[Show abstract][Hide abstract] ABSTRACT: A 53-year-old male presented with a 6-year duration of a child's-palm sized hypopigmented patch located on his neck. He had a history of surgical excision of an epidermal cyst on the neck, and the hypopigmented patch developed about one month after the excision next to the surgery site. Application of cold or heat did not make the lesion distinct from the surrounding skin. Pressure on the lesion by a glass slide made the lesion indistinguishable from surrounding uninvolved lesions. Giving friction to the lesion failed to induce erythematous change, making it clearly visible. Histologically, the lesion showed normal findings with adequate numbers of melanocytes in the basal layer. Herein, we present an interesting case of an acquired anemic patch which developed after a cyst excision. We postulate that nerve damage after surgery that regulates the vascular tone of cutaneous vessels may have been an inducing event of the anemic patch in this patient.
Annals of Dermatology 02/2012; 24(1):84-6. DOI:10.5021/ad.2012.24.1.84 · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Schwannoma is a benign neoplasm of the nerve sheath origin. It arises from the nerve sheath of large peripheral or cranial nerves and occurs at the level of the subcutaneous fat layer or deeper layer. Cutaneous schwannoma occurs more superficially and usually presents as a solitary dermal or subcutaneous nodule. We describe a case of cutaneous schwannoma that presented as an erythematous pedunculated protruding mass on the left flank of a 19-year-old female. It was clinically diagnosed as a granuloma pyogenicum. Shaving biopsy was conducted and histological examination revealed an encapsulated tumor mass containing dense, spindle-shaped cells whose nuclei are arranged back to back representing Verocay body, and a diagnosis of schwannoma was made. This is an unusual case of cutaneous schwannoma that presented as a pedunculated protruding mass.
[Show abstract][Hide abstract] ABSTRACT: Segmental vitiligo (SV), which frequently accompanies poliosis, indicating a poor prognosis that is likely resistant to treatments.
In this study, we performed a retrospective analysis to evaluate the treatment response to 308 nm excimer laser in SV patients.
A retrospective chart and photographic review was performed on 80 SV patients who had been treated with 308nm excimer laser for >3 months. Results: Eighty patients with SV (mean age: 24.0 years ± 15.3, males: 50%) were included in this study. The mean grade of repigmentation was 2.3 after 20.6 months of mean treatment duration; 23.8% of 80 patients showed grade 4, 20% showed grade 3, and 56.2% showed grade 1-2 repigmentation. However, none of them achieved complete repigmentation with excimer laser. The degree of repigmentation was positively correlated with treatment duration (r=0.315, P=0.004) and cumulative ultraviolet (UV) dosage (r=0.366, P=0.001), whereas it was negatively correlated with disease duration (r=-0.265, P=0.017).
This study suggests that SV has a better repigmentation response when excimer laser is used at earlier stages of the disease and long-term use and high cumulative UV energy of the excimer laser elicit better responses. Additional treatments like surgical procedures in addition to excimer laser should be considered for complete repigmentation.
[Show abstract][Hide abstract] ABSTRACT: Spitz naevi have not been widely studied in Asians.
To compare the epidemiology and clinicopathological features of Spitz naevi in Koreans with lesions in western countries.
In total, 80 Spitz naevi in 77 patients diagnosed over 10 years at 17 university hospitals in Korea were analysed.
The relative incidence of Spitz naevus vs. MM was 1 vs. 10.9. In most patients (75%) the Spitz naevi had been present for > 6 months. The size of the lesion was relatively large. Histologically, most of the lesions (54%) were the dermal type and pigmentation was common (49% of lesions). Immunohistochemical study found that all of the 34 lesions were positive for S-100 protein but only 14 (47%) were positive for HMB-45.
Spitz naevus is rare in Korea. The lesions were more commonly larger, pigmented, and of the dermal type than reported in western countries.
[Show abstract][Hide abstract] ABSTRACT: Cytotoxic T lymphocyte antigen 4 (CTLA4; CD152) is a costimulatory molecule expressed on activated T cells that plays a key inhibitory role during T lymphocyte activation. The gene encoding for CTLA4 has been suggested as a candidate for conferring susceptibility to autoinflammatory diseases. We investigated the polymorphisms of the CTLA4 gene [promoter region (-1722 T/C, -1661 A/G and -318 C/T) and exon 1 (+49 G/A)] and the differences of serum soluble sCTLA4 levels in 285 patients with Behcet's disease (BD) and 287 controls. The frequency of the CTLA4 -1661 GG genotype was significantly higher in BD patients than in controls [P = 0.019, odds ratio (OR) = 5.2, 95% confidence interval (CI) = 1.13-23.86]. Also, the genotype frequency for CTLA4 -1722 TC was significantly higher (P = 0.014, OR = 1.8, 95% CI = 1.13-2.99), while CTLA4 -1722 CC was significantly lower (P = 0.018, OR = 0.4, 95% CI = 0.20-0.87) in BD patients with ocular lesions compared with patients without this symptom. Serum sCTLA4 levels in BD patients were significantly lower, especially in BD patients with the CTLA4 +49 G allele, than those in healthy controls (P < 0.05). Although our understanding of the role of the CTLA4 gene and its protein product in BD is incomplete, these results suggest that single nucleotide polymorphisms of the promoter and exon regions in the CTLA4 gene are candidates that predispose to BD and that sCTLA4 may be related to the immunological abnormalities and disease expressions associated with BD.
[Show abstract][Hide abstract] ABSTRACT: Acne vulgaris is a distressing condition that affects the majority of adolescents, but the impact of acne vulgaris on the psychological aspects in this age group is poorly understood.
The purpose of this study was to determine the prevalence of acne, and the level of emotional, social, and functional impairments among Korean adolescents with acne.
Five hundred four middle school students (13~16 years) participated. The severity of acne was graded by visual examination using the Korean Acne Grading System. Self-reported questionnaires, including subjective acne severity rating, the Self Image Questionnaire, the Rosenberg Self-Esteem Questionnaire, the Index of Peer Relations, and the Beck Depression Inventory were used to assess psychologic status.
There was a prevalence of acne in 78.9% of the study samples, with 10.2% of students having moderate-to-severe acne. Acne was more prevalent and severe in boys than girls. Participants with severe acne and girls had higher levels of emotional and social impairments. The longer the acne persisted, the more stress the students felt. The degree of stress and extent of self-image impairment were related to subjective severity more than objective grading.
Acne is a common disorder among Korean adolescents and appears to have a considerable impact on mental health. Dermatologists should be aware of the importance of basic psychosomatic treatment in conjunction with early medical, educational intervention in the management of acne.
Annals of Dermatology 05/2009; 21(2):125-9. DOI:10.5021/ad.2009.21.2.125 · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent studies have shown the immunomodulatory effect of vitamin D(3) through down-regulation of Toll-like receptor (TLR) expression in human monocytes. To understand the implication of innate immunity with the role of vitamin D affecting TLR expression in Behçet's disease (BD), we focused on the association between the TLR expression and the serum vitamin D concentration in BD.
The expression of TLR2, TLR4 and CD16 on monocytes was detected by flow cytometric analysis and RT-PCR. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured in the patients with BD, psoriasis and healthy controls, and then the expression of TLRs was correlated with the value of serum 25(OH)D levels. To assess the influence of vitamin D(3) on expression and function of TLRs in vitro, human monocytes were treated with increasing concentrations of 1,25(OH)(2)D(3).
We found that the monocytes of active BD patients showed higher expressions of TLR2 and TLR4 than those of controls, and serum 25(OH)D levels tended to be lower in active BD. Furthermore, 25(OH)D levels were inversely correlated with the expressions of TLR2, TLR4 and clinical indicators. In vitro analysis showed that vitamin D(3) was found to dose-dependently suppress the protein and mRNA expressions of TLR2 and TLR4. TNF-alpha synthesis was also decreased upon TLR ligand stimulation in vitamin D(3)-treated monocytes.
These results suggest that the inflammation triggered through TLR2 and TLR4 is important in the pathogenesis of BD. And it seems possible that vitamin D may be used as a therapeutic option by modulating TLR2 and TLR4 expression of monocytes in BD.
[Show abstract][Hide abstract] ABSTRACT: Capecitabine was developed as a prodrug of 5-fluorouracil (FU), with the goal of improving tolerability and intratumour drug concentrations through tumour-specific conversion to the active drug against numerous types of neoplasms. The most frequent adverse cutaneous reaction associated with capecitabine is hand foot syndrome (HFS), presented with symmetrical erythema, dysaesthesia, and desquamation on the palms and soles. Acquired palmoplantar keratoderma (PPK) can occur in various dermatoses associated with metabolic abnormalities, malignancies, and toxic agents. However, there has been no report of PPK after capecitabine chemotherapy. We report two cases of diffuse PPK, which developed in patients with metastatic breast cancer after one cycle of capecitabine chemotherapy. Because oral capecitabine is increasingly used for various solid tumours, clinicians should be aware that keratoderma can develop during capecitabine chemotherapy as a sequential event of HFS.