Other causes of localized alopecia presenting with coin sized alopecic patches, which clinically simulates alopecia areata

( Shinwon Hwang ),( Min-young Park ),( Sooyie Choi ),( Do-young Kim ),( Sang Ho Oh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Alopecia areata(AA) usually presents with a few coin-sized bald spots. Even if AA is commonly diagnosed through history taking and physical examination without difficulty, there are other causes of hair loss simulating AA. Objectives: To identify other possible alopecic diseases, which are clinically similar to AA Methods: We investigated their final diagnoses of alopecia from 161 patients who had underwent skin biopsy between 2005 and 2018 to differentiate from AA due to clinical features of one to a few coin-sized alopecic patches. Chart review along with clinical photos and the results of skin pathology were carefully performed for accurate diagnosis. Results: Among 161 patients, AA(81 Patients, 50.3%) was the most common cause of alopecia. Lupus erythematosus(21 patients, 13%), trichotillomania(14 patients, 8.7%), epidermal cyst(7 patients, 4.3%), frontal fibrosing alopecia(3 patients, 1.9%), folliculitis decalvans(2 patients, 1.2%) and morphea(2 patients, 1.2%) were leading causes of localized alopecia, which clinically simulates AA in order. Conclusion: Even if AA is the most common cause of localized alopecia, other disease conditions including lupus erythematosus and trichotillomania can also present with similar features of AA. Since treatment modality, disease course and prognosis vary depending on diagnosed disease entities, dermatologists should be aware of other causes of localized alopecia mimicking AA through skin biopsy and careful history taking.

Grain alignment dependence of magnetization reversal mechanism in granulated Nd-Fe-B magnet studied by micromagnetic simulation

Shinwon Hwang,Jae-Hyeok Lee,Sang-Koog Kim 한국자기학회 2017 한국자기학회 학술연구발표회 논문개요집 Vol.2017 No.11

The analysis of the pathological characteristics of idiopathic guttate hypomelanosis

( Shinwon Hwang ),( Jae-won Lee ),( Tae-gyun Kim ),( Sang Ho Oh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Idiopathic guttate hypomelanosis(IGH) is a common acquired hypopigmentary disorder. The pathogenesis is still uncertain, however aging and ultraviolet exposure are regarded as implicated factors in its pathogenesis. Objectives: To confirm whether the aging-related histological characteristics are present in IGH. Methods: Analyzing the pathological characteristic by Hematoxylin & Eosin, Fontana-Masson, and Melan-A stains. Results: The epidermal area excluding horny area of the lesions was smaller than that of non-lesional skins of IGH (P=0.0009). On contrary, horny area of the lesions, which consist of stratum corneum was thicker than that of non-lesions. (P=0.0009). The number of rete ridge was significantly decreased in lesions compared to non-lesions (p<0.0001). Fontana-Masson and Melan-A stains showed that areas of the pigment or the number of melanocytes in the lesional skins were smaller than those of non-lesional skins (F-M, p=<0.0001, Melan-A, p=0.0389). Conclusion: Our data revealed that IGH lesions had thinner epidermal area excluding horny layer which is consistent with histological features of aged skins. Interestingly, horny layer was much thicker in lesional skins than in non-lesional skins. These results indicated that IGH lesions may be induced by an accelerated progression of the aging-related events with melanocyte loss and keratinization/desquamation problem.

P105 Clinical and therapeutic window of dapsone in various skin diseases

( Shinwon Hwang ),( Howard Chu ),( Kwang Hoon Lee ),( Min-geol Lee ),( Chang Ook Park ) 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: In dermatology, we use dapsone on a number of dermatologic disorders including inflammatory disease, pruritus and bullous disease. Although hemolyitic anemia, which is a typical side-effect of dapsone, is well known, but the mechanism of dapsone is not fully understood. Objectives: To evaluate the response of dapsone on various inflammatory dermatologic disorders and observe the monitoring markers for outcome and side effects. Methods: 167 patients treated with dapsone on various diseases were retrospectively reviewed. Clinical profiles, response of dapsone treatment, glucose-6 phosphate dehydrogenease(G6PD), hemoglobin, reticulocyte count and percentage(Reti%) were analyzed. Results: 167 patients were divided into 11 groups and treatment effect was evaluated. Dapsone usually showed good response. Almost patients had normal value of G6PD without severe hemolytic anemia. Mean of Reti(%) was 2.572%. Patients whose Reti(%) was higher than 2.5% were 64, while patients with lower than 2.5% value were 103. 31% of patients whose Reti(%) was higher than 2.5, had no effect or aggravation, while 19% of the patients with lower than 2.5% value had no effect or aggravation. Conclusion: Dapsone is very effective various dermatologic disorders. All patients showed mild to moderate hemolytic anemia and patients who have mild hemolytic anemia, need to check the possibility of insufficient use of dapsone and consider the increase in quantity or continue the use of dapsone with periodic monitoring.

Cytotoxic mycosis fungoides with clinical features of hypopigmentation and poikiloderma at the same time

( Shinwon Hwang ),( Jaemin Kim ),( Sun Och Yoon ),( Sang Ho Oh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

There are many variants type of mycosis fungoides (MF), including folliculotropic MF, hypopigmented MF and so on. Those variant types are usually rarely presented. Also, pathologically cytotoxic MF which expresses a CD8+ phenotype rather than CD4 is a rare clinical variant. We reported a case of cytotoxic MF which showed clinical features of hypopigmentation and poikiloderma simultaneously. A 51 year-old woman presented with about 20cm sized erythematous telangiectatic atrophic patch and several ill-defined hypopigmented patches on both buttock and thigh. She reported that she has had erythematous lesion on left buttock for more than 20 years and she noticed hypopigmented lesions from several months before. There were atypical infiltration in the epidermis and dermis with linear accumulation of atypical lymphocyte along the basement membrane on center of both pokiloderma and hypopigmented lesion. Immunohistochemistry study showed most infiltrated cells were CD3 positive, CD30 negative with CD8 dominant pattern. Positive clonality of T cell receptor was observed in gene rearrangement study. Therefore, she was diagnosed as cytotoxic MF due to CD8+ dominant infiltration with epidermotrophism. MF variant is usually rare presentation of cutaneous MF. Even in our case, disease showed that cytotoxic MF with hypopigmentation and poikilodermic features rare presentations of MF. Therefore, we report a unique MF case showed all of these features.

[P382] Is large cell transformation of mycosis fungoides or primary cutaneous anaplastic large cell lymphoma?

( Shinwon Hwang ),( Yeongjoo Oh ),( Jae Won Lee ),( Chang Ook Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

The course of mycosis fungoides(MF) is usually indolent. In case of large cell transformation(LCT) of MF, prognosis is still not definite. Large cell transformation in mycosis fungoides is rare and can be associated with an aggressive clinical course and shortened survival. We reported a case of large cell transformation from MF patients, which developed with new lesion and maintained well-controlled status without any other organ involvement. A 61-year-old female with MF who has been treated from 2007 with narrow band ultraviolet B therapy(NUVB), showed a new tumoral lesion on the Lt. postauricular area. We performed biopsy on the Lt. postauricular lesion and spontaneously regressed. The result was consistent with LCT with MF. We checked positron emission tomography of whole body, and no discernible FDG uptake to suggest any metastasis. She has been well-controlled with intermittent NUVB therapy. In previous reports, patients with LCT show bad prognosis. However, in other reports, authors concluded that early staged MF with LCT at presentation show good prognosis like primary cutaneous anaplastic large cell lymphoma (pALCL). Because, it is impossible to distinguish between LCT and pALCL by pathology, it can be possible that when patients with MF show new lesion, it can be pALCL rather than LCT. Therefore, the patients may show good prognosis in this case, and we need more prospective study for these results.

[P082] A case of intradermal nodular fasciitis

( Shinwon Hwang ),( Jun Young Kim ),( Sang Kyum Kim ),( Sang Ho Oh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Nodular fasciitis is a rapidly growing benign lesion, presenting with a solitary tender subcutaneous nodule. Nodular fasciitis usually occurs in the subcutaneous layer and less often in muscle. However, it is rarely reported that nodular fasciitis is developed in the dermis. We report a case of intradermal nodular fasciitis, which has not regressed spontaneously for 1 year. A 41-year-old male without other medical history visited to our clinic due to solitary 1.8 x 1.5cm sized erythematous protruded mass on the right chest for 1 year. Skin specimen revealed that a well demarcated lesion was observed in the intradermal area beneath epidermis and the mass consisted of plump spindle cells with ovoid, vesicular nuclei embedded in a loosely structured stroma with capillaries and scattered erythrocytes in dermis. Final diagnosis reached to intradermal nodular fasciitis. Although nodular fasciitis is regressed spontaneously, the lesion of this patient have increased in sized and was accompanied with pain. Therefore, excision was performed. Intradermal nodular fasciitis is situated primarily in the dermis and and shows well circumscribed feature without capsulation. Dermatologists should perceive that nodular fasciitis can rarely occur in dermal area.

[P502] A case of idiopathic guttate hypomelanosis developed after sunburn in a young woman

( Shinwon Hwang ),( Jae Won Lee ),( Sang Kyum Kim ),( Sang Ho Oh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Idiopathic guttate hypomelanosis (IGH) is a common acquired hypopigmentary disorder characterized by multiple, discrete round 2 to 5-mm sized, porcelain-white macules on sun-exposed areas, especially on the extensor surfaces of forearms and pretibial areas. The exact pathogenesis is still uncertain, however, aging and ultraviolet exposure are regarded as the main triggering factors because IGH is quite common in those over 40 years of age and commonly appear on sun-exposed areas. Although there is no doubt that sun exposure is a culprit for IGH, we don`t know which one of chronic cumulative sun exposure or short intense UV exposure could mainly trigger IGH. Herein, we report a case of IGH on unexposed area of a young woman following sunburn. A 29-year-old female with no medical history presented with several white colored macules on the back which occurred about 1 year ago. She had severe sunburn in a beach of California, USA several months before the development of IGH on the back. Wood light examination showed quite remarkable accentuation and histopathology showed decreased number of melanocytes on the lesions. This case suggests that acute sun damage could induce IGH even in young people and IGH can be associated with acute intense sun exposure rather than chronic cumulative sun exposure.

[P015] Allogenic collagen filler for facial lipodystrophy due to lupus erythematosus panniculitis

( Shinwon Hwang ),( Young In Lee ),( Jihee Kim ),( Ju Hee Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Many patients with lipodystrophy, have cosmetic problem, especially occurring on the face. These deformities are treated with surgical techniques such as injectable fillers, transplanted or autologous fat grafting or extensive resection of the lesion. We report a case of extensive lipodystrophy by lupus panniculitis resistant to classic treatment, successfully treated by allogenic collagen filler. A 27-years-old female with lipodystrophy come to scar clinic due to extensive atrophic and depressed lesions on the face. She got three times of autologous fat transplant but clinical outcome was unsatisfactory both to the patient and physician. For more sustainable approach, allogenic collagen filler was used. After 10 days from injection, collagen injected areas were well maintained without any side effects such as bruising or infection. On last visit, contour of the face was well maintained and patient was satisfied with the results. Depressive and atrophic lesion due to lipodystrophy is hard to treat due to rapid absorption or other side effect. In our case, allogenic collagen filler maintained over 2 months without recurrence. It maintained longer time than other way like autologous fat transplant. Therefore, allogenic collagen fiber can be an alternative treatment option for the lipodystrophy caused by systemic autoimmune disease. Nonetheless, selecting appropriate candidate who shows clinically stable lesions should be preceded

[P016] Successful treatment of angiofibroma with 10,600-nm carbon dioxide fractional laser

( Shinwon Hwang ),( Young In Lee ),( Jihee Kim ),( Ju Hee Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Facial angiofibromas occur in 70% to 80% of patients with tuberous sclerosis(TS). Current treatment options include dermabrasion, surgical excision and laser therapy. However, such treatment can cause significant scarring and recurrent lesions. Nowadays, mTOR inhibitor (rapamycin) has changed the paradigm. With topical application, existing angiofibroma papules show decrease without significant side effect. However, for longstanding larger lesions, topical application alone does not seem enough. We report a case of successful treatment of angiofibroma by using ablative fractional CO₂ laser with topical rapamycin occlusive dressing. A 19-years-old male diagnosed with TS came to our clinic for angiofibromas on the face. At first, we prescribed topical rapamycin to the patient for one year since November 2015. Erythema and overall size of the lesions showed improvement but larger ones persisted especially on the perinasal area and forehead. When he was scheduled for excision of parietal scalp mass under general anesthesia in cooperation with the department of Plastic Surgery, ablative fractional CO₂ laser on the face was done with rapamycin occlusive dressing afterwards. By using ablative fractional CO2 laser and point ablation, nodularity of angiofibroma was much improved and there is no significant recurrence or post-treatment scar. Therefore, combination treatment with laser can be a useful treatment options for angiofibroma in TS