Serum Procalcitonin Level Reflects the Severity of Cellulitis

BACKGROUND: Cellulitis is a common bacterial infection of the superficial skin. Procalcitonin is one of the precursor proteins of calcitonin, its levels are elevated in bacterial infection, and it has been established as a diagnostic marker for severe bacterial infections. OBJECTIVE: This study evaluated the clinical usefulness of procalcitonin for predicting disease severity and prognosis of cellulitis. METHODS: We reviewed the medical records of 160 patients diagnosed with cellulitis in the past 3 years. Body temperature, procalcitonin, white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were measured on their first day of admission. The associations of procalcitonin, WBC, ESR, and CRP with the body temperature and the number of hospitalized days were assessed. RESULTS: Procalcitonin, WBC, and CRP showed a positive correlation with body temperature. In addition, procalcitonin, WBC, ESR, and CRP showed a positive correlation with number of hospitalized days (p<0.05). CONCLUSION: In patients diagnosed with cellulitis, proclacitonin was a helpful parameter to indicate the severity of disease and also a useful predictor of prognosis.

Acute Generalized Exanthematous Pustulosis Caused by Terbinafine / 대한피부과학회지

A 12-year-old girl visited our clinic with pruritic non-follicular pustules on reddish bases and scales on her face, trunk, and proximal extremities. She complained of fever and chills. Before she was admitted to our clinic, she had been treated with terbinafine (125 mg/day) for tinea corporis. Three days after beginning the terbinafine treatment, whitish pustules on erythematous bases occurred abruptly in the intertriginous areas. A physical examination showed that the girl's body temperature was 38degrees C. Laboratory investigations revealed neutrophil-dominant leukocytosis. A skin biopsy specimen taken from a pustular lesion on the trunk revealed subcorneal pustules. The papillary dermis was edematous, and a superficial perivascular lymphocytic infiltrate with scattered interstitial neutrophils was noted. She was diagnosed as having acute generalized exanthematous pustulosis because of terbinafine use on the basis of her history, and clinical and histopathological findings. Her terbinafine treatment was discontinued promptly, and systemic corticosteroids and antihistamines were administered and topical corticosteroids were applied. Three days later, the skin lesions and constitutional symptoms had improved and there has been no recurrence to date.

A Case of Neutrophilic Dermatosis of the Dorsal Hands / 대한피부과학회지

No abstract available.

Nevus Lipomatosus Cutaneous Superficialis with Ectopic Sebaceous Glands on the Neck / 대한피부과학회지

No abstract available.

Dermatomyositis Associated with Follicular Lymphoma / 대한피부과학회지

No abstract available.

Pilar Sheath Acanthoma on Dorsum of Nose / 대한피부과학회지

No abstract available.

A Clinical and Epidemiological Study of Scabies in Korea: A Multicenter Prospective Study / 대한피부과학회지

BACKGROUND: Scabies is an old and common contagious skin disease. The incidence of scabies has decreased through the economic growth of Korea. However, recent outbreaks in medical facilities have created a suspicion that the infection of scabies is an emerging public health problem. OBJECTIVE: We evaluated the epidemiological and clinical aspects of patients diagnosed with scabies in Korea. This prospective study follows the retrospective study already performed by the same authors in 2011. METHODS: A multicenter, prospective study of scabies was performed at 25 hospitals in Korea. We included 914 patients who were diagnosed with scabies. Microscopic examination revealed scabies mites or eggs, or clinical improvement after treatment. Patients were asked to provide information on scabies, especially regarding the contact source, and the physicians examined them. RESULTS: Of the participants, 432 patients were men and 482 were women. Patients aged younger than 10 years and 60~69 years were the most common groups. Scabies more commonly affected patients during the fall and winter. Of the patients, 68.0% were thought to be infected at their homes, followed by nursing homes or hospitals (25.7%), and 31.6% through contact with other patients or, occasionally, staff members, including caregivers. CONCLUSION: We confirmed that scabies is an emerging threat in institutions, especially medical facilities. In addition, we suggest that public and in-hospital education is essential to minimize the problems associated with scabies.

Klebsiella pneumoniae Cellulitis Associated with Osteomyelitis was Suspected by Highly Elevated Inflammatory Marker Serum Procalcitonin / 대한피부과학회지

No abstract available.

Juvenile Dermatomyositis Presenting as Deep Skin Ulcerations as an Initial Manifestation / 대한피부과학회지

Juvenile dermatomyositis is a common idiopathic inflammatory myopathy in childhood and is characterized by symmetric proximal muscle weakness and specific cutaneous manifestations. We here report on a 12-year-old boy who presented with violaceous maculopatches with multiple deep skin ulcerations on the right arm and lower back 4 months ago. One month after the initial visit, he had difficulty climbing stairs and elevating his arms above the head. Laboratory tests showed elevation of the serum levels of skeletal muscle enzymes, and electromyogram and muscle biopsy indicated myopathy. Histopathological analysis of the ulceration indicated necrotizing vasculitis and calcification. Based on these findings, his condition was diagnosed as juvenile dermatomyositis. We believe that this case is unique because of the difficulty in diagnosing the condition, as skin ulceration is a rare cutaneous manifestation of dermatomyositis.

A Case of Squamous Cell Carcinoma Developing in a Nevus Sebaceus of the Scalp / 대한피부과학회지

Nevus sebaceus is frequently complicated by development of a variety of other benign skin tumors. On the other hand, malignant skin tumors are rarely observed in associated with nevus sebaceous. The most common benign skin tumor developing in nevus sebaceus is trichoblastoma, while the most common malignant skin tumor is basal cell carcinoma. However, cases of squamous cell carcinoma developing within nevus sebaceous are rare. A 42-year-old man presented a solitary 3x3-cm sized hemorrhagic, crusted, verrucous mass on the left occipital scalp, which was congenital. He visited our clinic due to the mass rapidly enlarging over the past 3 years and due to bleeding of the mass in the past 3 months. Histopathologically, the tumor showed typical findings of well-differentiated nevus sebaceus and squamous cell carcinoma. We herein report a case of squamous cell carcinoma developing in nevus sebaceous.

Solitary Plaque Nevus Lipomatosus Cutaneous Superficialis on the Face / 대한피부과학회지

Nevus lipomatosus cutaneous superficialis (NLCS) is an uncommon form of connective tissue nevus, which is manifested principally as the deposition of fatty tissue in the dermis. Lesions almost always arise unilaterally on the thigh or buttock. Although NLCS can affect any region of the skin, only five cases of NLCS on face have been reported. A 48-year-old female presented with a skin-colored, 1 cm sized, soft and edematous plaque on the right malar area. The histopathologic findings showed scattered ectopic fat lobules between collagen fibers in the mid to deep dermis. We herein reported a case of solitary and plaque-shaped NLCS on the malar area.

Association between Elevated Pleural Interleukin-33 Levels and Tuberculous Pleurisy

BACKGROUND: Interferon-gamma (IFN-gamma) plays a crucial role in Mycobacterium tuberculosis induced pleural responses. Interleukin (IL)-33 up-regulates the production of IFN-gamma. We aimed to identify whether an association between pleural IL-33 levels and tuberculous pleurisy exists and determine its diagnostic value. METHODS: Pleural IL-33, ST2 (a receptor of IL-33), adenosine deaminase (ADA), and IFN-gamma, as well as serum IL-33 and ST2 were measured in 220 patients with pleural effusions (PEs). Patients with malignant (MPEs), parapneumonic (PPEs), tuberculous (TPEs), and cardiogenic (CPEs) pleural effusions were included. RESULTS: Pleural and serum IL-33 levels were highest or tended to be higher in patients with TPEs than in those with other types of PEs. The median pleural fluid-to-serum IL-33 ratio was higher in TPE cases (> or = 0.91) than in other PE cases (< or = 0.56). Pleural IL-33 levels correlated with those of pleural ADA and IFN-gamma. However, the diagnostic accuracies of pleural IL-33 (0.74) and pleural fluid-to-serum IL-33 ratio (0.75) were lower than that of ADA (0.95) or IFN-gamma (0.97). Pleural ST2 levels in patients with MPEs were higher than in patients with TPEs. Serum ST2 levels did not differ among the groups. CONCLUSIONS: We identified an association between elevated pleural IL-33 levels and tuberculous pleurisy. However, we recommend conventional pleural markers (ADA or IFN-gamma) as diagnostic markers of TPE.

Differences in Antigen-presenting Cells between Normal and Systemic Contact Dermatitis Skin due to Rhus Lacquer / 대한피부과학회지

BACKGROUND: Urushiol is a widely known potent allergen that causes severe contact dermatitis through the epidermis or blood vessels. The role of antigen presenting cells (APC) in allergic contact dermatitis (ACD) is well known, but the role of APC in systemic contact dermatitis (SCD) is not yet fully evaluated. OBJECTIVE: The aim of this study is to observe the changes of APC in thenormal and SCD skin and to discuss their possible roles in the disease process. METHODS: Immunohistochemical differences of the Langerhans cells (LC) and dermal dendritic cells (DDC) were investigated in cases of the normal and SCD skin (Ed note: keep uniformity as above). Immunohistochemical staining with anti-CD1a, S-100 protein, HLA-DR, and factor XIIIa antibodies were performed. The number of CD1a, S-100 protein, and HLA-DR positive cells per mm2 of the epidermis was counted. The number of HLA-DR and Factor XIIIa-positive DDC per mm2 was also evaluated. RESULTS: The LC positive for CD1a and S-100 in the epidermis were slightly higher in SCD, but their difference was not statistically significant. HLA-DR and Factor XIIIa-positive DDC in the dermis weresignificantly increased in the skin of SCD than normal. HLA-DR positive LC in the epidermis was also increased. CONCLUSION: Our results suggest that DDC plays a more important role than that of epidermal LC in urushiol-induced SCD. Increased HLA-DR-positive LC in the epidermis suggests that antigen delivery through the blood also affects the epidermal Langerhans cell beside the dermal dendritic cells.

A Case of Clear Cell Basal Cell Carcinoma / 대한피부과학회지

Clear cell basal cell carcinoma is a rare histological variant of basal cell carcinoma, which is characterized by a variable component of clear cells. We report a case of clear cell basal cell carcinoma in a 53-year-old Caucasian male presented with a red 0.7x0.6 cm sized nodule with central bleeding on left cheek for 2 years. Histological examinations showed multiple dermal tumor lobules nested with basaloid cells of a peripheral palisading pattern. In addition, prominent clear cell changes were observed in the center of large nests. The clear cells showed a single large vacuole in their eosinophilic and granular cytoplasm with eccentric condensed nucleus. The clear tumor cells was stained with periodic acid Schiff and showed incomplete diastase-resistance. Intercellular mucin staining with alcian blue was positive. The tumor was successfully treated with Mohs micrographic surgery and no recurrence has been observed for 6 months.

Tuberculoid-type Leprosy Mimicking Tinea Corporis / 대한피부과학회지

A 59 year-old man developed a large, reddish, well-defined, scaly patch on his submental area 37 years before visiting our department; the patch showed central atrophy and was enlarged. He was erroneously treated for tinea corporis at private clinics for 5 years before the correct clinicopathological diagnosis of tuberculoid-type leprosy was made. We report this case to suggest that dermatologists should play an important role in the diagnosis and treatment of leprosy, and that they should pay careful attention while diagnosing new cases of leprosy.

A Case of Trichilemmal Cyst Developed on the Shin / 대한피부과학회지

No abstract available.

A Case of Traumatic Neuroma Probably Originated from Dorsal Digital Nerve / 대한피부과학회지

Neuromas are hyperplasia of axons and associated nerve sheath cells. Cutaneous neuromas are rare. Neuromas can be classified into three types: traumatic neuromas, solitary palisaded encapsulated neuromas, and multiple mucosal neuromas. Traumatic neuromas are tangles of neural fibers and connective tissue that develop following nerve injury. These usually present as a solitary, skin colored or pinkish, slowly growing, palpable and painful firm papule or nodule. A 15-year-old female patient presented a solitary 1.0x0.5 cm sized, pinkish palpable well-demarcated firm subcutaneous nodule on the right third proximal interphalangeal joint. We herein report a case of traumatic neuroma which probably originated from the dorsal digital nerve.

Effects of Angiotensin-Converting Enzyme Polymorphism on Soluble Receptor for Advanced Glycation End-Products in Maintenance Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Advanced glycation end-products (AGEs) exert various toxic effects through the receptor for AGEs (RAGE). Soluble RAGE (sRAGE) is a naturally occurring inhibitor of AGE-RAGE. Recent studies have suggested that inhibition of angiotensin-converting enzyme (ACE) reduces the accumulation of AGEs in diabetes partly by increasing the production and secretion of sRAGE into the plasma. This report describes the relationship between sRAGE and ACE polymorphism in maintenance hemodialysis patients. METHODS: The levels of sRAGE and advanced oxidation protein products (AOPPs) were assessed by enzyme-linked immunosorbent assay (ELISA), and ACE polymorphism was detected by PCR amplification. RESULTS: The distributions of ACE genotypes in 105 hemodialysis patients were as follows: II, 56 (35.9%); ID, 29 (18.6%); and DD, 20 (12.8%). According to the ACE genotypes, the study group consisted of II (n = 56) and ID + DD group (n = 49). sRAGE was correlated with age (r = -0.24; p = 0.013). There were significant differences in sRAGE, AOPP, age, duration of dialysis, C-reactive protein, or 24-h urine volume between two genotype groups. There were no significant differences in sRAGE levels, even though the effect of age was treated as a covariate. CONCLUSIONS: Our findings suggested that sRAGE may be affected only by age, and not by ACE polymorphism in maintenance hemodialysis patients.

Effects of Angiotensin-Converting Enzyme Polymorphism on Soluble Receptor for Advanced Glycation End-Products in Maintenance Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Advanced glycation end-products (AGEs) exert various toxic effects through the receptor for AGEs (RAGE). Soluble RAGE (sRAGE) is a naturally occurring inhibitor of AGE-RAGE. Recent studies have suggested that inhibition of angiotensin-converting enzyme (ACE) reduces the accumulation of AGEs in diabetes partly by increasing the production and secretion of sRAGE into the plasma. This report describes the relationship between sRAGE and ACE polymorphism in maintenance hemodialysis patients. METHODS: The levels of sRAGE and advanced oxidation protein products (AOPPs) were assessed by enzyme-linked immunosorbent assay (ELISA), and ACE polymorphism was detected by PCR amplification. RESULTS: The distributions of ACE genotypes in 105 hemodialysis patients were as follows: II, 56 (35.9%); ID, 29 (18.6%); and DD, 20 (12.8%). According to the ACE genotypes, the study group consisted of II (n = 56) and ID + DD group (n = 49). sRAGE was correlated with age (r = -0.24; p = 0.013). There were significant differences in sRAGE, AOPP, age, duration of dialysis, C-reactive protein, or 24-h urine volume between two genotype groups. There were no significant differences in sRAGE levels, even though the effect of age was treated as a covariate. CONCLUSIONS: Our findings suggested that sRAGE may be affected only by age, and not by ACE polymorphism in maintenance hemodialysis patients.

Epidemiological and Clinical Study of Scabies in Korea: Multicenter Retrospective Study / 대한피부과학회지

BACKGROUND: Scabies is one of the common skin diseases observed in developing countries. The incidence of scabies has decreased dramatically since the late 1980s in Korea. However, recent outbreaks in nursing homes or hospitals have been raising public health concerns. OBJECTIVE: We intended to evaluate the epidemiological and clinical aspects of patients diagnosed with scabies in Korea. In particular, we tried to investigate the changing trend of contact sources in our society. METHODS: A multi-center cross sectional study was performed at 25 hospitals in Korea. We included 1,539 patients who were diagnosed with scabies. These patients showed scabies mites or eggs under microscopic examination, or clinical improvement after treatment. Their medical records with information of contact sources were reviewed. RESULTS: Six hundred and ninety-three patients were males and 826 were females. Patients' age from 70 to 79 was the most common followed by patients below 10 years of age. More patients were found in the fall and winter months. 66.7% of patients were thought to be infected at their homes which were situated next to nursing homes or hospitals (23.1%). Place of infection could not be verified in 39.3% of patients. 25.8% of patients were suggested to be infected through contact with medical staff or patients from hospitals or nursing homes. CONCLUSION: We confirmed that the contact sources of scabies are changing in our society; nursing homes and hospitals are emerging sources of infection. The majority of patients are old or very young who are vulnerable to many diseases. Therefore, dermatologists should pay attention to new contact sources and appropriate care of patients.