Dermatologic Diseases Associated with Atopic Dermatitis in Koreans: Multicenter Study / 대한피부과학회지

BACKGROUND: Dermatological diseases can occur with atopic dermatitis. OBJECTIVE: The purpose of this study was to analyze diseases associated with atopic dermatitis in Koreans. METHODS: From November, 2007, to May, 2008, 948 patients with atopic dermatitis who visited the department of dermatology at 19 hospitals were evaluated for associated diseases. RESULTS: Of 948 patients, 53.8% (510) had symptoms associated with other dermatological diseases. In order of frequency, diseases associated with atopic dermatitis included acne, hand/foot eczema, seborrheic dermatitis, urticaria, warts, and recurrent herpes simplex. The number of associated diseases did not change significantly with the severity of atopic dermatitis. However, the incidence of hand/foot eczema and eczema herpeticum correlated significantly with the severity of atopic dermatitis. CONCLUSION: There is a distinct pattern of diseases associated with atopic dermatitis in Koreans.

The Biological Effects of Rhus (Japanese lacquer sap) on Rats / 대한피부과학회지

BACKGROUND: Exposure to Rhus (Japanese lacquer) can cause many adverse effects such as contact dermatitis, pruritus, rash and even hepatitis in human, and these effects can be caused by contact or ingestion of Japanese lacquer. Many Koreans currently eat Japanese lacquer boiled with chicken although it has many side effects. Koreans believe that Rhus will improve their health. However, they don't known its adverse effects, and there is no experimental report on this topic. OBJECTIVE: The principle objective of this study was to gather evidence on the toxicity and negative effects of Japanese lacquer through an experimental study with rats. METHODS: A total of 60 Sprague-Dawley rats were included in the study; 30 rats (experimental group) were given 0.1 ml of Japanese lacquer sap extract, water and food, and 30 rats (control group) were given only food and water. The WBC, the Hgb, ALT, AST, BUN and creatinine levels, the presence of pruritis and skin eruption, the skin biopsy findings and the liver biopsy findings were all checked at 5, 10, and 15 days. RESULTS: The rats that were given Japanese lacquer sap showed a higher WBC and higher ALT and AST levels and only these rats demonstrated erythroderma (5th day: 30%, 10th day: 40%, 15th day: 70%). In addition, they exhibited frequently scratching behavior. On histological examination of the skin of the rats given Rhus, dermal edema and mild inflammatory cell infiltration were found. On histological examination of the liver of the rats given Rhus, there was no significant change as compared with the rats that weren't given lacquer. CONCLUSION: In this experimental study, it was proven that Rhus could induce pruritis, erythroderma, skin inflammation and hepatotoxicity.

Levamisole Monotherapy for Oral Lichen Planus

BACKGROUND: Several different kinds of drugs have been used to treat chronic oral lichen planus (OLP). During the last decade, there have been several reports demonstrating success with levamisole and low dose prednisolone therapy for treating OLP. However, some OLP patients who have underlying diseases such as diabetes, hypertension and malignancy are unable to take steroids. OBJECTIVE: The aim of this study was to evaluate levamisole monotherapy for treating OLP. METHODS: Eleven patients who had OLP were treated with levamisole between 2005 and 2007. The levamisole was administered at a dose 50 mg thrice daily for three consecutive days, but then it was not administered on the following four days. RESULTS: After 2 weeks of treatment, 8 patients reported a partial response, 3 patients reported no response and no patients reported clearance of lesion. After 4 weeks of treatment, 6 patients reported a partial response, 3 patients reported no response and 2 patients reported clearance of lesion. Furthermore, after 3 months of treatment, 3 patients reported a partial response, 3 patients reported no response and 5 patients reported complete clearance of lesion. Clinical improvement was shown in 2 weeks, whilst the mean duration to achieve clearance of lesion was 6.2 weeks. Although 1 patient had mild itching, there were no significant adverse effects. CONCLUSION: Levamisole monotherapy could be a successful and safe treatment option for patients with chronic OLP and who cannot take steroids.

Epidemiological Studies of Vibrio vulnificus Sepsis / 대한피부과학회지

BACKGROUND: Vibrio vulnificus is an estuarine bacterium which is capable of causing rapidly fatal infections in humans following either ingestion of raw seafoods or entry from seawater into wounds. Although V. vulnificus sepsis (called as Vibrio sepsis) has been well known in Korea since 1982 and was designated as a legal communicable disease (group III) since August 2000, many patients occurr annually. OBJECTIVE: We investigated the epidemiological features of Vibrio sepsis to offer basic data such as correlation among disease occurrence, seawater temperature, salinity and pH, amount of rainfall, incidence rate and consumed seafoods, in order to further prevent this disease. METHODS: We reviewed the epidemiologic data on monthly disease occurrence, history of raw seafood consumption and kinds of consumed seafoods in 141 patients with Vibrio sepsis obtained from 105 admitted patients in hospitals and 36 case reports published in the Korean medical journals between 1982 and 2004. Environmental data on seawater temperature, salinity and pH were obtained from the National Fisheries Research & Development Institute. The monthly amount of rainfall was obtained from the Korea Meteorological Administration. The yearly occurrence of Vibrio vulnificus regional areas was obtained from the Korea Center for Disease Control & Prevention. Population data were obtained from the Korea National Statistical Office. RESULTS: Patients began to develop in June when mean seawater temperature was over 18.9degrees C, and with a peak from July to September when seawater temperature was over 22degrees C. The majority of the patients were found in the southern and western coastal areas of Korea, especially, estuaries, where sea mud is abundant. Also disease occurrence was positively correlated with the amount of rainfall which can lower the salt concentration of seawater. Yearly occurrence of patients by regional area was the highest in the Jellanam-do during the 5 years since August 2000. The incidence rates per 100,000 population were highest in the Jellanam-do (0.69), lowest in the Jeju-do (0.01) and 0.10 in the whole areas. Seventy two percent of patients ingested 38 kinds of seafoods raw such as blue crab, goby, blood ark shell and many kinds of fishes and shellfishes. 9% of patients had not eaten seafood and 17% had either no records or unknown. 2% developed sepsis resulted from exposure of wounds to seawater. CONCLUSION: Vibrio sepsis develops in summer months with much rain and mostly in the estuaries. These results suggest that Vibrio vulnificus multiply well in the warm and in relatively low salt seawater. We think that weather, environmental and geographic factors are important for the outbreak of Vibrio sepsis.

A Case of Lymphangioma Treated by OK-432 (Picibanil(R)) Sclerotherapy / 대한피부과학회지

Lymphangioma is an uncommon, benign hyperproliferation of the lymphatic vessels, and this consists of dilated lymphatic channels lined by a normal, single layer of endothelial cells. Various methods have been tried for the treatment of lymphangioma, including cryotherapy, electrocauterization, surgical excision, laser therapy, radiotherapy and itralesional injection of sclerosing agents. Yet these methods have shown low success rates and various side effects. It has recently been reported that intralesional injection of OK-432 is a safe and effective alternative therapy for lymphangioma, and especially for macrocystic lesion. In this report, we describe a patient with lymphangioma on the upper labial mucosa and this patient was successfully treated with intralesional injection of OK-432 without any serious complications. To the best of our knowledge, this is the first such case reported on in the Korean dermatological literature.

Determination of the Biogroup of Vibrio vulnificus Isolates from Patients and Oysters in Korea / 대한피부과학회지

BACKGROUND: Vibrio vulnificus are divided into 3 biogroups based on their biochemical and serological properties and the existence of eel virulence. Only a few studies can be found on the biogroups of V. vulnificus in other countries, and no such studies have been done in Korea. OBJECTIVE: The aim of this study was to determine the presence of biogroups other than biogroup 1 among the V. vulnificus isolated from septic patients and from oysters in Korea. METHODS: A total of 103 isolates (53 from septic patients and 50 from oyster) were used. The API 20E system was used to confirm identification of the V. vulnificus. Conventional biochemical tests and vvA gene detection by polymerase chain reaction (PCR) were used to determine the biogroups. RESULTS: The clinical and oyster isolates showed results similar to the biochemical tests. All of the clinical and oyster isolates showed the biochemical pattern of biogroup 1. The vvhA gene was detected in all of the isolates. CONCLUSION: All of the V. vulnificus isolates from the septic patients and oysters in Korea belong to biogroup 1.

A Case of Generalized Hyperpigmentation Caused by Antituberculosis Drugs / 대한피부과학회지

Hyperpigmentation caused by medication or toxic agents accounts for 10~20% of all the cases of acquired hyperpigmentations. Nonsteroidal anti-inflammatory drugs, antimalarials, amiodarone, cytotoxic drugs, tetracyclines, heavy metals and psychotropic drugs are most commonly responsible for hyperpigmentation. A 74-year-old man who had taken antituberculosis drugs (rifampin and isoniazid) for 4 months developed generalized hyperpigmentation. The histopathologic finding revealed an increased number of dermal melanophages with pigment incontinence. Eight months after termination of the antituberculosis medication, his skin lesion improved without any treatment. To the best of our knowledge, this is the first reported case of generalized hyperpigmentation due to rifampin and isoniazid in a patient without adrenal insufficiency in the dermatological literature.

Clinical Features in 147 Patients with Systemic Contact Dermatitisdue to the Ingestion of Chicken Boiled with Japanease Lacquer Tree / 대한피부과학회지

BACKGROUND: Systemic contact dermatitis (SCD) due to the ingestion of Japanese lacquer tree (Rhus verniciflua) is pretty common in Korea, and it is on a trend of increment. It is thought that the increase in ingestion of chickens boiled with the lacquer tree has been caused by the regard of the lacquer tree as a health food or herbal medicine for gastrointestinal disease. OBJECTIVE: To review the clinical findings and laboratory findings, and to make people aware of the harmful effects of the lacquer tree. METHODS: We retrospectively reviewed the medical records of 147 patients who had SCD due to chicken boiled with lacquer tree, 98 patients in Wonkwang University Hospital over the last 20 years (1998`2007) and 49 patients in Areumdaun Dermatology Clinic over the past 5 months (August~December, 2007). RESULTS: The sex ratio of patients (male to female) was 1.3:1 and the average age was 44.0 years old (range: 11~76). They ate chicken boiled with lacquer tree as a health food (42.9%) and for the treatment of gastrointestinal disease (22.4%). The mean incubation period was 47.7 hours (range: 30 min~16 days). The first symptoms they had were erythematous maculopapules (42.9%), itching without rash (33.7%), and edematous change (16.3%). The skin lesions developed as maculopapules (50.6%), erythroderma (40.9%), and erythema multiforme-like lesion (8.4%), vesicles, wheals, purpura, and pustules. On laboratory findings, some people had leukocytosis (61.2%), increment of Ig E (26.4%), abnormalities of liver function test (ALT: 16.3%, AST: 4.1%). Sixty percent of patients had a history of contact dermititous contracted via chicken boiled with rhus lacquer ingestion (36.7%) or contact with the lacquer tree. Clinical symptoms were developed by 29.5% who ate chicken boiled with lacquer. Mainly they had been treated with corticosteroids, antihistamines. The mean period needed for treatment was 8+/-2.4 days. CONCLUSION: Systemic contact dermatitis due to ingestion of the lacquer tree was developed in either sensitized or non-sensitized persons. It is suggested that SCD is caused by the highly allergic and toxic effects of lacquer. Physicians need to make people aware of the harmful effects of the lacquer tree and educate people not to ingest it.

A Case of Traumatic Panniculitis with Localized Hypertrichosis / 대한피부과학회지

A 32-year-old woman had a brownish hard plaque with localized hypertrichosis. She had fallen down some stairs 1 year previously, and the injury had left a scar on her right shin. Even though pain and the scar had gone, the brown patch had remained. During that time hair had been grown on the site. Histologic examination showed lobular panniculitis, fat necrosis, fibrotic change and lipomembranous change. We diagnosed the patient as a traumatic panniculitis with localized hypertrichosis, based on the trauma history, skin lesion and histologic findings. We report a case of traumatic panniculitis with localized hypertrichosis.

A Case of Parry-Romberg Syndrome with Shortening of Ipsilateral Lower Extremity / 대한피부과학회지

Parry-Romberg syndrome is an extremely rare connective tissue disorder. It might be a form of linear scleroderma, and it manifests as progressive hemifacial atrophy, epilepsy, exophthalmos or alopecia. Herein we report a case of Parry-Romberg syndrome. A 68-year-old woman had left hemifacial atrophy, shortening and deformity of the left leg, and deformities to her side fingers that occurred from her 1st decade to 2nd decade. Sclerotic change had stopped spontaneously when she was 20 years old. Histopathologically, there were a few signs of skin appendages, but no sclerotic change. On autoimmune antibody test, no positivity was shown. X-ray showed shrinkage of the lung field, elevation of the left diaphragm, shortening of length and reduction of bone mass in the left femur, tibia, and fibula. And there were multiple melorheostasis. Neck CT showed left facial sclerotic change, bone mass loss, and multiple melorheostasis. Because the progression of sclerosis had stopped the patient did not receive any treatment.

A Case of Primary Cutaneous Mucoepidermoid Carcinoma on the Cheek / 대한피부과학회지

Mucoepidermoid carcinoma is a rare disease that usually occurs in the salivary gland. In extremely rare cases, it can originate from the skin. These cases are more aggressive than the usual mucoepidermoid carcinoma, so they have high mortality and high recurrence rates. Herein we report a case of primary cutaneous mucoepidermoid carcinoma on the cheek. A 34-year-old man had a 1.0x1.0 cm sized cystic lesion. This lesion displayed central erosion and oily discharge. He had been operated on 4 times at a private hospital, but the lesion had recurred. Histopathologically, there were many tumor islands that consisted of mucoid cells, epidermoid cells, intermediate cells and clear cells. The tumor islets showed mild positivity for Alcian blue (pH 2.5), PAS, and d-PAS stain. There was no parotid tumor on the neck-CT scan, nor on positron emission tomography. We therefore diagnosed this cheek lesion as primary cutaneous mucoepidermoid carcinoma, and it was removed completely.

Roles of Sphingosine-1 Phosaphate During Pathogenesis of Bone Destruction and Inflammation in Rheumatoid Arthritis Mice Model / 대한해부학회지

Sphingosine 1-phosphate (S1P) is a bioactive lipid molecule that mediates cell proliferation, differentiation, migration, and angiogenesis in vivo. However, the roles of S1P on pathogenesis of arthritis have been not completely understood. This study was designed to determine the effects of S1P modulation on collageninduced arthritis (CIA) model. DBA/1J mice were injected with collagen into the tail for induction of CIA model. S1P was administered into the peritoneal cavity every other days from day 1 to day 42 after collagen injection. To determine the degree of damage in CIA, we examined macroscopic findings of CIA. The inflammation and bone destruction of CIA mice were evaluated by histo-patholigy and radiography (CT and microradiography). The expressions of TNF-alpha, IL-6, and RANKL which have important roles in pathogenesis of rheumatoid arthritis and bone destruction were observed by immuno-histochemical staining. After injection with collagen in the DBA/1J mice, CIA was induced by swelling in the knee and ankle joint. Administration of S1P suppressed damages and incidence of arthritis elicited by collagen. In histologic and radiographic studies, S1P strongly suppressed the infiltration of inflammatory cells, the swelling of synovial membrane, erosion, and the destruction of bone on CIA mice. Injection of S1P resulted in down-regulation of the expression of the pro-inflammatory and bone destruction mediators such as TNF-alpha, IL-6, and RANKL on CIA mice. Furthermore, S1P suppressed the differentiation of bone marrow cells into osteoclasts by RANKL. In conclusion, this study suggest that S1P has protective effects on inflammation and bone destruction during pathogenesis of CIA, which indicates S1P can be a new possible therapeutic strategy for rheumatoid arthritis

A Case of Carcinoma of Ampulla of Vater Metastasized to the Finger / 대한피부과학회지

Skin metastasis from internal malignancy is relatively rare. Skin metastasis from biliary tract cancer is known to be extremely uncommon (around 0.4~0.7%). In most cases, biliary tract cancer metastasizes into neighboring organs or other internal organs, but rarely into the skin. The authors have experienced a case of skin metastasis into a finger of a patient with carcinoma of Ampulla of Vater. This is thought to be the first case reported in Korea.

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.

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.

Reticulum Stain Findings in Various Cutaneous Granulomatous Diseases / 대한피부과학회지

BACKGROUND: Reticulum fibers represent a special type of thin collagen fiber that measures from 0.2 to 1.0 micrometer in diameter. A reticulum stain is currently used for diagnosing liver cirrhosis, chemodectoma, differentials of lymphoid tissue tumors and vascular tumors. In particular, it has been used for diagnosing sarcoidosis in the field of dermatology. OBJECTIVE: This study was conducted to ascertain whether reticulum fibers appeared when diseases showing granulomatous reaction were stained with a reticulum stain. METHODS: Patients who had been clinically or histopathologically diagnosed as having a granulomatous disease were used in this study. Granulomatous diseases included: sarcoidosis, leprosy, skin tuberculosis, lupus miliaris disseminatus faciei, granuloma annulare, paraffinoma, silicon granuloma or foreign body granuloma. A patient without a graunlomatous disease was used as the control. Hematoxylin-eosin staining and reticulum staining using Gomori's silver impregnation method were performed in all cases. RESULTS: A reticulum stain revealed a network of reticulum fibers surrounding and permeating the granulomas of various forms in patients with a granulomatous disease, although it was less abundant in sarcoidosis. CONCLUSION: We concluded that reticulum fibers appear in all granulomatous diseases.

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.