Effects of atopic dermatitis on the morphology and water content of scalp hair.

The effects of atopic dermatitis (AD) on scalp hair properties, such as morphology and water content, were investigated using atomic force microscopy (AFM) and thermogravimetric analyzer. Hairs from lesional and nonlesional scalp regions of eight patients with AD were investigated. The severity of the disease, which was evaluated using the SCORing Atopic Dermatitis index, was 48.75 (range, 40-80). Hairs from 15 normal adults were also examined as controls. The surface images were taken in an area of 20 × 20 µm(2) with 512 × 512 pixels and a scan speed of 0.8 line/s. AD affected the cuticle structures and scales of scalp hair. The edges of cuticles were torn and collapsed, and the scales were very thick. The water contents of both types of AD hair were less than the control: 12% ± 0.7%, 11.7% ± 0.4%, and 13% ± 0.8% for lesional AD hair, nonlesional AD hair, and control hair, respectively. The scalp hair of patients with AD can be characterized by thick and globular scale patterns. The hair of patients with AD has less water content than normal hair showing a good agreement with the property of skin having AD.

Acral angioosteoma cutis.

Acral angioosteoma cutis is a rare disease first described in 2006 that is characterized by vascular proliferation with ossification at the acral area, and which bears clinical similarity to pyogenic granuloma. However, there is no lobular pattern in the capillary proliferation that is a typical histopathological feature in pyogenic granuloma. Metaplastic cutaneous ossification is associated with multiple skin diseases and inflammatory conditions such as scars, nevi, basal cell carcinomas, pilomatricomas, chondroid syringomas, and venous stasis. It is rarely associated with vascular proliferation diseases like hemangiomas and pyogenic granulomas. We report a case of capillary proliferation with ectopic bone formation in a 43-year-old female who presented with an ulcerative, dome-shaped subungual nodule on the left fourth toe, which appeared to be a pyogenic granuloma. Because the biopsy findings showed no lobular capillary proliferation, we determined that this case was consistent with acral angioosteoma cutis.

Investigation of hair shaft in seborrheic dermatitis using atomic force microscopy.

BACKGROUND/PURPOSE: We have investigated the changes of seborrheic dermatitis (SD) on the hair shaft in the morphological and physical properties using atomic force microscopy (AFM). METHODS: Hair samples were obtained from the lesional and perilesional regions in 15 patients with SD. Fifteen healthy adults were included as the control group. From the topography of hair obtained by AFM, the height of the scale, step height, roughness, diameter, and pit were determined. RESULTS: The scale thickness of the SD-affected hair was sevenfold more than in the control hair showing statistically significance. The lesional hair showed greater roughness parameters of Sa, Sq, and Sz than the perilesional and the control hair, but this difference was not significant. The cuticle of the lesional hair was significantly damaged while perilesional hair showed a very distinct cuticle structure with smooth edges and a regular interval between the cuticles. The diameter of the lesional hair was significantly lesser by 10-35% than that of the perilesional hair. The pit was rarely observed in the SD-affected hair collected from both the lesional and perilesional regions. CONCLUSION: The changes in the hair shaft affected SD was measured using AFM non-invasively. AFM could be a useful tool in monitoring the treatment response and the severity of SD.

Atrophying pityriasis versicolor: is this a new variant of pityriasis versicolor?

An atypical clinical form of pityriasis versicolor has been infrequently reported, in which cutaneous atrophy is associated with individual pityriasis versicolor lesions. The pathogenesis of this atrophy remains unclear, but is believed to be a delayed-type hypersensitivity reaction to antigens derived from the Malassezia species. A 60-year-old man presented with multiple, slightly scaly, and depressed maculopatches or plaques on the trunk and extremities. Our microscopic examination of the skin scrapings on a KOH preparation revealed numerous short hyphae and spores. The patient was treated daily with 200 mg of itraconazole in combination with topical antifungals, achieving clinical improvement and mycological recovery, which was confirmed upon follow-up 1 month later. This is the first case report of atrophying pityriasis versicolor in Korea. It needs to be differentiated from other atrophying disorders of the skin.

The Efficacy and Safety of Long-term Oral Cyclosporine Treatment for Patients with Atopic Dermatitis.

BACKGROUND: Steroids are used in conventional treatment of atopic dermatitis (AD) and they are very effective for improving the symptoms, but they also have several complications. Many studies have reported that short-term use of cyclosporine (CsA) is effective for severe AD as a substitute for steroid. However, there are very few studies on the long-term use of CsA for AD in the Korean population. OBJECTIVE: The purpose of this study was to investigate whether long-term CsA therapy is effective and safe for treating AD. METHODS: We performed a retrospective study of the patients with AD and who were treated with CsA at Kyung Hee Medical Center between January 2001 and February 2008. Among 147 patients, 61 received CsA treatment for more than 6 months. To evaluate the efficacy of CsA treatment, the objective SCORAD was checked for all 61 patients at every visit. Extensive laboratory tests were performed every two months to assess the safety of treatment. RESULTS: The mean duration of CsA treatment was 13.5+/-8.4 months and the mean initial dose of CsA was 2.7+/-0.9 mg/kg/day. The mean objective SCORAD values significantly decreased from 34.1+/-11.2 at baseline to 11.4+/-10.7 after 6-month of CsA treatment (p<0.05). A significant decline of the SCORAD score was observed starting from 1-month of CsA treatment. The mean duration of remission was 4.5+/-2.9 months. A total of 13 adverse events in 10 patients were recorded during the study period. One patient dropped out due to renal dysfunction. Elevation of peripheral blood pressure was noted in 8 patients. Three patients complained of gastrointestinal troubles, and one patient had hypertrichosis, but the problems of these 4 patients were mild and easily treated. CONCLUSION: We suggest that long-term, low-dose CsA treatment is safe and effective for patients who suffer from AD.

Development of Korean Academy of Medical Sciences Guideline on the skin and related system: impairment evaluation of disfigurement in skin and appearance.

The purpose of this study is to develop new standards for the disability evaluation with reference to existing laws and other study reports regarding disabilities for the rational evaluation of the diverse kinds of disfigurement in appearance and skin. Three plastic surgery specialists and 3 dermatology specialists developed a new standard for the disability evaluation which is appropriate for circumstances in Korea. Disability rate does not take into account the social occupation, gender or age of the patient, but instead, evaluate the Activity of Daily Living and the social adaptability of the appearance and skin disfigurement regardless of the balance between different disabilities. We tried to include most cutaneous disorders and categorized them into 3 types; congenital (Type 1), acquired (Type 2) as well as any permanent skin impairment sequelae of disease, trauma or treatment process (Type 3). For type 3 disorders, we tried to rate the score according to the size of involved skin lesion. The disability rate is determined by dividing the disability class into 8 steps based on the seriousness of each type of disability.

A case of elephantiasis nostras verrucosa.

Elephantiasis nostras verrucosa (ENV) is a rare clinical condition associated with chronic non-filarial lymphedema caused by bacterial or non-infectious lymphatic obstruction. A variety of etiologies, including infection, tumor obstruction, trauma, radiation, chronic venous stasis, congestive heart failure, and obesity, can lead to chronic lymphatic obstruction and edema. Mossy papules, plaques, and cobblestone-like nodules are clinically impressive features of ENV, but biopsy reveals only moderately abnormal findings such as pseudoepitheliomatous hyperplasia, dilated lymphatic spaces, fibrous tissue hyperplasia, and chronic inflammation. We present a case of ENV in a 67-year-old man with a 10-year history of multiple nodules and verrucous plaques on both feet. Microbiology ruled out a filarial infection. Nodule biopsy revealed pseudoepitheliomatous hyperplasia, marked dermal fibrosis, and a chronic inflammatory infiltrate. No evidence of carcinoma was identified. Both venous stasis and recurrent cellulitis could contribute to the dermal fibrotic changes of the lesions. However, before the recurrent cellulitis, he did not have any nodular lesions on his feet despite a 10-year history of venous disease. Therefore, this case suggests that venous stasis alone cannot produce the fibrotic nodular lesions of ENV.

Coexistence of amelanotic melanoma and liposarcoma.

An amelanotic malignant melanoma is characterized by little or no pigment. It is frequently misdiagnosed because it is a rare entity in general, and because of its unusual clinical features. Liposarcoma is one of the most common adult soft tissue sarcomas. We encountered a case of amelanotic melanoma with a concurrent liposarcoma. A 68-year-old man presented with a single, 1.5x1.5 cm round erythematous, eroded nodule on the left heel. A biopsy specimen showed atypical, pleomorphic tumor cells with little melanin pigment. The tumor cells were positive for S-100, HMB-45 and negative for cytokeratins. These findings were consistent with amelanotic melanoma. On positron emission tomography/computed tomography (PET/CT), a hypermetabolic lesion was found in the left buttock. This lesion was excised and diagnosed as a well-differentiated liposarcoma. An association between sarcomas and other primary malignancies has been reported. However, an association between melanoma and liposarcoma is rare.

Majocchi's granuloma of the scrotum.

Majocchi's granuloma is a well known but uncommon folliculitic and perifolliculitic dermatophyte infection of the dermal and subcutaneous tissue by fungal organism, usually limited to the superficial dermis. We report a rare case of superficial perifollicular form of Majocchi's granuloma, caused by Trichophyton rubrum on the scrotal skin of a healthy man. Histological examination of the biopsied nodule revealed perifolliculitis with fungal elements and the periodic acid schiff staining was positive to fungal elements. His lesion cleared completely with the use of a topical antifungal agent.

Cutaneous drug eruption from cetirizine and hydroxyzine.

Topical application of the antihistamines commonly leads to sensitization for patients, but skin reactions provoked by their systemic use are very rare. The antihistamines cetirizine and hydroxyzine are piperazine derivatives, on the structural basis of an ethylenediamine, but the cross-reactions between the 2 have rarely been reported. A 44-year-old man visited because of the generalized morbilliform eruptions with pruritus over his whole body, after intake of hydroxyzine (Ucerax) and azelastine (Azeptine), administered during a 2-day period for chronic urticaria. Previously, he had presented the same cutaneous reactions after oral administration of cetirizine (Lotec). Oral challenge tests performed with cetirizine and hydroxyzine led to the same cutaneous reactions. He was given the diagnosis of drug eruption from cetirizine and hydroxyzine, which suggests that there were cross-reactions among cetirizine, hydroxyzine, and ethylenediamine.

Clinical and immunologic features of systemic contact dermatitis from ingestion of Rhus (Toxicodendron).

Oral or parenteral exposure to certain contact allergens may elicit an eczematous skin reaction in sensitized individuals. This phenomenon has been called systemic contact dermatitis (SCD) and is relatively rare when compared with classical contact dermatitis. We reviewed and analysed the clinical and immunologic features of 42 patients with SCD caused by ingestion of Rhus (Toxicodendron), 24 males and 18 females, average age 44 years (range 24-72). Several of such patients (33%) had a known history of allergy to lacquer. The patients developed skin lesions such as generalized maculopapular eruptions (50%), erythroderma (29%), vesiculobullous lesions (14%) and erythema multiform (EM)-like lesions (7%). Many patients (57%) developed leucocytosis with neutrophilia (74%). In some patients (5%), abnormalities of liver function developed. We also analysed lymphocyte subsets in the peripheral blood of 12 patients. The lymphocyte subsets studied were T cells (CD3), B cells (CD19), natural killer (NK) cells (CD3-CD16+/CD56+), helper/inducer cells (CD4), cytotoxic/suppressor cells (CD8) and helper/suppressor ratio (CD4/CD8). The lymphocyte subsets of all 12 patients studied were within the normal range. Moreover, there were no differences between patients with a history of allergy to lacquer and those without a history of allergy to lacquer. Therefore, rather than an immunologic response, the skin eruption seems to be caused by a toxic reaction because of Rhus.