A Case of Livedoid Vasculopathy Successfully Treated with Sulodexide

We report a 29-year-old female with a one-month history of non-healing multiple erythematous to violaceous plaques with crusts over both legs and feet. Tender, scarring ulcers with surrounding erythema were present. The clinical manifestation, together with histopathologic findings of fibrinoid plugs within vascular lumens and walls, as well as red blood cell extravasation, led to diagnosis of livedoid vasculopathy.The patient experienced recurrent painful violaceous plaques with ulcerations during the two years of treatment with oral pentoxifylline 400 mg three times daily. The cutaneous lesions and symptoms dramatically improved after the treatment regimen changed to oral sulodexide (250 lipasemic units) three times daily. Sulodexide, a highly purified mixture of glycosaminoglycans including dermatan sulfate and lowmolecular weight heparin, could be an effective therapy for recalcitrant livedoid vasculopathy. Herein, we report a case of livedoid vasculopathy treated with sulodexide, which has not previously been reported.

Candida famata Infection Presenting as an Erosive Patch on the Sole of an Immunocompetent Patient / 대한피부과학회지

Candida famata previously called Torulopsis famata or Debaryomyces hansenii, is usually found in natural substrates. It was earlier considered nonpathogenic in humans; however, a number of clinical cases of human infection have been reported showing isolation of this yeast. Dermatologic literature contains only a few reports regarding cutaneous infection caused by Candida famata. An 18-year old woman presented with a 4-month history of a 4.0×3.0 cm sized erythematous erosive patch on her left sole. A skin biopsy revealed numerous spores and hyphae in the epidermis. Histopathological specimens showed positive findings using the Periodic acid-Schiff and Gomori methenamine silver stains but negative findings using acid-fast bacilli stain. Cultures from skin scrapings yielded numerous colonies. Identification of the fungus was processed up to species level using VITEK 2 (bioMérieux, Inc. Hazelwood, MO, USA), and Candida famata was isolated. She was administered itraconazole at a dose of 200 mg once daily, and following 5 weeks of therapy, the erosive lesion was noted to have completely healed with postinflammatory hyperpigmentation.

Granuloma Annulare Successfully Treated with a Combined Regimen of Excimer Laser and Topical Tacrolimus / 대한피부과학회지

Granuloma annulare is a relatively common benign dermatosis of unknown etiology. It is typically characterized by skin-colored to violaceous annular or arcuate lesions. The localized form of the disease usually resolves spontaneously, but treatment may be required in cases of intractable symptoms such as pruritus, or for cosmetic purposes. Herein, we report the case of a 65-year-old man diagnosed with a localized form of granuloma annulare that was refractory to various treatments but showed clinical improvement with a combined regimen of excimer laser and topical tacrolimus.

Histiocytic Sarcoma of the Cervical Spinal Cord with Secondary Involvement of the Skin / 대한피부과학회지

Histiocytic sarcoma is a rare, lymphohematopoietic malignant tumor comprised of tumor cells with the morphological and immunophenotypic features of mature histiocytes. A 35-year-old man presented with a disseminated histiocytic sarcoma that first occurred in the spinal cord and metastasized to the skin and lymph nodes. The tumor cells of the primary histiocytic sarcoma of the spinal cord were very large epithelioid cells with abundant eosinophilic cytoplasms and large, round-to-oval nuclei. In contrast, the metastatic histiocytic sarcoma of the skin was composed of relatively small polygonal cells with well-defined cell borders and high N/C (nucleus/cytoplasm) ratios. Immunohistochemically, both tumors were diffusely positive for histiocyte-associated antigens; but negative for epithelial, melanocyte, lymphoid, and dendritic cell antigens. It is important to recognize the morphological features and immunohistochemical characteristics of metastatic cells in order to ensure accurate diagnoses.

Leukocytoclastic Vasculitis Associated with Orientia tsutsugamushi Infection: A Report of Two Cases / 대한피부과학회지

No abstract available.

Linear Scleroderma Clinically Improved with Cyclosporine / 대한피부과학회지

No abstract available.

Linear Scleroderma Clinically Improved with Cyclosporine / 대한피부과학회지

No abstract available.

Annular Erythema of Infancy / 대한피부과학회지

No abstract available.

Clinical Significance of Serum Varicella Zoster Virus Immunoglobulin M and G in Varicella and Herpes Zoster / 대한피부과학회지

BACKGROUND: The presence of serum varicella zoster virus (VZV) immunoglobulin M and G (IgM and IgG) aid diagnosis of and confirmation of immunization against varicella and herpes zoster. However, the relationship between serum VZV IgM and IgG and the clinical characteristics of VZV infection remains unclear. OBJECTIVE: We evaluated quantitative changes in serum VZV IgM and IgG in accordance with the clinical features of varicella, herpes zoster, and disseminated herpes zoster compared with a normal control group. METHODS: A total of 922 patients were classified into 3 groups: varicella, herpes zoster, and disseminated herpes zoster. We assessed serum VZV IgM and IgG titers in association with age, severity of skin lesions, duration of skin lesions, immune status, and neurologic complications. RESULTS: In patients with varicella and herpes zoster, serum antibody titer varied significantly depending on age and the duration of skin lesions. A high serum VZV IgM titer was related to varicella or disseminated herpes zoster viremia. In herpes zoster, elevated antibody titers, especially VZV IgM, were associated with severe skin lesions and the presence of neurologic complications. CONCLUSION: Serologic data for varicella and herpes zoster varied according to clinical features. A high serum VZV IgM titer was associated with an unfavorable clinical course of herpes zoster.

A Case of Solitary Trichoepithelioma on the Toe / 대한피부과학회지

Trichoepithelioma (TE) is a benign lesion that arises from hair follicles. Solitary TE occurs mainly on the face in young adults. Various previous reports have described the localization of this disorder, but there have been no reported cases with presentation on the toe. Histopathologically, TE shares characteristic features with basal cell carcinoma (BCC), so immunohistochemical stains are required for the differential diagnosis. Therefore, we report the first case of TE occurring on the toe, confirmed with immunohistochemial differentiation.

A Case of Lichen Nitidus Treated with Adapalene-benzoyl Peroxide Fixed-dose Combination Gel / 대한피부과학회지

No abstract available.

Eccrine Poroma Arising in Free-Flap Donor Site / 대한피부과학회지

No abstract available.

Pachydermoperiostosis Associated with Peptic Ulcer and Hyperplastic Polyp of Stomach / 대한피부과학회지

No abstract available.

Necrobiosis Lipoidica Over Surgical Scar in a Patient without Diabetes Mellitus / 대한피부과학회지

Necrobiosis lipoidica (NL) is a chronic granulomatous skin disease typified by indurated plaques on the shin. Although this condition is strongly associated with diabetes mellitus, its etiology and pathogenesis remains unknown. Localization of NL to the lower extremities suggests that local injury may be a contributing factor to the disease. A healthy 38-year-old man presented with localized erythematous to yellowish plaques on his right thigh that developed over several years. The lesion developed in the scar where suture had been done for laceration repair 25 years ago. A biopsy specimen showed degenerated collagen with surrounding palisading granulomas. Numerous lymphocytes and multinucleated giant cells were infiltrated throughout the reticular dermis. Plasma cells aggregation was found at the dermal subcutaneous junction.

Primary Cutaneous Cryptococcosis Mimicking Herpes Zoster / 대한피부과학회지

Primary cutaneous cryptococcosis (PCC) is a localized skin infection confined to one body region, without evidence of dissemination. The clinical presentation of PCC is so variable that its diagnosis requires a high index of suspicion. A 52-year-old woman presented with localized grouped erythematous papulovesicles on the left ear lobe for 6 months with wax and wane pattern. However, there were no signs of systemic cryptococcal infection. Histopathological examination showed numerous encapsulated round spores and budding yeasts in the dermis. Culture of aspirate from the wound and tissue samples revealed Cryptococcus neoformans. Herein, we report an interesting case of PCC on the left ear that clinically mimics herpes zoster.

Immunoresuscitation Effect on Hemorrhagic Shock-Induced Acute Lung Injury in Rats

PURPOSE: Recent studies have indicated that cytokines and inflammatory responses are related to hemorrhagic shock-(HS) induced acute lung injury. Novel, synthetic, broad-acting serine protease inhibitors that protect a wide range of animals from lethal shock have been evaluated as potential immunoresuscitation modulators. The aim of this study was to test the hypothesis that a test modulator could decrease serum and tissue pro-inflammatory mediator levels, prevent HS-induced acute lung injury, and suppress activation of the inflammatory cascade. METHODS: This HS model consisted of four phases: Phase I, initiation of HS (from 15~30 min) with a volume-controlled hemorrhage of 2.7 mL/100 g over 15 min; Phase II, maintenance of HS (HS Phase, from 30~90 min), with maintenance of shock without resuscitation; Phase III, resuscitation (RT phase, from 90~150 min), with reinfusion of 1.5 mL/100 g of blood and Ringer's lactate fluid; and Phase IV, observation and post-resuscitation (OB phase, from 150~270 min). The test rats were randomized into two groups of 15: group 1 with fluid resuscitation (control group) and group 2 with fluid and 0.5mg/kg nafamostat mesilateinfusion (treated group). RESULTS: The mean arterial pressure (MAP) of the treated group increased significantly during the observation and post-resuscitation period (Phase IV, OB 90 min). The heart rate of the control group increased significantly during the maintenance of shock (Phase II, HS 60 min), resuscitation (Phase III, RT 30 and 60 min), and observation periods (Phase IV, OB 120 min). The serum concentrations for IL-6 and IL-10 did not differ significantly between the treated and control groups. The TNF-alpha levels for the treated group were significantly lower than those of the control group (p<0.05). At the end of the observation period (OB 120 min), the treated group had significantly lower concentrations of IL-8 in the bronchoalveolar lavage fluid (BALF) than the control group (676.7+/-791.9 vs. 1062.5+/-609.9, p=0.013). CONCLUSION: We conclude that the tested serine protease inhibitor improves hemodynamic parameters, prevents acute lung injury after HS, and attenuates a robust proinflammatory cytokine response in rats.

Pulp response of beagle dog to direct pulp capping materials: Histological study / 대한치과보존학회지

The purpose of this study was to evaluate the pulp tissue reaction to direct pulp capping of mechanically exposed beagle dogs'pulp with several capping materials. A total of 36 teeth of 2 healthy beagle dongs were used. The mechanically exposed pulps were capped with one of the followings: (1) Mineral Trioxide Aggregate (MTA: ProRoot(R) MTA, Dentsply, Tulsa, USA), (2) Clearfil SE Bond (Dentin adhesive system: Kuraray, Osaka, Japan), (3) Ultra-Blend (Photo-polymerized Calcium hydroxide: Ultradent, South Jordan, USA), (4) Dycal (Quick setting Calcium hydroxide: LD Caulk Co., Milford, USA) at 7, 30, and 90 days before sacrificing. The cavities were restored with Z350 flowable composite resin (3M ESPE, St. Paul. MN, USA). After the beagle dogs were sacrificed, the extracted teeth were fixed, decalcified, prepared for histological examination and stained with HE stain. The pulpal tissue responses to direct pulp capping materials were assessed. In MTA, calcium hydroxide, and photo-polymerized calcium hydroxide groups, initial mild inflammatory cell infiltration, newly formed odontoblast-like cell layer and hard tissue bridge formation were observed. Compared with dentin adhesive system, these materials were biocompatible and good for pulp tissue regeneration. In dentin adhesive system group, severe inflammatory cell infiltration, pulp tissue degeneration and pulp tissue necrosis were observed. It seemed evident that application of dentin adhesive system in direct pulp capping of beagle dog teeth cannot lead to acceptable repair of the pulp tissue with dentine bridge formation.

A Case of Ciliochoroidal Detachment After Patterned Scanning Laser Photocoagulation With Short Exposure Time

PURPOSE: To report the case of a patient with ciliochoroidal detachment after brief exposure to patterned scanning laser photocoagulation. CASE SUMMARY: We examined a 62-year-old woman with early proliferative diabetic retinopathy and observed neovascularization and macular edema upon fundus examination. The patient underwent patterned scanning laser photocoagulation with an exposure time of 0.03 sec over the entire retina in a single pass. In vivo, the ciliary body and choroid were examined using ultrasound biomicroscopy (UBM), before, immediately after, 3 and 7 days after panretinal photocoagulation. Ciliochoroidal detachment was observed 3 days after panretinal photocoagulation and spontaneously disappeared by 7 days after photocoagulation. The change in IOP coincident with ciliochoroidal detachment were not significant. CONCLUSIONS: Ciliochoroidal detachment after panretinal photocoagulation may lead to complications such as angle-closure glaucoma. Patterned scanning laser photocoagulation with short exposure time should be practiced only with careful attention to the possible development of cilochoroidal detachment.

A Case of Needleless Jet Injector Induced Bilateral Chorioretinal Injury

PURPOSE: To report a case of bilateral chorioretinal injury by needleless jet injector misuse. CASE SUMMARY: In a dermatology department, the patient was diagnosed as having total alopecia and was scheduled to be injected on her eyelash by needleless jet injector for treatment but inexpert doctor injected on the eyelid, not eyelash, by mistake. She then suddenly complained of blurred vision and a floater just after that procedure and was referred to the ophthalmology department. Bilateral vitreous hemorrhage and preretinal hemorrhage were seen during indirect ophthalmoscopic examination and bilateral prophylactic argon laser photocoagulation was done around the suspicious tear site. Then bilateral vitreous hemorrhage and preretinal hemorrhage were absorbed and we found a partial retinal rupture lesion and choroidal rupture lesion in the right eye and a retinal injury lesion in the lefteye. Therefore we observed the lesions of both eyes continuously without further treatment. Her clinical symptoms improved. CONCLUSIONS: Needleless jet injector has many advantages, especially less pain and injury than a normal needle injector and is usually used in clinic as preoperative local anesthesia and steroid injection in many medical fields. In this case, the needleless injector was accidentally misused inducing both direct and indirect choroidal rupture and retinal injury. In general, while a needleless jet injector is used in ophthalmology department, we have to use it with the greatest care.

The Comparison of Macular Thickness Measurements and Repeatabilities Between Time Domain and Spectral Domain OCT

PURPOSE: To compare macular thickness measurements obtained from time domain optical coherence tomography (TD-OCT) and 2 spectral domain (SD) OCTs and to evaluate their repeatability and agreement in normal subjects and diabetic macular edema patients. METHODS: Fifty-four healthy, normal subjects and 26 diabetic macular edema patients were participated in this study. In a randomly selected eye from each subject, two serial macular measurements were obtained from TD-OCT (Stratus OCT) and SD-OCTs (Cirrus HD-OCT, Spectralis HRA+OCT) by an experienced technician in random order. Nine areas of macular thickness map and repeatabilities obtained by the 3 OCTs were compared. RESULTS: In relative repeatability, SD-OCT showed better results overall compared to TD-OCT. Macular thickness was greatest in the Spectralis HRA+OCT in both normal subjects and diabetic macular edema patients, followed by Cirrus HD-OCT and Stratus OCT. In normal subjects, regardless of the type of comparison between the machines there was a statistically significant difference in all 9 areas. CONCLUSIONS: While the TD-OCT and the 2 SD-OCTs are reliable for macular thickness measurement, SD-OCT has better measurement repeatability compared with TD-OCT. Because macular measurements obtained from the 3 OCT systems cannot be interchanged, an effort should be made to standardize the measurement of each system.