Clinical Experience in the Treatment of Port-Wine Stains with Blebs

BACKGROUND: The current modality of choice for the treatment of Port-wine stains (PWS) is laser photocoagulation. Laser therapy for the treatment of PWS, especially with a pulsed dye laser (PDL), has been proven safe and effective; however, because penetration of the PDL is too shallow for an effective ablation of the blebs, treatment of blebbed PWS, using PDL, may be insufficient. OBJECTIVE: We demonstrated the clinical efficacy of a 1,064 nm long pulsed Nd:YAG laser with contact cooling device for blebbed PWS. METHODS: Twenty one patients with blebbed PWS (Fitzpatrick skin types II-V) underwent a treatment, using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device at 8-week intervals. Treatments were done using 5~6 mm spot sizes at 20~30 ms and 95~170 J/cm2. Laser parameters were adjusted in order to meet the needs of each individual patient's lesions. RESULTS: All subjects tolerated the treatments well, and showed clinical improvement from blebs. Of the 21 patients, 18 of them experienced either moderate or excellent response. CONCLUSION: Use of a 1,064 nm long pulsed Nd:YAG laser results in a greater depth of vascular coagulation. A 1,064 nm long pulsed Nd:YAG laser with contact cooling device may be regarded as a promising therapeutic option for the treatment of blebbed PWS.

Treatment Using a Long Pulsed Nd:Yag Laser with a Pulsed Dye Laser for Four Cases of Blebbed Port Wine Stains

Port wine stains (PWS) are congenital capillary malformations consisting of ectasia of capillaries and venules. At birth,lesions are flat and relatively uniform in color, but evolve with age to become raised, thickened, irregularly surfaced, and deeply colored. Therefore, it is considered optimal to begin treatment of patients at an early age. Conventional treatment modalities, such as electrocautery or excision, require considerable effort and may be cosmetically unsatisfactory. We have performed treatment of blebbed PWS of four patients using a 1,064 nm long pulsed Nd:YAG laser with a contact cooling device. According to their size, most blebs required three or fewer treatment sessions at 8-week intervals. Treatments were well tolerated by all subjects and patients showed moderate to good improvement of blebs. A 1,064 nm long pulsed Nd:YAG laser with contact cooling may be considered as a promising therapeutic option for treatment of blebbed PWS.

Safety and Efficacy of Itraconazole for the Treatment of Onychomycosis in the Diabetic Population / 대한피부과학회지

INTRODUCTION: As the number of diabetics increase with younger onset and longer duration, patients are confronted with higher incidence of diabetes related complications such as distal extremity vasculopathy, neuropathy and various infectious diseases. Such diabetics are more prone to a much higher rate of onychomycosis compared to normal subjects and because this could trigger irreversible consequences, confirmation of fungal involvement should be promptly taken care of. Itraconazole is a widely used drug nowadays and compared to drugs such as griseofulvin and ketoconazole, has many advantages in efficacy, cost, duration of therapy which eventually results in better patient compliance. OBJECTIVE: Our study was designed to better dictate the usage of itraconazole in diabetics so these patient can receive quality treatment when it is needed. METHOD: The study consisted of 101 patients with both onychomycosis and diabetes who were receiving treatment in Eulji hospital. They all received 3 pulses of itraconazole and were evaluated for efficacy and safety of their treatment. The patients were observed on routine examinations for 36 weeks and at their visits they were interviewed and received microscopic examinations. RESULT: Eighty four percent of the patients showed clinical and mycological improvement with 33% of them showing total clearance. There were no hypo- or hyperglycemic events and 17 patients complained of mostly mild side effects such as indigestion. Two patients dropped out of the study due to epigastric pain and peripheral extremity swelling. CONCLUSION: The use of itraconazole in the treatment of onychomycosis seemed to be effective and relatively safe for diabetics.

A Case of Hyperkeratotic Vascular Stains / 대한피부과학회지

The term, hyperkeratotic vascular stains is a peculiar form of capillary malformations commonly called as angiokeratoma or verrucous hemangioma. Hyperkeratotic vascular stains present at birth and consist of vascular dilatation and epidermal proliferation manifested as hyperkeratosis, acanthosis, and papillomatosis. Some authors insisted that angiokeratoma and verrucous hemangioma are not proper terms because they are not true tumors but malformations due to their lack of endothelial proliferation. Wide and deep excisions have been preferred as a curative therapy. The patient was a 9-year-old girl with multiple, linear, bluish black colored, hyperkeratotic plaques on her left lower leg. The red patches at birth had slowly enlarged and had become verrucous. Some satellite lesions had also developed. Histopathologic examination showed dilated capillaries filled with red blood cells in the papillary dermis and subcutaneous fat layer. The carbon dioxide laser was used to remove hyperkeratotic plaques. The flash-lamp pumped-pulsed dye laser and intense noncoherent pulsed light were used to remove satellite lesions and vascular lesions for a year. One of the lesions resistant to laser therapy was completely excised. Because multiple hyperkeratotic vascular stains are often impossible to be excised completely, laser therapy may be tried as the first choice.

Two Cases of Nerve Sheath Myxomas

Nerve sheath myxoma(NSM) is a rare cutaneous neoplasm of uncertain histogenesis. NSM can be divided into two groups; NSM1 (a myxoid NSM) and NSM2 (a cellular neurothekeoma). NSMs are characterized histologically by well-defined, lobular or plexiform dermal proliferation of stellate, spindle-shaped cells embedded in abundant myxoid stroma. A variable amount of nerve fascicles are entrapped within and around the tumor. Two variants of NSM share the same features to a certain degree but differ in cellularity and mucin deposition. We report two cases of NSMs with different clinical and histopathologic features.

Two Cases of Cement Burn

Wet cement can cause caustic ulcers due to its alkalinity. Besides caustic ulcers frequently called cement burn, allergic and irritant contact dermatitides are common in cement workers. Alkalinity of calcium hydroxide in wet cement combined with the effect of pressure and occlusion against skin may result in cement burn. We report two cases of cement burn due to their occupational exposures.

Efficacy of Itraconazole Melt-Extrusion Tablet One-week Therapy in Treatment of Hyperkeratotic Type of Tinea Pedis and/or Tinea Manus / 대한피부과학회지

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.

Treatment of Chronic Ulcer with Epidermal Autograft / 대한피부과학회지

BACKGROUND: Reepithelialization is necessary to protect a wound from the surrounding harmful environment. Keratinocytes synthesize basement membrane proteins and various cytokines contribute to wound healing. OBJECTIVE: This study was done to evaluate the effect of autograft using suction blistered epidermis on the treatment of chronic ulcers. METHODS: Fourteen patients with chronic ulcers were treated using autologous epidermal grafts. Grafted epidermis was fixed to recipient sites with TegadermTM for a week. RESULTS: The treatment with epideraml autograft was effective in 9 cases. The results were affected not by underlying systemic diseases but by lesional sites and local factors. The lesions on the feet brought the poorest results. The results also depended on the immobilization of grafted sites. CONCLUSION: Epidermal autograft is a useful method of treatment in some kinds of chronic ulcers.

A Clinical observation on Skin Disease of Elderly patients / 대한피부과학회지

BACKGROUND: It is a trend that the average life span is prolonged in proportion to the advance of socio-economy and medical science. Consequently, the number of elderly patients with skin diseases is increasing. OBJECTIVE: This study was performed to see the change of patterns of skin diseases in elderly patients. METHODS: One thousand four hundred and twenty elderly patients, over the age of 65, who visited the departments of dermatology and in five hospitals, from January 1, 1997 to December 31, 1997 were selected. We surveyed the frequeney of skin disease by types and the distributions by month, season and age.

A Study of the Safety and Efficacy of Children's Skin Products / 대한피부과학회지

BACKGROUND: Atopic dermatitis, characterized by dry, flasky, easily irritated skin, is the most common form of dermatitis seen during childhood. Infants with atopic dermatitis and other eczematous conditions need special dermatologic care to hydrate their skin and to minimize contact with irritants or allergens. OBJECTIVE: The purpose of our study is to evaluate the safety and efficacy of the skin products developed for children. METHODS: Twenty-eight normal children and 26 children with atopic dermatitis were evaluated clinically after using following commercal skin products : (lotion, cream, shampoo, soap, face wash wash) for 2 weeks. Water content of the skin of 14 volunteers was measured serialy over 8 haurs at 2 hour intervals after the application of each skin product. The skin pH of 16 volunteers was also measured serialy over 60 minutes at 30 minute intervals after application. We performed visual skin erythema grading, skin erythema grading by dermaspectrometer, transepidermal water loss measurement, skin water content measurement, and keratinocyte morphology observation by D-squame after the application of the skin products to 13 volunteers for 4 days.

The Study of Tenascin Expression in Vitiligo / 대한피부과학회지

BACKGROUND: Defective adhesion and migration of melanocyte may be involved in pathogenesis of vitiligo. Tenascin, a glycoprotein of the extracellular matrix, has a role in cell adhesion and migration. It has been reported that abundant expression of tenascin in vitiligo lesion may inhibit melanocyte adhesion and migration. OBJECTIVE: To investigate the tenascin expression in vitiligo skin lesions and to compare with clinical findings. METHODS: We studied 9 patients with vitiligo. The expressions of tenascin were studied by immunahistochemieal techniques.

UVB Phototherapy in Atopic Dermatitis / 대한피부과학회지

There have been no known therapeutic modalities as effective as glucocorticoids for the treatment of chronic intractable atopic dermatitis. However, various attempts including phototherapy with UVB irradiation have been tried to avoid side effects from long term corticosteroids treatment. The therapeutic effect of UVB irradiation in the management of chronic atopic dermatitis was examined. Sixteen patients with atopic dermatitis showing severe itching and lichenified lesions, who were dependent on corticosteroids, were treated with UVB. After applying mineral oil or vaseline, patients received phototherapy. Intractable pruritus subsided or ameliorated after mean 5.2 times of treatments in 10 of 11 patients, and the skin lesions disappeared or improved after mean 13 times of treatments in 9 of 10 patients. No side effects were observed. UVB phototherapy could be avaluable alternate for the treatment of intractable atopic dermatitis.

A Case of Chronic Bullous Dermatosis of Childhood: Implication for Duration of Dapsone Maintenance Therapy / 대한피부과학회지

Chronic bullous dermatosis of childhood(CBDC) is a rare vesicobullous disorder in infancy and early childhood. The direct immunofluorescence(DIF) study is mandatory for diagnosis because its clinical and histological findings may be indistinguishable from those of bullous pemphigoid and dermatitis herpetiformis. The response to sulfonamides such as dapsone and sulfapyridine is usually rapid and complete. After remission of the disease, however, it is difficult to predict the course of the disease and to decide when treatment should be stopped. We report a case of CBDC in a 2-year-old boy. Treatment was started with dapsone and complete resolution of lesions was achieved in 2 weeks. The entire regimen was continued for 6 months and the patient has been clinically free of disease activity after 18 months of follow-up.

A Case of Relapsing Polychondritis / 대한피부과학회지

Relapsing polychondritis is a rare inflammatory disorder affecting the cartilaginous structures throughout the body. Although there is no pathognomonic laboratory tests, clinical features, when coupled with histopathologic findings, enable one to make a diagnosis of relapsing polychondritis. A 26-year-old man presented with purplish, swollen, and tender auricles and injected eyes. His symptoms had developed eight months ago and fluctuated irrespective of various medications such as corticosteroids and antibiotics. Histopathologic examination revealed loss of basophilic staining of the cartilage with some dissolution of its structures. Treatment was initiated with dapsone, However, the remission was too immediate to be considered as a effect of dapsone.

Two Cases of Allergic Contact Dermatitis to Povidone-iodine / 대한피부과학회지

Povidone-iodine(PVP-I) is a widely used antiseptic for the skin because of its low toxicity and high germieidal efficacy, Allergic contact dermatitis to PVP-I is known to be rare. Two patients who recently underwent surgical operations were referred to us due to pruritic well-demarcated eczematous skin lesions around the wounds. Their operation wounds had persisted in spite of the treatments using systemic antibiotics and topical antiseptics. Patch tests were performed with antiseptics including PVP-I, hydrogen peroxide, and benzalkonium chloride which had been used to dress their wounds. The patch tests resulted in positive reactions to PVP-I at the concentrations of 1% in one patient and 0.01% in another.

Ultraviolet B-Induced Apoptosis of Normal Human Melanocytes and G361 Cells

BACKGROUND: Ultraviolet(UV) light is one of the injurious environmental agents which is known to lead to apoptosis of cells. However, studies on UVB-induced apoptosis of melanocytes are still lacking and there are some discrepancies between researchers. OBJECTIVE: Our purpose was to evaluate the characteristics of UVB-induced apoptosis of melanocytes and G361 cells. METHODS: Cultured normal human melanocytes and malignant melanoma cell lines (G361 cells) were analyzed by several detection methods including morphological examination of propidium iodide(PI) stained cells under fluorescence microscopy, quantitation of fragmented DNA, and flow cytometric analysis. RESULTS: Both melanocytes and G361 cells showed similar rate of apoptosis with gradual increment of UVB doses by the quantitation of fragmented DNA. However, flow cytometric analysis using scatter properties and PI stainability revealed that the melanocytes were more resistant to UVB than G361 cells. CONCLUSION: We suggest that melanocytes seem to be more resistant to UVB-induced injury than G361 cells. In addition, various methods for the detection of apoptosis might be necessary for its study. (Ann Dermatol 10:(3) 147152, 1998).

Successful Desensitization of A Case of Anaphylaxis to Insulin / 대한피부과학회지

A small proportion of diabetics treated with exogenous insulin, reportedly ranging from 0.1% to 2%, experience systemic allergic reactions to insulin. We saw a 55-year-old male patient with insulin-dependent diabetes mellitus who had developed an anaphylatic reaction immediately after subcutaneous injections of neutral protamine Hagedorn (NPH) human recombinant insulin. Skin tests with insulins and a passive transfer test demonstrated that his reaction was IgE mediated. Since there were no therapeutic alternatives, desensitization with insulin was done following a slow protocol. It was successful and he was able to resume insulin therapy. During two year follow-up period, he did not developed any adverse reaction to insulin.

Early Phase of UVB-induced GM-CSF Upregulation in Epithelial Cell Line is not Totally Dependent on IL-1α

BACKGROUND: It was demonstrated that ultraviolet(UV) B light induces the release of IL-1α in cultured human epithelial cell line and augmentation of GM-CSF production by UVB is reported to be mediated by IL-1α in the murine keratinocyte cell line Pam 212. OBJECTIVE: The purpose of this study was to evaluate the effects of UVB on kinetic profile of IL-1 and GM-CSF mRNA expression and to see whether synthesis of GM-CSF by UVB can be completely inhibited by blocking IL-1α mediated pathway. METHODS: We used a competitive RT-PCR for measuring cytokine gene expression in epithelial cell line after UV radiation. RESULTS: The IL-1α mRNA increased as early as 1h after UV irradiation, and then decreased at 3h after the irradiation. Thereafter, the response of IL-1α mRNA was upregulated with a second peak at 6h after the UV irradiation. However, mRNA for GM-CSF increased at 1h after UV light exposure and anti-IL-1α antibodies could only partially inhibit UV-augmented GM- CSF production. CONCLUSION: UVB induced GM-CSF production seemed to be mainly mediated by UVB induced IL-1α but these results suggest that UVB may also induce GM-CSF production through an IL-1α independent pathway.

Peripheral T - Cell Lymphoma Involving Skin / 대한피부과학회지

BACKGROUND: Peripheral T-cell lymphomas(PTCL) frequently involve the skin and may occur as distinct clinicopathologic entities. However, clinicopathologic features of PTCLs involving the skin other than mycosis fungoides and Sezary syndrome have been poorly understood. OBJECT: This study aimed to characterize the nature of PTCL involving the skin in the Korean population. METHODS: Twenty-three cases of PTCL which involved the skin were collected during period from July, 1991 to June, 1995 In addition to reviewing the clinical records and routine histologic slides of t.hese cases, the immunohistochemical studies with several antibodies and in situhybridization for Epstein-Barr virus(EBV) early RNAs were performed on selected cases. RESULTS: We recognized five subtypes; mycosis fungoides, 5 cases, angiocentric T-cell lympho-ma, 9 cases, diffuse large cell lymphoma, 4 cases(Ki-1 positive, 3 cases, Ki-1 negative, 1 case), subcutaneous T-cell lymphoma, 1 case, and unspecified PTCL, 4 cases. Mycosis fungoides tends to involve papillary dermis with epidermotropism, where as angiocentric T-cell lymphoma and unspecified PTCI. predominantly affact adnexae, venules, and subcutis. Among 9 cases of angiocentric T-cell lymphoma, EBV RNAs were detected in 5 cases. In the prognostic point of view, mycosis fungoides and Ki- 1 positive large cell lymphoma were notably favorable and angiocentric T-cell lymphoma, especially EBV related, was guarded. CONCLUSION: A variety of the distinct entities of PTCL which frequently involve the skin were identified in the Korean population. In addition to the clinicopathologic information, immunophenotyping and EBV detection are thought to be crucial in diagnosing and predicting the behavior of T-cell neoplasms.

Alopecia Associated with Underlying Congenital Melanocytic Nevus

A localized area of alopecia of the scalp can be a challenge in diagnosis. We report two patients with alopecia which was found to be associated with underlying congenital melanocytic nevus. Congenital melanocytic nevus should be taken into consideration in the differential diagnosis of alopecic plaques of the scalp.