Three Cases of Trichophyton rubrum Syndrome / 대한피부과학회지

Dermatophytoses are often observed coexisting fungal infections. Trichophyton (T.) rubrum syndrome is defined as the following obligatory criteria. (A) Skin lesions at the following four sites: (1) feet; (2) hands; (3) nails; and (4) at least one lesion in another location than (1) (2) or (3), except for groins. (B) Positive microscopic findings of KOH preparations of skin scrapings in all four locations. (C) Identification of T. rubrum by culture at three of the four locations at least. Three cases of T. rubrum syndrome is reported in a 50-year-old woman, in a 73-year-old man, and in a 55-year-old man.

A Case of Nodular Hidradenoma with Apocrine Differentiation / 대한피부과학회지

Nodular hidradenoma is a relatively infrequent benign tumor that shows differentiation from or toward the structure of the eccrine sweat gland. We report a case of nodular hidradenoma with apocrine differentiation in a 74-year old female who had an asymptomatic, 3.5x2.7x1.0cm-sized, smooth-surfaced, round, erythematous to bluish tumor mass with cystic grape-like nature on the right thigh for 3 years. Histological findings showed a well-circumscribed tumor composed of solid portions with fusiform basophilic cells and clear round cells, cystic spaces, tubular lumina, squamoid feature and decapitation secretion.

A Case of Acquired Digital Fibrokeratoma Resembling Cutaneous Horn / 대한피부과학회지

Acquired digital fibrokeratoma is a relatively unusual benign fibrous tumor that is usually found on the distal extremities. It is characterized by a solitary, flesh-colored, firm and hyperkeratotic projection with a surrounding collarette of raised skin at the base. We report a case of acquired digital fibrokeratoma resembling cutaneous horn in a 31-year-old male who showed a 0.5x0.5x2 cm, firm, hyperkeratotic protruded mass with secondary changes including crust and bleeding on the left 4th finger.

Two Cases of Epidermolysis Bullosa Simplex (Dowling-Meara Type) / 대한피부과학회지

The Dowling-Meara type of epidermolysis bullosa simplex is a rare genodermatosis transmitted by autosomal dominant pattern. It starts during the first 3 months of life and is characterized by generalized bullae in a herpetiform pattern. We report two cases of Dowling-Meara type of epidermolysis bullosa simplex. The first case is an 18-year-old male patient who showed bullae in a herpetiform arrangement on the dorsa of both hands, forearms, and trunk, hyperkeratosis on the palms and soles, postinflammatory hypo- and hyperpigmentations, and dystrophy of finger and toe nails. The second case is a 1-month-old boy who showed multiple bullae in a herpetiform and confluent arrangement scattered on the whole body, particularly on the dorsa of both feet and hands. Microscopically and electro-microscopically, two cases all showed intraepidermal blisters formed within the basal keratinocyte in association with clumping of the tonofilaments and cytolysis of the basal cells.

Cutaneous Granulocytic Sarcoma: A report of two cases / 대한피부과학회지

Granulocytic sarcoma (GS), also known as chloroma, is an extramedullary tumor of granulocytic lineage. It usually occurs in patients with acute myelogenous leukemia (AML), myeloproliferative disorder, or myelodysplasia but can develop in patients with no known hematologic disorder (isolated chloroma). The sites of predilection are bone and periosteum, and the next most common sites are soft tissues of the skin, kidneys, gut and lymph nodes. We report herein two cases of GS in a 36 year-old male and a 39 year-old female. The former had been treated for AML for 4 months before GS developed as an exophytic and multiple cutaneous masses on his left arm. In the latter, whose chief complaint was plum-colored nodules on her trunk, the initial diagnosis was malignant lymphoma. A follow-up after chemotherapy revealed that she had AML and reversely the final diagnosis of GS could be made for her skin tumor.

Two Cases of Papular Mucinosis / 대한피부과학회지

Scleromyxedema is a rare fibromucinous disorder that is often difficult to treat and is associated with significant morbidity and mortality. Clinically, it shows white or flesh colored, dome-shaped waxy papules on the hands, arms, face, neck and upper trunk. There are proliferation of fibroblasts and mucin deposition in dermis and presence of serum paraproteins. It should be differentiated from scleroderma because of sclerotic skin changes. Patients were a 70 year old male and a 45 year old female. They showed multiple confluent or linearly arranged waxy papules on the head, neck and extremities. Sclerotic plaques were also seen. Abnormal findings were not detected in laboratory tests and bone marrow biopsy. Histologically, mucin deposition and marked proliferation of fibroblasts were seen in dermis. Therapy was performed with 200 mg/day of cyclophosphamide. Both patients showed good response and had no recurrence. The latter one had shown improvement of skin lesions but subsequently she developed leukocytopenia. Cyclophosphamide was stopped temporarily until the abnormal leukocytes count recovered. During therapy, mild hemiparesis developed. We could not find the cause of the symptom through physical examination and radiologic studies.

A Clinical Observation on Acute Pain and Postherpetic Neuralgia in Patients with Herpes Zoster / 대한피부과학회지

BACKGROUND: Pain in the form of acute neuritis and postherpetic neuralgia is by far the most frequent and most debilitating complication of herpes zoster. The pain of acute herpes zoster may be severe, but it is usually transitory. Some patients, with the elderly at particular risk, go on to develop postherpetic neuralgia. Postherpetic neuralgia is often severe and, unfortunately, refractory to most forms of treatment. OBJECTIVE: The purpose of this study was to compare the severity of acute pain and incidence of postherpetic neuralgia by age group, dermatomal distribution and the presence and absence of associated diseases. METHODS: We observed the severity of initial pain, changes in severity of pain during treatment, and the incidence of postherpetic neuralgia in 105 patients with herpes zoster with the same therapeutic measures (systemic steroid, acyclovir, analgesics, and tricyclic antidepressant). And we compared them by age group (the young & middle age vs the old age group), dermatomal distribution(trigeminal, cervical, thoracic, and lumbosacral), and the the presence and absence of associated diseases respectively. And we also analyzed the relationship between the incidence of postherpetic neuralgia and the severity of initial pain. RESULTS: 1. Sixty-six patients (63%) of the total number of subjects complained of initial 'severe pain', and the incidence of initial 'severe pain' was significantly higher in the old age group (78%) compared with the young & middle age group (48%). But, there was no significant difference by dermatomal distribution and the presence and absence of associated diseases. 2. The duration of pain was 2-4 weeks in 27 patients (26%), 1-2weeks in 26 (25%), more than 8 weeks(postherpetic neuralgia) in 24 (23%). 3. The mean comparative value of the severity of pain was 38% of initial pain after 3 days of treatment, 22% 1 week, 15% 2 weeks, 8% 4 weeks, and 5% 8 weeks, respectively. But, there was no significant difference in changes of severity of pain by age group, dermatomal distribution, and the presence and absence of associated diseases. 4. The incidence of postherpetic neuralgia was significantly higher in the old age group (35%) compared with the young & middle age group (11%). But there was no significant difference by dermatomal distribution and presence and absence of associated disease. And the incidence of postherpetic neuralgia was also significantly higher in the initial 'severe' pain group (33.3%) than in the initial 'mild' pain group (14.3%) and the `moderate' pain group (3.1%). CONCLUSIONS: Older patients with herpes zoster showed severer initial pain and a higher incidence of postherpetic neuralgia. But there was no significant difference in the severity of initial pain and incidence of postherpetic neuralgia by dermatomal distribution and the presence and absence of associated diseases. And patients with initial severe pain showed a higher incidence of postherpetic neuralgia than those with mild and moderate pain, respectively.

Congenital Smooth Muscle Hamartoma: a Patchy Follicular Variant

Cutaneous smooth muscle hamartomas are benign proliferations of smooth muscle bundles within the dermis. They can be congenital or acquired, and most cases are congenital. Congenital smooth muscle hamartomas (CSMHs) usually manifest at birth as well-circumscribed, frequently hypertrichotic, hyperpigmented or skin-colored patches or plaques on trunk or extremities. We report a case of CSMH in a 10 year-old girl, who showed a localized skin-colored patch showing prominent follicular papules on the lateral aspect of her right upper arm, which were found at birth. There was no hypertrichosis and the pseudo-Darier sign was negative. This patchy follicular variant is the less common clinical type of the disease.

A Case of Generalized Lichen Planus Cured by Griseofulvin / 대한피부과학회지

Although a number of remedies like corticosteroids, retinoids, griseofulvin, PUVA, cyclosporine, antibiotics, dapsone, cyclophosphamide, surgery, methotrexate, radiation therapy, antimalarial drugs, psychotharapy and psychiatric medications have been used to treat lichen planus, there were no specific methods until now. We report herein an interesting case of lichen planus in which complete healing was achieved by griseofulvin administration. The patient was a 54-year-old male who for 3 months had variouly sized and shaped, flat-topped, scaly, violaceous papules and plaques on the whole of his body. We confirmed the patients disease as lichen planus by a histopathologic examination of a skin biopsy specimen and gave him 500mg ultramicronized griseofulvin daily in divided dosages. After 12 weeks of the medication nearly all of the skin lesions were regressed, and by 14 weeks all skin lesions had disappeared leaving hyperpigmentation. Up to now, l9 months after discontinuation of the medication, no recurrence of the disease has been noted.

Two Cases of Venous Hemangioma / 대한피부과학회지

Venous hemangioma is a vascular tumor that has been reported by such diverse names as; "cirsoid aneurysm", "arteriovenous hemangioma", "acral arteriovenous tumor" according to the author's opinions of its origin and histopathologic classification. It is benign and rarely biopsied, and it is also rarely reported in dermatology literature. We present two cases of venous hemangioma. The first case was a 64-year-old man who was presented with an elliptical dark-red plaque with overlying several grouped papules on the left periorbital area which had been present for 7 years. The second case was a 56-year-old man who was presented with a single red papule on the right postauricular area which had been present for 4 months. Histopathologically, there were a well-circumscribed proliferation of thick-walled muscle-containing blood vessels in the dermis. Intermingled with the thick-walled blood vessels, there were also thin-walled dilated blood vessels. In both cases, the thick-walled blood vessels resembled arteries, but they lacked elastic fibers on the Verhoeff van Gieson stain.

Symptoms and Signs of Atopic Dermatitis and Levels of Serum IgE and Eosionphil Counts in Young Adult Patients with Seborrheic Dermatitis / 대한피부과학회지

BACKGROUND: Seborrheic dermatitis and atopic dermatitis are clinically different diseases, but symptoms and signs of atopic dermatitis often can be found simultaneously in patients with seborrheic dermatitis.OBJECTIVE: The aim of this study was to investigate if patients with seborrheic dermatitis have the symptoms and signs of atopic dermatitis at the same time, and to measure the levels of serum IgE and eosinophil counts. METHODS: Seventy eight patients with seborrheic dermatitis on the scalp and face, 64 patients with atopic dermatitis and 88 normal subjects were observed clinically by the dermatologist and studied statistically using questionnaires. Levels of total IgE and eosinophil counts were measured by blood sampling in the total number of subjects. RESULTS: Among 20 items of the questionnaire regarding the symptoms and signs of atopic dermatitis, 6 items were more frequent in only the atopic patients than in the normal control, 2 items were more frequent in only the seborrheic dermatitis patients and 8 in both diseases. The mean levels of serum IgE in seborrheic dermatitis patients were lower than in atopic patients, but significantly higher than that of the normal control and 21.3% of those had IgE levels above the normal range.When we classified the seborrheic dermatitis patients according to the combined skin diseases, the mean levels of IgE were highest in the patients with seborrheic dermatitis and male pattern bladness, but the value was not significant compared to that of the normal control. The mean levels of eosinophil counts in seborrheic dermatitis patients were higher than in the normal control, but it was not significant statistically. CONCLUSION: According to the results of the study, the patients with seborrheic dermatitis showed a higher incidence of symptoms and signs of atopic dermatitis and higher levels of serum IgE than the normal subjects. Further studies will be needed to elucidate the relationship between seborrheic dermatitis and atopic dermatitis.