Therapeutic effects of saline groundwater solution baths on atopic dermatitis- a pilot study

( Jisook Yoo ),( Ji Young Choi ),( Bo Young Lee ),( Chang Ho Shin ),( Sung-jae Lee ),( Jung-won Shin ),( Chang-hun Huh ),( Jung-im Na ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Saline groundwater collected from the east coast of Korea demonstrated protective effects against 2,4-dinitrochlorobenzene (DNCB)-induced atopic dermatitis (AD)-like skin lesions in murine model. Objectives: To determine the effect of saline groundwater solution baths as the treatment of mild-to moderate AD Methods: 24 subjects with mild to moderate AD were instructed to take a bath with saline groundwater solution for 20 minutes a day for two weeks. Evaluations were performed at baseline and week 2, including SCORing Atopic Dermatitis (SCORAD) index score, corneometry, trans-epidermal water loss (TEWL), visual analog scale (VAS) for pruritus and collection of adverse events. Results: Subjects showed significant improvement with respect to SCORAD index score, skin hydration, TEWL, and pruritus at weeks 2 when compared with baseline. Conclusion: Saline groundwater solution baths might be used as an alternative therapeutic strategy for the treatment of AD.

Cutaneous Plasmacytoma: Metastasis of Multiple Myeloma at the Fracture Site

( Jisook Yoo ),( Mingyul Jo ),( Min-soo Kim ),( Mihn-sook Jue ),( Hyang-joon Park ),( Kwang-hyun Choi ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.4

Multiple myeloma (MM) can be defined as a malignancy with monoclonal plasma cell proliferation. A 66-year-old man presented with pruritic erythematous to purplish plaque grouped nodule with black pigmentations and purpura on the right forearm. The patient was diagnosed with MM about five years prior to the visit at our hospital. Erythematous plaque on his right arm grew rapidly in size over one month and appeared about seven months after the fracture surgery. Skin biopsy showed multiple plasma cell infiltration with mono-clonality for lambda light chain, which was consistent with cutaneous plasmacytoma. The patient refused to be treated and died two months later. We herein report an interesting case of cutaneous plasmacytoma at the surgical site of frac-ture repair. (Ann Dermatol 29(4) 483∼486, 2017)

Giant Basal Cell Carcinoma Treated with a Paramedian Forehead Flap in a Patient with Leprosy

( Jisook Yoo ),( Joon-won Huh ),( Min Soo Kim ),( Kwang-hyun Choi ),( Mihn-sook Jue ),( Hyang-joon Park ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.5

Ethnicity and prevalence in patients with hidradenitis suppurativa worldwide: a systemic review and meta-analysis of observational studies

( Jisook Yoo ),( Jung Min Bae ),( Min Soo Kim ),( Mihn-sook Jue ),( Kwanghyun Choi ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder; while a few observational studies have discussed the differences between races in HS, no systemic review or meta-analysis of literatures has been conducted. Objectives: This study provides overall prevalence of HS worldwide and a comprehensive systemic review of disparities in clinical course and prevalence among different races or ethnicities. Methods: Using a prespecified search strategy, we initially retrieved 1559 articles and identified 14 relevant studies to include in the analysis. To obtain prevalence of different races or ethnicities, we performed a metaanalysis based on random effects models. Potential sources of heterogeneity and bias were sought using funnel plot and Egger’s test. Statistical analyses were performed using the Comprehensive Meta-Analysis software 2.0 (Biostat Inc., USA). Results: To estimate overall prevalence of HS, a total of 11 articles were used for analysis and an estimated average prevalence was 0.167% (95% confidence interval [CI], 0.009%-0.295%). To estimate prevalence of different races or ethnicities, a total of 9 articles were used and average prevalence are as follows: white, 0.085% (95% CI, 0.056%-0.129%), black, 0.210% (95% CI, 0.132%-0.336%), Hispanic, 0.029% (95% CI, 0.0.005%-0.167%), and Asian, 0.060% (95% CI, 0.020%-0.179%). Conclusion: Our results show that the HS occurs most frequently in black, followed by white, Asian and Hispanic.

[P391] Aggressive systemic metastasis of Merkel cell carcinoma from the buttock

( Jisook Yoo ),( Eunjung Park ),( Mingyul Jo ),( Min-soo Kim ),( Mihn-sook Jue ),( Kwang-hyun Choi ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer with high propensity to recur and metastasize rapidly. A 78-year-old female with medical history of diabetes mellitus, Alzheimer`s and Parkinson`s disease came to our clinic complaining of an asymptomatic 5x5cm-sized erythematous to purplish protruding mass on the right buttock. The mass started as a small nodule four months ago and grew rapidly in size. Skin biopsy confirmed the diagnosis of MCC and immunohistochemistry stains were positive for panCK, CK20, synaptophysin, and chromogranin. Abdominal and pelvic computed tomography (CT) did not show signs of local metastasis at the time. The patient underwent radiotherapy (RTx), but the treatment was interrupted after two months due to gastrointestinal bleeding. Torso positron emission tomography (PET)-CT showed multiple metastatic lymphadenopathies in the chest, and metastasis to the stomach, pancreas, peritoneum, and lung. The patient received additional RTx in the chest and abdomen, but died a month later. About 30% of patients have distant metastasis either at presentation or during follow-up, however, systemic metastasis involving multiple organs in a short period of time is rare. Our patient showed systemic metastasis within 2 months of RTx and died shortly after. We herein report a case of MCC in the buttock which aggressively metastasized to various organs in a short time.

[P207] A case of papular acantholytic dermatosis of the anogenital area

( Jisook Yoo ),( Eunjung Park ),( Mingyul Jo ),( Min-soo Kim ),( Kwang-hyun Choi ),( Mihn-sook Jue ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Papular acantholytic dermtosis (PAD) of the anogenital area is an uncommon type of focal acantholytic dermatosis first described by Ackerman in 1972. Histologically, it can mimic Hailey-Hailey disease, Darier’s disease, and Grover’s disease, but these diseases are clinicopathologically different entities. A 68-year-old male with history of hemorrhoidectomy came to our clinic complaining of asymptomatic grouped brownish papules and plaques with white scale on perianal area which started a year ago. Skin biopsy from the lesion showed suprabasal cleft with acantholytic keratinocytes. The lesions were only found in the perianal area and flexural areas were all intact. He also did not have any family history of similar lesions, thus ruling out the possibilities of Grover’s disease and hereditary disorders such as Hailey-Hailey disease and Darier’s disease. The lesions spontaneous resolved without treatment and the patient is still under clinical observation without recurrence. Patients with PAD in the anogenital area are often asymptomatic, but some complain itching and burning sensation. The moist and warm characteristics along with frequent friction are considered the cause of PAD in the anogenital area. PAD in the anogenital area may be underreported; therefore, it is critical for dermatologists to be aware of such entity to rule out hereditary disorders and infectious disorders such as condylomata or molluscum contagiosum.

Hidden Pictures of Kaposi`s Sarcoma in Psoriatic Lesions: A Diagnostic Challenge

( Jisook Yoo ),( Mingyul Jo ),( Min-soo Kim ),( Kwang-hyun Choi ),( Hyang-joon Park ),( Mihn-sook Jue ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.6

Kaposi`s sarcoma is a multifocal proliferative vascular tumor involving the skin and other organ and psoriasis is a chronic cutaneous disease with papules and plaques with white scale. Development of Kaposi`s sarcoma in psoriasis patients has been reported rarely. A 71-year-old man presented with multiple brownish to violaceous plaques on both feet and arms which were found 4 months ago. The biopsy confirmed Kaposi`s sarcoma. The patient was diagnosed with psoriasis vulgaris 10 years ago and Kaposi`s sarcoma lesions developed between psoriatic plaques. We herein report a rare case of simultaneous occurrence of Kaposi`s sarcoma and psoriasis vulgaris which need quite different treatment. (Ann Dermatol 28(6) 749∼752, 2016)

[P389] A rare case of umbilical metastasis from adenocarcinoma of the lung

( Jisook Yoo ),( Eunjung Park ),( Mingyul Jo ),( Kwang-hyun Choi ),( Mihn-sook Jue ),( Min-soo Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 85-year-old male with no medical history came to our clinic complaining of a solitary 2.5cm x 2.5cm sized, reddish protruding mass on the umbilicus with bleeding which started 2 months ago. The mass grew rapidly in size over short time and did not regress after topical and oral antibiotic treatments. Biopsy from the lesion revealed atypical cells with round to oval nuclei forming tubules and lymphatic tumor emboli. Atypical cells were positive for CK7, CK20, and TTF-1. Metastatic adenocarcinoma was suspected and abdominal and chest CT were conducted to identify an occult primary malignancy. Chest CT revealed about a 3.7cm-sized mass in the lung parenchyma suggestive of cancer, but the abdominal CT showed no evidence of malignancy. An umbilical metastasis from the lung adenocarcinoma was suspected, but the patient refused lung biopsy. Umbilical metastasis of cancer usually occurs from intra-abdominal malignancies and is rare from lung cancer. The pathogenesis is not clear, but it is suspected to occur from direct invasion through the preritoneum, distant metastasis by lymphatic spread, or hematogenous dissemination. Umbilical metastasis is associated with poor prognosis and patients are likely to survive between 10-21 months. To the best of our knowledge, there are only 4 reported cases of umbilical metastasis from the lung, including our case. We herein report a rare case

A rare case of primary cutaneous anaplastic large cell lymphoma showing epidermotropism

( Jisook Yoo ),( Taehan Koo ),( Eun-jung Park ),( Mingyul Jo ),( Mihn-sook Jue ),( Min-soo Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Primary cutaneous anaplastic large-cell lymphoma (PCALCL) belongs to CD30+ lymphoproliferative cutaneous diseases. It is characterized by single or multifocal nodules that ulcerate, self-regress and recur. A 70-year-old male complained of an asymptomatic 1.5cm-sized erythematous dome-shaped mass on his left flank. The mass grew rapidly from 3 weeks ago and eventually ulcerated. Punch biopsy from the lesion revealed epidermotropism along with diffuse cellular infiltration into subcutaneous layer. Atypical cells were positive for CD3 and more than 75% of cells were positive for CD30 and were negative for CD4, CD8, CD20, CD56, EBER, and ALK. Differential diagnoses included type C lymphomatoid papulosis and PCALCL, but because the lesion evolved in such a short time and showed infiltration of CD30+ cells into the subcutaneous layer, it was diagnosed as PCALCL. However, epidermotropism is rarely observed in PCALCL and only 2 cases of PCALCL with epidermotropism have been reported in the literature. The prognosis of PCALCL is good, but it is not known whether the epidermotropism plays any role as a prognostic factor. The lesion almost cleared after radiation therapy and the patient is under close observation without any recurrence. Further studies are needed to find the role of epidermotropism in PCALCL.

A case of pityriasis lichenoides et varioliformis acuta (PLEVA) with numerous CD30+ small cells

( Jisook Yoo ),( Taehan Koo ),( Eun-jung Park ),( Mingyul Jo ),( Min-soo Kim ),( Mihn-sook Jue ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

An 84-year-old male visited our clinic with asymptomatic multiple scattered hemorrhagic macules and papules with crusted lesions on whole body from 3 weeks ago. He had taken systemic methylprednisone for 3 weeks at a local clinic, but the lesions did not improve. He had medical history of hypertension and did not show other systemic symptoms such as fever. The lab results showed mild leukocytosis and viral antibodies were all negative. Skin biopsies from his trunk and thigh showed mild acanthosis, necrotic keratinocyte, multiple extravasated RBC in the upper dermis and lymphocytic perivascular cellular infiltration. Additional CD30 immunohistochemical staining was conducted and was positive for numerous small cells. A diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA) with CD30+ cells was made. The lesions waxed and waned, so low dose methotrexate regimen was used and the lesions improved. PLEVA is a cutaneous inflammatory disorder characterized by erythematous papules that rapidly become vesicular. The more severe ulcerative variant is known as pityriasis lichenoides with ulceronecrosis and hyperthermia (PLUH) and presents as purpuric papulonocules with central ulcers. Patients with PLUH often have fever. PLEVA with CD30+ small cell variant can be distinguished from PLEVA in that although the lesions appear more severe as purpuric and ulcerative, it does not accompany any systemic symptoms including fever.