A Case of Reed's Syndrome(Familial Leiomyomatosis Cutis Et Uteri) / 대한피부과학회지

Reed's syndrome is a rare, autosomal dominant disease with incomplete penetrance that is characterized by uterine and cutaneous leiomyomas. We report a case of Reed's syndrome in a 50-year-old woman. The patient underwent removal of the uterine leiomyoma at the age of 36. Following this the patient noticed development of multiple, cutaneous nodules on both arms at the age of 45. These nodules progressively increased in both number and size, while appearing in other sites. The histopathologic finding of an isolated, single skin lesion showed typical leiomyoma arising from arrector pilorum muscle. Familial history revealed that her father had been affected with similar cutaneous lesions.

Two Cases of Multiple Sebaceous Hyperplasia in Renal Transplant Patients Treated by Cyclosporine Therapy / 대한피부과학회지

Sebaceous hyperplasia can occur on the face during middle age, particularly in men. The risk of sebaceous hyperplasia is significantly increased in adult transplant patients, particularly males, following renal transplantation, and this is related to therapy with cyclosporine. We report on 2 cases of sebaceous hyperplasia in renal transplant patients who were treated with cyclosporine. The condition was improved, without scarring, by treatment with carbon dioxide laser or cryotherapy.

Suspected Case of Iatrogenic Cushing Syndrome Due to Topical Steroid / 대한피부과학회지

Chronic exogenous steroid therapy can result in hypothalamic-pituitary-adrenal axis dysfunction; this usually results from systemic steroid therapy, and is rarely associated with topical steroid therapy. We report a case of suspected iatrogenic Cushing syndrome that developed after the treatment of annular pustular psoriasis. The patient applied clobetasol-17-propionate cream (Betabate(R)) 15~30 g daily, for 4 months, without a dermatologist's prescription. After 4 months of application, the following symptoms developed; a moon face; facial flushing; hypertrichosis; central obesity; purple striae; and multiple erythematous scaly annular patches. The development of Cushing syndrome from exogenous corticosteroid treatment was supported by the typical clinical manifestations and the low basal state of the blood cortisol level, which was perhaps due to secondary suppression of the hypothalamic pituitary-adrenal axis. Steroid-containing drugs, especially during childhood, should be used with caution and monitored carefully.

A Case of Simultaneous Occurrence of Vitiligo-like and Morphea-like Lesion in Recipient of Allogenic Bone Marrow Transplantation / 대한피부과학회지

Vitiligo and morphea are two distinct entities of unknown etiology, although their existence implies that the immune system and/or the central or peripheral nervous system has been incriminated. Only a few reports of their simultaneous occurrence are on record. Here we report a case of a 39 year old woman affected with both vitiligo of the face, chest and hand and morphea of shoulder and trunk. Since the two diseases appeared after bone marrow transplantation, if could be deduced that there is a possible association between them. Two diseases observed simultaneously in this patient may be derived from the common pathomechanism. An autoimmune etiology is thought to play a part in both of these diseases.

An Occupational Chrome Ulcer / 대한피부과학회지

Chrome may have a corrosive, necrotizing effect on tissue, so repeated skin contact to chromate might induce perforations or ulcers on the skin. This condition is called a "chrome ulcer" or "chrome hole". It appears as a small, punched-out mark with a rolled-out border. It is rarely associated with pain, but a severe itching sensation is common. We report a case of a 33-year-old man who presented with a 3 month history of several ulcers on his abdomen. He was employed at a chromate alloying process. He had several hole-like atrophic scars and unbearable pruritus. After changing his occupation, plus treatment with oral corticosteroids and antihistamines, the lesions were healed and the itching sensation faded away. However, atrophic scarring remained.

Clinical Study of Vibrio vulnificus Sepsis / 대한피부과학회지

BACKGROUND: Vibrio (V.) vulnificus is a pathogenic marine bacterium that can cause rapid progression of a life-threatening infection. Although V. vulnificus sepsis is well-known to Koreans and was designated as a legal communicable disease in August 2000, many people still become infected each year. OBJECTIVE: The purpose of this study was to investigate the clinical features of V. vulnificus sepsis, in order to offer basic data for the treatment and prevention of this disease. METHODS: We reviewed the available data of 141 patients with V. vulnificus sepsis, which were obtained from 105 patients admitted to hospital and 36 case reports published in the Korean medical journals between 1982 and 2004. RESULTS: Eighty-five percent of patients were 40 to 60 years old. Men were affected 10.5 times more often than women. Patients with underlying chronic diseases (94%) such as alcohol abuse and liver diseases displayed primary sepsis starting with fever, chills, and/or diarrhea, often within 2.3 days of consumption of various kinds of raw seafood. Skin lesions appeared initially as a painful, localized swelling like a bee-sting, followed by edema, blisters, purpura, necrosis and, less commonly, maculopatch, cyanosis, papules, wheals, pustules or erythema multiforme-like lesions. The cutaneous lesions that were present in 91.5% of patients on admission, appeared on the lower extremities in 88.9% of the cases. Of the 141 patients, 88 patients (62.4%) died. The mortality rate increased as initiation of treatment was delayed. Laboratory findings revealed thrombocytopenia and elevated levels of liver enzymes in many tested cases. V. vulnificus was cultivated more easily from the skin lesion (95%) than blood (69%). There were significant differences in systolic blood pressure, leukocyte count and creatinine between survivors and nonsurvivors (p<0.05). V. vulnificus was highly susceptible to several kinds of antibiotics such as ampicillin, ciprofloxacin, and 3rd generation cephalosporins. Mortality rate increased as the delay from the onset of illness to the initiation of treatment was prolonged. CONCLUSION: Clinicians should promptly initiate appropriate therapy for patients with underlying chronic disease if they exhibit unexplained fever and diarrhea after ingesting raw seafood.

Carcinoma en Cuirasse on the Scrotum Originating from Gastric Adenocarcinoma / 대한피부과학회지

Cutaneous metastases originating from internal malignancy, including gastric adenocarcinoma, are uncommon. Although metastases may affect any cutaneous site, metastasis of the scrotum has very rarely been reported. It originates mostly from the kidneys and prostate. Carcinoma en cuirasse is a rare form of cutaneous metastasis characterized by a diffuse morphea-like induration of the skin. It is most commonly caused by breast cancer, but has occasionally been linked to the cancers of other organs. Herein, we report a rare case of carcinoma en cuirasse on the scrotum of a 53-year-old male patient, which developed from gastric adenocarcinoma.

Carcinoma en Cuirasse on the Scrotum Originating from Gastric Adenocarcinoma / 대한피부과학회지

Cutaneous metastases originating from internal malignancy, including gastric adenocarcinoma, are uncommon. Although metastases may affect any cutaneous site, metastasis of the scrotum has very rarely been reported. It originates mostly from the kidneys and prostate. Carcinoma en cuirasse is a rare form of cutaneous metastasis characterized by a diffuse morphea-like induration of the skin. It is most commonly caused by breast cancer, but has occasionally been linked to the cancers of other organs. Herein, we report a rare case of carcinoma en cuirasse on the scrotum of a 53-year-old male patient, which developed from gastric adenocarcinoma.

Eczema Herpeticum in Normal Skin of Two Siblings / 대한피부과학회지

Eczema herpeticum is a herpes simplex virus infection with disseminated skin involvement, which superimposes on a pre-existing dermatosis. Two siblings with simultaneous primary herpes simplex virus (HSV) infection on the normal skin of their backs, followed by their mother's herpes labialis. Eczema herpeticum was diagnosed on the basis of history, clinical feature, Tzanck test, histologic examination and a serologic test. Their skin lesions were healed by treatment with oral acyclovir and mupirocin ointment.

A Case of Multiple Cutaneous Reticulohistiocytosis / 대한피부과학회지

Mutiple cutaneous reticulohistiocytosis represent a unique pattern in the spectrum of reticulohistiocytoses, and are characterized by multiple granulomas confined to the skin without evidence of arthritis or underlying systemic illness. We report a case of multiple cutaneous reticulohistiocytosis in a 31-year-old male, who presented with multiple, asymptomatic reddish-brown or skin-colored papules on the whole body. Histopathologically, there were numerous mononuclear and multinucleated histiocytes with a ground glass appearance in the dermis. The histiocytes were diastase-resistant, and periodic acid-Schiff reagent and CD 68 positive. The patient was treated with narrow band UVB for 1 month and slightly improved slightly.

A Clinical Study of the Nature of Pain Associated with Herpes Zoster / 대한피부과학회지

BACKGROUND: Pain and paresthesia often precede the eruption of herpes zoster and vary from itching to stabbing. The preeruptive pain may simulate other diseases and may lead to misdiagnosis and misdirected interventions. OBJECTIVE: The aim of this study was to elucidate the clinical characteristics of herpes zoster and its nature of pain. METHODS: Three hundred and thirty three patients who were admitted with herpes zoster during a 10-year period from 1995 to 2004 were evaluated in regard to age, sex, dermatomal distribution, associated diseases, and complications. Patients were further assessed concerning the nature of the pain and its relationship to age, sex, dermatomal distribution, and postherpetic neuralgia. RESULTS: Herpes zoster was seen most frequently in the 70~79 year-old age group (30.9%), and the ratio of male to female patients was 1 : 2.2. The most common dermatomal distribution was thoracic dermatome (39.6%), followed by trigeminal (30.9%), cervical (11.7%), lumbar (7.2%), sacral (2.7%), and multiple dermatomal involvement (4.5%). Associated diseases to herpes zoster were observed in 180 patients (54.1%) which included hypertension (18.6%), diabetes mellitus (8.7%), gastritis and gastric ulcer (6.0%), fatty liver and hepatitis (5.1%), pulmonary tuberculosis (3.3%), malignancy (2.7%), rheumatoid arthritis (1.8%), and various other conditions (7.9%). The most common complication of herpes zoster was postherpetic neuralgia (15.6%), followed by ocular complications (6.9%), secondary infection (1.5%), scar formation (0.9%), Ramsay-Hunt syndrome (0.6%), and a neurogenic bladder (0.3%). The most common nature of pain associated with herpes zoster was pricking or stabbing (68%), followed by a dull ache (8.1%), tingling (7.2%), burning (4.2%), numbness (3.9%), throbbing (2.1%), a water trickling sensation (1.5%), itching (1.5%), formication (1.2%), soreness (0.9%), bursting (0.6%), sensation of being pulled down (0.3%), and sensation of cold water being poured on the skin (0.3%). Paresthesia was observed in 11 patients (3.3%), and 8 of these complained of this in the trigeminal dermatome (72.7%). CONCLUSION: Higher incidences of herpes zoster were observed in female and in the 70~79 year-old age group. The nature of pain associated with herpes zoster varied from a superficial itching to severe stabbing or bursting, and paresthesia occurred most frequently in the trigeminal dermatome.

A Case of Norwegian Scabies in a Patient with Down's Syndrome / 대한피부과학회지

Norwegian, or crusted scabies, is a fulminant and highly infectious form of scabies in which a large number of Sarcoptes scabiei mites infest the epidermis. This is often seen in senile or mentally retarded patients with poor cutaneous sensation, in subjects with severe systemic disease, or immunosuppressed patients. This form of scabies differs from ordinary scabies due to the hyperkeratotic, scaly, and crusted aspect of the lesions. We report a case of Norwegian scabies in 14-year-old boy with Down's syndrome. It is the first reported case in Korea.

The decision for termination of leprosy treatment using reticulum stain of leprosy skin lesions / 나학회지

The rate of the relapse of leprosy differs from researcher to researcher, so it is thought that the exact decision on the termination of a treatment would play an important role in lowering the rate of the relapse of leprosy. This study attempts to lower the rate of the relapse of leprosy by the decision for termination of leprosy treatment by using reticulum stain of skin in leprosy which is one of granulomatous diseases, as granuloma can be easily observed in reticulum stain in sarcoidosis which is one of the common granulomatous diseases. The patients for this study consisted of five cases of lepromatous type leprosy, three cases of tuberculoid type leprosy, and one case of borderline tuberculoid leprosy. They were treated by a multidrug therapy, and its clinical lesions were observed every month. Also skin biopsy was performed every six months, and the changes of granuloma and acid-fast bacilli were observed in accordance with hematoxylin-eosin, Fite-Farraco, and reticulum stain which provides a better observation of granuloma lesion. Skin lesion of paucibacillary leprosy disappeared in 8 to 12 months, but seen from skin biopsy, epitheloid cell granuloma began to disappear after several months and after 12 months, it almost disappeared. But in some lesion, it remained until 21 months, and even after 33 months, perivascular inflammatory cell infiltrations were found. Skin lesions of multibacillary leprosy disappeared within 9 to 33 months, and bacilli checked by skin smear turned negative, but according to a skin biopsy, the number or the size of the foamy histiocytic granuloma became smaller. There was an example that it still remained after 84-month treatment. As a rule, reticulum stain in leprosy made reticulum fibers surround granuloma in various ways, so it helped us to observe distinctively granuloma. In a treatment of leprosy, it could prevent the relapse of leprosy that the already treated lesions should be checked with repeated skin biopsies at certain intervals, though skin lesions disappear and bacilli are not found in a skin smear. It is concluded that reticulum stain could be one of the useful methods in observing granulomatous lesions for determination of healing of leprosy.

A Clinical Study of Chicken Pox in Adolescents and Adults / 대한피부과학회지

BACKGROUND: Chicken Pox, a highly contagious exanthem that occurs most frequently in childhood, is the result of primary infection with varicella zoster virus. Although it is generally a benign, self-limiting disease, varicella zoster virus infection may be associated with serious complications, especially in older adults. OBJECTIVE: The aim of this study was to elucidate the epidemiological and clinical characteristics and histopathologic features of varicella in adolescents and adults. METHOD: 57 patients who were admitted with varicella as adolescents or adults during a 20-year period from 1985 to 2004 were evaluated in regard to age, sex, monthly incidence, prodromal symptoms, and cutaneous manifestations. Patients were further assessed over abnormalities of laboratory tests, associated diseases, or histopathologic features. RESULTS: The results were as follows: 1. Varicella was seen most frequently in the 20~29 year-old group (47%), followed by the 10~19 year-old group (30%). The ratio of males to females was 1.36: 1. As a result of calculating the average age in five-year peroids from 1985 to 2004, the average age in the last period (2000-2004) was 29.2 +/- 7.0 years. This was found to be higher than in the other 5-year periods. 2. With regard to monthly occurrence, varicella was found to be most prevalant in May (21%). 3. The most common prodromal symptom was fever (74%), followed by a sore throat (32%) and headache (30%). 4. Common cutaneous manifestations of varicella were papules (84%), vesicles (79%) and typical umbilicated vesicles (65%). Pruritus (96%) was an extremely common symptom. 5. The most common laboratory abnormality was an abnormal liver function (28%). 6. Associated diseases of varicella were observed in 6 patients (10%). These included hepatitis or the hepatitis B virus carrier (5%), diabetes mellitus (2%), pulmonary tuberculosis (2%), and ulcerative colitis (2%). 7. Complications of varicella were 1 case (2%) of keratitis and 1 case (2%) of secondary infection. 8. In 7 cases of varicella stained with hematoxylin-eosin, all cases showed necrosis of keratinocytes and ballooning degeneration, and 5 cases had severe inflammatory infiltrations. Intra-epithelial vesicles were found in 6 cases, and multinucleated giant cells were found in 2 cases. CONCLUSION: The mean age of varicella patients showed an increase in the last 5-year period. In adolescents and adults with varicella, we recommend that patients should be evaluated for abnormalities of liver function.

A Case of Pseudofolliculitis Pubis in a Black Woman / 대한피부과학회지

Pseudofolliculitis is a chronic, inflammatory skin disorder seen mainly in individuals with curly hair. This condition is caused by hairs curling back into the skin and is seen most frequently in black men who shave their beards (pseudofolliculitis barbae), but may also be seen in all races who shave the axillary (pseudofolliculitis axillae) and pubic skin (pseudofolliculitis pubis). We report a case of pseudofolliculitis pubis in a 23-year-old black woman, who presented with multiple, dark, black-colored papules on both inner thighs, on the edge of the bikini line, which she regularly shaved. Histopathologically, foreign-body inflammatory reaction surrounding an ingrown hair was observed. We recommended her to stop shaving pubic hairs and to remove the hairs by laser.

A Case of Pigmented Fungiform Papillae of the Tongue / 대한피부과학회지

The fungiform papillae are generally described as being pink or red in colour. Pigmented fungiform papillae of the tongue (PFPT) are characterized clinically by pigmentation confined to these papillae and histopathologically by melanophages in the lamina propriae. PFPT appears to be relatively common among the black population, whereas this entity has rarely been reported in Asians. We report a case of PFPT in a 35-year-old Korean woman who had black dots, exclusively involved with fungiform papillae, on the anterior dorsolateral side of the tongue. The patient also had iron deficiency anemia. Histopathologic findings revealed an increase of melanophages in the upper dermis within the fungiform papillae.

A Case of Multiple Lentigines Sydrome with a Family History of Multiple Lentigines / 대한피부과학회지

Multiple lentigines syndrome is an autosomal dominant disorder of variable penetrance and expressivity. LEOPARD has been used to describe the main features of the syndrome, including lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retardation of growth and deafness. We describe a case of multiple lentigines syndrome with a family history of multiple lentigines. A 15-year-old boy presented with multiple brown macules and patches on the whole body, which had developed since the age of 3. He also had hypertrophic cardiomyopathy, EKG abnormalities and retarded growth. His maternal grandfather, maternal uncle and mother also presented with multiple brown macules scattered over the body. The biopsy specimen taken from the macule revealed elongated rete ridges, increased melanin deposition and increased number of melanocytes.

A Case of Subungual Exostosis of the Finger / 대한피부과학회지

Subungual exostosis is a benign osteochondral tumor usually involving the distal phalanx of the great toe. It rarely occurs on other toes or the fingers. We report a case of a 26-year-old male who presented with a growing painful nodule on his right 4th finger. Diagnosis was confirmed by radiologic and histopathologic studies, followed by complete excision of the lesion. At the 13-month follow-up, there was no sign of recurrence. We think that subungual exostosis should be considered in the differential diagnosis of any digital mass.

A Case of Herpes Zoster Duplex Bilateralis / 대한피부과학회지

Herpes zoster classically occurs unilaterally within the area of skin innervated by a single sensory ganglion. Simultaneous involvement of two noncontiguous dermatomes is very rare and it has been referred to as zoster duplex unilateralis or bilateralis, depending whether one or both halves of the body are involved. A 47-year-old woman presented with painful grouped vesicles on the right chest and the left lower back. The tzanck smear and the skin biopsy were consistent with herpetic infection. She was treated with intavenous acyclovir without any significant complications. We report a rare case of zoster duplex bilateralis.

A Case of Nicolau Syndrome Due to Diclofenac Sodium / 대한피부과학회지

Nicolau syndrome is defined as local cutaneous and sometimes muscular necrosis observed at the injection site of intramuscular preparations. It is characterized by severe pain immediately after the injection and variable degrees of skin necrosis. The only treatment is conservative. A 46-year-old man presented with painful skin necrosis on his buttock after the injection of diclofenac sodium. Histopathologic examination showed necrosis of the epidermis and upper 2/3 of the dermis. The lesion was treated conservatively with topical antibiotic ointment. We report a rare case of Nicolau syndrome due to diclofenac sodium.