A Nationwide Population-Based Study on the Association between Rosacea and Psychiatric Disorders: New Findings of Behavioral Disorders / 대한피부과학회지

Background@#Rosacea is a chronic skin inflammatory disorder that almost always occurs on the face, which can cause emotional stress and affect self-esteem. Rosacea is associated with psychiatric disorders, but there have been few studies on the relationship between rosacea and psychiatric disorders in Koreans. @*Objective@#We aimed to investigate the risk of psychiatric disorders in Korean patients with rosacea. @*Methods@#Data were obtained from the Korean National Health Insurance Service-National Sample Cohort. The database was collected according to the Korean Standard Classification of Diseases version 6, which is based on the International Classification of Diseases, 10th revision. This study was conducted with 595 patients diagnosed with rosacea from 2002 to 2013. A total of 2,380 controls were set by performing 1:4 matching for sex, age, and index year. @*Results@#The incidence of psychiatric disorders was higher in patients with rosacea (114/595, 19.16%) than in patients without rosacea (319/2,380, 13.40%), with a significant difference (p＜0.001). Among several types of psychiatric disorders, the prevalence of anxiety disorder and behavioral disorder was significantly higher in the rosacea patients than in patients without rosacea (p=0.008 and p=0.044, respectively). The adjusted hazard ratio for psychiatric disorders in patients with rosacea was 1.543 (95% confidence interval=1.238∼1.922, p＜0.001). @*Conclusion@#Rosacea is associated with many types of psychiatric disorders. Awareness of the psychological impact of rosacea might be helpful in improving patient quality of life.

A Case of Segmental Vitiligo Occurring Where Herpes Zoster Occurred Previously as an Isotopic Response / 대한피부과학회지

Wolf's isotopic response is defined as the occurrence of a new skin disorder at the site of another unrelated skin disease that has already healed. In most cases of isotopic response, the initial dermatosis is herpes infection, and the most frequent second dermatoses are granulomatous reactions. Various interpretations of this phenomenon have been attempted. However, the exact mechanism has not been identified yet. Herein, we report a case in which the secondary disease was segmental vitiligo that appeared over the same dermatomes of herpes zoster. A 71-year-old woman presented with well-defined, depigmented patches on the left chest and back. She had been diagnosed with herpes zoster on the same dermatomes and treated with an antiviral agent 3 years ago. Histological examination showed decreased basal melanin pigments and melanocytes. Consequently, the patient was diagnosed with segmental vitiligo based on the clinical and histological findings.

Late-onset of Generalized Eruptive Syringoma / 대한피부과학회지

No abstract available.

A Case of Dermatofibrosarcoma protuberans on Nose / 대한피부과학회지

No abstract available.

Topical Tacrolimus for the Treatment of Atopic Dermatitis with Truncal Lesion

BACKGROUND: Topical tacrolimus is an effective anti-inflammatory therapy for acute and chronic states of atopic dermatitis (AD) in both adults and children. Topical tacrolimus has particular use at sensitive areas such as the face, anogenitals, and skin folds of neck and extremities. However, many AD patients also experience aggravated symptoms on trunk. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of topical tacrolimus for AD patients with truncal lesions. METHODS: AD patients with truncal lesions who were aged ≥2 years were recruited from 20 centres in Korea. They received treatment with topical tacrolimus ointment twice daily during 4 weeks. The primary end point was change of the local eczema area and severity index (EASI) of the trunk from baseline to day 28. The secondary end points were changes in the patient global assessment (PGA) score and itch visual analogue scale (VAS) score of the trunk between baseline and day 28. RESULTS: Two hundred and ninety-one patients were recruited, and 176 patients completed the full 4-week treatment course. By the end of the treatment, the mean local EASI of the trunk (2.2±4.71) was significantly decreased from that at baseline (4.71±4.03, p < 0.001). PGA (1.71±1.15) and itch VAS score of the trunk (2.61±2.19) on day 28 were also profoundly decreased compared with the baseline (2.96±1.07 and 5.15±2.47, respectively). No serious adverse events were observed during the study period. CONCLUSION: Topical tacrolimus is an effective and safe therapy for truncal lesions in AD patients.

A Case of Combination Treatment with Oral Acitretin and Topical 5% Imiquimod Cream in an Immunosuppressive Patient with Widespread Verruca Plana / 대한피부과학회지

Verruca plana is a subtype of warts, which are one of the most common dermatological diseases. A 37-year-old man presented with multiple asymptomatic skin-colored, 1∼2-mm, flat-topped papules on both arms, neck, and face. The patient had ulcerative colitis, which had been treated with immunosuppressants for 15 years. After skin biopsy, verruca plana was confirmed. The patient was treated with 5% imiquimod cream for 6 months. However, only mild improvement was observed. Acitretin was then added to the treatment regimen. After 44 weeks of treatment, acitretin was stopped. Dramatic and rapid clinical improvement was achieved after 3 weeks of treatment, and no sign of recurrence after treatment cessation has been reported for 60 weeks. Consequently, the combination of oral acitretin and topical 5% imiquimod cream should be recommended for the effective and safe treatment of recalcitrant verruca plana in immunosuppressed patients.

Clinicopathologic Features and Outcomes of Extramammary Paget's Disease / 대한피부과학회지

BACKGROUND: Extramammary Paget's disease (EMPD) is a relatively rare cutaneous disorder. There are a few studies regarding the clinical features and prognostic factors of EMPD in Korean patients. OBJECTIVE: The aim of this study was to identify in detail the clinical findings and prognostic factors of EMPD in Korean patients. METHODS: A total of 19 patients with confirmed EMPD at our institution were included from January 2005 to December 2014. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS: Patients' ages ranged from 50 to 87 years (median, 64.5 years), and incidence of EMPD was higher in men than in women (17:2, male:female). The most common predilection site was the penoscrotal area in men and the vulva in women. All patients with EMPD had no underlying malignancy. Four of 19 patients treated with wide excision had local recurrence during the follow-up period. Two patients with deep dermal invasion died due to multiple metastases. CONCLUSION: EMPD in Korea is characterized by its male predominance and penoscrotal location. Disease recurrence is common regardless of the surgical margin. Its prognosis could be associated with depth of invasion and lymph node metastasis.

Representative Trichoscopic Findings of Outpatients with Androgenetic Alopecia and Alopecia Areata / 대한피부과학회지

BACKGROUND: By magnifying the scalp and structure of hair, trichoscopy enables easy differentiation among various hair loss diseases. OBJECTIVE: To measure the frequency of representative trichoscopic findings in outpatients with androgenetic alopecia and alopecia areata and the frequency of various trichoscopic findings depending on the disease severity of androgenetic alopecia. METHODS: This cross-sectional study included 87 patients with androgenetic alopecia (n=57) and alopecia areata (n=30) treated over a year (2014∼2015). Three dermatologists assessed the trichoscopic findings (hair shaft, hair follicle opening, and perifollicular epidermis) in these patients. RESULTS: Vellus hair was observed in 21 of the 30 patients (70%) with alopecia areata and 20 of the 57 patients (35%) with androgenetic alopecia. Among the patients with androgenetic alopecia, as the disease severity increased, the portion of patients with vellus hair, thickness heterogeneity, and honeycomb pigmentation also increased (p<0.05). CONCLUSION: Trichoscopy is very useful for the diagnosis of androgenetic alopecia and alopecia areata. Additionally, the severity of androgenetic alopecia can be assessed using trichoscopy.

Representative Trichoscopic Findings of Outpatients with Androgenetic Alopecia and Alopecia Areata / 대한피부과학회지

BACKGROUND: By magnifying the scalp and structure of hair, trichoscopy enables easy differentiation among various hair loss diseases. OBJECTIVE: To measure the frequency of representative trichoscopic findings in outpatients with androgenetic alopecia and alopecia areata and the frequency of various trichoscopic findings depending on the disease severity of androgenetic alopecia. METHODS: This cross-sectional study included 87 patients with androgenetic alopecia (n=57) and alopecia areata (n=30) treated over a year (2014∼2015). Three dermatologists assessed the trichoscopic findings (hair shaft, hair follicle opening, and perifollicular epidermis) in these patients. RESULTS: Vellus hair was observed in 21 of the 30 patients (70%) with alopecia areata and 20 of the 57 patients (35%) with androgenetic alopecia. Among the patients with androgenetic alopecia, as the disease severity increased, the portion of patients with vellus hair, thickness heterogeneity, and honeycomb pigmentation also increased (p<0.05). CONCLUSION: Trichoscopy is very useful for the diagnosis of androgenetic alopecia and alopecia areata. Additionally, the severity of androgenetic alopecia can be assessed using trichoscopy.

Clinical and Histopathologic Analysis of 148 Cases of Eyelid Skin Tumors Diagnosed a Tertiary Hospital in Korea / 대한피부과학회지

BACKGROUND: Eyelid tumors are common neoplasms encountered in daily dermatology practices and encompass a wide variety of benign and malignant tumors, since the eyelid has many tissue types. These tumors sometimes mimic common inflammatory conditions. Nonetheless, clinical investigation of these conditions remains limited. OBJECTIVE: To investigate the clinical and histopathological characteristics of eyelid skin tumors. METHODS: We retrospectively reviewed the medical records and clinical photographs of 148 patients with eyelid skin tumors confirmed by skin biopsy examination between January 2009 and May 2016. RESULTS: The mean patient age was 50.0 years, and the male-to-female ratio was 1:1.11. Malignant eyelid skin tumors accounted for 17.3% of the total number, and older patients were more likely to be affected by malignant tumors than benign tumors (66.2 years vs. 46.4 years). Epidermal cysts (15.5%), seborrheic keratosis (14.9%), and melanocytic nevus (14.2%) were the most common benign eyelid skin tumors. Basal cell carcinoma was the most common malignant tumor (69.2%), followed by squamous cell carcinoma (11.5%). Malignant skin tumors, especially basal cell carcinoma, predominantly involved the lower eyelid. No patient showed metastasis from the malignant skin tumors, and no case of recurrence was observed after wide excision of the tumors. CONCLUSION: Our findings suggest that various tumors, including malignant ones, can affect the eyelid area. This study provides useful data on the incidence and characteristics of eyelid skin tumors. Further investigation with a large group of patients is necessary to better understand the epidemiology of eyelid skin tumors.

Clinical and Histopathologic Analysis of 148 Cases of Eyelid Skin Tumors Diagnosed a Tertiary Hospital in Korea / 대한피부과학회지

BACKGROUND: Eyelid tumors are common neoplasms encountered in daily dermatology practices and encompass a wide variety of benign and malignant tumors, since the eyelid has many tissue types. These tumors sometimes mimic common inflammatory conditions. Nonetheless, clinical investigation of these conditions remains limited. OBJECTIVE: To investigate the clinical and histopathological characteristics of eyelid skin tumors. METHODS: We retrospectively reviewed the medical records and clinical photographs of 148 patients with eyelid skin tumors confirmed by skin biopsy examination between January 2009 and May 2016. RESULTS: The mean patient age was 50.0 years, and the male-to-female ratio was 1:1.11. Malignant eyelid skin tumors accounted for 17.3% of the total number, and older patients were more likely to be affected by malignant tumors than benign tumors (66.2 years vs. 46.4 years). Epidermal cysts (15.5%), seborrheic keratosis (14.9%), and melanocytic nevus (14.2%) were the most common benign eyelid skin tumors. Basal cell carcinoma was the most common malignant tumor (69.2%), followed by squamous cell carcinoma (11.5%). Malignant skin tumors, especially basal cell carcinoma, predominantly involved the lower eyelid. No patient showed metastasis from the malignant skin tumors, and no case of recurrence was observed after wide excision of the tumors. CONCLUSION: Our findings suggest that various tumors, including malignant ones, can affect the eyelid area. This study provides useful data on the incidence and characteristics of eyelid skin tumors. Further investigation with a large group of patients is necessary to better understand the epidemiology of eyelid skin tumors.

Curettage as an Effective Treatment for Gouty Tophi on the Ear / 대한피부과학회지

No abstract available.

A Case of Acute Urinary Retention Caused by Herpes Zoster / 대한피부과학회지

No abstract available.

A Case of Large Cell Lung Carcinoma with Rhabdoid Phenotype Presenting as Cutaneous Metastasis / 대한피부과학회지

Large cell carcinoma with a rhabdoid phenotype is very rare. We report the case of a 53-year-old man who presented with multiple nodules on the scalp, face, and trunk. A skin biopsy revealed large cell carcinoma with a rhabdoid phenotype throughout the dermis. Tumor cells had abundant cytoplasm, eccentric nuclei, and prominent nucleoli and did not adhere to each other. Immunohistochemical tests showed positive reactions for vimentin, epithelial membrane antigen (EMA), and thyroid transcription factor-1 (TTF-1) and weakly focal reactions for pan-CK, CK7, and p63. Imaging studies and a percutaneous lung biopsy were performed and the results were consistent with a large cell lung carcinoma with a rhabdoid phenotype. Based on these clinical and histopathological findings, we concluded that his condition was a cutaneous metastasis from a large cell lung carcinoma with a rhabdoid phenotype, which occurs very rarely.

Cutaneous Pili Migrans

No abstract available.

A Case of Diffuse Dermal Angiomatosis / 대한피부과학회지

Diffuse dermal angiomatosis is an acquired, benign vascular proliferation with poorly circumscribed, violaceous, and livedoid plaques with frequent ulceration. Histologically, there is diffuse and interstitial proliferation of CD31-positive endothelial cells and myofibroblasts within the dermis. Endothelial atypia, mitoses, and vasculitis are lacking. Here we describe a 52-year-old male who presented with erythematous and purpuric patches on the trunk and lower extremities for 2 years. Histologic examination demonstrated a dense proliferation of endothelial cells in the papillary and reticular dermis. Small vascular spaces and extravasated erythrocytes were noted. Immunohistochemical staining using anti-CD31 antibody was positive.

A Case of Intractable Postherpetic Itch / 대한피부과학회지

Herpes zoster is an infective skin disease that is encountered commonly in dermatologic field. The best known complication of herpes zoster is postherpetic neuralgia (PHN). Also, many patients with herpes zoster experience neuropathic itch with or without pain. Those postherpetic itches (PHI) are rare, but some patients injure themselves by scratching skin with severe itching sensation, and with the loss of the protective sensation. So, PHI should be considered when evaluating a patient after an occurance of herpes zoster. Gabapentin has been successfully used to treat PHI in some cases. We report a case of postherpetic itch that has been successfully treated with gabapentin, as an unusual clinical presentation.

A Case of Perifollicular Fibroma

Perifollicular fibroma (PFF) is a very rare proliferative lesion of the perifollicular sheath. A flesh-colored, dome-shaped papulonodule is usually located on the face or the neck. These papulonodules may be single or multiple. Histologically, the lesion consists of a concentric arrangement of cellular fibrous tissue around a normal hair follicle. We describe here an unusual case of PFF in a 41-year-old female who had an asymptomatic small skin colored papule on the scalp, and this is an uncommon location for PFF.

Clinical Aspects of Scabies / 대한피부과학회지

BACKGROUND: Scabies is an ectoparasite caused by the mite Sarcoptesscabiei var. hominis, an obligate human parasite. Although the incidence of scabies is decreased nowadays, it is not rare and it is difficult to diagnose without experience. OBJECTIVE: We conducted this study to evaluate clinical aspects of patients diagnosed with scabies in the last 4 years. METHODS: We evaluated 56 patients who were diagnosed with scabies with a skin biopsy or with the mineral oil test. Medical records and telephone-interviews were used for more information. RESULTS: There were 56 scabies patients, 28 males and 28 females. The mean age of the patients was 54 (male; 44.4/ female; 62.9) and 39.3% of patients were over 65 years. The most common affected site was the groin; common cutaneous lesions were pruritic papules and burrow. There was no seasonal variation in occurrence. The majority of suspected routes of infection were unknown but, nosocomial infection and communal living were also major causes. On average, 102 days were required to confirm scabies, which suggests the difficulty in early diagnosis of scabies. CONCLUSION: We suggest that dermatologists should consider scabies infection in patients who show pruritis that does not improve with ordinary treatment.