Clinical predictor of insulin resistance for acanthosis nigricans in pediatric patients; Homeostasis model assessment of insulin resistance (HOMA-IR)

( Yeona Kim ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Byung-soo Kim ),( Moon-bum Kim ),( Hyun-chang Ko 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Acanthosis nigricans (AN) is not only simple cosmetically disorder but also considered as a cutaneous marker for insulin resistance (IR). Prevalence of obesity and insulin resistance has been increasing in pediatric patients. However, the relationship between AN and IR in this group is rarely reported in the dermatologic literature. Objectives: To evaluate the role of HOMA-IR for finding insulin resistance in pediatric patients with AN. Methods: We designed a prospective study for pediatric patients with AN visiting department of dermatology at Pusan National University Hospital (Pusan and Yangsan) from 2012 to 2018. We analyzed AN severity scale (ANSS), HOMA-IR, oral glucose tolerance test (OGTT), and biochemical laboratory findings. Results: A total of 20 patients (mean age 13.10±3.54 years) with AN were included. 13 patients (65%) showed a positive result in HOMA-IR, while only 3 patients (15%) in OGTT. HOMA-IR positive group had higher ANSS (2.96±0.82 vs. 1.86±0.99, p=0.018) than negative group. Also, there is a positive correlation between ANSS and HOMA-IR. (R=0.751, p<0.01) Conclusion: We suggest ANSS and HOMA-IR are more useful and convenient tool than OGTT in detecting IR in pediatric patients with AN.

A case of unclassifiable phakomatosis pigmentovascularis

( Yeona Kim ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Hoon-soo Kim ),( Moon-bum Kim 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Phakomatosis pigmentovascularis (PPV) can be classified by Classic Hasegawa’s 5 types or new Happle’s 4 types. Though the new Happle’s has some points, it has demerits considering it excluded type I of Classic Hasegawa’s and didn’t cover combined extracutaneous disorders. Classic Hasegawa’s is divided into two subtypes, subtype A and B, based on whether there are only skin manifestations or combined extracutaneous disorders. Although both classifications encompass various congenital skin disorders from keratinocytic, melanocytic, or vascular origin and some extracutaneous disorders, some cases of PPV can’t be classified properly. A 17-month-old female infant presented with brownish macules on left neck, hyperkeratotic brownish plaques on left arm, whitish plaque on right hand dorsum, and erythematous linear patch on both legs. Skin biopsy from each lesion was consistent with agminated lentigines on left neck, epidermal nevus on left arm, connective tissue nevus on right hand dorsum and nevus flammeus on both legs. Discrepancy in the length of extremities was also noted. Therefore, this case was not properly classified by by Classic Hasegawa’s 5 types or new Happle’s 4 types, and so we finally diagnosed her condition as unclassifiable PPV. To the best of our knowledge, there has been no report of PPV with agminated lentigines, epidermal nevus, and connective tissue nevus like this case.

Clinical study of Morbihan disease: analysis of 24 cases

( Yeona Kim ),( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Hoon-soo Kim ),( Byung-soo Kim ),( Tae-wook Kim ),( Moon-bum Kim ),( Hyun-chang Ko ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Morbihan disease (MD), also known as edematous rosacea, is a rare variant of rosacea that involves chronic erythema and persistent upper-facial swelling. MD is not extremely rare disease, but there is little articles regarding its clinical features and course. Objectives: The aim of this study is to examine the clinical characteristics of MD. Methods: We reviewed clinical photographs, medical records of 24 cases diagnosed as MD visiting Pusan national university hospital (Pusan and Yangsan) since 2010. Results: The mean age of patients was 56 (range: 36-75) years old, and 19 (79%) patients were male. 10 patients (42%) showed unilateral upper-facial swelling. The most common subtype was erythematotelangiectatic rosacea (15, 62.5%), followed by ocular rosacea. No significant correlation was found among the severities of cutaneous finding, eyelid swelling and feature of rosacea. Patients were treated by various modalities (including systemic antibiotics, corticosteroids, isotretinoin etc.). However, only one quarter of patients noted partial and transient improvement. Conclusion: We have analyzed various clinical features of MD, and showed that upper-facial edema of MD and cutaneous rosacea features had no relationships. Our results support that although MD is described as a variant of rosacea, pathomechanism between typical rosacea and MD may be different.

Meralgia paresthetica associated with malignant peripheral nerve sheath tumor arising from neurofibroma

( Yeona Kim ),( Kihyuk Shin ),( Woo-il Kim ),( Won-ku Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ),( Min-young Yang ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Meralgia paresthetica (MP) is a compression neuropathy of the lateral femoral cutaneous nerve (LFCN). It results pain, paresthesia, and sensory loss within the territory of LFCN. Obesity, diabetes mellitus, pregnancy and injury during surgery are common associated factors. Rarely, neoplasm could be a cause of MP by pressing the LFCN. A 27-year-old man presented with localized burning pain on right antero-lateral thigh for a year. A soft flesh-colored nodule was identified on the same site. He had family history of neurofibromatosis type I. Physical examination showed numerous skin-colored nodules and cafe-au-late macules on trunk compatible with neurofibromatosis. The nodule was excised for pain control. However, pain was persistent even after excision. MRI was done to evaluate the pain. MRI revealed multiple nerve sheath tumors on the pelvic cavity. Especially, 75 X 49 mm sized tumor on showed the findings of malignancy and was considered as the cause of pain. The tumor on the lumbar plexus was excised and histopathologic finding was consistent with malignant peripheral nerve sheath tumor (MPNST). Though, pain was relived after surgery, lung metastasis was found in follow-up CT. He chose hospice care rather than chemotherapy. To our knowledge, MP associated with MPNST arising from neurofibroma has not been reported in the Korean dermatology literature. If neuropathic pain is localized on the thigh, MP might be considered as the entity.

Nickel allergy in patients with ear keloid

( Yeona Kim ),( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Keloids are thought to be the result of abnormal wound healing related to inflammation on the reticular dermis. Dermatologists often encounter patients with ear keloid. However, there is a lack of research on factors that can affect the development of ear keloids. Objectives: To investigate the relationship between nickel allergy and ear keloids. Methods: A questionnaire survey and patch test was conducted on patients who attended department of dermatology at Pusan national university hospital between October 2016 and November 2018. Results: A total of 17 patients (mean onset age 21.4) with ear keloids were included. All 17 patients were female. All patients had history of piercing on keloid site and the piercings were made of alloy. In 9 patients (52.9%), keloid was dominant on the posterior surface of the ear noted keloid. Before keloid formation, 10 patients (58.8%) reported inflammatory signs and most patients (88.2%) complained about itching or pain. Half of patients (58.8%) presented positive result of nickel patch test and 4 patients showed positive result of cobalt. Conclusion: In a previous Korean studies, 34% subjects had nickel allergy, while this study found a higher percentage of patients with nickel allergy. Keloid dominant on the posterior surface could explain by earring’s metallic backs made of nickel. These results suggest not only mechanical force but inflammation induced by metal allergy like nickel could contribute the keloid formation.

Is there a change in the usage of complementary and alternative medicine among Koreans with psoriasis after development of biologics?

( Yeona Kim ),( Dae-lyong Ha ),( Jin-hwa Son ),( Jung-soo Lee ),( Kihyuk Shin ),( Kyunghyung Seo ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Jun Young Kim ),( Byung-soo Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Patients with long standing psoriasis who have failed with conventional medicine seek for complementary and alternative medicine (CAM). Biologic revolution in the field of psoriasis since late 2000s has progressed expecting 90%-100% clearance of disease. The frequency and type associated with usage of CAM may have changed after these advances. Objectives: To investigate the change with the use of CAM in Korean psoriasis patients before and after the development of biologics. Methods: From March to June 2020, patients with psoriasis who visited the Pusan National University Hospitals (Busan and Yangsan) filled out a face-to-face structured questionnaire. These results were compared with the results from our previous study done approximately 10 years ago. Results: A total 207 patients were included. Compared with the previous result, the frequency of using of CAM (67.63%) were increased (p<0.0001). Oriental medicine (45.41%) was still been most commonly used, followed by health supplements and bath therapy. The biggest reason for using of CAM was 'to try all potential treatments'. Meanwhile, negative concern about the conventional medicine (13.53%) was significantly decreased (p<0.0001). Conclusion: Although the efficacy of conventional therapies has been increased after the development biologics, CAM usage tends to be more prevalent among Korean psoriasis patients. Therefore dermatologist should recognize the use of CAM to better empathize with their psoriasis patients.

A case of poromatosis related to chemotherapy

( Yeona Kim ),( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Poroma is a benign adnexal neoplasm originating from the sweat gland duct. Clinically, it presents as a soft erythematous or flesh-colored papule, plaque, or nodule on palms and soles. In most cases, poroma manifests as a solitary lesion, but it has been rarely reported as multiple lesions defined as poromatosis. Although the pathogenesis is unclear, poromatosis is known to be associated with radiation therapy or polychemotherapy. Herein, we report on a 53-year-old female who had erythematous papules on her feet for a year. She has medical history of acute lymphoblastic leukemia and undergone polychemotherapy with stem cell transplantation. According to the patient, lesion started as a small papule on her right foot and it gradually spread to her left foot. The sizes of lesion were 2 to 10mm in diameter. Biopsy was done for differential diagnosis of skin metastasis. Histopathologic analysis showed consistant with eccrine poroma. Therefore, she diagnosed with poromatosis and treated with combination of shave excision and cryosurgery. To our knowledge, poromatosis related to chemotherapy is a rare entity and only 14 cases have been reported in English literature. Moreover, the case of poromatosis has not previously been reported in the Korean dermatology literature.

A case of reflex sympathetic dystrophy (RSD) following prosthetic infection

( Yeona Kim ),( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Byung-soo Kim ),( Moon-bum Kim ),( Hyun-chang Ko ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Reflex sympathetic dystrophy (RSD), known as complex regional pain syndrome type 1, is usually arises after trauma . RSD is characterized by hyperalgesia, sudomotor change and impaired motor function. Patients complain of changing in skin temperature, color, or swelling of lesion. It can often be misdiagnosed as soft tissue infection, vascular disease, and peripheral neuropathy. A 74-year-old female consulted to our clinic for evaluation for cutaneous infection of the right knee region. She presented with shiny erythematous patch accompany with hyperalgesia, swelling and heating sensation for 8 months. She also suffered motor weakness and knee stiffness. She had past history of repeated prosthetic infection after knee surgery several years ago. However, her symptom didn’t improve after treatment of antibiotics for 8 months. Bacterial culture from blood and skin tissue were both negative for pathogen. Radiologic and additional laboratory findings also showed no evidence of infection. Digital infrared thermal imaging showed localized hyperthermia on the lesion. She was finally diagnosed as RSD based on the above findings, and treated with oral pregabalin. RSD is rarely reported in the dermatologic literature, but it is not uncommon in practice. Therefore, dermatologists should consider the possibility of RSD when symptoms mimic skin infections not responding to antibiotics persist.

Secondary intention repair after conservative surgery for nail-unit melanoma

( Yeona Kim ),( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Gun-wook Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ),( Hoon-soo Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Nail-unit melanoma is one clinical subtype of acral lentiginous melanoma that arises from the structures of the nail apparatus.Nowadays, several reports released the results about conservative treatment of nail-unit melanoma. They reported amputation had no significant benefit when the melanoma was in situ or microinvasive. Conservative therapy has resulted in better functional outcomes than radical surgery, but there is still a problem with reconstruction that needs to be solved. After conservative surgery, there are several repair strategies like primary closure, flap, graft and secondary intention healing. Primary closure and local skin flap are limited to repair because there is no adjacent tissue available. Therefore, delayed skin graft is widely used because of functional and cosmetic outcomes. Herein we report 3 cases of nail-unit melanoma repaired by secondary intention healing for the defect after surgical removal. Patients had been treated by wide local excision. At first, we planned delayed skin graft. However, during the secondary intention healing process, patients showed rapid healing of defect lesion. Patients chose to maintain the process rather than skin graft. The patients were satisfied with results and could avoid further surgery. Therefore, for patients with a relatively rapid healing process during the second intention healing for delayed treatment, only the second intention healing could be an option

Change in the Usage of Complementary and Alternative Medicine in the Era of Biologics Among Korean Patients With Psoriasis

Kim Yeona,Won Sang-Hyun,Bae Kyung-Nam,Lee Jungsoo,Shin Kihyuk,Kim Hoonsoo,Ko Hyun-chang,Kim Moon-Bum,Kim Byung Soo 대한의학회 2023 Journal of Korean medical science Vol.38 No.26

Background: Patients with long-standing psoriasis who are not treated with conventional medicine seek complementary and alternative medicine (CAM). The biological revolution in the field of psoriasis since the late 2000s has progressed, expecting clearance or almost clearance of the disease. The frequency and type of CAM usage may have changed after these advances. We aimed to investigate changes in CAM use in Korean patients with psoriasis before and after the prevalent use of biologics. Methods: Patients with psoriasis who visited Pusan National University Hospitals (Busan and Yangsan) between March 2020 and June 2022 were made to complete a face-to-face structured questionnaire. These results were compared with our previous study conducted approximately 10 years ago. Results: In total, 207 patients were included. Compared with the previous results, the frequency of CAM use (67.6%) increased (P < 0.001). Oriental medicine (67.1%) has most commonly been used, followed by health supplements and bath therapy. The biggest reason for using CAM was “to try all the potential treatments.” Meanwhile, negative concerns about conventional medicine (13.5%) significantly decreased during the 10-year period (P < 0.001). Conclusion: Although treatment efficacy has increased with biologics development, CAM usage remains prevalent among Korean patients with psoriasis. Therefore, dermatologists need more efforts to improve patients’ understanding of conventional medicine, including biologics.