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A case of erythema multiforme-like drug eruption after taking Noni-powder
( Byeong Hak Seo ),( Ji Hyun Kim ),( Yong Woo Oh ),( Dong Hee Kim ),( Yu Sung Choi ),( Ho Seok Suh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Morinda citrifolia, also known as Noni, is a Polynesian plant with a long history of medicinal applications. Noni and its products are popular herbal dietary supplements globally used for preventive or therapeutic purposes in a variety of disease, including arthritis, diabetes and liver disease. However, no detailed pharmacological studies were reported on the putative active ingredients of the Noni, which include scopoletin and several volatile components. Recently, several cases of liver and kidney toxicities after taking Noni products have been reported, but there are limited data on cutaneous toxicity of Noni. A 35-year old woman presented with a sudden onset of erythematous, discrete papules on the elbow, knee and axilla for 5 days. She was on Noni powder for treatment of arthritis. There was no history of other drugs or signs of infection. Histopathologic findings showed spongiosis, exocytosis of the epidermis, papillary dermal edema and moderate to dense lymphohistiocytic cell infiltrates in the dermoepidermal junction. Parakeratosis with a few numbers of eosinophils were observed. Based on the clinical and histologic findings, the patient was diagnosed with erythema multiforme (EM)-like drug eruption and treated with topical steroids in addition to halting the previous noni powder. The lesions were improved within three weeks. Herein, we report a case of EM-like eruption after taking Noni-powder.
A case of unilateral facial vitiligo after bevacizumab
( Byeong Hak Seo ),( Ji Hyun Kim ),( Yong Woo Oh ),( Dong Hee Kim ),( Yu Sung Choi ),( Ho Seok Suh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Vitiligo is a multifactorial, polygenic disorder, characterized by progressive autoimmune-mediated destruction of epidermal melanocytes. Its pathogenesis is still unclear, but various precipitating factors, including sun exposure, physical trauma, chemicals and drugs have been suggested. Bevacizumab is an anti-vascular endothelial growth factor (VEGF) monoclonal antibody approved for the treatment of colorectal, lung cancer, glioblastoma and melanoma. Cutaneous adverse reactions are common with bevacizumb, including exfoliative dermatitis, maculopapular rash, perforating dermatoses and acneiform eruptions. However, vitiligo induced by bevacizumab is rarely reported. A 27-year-old man presented with 4-day history of unilateral, well-circumscribed, hypopigmented patches on the right side of neck and chin. He had started bevacizumab therapy for colon cancer 1 month ago. In wood lamp examinations, well-demarcated, bright blue to whitish accentuation was observed. The patient was diagnosed with segmental vitiligo. He has been treated with the 311-nm titanium: sapphire laser third times a week for 7 months and hypopigmented patches were gradually improved. Herein, we present a case of unilateral facial vitiligo after bevacizumab.
Facial flushing and erythema of rosacea improved by carvedilol
( Byeong Hak Seo ),( Yong Woo Oh ),( Dong Hee Kim ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1
Background: Flushing and erythema are the most common symptoms of rosacea; however, management of these symptoms remains challenging. Recent studies suggest that treatment with carvedilol may reduce facial flushing and persistent erythema in the pathogenesis of rosacea. Objectives: To find the effect of carvedilol in the treatment of facial flushing and erythema in rosacea. Methods: Twenty-four rosacea patients treated with carvedilol for facial flushing and erythema were retrospectively reviewed. All patients were prescribed carvedilol 6.25 mg either once or twice per day, and the daily dose was gradually titrated up to 12.5 mg. Clinical erythema severity was assessed by the Clinician’s Erythema Assessment (CEA) and Patient’s Self-Assessment (PSA) scales. Improvement of CEA and PSA scores compared to the baseline were assessed. The proportion of patients with improvement of 2 or more points from baseline in CEA score was analyzed by sex, previous treatment exposure, disease duration, and subtypes. Results: The mean change of -1.6 in the CEA score and of -1.8 in the PSA score showed significant improvement from baseline. Erythematotelangiectatic rosacea (ETR) patients achieved more than 2-points improvement in the CEA score, compared with non-ETR patients. No statistically significant differences were observed by sex, disease duration, or previous treatment exposure. No serious adverse event was observed. Conclusion: Carvedilol can be an effective and safe treatment option for rosacea.
A case of generalized pseudoxanthoma elasticum
( Byeong Hak Seo ),( Ji Hyun Kim ),( Yong Woo Oh ),( Dong Hee Kim ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Pseudoxanthoma elasticum (PXE) is a rare, genetic, multisystem disorder characterized by progressive calcification and degeneration of elastic fibers, involving skin, eyes and cardiovascular system. It is caused by mutations in ATP-binding cassette subfamily C member 6 (ABCC6) on chromosome 16q13.1. It clinically presents as yellowish, flat-topped, discrete, and confluent papules on the lateral neck, axillae, and flexural areas. Ocular angioid streaks, visual impairment, peau d’orange retinal hyperpigmentation are other diagnostic clues for PXE. Histopathologically, PXE shows swollen, clumped, fragmented elastic fibers with calcium deposits in the mid and deep reticular dermis. There is no specific treatment for PXE, but multidisciplinary approach is required for the systemic complications. A 49-year old man presented with generalized, confluent brownish patches on the trunk and skin-colored to yellowish, flat-topped, discrete papules on his neck since childhood. He was diagnosed with choroidal neovascularization with angioid streaks at the ophthalmology department 6 months ago. His sister also had similar cutaneous lesions. Histopathologic findings from neck and abdomen showed irregularly clumped, fragmented, bright pink-colored elastic fibers with degeneration in the dermis. Immunohistochemical staining was positive for elastic fibers. The patient was diagnosed with generalized PXE. Herein, we report a case of generalized PXE.
A case of simultaneous onset of congenital melanocytic nevus with halo phenomenon and vitiligo
( Byeong Hak Seo ),( Ji Hyun Kim ),( Yong Woo Oh ),( Dong Hee Kim ),( Yu Sung Choi ),( Ho Seok Suh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Halo nevus is a benign melanocytic nevus surrounded by a round, well-demarcated area of depigmentation. Halo phenomenon often occurs around acquired melanocytic lesions, including intradermal and compound nevi, Spitz nevus, malignant melanoma and congenital melanocytic nevus (CMN). Vitiligo is an acquired, autoimmune, depigmenting disorder of the skin and mucous membrane, resulting from a selective loss of melanocyte. The pathogenesis of halo nevus and vitiligo is still unclear, but a similar autoimmune mechanism of cytotoxic T-lymphocytes and autoantibodies to melanocytes has been suggested in both diseases. However, so far, simultaneous onset of CMN with halo phenomenon and vitiligo is rarely reported. A 6-year old boy presented with an annular whitish hypopigmented patch around a hairy pigmented plaque on the left knee and a coin-sized hypopigmented patch on the upper back. The hairy pigmented plaque appeared since birth and the depigmented patches appeared 6 months ago. Histopathologic findings from the central pigmented plaque showed nests of nevus cell, surrounded by lymphohistiocytic infiltrates in the dermis. The patient was diagnosed with CMN with halo phenomenon accompanied by vitiligo. Herein, we report a case of simultaneous onset of CMN with halo phenomenon and vitiligo.
A case of perforating pilomatricoma mimicking intradermal nevus on the scalp
( Byeong Hak Seo ),( Ji Hyun Kim ),( Yong Woo Oh ),( Dong Hee Kim ),( Ho Seok Suh ),( Yu Sung Choi ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1
Pilomatricoma (calcifying epithelioma of Malherbe) is a relatively common benign skin tumor of childhood arising from the hair follicle matrix. There are several clinical variants of pilomatricoma, including, lymphangiectatic, anetodermic, pseudo-bullous and perforating form. Perforating pilomatricoma is a rare clinical subtype, and typically presents as an exophytic, crusted or ulcerated, erythematous to flesh-colored nodule on the head and neck. Histopathologically, it shows islands of cells composed of peripheral nucleated basaloid cells and central enucleated shadow cells in the dermis. Differential diagnosis includes trichoepithelioma, trichilemmal cyst, and intradermal nevus. The treatment of choice for pilomatricoma is surgical excision, and the recurrence rate is low. A 10-year old boy presented with 2-month history of a 0.6 x 0.5 cm sized, skin-colored to erythematous, protruding mass, without ulcer and crust, on the scalp. Excisional biopsy was done under the impression of intradermal nevus and histopathologic findings from the excised specimen showed a well-circumscribed tumor composed of enucleated eosinophlic cells surrounded by basaloid cells in the papillary dermis. The patient was diagnosed with perforating pilomatricoma. Herein, we report a case of perforating pilomatricoma mimiking intradermal nevus.