A Comparison of Acquired Port-wine Stain with Congenital Port-wine Stain Using an Image Analyzer

BACKGROUND: Recent reports have proposed that there were no differences between acquired port-wine stain (APWS) and congenital port-wine stain (CPWS) except the onset of disease. Pulsed dye laser (PDL) therapy is regarded as the treatment of choice in PWS. Although in some articles, APWS might have shown a better response to PDL than CPWS, this is still controversial. It has been assumed however, that there might be some differences determining therapeutic responses between the two entities. OBJECTIVE: The purpose of this study is to find out some histopathologic differences between APWS and CPWS. METHODS: 14 patients with APWS and 17 patients with CPWS from our patient files were included in this study. Immunohistochemical staining by factor VIII-related antigen was carried out on the specimens of punch biopsy to better visualize the blood vessels. Histopathologic assessment of variables such as vessel area, percentage of vascular area and vessel depth was performed using a computer-assisted image analyzer program. RESULTS: The mean vessel area in APWS was 1014.7 +/- 782.5micrometer2 and that of CPWS was 1341.5 +/- 689.9micrometer2. The mean percentage of vascular area in APWS was 2.02 +/- 1.38% and that of CPWS was 2.65 +/- 1.56%. The mean vessel depth in APWS was 327.5 +/- 120.7micrometer and 321.7 +/- 93.1micrometer in CPWS. No histopathologic variable was statistically significant using the Mann- Whitney test (p>0.05).

A Case of Hypomelanosis of Ito with Diploid/triploid Mosaicism / 대한피부과학회지

Hypomelanosis of Ito was first described by Ito in 1952 as incontinentia pigmenti achromians. The consistent feature of the disease is a characteristic cutaneous hypopigmentation following the lines of Blaschko, and associated extracutaneous manifestations include anomalies of the central nervous system, eye and musculoskeletal system. It is a sporadic condition and more than half of patients are found to have chromosomal abnormalities, such as mosaicism. It has been suggested that hypomelanosis of Ito is not a single condition, but rather a nonspecific manifestation of chromosomal mosaicism. We report a case of a 6 year-old girl with hypomelanosis of Ito with diploid/triploid mosaicism (46, XX/69, XXX). She did not show any other extracutaneous symptoms, except a mild developmental delay. Hypopigmented lesions showed a gradual improvement but new hyperpigmented, brownish macules developed within hypopigmented lesions without any treatment.

Change of Skin Barrier Function According to Stratum Corneum Removal by Tape Stripping / 대한피부과학회지

BACKGROUND: The major function of the skin is to prevent loss of water and electrolytes and transepidermal penetration of harmful materials. The stratum corneum is known to play a major role in the skin barrier function. Tape stripping (TS) with adhesive cellophane tape is one of the best method of removing the stratum corneum on the skin surface, and has been used in studies of the skin barrier function when investigating material distribution in the stratum corneum and transepidermal absorption of drugs. OBJECTIVE: This study was performed to evaluate the skin barrier function according to removal of the stratum corneum by TS. METHOD: Six vitiligo patients who had undergone autologous suction blister grafting were tested. Transepidermal water loss (TEWL) was measured on the normal skin of the buttocks in each patient after every fifth TS, plus on the skin where the entire epidermis had been removed by autologous suction blister grafting. We compared these two values and also examined morphological change of the stratum corneum after TS, by both light and electron microscope. RESULTS: The TEWL value slightly increased when TS was carried out up to 30 times, but greatly increased to 20g/m2h of TEWL when TS was done 30-40 times. Thereafter, no increase in TEWL was observed when TS was carried out up to 100 times. The pattern of TEWL according to numbers of TS approximately plotted a sigmoid curve. On average, there was about 88% impairment to the skin permeability barrier function after TS. When the TEWL increased to more than 70g/m2h over baseline TEWL, the stratum corneum was almost removed, as revealed by light and transmission electron microscope. CONCLUSION: The stratum corneum acts as a major skin barrier, and the mid to lower portion of the entire stratum corneum appears to play a significant role in the skin permeability barrier function.

Two Cases of Nodular Cystic Fat Necrosis Possibly Related to Previous Trauma

Nodular cystic fat necrosis, first described by Przyjemski and Schuster, is a peculiar form of encapsulated necrosis of subcutaneous fat characterized by totally or near-totally encapsulated necrosis of fatty tissue in which clusters of nonviable adipocytes are surrounded by condensed fibrous tissue. We report two cases of nodular cystic fat necrosis associated with history of trauma about the site of the lesion. Each lesion was a subcutaneous movable nodule on buttock (case 1) and shin (case 2) which has evolved over months. Both cases showed possible relation to multiple intramuscular injection or direct trauma injury. Pathologically, encapsulated nodule showed a characteristic feature of nodular cystic fat necrosis which composed of the ghosts of anucleated adipocytes showing fairly well-preserved outline.

Comparison of Results of Lactic Acid Sting Tests between Sensitive Skin and Nonsensitive Skin after Tape Stripping / 대한피부과학회지

BACKGROUND: Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to internal stimulants and external irritants. The Lactic acid sting test is a widely accepted method for evaluating sensitive skin and is employed for the selection of subjects experiencing invisible sensory irritation. Tape stripping of skin is a useful method for removing stratum corneum which plays a most important part in the barrier function of the skin. Measurement of the transepidermal water loss (TEWL) is the standard method to determine stratum corneum barrier status. A disturbed skin barrier is characterized by high TEWL. OBJECTIVE: The author performed this study to compare lactic acid sting test between sensitive skin and nonsensitive skin after tape stripping, not on the face but on the forearm. METHODS: A total of 40 individuals (20 individuals of the sensitive skin group and 20 individuals of the nonsensitive skin group) were selected by the method of self-assessment questionnaires related to sensitive skin. The individuals were tested a total of 6times, at internals of 2weeks, on the volar aspects of both forearms with 10% lactic acid after tape stripping, with or without a Hilltop chamber. The frequency of tape stripping was divided according to the TEWL into 3 groups as follows: mild(increase of TEWL> or = 5g/m2h compared to baseline TEWL), moderate (> or = 10g/m2h), and severe (> or = 20g/m2h). RESULTS: When 10% lactic acid sting tests were performed after mild and moderate tape stripping of skin, irrespective of the Hilltop chamber, there were more positive responders in the sensitive skin group (p<0.05). Also statistically, there was a significant difference between the sensitive skin group and the nonsensitive skin group in the comparison of the mean values of lactic acid sting scores (p<0.05). However, when 10% lactic acid sting tests were conducted after severe tape stripping of skin, irrespective of the Hilltop chamber, there were no statistically significant difference between two groups when comparison of the positive rates and the mean values were made. CONCLUSION: The Lactic acid sting test with the Hilltop chamber, after mild and moderate tape stripping is a useful method to discover sensitive skin.

A Case of Primary Cutaneous Adenoid Cystic Carcinoma / 대한피부과학회지

Adenoid cystic carcinoma of the skin is the rarest type of eccrine sweat gland carcinoma. Although it is mostly known as a neoplasm of the salivary gland, it could occur as a primary tumor of the skin. We report a case of primary cutaneous adenoid cystic carcinoma in a 75-year-old male patient with two local recurrences. It was a lobulated tender erythematous nodule on the scalp measuring 2.5x1cm. Histopathologic examination after total excision showed cribriform, tubular, and solid masses of various size and shape involving dermis and the upper part of subcutis including perineural invasion. They consisted of almost uniform basaloid cells surrounded by myxoid or slightly fibrotic stroma. Adjacent organ such as salivary gland, bronchus, esophagus, and regional lymph nodes were examined with no evidence of neoplasm. Systemic evaluation for metastasis were also negative.

A Case of Coccidioidomycosis Showing Cutaneous and Pulmonary Nodules / 대한의진균학회지

Coccidioidomycosis is a systemic infection caused by inhalation of airborne spores of Coccidioides immitis, a fungus found in soil in the southwestern area of United States and in parts of Mexico and South America. Although its human infection has not been reported infrequently in nonendemic areas, it has rarely been done in Korea since first report of a case of systemic coccidioidomycosis with cutaneous lesions. The patient was a 32-year-old male with granulating cutaneous nodules on left side of upper back for 1 month. Three months ago, he had stayed at northern area of Mexico for 2 months with mild transient upper respiratory symptoms during his stay. After he returned to Korea, cervical lymphadenopathy and skin lesions developed. He had also respiratory symptoms such as chest discomfort and mild chest pain and chest X-ray revealed a solitary nodule. The cutaneous nodules of walnut size were removed surgically and he was recieved daily oral medication of itraconazole 400 mg for 10 months showing good clinical response. Even though lung nodule was not disappeared in radiological exam, repeated CT guided biopsy and fungal tissue culture of lung nodule were undertaken with no growth throughout 10 months. After 10 months itraconazole therapy, there was no evidence of clinical relapse and no change on chest film for following 16 months. We report a case of disseminated coccidioidomycosis involving lung, skin and lymph node simmultaneously and successfully treated with both surgical excision and systemic antifungal therapy.

Comparision of Results of Sting Tests Using Various Kinds of Alpha Hydroxy Acids on Sensitive Skin / 대한피부과학회지

BACKGROUND: Users of cosmetics and skin care products often report adverse reactions ranging from itching, stinging and dryness to intense inflammatory responses such as erythema, wheals and rashes. Sensitive skin has been described as a skin type showing higher reactivity than normal skin, and it develops exaggerated reactions when exposed to internal stimulants and external irritants. The alpha hydroxy acids (AHAs), naturally occurring organic acids which include lactic acid, glycolic acid, citric acid, malic acid and tartaric acid are all kinds of noncorrosive irritants. The lactic acid sting test is widely accepted as a marker of sensitive skin and is employed for the selection of subjects experiencing invisible sensory irritation. OBJECTIVE: This study was performed to compare the results of sting tests conducted on the sensitive and nonsensitive skin group which had been exposed to various kinds of AHAs. METHOD: A total of 50 individuals (25 individuals with a sensitive skin group and 25 individuals with a nonsensitive skin group) were selected by the method of self-assessment questionnaires relating to sensitive skin. The subjects were tested on the face with 2 variables of 5 AHA types ( with or without Hilltop chamber occlusion), at 2 weeks intervals, for a total of 10 times. RESULTS: The positive response rate of stinging in the sensitive skin group was higher than that in the nonsensitive skin group for all tests except the glycolic acid sting test using Hilltop chamber (p<0.05). The mean value of sting scores in the sensitive skin group was higher than that in the nonsensitive skin group for all tests (p<0.05). CONCLUSION: Sting tests using various kinds of AHAs are a useful method in determining sensitive skin.

Two Cases of Generalized Pustular Psoriasis Improved with Combination Treatment of Mycophenolate Mofetil / 대한피부과학회지

Mycophenolate mofetil(MMF) is a new immunosuppressant which non-competitively and reversibly blocks the de novo synthesis of guanine nucleotides required for DNA and RNA synthesis during lymphocyte proliferation. So MMF selectively inhibits lymphocyte proliferation and it has less side-effects than other immunosuppressants. We described 2 cases of generalized pustular psoriasis improved with MMF. We administered MMF combined with cyclosporin in case 1 and acitretin in case 2. Both patients markedly improved with MMF administration 3 days after and had no severe side-effects. Thus the authors thought that MMF appears to be an effective therapeutic alternative in the treatment of generalized pustular psoriasis.

Avascular Necrosis of the Femoral Head in Patient with Psoriatic Arthritis / 대한류마티스학회지

Psoriatic arthritis and avascular necrosis of the femoral head each are relatively common diseases. However, avascular necrosis of the femoral head in psoriatic arthritisis extremely rare disease and a few cases have been reported to date. It is suggested that the use of steroids or chemotherapeutic agents, hyperuricemia, alcohol abuse, immunologic disorders, coagulopathies are risk factors of the development of avascular necrosis of the femoral head in psoriatic arthritis. This report describes a 58-year-old female patient without any of forementioned risk factors who underwent total hip replacement for femoral head avascular necrosis associated with psoriatic arthritis.

Ganglioneuroma Associated with Von Recklinghausen Neurofibromatosis / 대한피부과학회지

Ganglioneuroma is the benign tumor exclusively composed of fully differentiated mature ganglion cell, Schwann cells and fibrous tissue. It develops most commonly in the posterior mediastinum and retroperitoneum but cutaneous involvement is exceedingly rare. Cutaneous tumor showing ganglion cells includes the following three entities: 1) primary ganglioneuroma, 2) well differentiated cutaneous metastasis from neuroblastoma, and 3) ganglioneuroma associated with von Recklinghausen's neurofibromatosis. Among them, the third has been considered as a neurofibroma with entrapment of ganglion cell. We described 2 cases of ganglioneuroma associated with von Recklinghausen neurofibromatosis and reviewed the histopathological and immunohistochemical findings.

The Objective Evaluation Methods for Therapeutic Effectiveness and the Efficacy of Systemic Corticosteroid in the Treatment of Cellulitis / 대한피부과학회지

BACKGROUND: Because it has been known that the inflammatory process of cellulitis can be modified by the immune reaction, systemic corticosteroid may be helpful to reduce the inflammatory reaction of the cellulitis and its consequent complications such as skin necrosis and lymphangitis. OBJECTIVE: The purpose of this study was as follows; To find out the appropriate and objective examination methods to evaluate the improvement of cellulitis. To estimate the efficacy of the systemic corticosteroid of short period in the treatment of cellulitis. METHODS: First, as methods of evaluation of therapeutic effectiveness, we measured the lesional skin temperature, circumference of extremity and subjective tenderness in two groups-patients with cellulitis and controls to find out the objective tools showing the improvement of cellulitis. Second, we also measured the skin temperature, circumference of extremity and subjective tenderness in another two groups-patients with systemic corticosteroid and those without to evaluate the effect of systemic corticosteroid in cellulitis. RESULTS: The results were as follows ; Measurements of the skin temperature, circumference and subjective tenderness all showed statistic significance to evaluate the improvement of cellulitis. Patients who were treated with systemic corticosteroid showed statistically better improvement than control group in the lesion of cellulitis. CONCLUSION: The lesional skin temperature, circumference and tenderness can be an objective evaluation method of clinical effectiveness and the systemic corticosteroid may be as adjunct to improvement of the cellulitis.

A Case of Symplastic Glomus Tumor / 대한피부과학회지

Glomus tumor is a benign lesion characterized by vessels and glomus cells in the varying proportion and it classically presents as a solitary, painful papule or nodule. Occasionally it displays unusual histopathologic features diagnosed as "atypical" glomus tumor, including malignant glomus tumor, glomus tumor of uncertain malignant potential, glomangiomatosis, and symplastic glomus tumor. Glomangiomatosis and symplastic glomus tumor reveal benign biologic behavior. We report herein a typical case of symplastic glomus tumor showing marked nuclear atypia, its only unusual feature comparing with classical one, in addition to the typical clinical and pathological features.