Clinical Study for Alopecia Areata in Children under 12 Years old / 대한피부과학회지

BACKGROUND: Child hairs are not the same as adult hairs because human hair follicles produce different types of hairs throughout life from fetal stage to adult time through neonatal, childhood, and adolescent stage. Alopecia areata is a chronic recurrent hair disease caused by autoimmune mechanism. Considering above facts and psychophysical immaturity of children, there may be some difference in clinical and therapeutical aspects between childhood and adult in alopecia areata. OBJECTIVE: To observe and evaluate the characteristic clinical findings of alopecia areata in children. METHOD: 138 cases of alopecia areata developed before 12 years old were clinically studied and followed up for at least three years. RESULTS: 1. The total number of child patients(138) was 13.5% of total cases of alopecia areata(1,023) seen at the same period in the hospital. There was no sexual difference in this incidence. 2. The incidence rate was low before 5 years old. No case was found in neonatal stage. 97 cases(70%) developed after 6 years old. 3. 100 cases(72.5%) were common type showing one to several coin shaped bald lesions. 38 cases(27.5%) were severe type belonging to one of the following; alopecia universalis, alopecia totalis, alopecia semitotalis or ophiasis. 4. Intralesional injection of corticosteroid suspension was possible only after prior local anesthesia with anesthetic ointment(EMLA(R)) in 70%(41/59) even with buffering of the suspension and adding lidocain. 5. In common type, the overall therapeutic rate was 76.3%. In the cases of less than 6 months duration the rate was 90%, but no significant difference was found between the treated goup and the non-treated group with intralesional corticosteroid. In the cases of longer than 6 months the therapeutic rate was 20% but far better with intralesional injection group. 6. In severe type, the overall therapeutic rate was 44.1%(15/43). Intravenous pulse corticosteroid which was used for the type could be administered in safe in general. Follow-up observation up to 9 years revealed that 2(4.7%) patients who had taken the pulse therapy were under the 3 percentile of Koreans of that age in body height and weight.

Walking Inability in a Patient with Darier Disease and its Sociomedical Care / 대한피부과학회지

The patient was a 38-year-old man suffering from walking inability due to Darier's disease mainly involving both soles. The plantar areas showed persistent painful keratotic plaques and erosive fissures. Continuing dermatological treatment did not give him relief from the plantar pain and the actual physical inability. We approached the illness sociomedically to get him relief from the painful soles and helped him get a disability license from the social welfare department of his city, by which he could get an economical automobile for his purpose. We think that dermatologists shoulds try to help the patients with intractable dermatoses not only by medical treatment but also by a social welfare approach.

Four Cases of Majocchi's granuloma / 대한의진균학회지

Dermatophytes usually do not invade beyond the epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state, such as diabetes mellitus, lymphoma, and long-term steroid use may allow penetration of the fungi into reticular dermis. Cutaneous granulomas produced by infection with superficial fungi are infrequently recognized. We report four cases of dermatophytic granuloma on the lower extremities. Histopathologic examinations of the skin lesions of four patients showed chronic granulomatous inflammation with fungal elements. Cultures of Sabouraud's media with excised tissue revealed Trichophyton(T.) rubrum in two patients and T. mentagrophytes in one patient. The patients were treated with oral administration of terbinafine or itraconazole for 2-4 weeks.

A Case of Chloracne Due to Exposure to Defoliating Agent During Vietnam war / 대한피부과학회지

Chloracne is a refractory acneiform eruption due to halogenated polyaromatic compound(eg. dioxin, dibenzofurans, polychlorinated biphenyls, etc.). 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin, a kind of dioxin isomer, contained in the Agent Orange which was used for defoliating agent during Vietnam war. It is characterized by recalcitrant comedones and cyst predominantly in the malar and postauricular area. Lesions of the penis and scrotum are also relatively frequent. The key pathological feature is the non-inflammatory keratinization of pilosebaceous unit. The meibomian glands are typically affected. Xerosis, conjunctivitis, pigmentation, follicular hyperkeratosis, actinic elastosis are occasionally associated with chloracne. We report a case of typical chloracne due to exposure to defoliating agent during Vietnam war in a 54-year-old-man who shows typical clinical and histopathological features.

Clinical Features of 27 Cases of Ingrowing Toenails and Treatment with Flexible Plastic Tube Insertion / 대한피부과학회지

BACKGROUND: Ingrowing toenail is one of common dermatological disorders causing significant daily disability. Clinical study of the disease seems not to be enough. OBJECTIVE: To elucidate clinical aspects of the disease and to evaluate the plastic tube insertion method for the treatment. METHOD: In 27 cases, clinical stages, sites and duration of lesions, duration and previous treatments were examined. The plastic tube insertion method was done in all of the cases and its results were evaluated. The method ws consisted of insertion of a longitudinally slitted soft flexible plastic tube between the lateral edge of the nail plate and the inflamed soft nail fold. RESULT: 1. Age distribution showed 96% (26 cases) were between 15 to 36 years with mean 25 years. 2. Average duration of illness was 18 months. 12 cases(45%) was previously treated with various operative methods. 3. 9 cases wre involved in both feet and 18 cases in unilateral foot. Among the unilateral 18 cases, 12 cases were in right foot and 6 cases in left foot. 4. In each involved toenail 8 cases showed both side lesions and 19 cases showed one side lesions. Among the 19 cases 6 cases had medial side lesions and 13 cases lateral side lesions. 5. By the plastic tube method, 96% (26 cases) had immediate relief of the pain. But 63%(17 cases) showed recurrence and needed other treatment within 6 months. CONCLUSION: Predilection age of the ingrowing toenail was between 15 to 36. The most common site is the lateral side of the right great toe. The rate of the cure by the plastic tube method was only 37%.

A Case of Spontanous Bullae at Recipient Site after Epidermal Graft for the Treatment of Vitiligo / 대한피부과학회지

Vesicles and bullae are the primary lesions in many diseases. The histologic classification of bullous disorders is based on the level in the skin on which that cleavage developed. We report a 44-year-old man with vitiligo at dorsum of hand who has experienced spontanous bullae at recipient site after epidermal graft for the treatment of vitiligo. Histopathologic examination revealed a subepidermal bullae and moderate lymphocytes and eosinophil infiltration in the dermis. Direct immunofluorescence test was negative. There was a change of CD4/CD8 ratio in immunohistochemical staining for CD4 and CD8 monoclonal antibody. There were no clinical signs of infection and drug eruption, and friction did not seem to have been a contributing factor.