Annular elastolytic giant cell granuloma initially misdiagnosed as granuloma annulare

( Ga Ram Ahn ),( Hyun Jung Kwon ),( Kui Young Park ),( Seong Jun Seo ),( Chang Kwun Hong ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous dermatosis which is characterized by annular atrophic lesions which tend to occur in sun-exposed area. Due to its annular morphology and histopathologic feature which include a granulomatous infiltration with multinucleated giant cells, AEGCG is often difficult to be distinguished from granuloma annulare (GA). A 49-year-old woman was referred to our clinic presenting multiple annular lesions on her forehead, upper chest and both forearms and hand dorsa. With the initial impression of GA, she was treated with systemic steroid and UV-A therapy. Since the lesions progressed gradually in spite of the treatment, skin biopsy was performed. The biopsy specimen showed granulomatous hystiocytic infiltration with multinucleated giant cells engulfing fragmented elastin fibers. Herein, we report a case of AEGCG which was initially misdiagnosed as GA and discuss the clinical and histopathological differential diagnosis through review of literatures.

Noninvasive size reduction of lipoma with an insulated monopolar radiofrequency microneedle device

( Ga Ram Ahn ),( Ji Yeon Hong ),( Kapsok Li ),( Beom Joon Kim ),( Myeung Nam Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Lipoma is a common benign adipose tumor which usually appears as painless, round and mobile mass. Surgical excision is considered as the treatment of choice for lipoma. However, some patients are reluctant to undergo an operation due to the risk of scarring especially when the lesion occurred on the exposed area such as face. A radiofrequency (RF) microneedle device can create a thermal coagulation zone at a controlled depth around the needle tip without unwanted epidermal damage. A 54-year-old healthy male presented with a painless slow-growing mass on his right cheek. Ultrasonography revealed an oval compressible hyperechoic mass with a fat density. Under the clinical and ultrasonographic impression of lipoma, monopolar RF device with insulated microneedle was chosen for a minimally invasive treatment. After the repeated sessions of treatment, the volume of the affected cheek was dramatically diminished and the patient was very satisfied with the outcome. In this study, we report size reduction and cosmetic improvements in a large facial lipoma treated with a novel RF microneedle device.

[P160] Inverse Psoriasis with Autoimmune Hepatitis

( Ga Ram Ahn ),( Joon Seok ),( Kui Young Park ),( Seong Jun Seo ),( Chang Kwun Hong ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Inverse psoriasis is characterized by a lack of or lesser degree of scaling at the intertriginous areas, which is the most prominent dissimilarity between classical plaque-type psoriasis and inverse psoriasis. Psoriasis is commonly associated with autoimmune diseases and recent studies suggest that resident memory T cells act as a possible mechanistic link between two disease entities. However, research regarding autoimmune comorbidities associated with inverse psoriasis is scarce. A 49-year-old woman was diagnosed as inverse psoriasis affecting both inguinal and axillary areas through skin biopsy. Subsequently, the patient complained myalgia, nausea and profound jaundice and was referred to the gastroenterology department. Through clinical manifestation, laboratory findings and liver biopsy, the patient was finally diagnosed with Type I autoimmune hepatitis. Herein, we report a case of autoimmune hepatitis in a patient with inverse psoriasis and discuss the possible pathophysiologic mechanism between autoimmune hepatitis and inverse psoriasis.

[P001] Combination treatment of propranolol, minocycline, and tranexamic acid for effective control of rosacea

( Ga Ram Ahn ),( Yeon A No ),( Sun Young Choi ),( Beom Joon Kim ),( Myeung Nam Kim ),( Chang Kwun Hong ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Rosacea is a chronic inflammatory skin condition that usually affects the central portion of the face. Although there is no curative treatment for rosacea, tetracycline has been the mainstay therapy. A 37-year-old female was referred to our department presenting with erythematous scaly patches and pustules on the face. She had been treated for rosacea with oral antihistamine, topical metronidazole, and 595nm-pulsed-dye laser therapy. However, the symptoms had not improved despite the treatments and eventually worsened. We treated the patient with an oral combination of propranolol, minocycline, and tranexamic acid and noticeable improvement of erythema and subjective symptoms was noted. Although the exact mechanisms and possible interactions of the triple combination treatment are not yet known, it suggest that this therapeutic regimen may be a possible strategy for treatment of rosacea. Herein, we report a case of successful treatment of rosacea with propranolol, minocycline and tranexamic acid.

Facial hypopigmentation of abrupt onset due to chloroquine

( Ga Ram Ahn ),( Won Jong Oh ),( Beom Joon Kim ),( Myeung Nam Kim ),( Chang Kwun Hong ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Pigmentation disorder, especially hypopigmentation due to medication is uncommon. Chloroquine, fluphenazine, physostigmine, and imatinib are reported to have possibility to induce vitiligo-like lesions with rare incidence. A 80-year-old female visited our department presenting multiple sharply demarcated hypopigmented macules and patches with rapid spreading pattern on the face. The skin lesion suddenly developed 2 weeks ago. She had been prescribed hydroxychloroquine for 2 years as a treatment for rheumatoid arthritis. Histopathological findings revealed no melanocytes in dermoepidermal junction and markedly decreased basal pigmentation. This case was diagnosed as chloroquine-induced hypopigmentation considering the clinical history of sudden onset, chloroquine administration, improvement with drug cessation and lack of melanocytes in dermoepidermal junction. Herein, we report an interesting case of hypopigmentation induced by chloroquine.

The efficacy of newly developed botulinum toxin type A for treatment of muscle hypertrophy in myostatin-deficient mice

( Ga Ram Ahn ),( Joon Seok ),( Jungtae Na ),( Beom Joon Kim ),( Chang Kwun Hong ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Botulinum toxin A (BTX-A) is clinically used for muscular disorders, migraine, hyperhidrosis and cosmetics by preventing the release of neurotransmitter acetylcholine into synaptic cleft. Objectives: The aim of this study is to investigate the efficacy and safety of newly developed BTX-A product (Korea) compared to conventional BTX-A (USA) for the reduction of muscle hypertrophy in Myostatin-deficient (Mstn^-/-) mouse. Methods: Two different BTX-As were injected on the hindlimb of Mstn^-/-mouse. Since then, serial sciatic nerve conduction study (NCS), X-ray, 3D micro-CT and muscle biopsy was done. Results: Administration of BTX-A in both product group induced denervation-mediated atrophy and alleviated muscle hypertrophy generated in Mstn^-/- mice. On day 56, newly developed BTX-A product group showed significant suppression in NCS compared with conventional BTX-A product group. Conclusion: In this study, the results suggest that both BTX-A regulate skeletal muscle size and the number and diameter of myofibers. Also, newly developed BTX-A product seems to have longer duration compared with conventional BTX-A product in the ability to act in a local area.

Non-Invasive Diagnosis of a Facial Tumor Using Dermoscopy and Successful Treatment with 595 nm Pulsed Dye Laser

( Ga Ram Ahn ),( Guk Jin Jeong ),( Su Jung Park ),( Kui Young Park ),( Seong Jun Seo ),( Hae Woong Lee ) 대한피부과학회 2021 Annals of Dermatology Vol.33 No.3

Clear cell acanthoma (CCA) is an uncommon, benign epithelial tumor presenting as a well-defined, slow-growing solitary nodule. The diagnosis of CCA is usually based on clinical and histopathological evaluation of the tumor. However, when such type of benign tumor occurs on an exposed area, a biopsy is not always the best diagnostic option since it may leave scar. The recent advent of dermoscopy has offered an accurate and non-invasive method to diagnose CCA without resorting to skin biopsy. A 40-year-old male presented with a shiny, erythematous-to-brown, flattened nodule on the left cheek. Dermoscopic examination revealed a ‘string of pearls’ vascular pattern, a characteristic dermoscopic feature of CCA. Under the clinical and dermoscopic impression of CCA, a 595 nm pulsed dye laser (PDL) therapy targeting the vascular tissue in the superficial dermis of the lesion was chosen for a minimally invasive treatment. After repeated sessions of PDL, an optimal cosmetic outcome was achieved and no recurrence was recorded during the follow-up period. Herein, we report a case of presumed CCA which was successfully diagnosed and treated by utilizing non-invasive modalities. (Ann Dermatol 33(3) 275∼277, 2021)

P021 Association between COL6A6 polymorphisms and early-onset atopic dermatitis in Korean population

( Ga Ram Ahn ),( Won Jong Oh ),( Won Il Heo ),( Seong Jun Seo ),( Chang Kwun Hong ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: The prevalence of atopic dermatitis is as high as 20% in children. Thus, early diagnosis and treatment of atopic dermatitis are important, and understanding of its genetic basis is needed to facilitate early detection. The polymorphisms of COL6A6 are family-specific candidate variants of early-onset AD detected by whole exome sequencing in previous study. Objectives: Our present study validated the association between early-onset AD and COL6A6 variation in Korean population-based case-control study. Methods: 110 AD patients and 62 control subjects under 3years old were enrolled in the study. Three variants (rs16830494 in exon 30, rs59021909 in exon 4 and rs200963433 in exon 6) of COL6A6 were sequenced by Sanger sequencing. Three variants were also compared with serum levels of total IgE and blood eosinophil count. Results: We were able to detect a rare variant (rs200963433) exclusively in AD patients. The frequency of a minor allele (T) rs59021909 was increased in the AD group, and rs59021909 also influences lower serum IgE levels. Conclusion: Our study suggests the possibility that COL6A6 variants are significantly associated with risk of early-onset atopic dermatitis. This study will provide a genetic basis for diagnosis and the development of new therapies for early-onset atopic dermatitis in Koreans. Functional studies are necessary to discover variant function.

Annular Elastolytic Giant Cell Granuloma: Chronic Heat Exposure, an Underestimated Factor

( Ga Ram Ahn ),( Guk Jin Jeong ),( Hye Sung Han ),( Hyun Jung Kwon ),( Kapsok Li ),( Seong Jun Seo ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.Suppl

FC 2-4 Improved methods for selective cryolipolysis results in subcutaneous fat layer reduction in a porcine model

( Ga Ram Ahn ),( Hyun Jung Kwon ),( Yu Jin Jang ),( Eun Ja Choi ),( Hee Su Kim ),( Kap Sok Li ),( Myeung Nam Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Background: Cryolipolysis is a noninvasive method for the selective reduction of localized fat tissues. It has demonstrated efficacy in both clinical and preclinical trials; however, despite its popularity, its mechanisms of action and evaluation methods are not yet fully defined. Objectives: The purpose of this study was to improved methods for cryolipolysis using a porcine model. Methods: The abdomens of female Prestige World Genetics (PWG) micro-pigs were treated with a cooling device (CRYOLIPO II™), and we examined photography, three-dimensional photography, ultrasound, gross, and microscopic pathology, and serum lipid level analyses in order to determine the mechanism of action, efficacy, and safety of the device. Results: CRYOLIPO II™ reduced abdominal fat in porcine model. Gross and microscopic histological results confirmed the noninvasive cold-induced selective subcutaneous fat destruction, and showed increases in pre-adipocyte differentiation and in the activation of lipid catabolism. In particular, we found that the device may increase PPARδ (delta) levels in adipose tissue at 30.60 days post-treatment. Conclusion: Fat reduction by cryolipolysis was achieved in our porcine model. Thus, our findings indicate that CRYOLIPO II™ may be a promising fat reduction device for body contouring and fat reduction in humans, and that cryolipolysis exerts its effects, at least partly, by targeting the PPARδ signaling pathway.