of the vesicle revealed many neutrophils. She was treated with dapsone (2mg/kg/day) and the pruritic vesicles and pustules had disappeared by 48 hours.

Metastatic Cancer of the Skin: Clinical and histopathologic study / 대한피부과학회지

BACKGROUND: Metastatic skin cancer may have profound diagnostic, therapeutic, and prognostic significance. OBJECTIVE: We studied patients with metastatic skin cancer to determine the relative frequencies of metastatic skin cancer according to the type and location of the primary tumor and the site of the cutaneous metastasis. METHODS: We reviewed medical records and histologic materials of 68 patients with metastatic skin cancer in Catholic University Hospital from January 1991 to March 2001. RESULTS AND CONCLUSIONS:Of 61,218 patients with internal malignancy, 68(0.11%) had metastatic skin cancer. The mean age at diagnosis was 64.7 in male and 58.2 in female. Male to female ratio was 1:2.2. Breast carcinoma was by far the most common primary neoplasm resulting in skin involvement and accounted for 31(45.6%) of total cases and 63.8% of the cases in women. The most common clinical presentation is a nodule(26.5%) or multiple nodules(64.7%) although carcinoma erysipelatoides(4.4%) and carcinoma en cuirasse(4.4%) were also seen. Histopathologic examination most frequently revealed adenocarcinoma(70.6%) that was sometimes suggestive of the site of origin.

A Case of Dermal Duct Tumor / 대한피부과학회지

Dermal duct tumor arising from the intradermal portion of the eccrine duct is a variant of benign eccrine sweat duct tumor. The tumor is a rare, usually occurs on the head and neck or limbs and presents as a non-characteristic, usually asymptomatic, flesh-colored or erythematous, firm nodule or papule. Histologically, the tumor lobules are located principally in the dermis with or without connection to the epidermis, showed similar architectural features and identical cytologic features of eccrine poroma. We report a case of dermal duct tumor which developed on the left calf area in a 57-year-old male patient

Two Cases of Telangiectasia Macularis Eruptiva Perstans / 대한피부과학회지

Telangiectasia macularis eruptiva perstans(TMEP) is an uncommon form of mastocytosis. This disorder is characterized by reddish-brown macules with telangiectases, usually involving the trunk. Due to the small number of mast cells, Darier's sign is usually absent. Histologic changes are very subtle, showing only a slight increase in mast cell numbers around capillaries and venules of the superficial plexus. We report two cases of TMEP. Their histologic alterations include dermal vascular dilatation and perivascular mast cell infiltration.

A Case of Linear Cutaneous Lupus Erythematosus / 대한피부과학회지

"Linear cutaneous lupus erythematosus(LCLE)" is linear lesion of discoid lupus erythematosus(DLE). Eleven cases LCLE were reported in the English literature including 6 Korean children. We describe an 11-year-old girl with slightly erythematous, well-defined atrophic patches arranged in a linear configuration on the left cheek. Histologic findings were consistent with DLE though the direct immunofluorescent test was negative. Moderate improvement of the lesion was observed with use of sunscreen and topical steroid for 5 months.

A Case of Nodular Melanoma Mimicking Seborrheic Keratosis / 대한피부과학회지

The diagnosis of nodular melanomas can be sometimes difficult, in case they lack the conventional clinical features of melanoma. Herein, we report a case of malignant melanoma mimicking seborrheic keratosis. The clinical diagnosis was seborrheic keratosis. The histopathologic examination revealed nodular melanoma with features of reticulated form of epidermal hyperplasia, pseudohorn cysts, and irregular hyperkeratosis and acanthosis. The tumor was excised with 2.5 cm margins and no remnant of tumor cells was found in the microscopic examination.

A Case of Squamous Cell Carcinoma Arising in Nevus Sebaceus / 대한피부과학회지

In adulthood, nevus sebaceus is frequently associated with the development of a number of benign and malignant neoplasms. Basal cell carcinoma is known to be the most frequent malignant tumor arising in nevus sebaceus, while squamous cell carcinoma is a rare complication of nevus sebaceus. Herein, we report a 42 year-old man who had a slightly tender, 0.6 X 0.6cm sized, erosive papule in a 1.0 X 3.5cm sized, linear nevus sebaceous on the right parietal scalp. The histopathologic examination showed invasion of the dermis by epidermal masses with many horn pearls. The tumor was excised with 1.5cm margins and there has been no recurrence for 5 months.