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( Byung Soo Kim ),( Won Ku Lee ),( Kyoungjune Pak ),( Seong Jang Kim ),( Junhee Han ),( Jeong Min Kim ),( Gun Wook Kim ),( Margaret Song ),( Hoon Soo Kim ),( Hyun Chang Ko ),( Moon Bum Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2
Background: Ustekinumab has established a favorable benefit-risk profile for moderate to severe chronic plaque psoriasis, but little is known about its efficacy on the comorbidities especially systemic inflammation.Objectives: To evaluate the efficacy of ustekinumab for systemic and vascular inflammation of patients with moderate to severe psoriasis by by [18F]- fluorodeoxyglucose positron emission tomography-computed tomography (18FDGPET/CT). Methods: Moderate to severe psoriasis patients were evaluated with 18FDG PET/CT before ustekinumab treatment and after achieving PASI75 with ustekinumab. FDG uptake in the liver, spleen and 5 segments of aorta was evaluated by calculating the maximum standardized uptake value (SUVmax). Results: Eleven patients with psoriasis were enrolled in this study (6 males, 5 females; mean age, 41.5 years).In accordance with clinical improvement in psoriatic skin lesions, images on subsequent 18FDG PET/CT scan revealed an appreciable decrease in FDG uptake in the liver, spleen and aorta. Conclusion: This study suggests that treatment ustekinumab is effective in reducing systemic and vascular inflammation accompanied with moderate to severe psoriasis. We also show the usefulness of 18 FDG PET/CT to monitor whole-body inflammation during psoriasis treatment.
Topical timolol agent for managing infantile hemangiomas: Should it be limited to small lesions?
( Woo Il Kim ),( Jeong Min Kim ),( Gun Wook Kim ),( Margaret Song ),( Hyun Chang Ko ),( Byung Soo Kim ),( Moon Bum Kim ),( Hoon Soo Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2
Background: Infantile hemangiomas (IHs) are the most common vascular tumors of infancy. Topical timolol is a nonselective beta-blocker known as a possible management option for small and superficial IHs. However, there have been few large-scale studies about efficacy and safety of topical timolol for managing IHs. Objectives: The purpose of this study was to investigate efficacy and safety of topical timolol for managing IHs according to type, thickness and size of the lesions. Methods: A total of 132 lesions of 110 patients with IHswere applied with timolol 0.5% ophthalmic solution twice a day without any other therapeutic modalities. Clinical outcome was evaluated at 4-weeks intervals using visual analog scale (VAS) system of 10 as the original lesion before management and 0 as completely normal skin.Results: The duration of timolol therapy ranged from 8 to 100 weeks (mean: 24 weeks). In all patients, mean VAS score decreased from 10 before the management to 8.17 at 4 weeks, 6.94 at 12 weeks, and 4.62 at 24 weeks. Especially, there was significantly better improvement of VAS score in the group of superficial and thinner IHs, while size of the lesions did not affect the rate to change of mean VAS score through the management. No adverse events were observed for all patients. Conclusion: In this study, topical timolol is shown to be a very effective and safe management option for localized superficial and thinner IHs regardless of size of the lesions.
( Woo Il Kim ),( Jeong Min Kim ),( Gun Wook Kim ),( Margaret Song ),( Hoon Soo Kim ),( Hyun Chang Ko ),( Byung Soo Kim ),( Moon Bum Kim ),( Je Ho Mun ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
Pancreatic panniculitis is characterized by the pathognomic histopathologic finding showing lobular panniculitis with focal fat necrosis and ghost-like cells. It appears in 2~3% of all patients with pancreatic diseases and occasionally associated with polyarthritis. This triad is known as the pancreatitis, panniculitis, and polyarthritis (PPP) syndrome. Although, several cases of pancreatic panniculitis were presented in the Korean dermatologic literature, PPP syndrome has not been reported. A 69-year-old man was referred to our clinic with multiple erythematous painful subcutaneous nodules on his both lower legs. He was under the care of hospice for end-stage pancreatic acinar cell carcinoma. His serum lipase level was markedly elevated. Incisional biopsy was performed, and histopathologic finding was consistent with pancreatic panniculitis. After five weeks, he developed pain and marked swelling involving hands, knees and ankles. The radiographic finding of both hands showed multifocal osteolysis. Consequently, the diagnosis of PPP syndrome was made based on the clinical, radiologic and pathologic findings. Herein, we report the first case of PPP syndrome in the Korean dermatologic literature. PPP syndrome should be suspected in pancreatic cancer patients with dermatologic and arthritic symptom.
C-arm related squamous cell carcinoma: consequence of carelessness in anesthesiologist
( Woo Il Kim ),( Jeong Min Kim ),( Gun Wook Kim ),( Je Ho Mun ),( Margaret Song ),( Hyun Chang Ko ),( Byung Soo Kim ),( Moon Bum Kim ),( Hoon Soo Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1
Ionizing radiation is indispensable for modern medical science and physicians. It is used to make numerous diagnostic modalities and treat a variety of diseases. On the other hand, unwanted chronic exposure to ionizing radiation in medical environment isdispensable and should be avoided because it has been known to be a cause ofradiation dermatitis and skin cancer. Case reports ofradiation-induced skin cancers related with technicians handling x-ray devices have been documented but that with physicians are relatively rare. A 49-year-old anesthesiologist presented with erythema toussolitary protruding mass on leftthumb for six months. Since ten years ago, he had performed nerve block using fluoroscopy without any protection. Three years after, he had become aware of erythematous patches on his left 1st to 3rd fingers,and then stopped the procedure. During seven years of follow-up, the lesion had never been improved. Incisional biopsy performed on protruding massshowed histopathologic findings compatible with squamous cell carcinoma. Bone involvement was detected by magnetic resonance imagingand, amputation at the middle level of proximal phalanx was performed. We report a rare case of squamous cell carcinoma arising from chronic radiation dermatitis of physician’s hand. This case alerts physicians handling radiation device to danger of the chronic radiation exposure and need for protecting themselves.
A plaque-type variant of acquired rhabdomyomatous mesenchymal hamartoma on the chin
( Woo Il Kim ),( Hyun Ju Jin ),( Hyang Suk You ),( Woo Haing Shim ),( Jeong Min Kim ),( Margaret Song ),( Hoon Soo Kim ),( Hyun Chang Ko ),( Byung Soo Kim ),( Moon Bum Kim ),( Gun Wook Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1
Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital skin disease. The lesion commonly presents as a solitary sessile papule or nodule on the head and neck in childhood. Its pathologic finding is characterized by aberrant existence of striated muscle fibers in the dermis and subcutaneous tissue. The treatment of typical RMH usually can be a simple excision. However, certain variant of acquired RMH presenting as a plaque on the chin tends to be difficult to be simply excised. To the best of our knowledge, there have been only two reported cases of plaque-type variant of acquired RMH in pubmed searching. A 22-year-old man presented with an asymptomatic erythematous indurated plaque on the chin. The lesion appeared 18 months ago and has shown recent increase of size. Incisional biopsy was performed on the chin and histopathologic finding showed mature striated muscle fibers interspersed haphazardly with collagen fibers and adipocytes in the dermis and subcutaneous tissue. The diagnosis of plaque-type RMH was made based on clinicopathologic finding. We recommended observation with regular follow-up because the lesion was too wide to be excised. We report an extremely rare case of plaque. type variant of acquired RMH and discuss its peculiar clinicopathologic features with the review of literatures.
( Woo Il Kim ),( Jeong Min Kim ),( Gun Wook Kim ),( Margaret Song ),( Hoon Soo Kim ),( Hyun Chang Ko ),( Byung Soo Kim ),( Moon Bum Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2
Background: Pigmented purpuric dermatosis (PPD) is a group of dermatosis with rash of petechiae and pigmentation, and usually has chronic and relapsing course. Although the subtypes of PPD are relatively well established, we experienced new subtype which was not compatible with the previous subtypes. Objectives: The purpose of this study was to present a new subtype of PPD. Methods: There were 17 patients with a new subtype of PPD in whom we analyzed the clinicopathologic characteristics. Results: All of 17 patients were female and mean age was 25.6 years. None of them had histories of drugs and underlying diseases. Mean duration of disease was 5 months. Sites of involvement included lower extremities in 94% (n=16), upper extremities in 82% (n=14), and trunk in 24% (n=4) of patients. Only 2 patients had puritus and the others had no specific symptom. Five of them were treated with oral antihistamines, pentoxifylline or topical steroids while the rest of them showed spontaneous resolution without treatment. Conclusion: Based on these results, we suggests a new subtype of PPD and highlights its detailed clinical characteristics, that is to say, well-demarcated, mostly asymptomatic petechial and pigmentary lesions over extremities in young female with a short duration of disease.
P205 : Xanthoma striatum palmare in a patient of primary biliary cirrhosis with autoimmune hepatitis
( Jeong Min Kim ),( Gun Wook Kim ),( Hyun Ho Cho ),( Won Jeong Kim ),( Je Ho Mun ),( Margaret Song ),( Hoon Soo Kim ),( Byung Soo Kim ),( Moon Bum Kim ),( Hyun Chang Ko ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.1
( Woo Il Kim ),( Jeong Min Kim ),( Gun Wook Kim ),( Margaret Song ),( Hoon Soo Kim ),( Byung Soo Kim ),( Moon Bum Kim ),( Hyun Chang Ko ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2
Background: Keratosis pilaris (KP) is common andcosmetically problematic disorder, but the response to treatment is variable. Topical tretinoin and tacalcitol have been tried for treating variable disorders with abnormal keratinization, but there have been few investigations about comparing efficacy and safety of topical tretinoin and tacalcitol for KP. Objectives: The purpose of this study was to compare efficacy and safety between topical tretinoin and tacalcitol for treating KP. Methods: We conducted a prospective, split-body study in 15 patients with bilaterally symmetrical KP lesions on both arms. Once-daily tretinoin 0.025% cream for the right arm and once-daily tacalcitol 0.002% oint for the left arm were applied. Clinical outcome was evaluated using 5-point investigator’s global assessment (IGA) scoreto rate the changes in roughness and number of keratotic papules at 4-week intervals. In addition, adverse events related to topical treatment were evaluated. Results: There was significantly better improvement of IGA score in roughness and number of keratotic papules on the lesions treated with tretinoin, compared with tacalcitol. 73% (n=11) of patients experienced mild irritation after application of tretinoin while only 1 patient experienced mild irritation on the lesion with tacalcitol. Conclusion: Topical tretinoin 0.025% cream is more effective than topical tacalcitol 0.002% oint for treating KP in spite of mild irritation.
( Woo Il Kim ),( Gun Wook Kim ),( Hyun Ho Cho ),( Won Jeong Kim ),( Je Ho Mun ),( Margaret Song ),( Hoon Soo Kim ),( Byung Soo Kim ),( Moon Bum Kim ),( Hyun Chang Ko ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2
Background: Cafe-au-lait macules (CALMs) are a benign disorder but the response to treatment is variable. Majority of studies have covered how to treat CALMs, but there have been few investigations about the re-pigmentation patterns of CALMs after treatment with Q-switched lasers. Objectives: To assess the patterns of re-pigmentation of CALMs following Q-switched laser treatment. Methods: We enrolled 24 patients who had re-pigmentation of CALMs which was once lightened after Q-switched laser treatment from February 2011 to August 2014. Evaluations of patterns of re-pigmentation were conducted at the beginning and completion of laser treatment and at the time of re-pigmentation occurred. These evaluations were done by digital photographs and dermoscopic findings. Results: At the beginning of this study, we classified the re-pigmentation patterns into four types: perifollicular, marginal, diffuse and combined. We could further divide perifollicuar type into 2 other types: pseudoperifollicuar (or cribriform) and perifollicular through dermoscopic finding. The most frequent re-pigmentation pattern was ‘diffuse’ (N=8), followed by ‘pseudoperifollicuar’ (N=6), ‘combined’ (N=3), ‘perifollicular’ (N=3), ‘marginal’ (N=3). Conclusion: We present different patterns of re-pigmentation of CALMs following Q-switched laser treatment could be classified into 5 types and the most frequent pattern is diffuse type.
Topical rapamycin: The promising therapeutic agent for lymphangioma circumscriptum
( Woo Il Kim ),( Hyunju Jin ),( Hyang Suk You ),( Woo Haing Shim ),( Jeong Min Kim ),( Gun Wook Kim ),( Margaret Song ),( Hyun Chang Ko ),( Byung Soo Kim ),( Moon Bum Kim ),( Hoon Soo Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1
Lymphangioma circumscriptum (LC) is an uncommon lymphatic malformation characterized by grapelike groups of thin-walled translucent lymph-filled vesicles, often compared to frog spawn. The treatment of LC is challenging and complete surgical excision has the lowest recurrence rate but it is sometimes unavailable because of size of the lesion or cosmetic concern of postsurgical scar on the exposed area. Less invasive therapeutic options including laser or sclerotherapy can be tried but the recurrence tends to be common. A 23-year-old woman presented with papules resembling frog spawn on her left neck. The lesions appeared when she was 4 years old and she had treatment with CO2 laser and vascular laser ten more times at local clinic but they had not been improved enough. Skin biopsy was done from papules on her neck and histopathologic finding was consistent with LC. Surgical excision was unavailable because of the cosmetic concern of postsurgical scar. We instructed the patient to apply topical rapamycin cream twice a day. After 4 months of treatment, the lesions significantly improved in size and color compared to the initial presentation. She also had no side effects on the treated site. To the best of our knowledge, there is only one reported proceeding of topical rapamycin used to manage LC. We report this extremely rare experience of treatment and suggest topical rapamycin can be a good therapeutic option for the management of LC.