성인 아토피피부염 환자에서 해운대지구 식염천 입욕효과에 관한 연구

심우행 ( Woo Haing Shim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ),민정아 ( Jung Ah Min ),김진우 ( Jin Wou Kim ) 대한피부과학회 2010 大韓皮膚科學會誌 Vol.48 No.12

Background: Spa therapy is widely used in many countries for the treatment of atopic dermatitis. There have been some reports about the therapeutic efficacies and mechanisms of spa therapy for the treatment of atopic dermatitis (AD) from other countries, but there have been no such reports from Korea. Objective: The purpose of this study was to investigate the therapeutic efficacy and the safety of Hae-Un-Dae spa therapy for adult AD patients. Methods: A total of 15 patients with AD were recruited in this study. The patients were classified into the mild group (n=5) and severe group (n=10) according to their eczema area and severity index (EASI) score at baseline. They had a bath in a Hae-Un-Dae spa three times per week for 4 weeks. To evaluate the therapeutic efficacy, the EASI score, the physician`s global assessment (PGA) and the visual analogue scale (VAS) for pruritus were assessed every week. The skin hydration, the skin pH and the transepidermal water loss (TEWL) were also measured weekly to investigate the changes of the skin barrier function during the spa therapy. Results: Compared to baseline, the EASI scores of the total group and the severe group decreased at 2, 3 and 4 weeks. Furthermore, the VAS for pruritus of the total group and the severe group was also decreased. Among the factors of the skin barrier function, the skin pH decreased in the mild group and it increased in the severe group during the spa therapy. Of the 15 patients, one patient experienced exacerbation of symptoms and two patients reported a transient pickling sensation during the spa therapy. Conclusion: Our study suggests that Hae-Un-Dae spa therapy could be an effective and safe modality for the management of adult AD, yet more studies should be performed to determine the therapeutic mechanism. (Korean J Dermatol 2010;48(12):1052∼1059)

스테로이드성 주사 환자 66예의 임상적 고찰

심우행 ( Woo Haing Shim ),문제호 ( Je Ho Mun ),좌승욱 ( Seung Wook Jwa ),송마가렛 ( Margaret Song ),김훈수 ( Hoon Soo Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.12

Background: Topical corticosteroids are not uncommonly abused in patients with facial dermatoses. Although it iswell known that uncontrolled use of topical corticosteroids cause steroid-induced rosacea, its clinical manifestation isnot studied yet in Korean patients.Objective: The purpose of this epidemiological study was to investigate a usage history of topical corticosteroid andclinical manifestation of steroid-induced rosacea.Methods: Among the 424 rosacea patients who visited the dermatologic clinics of Pusan National University Hospitalbetween January 2006 and May 2011, a face-to-face structured questionnaire was given to 66 rosacea patients witha history of topical corticosteroid use on the face for more than 1 month before onset of rosacea symptoms.Investigated factors include sex, age, history about use of topical corticosteroids and clinical manifestations.Results: Of the 66 patients, 41 were female and 25 were male with the mean age of 52.1±14.6 (range 16∼76)year. Celestone-G(R)(n=14) was the most commonly used product in the 34 patients who remembered the brandname of topical corticosteroids, which they had used. Forty-three patients used topical corticosteroids for treatmentof facial skin lesions without diagnosis. Eighteen patients purchased topical corticosteroids without doctor`sprescription. The mean duration and frequency of topical corticosteroid use was 3.8 years and 1.3 times per day,respectively. Constant erythema (n=31) was the most common symptom and it started to occur 2 months after useof topical corticosteroid.Conclusion: High-potency topical corticosteroids are frequently used for patients with facial dermatoses withoutcorrect diagnosis and without doctor`s prescription. Besides, abuse of topical corticosteroids cause rosacea symptoms,such as constant erythema. To prevent the occurrence of steroid-induced rosacea, there should be a great socialconcern for abuse and misuse of topical corticosteroid in patients with facial dermatosis. (Korean J Dermatol2012;50(12):1036∼1041)

Morbihan 병

심우행 ( Woo Haing Shim ),좌승욱 ( Seung Wook Jwa ),송마가렛 ( Margaret Song ),김훈수 ( Hoon Soo Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.4

Morbihan disease, also known as ``rosacea lymphedema`` or ``solid persistent facial edema`` was first reported by Degos, in 1957, for describing persistent lymphedema on the upper half of the face in association with rosacea. Although the pathogenesis of Morbihan disease is not established well, two hypotheses were proposed; firstly, the hypothesis of lymphatic obstruction by destruction of vessel supporting connective tissue (e.g. elastin), and secondly, the hypothesis of mast cell-induced fibrosis. Herein, we report a 71-year-old man who had 9-months history of persistent bilateral edema of the eyelids. The histopathologic exam from edematous eyelid revealed marked dermal edema, dilated vascular structure with perivascular mixed cellular inflammatory infiltration. Moreover, focal granulomatous infiltration adjacent to a vascular structure and numerous mast cells were also identified. This case is the first reported case of Morbihan disease in Korean dermatological literature. Furthermore, the histopathologic findings of this case support both of the two hypotheses for development of Morbihan disease. (Korean J Dermatol 2012;50(4):320∼323)

귓바퀴 피부질환으로 피부과를 내원한 환자군에서의 귓바퀴 부위별 흔한 피부질환에 대한 연구

심우행 ( Woo Haing Shim ),좌승욱 ( Seung Wook Jwa ),송마가렛 ( Margaret Song ),김훈수 ( Hoon Soo Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.8

Background: Skin diseases on the auricle are common and can sometimes cause severe functional and morphological problems. Objective: This study was conducted to investigate the epidemiological aspects of auricular skin diseases and to emphasize common skin diseases according to each part of the auricle. Methods: We retrospectively reviewed the data of 301 patients with auricular skin disease, who had visited Pusan National University Hospital between January 1999 and December 2009. Results: The most frequent auricular skin diseases were basal cell carcinoma, keloid, psoriasis, epidermal cysts, allergic contact dermatitis, atopic dermatitis, and vitiligo, in decreasing order of frequency. Of 174 patients with generalized skin lesions involving the auricles, the common skin diseases were psoriasis, atopic dermatitis, and allergic contact dermatitis. Of 22 patients whose skin diseases were involved in both auricles without generalized lesions, keloid was the most common skin disease. Of 105 patients with skin diseases involving only one auricle, the common skin diseases were basal cell carcinoma, keloid, and seborrheic keratosis. In patients with unilaterally auricle-localized skin lesions, the most common skin diseases according to each part of the auricle were as follows: helix and ear lobe, keloid; concha, seborrheic keratosis; tragus, melanocytic nevus; and preauricular and postauricular area, basal cell carcinoma. Conclusion: The frequency of auricular skin diseases was different according to each part of the auricle. Thus, it would be helpful for dermatologists to be aware of common skin diseases in each part of the auricle. (Korean J Dermatol 2011;49(8):699∼706)

특징적인 Dermoscopy 소견을 보이며 국소 Tacalcitol 치료에 의해 호전된 천공성 광택태선

심우행 ( Woo Haing Shim ),좌승욱 ( Seung Wook Jwa ),송마가렛 ( Mar Ga Ret Song ),김훈수 ( Hoon Soo Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.12

Perforating lichen nitidus is an unusual variant of lichen nitidus. It is clinically characterized by umbilicated papules and histopathologically characterized by transepidermal elimination of inflammatory debris from granulomatous infiltrates. Most cases of perforating lichen nitidus are treated with topical corticosteroids, but long-term use of topical corticosteroids could provoke several side effects. Herein, we report a case of perforating lichen nitidus treated effectively and safely with topical tacalcitol ointment. We performed a dermoscopic examination for the perforating lichen nitidus lesion and found the characteristic frogspawn dermoscopic feature. (Korean J Dermatol 2011;49(12):1083~1086)

손발톱세로고랑을 동반한 고립성 손발톱주위 아교질종

심우행 ( Woo Haing Shim ),송마가렛 ( Margaret Song ),김훈수 ( Hoon Soo Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ),좌승욱 ( Seung Wook Jwa ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.11

Isolated collagenoma usually occurs on the plantar area and is frequently associated with Proteus syndrome. A few reports have described isolated collagenoma on extra-plantar areas such as palm, scalp, face, thigh and finger. Herein, we report a case of isolated collagenoma on the periungual area, which was confused with digital mucous cyst. A 26-year-old man visited our clinic with an asymptomatic, 0.8×0.7 cm-sized, firm, skin-colored nodule on the periungual area of the left fourth finger. The distal nail of the nodule showed a longitudinal groove. Histopathologic findings from periungual nodule showed thickened collagen bundles packing reticular dermis. (Korean J Dermatol 2011;49(11):1014∼1016)

성인과 소아 아토피피부염 환자에서 가려움증의 임상적 특징

심우행 ( Woo Haing Shim ),송창현 ( Chang Hyun Song ),박현제 ( Hyun Je Park ),김훈수 ( Hoon Soo Kim ),진현우 ( Hyun Woo Chin ),김수한 ( Su Han Kim ),고현창 ( Hyun Chang Ko ),김문범 ( Moon Bum Kim ),김도원 ( Do Won Kim ),김병수 ( By 대한피부과학회 2011 대한피부과학회지 Vol.49 No.4

Background: Itch is an essential feature of atopic dermatitis (AD). Active AD cannot be diagnosed without a history of itch. There has been no previous study delineating the different characteristics of itch according to age. Objective: We wanted to characterize and compare the clinical patterns and the sensory and affective dimensions of itch in adult and childhood AD patients. Methods: A face-to-face structured questionnaire based on the McGill pain questionnaire was given to 90 patients with AD. The patients were classified into two groups: adult AD patients (≥15 years old) and childhood AD patients (<15 years old). Results: Eighty-eight percent of the total AD patients experienced itch everyday. This itch was mostly aggravated during the summer and at night in both groups of AD patients. The antecubital fossae, popliteal fossae and neck were the major sites of involvement with itch. More patients perceived the characteristics of itch as crawling, burning and tickling rather than stinging, stabbing and pinching. The majority of AD patients answered that sweat and hot climate aggravated the itch and medications and cold climate alleviated the itch. However, compared with the childhood patients, more adult patients experienced the aggravation of itch by exposure to dust, and the itch was alleviated by taking medications and by concentrating on work. A burning sensation with itch was more frequently reported by the adult patients when compared to that of the childhood patients. Conclusion: This study highlights the detailed description and characteristics of itch in adult and childhood AD patients. The proper management of itch according to age may be prerequisite to improve AD patients` quality of life. (Korean J Dermatol 2011;49(4):318∼327)

봉침요법 부위에 발생한 Mycobacterium chelonae 감염

심우행 ( Woo Haing Shim ),박현제 ( Hyun Je Park ),김훈수 ( Hoon Soo Kim ),진현우 ( Hyun Woo Chin ),김수한 ( Su Han Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ),권경술 ( Kyung Sool Kwon ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.4

Mycobacterium chelonae is a rapidly growing atypical mycobacterium found in soil and water. In a healthy person, it causes cutaneous infection after an invasive procedure or surgery. Herein, we present a case of a 52-year-old man with multiple erythematous plaques and nodules on the back and left arm, and these occurred at the site of bee sting therapy by a herbal medical doctor. The histologic findings showed a granulomatous infiltration composed of numerous neutrophils, lymphocytes, eosinophils, histiocytes and multinucleated giant cells. Acid fast bacilli were detected by Ziehl-Neelsen stain and Mycobacterium chelonae infection was confirmed by an INNO-LiPA mycobacteria kit. The patient was treated with 1 g of clarithromycin and 200 mg of doxycycline for 6 months and his condition improved considerably. (Korean J Dermatol 2011;49(4):374∼378)

스테로이드 병변내 주입에 의해 발생한 저색소침착증에 대한 임상적 고찰

심우행 ( Woo Haing Shim ),좌승욱 ( Seung Wook Jwa ),송마가렛 ( Margaret Song ),김훈수 ( Hoon Soo Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ) 대한피부과학회 2012 大韓皮膚科學會誌 Vol.50 No.6

Background: Several cases of hypopigmentation induced by intralesional corticosteroid injection have been reported. However, there is little information concerning the epidemiology and clinical characteristics of such cases. Objective: To describe the epidemiology and clinical characteristics of hypopigmentation induced by intralesional corticosteroid injection. Methods: A retrospective clinical study was performed on 22 patients with hypopigmentation induced by intralesional corticosteroid injection, during a period of January 2003 to December 2010. Investigated factors included sex, age, previous history of intralesional corticosteroid injection, clinical manifestations, treatment modalities and clinical course, Results: Of the 22 patients, 21 were female and 1 were male with the mean age of 34.3±17.5 (range 4∼68) years old. Twelve patients were treated with corticosteroid injection for the treatment of musculoskeletal diseases, whereas, 10 patients for treatment of skin diseases. Eight patients were injected by dermatologists, 3 patients by orthopedists and 11 patients by doctors of unknown specialty. The mean number of the times of corticosteroid injection was 1.9. On the average, hypopigmentation occurred 4.2 months after corticosteroid injection. Upper extremities were most frequently affected, followed by the scalp, face, lower extremities and trunk. Hypopigmentation in most patients were localized and accompanied with skin depression and telangiectasia. There was complete resolution of hypopigmentation within 3.7 months, on average. Conclusion: Intralesional injections of corticosteroid are performed not only as the treatment of various skin diseases, but also for the treatment of musculoskeletal diseases. Intralesional corticosteroid injection could cause hypopigmentation of the skin, and it could be confused with other skin diseases presented with hypopigmented patch. However, dermatologist could distinguish hypopigmentaion induced by intralesional corticosteroid injection from other skin diseases, such as vitiligo, by the presence of skin depression, telangiectasia and spontaneous resolution.

외부 물질의 주입에 의해 발생한 이물 육아종의 임상 및 병리조직학적 고찰

심우행 ( Woo Haing Shim ),좌승욱 ( Seung Wook Jwa ),송마가렛 ( Mar Ga Ret Song ),김훈수 ( Hoon Soo Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ) 대한피부과학회 2011 大韓皮膚科學會誌 Vol.49 No.9

Background: Various foreign materials injected into the skin can cause foreign body granuloma, which can cause severe disfigurement. Objective: To describe the clinicopathological characteristics of injection-induced foreign body granuloma. Methods: We did a retrospective study of 27 cases of injection-induced foreign body granuloma. Factors investigated included sex, age, injected material, purpose of injection, operator who gave the injection, number of injections, onset time of the granuloma after the injection, affected parts of the body, cutaneous manifestations, associated symptoms, histopathologic findings, treatment modalities and clinical course. Results: The male-female ratio was 2 to 25. Twenty five patients received injection for cosmetic improvement and 2 patients for treatment of musculoskeletal disease. Twenty patients were treated by unlicensed practitioners. The injected materials were unknown in 14 cases, whereas silicone (n=5) was most common among known injected materials. On average, foreign body granuloma occurred 131.3±136.3 months after injection. The face was the most frequently affected site and usually presented as skin-colored or erythematous plaques. The histopathologic exam revealed variable infiltration of inflammatory cells, including lymphocytes, histiocytes, multinucleated giant cells, plasma cells, neutrophils, and eosinophils. A swiss cheese appearance was observed in 19 cases. Complete response was achieved in four patients: those who had been treated with surgical excision (n=2) and those treated with systemic corticosteroids with antibiotics (n=2). Conclusion: Foreign body granuloma can arise from injection of various foreign materials. Dermatologists should be aware of the clinical manifestations of injection-related foreign body granuloma to make an appropriate diagnosis and to provide proper treatment. Moreover, there should be great social concern about injection-related foreign body granuloma, because many cases are caused by unlicenced practitioners. (Korean J Dermatol 2011;49(9):801~808)