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( Ju Wang Jang ),( You Jin Jung ),( Tae Lim Kim ),( Sung Soo Han ),( Min Won Lee ),( Hyun-min Seo ),( Joung Soo Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2
Background: Rosacea is widely treated with topical metronidazole, oral minocycline and oral isotretinoin according to its clinical features and frequently in combination with intense pulsed light (IPL). Objectives: The aim of this study was to investigate the clinical responses of minocycline versus isotretinoin with or without IPL for the treatment of rosacea. Methods: A total of 66 patients were included in this study. Patients were classified as 3 groups; oral minocycline (200mg/day) only (group 1, n=23), subsequently administrated of oral isotretinoin (20mg/day) after cessation of minocycline (group 2, n=21) and additional IPL every 4 weeks (group 3, n=22,). Two independent physicians evaluated clinical outcomes of erythema, telangiectasia and numbers of inflammatory lesions (papules and pustules) every visit for 6 months. Additionally, patient satisfaction was assessed on a patient’s global assessment (PGA). Results: Every group showed improvement in erythema, telangiectasia and inflammatory lesions (mean 63%, 67%, 74%). The improvement of the telangiectasia and PGA statistically significant in subjects treated with minocycline subsequent isotretinoin with IPL compared to patients who received without IPL (p=0.003, p=0.021). Conclusion: Minocycline with subsequent isotretinoin decreased the inflammation of lesions and IPL was more effective for improving of telangiectasia and PGA.
( Ju Wang Jang ),( Dong Uk Cheon ),( Sung Soo Han ),( Hyun-min Seo ),( Joung Soo Kim ),( Hee Joon Yu ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1
Viral warts are benign proliferations of the epithelium caused by human papillomavirus infection. There are multiple treatment options including cryotherapy, lasers, topical keratolytic and antimitotic agents, and immunotherapy. However, about 35% of the warts tend to be recalcitrant showing no response to treatment, which demonstrate the need for combination therapy. Acitretin, a synthetic second generation retinoid, exert a wide range of biological effects on keratinocytes, including the regulation of growth and differentiation. Because HPV replication is related to the keratinocytic differentiation, acitretin could be an effective treatment option for systemic, recalcitrant viral warts. A 19-year-old man presented with multiple viral warts on hands and feet for several years. Previous treatments with cryotherapy and topical keratolytics were unsuccessful. The patient started topical immunotherapy with diphenylcyclopropenone, but only mild improvement was observed for 3 months. Oral acitretin was added to the treatment regimen (20mg/day) and there was complete regression of the warts after 3 months. There was no recurrence even after the oral acitretin was discontinued. Herein we report an interesting case of recalcitrant viral warts showing complete regression to a combination of oral acitretin and topical immunotherapy.
Prediction of Treatment Response of Verruca Vulgaris Based on Lesion Hardening
( Ju Wang Jang ),( Sung Soo Han ),( Hyun-min Seo ),( Joung Soo Kim ) 대한피부과학회 2020 大韓皮膚科學會誌 Vol.58 No.5
Background: Verruca vulgaris is a common cutaneous viral infectious disease caused by human papilloma virus (HPV). The main treatment modalities are cryotherapy, immunotherapy, laser therapy, intralesional injection of bleomycin, and salicylic acid therapy. However, there is no definitive tool for predicting clinical improvement or treatment response. Objective: This study was designed to evaluate clinical treatment response according to the hardness of verruca vulgaris skin lesions. We developed a new prediction tool called the “hardening sign” that divides the course of treatment into four categories based on inspection and palpation. Methods: We conducted a retrospective medical chart review of patients who visited Hanyang University Guri Hospital between January 2016 and January 2017 and were clinically diagnosed with verruca vulgaris. We divided the patients into four groups according to the grade of rigidity of their lesions. Results: Forty-seven patients (24 male and 23 female) were identified. The mean age at diagnosis was 17.2±8.5 years, and the mean duration of treatment was 28.8±27.7 weeks. The mean number of hospital visits was 16.5±12.4. Eleven patients underwent only cryotherapy, while 36 patients underwent combined cryotherapy and immunotherapy. We observed significantly shorter durations of treatment for patients with higher grades of hardening. There was no correlation between the hardening grade and the number of treatments required for patients to be completely cured. Conclusion: This study suggests that the therapeutic response of verruca vulgaris warts to cryotherapy can be easily predicted by careful consideration of the “hardening sign”. (Korean J Dermatol 2020;58(5):324∼329)
[P049] A case of pachydermodactyly
( Ju Wang Jang ),( Tae Lim Kim ),( Byeong Jin Park ),( Hyun Seok Choi ),( Hyun Min Seo ),( Joung Soo Kim ),( Hee Joon Yu ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1
Pachydermodactyly is a rare acquired fibromatosis characterized by asymptomatic, asymmetric thickening of finger bases, especially dorsal and lateral side, and proximal interphalangeal joints. It typically involves 2nd, 3rd, 4th fingers. The etiology is not yet clear, but there is a suggestion that physical stimuli such as interlocking fingers are related to the pachydermodactyly. A 18-year old boy presented with asymmetric swelling around finger bases and proximal interphalangeal joints of both hands except thumbs for 4 years. He was in the habit of rubbing his hands. Histopathology revealed marked hyperkeratosis and acanthosis in the epidermis, and thickened dermis with collagen fiber. Immunohistochemically, irregularly arranged collagen fiber was shown in Masson`s trichrome stain and mucin deposition in the dermis was observed in Alcian blue stain. No proliferation of fibroblast was noticed. From these findings, he was diagnosed with pachydermodactyly. Herein, we report a case of pachydermodactyly, which has rarely been reported in the Korean dermatologic literature.
( Ju Wang Jang ),( Dong Uk Cheon ),( Sung Soo Han ),( Hyun-min Seo ),( Joung Soo Kim ),( Hee Joon Yu ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1
Actinic keratosis is a precancerous cutaneous neoplasm consisting of proliferations of cytologically abnormal epidermal keratinocytes that develop in response to prolonged exposure to ultraviolet radiation. Cumulative exposure to ultraviolet radiation is the major risk factor for developing actinic keratosis. Although over 80% of all actinic keratoses are distributed on habitually sun-exposed areas such as head, neck, forearms and dorsal hands, disseminated forms of actinic keratosis also have been rarely reported. A 69 year-old woman presented with multiple scaly brownish papules and plaques on the upper and lower extremities which has lasted for 10 years. Multiple hyperkeratotic, well-circumscribed lesions were distributed on the lower legs. Punch biopsy was performed under the impression of disseminated superficial actinic porokeratosis (DSAP). Histological examination revealed hyperkeratosis of the lesion showing smooth transition without cornoid lamella. Pleomorphic and hyperchromatic basal keratinocytes and solar elastosis of the dermis were consistent with actinic keratosis. The lesions showed clinical improvement after repeated cryotherapy. Herein, we report an interesting case of disseminated actinic keratosis, which showed an unusual clinical presentation.
[P050] A case of sclerosing panniculitis
( Ju Wang Jang ),( Tae Lim Kim ),( Byeong Jin Park ),( Hyun Seok Choi ),( Hyun Min Seo ),( Joung Soo Kim ),( Hee Joon Yu ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1
Sclerosing panniculitis is a type of chronic subcutaneous inflammation involving lower legs characterized by hyperpigmentation and induration, causing `inverted champagne bottle` or `bowling pin` appearance. A 43-year-old woman presented with localized hyperpigmented nodules on both lower legs for 4 years. Her legs were apparently indurated and contracted at the ankle with edematous calf, consistent with characteristic deformity of sclerosing panniculitis. Her body mass index score was measured by 31kg/m2. Histopathologic analysis revealed lobular pannicultis, fat necrosis and thick, fibrotic septum with no evidence of vasculitis. The lobule had various sized fat cysts lined by a thin layer of protein that has fine, feathery projections into the fat cavity. From these findings, she was diagnosed with sclerosing panniculitis. Herein, we present a case of sclerosing panniculitis in an obese middle-aged woman clinically manifested as typical `inverted champagne bottle` appearance.
( Ju Wang Jang ),( Dong Uk Cheon ),( Byeong Jin Park ),( Eui Hyun Oh ),( Joo Yeon Ko ),( Young Suck Ro ),( Jeong Eun Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2
Background: Facial pigmentary disorders are common in Asians. Although various treatments including lasers and topical agents have been tried with variable outcomes, treatment remains challenging. Objectives: To evaluate the efficacy and safety of the invasive micro-pulsed electric signal device (IMPES, Sylfirm<sup>®</sup>) for the treatment of pigmented diseases. Methods: We enrolled 25 patients diagnosed with facial melasma or pigmented contact dermatitis that received 3 to 6 successive treatments with Sylfirm<sup>®</sup> at 2-week intervals. Treatment outcomes were evaluated by PGA score, skin biophysical parameters including erythema index (EI), melanin index (MI) and transepidermal water loss (TEWL), and clinical photographs at each follow-up visit. Additionally, skin biopsies and immunohistochemical staining including Melan-A and Fontana silver were performed. Results: Most patients showed significant clinical improvement. EI and MI showed significant improvement after the second and fourth treatment, (p=0.011, p=0.033, respectively), but TEWL did not have a statistical significance. Histopathologic examination revealed a decrease in melanin pigment and melanophages in the dermis after treatment. There was no serious adverse event during the study. Conclusion: IMPES(Sylfirm<sup>®</sup>) showed clinical and histologic improvement in facial pigmentary disorder and could be an effective and safe treatment option.
( Ju Wang Jang ),( Se Kwang Park ),( Dong Seok Shin ),( Tae Lim Kim ),( Sung Soo Han ),( Hyun-min Seo ),( Joung Soo Kim ) 대한피부과학회 2020 大韓皮膚科學會誌 Vol.58 No.2
While lymphangioma circumscriptum may present anywhere on the body, the vulva is a rare site. However, vulvar involvement can occur in some clinical settings, and Crohn’s disease is one of the underlying etiologies of acquired lymphangioma circumscriptum. A 31-year-old woman presented with an 8-year history of widespread verruciform plaques on her vulva. She complained of a mild itching sensation at the lesion site. She was diagnosed with Crohn’s disease 11 years prior but had not been treated. She had no history of trauma or surgery in the perineal area and no familial history of cancer or hereditary disorders. The histopathologic findings were consistent with lymphangioma. Based on the clinicopathologic findings, the patient was diagnosed with lymphangioma circumscriptum on the vulva. Herein, we report a rare case of acquired lymphangioma circumscriptum of the vulva mimicking condyloma acuminatum in a patient with Crohn’s disease. (Korean J Dermatol 2020;58(2):134∼137)