Subungual soft tissue chondroma with nail deformity in a child.

Soft tissue chondroma is a rare benign tumor of the cartilage. It occurs commonly in distal extremities of middle-aged patients. It is usually asymptomatic and grows slowly, making early diagnosis difficult. We report a 10-year-old patient with a 1-year history of a subungual soft tissue chondroma on her left fifth finger. The lesion arose from nail bed and distal nail matrix, resulting in nail dystrophy. Magnetic resonance imaging revealed a soft tissue tumor in the subungual region and soft tissue chondroma was diagnosed, based on histopathologic findings. Dermatologists should consider soft tissue chondroma in the differential diagnosis of subungual tumors of children.

Expression of insulin-like growth factor-1 receptor in conventional cutaneous squamous cell carcinoma with different histological grades of differentiation.

BACKGROUND: Insulin-like growth factor-1 receptor (IGF-1R) is a key regulator of cell transformation and controls the expression of genes that governs cell cycling and cell survival. The aim of this pilot study was to gain insight into the expression pattern of IGF-1R in conventional cutaneous squamous cell carcinoma (CSCC) using immunohistochemical analysis. MATERIALS AND METHODS: Five cases of normal human paraffin-embedded skin sections, 4 cases of actinic keratosis, and 28 cases of paraffin-embedded sections of different histological subtypes of CSCC were selected for immunohistochemical analysis. RESULTS: In normal skin, IGF-1R expression was detected in the epidermal basal cell layer. In actinic keratosis, IGF-1R was expressed in the lower part of the epidermis. IGF-1R was detected in the cell surface membrane of well-differentiated CSCC. In moderately differentiated CSCC, IGF-1R was expressed predominantly in the cytoplasm. Interestingly, IGF-1R was expressed in the nuclei of tumor cells of poorly differentiated CSCC. CONCLUSIONS: The strong and differential expression of IGF-1R in different histological degrees of CSCC indicates a possible role for IGF-insulin receptor in the carcinogenesis and differentiation of this disease and identifies IGF-1R as an interesting target for prevention and treatment of CSCC that deserves further investigation.

Expression of hypothalamic-pituitary-adrenal axis in common skin diseases: evidence of its association with stress-related disease activity.

Hypothalamic-pituitary-adrenal (HPA) axis hormones and their receptors expressed in the skin are known to function locally, but how these hormones affect the maintenance of skin homeostasis or the pathogenesis of skin diseases is not fully understood. We comprehensively reviewed the distribution and function of the central and peripheral HPA axis in various stress-related skin diseases. Previous studies have shown altered expression of central and peripheral HPA axis hormones in chronic inflammatory skin diseases and skin tumours, and that hyper-active lesional HPA axis hormones may negatively feedback to the central HPA axis and interact with some cytokines and neuropeptides, leading to symptom deterioration. This provides an evidence-based understanding of the expression of the central and peripheral HPA axis in common skin diseases and its association with disease activity.

Clinical characteristics of 75 patients with leukemia cutis.

Leukemia cutis (LC) is defined as a neoplastic leukocytic infiltration of the skin. Few clinical studies are available on recent trends of LC in Korea. The purpose of this study was to analyze the clinical features and prognosis of LC in Korea and to compare findings with previous studies. We performed a retrospective study of 75 patients with LC and evaluated the patients' age and sex, clinical features and skin lesion distribution according to the type of leukemia, interval between the diagnosis of leukemia and the development of LC, and prognosis. The male to female ratio was 2:1, and the mean age at diagnosis was 37.6 yr. The most common cutaneous lesions were nodules. The most commonly affected site was the extremities in acute myelocytic leukemia and chronic myelocytic leukemia except for acute lymphocytic leukemia. Compared with previous studies, there was an increasing tendency in the proportion of males and nodular lesions, and LC most often occurred in the extremities. The prognosis of LC was still poor within 1 yr, which was similar to the results of previous studies. These results suggest that there is a difference in the clinical characteristics and predilection sites according to type of leukemia.

Effects of long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet laser on dermal collagen remodeling in hairless mice.

BACKGROUND: Nonablative lasers are used for dermal collagen remodeling. Although clinical improvements have been reported using various laser devices, the mechanism of dermal collagen remodeling remains unknown. OBJECTIVE: To investigate the effects of energy fluences of the long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) nonablative laser on dermal collagen remodeling and evaluate the dermal collagen remodeling mechanism. MATERIALS AND METHODS: Hairless mice were pretreated with ultraviolet B irradiation to produce photo-damage. The laser treatment used a long-pulse 1,064-nm Nd:YAG laser at energy fluences of 20, 40, and 60 J/cm(2) . The amount of dermal collagen and expressions of transforming growth factor beta (TGF-ß), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) of laser treated skin were compared with those of nontreated control skin. RESULTS: The long-pulse Nd:YAG laser treatment increased dermal collagen and significantly increased TGF-ß expression. The expression of MMP-1 decreased with low energy fluence. The expression of TIMP-1 was not significantly different. CONCLUSION: Long-pulsed 1,064-nm Nd:YAG laser increases the dermal collagen in association with the increased expression of TGF-ß.

Coexistence of congenital linear porokeratosis and disseminated superficial porokeratosis.

The coexistence of two or more forms of porokeratosis in a single individual is rarely reported. We report here on a patient exhibiting the coexistence of congenital linear porokeratosis and disseminated superficial porokeratosis. To our knowledge, this entity has been previously reported only once.

LL-37 suppresses sodium nitroprusside-induced apoptosis of systemic sclerosis dermal fibroblasts.

The human cathelicidin antimicrobial peptide LL-37 regulates apoptosis of several cell types. Defective apoptosis of skin fibroblasts may contribute to systemic sclerosis (SSc). Here, we show that LL-37 inhibited apoptosis of SSc fibroblasts and identified the signalling pathways by which LL-37 mediates apoptosis. Immunohistochemistry showed that cathelicidin expression was enhanced in SSc patients compared with healthy controls. In addition, LL-37 decreased sodium nitroprusside (SNP)-induced apoptosis of SSc fibroblasts. LL-37 significantly increased expression of Bcl-2 and decreased levels of BAX protein. Pretreatment with LL-37 decreased activation of caspase-3 following SNP-treatment. Moreover, exposure of SSc fibroblasts to LL-37 resulted in increased expression of COX-2 and stimulation of prostaglandin E(2) (PGE(2)). Furthermore, LL-37 induced phosphorylation of ERK and the ERK inhibitor PD98059 blocked the inhibitory effect of LL-37 on apoptosis. Our data indicate that LL-37 may be associated with skin sclerosis by inhibiting apoptosis of dermal fibroblasts.

Erythroid differentiation regulator 1 (Erdr1) is a proapototic factor in human keratinocytes.

Skin is constantly exposed to physical and chemical stressors. The exposure of keratinocytes to ultraviolet B (UVB) irradiation causes epidermal damage via induction of apoptosis. Erythroid differentiation regulator 1 (Erdr1) modulates growth and survival of cells under various stressful conditions, but the function of Erdr1 in human keratinocyte apoptosis has not been investigated so far. Here, we investigated the effect of Erdr1 on UVB-induced apoptosis in human keratinocytes and also examined the underlying regulatory mechanism. First, Erdr1 expression was detected in human primary keratinocytes and normal human skin tissues. Expression of Erdr1 was enhanced in human keratinocytes following UVB irradiation. Knock-down of Erdr1 led to resistance to UVB-induced apoptosis. Also, Erdr1 overexpression increased UVB-induced apoptosis and induced caspase-3 activation. Furthermore, the extracellular signal-regulated kinase (ERK) inhibitor PD98059 and the p38 mitogen-activated protein kinase (MAPK) inhibitor SB203580 significantly reduced Erdr1 expression following UVB irradiation. These results indicate that UVB induces Erdr1 via a MAPK-dependent mechanism. Taken together, these findings suggest that Erdr1 has a role as a proapoptotic factor in human keratinocytes and acts via ERK and p38 MAPK pathways. Therefore, Erdr1 may be a potential therapeutic target to reduce apoptosis in keratinocytes in conditions such as psoriasis and skin cancer.

Vitamin C attenuates ERK signalling to inhibit the regulation of collagen production by LL-37 in human dermal fibroblasts.

Vitamin C is used as an anti-ageing agent because of its collagen enhancing effects. The precise cellular signalling mechanism of vitamin C is not well known. Here, we investigate the profibrotic mechanism of vitamin C against LL-37. Antimicrobial peptide LL-37 decreases collagen expression at mRNA and protein levels in human dermal fibroblasts (HDFs). The ability of LL-37 to inhibit collagen expression is dependent on phosphorylation of extracellular signal-regulated kinase (ERK). HDFs and human keloid fibroblasts were treated with vitamin C followed by 2 h of LL-37 treatment. Collagen mRNA expression and total soluble collagen production inhibited by LL-37 was enhanced by treatment with 0.5 mm vitamin C. Vitamin C also decreased intracellular reactive oxygen intermediates (ROI) levels that were increased by LL-37. Furthermore, the phosphorylation of ERK was analysed by Western blot following treatment with vitamin C and LL-37. Vitamin C turned off phosphorylation of ERK that was induced by LL-37. Ets-1 transcriptional factor, which is involved in the regulation of collagen expression by LL-37, was also inhibited by vitamin C. This study shows that vitamin C enhances collagen production by inhibiting the ERK pathway induced by LL-37.

Influence of skin peeling procedure in allergic contact dermatitis.

BACKGROUND: The prevalence of allergic contact dermatitis in patients who have previously undergone skin peeling has been rarely studied. OBJECTIVES: We compared the frequency of positive patch test (PT) reactions in a patient group with a history of peeling, to that of a control group with no history of peeling. PATIENTS/METHODS: The Korean standard series and cosmetic series were performed on a total of 262 patients. 62 patients had previously undergone peeling and 200 patients did not. RESULTS: The frequency of positive PT reactions on Korean standard series was significantly higher in the peeling group compared with that of the control group (P < 0.05, chi-square test). However, the most commonly identified allergens were mostly cosmetic-unrelated allergens. The frequency of positive PT reactions on cosmetic series in the peeling group was higher than that of the control group, but lacked statistical significance. The frequency (%) of positive PT reactions on cosmetic series in the high-frequency peel group was higher than that of the low-frequency group, but lacked statistical significance. CONCLUSION: It appears peeling may not generally affect the development of contact sensitization. Further work is required focusing on the large-scale prospective studies by performing a PT before and after peeling.

Case of dystrophic calcinosis cutis in epidermal cyst arising from verrucous epidermal nevus.

Dystrophic calcinosis cutis is diagnosed when calcium is deposited into previously damaged tissue by connective tissue disease, panniculitis, pseudoxanthoma elasticum or trauma. We report a case of dystrophic calcinosis cutis arising from the lesion of an epidermal cyst on the verrucous epidermal nevus. A 20-year-old woman presented with a polypoid pinkish tumor on a brownish, verrucous plaque. Histopathological findings of the pinkish tumor showed calcium deposits as amorphous, basophilic material lining the true epidermis in the upper dermis, which were compatible with dystrophic calcinosis cutis and the plaque was diagnosed as a verrucous epidermal nevus.

An Uncommon Presentation of Human Otoacariasis by Haemaphysalis longicornis.

Ticks are obligate parasites on animals and sometimes humans. They usually suck the blood of the hosts and can carry various infectious diseases as a vector. Otoacariasis is the presence of ticks and mites within the ear canal and relatively common in domestic and wild animals. However, tick infestations of human ear canals are rarely reported in the scientific literature and hardly occur in developed countries. Herein, we report a rare case of otoaracariasis involving Haemaphysalis longicornis . A 9-year-old girl living in a suburb presented with otalgia of left ear for 1 day. Otoscopic examination revealed a huge insect occluding the tympanic membrane. Tick removal and washing of external auditory canal was done successfully. The causative tick was identified as the H. longicornis. To our knowledge, this is the first reported case of human otoacariasis by a H. longicornis in Korea.

Clinical characteristics of acquired ungual fibrokeratoma.

BACKGROUND: Acquired ungual fibrokeratomas are uncommon fibrous tissue tumors located in the ungual area. Though there are many reports of this entity, only some reports have reviewed the clinical features of the tumor. AIMS: The aim of this study was to clarify the clinical characteristics of acquired ungual fibrokeratomas. METHODS: We reviewed twenty patients who were treated surgically at our clinic from 2003 to 2014 for acquired ungual fibrokeratomas confirmed on histopathological examination. Our study was conducted by retrospective analysis of charts, clinical pictures and patient records. Cases of tuberous sclerosis were not included. RESULTS: Acquired ungual fibrokeratomas occurred on toenails in 16 (80%) patients and on fingernails in 4 (20%) patients. Periungual lesions were noted in 15 (75%) patients followed by intraungual lesions in 4 (20%) patients and subungual lesions in 1 (5%) patient. A longitudinal groove was observed in 80% of patients. Surgical resection was performed in all cases for both medical and cosmetic reasons. After excision, recurrence occurred in three cases. LIMITATIONS: This was a retrospective study of a limited number of patients. CONCLUSIONS: Acquired ungual fibrokeratomas occurred more commonly on toenails than on fingernails and were located in the periungual area in most patients. A longitudinal groove in the nail plate was a frequent finding. Surgical resection led to medical and cosmetic improvement with a recurrence in 3 (15%) patients.

Onychomatricoma: A Rare Tumor of Nail Matrix.

Onychomatricoma is a rare tumor of the nail matrix. Until now, few cases of onychomatricoma have been reported in the literature. Immunohistochemically, CD10, a marker of the onychodermis, is expressed in the stroma of the onychomatricoma. In the present case, a 27-year-old woman presented with an 8-year history of a yellowish, thickened, and overcurved nail plate of the right index finger, mimicking onychomycosis. She had been treated for 4 years with antifungal agents by general physicians, without improvement. The nail was surgically removed, and the tumor at the nail matrix was excised. The nail plate continued to grow in the 2 months after the excision. This is a case of onychomatricoma in South Korea, which was initially misdiagnosed as onychomycosis. In addition, we present a review of the literature regarding clinical, sonographic, and histological features, differential diagnoses, and treatment of onychomatricoma.

Corticotropin-releasing hormone (CRH) downregulates interleukin-18 expression in human HaCaT keratinocytes by activation of p38 mitogen-activated protein kinase (MAPK) pathway.

It is generally accepted that corticotropin-releasing hormone (CRH) acts as the main coordinator of the central response to stress. Stress or an abnormal response to stressors has been found to modify the evolution of skin disorders, including psoriasis and atopic dermatitis. Nevertheless, the specific pathogenic role of stress remains unknown in skin diseases. Interleukin (IL)-18, a member of the IL-1 family, is a key mediator of peripheral inflammation and host defense responses, and is secreted by human keratinocytes. Here, we investigated the regulatory effect of CRH on expression of IL-18 in skin keratinocytes. Exposure of HaCaT cells to CRH resulted in a reduction of IL-18 mRNA transcripts and its production was in a concentration-dependent manner. In order to investigate whether the mitogen-activated protein kinase (MAPK) signaling pathway is involved in the downregulation of IL-18 production, cells were pre-treated with SB203580, an inhibitor of p38 MAPK, prior to the addition of CRH. This pre-treatment blocked the decrease in IL-18 production. In addition, CRH treatment induced rapid phosphorylation of p38 MAPK. SB203580 were able to inhibit CRH-induced p38 MAPK phosphorylation. CRH also inhibited production of IL-18 in human primary keratinocytes. These results suggest that CRH regulates IL-18 production through the MAPK signaling pathway in human keratinocytes.